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) · May 2020
Multicenter Study Observational StudyMetformin-related lactic acidosis with acute kidney injury: results of a French observational multicenter study.
Background: Metformin-associated lactic acidosis (MALA) and metformin-induced lactic acidosis (MILA) remain controversial entities. Metformin toxic effect depends on accumulation to lead to lactic acidosis (LA), particularly during an episode of acute kidney injury (AKI). In MILA, no other condition contributing to LA is found. ⋯ In multivariate analysis, metformin level was independently associated with pH or lactate level only in MILA patients. Conclusions: MILA is associated with DD and death is due to severe refractory acidosis leading to cardiovascular collapse attributed to metformin accumulation mainly via AKI. MALA patients are more frequently shocked and death is related to their underlying condition, metformin accumulation increasing LA.
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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.
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Clin Toxicol (Phila) · Apr 2019
Multicenter StudyShort-term glucose dysregulation following acute poisoning with organophosphorus insecticides but not herbicides, carbamate or pyrethroid insecticides in South Asia.
Ingestion of organophosphorus (OP) insecticides is associated with acute hyperglycaemia. We conducted a prospective study to determine whether glucose dysregulation on admission associated with ingestion of OP insecticides or other pesticides is sustained to hospital discharge or to 3-12 months later. ⋯ We found in this small prospective study that acute OP insecticide poisoning caused acute glucose dysregulation that was sustained to hospital discharge but had recovered by 3-12 months. Acute glucose dysregulation was related to defects in insulin action and secretion. This study did not address long-term risk of diabetes following acute OP insecticide poisoning, but could provide the data for a power calculation for such a study.
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Clin Toxicol (Phila) · Sep 2017
Multicenter StudyResolution of cannabis hyperemesis syndrome with topical capsaicin in the emergency department: a case series.
Cannabinoid hyperemesis syndrome (CHS) is characterized by symptoms of cyclic abdominal pain, nausea, and vomiting in the setting of prolonged cannabis use. The transient receptor potential vanilloid 1 (TRPV1) receptor may be involved in this syndrome. Topical capsaicin is a proposed treatment for CHS; it binds TRPV1 with high specificity, impairing substance P signaling in the area postrema and nucleus tractus solitarius via overstimulation of TRPV1. This may explain its apparent antiemetic effect in this syndrome. ⋯ Topical capsaicin was associated with improvement in symptoms of CHS after other treatments failed.
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Clin Toxicol (Phila) · Jun 2016
Multicenter StudyTrends in analgesic exposures reported to Texas Poison Centers following increased regulation of hydrocodone.
In October 2014, the Drug Enforcement Administration reclassified hydrocodone to schedule II, increasing regulations on use. The impact of rescheduling hydrocodone on opioid exposures is unclear, especially in states with special restrictions required for prescribing schedule II agents. ⋯ The increased regulation was temporally associated with decreased hydrocodone exposures reported to Texas Poison Centers.