Veterinary and human toxicology
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Fentanyl patches create unique opportunities for use and abuse. Each patch contains 100-fold more drug than is stated on the label in order to create the gradient required to deliver the stated amount (ie 25-100 microg/h). ⋯ Coma and hypoventilation resulted. The woman was resuscitated with naloxone i.v. and recovered without sequelae.
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This study examined age-specific trends in the annual incidence rates of poisoning exposures reported to a regional poison control center over a 5-y period. Data from the poison control center's 1997-2001 computerized case records were combined with age-specific population estimates from the US Census Bureau. ⋯ Different patterns were observed in the rates of reported poisoning exposures between the 6 age groups. While there was a significant decrease in the rate of reported poisoning exposures in children < 6 y of age or less, and for adults 20-35 and 36-65 y-old, the incidence rate among children 6-12 y, adolescents, and people > 65 y-old showed no significant decreasing trend.
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The main cause of death due to acute organophosphate poisoning is believed acute respiratory failure caused by peripheral and central cholinergic actions. Today, advances in respiratory management and intensive care make it possible to maintain the respiratory function of patients with organophosphate poisoning, but it is still difficult to maintain their circulation, and some patients with acute organophosphate poisoning die of metabolic acidosis. The present study clarified the hemodynamics of patients with acute lethal organophosphate poisoning. ⋯ In 3/4 patients respiration was maintained favorably. In all 4 patients cardiac output was maintained, but systemic vascular resistance index (SVRI) was significantly reduced. Catecholamine administration was ineffective and did not increase SVRI.
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Case Reports
Association between droperidol use and sudden death in two patients intoxicated with illicit stimulant drugs.
Illicit drug intoxication is often a cause of extreme agitation in the emergency department and prehospital settings. Chemical restraint is often required to protect patient as well as health-care providers. ⋯ Its safety has been demonstrated in these settings and in patients who's agitation has been attributed to amphetamine toxicity. We present 2 cases of sudden death following the use of droperidol to sedate 1 patient who was extremely agitated secondary to cocaine intoxication and another secondary to phencyclidine intoxication.
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Adverse effects resulting from topical exposure to isopropanol appears exceptional in adults with intact skin. We describe the case of a young woman who developed an acute sensori-motor axonal polyneuropathy after walking bare-feet for several hours on carpets soaked by a disinfectant containing isopropanolol. ⋯ The occurrence shortly after contact, however, strongly suggested responsibility of the dermal isopropanol exposure. This case being, to our knowledge, the second reported, peripheral nerve toxicity appears possible in adults on prolonged topical exposure, probably in susceptible individuals.