Human & experimental toxicology
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Some experimental models suggest that the use of pralidoxime in carbamate toxicity is deleterious. Although pretreatment with atropine minimizes the adverse effect of pralidoxime reported in these models, concerns over the risks of pralidoxime in humans with carbamate poisoning continue. We present a unique case of carbamate toxicity treated successfully with pralidoxime alone. ⋯ In overdose, cholinergic crisis is expected and in this case was precipitated by patch overuse. We believe there was a causal relationship between pralidoxime administration and the prompt resolution of symptoms and fasciculations. This case of apparently safe and effective pralidoxime use without concomitant atropine administration in a patient with carbamate toxicity reinforces recent data demonstrating the potential safety of pralidoxime in carbamate toxicity.
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Prognostic factors for severe complications in tricyclic antidepressant (TCA) overdose remain unclear. We therefore evaluated the value of clinical characteristics and electrocardiograph (ECG) parameters to predict serious events (seizures, arrhythmia, death) in severe TCA overdose of 100 patients using logistic regression models for risk assessment. ⋯ In the multivariable logistic regression model, the QRS interval could not be established as independent predictor, however, the terminal 40-ms frontal plane QRS vector (T40) reached statistical significance regarding prediction of serious events (odds ration [OR] 1.70; 95% confidence interval [CI] 1.02-2.84; p = .041), along with age and time lag between ingestion and onset of symptoms of overdose with a sensitivity and specificity of 71% and 70%, respectively. Evaluation of both clinical characteristics and ECG-parameters in the early stage of TCA overdose may help to identify those patients who urgently need further aggressive medical observation and management.
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Zolpidem is available in immediate-release (IR) and controlled-release (CR) formulations. This investigation examined whether there were differences in zolpidem IR and CR ingestions reported to poison control centers. Zolpidem ingestions that did not involve co-ingestants reported to Texas poison control centers during 2005-2008 were identified. ⋯ The most frequently reported adverse clinical effects were, for IR and CR, respectively, drowsiness (54.4% vs 42.3%), tachycardia (10.6% vs 11.7%), ataxia (6.3% vs 11.7%), slurred speech (6.3% vs 6.7%), vomiting (5.0% vs 5.5%) and hallucinations/delusions (4.9% vs 3.1%). The distribution of zolpidem IR and CR ingestions reported to Texas poison control centers were similar. However, zolpidem CR ingestions appeared less likely to result in drowsiness and hallucinations but more likely to result in ataxia.
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The aim of our study was to investigate the etiological and demographical characteristics of acute adult poisoning cases admitted to a university hospital in Tabriz, Iran. This retrospective study was performed on 1342 poisoning admissions to a university hospital from 2003 to 2005, by data collection from the medical records of patients. Poisonings were 5.40% of the total admissions. ⋯ This was a university hospital-based study, so these results may not be representative of the general population. Despite this drawback, these data still provide important information on the characteristics of the poisoning in this part of Iran. To prevent such poisonings, the community education about the danger of central nervous system-acting drugs and reducing the exposure period of people to pesticides are recommended.
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Little data exist regarding pediatric celecoxib ingestions. This study described the pattern of pediatric celecoxib ingestions reported to poison control centers. Cases were isolated celecoxib ingestions by patients aged 0-5 years during 2000-2007 reported to Texas poison control centers. ⋯ Final medical outcome was no effect for 95.7% cases and minor effect for 4.3% cases. Specific clinical effects reported (in only one case each) were rash, abdominal pain, vomiting, agitation/irritability, and drowsiness. All of the pediatric celecoxib ingestions reported to Texas poison control centers resulted in no or minor effect.