Abrus and ricinus ingestion: management of three cases.

Three instances of toxic bean ingestion, all in the course of 1 week in the St. Louis area, have led us to submit this article. One case of jequirty bean (Abrus precatorius L.) and two of castor bean (Ricinus communis L.) were treated at Cardial Glennon Memorial Hospital for Children during the third week of August in 1979. These seeds contain phytotoxins which are among the most potent toxic principles known to man.

A comparison of the absorption and metabolism of isopropyl alcohol by oral, dermal and inhalation routes.

The admission of a child with an almost lethal level of isopropyl (alcohol 380 mg/dl) after sponge bathing for fever, and questionable ingestion, prompted the present experiment in animals. Twelve rabbits (2-2.6 kg) were divided into 4 groups of 3 each. Groups 1 and 2 were given isopropyl alcohol, 2 and 4 ml/kg respectively, by gavage. Groups 3 and 4 were placed in an inhalation chamber with group 3 having a towel soaked with isopropyl alcohol applied to the chest. Group 4 had a similar towel placed on the chest but with a plastic layer to preclude skin contact. Average blood levels (mg/dl) of isopropanol/acetone were then measured over 4 hr. Oral absorption produced the highest levels of isopropyl alcohol and acetone, followed by inhalation and dermal. Inhalation alone was of little significance. Acetone levels continued to rise even as isopropyl levels fell following oral exposure. With the inhalation plus skin absorption group, both isopropyl and acetone levels continued to rise throughout the 4 hr time period. These results indicate that skin absorption is a significant factor in isopropyl alcohol toxicity, and the delayed rise in acetone levels may be responsible for prolonged activity.

Extracorporeal membrane oxygenation for hydrocarbon aspiration.

Extracorporeal membrane oxygenation is a pulmonary bypass procedure that has been employed in adults to provide temporary treatment for reversible acute pulmonary and cardiac insufficiency. The technology of membrane oxygenation has been used since 1977 in neonates with predictably fatal pulmonary failure due to respiratory distress syndrome, persistent fetal circulation or persistent pulmonary hypertension of the newborn, meconium aspiration syndrome, and congenital diaphragmatic hernia. The use of extracorporeal membrane oxygenation in older children with other pulmonary disorders has been limited. We report two cases of hydrocarbon aspiration involving petroleum-based products, both successfully treated with extracorporeal membrane oxygenation. A 15-month-old male infant who aspirated baby oil (light mineral oil) is particularly unusual owing to the generally expected low risk of aspiration with a hydrocarbon of such viscosity (greater than 60 Saybolt Universal Seconds). The second patient is a 16-month-old male infant who aspirated furniture polish (mineral seal oil). In both children severe intractable hypoxemia developed despite intensive ventilatory support, and they became candidates for alternative therapy. Extracorporeal membrane oxygenation provides a potentially life-saving option when a patient fails to respond to conventional therapy for hydrocarbon aspiration.