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1.
Clin Toxicol (Phila) ; : 1-4, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31456429

RESUMO

Introduction: The jequirity bean (Abrus precatorius) seed contains abrin, a toxalbumin, that irreversibly binds the 60-s ribosomal subunit inhibiting protein synthesis. Neurologic manifestations of ingestions are rare. Case details: We present a case of a 20-year-old man with 24 h of vomiting, diarrhea and 2 h of hematemesis and hematochezia. He admitted to purchasing 1000 jequirity beans online, crushing and ingesting them 26 h prior to presentation in a suicide attempt. Over the next 2 days, he developed hallucinations, incomprehensible mumbling and grunting, disconjugate gaze with abnormal roving eye movements and a left gaze preference with his right eye deviated medially. There was a fine tremor of the upper extremities and he had brief episodes of choreoathetoid movements of his legs. A head CT was normal with no cerebral edema. He progressed to minimally responsive to noxious stimuli, and was unable to converse or follow commands and displayed increased choreoathetoid movements of his extremities. An electroencephalogram (EEG) showed only mild background slowing. Magnetic resonance imaging (MRI) was performed showing bilaterally symmetric signal abnormalities in the basal ganglia, brainstem, corpus callosum and corona radiata with diffuse leptomeningeal enhancement. The patient developed a tonic-clonic seizure followed by pulseless electrical activity, from which he was resuscitated. He was provided comfort care and died just under 5 days after his ingestion. Results: Urine analysis using liquid chromatography coupled to tandem mass spectrometry was positive for 8.84 ng/ml of l-abrine (4.96 ng l-abrine/mg creatinine) 61 h after admission to the hospital (approximately 87 h post-ingestion). Serum concentrations for l-abrine and ricinine were both below the limits of detection. Discussion: Ingestion of 1000 crushed jequirity beans purchased on the internet resulted in progressive encephalopathy and death.

2.
Breastfeed Med ; 14(7): 508-512, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31211594

RESUMO

Introduction: We described calls to U.S. poison centers (PCs) related to potential exposure to substances through breast milk. Materials and Methods: We analyzed National Poison Data System calls between 2001 and 2017 with "Exposure through breast milk" or "Drug use during breastfeeding" as the coded scenario. Data handling and descriptive statistics were carried out using SAS JMP 12.01. Results: U.S. PCs received 76,416 information calls and 2,319 exposure calls related to breast milk. Exposure calls were from a residence in 76% (n = 1,758), from health care facilities (HCFs) in 15.5% (n = 360), and from a workplace in 0.6% (n = 15). A total of 466 exposures (20.1%) were subsequently managed at a HCF: 269 were evaluated and released (58%), 38 were admitted to intensive care unit (8.2%), and 53 were admitted to hospital floor (11%). Medical outcomes included 1 death (0.04%), 8 major effect (0.3%), 43 moderate effect (1.9%), 170 minor effect (7.3%), and 390 no effect (16.8%). Exposure calls that reported major effects involved opioids, benzodiazepines, ethanol, cyclobenzaprine, insulin, and amphetamines. Exposure calls most commonly involved antibiotics, antifungals, benzodiazepines, opioids, and selective serotonin reuptake inhibitors (SSRIs). A total of 1,192 exposures (51.4%) had reported signs/symptoms including drowsiness, agitation, rash, and vomiting/diarrhea. Information calls most commonly involved systemic antibiotics, SSRIs, antihistamines, corticosteroids, and benzodiazepines. Conclusions: Substances common to both exposure and information calls included antibiotics, benzodiazepines, and SSRIs. Most cases of severe toxicity included potential exposures through breast milk to benzodiazepines and opioids. These data may help inform educational outreach, risk assessment, and bedside care for breastfeeding mothers.

