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 2016
Comparative Study Observational StudyAbsorption of salicylate powders versus tablets following overdose: a poison center observational study.
Salicylate absorption following overdose of aspirin (ASA) tablet formulations can be prolonged for greater than 24 h. Accordingly, serial serum concentrations are typically recommended to guide treatment. However, there are little published data on absorption following ingestion of powder ASA formulations, and it is not known if delayed ASA absorption occurs following overdose of powder formulations. The objective of this study is to compare the absorption characteristics of powder and tablet formulations of ASA in patients reported to a single poison center. ⋯ In contrast to persistent concentrations following overdose of tablets, the majority of serum salicylate concentrations declined following ingestion of powder formulations. In this small study population, these findings suggest that prolonged absorption is unlikely following ingestions of ASA powders.
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Clin Toxicol (Phila) · Nov 2016
Case ReportsFatal Taxus baccata ingestion with perimortem serum taxine B quantification.
Common yew (Taxus baccata) is a common decorative evergreen shrub with potentially fatal toxicity hallmarked by seizure, arrhythmia and cardiovascular collapse if ingested. Taxine B has been identified as one of the most cardiotoxic taxine alkaloids in Taxus spp, and another alkaloid, 3,5-dimethoxyphenol (3,5-DMP), is used as a marker of ingestion. We present a fatal case of ingestion of yew with perimortem serum and gastric taxine B, and 3,5-DMP concentrations. ⋯ We report a perimortem serum and gastric taxine B and 3,5-DMP concentrations in a fatal case of T. baccata toxicity.
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Clin Toxicol (Phila) · Nov 2016
Adverse events related to the new psychoactive substance 3-fluorophenmetrazine - results from the Swedish STRIDA project.
New psychoactive substances (NPS) are often poorly pharmacologically documented and the production is unregulated, implying high risks for toxic side effects. This report from the STRIDA project describes analytically confirmed non-fatal intoxications involving the phenmetrazine analogue 3-fluorophenmetrazine (3-FPM). ⋯ In 19 patients testing positive for 3-FPM, a high incidence of severe clinical features was demonstrated. However, as all patients had also used other psychoactive substances, it was difficult to identify a unique toxidrome for 3-FPM. The results further showed that many 3-FPM intoxications would have been missed, if relying solely on information from PIC consultations. These results emphasize the importance of performing bioanalytical investigation in cases of suspected NPS intoxication.
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Apixaban is a novel oral anticoagulation agent that exerts its effect through direct factor Xa inhibition. We present a case of multi-drug overdose including apixaban with associated apixaban concentrations. ⋯ A case of apixaban overdose with associated apixaban concentrations is presented. There was rapid resolution of anticoagulation with no demonstrable benefit of currently available clotting factor replacement.
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Clin Toxicol (Phila) · Nov 2016
Comparative StudyMethemoglobin measurements are underestimated by the Radical 7 co-oximeter: experience from a series of moderate to severe propanil poisonings.
In Asia methemoglobinemia (MetHb) is commonly caused through self-poisoning with the pesticide propranil. MetHb can cause hypoxia, coma and death, but usually responds to methylene blue. It is therefore vital to have accurate methods to measure blood MetHb to guide appropriate treatments. The gold standard to measure MetHb utilizes a spectrophotometer, but recent bedside tests have been developed e.g., pulse co-oximeter probe and blood color chart. ⋯ This small cohort highlights the potential for extreme inaccuracy of the Radical-7 co-oximeter, especially with a MetHb greater than 20%. Pulse co-oximeters should be required to be validated for the complete range of MetHb prior to regulatory approval.