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) · Aug 2011
ReviewOccupational health of miners at altitude: adverse health effects, toxic exposures, pre-placement screening, acclimatization, and worker surveillance.
Mining operations conducted at high altitudes provide health challenges for workers as well as for medical personnel. ⋯ Both mining and work at altitude have independently been associated with a number of adverse health effects, although the combined effect of mining activities and high altitude has not been adequately studied. Careful selection of workers, appropriate acclimatization, and limited on-site surveillance can help control most health risks. Further research is necessary to more completely understand the risks of mining at altitude and delineate what characteristics of potential employees put them at risk for altitude-related morbidity or mortality.
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Clin Toxicol (Phila) · Aug 2011
Case ReportsCarbon monoxide poisoning associated with water pipe smoking.
The water pipe is a means of tobacco consumption widespread in Turkey and Arab countries. We present two patients brought to our emergency department due to a syncopal attack secondary to carbon monoxide toxicity following water pipe use. This rare form of poisoning should be borne in mind by emergency physicians as a differential diagnosis in water pipe smokers. Water pipes should be used where there is adequate ventilation.
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Clin Toxicol (Phila) · Aug 2011
High-dose insulin: a consecutive case series in toxin-induced cardiogenic shock.
Cardiovascular medication overdoses can be difficult to treat. Various treatment modalities are currently recommended. ⋯ High-dose insulin therapy based on a 1-10 U/kg/h dosing guideline and recommending avoidance of vasopressors appears to be effective in the treatment of toxin-induced cardiogenic shock. Hypoglycemia was the most frequent adverse event, followed by hypokalemia. Adverse events did not lead to adverse sequelae.
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Clin Toxicol (Phila) · Aug 2011
A dosing regimen for immediate N-acetylcysteine treatment for acute paracetamol overdose.
Current treatment of paracetamol (acetaminophen) poisoning involves initiating a 3-phase N-acetylcysteine (NAC) infusion after comparing a plasma concentration, taken ≥ 4 h post-overdose, to a nomogram. This may result in dosing errors, a delay in treatment, or possibly more adverse effects - due to the use of a high dose rate for the first infusion when treatment is initiated. ⋯ The novel dosing regimen allowed immediate treatment of a patient using a lower dosing rate. This greatly simplifies the current dosing regimen and may reduce NAC adverse effects while ensuring the same amount of NAC is delivered.
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Clin Toxicol (Phila) · Aug 2011
Acetaminophen psi parameter: a useful tool to quantify hepatotoxicity risk in acute acetaminophen overdose.
The risk of hepatotoxicity secondary to acute acetaminophen overdose is related to serum acetaminophen concentration and lag time from ingestion to N-acetylcysteine (NAC) therapy. Psi (Greek letter ψ) is a toxicokinetic parameter that takes the acetaminophen level at 4 h post-ingestion ([APAP](4 h)) and the time-to-initiation of NAC (tNAC) into account and was found to be significantly predictive of hepatotoxicity in Canadian patients with acetaminophen overdose treated with intravenous NAC. ⋯ The psi parameter is a reliable prognostic tool to predict hepatotoxicity secondary to acute acetaminophen overdose treated with intravenous NAC. Our evidence shows that psi may be a more superior tool than either acetaminophen level or time-to-initiation of NAC at predicting hepatotoxicity.