3.
Pediatr Emerg Care ; 35(3): 176-179, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27749797

RESUMO

OBJECTIVE: Adolescent intentional ingestions remain a significant public health problem in the United States with little research to date on the over-the-counter or prescription medicines that adolescents abuse. These data are important for anticipatory guidance by primary care providers, preventive health, and poison center outreach. METHODS: This was an observational study using the American Association of Poison Control Centers National Poison Data System. The study population consisted of all cases of patients aged 13 to 19 years from 2004 to 2013 with a coding of "intentional abuse." RESULTS: There were 95,695 patient calls that were coded for intentional abuse between 2004 and 2013 for adolescents aged 13 to 19 years. The most common agent reportedly ingested in intentional-abuse cases was antihistamine and/or decongestant with dextromethorphan, and this agent remained the most common throughout the 10-year study period. The next 4 most common agents remained similar across the study period as well and included ethanol, benzodiazepines, dextromethorphan alone, and marijuana. These 5 agents remained the most commonly reported across the study period for all US regions (West, Midwest, South Northeast, and US territories). CONCLUSIONS: Over a recent 10-year period, common cough preparations remain the most commonly reported intentional abuse ingestion among all years and regions for adolescents.


Assuntos
Centros de Controle de Intoxicações/tendências , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Comportamento do Adolescente , Bases de Dados Factuais , Ingestão de Alimentos , Feminino , Humanos , Masculino , Medicamentos sem Prescrição/envenenamento , Medicamentos sob Prescrição/envenenamento , Estados Unidos/epidemiologia , Adulto Jovem
5.
Clin Toxicol (Phila) ; 56(5): 360-364, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-28944696

RESUMO

OBJECTIVE: Bupropion is often categorized as a newer generation antidepressant and assessed with serotonin reuptake inhibitors as a lower risk than older tricyclic antidepressants (TCAs). The objective of this study was to compare outcomes in adolescent suicide from ingestions between bupropion and TCA medications. STUDY DESIGN: An analysis of the National Poison Data System for exposures coded "suspected suicide" in adolescents (age: 13-19) was undertaken for the years 2013-2016 and included TCAs or bupropion. We compared clinical effects, therapies and medical outcomes. RESULTS: Over the four-year period there were 2253 bupropion and 1496 TCA adolescent suspected suicide calls. There was a significant linear increase in bupropion ingestions over the four years. Across all years, there were on average 189.2 (95% CI: 58.1-320.4; p = .01) more ingestions of bupropion than TCA. When comparing bupropion to a TCA, ingestions of bupropion were significantly more likely to be accompanied by seizure (30.7% vs 3.9%; p < .01), to be admitted (74.8% vs 61.6%; p < .01) and medical outcomes to be coded as a major outcome (19.3% vs 10.0%; p < .01). The number of cases with death or major clinical outcome for both increased over the four-year period. Ingestions of bupropion were less likely to have hypotension (2.7% vs 8.0%; p < .01) and less likely to be intubated (5.6% vs 16.4%; p < .01) as compared to ingestions of TCA. CONCLUSIONS: Adolescents who overdose on a single medication in a suicide attempt with bupropion have a statistically significant higher incidence of major outcomes and seizures. The risks of bupropion as a potential means of suicidal gesture by overdose must be considered, and weighed against its benefits and side effect profile when choosing an appropriate agent for the treatment of depression in adolescents.


Assuntos
Antidepressivos/envenenamento , Bupropiona/envenenamento , Tentativa de Suicídio , Adolescente , Antidepressivos de Segunda Geração/envenenamento , Antidepressivos Tricíclicos/envenenamento , Feminino , Humanos , Masculino , Estudos Retrospectivos , Tentativa de Suicídio/estatística & dados numéricos , Adulto Jovem
6.
Clin Toxicol (Phila) ; 56(3): 223-225, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28753074

RESUMO

BACKGROUND: We describe the clinical course of one industrial technician occupationally exposed to nickel carbonyl (NiC). CASE REPORT: A 50-year-old male industrial technician presented with complaints of nausea, myalgia, and cough to a local clinic after suspected occupational exposure to nickel carbonyl. He has no history of lung disease or smoking. His initial urine nickel concentration was 692 ug/L. He had infiltrates on the initial chest X-ray (CXR) and an oxygen saturation (O2) of 97% on room air. The patient was started on disulfiram 1 g by mouth (PO), 500 mg six hours after the first dose, then 250 mg twice daily for five days with prednisone 60 mg by mouth for five days. He presented 48 hours later with worsening respiratory symptoms. His O2 saturation decreased to 85% despite two days of oral steroids, and he was admitted to a hospital. He received prednisone 60 mg/day PO, 4 L nasal O2, and disulfiram 500 mg twice daily. He was discharged on day 7 post-exposure with disulfiram and prednisone. Case discussions: NiC is a severe respiratory irritant. Disulfiram was used off-label and was based on an established company protocol. CONCLUSIONS: Inhalation exposure to NiC resulted in a delayed respiratory dysfunction which responded to disulfiram treatment.


