Veterinary and human toxicology
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The main cause of death due to acute organophosphate poisoning is believed acute respiratory failure caused by peripheral and central cholinergic actions. Today, advances in respiratory management and intensive care make it possible to maintain the respiratory function of patients with organophosphate poisoning, but it is still difficult to maintain their circulation, and some patients with acute organophosphate poisoning die of metabolic acidosis. The present study clarified the hemodynamics of patients with acute lethal organophosphate poisoning. ⋯ In 3/4 patients respiration was maintained favorably. In all 4 patients cardiac output was maintained, but systemic vascular resistance index (SVRI) was significantly reduced. Catecholamine administration was ineffective and did not increase SVRI.
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Case Reports
Association between droperidol use and sudden death in two patients intoxicated with illicit stimulant drugs.
Illicit drug intoxication is often a cause of extreme agitation in the emergency department and prehospital settings. Chemical restraint is often required to protect patient as well as health-care providers. ⋯ Its safety has been demonstrated in these settings and in patients who's agitation has been attributed to amphetamine toxicity. We present 2 cases of sudden death following the use of droperidol to sedate 1 patient who was extremely agitated secondary to cocaine intoxication and another secondary to phencyclidine intoxication.
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Adverse effects resulting from topical exposure to isopropanol appears exceptional in adults with intact skin. We describe the case of a young woman who developed an acute sensori-motor axonal polyneuropathy after walking bare-feet for several hours on carpets soaked by a disinfectant containing isopropanolol. ⋯ The occurrence shortly after contact, however, strongly suggested responsibility of the dermal isopropanol exposure. This case being, to our knowledge, the second reported, peripheral nerve toxicity appears possible in adults on prolonged topical exposure, probably in susceptible individuals.
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Pepper spray is used as an incapacitant agent. Although now available for general use in the US, the health consequences of pepper spray exposures are poorly understood. This study used data from human exposure calls to poison centers in Texas to investigate the epidemiology of pepper spray exposures. ⋯ Risk factors for pepper spray exposure varied by patient age. Although 85% of the pepper spray exposures were managed outside of health care facilities, 97% of exposures involved at least minimal notable clinical effects. Given the level of detectable clinical effects of this intervention and the widespread availability of these agents, there is a need for better education of the public regarding the proper use of pepper spray and the effects of its use.
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California recycles 50% of previously disposed trash. Increased use of yardwastes and composts has raised concern about toxic materials in these products. Oleander is a toxic shrub common to CA landscapes and is frequently clipped and disposed of in greenwaste containers, resulting in concerns about the toxicity of oleander-contaminated yardwastes and composts from these wastes. ⋯ In an amendment study with fresh uncomposted oleander, no oleandrin was detected in tomato and zuchinni fruit, snap beans, carrot tubers, or green lettuce. Oleandrin was found in red leaf lettuce growing in soils mulched with oleander, but oleandrin concentrations were near the detection limit of the assay. Soil from oleander mulched and amended plots contained low levels of oleandrin at the time of harvest.