Veterinary and human toxicology
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Case Reports
Hemodialysis and hemoperfusion for treatment of valproic acid and gabapentin poisoning.
A 31-y-old epileptic man developed coma and shock after suicidally ingesting large amounts of valproic acid and gabapentin. His peak valproic acid, level was 1306.9 micrograms/mL (therapeutic range = 30-100 micrograms/mL). ⋯ His hypotension was refractory to crystalloid and pressor infusions, but resolved during concurrent hemoperfusion and hemodialysis to enhance elimination of valproic acid. Concurrent hemoperfusion and hemodialysis, in series, produced a maximum valproic acid plasma clearance of 55.4 mL/min versus a maximum reported intrinsic valproic acid plasma clearance of 10.6 mL/min. concurrent hemoperfusion and hemodialysis, in series, should be considered in hemodynamically unstable patients with valproic acid poisoning whose clinical condition is worsening in spite of aggressive supportive care.
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On a temporal basis, air has immense capacity for moving a large mass of pollutants. Mammals and birds are exposed to pollutants in air by the inhalation (nose and mouth), cutaneous or ocular routes. Most laboratory studies on air pollutants have been limited to single air pollutants and very little research has been done on the complex mixture of compounds that exist in ambient air. ⋯ Studies are expensive. In the rural agricultural settings, the economic and environmental health risks are high. Should field observations and chemical problems be used as "red flags" for action?
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We have previously showed that routine screening of all patients with acute poisoning for salicylates in Hong Kong is unnecessary. We suggested that plasma measurements should be restricted to those suspected of having ingested salicylates. Our results and suggestion have since been presented and discussed in our medical unit meetings. ⋯ In 172 patients (88%), ingestion of salicylates was not suspected; 3 (1.7%) had plasma salicylate concentrations of 0.47-2.05 mmol/L but mild symptoms only. We confirmed that routine screening for salicylates in all patients with acute poisoning was unnecessary. Despite our suggestion, 88% of plasma salicylate measurements in this follow-up study (76% in January 1992-June 1993) involved patients not suspected of having ingested salicylates.
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The mainstay of treatment for acetaminophen-induced hepatotoxicity, produced by the accumulation of the toxic metabolite N-acetylbenzoquinoneimine, is an enteral 18-dose course of N-acetylcysteine (NAC). However, absence of characteristic symptomatology is a frequent reason for premature cessation of NAC and early discharge of the toxic acetaminophen poisoned patient. We report a series of confirmed acetaminophen poisonings who were discharged early with NAC and instructions to self-administer. ⋯ All 6 patients remained asymptomatic with normal liver function testing. Since health care reform encourages practitioners to reconsider established approaches to the delivery of health care, perhaps home delivery of NAC would not only be clinically preferred to premature cessation of the antidote, but also offer cost savings. Self-administration of NAC in the home setting may be representative of a new era in America's health care delivery system.
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Comparative Study
The effects of verapamil and lidocaine on the duration of propofol and xylazine-ketamine anesthesia in broiler chickens.
The effects of verapamil, a calcium channel blocker, and lidocaine, a sodium channel blocker, administration on the duration of 1 mg propofol/kg i.v. or 5 mg xylazine/kg + 15 mg ketamine/kg i.m. anesthesia were examined in 1 and 6-w-old broiler chickens. The use of 2.5 or 1.25 mg verapamil/kg i.m. or 5 mg lidocaine/kg im prolonged the sleep time induced by the anesthetic agents. Administration of 5 mg verapamil/kg i.m. caused unexpected acute toxicity and mortality. This study suggests that propofol and xylazine + ketamine anesthesia in broilers may be modulated by calcium and sodium channels.