Assuntos
Dissulfiram/uso terapêutico , Exposição por Inalação/efeitos adversos , Exposição Ocupacional/efeitos adversos , Compostos Organometálicos/toxicidade , Pneumonia/induzido quimicamente , Pneumonia/tratamento farmacológico , Prednisolona/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
8.
Ann Emerg Med ; 69(6): 726-736.e2, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28153539

RESUMO

STUDY OBJECTIVE: In cases of high-concentration peroxide ingestion reported to US poison centers, we describe medical outcomes, examine the role of hyperbaric oxygen, and review the use of endoscopy. METHODS: The study was a retrospective analysis of a structured database, the National Poison Data System. The chart for each poison center case of a high-concentration (>10%) peroxide ingestion was obtained and abstracted in a standardized fashion; 1,054 cases were initially considered and 294 cases met inclusion criteria. The primary outcome of possible embolic event was defined as seizure, altered mental status, respiratory distress, hypoxia, hemodynamic instability, ECG changes, radiographic evidence of cerebrovascular accident, focal neurologic deficit on examination, pulmonary embolism, cardiac emboli, elevated troponin level, physician bedside diagnosis, or rapid improvement after hyperbaric oxygen therapy. Both descriptive statistics and logistic regression models were used to analyze the data. RESULTS: In the 10-year study period, 41 of 294 patients (13.9%; 95% confidence interval 10.2% to 18.4%) with symptoms after high-concentration peroxide ingestion demonstrated evidence of embolic events, and 20 of 294 (6.8%; 95% confidence interval 4.2% to 10.3%) either died or exhibited continued disability when the poison center chart was closed. Improved outcomes were demonstrated after early hyperbaric oxygen therapy. Endoscopy revealed grade 3 or 4 lesions in only 5 cases. CONCLUSION: Symptomatic high-concentration peroxide exposures had a high incidence of associated embolic events in this cohort. Patients with evidence of embolic events had a high rate of death. Early hyperbaric oxygen therapy may be useful, but routine endoscopy is unlikely to be of benefit.


Assuntos
Anti-Infecciosos Locais/envenenamento , Endoscopia , Gastroenteropatias/induzido quimicamente , Peróxido de Hidrogênio/envenenamento , Oxigenação Hiperbárica , Centros de Controle de Intoxicações , Acidentes/estatística & dados numéricos , Adulto , Distribuição por Idade , Assistência Ambulatorial , Feminino , Gastroenteropatias/diagnóstico , Humanos , Oxigenação Hiperbárica/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tentativa de Suicídio/estatística & dados numéricos , Estados Unidos
9.
J Adolesc Health ; 60(2): 191-195, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27889404

RESUMO

PURPOSE: Suicide attempts by adolescents most commonly involve the overdose of medications. To date, there has been little information on the over-the-counter or prescription medicines that adolescents ingest for self-harm. Identification of medications chosen in suicide attempts may help guide anticipatory guidance to parents by primary care providers and Poison Centers in prevention programs. METHODS: This was a retrospective observational study using the American Association of Poison Control Center's National Poison Data System. Data were collected on patients aged 13-19 years old at the time of their substance ingestion, between the years 2004 and 2013 and that were coded as reason for ingestion of "intentional-suspected suicide." RESULTS: During the 10-year study period, there were 390,560 poison center calls for intentional-suspected suicide in the United States between 2004 and 2013, accounting for 80.3% of all "intentional" ingestion calls in the adolescent population. Over the entire age range, the most common substance ingested included acetaminophen (10.9%), ibuprofen (9%), selective serotonin reuptake inhibitors (7.7%), atypical antipsychotic (6%), and antihistamines (5%). The most common medications coded as resulting in major clinical effects or death were antidepressants and atypical antipsychotics. CONCLUSIONS: Adolescent ingestion choices for suicide attempts have remained relatively consistent over the past 10 years. However, there was a recent decrease in selective serotonin reuptake inhibitor ingestions. The most common medications used in an overdose attempt were ibuprofen and acetaminophen. Further preventative efforts are needed in this at-risk population from multiple providers at various levels.


