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) · Jan 2005
Does ethanol explain the acidosis commonly seen in ethanol-intoxicated patients?
Emergency physicians frequently treat ethanol-intoxicated trauma patients. In patients with apparently minor injuries, the presence of metabolic acidosis is often attributed to serum ethanol. We tested whether there is justification for the bias that ethanol reliably explains the acidosis commonly seen in alcohol-intoxicated patients. ⋯ Ethanol intoxication is associated with acidosis, which does not correlate with BD or LAC. The complexity of pathogenesis of acidosis in ethanol intoxication justifies further diagnostic evaluation of these patients in order to rule out other causes of acidosis.
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Clin Toxicol (Phila) · Jan 2005
Case ReportsConservative management of delayed, multicomponent coagulopathy following rattlesnake envenomation.
Crotaline Fab therapy is recommended for controlling local tissue effects, coagulation abnormalities, and other systemic signs following mild-to-moderate N American Crotaline envenomations. Occasionally, coagulation abnormalities emerge after control of tissue effects has been achieved. These coagulation changes range from minor, single parameter abnormalities to multicomponent, critical value derangements. The bleeding risk associated with these abnormalities is unknown, and dosing guidelines for Crotaline Fab therapy in treating coagulation abnormalities that are severe or delayed-in-onset have not been clearly established. ⋯ We report a case of rattlesnake envenomation with profound, delayed hematologic effects that were resistant to 32 vials of Crotaline Fab given over post-envenomation days 1 to 4. After day 4, no further attempt was made to achieve normal lab indices using antivenom. Close observation alone may be adequate in cases of multicomponent, critical value coagulopathies following rattlesnake envenomation as long as there is no evidence of bleeding and local tissue effects and systemic effects have been adequately controlled.
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Clin Toxicol (Phila) · Jan 2005
Practice Guideline GuidelineEthylene glycol exposure: an evidence-based consensus guideline for out-of-hospital management.
In 2002, poison centers in the US reported 5816 human exposures to ethylene glycol. A guideline that effectively determines the threshold dose for emergency department referral and need for pre-hospital decontamination could potentially avoid unnecessary emergency department visits, reduce health care costs, optimize patient outcome, and reduce life disruption for patients and caregivers. An evidence-based expert consensus process was used to create this guideline. ⋯ Transportation to an emergency department should not be delayed for any decontamination procedures (Grade D). (10) Patients meeting referral criteria should be evaluated at a hospital emergency department rather than a clinic. A facility that can quickly obtain an ethylene glycol serum concentration and has alcohol or fomepizole therapy available is preferred. This referral should be guided by local poison center procedures and community resources (Grade D). (11) The administration of alcohol, fomepizole, thiamine, or pyridoxine is not recommended in the out-of-hospital setting (Grade D).
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Clin Toxicol (Phila) · Jan 2005
Practice Guideline Guidelinebeta-blocker ingestion: an evidence-based consensus guideline for out-of-hospital management.
In 2003, US poison centers were contacted regarding ingestion of beta-blockers by 15,350 patients including 3766 (25%) under 6 years of age; 7415 (48%) were evaluated in healthcare facilities and 33 died. An evidence-based expert consensus process was used to create this guideline. Relevant articles were abstracted by a trained physician researcher. ⋯ Consider the oral administration of activated charcoal if it is available and no contraindications are present but do not delay transportation to administer charcoal (Grade A). 4) Asymptomatic patients who ingest more than the referral dose should be sent to an emergency department if the ingestion occurred within 6 hours of contacting the poison center for an immediate-release product other than sotalol, within 8 hours of contacting the poison center for a sustained-release product, and 12 hours if they took sotalol (Grade C). 5) Ambulance transportation is recommended for patients who are referred to emergency departments because of the potential for life-threatening complications of beta-blocker overdose. Provide usual supportive care en route to the hospital, including intravenous fluids for hypotension (Grade D). 6) Follow-up calls should be made to determine outcome at appropriate intervals for up to 12-24 hours based on the judgment of the poison center staff (Grade D). 7) Asymptomatic patients who are referred to healthcare facilities should be monitored for at least 6 hours after ingestion if they took an immediate-release preparation other than sotalol, 8 hours if they took a sustained-release preparation, and 12 hours if they took sotalol. Routine 24-hour admission of an asymptomatic patient who has unintentionally ingested a sustained-release preparation is not warranted (Grade D).