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.
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Copperhead envenomation cases reported in the literature frequently lack identification of the subspecies of copperhead responsible for the envenomation. Whether subspecific identity would be useful in predicting possible different toxicity profiles may have clinical relevance. We report here the clinical profiles from envenomations involving 3 different subspecies of captive adult copperhead snakes--the southern copperhead (Agkistrodon contortrix contortrix), the northern copperhead (Agkistrodon contortrix mokasen), and the broad-banded copperhead (Agkistrodon contortrix laticinctus). ⋯ In addition to these symptoms, southern copperhead envenomation resulted in a more severe clinical toxicity profile as evidenced by propulsive emesis, diarrhea and hematuria. Whether these differences in observed clinical toxicity were the result of unique subspecific venom pharmacological actions is an interesting question. However, independent of the copperhead subspecies involved, conservative medical management was effective in each case.
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Acute pesticide poisoning is a global health problem, especially in developing countries. Although Taiwan has quickly industrialized during the last several decades, pesticide use is still prevalent in the agricultural sector. We reviewed 187 consecutive hospitalized cases of the Provincial HsinChu Hospital from January 1989 through December 1995 to explore the determinants of acute pesticide poisoning in Metropolitan HsinChu. ⋯ Alcohol abuse, history of major medical illnesses, and history of suicide were significantly associated with suicidal poisoning; quarrel was the immediate risk factor. Causes of poisoning (suicide vs non-suicide) and selection of the pesticides were major determinants of lethality. More stringent legislation and enforcement regarding the sale and distribution of extremely toxic pesticides are needed to reduce fatalities due to acute pesticide poisoning.
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Case Reports
A case of severe hyperammonemia and unconsciousness following sodium valproate intoxication.
Although valproic acid has gradually gained its popularity in the treatment of various seizure disorders, overdose of valproate is not common. An 18-y-old man with a history of epilepsy controlled by sodium valproate and clonazepam attempted suicide with an ingestion of 45 g sodium valproate. He presented to our service with drowsiness and irritability. ⋯ However, impairment of liver function, hyperammonemia, fluid-electrolyte disturbances, coma, seizures, hypotension and even death may occur following valproate overdose. Symptomatic and supportive measures are the mainstay in the treatment of valproic acid overdose. With prompt diagnosis and early institution of treatment, a complete recovery should be anticipated.