Journal of toxicology. Clinical toxicology
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J. Toxicol. Clin. Toxicol. · Jan 1999
Case ReportsDiverse manifestations of oral methylene chloride poisoning: report of 6 cases.
Methylene chloride is a solvent used in domestic and industrial preparations, such as paint removers and degreasing agents. Although it is considered of low toxicity, acute toxic manifestations have been reported following inhalation of methylene chloride, mainly from working in an enclosed environment. Oral ingestion of methylene chloride, however, remains rare and its consequences are less clearly understood. ⋯ Ingestion of methylene chloride can result in diverse manifestations, including a high carboxyhemoglobin level. Corrosive gastrointestinal injury is common in oral poisoning and needs further therapeutic consideration. A high index of suspicion and appropriate laboratory studies are needed in those patients who allegedly ingest "chloroform" but do not present the incriminating solvent to their treating physicians. The presence of an elevated carboxyhemoglobin level suggests the diagnosis of methylene chloride poisoning. Symptomatic and supportive measures remain the mainstay in the treatment of patients with oral methylene chloride poisoning.
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J. Toxicol. Clin. Toxicol. · Jan 1999
Multicenter Study Clinical TrialEffect of metoclopramide dose on preventing emesis after oral administration of N-acetylcysteine for acetaminophen overdose.
To determine the effect of the metoclopramide dose on the prevention of vomiting of N-acetylcysteine in acetaminophen overdose. ⋯ This study supports the efficacy of high-dose metoclopramide to prevent emesis after the oral loading dose of N-acetylcysteine.
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J. Toxicol. Clin. Toxicol. · Jan 1999
Activated charcoal reduces the need for N-acetylcysteine treatment after acetaminophen (paracetamol) overdose.
The evidence for efficacy of gastric lavage and activated charcoal for gastrointestinal decontamination in poisoning has relied entirely on volunteer studies and/or pharmacokinetic studies and evidence for any clinical benefits or resource savings is lacking. ⋯ Toxic concentrations of serum acetaminophen (paracetamol) are uncommon in patients ingesting less than 10 g. In those ingesting more, activated charcoal appears to reduce the number of patients who achieve toxic acetaminophen concentrations and thus may reduce the need for treatment and hospital stay.
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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.