Human toxicology
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Case Reports
Combined boric acid and cinchocaine chloride poisoning in a 12-month-old infant: evaluation of haemodialysis.
A mixture containing 3 g of boric acid and 300 mg of cinchocaine chloride prescribed due to painful dental protrusion was accidentally ingested by a 12-month-old girl. She developed violent vomiting and coughing. Irritability, tremor, seizures and a delirious reaction. ⋯ The total body clearance of boric acid increased correspondingly from 21 ml/min to 41 and 34 ml/min. The in vitro clearance of boric acid of the dialyser was later determined to be 18 ml/min. It is concluded that haemodialysis is valuable in the treatment of boric acid intoxication because it increases the elimination of the drug even in patients without any sign of renal toxicity.
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Blood concentrations of lactate, ketone bodies and non-esterified (free) fatty acids were measured in 45 adult patients on admission to the poisoning treatment centre, with salicylate and mixed salicylate-sedative/ethanol poisoning. Nine patients had blood lactate concentrations above 2 mmol/l and six patients had ketone-body concentrations greater than 1 mmol/l. ⋯ No direct correlation was found between the presence of these metabolic disturbances and the severity of poisoning. Since only one patient was found with organic acid concentration in the blood exceeding 5 mmol/l, it is concluded that concomitant endogenous acidosis rarely contributes to the acid-base disturbance seen in salicylate poisoning in adults.
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In 1984, 60% of all the enquiries made to the Welsh National Poisons Unit in Cardiff concerned children under 15, and 86% of the latter concerned children under 5. Nearly 60% of requests for information in childhood poisoning were about non-medicinal products and this contrasts with hospital admissions which are more often associated with medicinal products in this age group. ⋯ The latter was due to increased reports of ingestion of garden plants since the number of enquiries concerning house plants remained constant. Thus availability appears to be a major determinant of the risk of poisoning with any particular product in childhood.
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Coma and profound metabolic acidosis early in acute paracetamol poisoning have been described in three patients. Of five further patients (four female, one male, aged 17-80 years) with severe poisoning (plasma paracetamol concentration greater than 800 mg/l, 4-12 h postingestion), four were deeply unconscious on admission and two had a severe metabolic acidosis. ⋯ Paracetamol poisoning, when associated with exceptionally high plasma concentrations, can give rise to coma and metabolic acidosis in the absence of hepatic failure or other drugs. Although unusual, other such presentations may not have been recognized because a toxicology screen was not performed.