Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 35
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
J Pediatr ; 219: 188-195.e6, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32005542

RESUMO

OBJECTIVE: To identify types of containers from which young children accessed solid dose medications (SDMs) during unsupervised medication exposures and the intended recipients of the medications to advance prevention. STUDY DESIGN: From February to September 2017, 5 US poison centers enrolled individuals calling about unsupervised solid dose medication exposures by children ≤5 years. Study participants answered contextually directed questions about exposure circumstances. RESULTS: Sixty-two percent of eligible callers participated. Among 4496 participants, 71.6% of SDM exposures involved children aged ≤2 years; 33.8% involved only prescription medications, 32.8% involved only over-the-counter (OTC) products that require child-resistant packaging, and 29.9% involved ≥1 OTC product that does not require child-resistant packaging. More than one-half of exposures (51.5%) involving prescription medications involved children accessing medications that had previously been removed from original packaging, compared with 20.8% of exposures involving OTC products (aOR, 3.39; 95% CI, 2.87-4.00). Attention deficit hyperactivity disorder medications (49.3%) and opioids (42.6%) were often not in any container when accessed; anticonvulsants (41.1%), hypoglycemic agents (33.8%), and cardiovascular/antithrombotic agents (30.8%) were often transferred to alternate containers. Grandparents' medications were involved in 30.7% of prescription medication exposures, but only 7.8% of OTC product exposures (aOR, 3.99; 95% CI, 3.26-4.87). CONCLUSIONS: Efforts to reduce pediatric SDM exposures should also address exposures in which adults, rather than children, remove medications from child-resistant packaging. Packaging/storage innovations designed to encourage adults to keep products within child-resistant packaging and specific educational messages could be targeted based on common exposure circumstances, medication classes, and medication intended recipients.

2.
Clin Toxicol (Phila) ; : 1-7, 2020 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-31933390

RESUMO

Introduction: This study aims to describe the epidemiology of toxicological exposures reported to a telephonic medical toxicology service at a tertiary care center in Lebanon during a 46-months period.Methods: This study is a secondary analysis of a database for a telephonic medical toxicology service at a tertiary care center in Lebanon. Clinical information from all pediatric and adult patients, presenting with intentional or unintentional toxicological exposure, was entered into the database by the medical toxicology team.Results: Four hundred and seventy-seven exposures were recorded from 1 March 2015 to 31 December 2018. Female patients were involved in 60.2% of cases. Children less than 5 years old constituted 23.5% of cases and adults aged 20-49 constituted 48.6%. Up to 51.6% of cases were intentional, with 37.7% resulting from suicidal attempts. The majority of patients displayed no effects (33.1%) or minor effects (39.2%). Almost half of patients were treated and discharged from the Emergency Department (ED) without further hospitalization, and another 18.9% of patients left the ED against medical advice. The most common pharmaceutical agents involved were sedative/hypnotics/antipsychotics (14.7%), analgesics (12.6%) and antidepressants (11.3%). The most common non-pharmaceutical agents involved were household cleaning substances (8.0%), pesticides (5.2%) and bites and envenomations (3.8%).Conclusions: The results of this study suggest that sedative/hypnotics/antipsychotics, analgesics, antidepressants and household cleaning substances are the most common agents involved. Adult women and children ≤5 years old constitute a large portion of patients with toxicological exposures. Prevention strategies and policies should be implemented to mitigate these hazards.

3.
J Med Toxicol ; 15(4): 255-261, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31264143

RESUMO

BACKGROUND: Individuals who have tested positive for cocaine have claimed that lidocaine, or its primary metabolite, norlidocaine (monoethylglycinexylidide (MEGX)), have caused false positive results for the cocaine metabolite benzoylecgonine (BE) on urinary immunoassay testing. OBJECTIVE: The goal of the study was to determine if lidocaine exposure from routine medical procedures can result in false positives on a commercially available cocaine immunoassay urine drug screen (UDS). METHODS: We performed a cross-sectional observational study of patients receiving lidocaine as part of their regular care. Standard immunoassay drug screens and confirmatory liquid chromatography-mass spectrometry (LC-MS) were performed on all urine samples to assess for MEGX and BE. RESULTS: In total, 168 subjects were enrolled; 121 samples positive for lidocaine were ultimately included for analysis. One hundred fourteen of the 121 were also positive for MEGX. None of the 121 were positive for cocaine/BE on the UDS (95% CI), 0-3.7% for the full sample and 0-3.9% for the 114 who tested positive for MEGX. CONCLUSION: The present study found no evidence that lidocaine or norlidocaine are capable of producing false positive results on standard cocaine urine immunoassays.

