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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Accidental cigarette ingestion by children is a frequent occurrence in Japan where hundreds of cigarette brands (domestic and imported) are purchased. To evaluate the predictive value of the nicotine yield given on the label and determined by a smoking machine, we measured the actual nicotine content of tobacco in 33 popular cigarette brands. Average amounts of nicotine and tobacco/whole cigarette of 32 filter and 1 non-filter brands were as follows: 11.72 +/- 2.27 (SD) mg nicotine (range 6.94-18.33 mg) and 23.97 mg tobacco, and 0.67 +/- 0.07 g nicotine (range 0.49-0.79 g) and 1.02 g tobacco, respectively. ⋯ The tobacco in low-yield cigarettes did not contain less nicotine than high-yield cigarettes, and the nicotine yield did not highly correlate with the nicotine content in the low-yield cigarette group (r = 0.243). We conclude that the nicotine yields on labels are not useful in estimating likely nicotine intake in cigarette-ingestion cases. The actual nicotine content of cigarettes should be included on the product label.
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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.