Journal of toxicology. Clinical toxicology
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J. Toxicol. Clin. Toxicol. · Jan 2000
A descriptive study of an epidemic of poisoning caused by heroin adulterated with scopolamine.
Adulterants, contaminants, and diluents are all examples of additives to street drugs. Some of these additives may be pharmacologically active; however, it is unusual for them to cause toxic side effects. In the spring of 1995, a new form of heroin appeared in New York City, spreading to other East Coast cities, that was adulterated with scopolamine. It caused severe anticholinergic toxicity in heroin users with patients often presenting to emergency departments in great numbers. This is a report of the demographics and clinical characteristics of the epidemic. ⋯ Adulteration of street drugs can lead to toxic epidemics. Poison centers are essential for identification of these trends and are the primary source of information on diagnosis and treatment.
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A case of combined, massive overdose of both atenolol and diltiazem in an adult male is reported. Cardiac arrest ensued which was responsive to cardiopulmonary resuscitation. Bradycardia, hypotension, and oliguria followed which were resistant to intravenous pacing and multiple pharmacologic interventions, including intravenous fluids, calcium, dopamine, dobutamine, epinephrine, prenalterol, and glucagon. Adequate mean arterial pressure and urine output were restored only after addition of phenylephrine to therapy with multiple agents and transvenous pacing. The patient survived until discharge after a hospital course complicated by nontransmural myocardial infarct on hospital day 4 and pneumonia. Laboratory testing subsequently revealed high serum levels of both atenolol and diltiazem. The atenolol level of 35 microg/mL in this patient is the highest reported associated with survival. ⋯ This case illustrates severe cardiovascular toxicity after overdose of both atenolol and diltiazem. Oliguria, which has previously been reported in severe atenolol overdose, was successfully treated without hemodialysis by the addition of phenylephrine to aggressive therapy with pacing, inotropic, and pressor support.
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J. Toxicol. Clin. Toxicol. · Jan 2000
Case ReportsFelbamate overdose complicated by massive crystalluria and acute renal failure.
We report a 20-year-old woman who developed altered mental status, massive crystalluria, and acute renal failure following an intentional overdose of felbamate and sodium valproate. Peak plasma concentrations of felbamate and sodium valproate were 200 microg/mL and 470 microg/mL, respectively. ⋯ Following parenteral hydration, the crystalluria and acute renal failure resolved and the patient recovered. The frequency and significance of crystalluria in felbamate intoxication is unknown.
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J. Toxicol. Clin. Toxicol. · Jan 2000
The hemodynamic effects of cocaine during acute controlled hemorrhage in conscious rats.
Cocaine is often associated with trauma; however, little is known about how its use alters the response to blood loss. The effect of cocaine on hemodynamics following acute hemorrhage was studied in a rat model. ⋯ Although transient, cocaine blunted the hypotensive response to acute controlled hemorrhage and resulted in tachycardia.
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To report a massive, 100 g ibuprofen ingestion in an adolescent, with survival. ⋯ Massive ingestion of ibuprofen may result in a variable picture with some elements of significant toxicity, but supportive care usually results in survival without sequelae.