Clinical toxicology : the official journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists
-
Clin Toxicol (Phila) · Sep 2019
Case ReportsNew synthetic opioid cyclopropylfentanyl together with other novel synthetic opioids in respiratory insufficient comatose patients detected by toxicological analysis.
Introduction: Fentanyl derivatives like cyclopropylfentanyl have recently appeared on the recreational drug market. Cyclopropylfentanyl is probably a highly potent opioid, but human toxicological data are not available so far. Similar to other fentanyl derivatives the most serious acute health risk due to the use of cyclopropylfentanyl is likely to be respiratory depression. ⋯ The ingested substance, as well as the excreted metabolites, were detected by application of various mass spectrometric techniques. Conclusions: In cases of intoxication without a medical history, the detailed toxicological analysis may reveal new psychoactive substances which are not detected by standard toxicological screening approaches. The high pharmacological potency of new products with unknown toxicological data and unknown synergistic effects may easily lead to a life-threatening overdose.
-
Objective: We describe the clinical effects of, and products associated with, acute exposures to cannabis during the early legalization period of recreational cannabis in Oregon and Alaska. Methods: This was an observational study of Oregon/Alaska Poison Center data between 4 December 2015 and 15 April 2017. A standardized data collection instrument was created for this study that captured information about cannabis product description, route of exposure, intentional vs unintentional exposure, product dose, product manufacture source, product ownership source, initial vital signs, clinical signs and symptoms, and subject disposition. ⋯ Children experienced unintentional exposures, particularly within the home and occasionally with major adverse outcomes. Concentrated products such as resins and liquid concentrates were associated with greater toxicity than other cannabis products. These findings may help guide other states during the early retail cannabis legalization period.
-
Clin Toxicol (Phila) · Jul 2019
Multicenter Study Observational StudyPoisoning with malicious or criminal intent: characteristics and outcome of patients presenting for emergency care.
Background: Poisoning is the leading cause of injury-related death in the USA. Poisoning with malicious or criminal intent is uncommon, and poorly characterized. Objectives: To explore substances, patients' demographics, clinical presentation, management and outcome in victims of malicious poisoning in the USA. ⋯ Children received more treatment interventions compared to adults (overall treatment 81% versus 46% [p = 0.0132]; mechanical ventilation: 29% versus 5% [p = 0.0176], respectively). Three (5%) patients died (two children, one adult). Conclusions: Poisonings with malicious intent are uncommon; they are disproportionally directed towards infants, frequently resulting in severe injury and carry relatively high mortality.
-
Clin Toxicol (Phila) · Jul 2019
Observational StudyDetermination of carboxyhemoglobin half-life in patients with carbon monoxide toxicity treated with high flow nasal cannula oxygen therapy.
Background: Acute carbon monoxide poisoning is a common environmental emergency worldwide. Treatment options are limited to normobaric oxygen therapy with a nonrebreather face mask or endotracheal tube and hyperbaric oxygen. The aim of this study is to determine the half-life of carboxyhemoglobin (COHb) in adult patients admitted to the emergency department with acute carbon monoxide poisoning receiving high flow nasal cannula (HFNC) oxygen. ⋯ After decreasing the flow rate, the median verbal numeric rating score was 9. Conclusion: High flow nasal cannula oxygen is an easy, safe, comfortable and effective method to reduce COHb. HFNC may be a promising alternative method if it is validated as effective in future studies with clinical outcomes.
-
Clin Toxicol (Phila) · Jul 2019
Effect of early and focused benzodiazepine therapy on length of stay in severe alcohol withdrawal syndrome.
Objective: Current evidence supports symptom-triggered therapy for alcohol withdrawal syndrome (AWS). Early, escalating therapy with benzodiazepines (BZD) appears to decrease ICU length of stay (LOS); however, the effect on hospital LOS remains unknown. The hypothesis of this study is that focused BZD treatment in the first 24 h will decrease hospital LOS. ⋯ There was a substantial difference in POST patients who received focused treatment (51.3% vs. 73.7%, p = .03). The POST group had a significant decrease in hospital LOS (14.0 vs. 9.8 days, p = .03) and ICU LOS (7.4 vs. 4.4 days, p = .03). Conclusion: Early, focused management of severe AWS was associated with a decrease in ICU and hospital LOS.