Clinical toxicology : the official journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists
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Clin Toxicol (Phila) · Jul 2008
Clinical TrialLower incidence of anaphylactoid reactions to N-acetylcysteine in patients with high acetaminophen concentrations after overdose.
Mechanisms responsible for anaphylactoid reactions to N-acetylcysteine (NAC) are poorly understood, and acetaminophen itself may play an important role. The present study examined the relationship between serum acetaminophen concentrations and risk of anaphylactoid reactions. ⋯ High serum acetaminophen concentrations were associated with fewer anaphylactoid reactions, suggesting that these might in some way be protective. The biological basis needs further exploration so as to allow a better understanding of the mechanisms responsible for adverse reactions to NAC treatment.
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Clin Toxicol (Phila) · Jul 2008
Case ReportsBradycardia and hypotension associated with fomepizole infusion during hemodialysis.
We report a case of hypotension and bradycardia associated with intravenous fomepizole infusion. ⋯ Fomepizole may precipitate bradycardia and/or hypotension during hemodialysis. Monitor vital signs closely during and immediately after infusion.
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Epidemics related to illicit fentanyl abuse have been reported and the potential exists for a national epidemic associated with high mortality. This report describes emergency department visits for opioid toxicity and a recent outbreak of illicit fentanyl fatalities in Chicago, Illinois and surrounding Cook County. ⋯ Chicago and surrounding Cook County experienced an outbreak of 342 fentanyl-related deaths between April 2005 and December 2006. The experience demonstrated a clear need for an interdisciplinary approach to identifying, communicating, and managing an outbreak.
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Clin Toxicol (Phila) · Jul 2008
Correlation of paired plasma and saliva paracetamol levels following deliberate self-poisoning with paracetamol (the Salivary Paracetamol In Toxicology [SPIT] study).
To determine the correlation between plasma and saliva paracetamol levels following paracetamol deliberate self-poisoning. ⋯ There is concordance between the indications for treatment of paracetamol deliberate self-poisoning based on plasma and saliva paracetamol levels. Saliva paracetamol levels are typically higher than plasma levels. Further studies involving larger numbers of patients, comparing plasma and saliva paracetamol levels in patients with potentially toxic plasma paracetamol concentrations, would be useful in determining the potential clinical value of this method.
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Clin Toxicol (Phila) · Jul 2008
Spectrophotometry of hydroxocobalamin and hemoglobin reveals production of an unanticipated methemoglobin variant.
Cyanide-poisoned patients often require pulse oximetry and co-oximetry to measure oxyhemoglobin, deoxyhemoglobin, carboxyhemoglobin, and methemoglobin. These and other critical laboratory measurements can be confounded by the cyanide antidote hydroxocobalamin. The postulated mechanism of this confounding is direct optical interference. ⋯ The remainder spectrum appears to be a methemoglobin variant quantitatively dependant on the amount of hydroxocobalamin added to the hemoglobin solution and the presence of oxygen. The Pearson's correlation coefficient comparing the known swine methemoglobin spectrum with the remainder spectrum reveals a very high degree of correlation (r(2) = 0.986). CONCLUSION. This is the first study to document methemoglobin formation caused by hydroxocobalamin. Further studies are needed in vitro and in vivo to assess this previously unreported methemoglobin variant.