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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Poisoning is the second leading cause of injury-related fatality in the United States. An elevated serum lactate concentration identifies medical and surgical patients at risk for death; however, its utility in predicting death in drug overdose is controversial and unclear. ⋯ In this derivation study, serum lactate concentration had excellent prognostic utility to predict drug-overdose fatality. Prospective validation in the ED evaluation of drug overdoses is warranted.
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Clin Toxicol (Phila) · Aug 2010
Cobinamide is superior to other treatments in a mouse model of cyanide poisoning.
Cyanide is a rapidly acting cellular poison, primarily targeting cytochrome c oxidase, and is a common occupational and residential toxin, mostly via smoke inhalation. Cyanide is also a potential weapon of mass destruction, with recent credible threats of attacks focusing the need for better treatments, as current cyanide antidotes are limited and impractical for rapid deployment in mass casualty settings. ⋯ These studies demonstrate that Cbi is a highly effective cyanide antidote in mouse models, and suggest it could be used in a mass casualty setting, because it can be given rapidly as an intramuscular injection when administered as Cbi-SO(3). Based on these animal data Cbi-SO(3) appears to be an antidote worthy of further testing as a therapy for mass casualties.
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Clin Toxicol (Phila) · Aug 2010
Predicting acute complicated glyphosate intoxication in the emergency department.
Glyphosate herbicide intoxication results in a range of mortality and morbidity, depending on patients' factors. Predicting which patient will need intensive medical treatment might help reduce mortality by providing prompt treatment, as well as triage those patients not likely to develop complications. Thus, we sought to identify independent factors that could predict which patient will develop subsequent medical complications. ⋯ The results of this study showed that age > 50 years, X-ray abnormalities, and ALT > 40 U/L were significant predictive factors for complications in patients with glyphosate surfactant herbicide poisoning; patients with these findings might require admission to the intensive care unit.
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Clin Toxicol (Phila) · Jul 2010
Review Case ReportsHydrogen peroxide ingestion associated with portal venous gas and treatment with hyperbaric oxygen: a case series and review of the literature.
Ingestion of concentrated hydrogen peroxide (H(2)O(2)) has been associated with venous and arterial gas embolic events, hemorrhagic gastritis, gastrointestinal bleeding, shock, and death. Although H(2)O(2) is generally considered a benign ingestion in low concentrations, case reports have described serious toxicity following high concentration exposures. Hyperbaric oxygen (HBO) has been used with success in managing patients suffering from gas embolism with and without manifestations of ischemia. ⋯ HBO was successful in resolving portal venous gas embolism from accidental concentrated H(2)O(2) ingestions.
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Clin Toxicol (Phila) · Jul 2010
Randomized Controlled TrialDoes wearing CBRN-PPE adversely affect the ability for clinicians to accurately, safely, and speedily draw up drugs?
Following a Chemical, Biological, Radiation, or Nuclear (CBRN) incident, the attending rescuers will be required to administer drugs while wearing the CBRN Personal Protective Equipment (CBRN-PPE). Little is known regarding the impact of the CBRN-PPE on the ability to speedily, safely, and accurately draw up drugs for subsequent administration. ⋯ The NHS CBRN-PPE has a negative effect on the drawing up of drugs especially from glass ampoules. Glass ampoules represent a poor choice of drug preparation when considering speed, safety, and accuracy of drawing up of drugs while wearing protective clothing.