Journal of toxicology. Clinical toxicology
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J. Toxicol. Clin. Toxicol. · Jan 1998
Case ReportsECG conduction delays associated with massive bupropion overdose.
Bupropion, a relatively new antidepressant, is highly regarded for its safety profile in therapeutic doses and in the overdose. Seizure is the primary adverse reaction associated with bupropion overdoses. Clinically significant cardiovascular complications are rare. ⋯ We report the case of an adult male who ingested 9 g bupropion and developed neurologic toxicity as well as intraventricular conduction disturbances on electrocardiogram. Cardiac monitoring of these patients should be considered.
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J. Toxicol. Clin. Toxicol. · Jan 1998
Case ReportsProlonged severe withdrawal symptoms after acute-on-chronic baclofen overdose.
Baclofen is frequently used to treat muscle spasticity due to spinal cord injury and multiple sclerosis. Baclofen overdose can lead to coma, respiratory depression, hyporeflexia, and flaccidity. An abrupt decrease in the dose of baclofen due to surgery or a rapid tapering program may result in severe baclofen withdrawal syndrome manifesting hallucinations, delirium, seizures, and high fever. Severe baclofen withdrawal syndrome secondary to intentional overdose, however, has not received mention. ⋯ A 42-year-old male receiving chronic baclofen therapy, 20 mg/d, attempted suicide by ingesting at least 800 mg of baclofen. He was found in coma 2 hours postingestion with depressed respirations, areflexia, hypotonia, bradycardia, and hypotension. Treatment with intravenous fluids, atropine, dopamine, and hemodialysis was associated with restoration of consciousness within 2 days but disorientation, hallucinations, fever, delirium, hypotension, bradycardia, and coma developed during the following week. Baclofen withdrawal syndrome was not diagnosed until hospital day 9, when reinstitution of baclofen rapidly stabilized his condition. Oral overdosage of baclofen causes severe neurological and cardiovascular manifestations due to its GABA and dominant cholinergic effects. Severe baclofen withdrawal syndrome is manifest by neuropsychiatric manifestations and hemodynamic instability. Caution should be exercised after a baclofen overdose in patients receiving chronic baclofen therapy.
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An accidental exposure due to reuse of containers of toluene diisocyanate to transport nontoxic substances and subsequent occupational toxic exposure caused illness among forty workers in a glove manufacturing plant. Examination and investigation of the patients and factory site inspection were carried out. ⋯ Thirty-two of forty patients had muscle pain and seven had elevated creatine phosphokinase activity. These features have not been reported previously as components of toluene diisocyanate toxicity and their underlying causation remains speculative.
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J. Toxicol. Clin. Toxicol. · Jan 1998
Comparative StudyUse of ondansetron and other antiemetics in the management of toxic acetaminophen ingestions.
Patients presenting with acetaminophen toxicity and vomiting are often treated with antiemetics so that orally administered N-acetylcysteine can be retained. The policy at the West Virginia Poison Center is to reserve ondansetron, an antiemetic with a higher cost than other antiemetics, as a second line agent for patients presenting within 8 hours of an acetaminophen ingestion. ⋯ Ondansetron should be utilized as a second-line agent in the management of acetaminophen toxic patients with vomiting. Because of its lower failure rate, ondansetron should be administered as a first-line agent in patients with a delay in N-acetylcysteine administration approaching 8 or more hours.