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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Envenomations during pregnancy pose all the problems of envenomation in the nonpregnant state with additional complexity related to maternal physiologic changes, medication use during pregnancy, and the well-being of the fetus. ⋯ The medical literature regarding envenomation in pregnancy includes primarily retrospective reviews and case series. The limited available evidence suggests that optimal management includes a venom-specific approach, including supportive care, antivenom administration in appropriate cases, treatment of anaphylaxis if present, and fetal assessment. The current available evidence suggests that antivenom use is safe in pregnancy and that what is good for the mother is good for the fetus. Further research is needed to clarify the optimal management schema for envenomation in pregnancy.
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Clin Toxicol (Phila) · Jan 2013
Case ReportsManagement of methylergonovine induced respiratory depression in a newborn with naloxone.
We report a case of a female neonate who developed respiratory depression following the unintentional administration of methylergonovine. The respiratory depression appeared to improve after the administration of bag mask ventilation, stimulation, and naloxone; and the baby was able to be managed without endotracheal intubation and prolonged positive-pressure ventilation. ⋯ It appears that naloxone may reverse methylergonovine toxicity in neonates. The identification of a safe and potentially useful antidote to mitigate respiratory depression, potentially avoiding the need for intubation and more invasive interventions in this patient population is important.
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Clin Toxicol (Phila) · Jan 2013
Case ReportsAcetaminophen/diphenhydramine overdose in profound hypothermia.
There are few reports of acetaminophen overdose in hypothermic patients and even fewer reports describing profound hypothermia. The kinetics, risk of hepatotoxicity, and the possible dose adjustments to N-acetylcysteine (NAC) therapy are not known in this setting. ⋯ Profound hypothermia may be protective of hepatic injury in acetaminophen overdose. Delayed absorption from the coingestant, diphenhydramine, may also have played a role. IV NAC was given in a standard dose without apparent toxicity in the setting of profound hypothermia. Lastly, IV NAC, in standard dosing, appeared to be effective in preventing hepatotoxicity during rewarming in a patient with a potentially hepatotoxic concentration of acetaminophen with a coingestion of the anticholinergic agent, diphenhydramine.
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Clin Toxicol (Phila) · Jan 2013
Comparative StudyThe difference in C-reactive protein value between initial and 24 hours follow-up (D-CRP) data as a predictor of mortality in organophosphate poisoned patients.
Organophosphate poisoning is a worldwide concern and there have been many reports about factors involved in the severity and prognosis of toxicity. The aim of this study was to evaluate the relationship between the serum C-reactive protein activity and clinical outcome in acute organophosphate-poisoned patients. ⋯ The initial serum C-reactive protein and acetylcholinesterase were not found to be associated with the severity of acute organophosphate poisoning. However, the difference in C-reactive protein value between initial and follow-up after 24 hours (D-CRP) was associated with mortality in the total population of patients with acute organophosphate poisoning.