Veterinary and human toxicology
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L-Thyroxine (T4) is commonly prescribed medication for hypothyroidism in humans and animals. Overdose has generally resulted in limited symptomatology managed with sedatives and beta-adrenergic receptor antagonists. We describe the largest acute T4 ingestion ever reported, which resulted in a profound thyrotoxicosis, resistant to treatment. ⋯ Free T4 levels ranged from > 13 mcg/dL on day 6 to 1.2 mcg/dL on day 12. By discharge (day 15) he had lost 20 kilograms of body weight, but was clinically euthyroid 2 w later. This case suggests that large intentional T4 ingestions should be managed differently than current T4 overdose protocol.
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Incidences of swallowing lithium batteries have been increasing. A lithium battery is more dangerous than button alkali batteries because the tissue erosion and perforation of the esophagus is more rapid than with button alkali batteries. We hypothesized that a bolus fresh water wash out or dilution of the alkali produced by the direct current flow, and/or inhibition of the alkali production by interrupting the direct current flow, might lessen the severity of the necrotic injury at a contact esophageal site with a battery. ⋯ The consumed electricity of the batteries was also evaluated. Serial bolus administration of water reduced the consumed electricity of the batteries significantly 30 and 60 min after fixation and delayed the corrosive change in a contact esophageal area during the first 30 min. Dosing with tap water as soon as possible within 30 min after ingestion seemed a useful first aid measure to prevent esophageal injury after accidental swallowing of a lithium battery.