Journal of toxicology. Clinical toxicology
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J. Toxicol. Clin. Toxicol. · Jan 1990
Occult carbon monoxide poisoning in patients with neurologic illness.
To investigate occult carbon monoxide poisoning in patients with neurologic illness, we prospectively studied 168 patients who presented to the emergency department between December 1987 and February 1988 with neurologic symptoms for evidence of carbon monoxide exposure. Patients with known carbon monoxide poisoning were excluded. The mean carboxyhemoglobin level was 3.1 percent; there were no significant differences in carboxyhemoglobin between categories of neurologic illness (F(5,162) = 1.35; p less than 0.25). ⋯ After controlling for the effects of active and passive exposure to cigarette smoke, problems with the home heating system (odds ratio 9.6; p less than 0.03) and the presence of cohabitants with concurrent headache or dizziness (odds ratio 21.6; p less than 0.0001) were associated with an increased risk of a carboxyhemoglobin greater than 10 percent. A rule for obtaining carboxyhemoglobin tests only on patients who used gas stoves for heat or who had symptomatic cohabitants would have correctly identified all patients with carboxyhemoglobins greater than 10 percent, correctly excluded 77 percent of patients with lower levels, and eliminated the need for testing in 75 percent of cases. We conclude that unrecognized carbon monoxide poisoning occurs in a small but important fraction of patients with wintertime neurologic illness and can be identified by a characteristic risk factor profile.
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J. Toxicol. Clin. Toxicol. · Jan 1990
Comparative StudyRhabdomyolysis and acute renal failure associated with cocaine abuse.
Cocaine abuse has emerged as a major public health problem among young adults. Illicit use of cocaine has been associated with an increasing array of medical complications. ⋯ The present report describes our experience with 15 such patients and serves to further define the spectrum of muscle injury associated with cocaine abuse ranging from the incidental finding of elevated serum levels of muscle enzymes to acute renal failure. Those patients who developed renal failure experienced more severe rhabdomyolysis in association with trauma, seizures or hyperpyrexia.
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A one month old child inadvertently received an intravenous bolus injection of 50 mg of lidocaine instead of contrast iodine. The clinical picture comprised collapse, respiratory arrest, convulsions and coma. ⋯ The recovery was complete. The toxicity of lidocaine is discussed.