Clinical toxicology : the official journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists
-
Clin Toxicol (Phila) · Feb 2010
Historical ArticleMedicine, poison, and mystic potion: a personal perspective on paracetamol Louis Roche lecture, Stockholm, 2009.
Paracetamol poisoning has been a clinical problem for over 40 years. This article reflects the content of the Louis Roche lecture given on this topic in 2009. HISTORICAL CONTEXT: Initially key work illustrated the relationship between plasma paracetamol concentration and risk of liver injury facilitating the development of antidote strategies. Much of this work was done in the Edinburgh clinical toxicology unit. ⋯ Paracetamol poisoning remains a challenging problem, but new approaches to treatment seem possible based on recent experimental studies in animals and humans.
-
Clin Toxicol (Phila) · Feb 2010
Case ReportsA case of torsades de pointes induced by severe QT prolongation after an overdose of eperisone and triazolam in a patient receiving nifedipine.
Eperisone hydrochloride is a centrally acting muscle relaxant, and triazolam is a short-acting benzodiazepine. Although commonly prescribed, cardiotoxicity induced by a single overdose of either drug is comparatively rare. A patient receiving nifedipine developed torsades de pointes (TdP) because of prolongation of the corrected QT (QTc) interval after an overdose of eperisone hydrochloride and triazolam. ⋯ Eperisone and triazolam overdose can cause life-threatening cardiotoxicity. Electrocardiographic monitoring and serial determination of QTc interval are likely the best way to observe these patients and evaluate the risk of cardiotoxicity.
-
Clin Toxicol (Phila) · Feb 2010
Case ReportsGuanfacine overdose resulting in initial hypertension and subsequent delayed, persistent orthostatic hypotension.
Guanfacine is an alpha(2)-adrenoreceptor agonist used for the treatment of attention-deficit hyperactivity disorder and tic disorders. Few reports exist regarding overdose with guanfacine. ⋯ This experience suggests a much delayed onset of symptoms may occur and that the QTc interval may be prolonged, necessitating a longer period of monitoring in a patient presenting with an overdose.
-
Clin Toxicol (Phila) · Feb 2010
Case ReportsMassive acetaminophen ingestion with early metabolic acidosis and coma: treatment with IV NAC and continuous venovenous hemodiafiltration.
We report the extraction of acetaminophen by continuous venovenous hemodiafiltration (CVVHD) during treatment of an acute ingestion of 200 g with a peak recorded serum acetaminophen level of 1,614 mg/L (10,652 micromol/L). ⋯ The average clearance of acetaminophen by CVVHD was 2.53 L/h, with removal of 24 g of acetaminophen over 16 h. As NAC is effective in preventing hepatic injury after acute acetaminophen overdose, the role of dialysis or CVVHD is limited.