4.
J Emerg Med ; 57(2): 181-186, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31060846

RESUMO

BACKGROUND: The Emergency Department (ED) frequently treats patients with drug overdoses and is an important resource for individuals with opioid use disorder who are seeking treatment. Initiating medication-assisted treatment (MAT) in the ED seems to be an effective way to link patients with opioid use disorder (OUD) to treatment programs. There is ongoing discussion on the best approach to MAT in the ED setting. OBJECTIVE: Describe a new model for managing OUD in the ED. METHOD: Information was obtained retrospectively from the electronic medical records of patients seen in a large county tertiary care center's Clinical Decision Unit (CDU) for OUD between September 1, 2017 and February 6, 2018. Data were summarized descriptively. RESULTS: There were 18 different patients placed in the CDU during the study period. Ninety-five percent were induced with buprenorphine-naloxone in the CDU. The median initial Clinical Opioid Withdrawal Scale score at the time of induction was 10. The median total dose of buprenorphine-naloxone that was administered was 8/2 mg. The median amount of time spent in the CDU and ED combined was 23 h. Approximately (12/19) 63% of subjects went to their initial follow-up appointment in clinic. Nine were still active in clinic at 30 days and 4 were active at 6 months. CONCLUSIONS: This retrospective chart review shows promising preliminary data for managing OUD in an ED CDU. Such strategies have the potential to increase access to care in a vulnerable patient population.

6.
Clin Toxicol (Phila) ; 57(1): 56-59, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29929405

RESUMO

CONTEXT: Trazodone is an atypical antidepressant with no established safety in children. Previous case reports showed no complications at doses 50-500 mg in children. Our study objective is to characterize the clinical effects, dose-related toxicity, and establish triage dose for acute trazodone ingestions in children ≤6 years of age. METHODS: Cases with acute trazodone ingestions in children ≤6 years of age between 2000 and 2015 were retrospectively reviewed. Data were analyzed for dose (mg/kg), clinical effects, management site, treatment, and outcome. Cases with coingestions, unknown outcome, or unknown dose were excluded. RESULTS: A total of 84 patients (mean age 26.7 months, 35 females, 49 males) were included. Of those, 52 (61.9%) had no clinical effects; 29 (34.5%) had minor effects (vomiting, dizziness, headache); and three (3.6%) had moderate effects (ataxia, slurred speech, priapism). No major effects or deaths were observed. Moderate effects were manifested at doses ≥6.9 mg/kg. Priapism occurred in a 2-year-old child at a dose of 6.9 mg/kg. Sixteen (19%) patients were managed at home and 68 (81%) patients were referred to a HCF. Among those referred to a HCF, three (4.4%) patients had moderate effects with ingested dose ≥6.9 mg/kg. However, 27 (39.7%) patients of those referred to a HCF had an ingested dose <6 mg/kg and none of them manifested symptoms beyond minor effects. All referred patients had uneventful recovery and no sequela. CONCLUSIONS: Children should be referred for further evaluation in acute unintentional trazodone ingestions with doses ≥6 mg/kg.