Assuntos
Comportamento do Adolescente/psicologia , Overdose de Drogas/epidemiologia , Medicamentos sem Prescrição/envenenamento , Medicamentos sob Prescrição/envenenamento , Tentativa de Suicídio/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Masculino , Centros de Controle de Intoxicações/estatística & dados numéricos , Estudos Retrospectivos , Distribuição por Sexo , Tentativa de Suicídio/prevenção & controle , Estados Unidos/epidemiologia , Adulto Jovem
10.
Am J Emerg Med ; 35(3): 519.e1-519.e4, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27707569
11.
J Emerg Med ; 51(5): 485-490, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27596964

RESUMO

BACKGROUND: Opioid abuse is a public health epidemic in the United States. Much literature has focused on the prescribing practices of physicians and opioid misuse by adults. However, there are limited data on the effect of opioid prescriptions on adolescent recreational ingestion of these medications. OBJECTIVES: The objective of this study was to assess for a relationship between opioid prescribing practices across the United States and adolescent opioid ingestion calls to poison centers. METHODS: This was an observational study using the National Poison Data System. The study population consisted of poison center calls regarding adolescents between 2005 and 2010 in the database with a coding of "intentional abuse" and an opioid ingestion. National opioid prescription estimates were generated using nationally representative outpatient and inpatient databases. RESULTS: There were 4186 adolescent opioid ingestion calls during the study period. There was a general increase between 2005 and 2010 in both teen opioid abuse calls (617 in 2005 to 782 in 2010) and national opioid prescriptions (approximately 78 million in 2005 to 108 million in 2010). For each opioid prescription increase per 100 persons per year, the annual teen opioid abuse calls increased by 1.8% (95% confidence interval 0.9-2.8%), equivalent to an absolute increase of about 0.04 to 0.05 calls per 100,000 teens annually. CONCLUSIONS: There appears to be an association between opioid prescriptions nationally and poison center calls for adolescent opioid ingestions. This is particularly important in this patient population because of impulsivity and early exposure to substance abuse. Providers should be aware of the nonmedical use of opioids by adolescents and educate patients accordingly.


Assuntos
Analgésicos Opioides/uso terapêutico , Centros de Controle de Intoxicações/estatística & dados numéricos , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Adolescente , Analgésicos/farmacologia , Analgésicos/uso terapêutico , Feminino , Humanos , Masculino , Distribuição de Poisson , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
12.
J Med Toxicol ; 12(3): 295-300, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27043735

RESUMO

INTRODUCTION: Anhydrous caffeine, often sold on the Internet as a powdered caffeine product, is sold as "pure caffeine" to be used as an additive to beverages and has also been used as an ingredient in energy supplement products. METHODS: This is a retrospective multiple-poison center chart review of calls regarding powdered caffeine to poison centers covering Oregon, Alaska, Guam, Washington, and Utah between January 1, 2013 and June 30, 2015. RESULTS: There were 40 calls to three poison centers over 30 months for powdered caffeine exposure. The majority of patients were over age 19 (52.5 %; 21/40) and male (70 %; 28/40). Sixty percent (24/40) of the patients were symptomatic but only 10 % (4/40) required admission; 52.5 % (21/40) of the patient calls were for inadvertent overdose of powdered caffeine; one patient overdosed in a self-harm attempt. DISCUSSION: Powdered caffeine calls to three poison centers during a 30-month study period were rare, and severe caffeine toxicity due to exposure was found in few patients. The majority of symptoms were reported after an inadvertent powdered caffeine overdose. CONCLUSIONS: An analysis of calls to three poison centers for powdered caffeine found that exposures were uncommon, but did result in toxicity, and highlighted that the lack of clear dosing instructions on product packaging may place patients at risk of inadvertent overdose.


