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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Brain death guidelines should be used with caution in patients with drug intoxication. It is often suggested that physicians use five half-lives of a drug when observing a patient with an overdose. We report two cases of baclofen intoxication where brain death was entertained as an explanation for prolonged coma, with arousal seen days later, suggesting that routine use of a 5-half-life observation period is insufficient with baclofen intoxication. ⋯ Our two cases suggest that baclofen intoxication may result in very prolonged and profound coma and may, in fact, mimic brain death. Conclusion. The determination of brain death in the comatose overdose patient must proceed with caution. An adequate period of time to allow drug clearance must be allowed.
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Clin Toxicol (Phila) · Jan 2012
Review'Legal highs'--novel and emerging psychoactive drugs: a chemical overview for the toxicologist.
'Legal highs' are psychoactive chemicals which are sold from 'head shops', the internet and from street suppliers and may be possessed without legal restriction. An increase in the marketing of these materials has resulted in a corresponding increase in published reports of their adverse effects. However, a lack of primary literature pertaining to their chemistry, pharmacology and toxicology, makes an evaluation of their harm difficult. This review covers the basic chemistry of these novel psychoactive compounds and relates them to endogenous neurotransmitters and existing drugs of abuse. ⋯ 'Legal highs' are gaining in popularity and present clear challenges to toxicologists and society as a whole. Whilst improved use of existing legislation and development of new legislation can be used to reduce the supply of these materials, investment in better education for young people on the harms associated with 'legal highs' is needed.
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Clin Toxicol (Phila) · Jan 2012
Arterial lactate as a predictor of mortality in emergency department patients with paraquat intoxication.
Plasma paraquat concentration is recognized as the best prognostic indicator in patients with acute paraquat poisoning, but it cannot be measured in many hospitals due to limited medical resources. By contrast, arterial lactate is easily obtainable, even in local hospitals. ⋯ The arterial lactate had a good predictive power in evaluating the prognosis of patients with acute paraquat poisoning. In the case of hospitals without facilities to test plasma paraquat concentration, measurement of the arterial lactate may be a simple and practical tool for assessing the severity of paraquat poisoning.
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Clin Toxicol (Phila) · Jan 2012
Radiological preparedness-awareness and attitudes: a cross-sectional survey of emergency medicine residents and physicians at three academic institutions in the United States.
Emergency preparedness has been increasingly recognized as important. Research shows many medical personnel feel unprepared to respond to radiation incidents. Knowledge and attitudes of emergency medicine residents and faculty are largely unstudied, regarding their abilities to provide care for radiation disaster victims. It is unknown whether receiving training in radiological emergency preparedness improves knowledge and attitudes. ⋯ Our results suggest a need for additional radiological-nuclear preparedness training for emergency medicine residents and faculty. Training should include radiation detection, decontamination, explaining differences between radiation exposure and contamination, and teaching patient management, including DTPA and Prussian blue.
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In a clinical study, healthy subjects were given an antidote to a toxin that may be encountered by emergency physicians. Urine was collected for seven days following administration of the antidote. The drastic dark purple color of the urine on day 1, taken immediately after the antidote was given, is clearly of note.