Assuntos
Overdose de Drogas/etiologia , Centros de Controle de Intoxicações , Trazodona/envenenamento , Triagem , Pré-Escolar , Relação Dose-Resposta a Droga , Overdose de Drogas/epidemiologia , Feminino , Georgia , Humanos , Masculino , Centros de Controle de Intoxicações/estatística & dados numéricos , Estudos Retrospectivos , Trazodona/administração & dosagem
7.
Clin Toxicol (Phila) ; 56(11): 1159-1161, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29623731

RESUMO

CONTEXT: Across the world, tobacco is used in a variety of forms, including being smoked or added to a "quid" that is then chewed. We report a case of lead poisoning in a child from tobacco imported from Thailand. CASE DETAILS: A 12-year-old Thai immigrant boy had a blood lead level (BLL) of 6 mcg/dL on routine testing upon arrival to the United States, but which increased to 72 mcg/dL six months after his arrival. He was asymptomatic with unremarkable workup. At this time his father, mother and two siblings were also found to have elevated BLLs of 53, 16, 22, and 11 mcg/dL, respectively. Water, paint, food and cookware sources tested negative for lead, whereas samples of the father's dried tobacco leaves imported from Thailand contained 36.12 ppm (mcg/g) of lead. The mother admitted that both she and the patient used the tobacco as well. The child was chelated with oral succimer and his BLL decreased. DISCUSSION: In our case, the source of the lead exposure was from the tobacco that the patient was chewing. Tobacco is often overlooked as a source of lead exposure, though it has been reported in the literature, both from direct smoking and from chewing, as well as through secondhand smoke. Toxicologists and health care professionals should consider cultural practices when evaluating patients with elevated BLLs.


Assuntos
Quelantes/uso terapêutico , Intoxicação por Chumbo/tratamento farmacológico , Intoxicação por Chumbo/etnologia , Chumbo/sangue , Succímero/uso terapêutico , Tabaco sem Fumaça/efeitos adversos , Tabaco/química , Adulto , Criança , Exposição Ambiental/análise , Feminino , Humanos , Masculino , Tailândia , Resultado do Tratamento , Estados Unidos/etnologia
8.
Clin Toxicol (Phila) ; 56(9): 841-845, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29490507

RESUMO

INTRODUCTION: Steroidal alkaloids are found in plants of the genus Veratrum. Their toxicity manifests as gastrointestinal symptoms followed by a Bezold-Jarisch reflex: hypopnea, hypotension, and bradycardia. Some Veratrum steroidal alkaloids are also teratogens interfering with the hedgehog-2 signaling pathway, which causes cyclopsia and holoprosencephaly. We present a case of accidental poisoning from Veratrum parviflorum mistaken for the edible Allium tricoccum (ramps, wild leek). CASE HISTORY: A 27-year-old man and his 25-year-old wife presented to the emergency department with nausea, vomiting, hypotension, and bradycardia after foraging and ingesting plants that they believed to be a local native species of wild leek. METHODS: We collected and analyzed the implicated fresh plant material and both patients' serum/plasma. We used liquid chromatography-mass spectroscopy and high-resolution electrospray ionization time of flight tandem mass spectrometry to extract and characterize steroidal alkaloids from the foraged plant and patients' serum. RESULTS: Our V. parviflorum samples contained verazine, veratramine, veratridine, and cyclopamine. DISCUSSION: Steroidal alkaloids have been previously isolated from Veratrum viride and Veratrum album and toxicity has been reported mainly from V. album species. CONCLUSION: V. parviflorum toxicity manifests with gastrointestinal and cardiac symptoms. Treatment is symptomatic and supportive as with previous case reports of toxicity with other Veratrum species.


Assuntos
Antieméticos/uso terapêutico , Gastroenteropatias/tratamento farmacológico , Intoxicação por Plantas/tratamento farmacológico , Intoxicação por Plantas/fisiopatologia , Alcaloides de Veratrum/envenenamento , Veratrum/envenenamento , Vômito/tratamento farmacológico , Adulto , Feminino , Gastroenteropatias/etiologia , Georgia , Humanos , Masculino , Resultado do Tratamento , Vômito/etiologia
9.
Am J Emerg Med ; 35(5): 802.e7-802.e8, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27884585

