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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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.
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We reviewed 130 admissions of organophosphate poisoning and analyzed the causes of death. Fenitrothion, malathion, dichlorvos, trichlorfon and fenitrothion/malathion were the most frequent chemicals involved. Mortality was 25% (32/130); delay in discovery and transport (18 cases), insufficient respiratory management (8 cases), and severe underlying or co-existing diseases (6 cases) were noted in the lethalities. ⋯ About 3/4 of the severely serum cholinesterase-depressed cases needed ventilators. This suggests that better respiratory management would improve the outcome of organophosphate poisonings. Close observation of the clinical symptoms is essential, and detection of changes in serum cholinesterase may be helpful.
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The prince of Wales Hospital is in a unique position for the study of the actual incidence of acetaminophen poisoning in Hong Kong because it is the sole general teaching hospital in the New Territories East and the age and sex distribution of the population in the region are readily available. Between 1991 and 1994, the rate of admission in subjects aged > or = 15 years slightly increased from 5.7 to 7.3/100,000. In both 1991 and 1994, the highest rates in women were in the 15-19 age group (from 22.8 to 53.0/100,000) and in men in the 25-29 age group (from 10.5 to 6.0/100,000). ⋯ There were no deaths. Thus, acetaminophen poisoning appears to cause less fulminant liver failure and deaths in Hong Kong than in other Western societies. Reasons for such differences need to be better understood.