Assuntos
Cafeína/envenenamento , Estimulantes do Sistema Nervoso Central/envenenamento , Suplementos Nutricionais/envenenamento , Doenças Transmitidas por Alimentos/etiologia , Adulto , Criança , Terapia Combinada , Overdose de Drogas/etiologia , Overdose de Drogas/fisiopatologia , Overdose de Drogas/terapia , Feminino , Doenças Transmitidas por Alimentos/fisiopatologia , Doenças Transmitidas por Alimentos/terapia , Guam , Humanos , Lactente , Masculino , Registros Médicos , Náusea/etiologia , Náusea/prevenção & controle , Estados do Pacífico , Centros de Controle de Intoxicações , Pós , Estudos Retrospectivos , Taquicardia/etiologia , Taquicardia/prevenção & controle , Utah , Vômito/etiologia , Vômito/prevenção & controle
13.
Drug Alcohol Depend ; 150: 1-13, 2015 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-25724076

RESUMO

BACKGROUND: Overdose of amphetamine, related derivatives, and analogues (ARDA) continues to be a serious worldwide health problem. Patients frequently present to the hospital and require treatment for agitation, psychosis, and hyperadrenegic symptoms leading to pathologic sequelae and mortality. OBJECTIVE: To review the pharmacologic treatment of agitation, psychosis, and the hyperadrenergic state resulting from ARDA toxicity. METHODS: MEDLINE, PsycINFO, and the Cochrane Library were searched from inception to September 2014. Articles on pharmacologic treatment of ARDA-induced agitation, psychosis, and hyperadrenergic symptoms were selected. Evidence was graded using Oxford CEBM. Treatment recommendations were compared to current ACCF/AHA guidelines. RESULTS: The search resulted in 6082 articles with 81 eligible treatment involving 835 human subjects. There were 6 high-quality studies supporting the use of antipsychotics and benzodiazepines for control of agitation and psychosis. There were several case reports detailing the successful use of dexmedetomidine for this indication. There were 9 high-quality studies reporting the overall safety and efficacy of ß-blockers for control of hypertension and tachycardia associated with ARDA. There were 3 high-quality studies of calcium channel blockers. There were 2 level I studies of α-blockers and a small number of case reports for nitric oxide-mediated vasodilators. CONCLUSIONS: High-quality evidence for pharmacologic treatment of overdose from ARDA is limited but can help guide management of acute agitation, psychosis, tachycardia, and hypertension. The use of butyrophenone and later-generation antipsychotics, benzodiazepines, and ß-blockers is recommended based on existing evidence. Future randomized prospective trials are needed to evaluate new agents and further define treatment of these patients.


Assuntos
Acatisia Induzida por Medicamentos/tratamento farmacológico , Anfetaminas/efeitos adversos , Hipertensão/tratamento farmacológico , Psicoses Induzidas por Substâncias/tratamento farmacológico , Taquicardia/tratamento farmacológico , Antagonistas Adrenérgicos/uso terapêutico , Transtornos Relacionados ao Uso de Anfetaminas , Antipsicóticos/uso terapêutico , Benzodiazepinas/uso terapêutico , Dexmedetomidina/uso terapêutico , Humanos , Hipertensão/induzido quimicamente , Hipnóticos e Sedativos/uso terapêutico , Estudos Prospectivos , Taquicardia/induzido quimicamente
14.
Am J Crit Care ; 22(2): 169-76, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23455868

RESUMO

A 54-year-old man treated with dabigatran experienced new onset of a stroke with a score of 9 on the National Institutes of Health Stroke Scale. Administration of recombinant tissue plasminogen activator (rtPA) was not recommended because of the dabigatran therapy. Angiography showed occlusion of the left middle cerebral artery by an embolic thrombus. Suction thrombectomy achieved flow through the inferior division of the artery. Computed tomography of the head showed possible intracranial hemorrhage, and dabigatran reversal was attempted with prothrombin complex concentrate and recombinant factor VIIa. Coagulation studies before administration of the reversal blood products showed a partial thromboplastin time of 30.3 seconds; 1 hour after administration, the partial thromboplastin time was 28.5 seconds. No evidence of intracranial hemorrhage was apparent on repeated computed tomography scans of the brain. He was discharged with aspirin and warfarin and a stroke score of 8. (American Journal of Critical Care. 2013;22:169-176) The use of long-term oral anticoagulation is indicated for prevention of cardiac thromboembolism in selected patients with nonvalvular atrial fibrillation. With the emergence of new potent oral agents- including the selective direct thrombin inhibitor dabigatran-clinicians must become familiar with the management of such patients. In this case report, we present a man who had an acute ischemic stroke while taking dabigatran and discuss the medical decision making regarding management issues.