RESUMO

According to the NIH, about 275000 patients receive treatment with 5-Fluorouracil (5-FU) and more than 1300 die from 5-FU toxicity every year from life-threatening myelosuppression, gastrointestinal complications, and neurotoxicity. Immunocompromised persons are at higher risk of developing toxicity. Recently uridine triacetate (Vistagard®) has been approved by the Food and Drug Administration (FDA) as the only specific antidote available for 5-FU poisoning. In a clinical trial (n=135), 96% of patients with 5-FU toxicity recovered after treatment, where as in a historical control group only 10% survived. This is the first published case report of survival after 5-FU overdose who also was immunocompromised from HIV/AIDs. A 52year old male with history of HIV/AIDS (CD4 70), CNS toxoplasmosis and anal cancer presented to the emergency department after realizing he had received an entire course of 5-FU in 24 instead of 96h. Treatment with uridine triacetate was arranged in the emergency department. After receiving treatment the patient was asymptomatic and had an uncomplicated hospital course. 5-FU poisoning must be recognized early as uridine triacetate is approved by the FDA for use within 96h following the end of 5-FU administration. Emergency medicine physicians should promptly recognize and treat 5-FU poisoning. However, this may be challenging as patients may not seek medical attention until many hours or several days after last administration since symptoms are often delayed with 5-FU poisoning.


Assuntos
Acetatos/uso terapêutico , Antimetabólitos Antineoplásicos/envenenamento , Neoplasias do Ânus/tratamento farmacológico , Depressão/tratamento farmacológico , Medicina de Emergência , Fluoruracila/envenenamento , Infecções por HIV/tratamento farmacológico , Toxoplasmose Cerebral/tratamento farmacológico , Uridina/análogos & derivados , Antimetabólitos Antineoplásicos/administração & dosagem , Antimetabólitos Antineoplásicos/farmacocinética , Overdose de Drogas , Fluoruracila/administração & dosagem , Fluoruracila/farmacocinética , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Uridina/uso terapêutico
10.
J Med Toxicol ; 12(3): 282-8, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27150104

RESUMO

INTRODUCTION: Little is known about the factors driving decision-making among emergency department (ED) providers when prescribing opioid analgesics (OA). The aim of this pilot study was to identify the importance of factors influencing OA-prescribing decisions and to determine how this varied among different types of providers. METHODS: This was an observational cross-sectional survey study of 203 ED providers. The importance of decisional factors was rated on a 5-point Likert scale. Differences between provider groups were tested using Chi-squared or ANOVA tests where applicable. RESULTS: Overall, 142/203 (69.9 %) potential respondents participated in the study. The five highest-rated factors were (mean ± SD) patient's opioid prescription history (4.4 ± 0.8), patient's history of substance abuse or dependence (4.4 ± 0.7), diagnosis thought to be the cause of patient's pain (4.2 ± 0.8), clinical gestalt (4.2 ± 0.7), and provider's concern about unsafe use of the medication (4.0 ± 0.9). The importance of 6 of 21 decisional factors varied significantly between different groups of providers. CONCLUSION: In this pilot study of ED providers, the self-reported importance of several factors influencing OA-prescribing decisions were significantly different among attending physicians, resident physicians, and advanced practice providers. Further investigation into how ED providers make OA-prescribing decisions is needed to help guide interventions aimed at improving appropriate pain management.


Assuntos
Analgésicos Opioides/uso terapêutico , Tomada de Decisão Clínica , Medicina de Emergência/métodos , Serviço Hospitalar de Emergência , Manejo da Dor/métodos , Padrões de Prática Médica , Centros Médicos Acadêmicos , Adulto , Analgésicos Opioides/efeitos adversos , Estudos Transversais , Prescrições de Medicamentos , Medicina de Emergência/educação , Georgia , Teoria Gestáltica , Pesquisas sobre Serviços de Saúde , Humanos , Internet , Internato e Residência , Corpo Clínico Hospitalar , Profissionais de Enfermagem , Assistentes Médicos , Projetos Piloto , Prevenção Secundária , Autorrelato , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Recursos Humanos
11.
J Med Toxicol ; 11(2): 242-4, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25403810

