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) · Oct 2011
Case ReportsEsophageal perforation and mediastinitis after suicidal ingestion of 4.5% sodium hypochlorite [correction of hydrochlorite] bleach.
A 16-year-old woman deliberately drank 4.5% sodium hypochlorite bleach. She was transferred to the emergency department after gastric lavage was performed at a local clinic. She experienced chest pain and fever after several vomiting episodes and esophagoscopy. ⋯ Sodium hypochlorite is found in household bleaching agents used to disinfect dishes and bleach laundry. Poisoning due to ingestion of sodium hypochlorite bleach usually follows a benign clinical course. Few studies report severe complications such as esophageal stenosis or perforation.
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Theories regarding the mechanism of intravenous fat emulsion for bupivacaine cardiotoxicity include creation of an intravascular lipid sink into which the cardiotoxic drug is sequestered, an improvement of impaired cardiac metabolism, and restoration of cardiomyocyte function by increasing intracellular calcium. However, work in this area is inconclusive and a more mechanistic explanation is desirable. We used a heterologous expression system (HEK-293 cells) and voltage clamp techniques to study the electrophysiologic effects of bupivacaine, polyunsaturated, and saturated fatty acids on sodium current (I(Na)) in stable cell lines expressing human cardiac sodium channels. ⋯ Simultaneous exposure to bupivacaine and fatty acids reduced both the tonic and use dependent block compared with bupivacaine alone. Reduction of bupivacaine-induced I(Na) block was greatest in cells treated with linolenic acid. These results suggest that the salutary effects of intravenous fat emulsion may be, in part, due to a direct modulatory effect of fatty acids on cardiac sodium channels.
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Clin Toxicol (Phila) · Oct 2011
Prognostic significance of arterial blood gas analysis in the early evaluation of paraquat poisoning patients.
To examine the utility of arterial blood gas analysis (ABG) in early evaluation of prognosis in paraquat poisoning. ⋯ BE values may be a reliable index in early evaluation of prognosis in paraquat poisoning.
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Clin Toxicol (Phila) · Aug 2011
ReviewOccupational health of miners at altitude: adverse health effects, toxic exposures, pre-placement screening, acclimatization, and worker surveillance.
Mining operations conducted at high altitudes provide health challenges for workers as well as for medical personnel. ⋯ Both mining and work at altitude have independently been associated with a number of adverse health effects, although the combined effect of mining activities and high altitude has not been adequately studied. Careful selection of workers, appropriate acclimatization, and limited on-site surveillance can help control most health risks. Further research is necessary to more completely understand the risks of mining at altitude and delineate what characteristics of potential employees put them at risk for altitude-related morbidity or mortality.