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) · Dec 2011
Case ReportsRefractory hypotension due to Rogaine® (minoxidil) ingestion managed with midodrine.
Minoxidil (Rogaine®) is a direct vasodilator that can cause significant toxicity when ingested. We report a case of ingestion of topical minoxidil [Rogaine® (Johnson & Johnson Healthcare Products, Division of McNeil-PPC, Inc)] resulting in refractory hypotension that was successfully managed with the oral α (1) agonist midodrine. ⋯ Midodrine may serve as an additional option to treat toxicant induced hypotension.
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Clin Toxicol (Phila) · Nov 2011
Prediction of prognosis in acute paraquat poisoning using severity scoring system in emergency department.
The aim of this study was to validate and compare the performance of serum paraquat level, severity index of paraquat poisoning (SIPP), Acute Physiology And Chronic Health Evaluation II (APACHE II), modified Simplified Acute Physiology Score II (MSAPS II), and modified Expanded Simplified Acute Physiology Score II (MSAPS IIe) calculated immediately after arrival on emergency department (ED) for assessing the mortality of acute paraquat poisoning. ⋯ Serum paraquat level is still the most reliable prognosis factor in acute paraquat poisoning. But MSAPS II or MSAPS IIe calculated immediately after arrival on ED may be helpful to predict mortality in acute paraquat poisoning especially when hospital has no facility to measure serum paraquat level.
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Clin Toxicol (Phila) · Nov 2011
Mortality rate and pattern following carbamate methomyl poisoning. Comparison with organophosphate poisoning of comparable toxicity.
Methomyl is a widely used carbamate insecticide. It is known that mortality rate is generally low in carbamate poisoning, but fatalities from methomyl poisoning have been reported. Nevertheless, there is no reported comparative outcome of methomyl and organophosphate poisoning of comparable toxicity concerning mortality rate and mortality pattern. ⋯ The mortality rate of methomyl poisoning was comparable to that of World Health Organisation Class I organophosphate poisoning. All died patients in the methomyl group experienced cardiac arrest, and died from multiple organ dysfunction syndrome after resuscitation from cardiac arrest.
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Clin Toxicol (Phila) · Nov 2011
Case ReportsSevere acute cardiomyopathy associated with venlafaxine overdose and possible role of CYP2D6 and CYP2C19 polymorphisms.
Venlafaxine (VEN) is a serotonin-norepinephrine-dopamine reuptake inhibitor that causes usually a mild cardiotoxicity when ingested in overdose. We report a patient who developed acute heart failure following overdose. As the toxicokinetic data suggested a prolonged metabolism, genetic polymorphisms for cytochrome P450 isoenzymes CYP2D6 and CYP2C19 were also investigated. ⋯ Severe and sustained cardiotoxicity following VEN overdose may be related to the amount ingested, as well as to the genetic polymorphism for CYP2D6 leading to a delayed elimination of active metabolite.