Journal of toxicology. Clinical toxicology
-
J. Toxicol. Clin. Toxicol. · Jan 1987
Case ReportsRepeated hemoperfusion and continuous arteriovenous hemofiltration in a paraquat poisoned patient.
Prompt hemodialysis or hemoperfusion can be of value during the first 24 hours after paraquat ingestion particularly when the patient has developed acute renal failure. However, many cases of paraquat poisoning occur in areas where hemoperfusion facilities are unavailable. In contrast, continuous arteriovenous hemofiltration (CAVH) could be instituted easily. ⋯ The mean hemoperfusion clearance of paraquat was 50 ml/min and the total amount of paraquat removed by the 34 hours of hemoperfusion was 9 mg. Because of the relative ease with which CAVH can be performed, its low cost, compared to that of hemoperfusion or hemodialysis, and the continuous nature of the procedure, CAVH may be worth considering in paraquat poisoning. It could be used particularly in those patients who have developed renal failure or while patients are being prepared for hemoperfusion.
-
In three patients with severe acute cyanide poisoning, a cyanosis was observed instead of the bright pink skin coloration often mentioned as a sign in textbooks. Treatment of cardiopulmonary insufficiency is as essential as antidotal therapy and the use of sodium nitrite and 4-DMAP is not without risk as, in practice, the methemoglobin-level induced is difficult to control.
-
J. Toxicol. Clin. Toxicol. · Jan 1987
Case ReportsNitrite/thiosulfate treated acute cyanide poisoning: estimated kinetics after antidote.
A 34 year old, 73 kg man ingested a 1 gram potassium cyanide pellet in a suicide attempt. Within one hour, coma, apnea, metabolic acidosis, and seizures developed. Sodium nitrite and sodium thiosulfate were administered. ⋯ Serial whole blood cyanide levels were obtained, documenting a highest measured level of 15.68 mcg/mL. Estimations of toxicokinetic parameters including terminal half-life (t 1/2) (19 hours), clearance (163 mL/minute), and volume of distribution (Vd) (0.41 L/kg) were calculated. The nitrite/thiosulfate combination was clinically efficacious in this case and resulted in complete recovery.
-
A six-year-old child inadvertently received an IV solution containing lidocaine HCl. An estimated total dose of 1.2 gm. was administered over approximately an hour. The child had asystole and grand mal seizures associated with lidocaine serum concentration of 19.2 mcg/ml. The pharmacokinetics of lidocaine overdose and treatment are discussed.
-
J. Toxicol. Clin. Toxicol. · Jan 1986
Serum osmolal gap and ethanol concentration: a simple and accurate formula.
The estimation of serum ethanol concentration by measurement of serum osmolality has been re-evaluated. A formula for calculation of serum osmolality was first validated in 193 patients who had not ingested ethanol. The mean difference between measured and calculated osmolality ("osmolal gap") was 1.5 mOsm/Kg +/- 5.3 mOsm/Kg (1 S. ⋯ This equation accurately predicted serum ethanol in 32 additional samples (r = 0.988). We propose that the formula above be used in place of those that have been previously proposed. The previous formulas involved unwarranted assumptions of ideality and had not been experimentally derived from studies of ethanol in serum.