RESUMO

BACKGROUND: Carpet vipers (Echis) are found across the semiarid regions of west, north, and east Africa; west, south, and east Arabia; parts of Iran and Afghanistan north to Uzbekistan; and in Pakistan, India, and Sri Lanka. Recently, a new species belonging to the Echis genus, Echis omanensis has been recognized in Oman. Not much is known about the clinical manifestations of envenomation from its bite. CASE REPORT: A 63-year-old snake keeper presented to the emergency department shortly after being bitten by an Oman carpet viper (E. omanensis). The incident occurred during expression of the venom at a research center. The patient complained of severe pain and swelling of the left index finger, which extended to the mid-forearm within 1 h. His vital signs remained stable, with no evidence of systemic manifestations. He was treated initially with analgesics and tetanus toxoid. Due to rapidly progressive swelling and the potential for a delayed coagulopathy, the Saudi National Guard polyvalent snake antivenom was administered according to the Ministry of Health protocol. The patient was admitted to the intensive care unit, remained hemodynamically stable, and had normal serial coagulation tests, with subsequent resolution of the swelling. CONCLUSION: We report the first case of an E. omanensis bite in which the patient developed rapidly progressive local toxicity, which improved after administration of the Saudi polyvalent antivenom.


Assuntos
Mordeduras de Serpentes/terapia , Venenos de Víboras , Viperidae , Analgésicos Opioides/uso terapêutico , Animais , Antivenenos/uso terapêutico , Coagulação Sanguínea , Cuidados Críticos , Edema/induzido quimicamente , Dedos/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Morfina/uso terapêutico , Dor/tratamento farmacológico , Dor/etiologia , Mordeduras de Serpentes/sangue , Toxoide Tetânico/uso terapêutico , Resultado do Tratamento
12.
J Med Toxicol ; 10(1): 61-4, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24129834

RESUMO

INTRODUCTION: Clonidine is an imidazoline derivative antihypertensive medication that is also used as adjunctive therapy for neuropathic pain disorders via topical administration. Clonidine overdose can manifest both central and peripheral alpha-adrenergic agonist effects. CASE REPORT: A 23-year-old man presented to an emergency department with altered mental status, bradycardia, and hypertension after suspected overdose. He had rubbed a specially compounded medicinal cream over his entire body containing clonidine 0.2 % (w/w), gabapentin 6 %, imipramine 3 %, ketamine 10 %, lidocaine 2 %, and mefenamic acid 1 %. The patient presented with severe hypertension, bradycardia, and altered mental status. He was found to have a subarachnoid hemorrhage and was treated for hypertensive emergency. Toxicological analysis of initial blood samples revealed a serum clonidine concentration of 5,200 ng/ml. At 6-month follow-up, the patient had made a full recovery. DISCUSSION: There are limited reports of topical clonidine toxicity, and to our knowledge, this case involves the highest concentration yet reported following clonidine overdose by any route of exposure. The severely elevated serum clonidine concentration found in our patient demonstrates the possibility of toxicity resulting from inappropriate use of such a product. At high serum concentrations, the pharmacodynamic effects of clonidine appear to cause significant peripheral alpha-1 adrenergic stimulation. Toxicologists should be aware of the increasing use of topical clonidine preparations for the treatment of neuropathic pain and the potential for toxicity.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/envenenamento , Analgésicos/envenenamento , Clonidina/envenenamento , Overdose de Drogas/terapia , Adesão à Medicação , Creme para a Pele/efeitos adversos , Administração Cutânea , Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Adulto , Analgésicos/administração & dosagem , Analgésicos/sangue , Analgésicos/farmacocinética , Bradicardia/etiologia , Bradicardia/prevenção & controle , Clonidina/administração & dosagem , Clonidina/sangue , Clonidina/farmacocinética , Combinação de Medicamentos , Composição de Medicamentos , Overdose de Drogas/sangue , Overdose de Drogas/fisiopatologia , Humanos , Hipertensão/etiologia , Hipertensão/prevenção & controle , Masculino , Síndromes Neurotóxicas/etiologia , Síndromes Neurotóxicas/prevenção & controle , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/prevenção & controle , Resultado do Tratamento , Adulto Jovem
13.
J Med Toxicol ; 9(4): 405-15, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24222555

