Veterinary and human toxicology
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Metformin poisoning is not common and is usually associated with lactic acidosis and acute hepatitis. A case of metformin-poisoning associated with acute pancreatitis is reported here for the first time.
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Diphenhydramine (DPH) is a commonly reported overdose that shares similar toxicities with other agents. such as tricyclic antidepressants, that interact with the fast sodium channels. Although physostigmine is considered an acceptable antidote for severe DPH toxicity, adverse effects such as seizures and cholinergic crisis may occur. We hypothesized that hypertonic saline or bicarbonate is equivalent or are better antidotes in an animal model of DPH toxicity. ⋯ Control had initial "drop-off" seizure burst rates over time; seizure bursts in the treatment groups were compared to these rates. Hypertonic sodium bicarbonate was the most effective treatment, followed closely by hypertonic saline. Hypertonic sodium bicarbonate may interact with DPH neuronal sodium channels and may be considered adjuvant therapy in humans with DPH-induced seizures.
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Case Reports
Pancytopenia, hyperglycemia, shock, coma, rhabdomyolysis, and pancreatitis associated with acetaminophen poisoning.
It is well recognized that acetaminophen overdose can cause severe hepatic injury. However, extra-hepatic manifestations may also develop following inappropriate use or ingestion of large amounts of acetaminophen. ⋯ Although her consciousness and hemodynamic status gradually improved after treatment with N-acetylcysteine and other supportive measures, she was found to have pancytopenia, pancreatitis and hepatorenal failure during the hospitalization and eventually died 18 d post-admission. Review of relevant literature reports and the clinical findings in our patient suggests that direct toxic effects mediated by acetaminophen or its metabolites were most likely responsible for most of the observed clinical features.
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Comparative Study
A nationwide survey of poison control centers comparing 1999 to 1998 triage and management of asymptomatic children who ingested tricyclic antidepressant.
Triage of asymptomatic, unintentional pediatric (< 6y) tricyclic antidepressant (TCA) exposures has been based upon single cases or small studies involving large dose, symptomatic ingestions. This study evaluated patterns of triage for asymptomatic pediatric TCA exposures as practiced nationally by regional centers and compared them to 1998 patterns. It also evaluated the role of activated charcoal in the management of these exposures. ⋯ The lowest toxic dose reported in the literature is 6.7 mg/kg. This is consistent with poison control data during the past 6y where no child became toxic at doses < 5 mg/kg. This survey demonstrated significant changes in triage patterns for asymptomatic pediatric TCA exposures.