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) · Jul 2008
Spectrophotometry of hydroxocobalamin and hemoglobin reveals production of an unanticipated methemoglobin variant.
Cyanide-poisoned patients often require pulse oximetry and co-oximetry to measure oxyhemoglobin, deoxyhemoglobin, carboxyhemoglobin, and methemoglobin. These and other critical laboratory measurements can be confounded by the cyanide antidote hydroxocobalamin. The postulated mechanism of this confounding is direct optical interference. ⋯ The remainder spectrum appears to be a methemoglobin variant quantitatively dependant on the amount of hydroxocobalamin added to the hemoglobin solution and the presence of oxygen. The Pearson's correlation coefficient comparing the known swine methemoglobin spectrum with the remainder spectrum reveals a very high degree of correlation (r(2) = 0.986). CONCLUSION. This is the first study to document methemoglobin formation caused by hydroxocobalamin. Further studies are needed in vitro and in vivo to assess this previously unreported methemoglobin variant.
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Clin Toxicol (Phila) · Jun 2008
Case ReportsFinding needles in a haystack: a case series of carbon monoxide poisoning detected using new technology in the emergency department.
The diagnosis of carbon monoxide poisoning can be difficult because the symptoms are nonspecific and may mimic other illnesses. If carbon monoxide poisoning is suspected, the standard test at this time is venous or arterial carboxyhemoglobin levels. A new device, the Rad-57 pulse CO-oximeter (Masimo Inc.), can measure carboxyhemoglobin levels non-invasively at emergency department triage. ⋯ The non-invasive pulse CO-oximeter could be a major triage tool for identifying unsuspected carbon monoxide poisoning among patients with nonspecific symptoms.
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Clin Toxicol (Phila) · Jun 2008
Case ReportsProlonged severe hypotension following combined amlodipine and valsartan ingestion.
Compared to other calcium channel blockers (CCBs), overdose with dihydropyridine CCBs are considered relatively benign due to their vascular selectivity. Although not a sustained-release preparation, amlodipine's prolonged duration of effect is concerning following overdose. In addition, angiotensin II receptor blocker blunting of vasoconstrictive and sympathetic compensatory responses could exacerbate calcium channel blocker toxicity. We describe severe toxicity associated with an overdose of amlodipine and valsartan. ⋯ Co-ingestion of amlodipine with valsartan produced profound toxicity. Early institution of HIE therapy may be beneficial to reverse these effects.
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To examine the costs of acute poisoning patients admitted to an intensive care unit. ⋯ Poisoned patients admitted to an intensive care unit represent a considerable cost for the health care system in Turkey.
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Clin Toxicol (Phila) · Apr 2008
Case ReportsCalcium oxalate crystals in acute ethylene glycol poisoning: a confocal laser scanning microscope study in a fatal case.
The severity of ethylene glycol toxicity is related to the metabolic acidosis resulting from the biotransformation of ethylene glycol into toxic metabolites. Glycolic acid causes severe acidosis and oxalate precipitates as calcium oxalate in the kidneys and other tissues. ⋯ The histologic diagnosis of acute renal failure secondary to ethylene glycol poisoning depends on the recognitions of the changes of acute tubular damage in association with calcium oxalate crystals deposition within the tubular epithelial cells and the widespread necrosis of the tubular epithelium in the proximal tubules.