Veterinary and human toxicology
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We present the case of a patient who attempted suicide by ingestion of the rodenticide zinc phosphide. Zinc phosphide manifests its immediate toxicity through production of phosphine gas. ⋯ Delayed deaths are related to a direct cardiotoxicity. Treatment is mainly symptomatic and supportive; aggressive airway management and circulatory support are critical to a successful outcome.
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Methemoglobinemia following fire exposure is largely unrecognized. Fire related morbidity and mortality are customarily attributed to thermal injury, associated trauma, and carbon monoxide poisoning. ⋯ Relatively low levels of methemoglobin could complicate concomitant carbon monoxide poisoning by additive or synergistic effects on oxygen binding and delivery. We report 3 cases of significant methemoglobinemia (levels of 19, 12, and 12%) in survivors of a dwelling fire and review the literature with regard to this phenomenon.
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In a retrospective study of 49 cases of carbon monoxide (CO) intoxication presented to the University of Illinois Hospital (UIH) Emergency Department between November 1986 and April 1988, we looked for a correlation between carboxyhemoglobin (COHb) as determined by a venous sample and the pH as determined by arterial blood gas analysis. The range of COHb levels in our study was 10-64% (mean 21.8% +/- 10.2%). Smoke inhalation cases (n = 3) were excluded from our study because they did not represent pure CO intoxication. ⋯ We also retrospectively reviewed records of 104 cases who presented to Cook County Hospital Emergency Department with COHb levels over 10% during the period between March 1986 and May 1988. In these cases, we found no significant correlation between COHb level and arterial pH. We therefore conclude that arterial blood gases drawn in order to determine the degree of acidosis in mild CO intoxication without respiratory distress may not be useful in guiding therapeutic intervention and need not be routinely drawn.
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The fact that intentional drug and toxic substance use/abuse by adolescents has dramatically increased during the past 2 decades often overshadows the knowledge that adolescents also suffer accidental poisonings as well. A 1-year retrospective analysis of 1,879 poison exposures involving children 13 to 17 years of age revealed 894 (47.6%) were due to accidental circumstances and 945 (50.2%) were intentional in nature. Nonpharmaceuticals were involved in 63.5% of all accidental adolescent poisonings versus 36.5% involving various drugs. ⋯ Management at the nearest health care facility (HCF) was necessary in 1,252 (66.6%) of the poisonings versus 627 (33.4%) who were treated in non-HCF environments. Regional poison centers must be cognizant that accidental as well as intentional poisoning can occur with adolescents. Distinct viable prevention strategies should be developed to address these problems.