Acute copper intoxication. Pathophysiology and therapy with a case report.

We report a case of cupric sulfate intoxication in a child who had a serum copper level of 1,650 mug/100 ml. His course was accompanied by hemolytic anemia and renal tubular damage. We review the pathophysiology of copper metabolism and intoxication. We also review modes of therapy, with specific reference to the initial approach, using dimercaprol (BAL) and edetic acid rather than penicillamine.

Extrinsic allergic alveolitis after Aspergillus fumigatus inhalation. Evidence of a type IV immunologic pathogenesis.

Three weeks after a massive inhalation of mold present on infected oats, a farmer's wife had extrinsic allergic alveolitis. Aspergillus fumigatus was cultured from the moldy oats and from deep bronchial washings obtained at fiberoptic bronchoscopy. Spores and hyphae characteristic of Aspergillus species were demonstrated within granulomas in the pulmonary tissue obtained by transbrochial biopsy. Serum precipitins, delayed (48 hour) cutaneous hypersensitivity and in vitro lymphocyte transformation to A. fumigatus were demonstrated. The findings in this case suggest that a type IV immunologic response and subsequent (lymphocyte-mediated) tissue inflammation may underlie the pathogenesis of this and other forms of hypersensitivity pneumonitis.

Report of a fatal, acute tripelennamine intoxication.

A death resulting from tripelennamine overdose in a 19-year-old male Caucasian is reported. The patient died 7 h after ingesting approximately twenty 50-mg tripelennamine tablets. A concentration of 1.0 mg/100 ml was found in the blood. All tissue concentrations were measured by ultraviolet spectroscopy and verified by gas-liquid chromatography. Significant findings included pulmonary edema and multiple small petechial hemorrhages in the soft tissue of the scalp.

Fatal overdose from Bendectin.

A three-year old male ingested approximately 100 tablets of Bendectin. He developed tonic-clonic seizures followed by cardiac arrest. Toxicologic analysis yielded high levels of doxylamine, dicyclomine, and pyridoxine in blood, peritoneal fluid, and tissue homogenates. The antihistamine, doxylamine succinate appears to be the toxic constituent. Analytical methods used to document the case are herein described.

Polytef granuloma clinically simulating carcinoma of the thyroid.

A case of a foreign body granuloma to polytef (Teflon) appeared as a mass on the left side of the neck and clinically simulated carcinoma of the thyroid. Autopsy results demonstrated that the intracordal polytef extended through the cricothyroid membrane via a fistulous tract forming a suprathyroid nodule.

Significance of non-steady-state serum digoxin concentrations.

In order better to define the optimal time for sample collection, the authors examined the serial concentrations of digoxin in serum and urine of six hospitalized patients during the first 8 hours after administration of their maintenance doses of digoxin. Expressed as % of baseline value, mean serum digoxin concentrations 1/2, 1, 1 1/2, 2,4, 6, and 8 hours after administration of the drug were 167, 185, 228, 256, 175, 145, and 134%, respectively. Steady-state serum concentrations were not established until 6-8 hours after administration of the drug, and high serum values during the first 6 hours did not correlate with clinical and/or electrocardiographic evidence of digoxin toxicity. It is concluded that when serum digoxin levels are utilized as an index of digitalization or toxicity in patients on maintenance therapy, the blood samples should be drawn just prior to the daily dose and no sooner than 6 hours after administration of the drug.