Veterinary and human toxicology
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A spontaneous outbreak of neurological disease in swine caused by the ingestion of Aeschynomene indica seeds and reproduction of the disease in the same specie are reported. In the natural outbreak the morbidity, mortality and lethality rates were respectively 25%-40%, 8.5%-20%, and 25%-66%. Clinical signs were variable degrees of incoordination of gait, falls, sternal recumbency with wide base stance of the hind limbs, lateral recumbency and death. ⋯ Pigs fed 10% and 15% A. indica had histopathological changes in the brain of discrete focal symmetrical areas of malacia. These findings indicate that one or more toxic principles in A. indica seeds are responsible for this neurological condition and that clinical outcome and pathological changes are dose-dependent. The symmetrical malacic foci from the ingestion of A. indica seeds in pigs affected vestibular and cerebellar nuclei, putamen, and the mesencephalic substantia nigra, oculomotor, and red nucleus; thus, focal symmetrical encephalomalacia is suggested as a better name for the disease.
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Melatonin regulates circadian rhythms, and although widely used in the US, information on the public use of melatonin and patterns of reported adverse effects associated with the substance is limited. To describe the patterns of melatonin calls to poison centers in Texas during 1998-2003, data on all melatonin calls reported to the Texas Poison Center Network were analyzed. During 1998-2003, there were 779 identified human exposures to melatonin identified. ⋯ The majority of melatonin exposures reported to Texas poison centers involved children < 6 y. Younger patients were more likely to be male, have unintentional exposures, have no clinical effect, and to not require management at health care facilities. The observed clinical effects and treatment methods were consistent with the literature.
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The non life-threatening results of a bite from a grass snake in a 17-y-old patient are described, their significance evaluated, and the hazard of such bites discussed.
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Case Reports
Fentanyl patch abuse: naloxone complications and extracorporeal membrane oxygenation rescue.
Fentanyl patches offer a novel, but increasingly common method of drug abuse. We describe a patient who developed severe respiratory dysfunction after fentanyl patch abuse via insufflation, naloxone administration and aspiration. ⋯ To our knowledge, this is the 1st reported case of ECMO being used to correct severe pulmonary dysfunction associated with opioid abuse. The risks associated with naloxone administration are discussed.
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Paraquat is one of the few broad-spectrum herbicides available in the US; however, it is extremely toxic to companion animals when ingested. Despite its restricted use status, poisoning of dogs and cats remains relatively common. This clinical report documents a series of chronologically and geographically related cases of presumed malicious and fatal sub-acute paraquat poisoning in 7 dogs in Portland, OR. ⋯ Hyperlipasemia and moderate hypertension were notable featured in 5/7 cases. Trace levels of paraquat were demonstrated in the urine of 4/7 animals by gas-liquid chromatography/mass spectroscopy. Diagnosis in the remaining 3 cases was made through a combination of history or exposure, clinical signs and their progression, and pulmonary and renal histopathology.