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) · Mar 2013
Comparative StudyComparison of US population and live birth rates with poison exposures reported to the National Poison Data System (NPDS): children ages 0-5 years from 2000 to 2012.
Monitoring of poison control center data has provided an important public health surveillance tool. Previous work has identified the population with the greatest risk of poisoning as children of < 6 years. It follows that the size of the population at highest risk should be an important driver/factor of poison center volume. Therefore, one would expect population changes to be reflected in corresponding National Poison Data system (NPDS) call volume changes. We examined this relationship. ⋯ These results provide a quantitative assessment of the age-based risk rates and changes over time for NPDS exposure in children who are 0-5 years old. With the decrease in live births noted over the last 4 years (2008, 2009, 2010, and estimated 2011), US poison centers may expect a similar decline in human exposures in children of 0-5 years. Our analysis adds additional support to the validity of this data set as a public health surveillance tool.
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Clin Toxicol (Phila) · Mar 2013
Case ReportsCases from NACCT acute and intensive care symposium: altered mental status, seizures, and rash in a fumigation company employee.
Methyl bromide is a halogenated aliphatic hydrocarbon that exists as a colorless gas or a volatile liquid. Methyl bromide historically had been used in fire extinguishers but is more commonly used as a gas fumigant for soil-borne diseases and pests. Methyl bromide is being phased out due to concerns for ozone depletion but can still be found. It is readily absorbed through the lungs while dermal absorption can also occur. Signs and symptoms of severe exposures include headache, respiratory distress, pulmonary hemorrhage, and seizures. In large pulmonary exposures, death can occur as rapidly as 1 h usually from respiratory failure. Methyl bromide can penetrate clothing and protective equipment presenting challenges to first responders. There is a debate over the mechanism of toxicity of methyl bromide and the role of hemodialysis and chelation in treatment. ⋯ Methyl bromide exposures can be fatal, and this case highlights the difficulty in managing these acutely poisoned patients. Questions for consideration after this case include time spent on decontamination, use of adjunctive anti-epileptic drugs, role of chelation therapy, and the role of hemodialysis in the treatment of methyl bromide poisoning.
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Clin Toxicol (Phila) · Mar 2013
Treating acetaminophen overdose: thresholds, costs and uncertainties.
The United Kingdom's Medicines and Healthcare Products Regulatory Agency (MHRA) modified the indications for N-acetylcysteine therapy of acetaminophen (paracetamol) overdose in September 2012. The new treatment threshold line was lowered to 100 mg/L (662 μmol/L) for a 4 hours acetaminophen concentration from the previous 200 mg/L (1325 μmol/L). ⋯ As a result, more individuals will be sent to hospitals in order that everyone with a predicted 4 hours concentration above the 100 mg/L line will have concentrations measured and potentially be treated with N-acetylcysteine. Before others consider adopting this new treatment guideline, formal cost-effectiveness analyses need to be performed to define the appropriate thresholds for referral and treatment.
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Clin Toxicol (Phila) · Mar 2013
Case ReportsSuccessful management of olanzapine-induced anticholinergic agitation and delirium with a continuous intravenous infusion of physostigmine in a pediatric patient.
Physostigmine effectively reverses anticholinergic delirium. However, continuous IV infusion of physostigmine is rarely used due to concern for cardiotoxicity and signs of cholinergic excess such as seizures, nausea, and vomiting. We report the successful use of continuous IV physostigmine in a 6-year-old boy with anticholinergic delirium. ⋯ There are few publications describing a continuous infusion of physostigmine to reverse anticholinergic delirium. Our patient received a total dose of 25.5 mg with complete resolution of symptoms. We report the successful use of continuous infusion of physostigmine to reverse anticholinergic delirium in a pediatric patient who unintentionally ingested olanzapine.
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Clin Toxicol (Phila) · Mar 2013
Case ReportsA case of 25I-NBOMe (25-I) intoxication: a new potent 5-HT2A agonist designer drug.
Abuse of synthetic stimulant compounds resulting in significant toxicity is being increasingly reported by poison centers. Toxicologic assessment is complicated by inconsistent manufacturing processes and limited laboratory testing. We describe a case of self-reported exposure to 25-I (25I-NBOMe), a novel phenethylamine derivative, with subsequent quantification in serum. ⋯ An 18-year-old male presented to the emergency department (ED) with severe agitation and hallucinations after jumping out of a moving car. He was tachycardiac (150-160 bpm) and hypertensive (150-170 mm Hg systolic and 110 mg Hg diastolic), and required physical restraints and treatment with intravenous lorazepam administration. His symptoms gradually improved and vital signs returned to normal over 48 h, though he continued to have episodes of aggressiveness. An assay was developed by our analytical toxicology laboratory for 25-I, and serum obtained during ED evaluation and treatment was found to contain 0.76 ng/ml of 25-I. Case discussion. For 25I-NBOMe, 25-I is a common abbreviation for 25I-NBOMe, which is a (n-benzyl) phenethylamine in the 2C "family."Initially synthesized for research, cases of self-reported use of 25-I have recently appeared in the literature, some of which contain qualitative urine confirmation. There are no commercially available quantitative assays, and no previous reports have published serum concentrations. 25-I is a potent new synthetic drug with apparent significant behavioral toxicity that can be detected and quantified in serum.