Journal of medical toxicology : official journal of the American College of Medical Toxicology
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The need to treat withdrawal syndromes is a common occurrence in outpatient, inpatient ward, and intensive care unit (ICU) settings. A PubMed and Google Scholar search using alpha2-adrenoreceptor agonist (A2AA), specific A2AA agents, withdrawal syndrome and nicotine, and alcohol and opioid withdrawal terms was performed. A2AA agents appear to be able to modulate many of the signs and symptoms of significant withdrawal syndromes but are also capable of significant side effects, which can limit clinical use. ⋯ The A2AA dexmedetomidine may be useful as an adjunctive agent in treating severe alcohol withdrawal syndromes in the ICU. In general, the current data does not support the routine use of A2AA as the primary or sole agent to treat ethanol/alcohol or nicotine withdrawal syndromes. Specific A2AA agents such as lofexidine has been shown to have a primary role in non-opioid-based treatment of opioid withdrawal syndrome and dexmedetomidine in combination with benzodiazepines has been shown to have potential in the treatment of severe ICU-based alcohol withdrawal syndrome.
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Unintentional non-fire-related (UNFR) carbon monoxide (CO) poisonings continue to account for a significant health and economic burden in the United States. While most of these poisonings are related to faulty central heating or water heaters in private dwellings, less common sources should also be considered when a patient presents with any signs or symptoms suggestive of CO toxicity. ⋯ In recent years, hookah bars have gained in popularity, especially in urban areas and around college campuses. This was the first case to identify the potential occupational exposure of employees working at hookah bars to CO. Furthermore, the patient's COHb level of 33.8 % was higher than any previously reported in the literature with exposure via hookah pipe. The practitioner should consider CO poisoning in patients who smoke tobacco via a hookah and consider early hyperbaric oxygen therapy in those experiencing significant symptoms.
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Use of intravenous fat emulsion (IFE) for the treatment of poisoned patients in extremis is increasing. Little literature exists describing failures and complications of IFE. We describe two cardiac arrests temporally associated with IFE. ⋯ Reported cases of IFE failures or potential complications are sparse. This report adds only case experience, not clarity. We report two cardiac arrests that were temporally associated with IFE.