RESUMO

Safety concerns regarding cobalt-containing metal alloy hip prosthetics (Co-HP) have resulted in product recalls, a medical device alert, and issuance of guidance for clinicians. Recently, cases of suspected prosthetic hip-associated cobalt toxicity (PHACT) from Co-HP have been reported. Although little is known about suspected PHACT, these patients may be referred to medical toxicologists for evaluation and management recommendations. We searched MEDLINE, EMBASE, and unpublished abstracts from toxicology scientific meetings for references relevant to PHACT. Authors independently screened publications for inclusion criteria: publication in English, human study population, subject(s) are symptomatic (except for isolated hip pain), and cobalt values in any matrix (blood, serum, urine, CSF, synovial fluid) available for review. Data from 10 cases are reviewed. Patients with suspected PHACT had findings consistent with cobalt toxicity, including thyroid, cardiac, and neurologic dysfunction. Signs and symptoms appeared between 3 and 72 months after arthroplasty (median 19 months). Neurologic symptoms were most common. Ancillary testing varied considerably. All patients had elevated cobalt levels in one or more matrices. Enhanced elimination was attempted in 27 % of patients. At this time, the information currently available regarding patients with suspected PHACT is inadequate to guide clinical decision making. No consensus has been reached regarding the management of Co-HP patients with systemic symptoms. Indications for chelation have not been established and require further study. Improved case definitions, improved surveillance, and controlled studies are needed to elucidate the scope of this problem and guide future investigations.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Cobalto/envenenamento , Intoxicação por Metais Pesados , Prótese de Quadril/efeitos adversos , Envenenamento/diagnóstico , Envenenamento/terapia , Biomarcadores/metabolismo , Quelantes/uso terapêutico , Terapia por Quelação , Cobalto/metabolismo , Remoção de Dispositivo , Humanos , Metais Pesados/metabolismo , Envenenamento/etiologia , Envenenamento/metabolismo , Valor Preditivo dos Testes , Desenho de Prótese , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
15.
Clin Toxicol (Phila) ; 50(8): 764-9, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22897408

RESUMO

INTRODUCTION: We conducted a prospective randomized controlled study on the influence of multiple doses of activated charcoal (MDAC) in patients with supratherapeutic serum phenytoin levels; METHODS: Patients with serum phenytoin levels greater than 30 mg/L upon presentation to the ED were recruited from two urban teaching hospitals. Patients enrolled were older than 18, nonpregnant, able to tolerate activated charcoal by mouth and able to give written consent. They were randomized to receive 50 g activated charcoal by mouth every 4 hours or no activated charcoal. They continued in the study until the patient was discharged or the serum level was <25 mg/L. Serum levels were drawn every 6 hours initially, then every 24 hours after the 1st day. The presence of gait abnormalities and nystagmus was recorded and mini-mental status exam (MMSE) scores were collected from each patient enrolled. Time to reach subtoxic levels was recorded; RESULTS: Seventeen patients were enrolled in the study. Seven patients received MDAC, eight patients served as controls and two patients who were initially enrolled as controls inadvertently received one dose of activated charcoal and were excluded from the analysis. Both groups were comparable in age and all were male. The median time to reach a subtoxic level was 41.1 hours (range, 11.6-196) and 19.3 hours (range, 13-33) in the control and charcoal groups, respectively (p = 0.049). The median and range peak serum levels were 40.0 hours (range, 32.0-47.6) and 35.6 hours (range, 32.5-40.0) in the control and charcoal groups, respectively (p = 0.082). The median and range MMSE scores were 20 points (range, 12-30) and 19.5 points (range, 16-29) in the control and charcoal groups, respectively; CONCLUSION: Further study is needed to determine if MDAC decreases the time to reach a subtoxic level of phenytoin in patients with supratherapeutic phenytoin levels.


