Veterinary and human toxicology
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Review Case Reports
Acute caffeine ingestion fatalities: management issues.
Caffeine is used and abused on a daily basis in different beverages, OTC products, and as a prescribed medication. The strength varies widely from negligible in decaffeinated drinks to medicinal grade of 200 mg/tablet. ⋯ However, within a 4-mo period, the Panhandle Poison Center recorded 2 deaths due to caffeine overdose. The abrupt onset of intractable seizures needs to be anticipated in order to appropriately manage the victims and to prevent the adverse outcome.
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We studied the frequency of use of flumazenil by emergency departments in our region and compared it to recommendations made by specialists in poison information at our poison control center. For a 5-mo period, we prospectively collected cases involving benzodiazepines or zolpidem. Data was documented only from calls from emergency departments. ⋯ Despite possible contraindications, flumazenil was given 10/14 times (71%) prior to calling the poison control center. These results point to potential overuse of this antidote where contraindications or cautions are suspected in the overdosed patients. Our study suggests that when flumazenil use is contemplated by an emergency department physician, a poison control center consult may have a contrary recommendation.
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Accidental cigarette ingestion by children is a frequent occurrence in Japan where hundreds of cigarette brands (domestic and imported) are purchased. To evaluate the predictive value of the nicotine yield given on the label and determined by a smoking machine, we measured the actual nicotine content of tobacco in 33 popular cigarette brands. Average amounts of nicotine and tobacco/whole cigarette of 32 filter and 1 non-filter brands were as follows: 11.72 +/- 2.27 (SD) mg nicotine (range 6.94-18.33 mg) and 23.97 mg tobacco, and 0.67 +/- 0.07 g nicotine (range 0.49-0.79 g) and 1.02 g tobacco, respectively. ⋯ The tobacco in low-yield cigarettes did not contain less nicotine than high-yield cigarettes, and the nicotine yield did not highly correlate with the nicotine content in the low-yield cigarette group (r = 0.243). We conclude that the nicotine yields on labels are not useful in estimating likely nicotine intake in cigarette-ingestion cases. The actual nicotine content of cigarettes should be included on the product label.
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Scombroid fish poisoning is a food-borne chemical intoxication caused by certain spoiled fish that contain a large amount of histamine and some biogenic diamines. It has gradually become a world-wide medical problem and probably is the most common cause of fish poisoning. As the data on the incidents of scombroid fish poisoning in Taiwan remains scarce, we report 2 incidents of scombroid fish poisoning in Northern Taiwan. ⋯ The nonspecific but characteristic symptomatology of histamine food poisoning and previous consumption of fish should alert physicians to the possibility of scombroid fish poisoning. Unless complicated with shock or respiratory distress, supportive treatment with antihistamines usually concludes with a good prognosis. Toxin analysis of the fish flesh remains the most important step in approaching a confirmed diagnosis.