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) · Nov 2012
Case ReportsA case of near-fatal fenpyroximate intoxication: the role of percutaneous cardiopulmonary support and therapeutic hypothermia.
Fenpyroximate is a potent inhibitor of the mitochondrial proton-translocating NADH-quinone oxidoreductase (complex I). Although it is widely used as an acaricide, data on the acute toxicity of fenpyroximate in humans are very limited. ⋯ The present case, along with previous cases of fatal complex I inhibitor poisoning, indicates that impaired oxygen utilization at the tissue level is the major mechanism underlying the fatality of this condition. Percutaneous cardiopulmonary support may help restore vital organ perfusion by increasing oxygen delivery even in the presence of decreased oxygen consumption, thereby allowing additional time for recovery and drug metabolism. Therapeutic hypothermia also may be beneficial in treating severe complex I inhibitor poisoning, since hypothermia itself attenuates oxidative processes and decreases the metabolic rate.
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Sulfonylureas are used extensively for treating type-2 diabetes mellitus. Sulfonylurea poisoning can produce sustained and profound hypoglycemia refractory to IV dextrose, particularly in children and the elderly. ⋯ Although relatively limited, the available data suggest that octreotide should be considered first-line therapy in both pediatric and adult sulfonylurea poisoning with clinical and laboratory evidence of hypoglycemia. Maintenance doses of octreotide may be required to prevent recurrent hypoglycemia.
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Clin Toxicol (Phila) · Nov 2012
Surveillance detection of concentrated laundry detergent pack exposures.
In early 2012, concentrated laundry detergent packs began to be marketed in the United States. Around May 2012, poison centers began to notice that they were handling serious exposures among young children to these products. ⋯ Surveillance of total exposures, all exposures involving young children, and exposures involving vomiting would not have been effective for identifying the influx of calls due to exposures to laundry detergent packs involving young children. Surveillance of any laundry detergent exposures would have identified these calls almost immediately.
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Lipid resuscitation therapy using intravenous lipid emulsion (IVLE) for drug overdoses has gained widespread use. However, there is little information regarding its adverse effects. ⋯ IVLE results in appreciable analytical interferences at concentrations demonstrated in lipid resuscitation therapy. Of particular concern is the marked interference on glucose and magnesium, which may result in unsuccessful and potentially harmful interventions. Major implications for patient care include reporting of incorrect results and delays in the reporting of time-sensitive results. Whenever possible, blood samples should be collected prior to initiating lipid therapy. Interferences can be minimized by brief centrifugation at relatively low speeds on equipment readily available in most core labs.