Assuntos
Benzimidazóis/efeitos adversos , Hemorragias Intracranianas/tratamento farmacológico , Trombose Intracraniana/cirurgia , Piridinas/efeitos adversos , Acidente Vascular Cerebral/tratamento farmacológico , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Benzimidazóis/administração & dosagem , Benzimidazóis/uso terapêutico , Angiografia Cerebral , Coagulantes/administração & dosagem , Coagulantes/uso terapêutico , Dabigatrana , Quimioterapia Combinada , Fator VIIa/administração & dosagem , Fator VIIa/uso terapêutico , Humanos , Hemorragias Intracranianas/induzido quimicamente , Hemorragias Intracranianas/diagnóstico , Trombose Intracraniana/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Protrombina/administração & dosagem , Protrombina/uso terapêutico , Piridinas/administração & dosagem , Piridinas/uso terapêutico , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/uso terapêutico , Índice de Gravidade de Doença , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral/complicações , Sucção , Tomografia Computadorizada por Raios X
15.
Clin Toxicol (Phila) ; 51(2): 114-6, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23327286

RESUMO

INTRODUCTION: We present a case of envenomation by a Great Lakes Bush Viper, Atheris nitschei. Atheris species are a group of snakes that are indigenous to the forested areas of Central Africa. Prior reports of envenomation by Great Lakes Bush Vipers were not found in a Medline search. However, reports of other Atheris species envenomations describe coagulopathy and acute renal failure. CASE DETAILS: A 30-year-old male was bitten by a Great Lakes Bush Viper on his left hand. His left upper extremity was edematous with ecchymoses in the left axilla. There was bleeding from the bite site and from the patient's oral mucosa. Initial laboratory studies demonstrated significant derangement of hematologic parameters including anemia, thrombocytopenia, coagulopathy, and hypofibrinoginemia. There is no antivenom for this species. The patient was treated with blood products. Mucosal bleeding ceased within 12 h of admission. DISCUSSION: Atheris nitschei is an African snake with no available antivenom. In this case, the patient developed coagulopathy with hemolytic anemia, thrombocytopenia, and low fibrinogen. Renal function remained unaffected. Despite the lack of specific antivenom or the use of plasmapheresis, our patient was successfully treated with transfusion of multiple blood products.


Assuntos
Mordeduras de Serpentes/terapia , Venenos de Víboras , Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/terapia , Adulto , Animais , Transtornos da Coagulação Sanguínea/induzido quimicamente , Transfusão de Sangue , Fator VIIa/uso terapêutico , Hemorragia/induzido quimicamente , Humanos , Masculino , Animais de Estimação , Plasma , Proteínas Recombinantes/uso terapêutico , Serpentes
16.
Clin Toxicol (Phila) ; 49(4): 345-7, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21563914

RESUMO

Botulism was believed to be a rare disease in both the US and UK in the 1920's, until two deadly outbreaks altered that view and launched public health measures to control it. In the United States, the ripe olive scare of 1920 found glass-packaged olives linked to multiple deaths. In the United Kingdom, eight deaths from glass-potted duck paste, in the summer of 1922 at Loch Maree, Scotland will always be associated with botulism.


Assuntos
Botulismo/epidemiologia , Surtos de Doenças , Olea/microbiologia , Botulismo/mortalidade , Feminino , Humanos , Masculino , Reino Unido/epidemiologia , Estados Unidos/epidemiologia
17.
Clin Toxicol (Phila) ; 49(2): 128-9, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21370953

RESUMO

A Vietnamese family living in the Pacific Northwest harvested several wild mushrooms grown in their front lawn. All three in the family suffered from delayed GI symptoms starting approximately 12 h after ingestion. One patient died and two developed hepatic injury. We provide photography and describe common characteristics of Amanita phalloides mushroom.


