Journal of medical toxicology : official journal of the American College of Medical Toxicology
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Naloxone is commonly administered in emergency department (ED) to reverse opioid intoxication. Several naloxone dose recommendations exist for acute management of opioid intoxication based on limited published clinical data. A case series of ED patients with opioid-induced ventilatory depression that was reversed using a low-dose naloxone (0.04 mg with titration) is presented. ⋯ ED patients with moderate to severe opioid-induced ventilatory depression can be reversed using 0.04 mg IV naloxone with appropriate dose titration.
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Although there have been many developments related to specific strategies for treating patients after poisoning exposures, the mainstay of therapy remains symptomatic and supportive care. One of the most aggressive supportive modalities is extracorporeal membrane oxygenation (ECMO). Our goal was to describe the use of ECMO for toxicological exposures reported to the American College of Medical Toxicology (ACMT) Toxicology Investigators Consortium (ToxIC). ⋯ ECMO was utilized for a variety of ages and for pharmaceutical and non-pharmaceutical exposures. In most cases, ECMO was administered prior to cardiovascular failure, and survival rate was high. If available, ECMO may be a valid treatment modality.
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The Toxicology Investigators Consortium (ToxIC) Case Registry was established in 2010 by the American College of Medical Toxicology. The Registry includes all medical toxicology consultations performed at participating sites. The Registry was queried for all cases entered between January 1 and December 31, 2014. ⋯ The majority of consultations arose in the acute care setting (emergency department or inpatient) and involved exposures to pharmaceutical products. Among exposures, non-opioid analgesics, sedative/hypnotics, and opioids were the most frequently encountered. A majority of cases required some form of treatment, but fatalities were rare.
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Synthetic cannabinoid receptor agonists (SCRAs) are emerging designer drugs of abuse. Most reports on the health effects of these drugs are case reports. Unlike SCRAs, marijuana has classically been used via many routes of exposure including oral, such as in brownies. We report on 11 symptomatic patients who unknowingly ingested brownies laced with analytically confirmed SCRA and presented with mostly neuropsychiatric and cardiovascular symptoms. ⋯ Oral exposure of 11 patients to brownies laced with analytically confirmed SCRA resulted in neuropsychiatric and cardiovascular symptoms. This series reflects that like marijuana, oral exposures to SCRAs can lead to symptoms.