ABSTRACT
Acetaminophen and acetaminophen combination products are the most frequent medications involved in intentional and unintentional poisonings. The 2008 National Poison Data System compiled by the American Association of Poison Control Centers documented 98,578 acetaminophen-related poisonings, which includes 91 fatalities. Very few case reports of ingestions of acetaminophen extended release with anticholinergics are reported in the literature.
Subject(s)
Acetaminophen/poisoning , Delayed-Action Preparations/poisoning , Diphenhydramine/poisoning , Drug Overdose/epidemiology , Acetaminophen/pharmacokinetics , Adult , Delayed-Action Preparations/pharmacokinetics , Diphenhydramine/pharmacokinetics , Female , Humans , Poison Control Centers/statistics & numerical data , Suicide, Attempted , United States/epidemiologyABSTRACT
Sustained-release calcium channel blocker (CCB SR) overdoses are potentially life-threatening ingestions. These patients may not become hemodynamically unstable until many hours after ingestion. On theoretical grounds, some have suggested that whole bowel irrigation (WBI) with polyethylene glycol electrolyte lavage solution may be of value in the management of these cases. We report two cases with poor outcome (including one fatality) that were complicated by the use of WBI. Both cases were treated with WBI beginning before and continuing after developing hypotension. WBI should be avoided in the setting of the hemodynamically unstable CCB SR overdose.
Subject(s)
Attitude of Health Personnel , Calcium Channel Blockers/poisoning , Intestines/blood supply , Therapeutic Irrigation/methods , Drug Overdose , Hemodynamics , Humans , Male , Middle Aged , Suicide, Attempted/psychologySubject(s)
Antidotes/therapeutic use , Antitubercular Agents/poisoning , Isoniazid/poisoning , Pyridoxine/therapeutic use , Vitamin B Complex/therapeutic use , Adolescent , Adult , Antidotes/economics , Antidotes/supply & distribution , Female , Humans , Illinois , Male , Poison Control Centers/statistics & numerical data , Pyridoxine/economics , Pyridoxine/supply & distribution , Retrospective Studies , Treatment Outcome , Vitamin B Complex/economics , Vitamin B Complex/supply & distributionSubject(s)
Antidotes/supply & distribution , Inventories, Hospital/standards , Pralidoxime Compounds/supply & distribution , Antidotes/therapeutic use , Drug Industry , Drug Storage , Guidelines as Topic , Humans , Insecticides/poisoning , Organophosphorus Compounds , Pharmacy Service, Hospital/organization & administration , Pharmacy Service, Hospital/supply & distribution , Pralidoxime Compounds/therapeutic use , United StatesABSTRACT
A 33-y-old male developed severe acidosis, renal failure, and profound neutrophilia after ingesting ethylene glycol. Workup for his neutrophilia excluded infectious and malignant causes. An elevated leukocyte alkaline phosphatase (LAP) level confirmed a leukemoid response, and the neutrophila resolved. Although several leukemoid reactions have been published due to therapeutic agents these reports are often incomplete or inaccurate; this is the first case of leukemoid response to a toxin. Leukemoid response is distinguishable from leukemia by the absence of clonally derived cells, although this is not easily apparent in extreme neutrophilia. Elevated LAP is useful in identifying leukemoid reaction from leukemia in cases of extreme neutrophila. If a patient develops extreme neutrophila in association with drug or toxin exposure, a leukemoid reaction should be considered and an LAP obtained.