Assuntos
Amanita , Gastroenteropatias/patologia , Intoxicação Alimentar por Cogumelos/patologia , Evolução Fatal , Feminino , Gastroenteropatias/induzido quimicamente , Humanos , Masculino , Intoxicação Alimentar por Cogumelos/complicações , Intoxicação Alimentar por Cogumelos/terapia
18.
J Med Toxicol ; 7(2): 147-50, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20865465

RESUMO

A 13-month-old male who ingested 20 diphenhydramine (25 mg) tablets presented with seizures and ultimately progressed to status epilepticus and wide-complex tachycardia. Due to worsening clinical course, hemodialysis was performed with temporal resolution of his symptoms. Hemodialysis may be considered in critically ill diphenhydramine overdoses not responsive to conventional supportive care.


Assuntos
Difenidramina/envenenamento , Hipnóticos e Sedativos/envenenamento , Envenenamento/etiologia , Humanos , Hipnóticos e Sedativos/uso terapêutico , Lactente , Injeções Intramusculares , Masculino , Midazolam/uso terapêutico , Envenenamento/fisiopatologia , Envenenamento/terapia , Diálise Renal , Convulsões/induzido quimicamente , Convulsões/tratamento farmacológico , Convulsões/fisiopatologia , Estado Epiléptico/induzido quimicamente , Taquicardia/induzido quimicamente , Taquicardia/fisiopatologia , Resultado do Tratamento
19.
Clin Toxicol (Phila) ; 48(9): 880-95, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21171846

RESUMO

There are seven known serotypes of botulism, designated A through G; almost all human cases of botulism are caused by types A, B, and E. Botulism type E is the predominant serotype causing disease associated with native Arctic foods. In the circumpolar regions of the world, the coastal soils are rich in botulism type E, and consumption of fish and marine animals in these areas are the sources of clusters of botulism. Unlike spores of type A and B, botulism type E can withstand freezing down to 3.5°C. Alaskan native fermentation of fish heads, fish eggs, and beaver tail allow proper anaerobic conditions for botulinum toxin to be elaborated from Clostridium botulinum. The consumption of whale meat, "muktuk" has also been associated with outbreaks of botulism in Alaska and the Canadian Arctic. Elsewhere in the Arctic regions, type E botulism has been associated with Norwegian "rakfisk" prepared by a process similar to fermented Alaskan foods. Outbreaks in Egypt with the salted gray mullet "faseikh", in Israel and New York linked to salted uneviscerated whitefish "kapchunka", in Iran from eating "ashbal" an uncooked salmon, and in Japan with "izushi" a traditional fermented fish preserved in rice have occurred. Importation of vacuum-packed whitefish from Alaska and Canada has also been associated with sporadic cases of botulism type E in Europe. In March 2010, the Center for Disease Control and Prevention released the heptavalent antitoxin (H-BAT) for use in the USA, under an Investigational New Drug program, as the preferred treatment for food-borne botulism, including type E, which had not been covered by the bivalent antitoxin, the prior approved antitoxin product in the USA.


Assuntos
Botulismo/epidemiologia , Clostridium botulinum/classificação , Vacinas Bacterianas/imunologia , Antitoxina Botulínica/uso terapêutico , Botulismo/diagnóstico , Botulismo/etiologia , Botulismo/terapia , Clostridium botulinum/imunologia , Clostridium botulinum/patogenicidade , Humanos , Prognóstico , Sorotipagem
20.
West J Emerg Med ; 11(2): 186-8, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20823970

RESUMO

We present a case of catatonia, which occurred shortly after starting a new antipsychotic, paliperidone, an active metabolite of risperidone. Catatonia may be caused by a variety of conditions, including metabolic, neurologic, psychiatric and toxic processes. Interestingly, risperidone, which has been thought to cause several cases of catatonia, has also been recommended as a potential treatment. We discuss potential mechanisms for causes of drug-induced catatonia as well as potential treatment options.

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