Assuntos
Anticonvulsivantes/envenenamento , Antídotos/administração & dosagem , Carvão Vegetal/administração & dosagem , Fenitoína/envenenamento , Adulto , Idoso , Anticonvulsivantes/sangue , Overdose de Drogas , Marcha Atáxica/induzido quimicamente , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Nistagmo Patológico/induzido quimicamente , Fenitoína/sangue , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
16.
West J Emerg Med ; 13(3): 294-7, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22928059

RESUMO

INTRODUCTION: Self-exposure is a leading method for suicide both in the United States and worldwide and thus is a major preventable public health issue. Surrogate decision makers are tasked with making medical decisions for the patient while keeping the patient's wishes in mind. Decisions related to code status become more complicated when the patient's situation is the result of a suicidal act. The objectives were to 1) determine how frequently Do Not Resuscitate orders (DNR orders) are placed for the intentionally self-exposed (ISE) patient using the Regional Poison Control Center (RPCC) data, and 2) identify if DNR orders in intentionally self-exposed patients were placed before or after development of poor prognostic signs. METHODS: We analyzed all exposure-related deaths reported to the RPCC from January 1, 2000 to December 31, 2010. We reviewed data for the following: exposure intent, exposure substance, outcome, age, code status, date of DNR/withdrawal of care order, previous suicide attempts, and poor prognostic signs. RESULTS: Of the 476 total deaths, nearly half were the result of an intentional self-exposure (n= 235; 49.4%). Most deaths, when code status was reported, had advanced cardiac life support, or "full codes" (n=131; 55.6%). Of the total deaths with a DNR or withdrawal of care order (n=104), over half were from an ISE (n=55; 52.9%). A higher percentage of the ISEs had a DNR order/withdrawal of care order; however, it was not a statistically significant difference OR 1.23 (95% CI 0.64, 2.37). of intent, patients treated as full codes were on average 19.5 years younger than the DNR orders group. Only 2 DNR orders were placed prior to development of poor prognostic signs. Unintentional self-exposures consumed a mean of 1.4 substances (range 1 to 4). ISEs consumed a mean of 2.3 substances (range 1 to 19). CONCLUSION: People are often asked to make life-and-death decisions for a loved one. The nature of the exposure can complicate the issue if the exposure has an antidote or is known to have a limited effect. Further study is needed to assess the extent of these cases and to identify optimal management guidelines or policy to aid both the medical teams caring for these patients and the surrogate decision makers.

17.
Clin Toxicol (Phila) ; 50(6): 490-6, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22624659

RESUMO

BACKGROUND: There were 900 exotic venomous snakebites reported from 2000 to 2009. The Association of Zoos and Aquariums' recommends institutions housing venomous reptiles have protocols for appropriate and timely transport of envenomed individuals to hospitals. The study objective was to evaluate functional aspects and potential problems of our emergency operation procedure designed for handling the response to an exotic venomous snakebite during implementation via a simulated drill. The emergency operation procedure consists of two protocols, the protocol for zoo personnel and exotic snakebite protocol for hospital personnel. METHODS: Before the exercise the poison center (PC), zoo, Emergency Medical Services (EMS), receiving hospital emergency department (ED), and pharmacy were contacted. The emergency operation procedure was reviewed to determine areas of deficiency. A checklist of all required actions for each participating institution was created for use during the exercise. The exercise was divided into four phases: zoo, EMS, PC, and ED. Each phase was evaluated by an independent observer. RESULTS: Review of the emergency operation procedure revealed sufficient and easy to follow information for zoo personnel. However, the exotic snakebite protocol for hospital personnel lacked details regarding signs and symptoms expected from each exotic venomous species in the zoo; and indications, dosing, and instructions on reconstitution for each of the antivenom carried by the zoo. Zoo, EMS, ED, and PC personnel completed 95%, 90%, 83%, and 25% of the required tasks, respectively. The PC encountered problems communicating the exotic snakebite protocol for hospital personnel to the ED due to phone and fax equipment failures. Creative solutions to the PC system issues were not identified in a timely manner. Despite the shortcomings, the time from simulated envenomation to antivenom (AV) administration was under an hour. CONCLUSIONS: This drill identified several issues leading to revision of our exotic snakebite protocol for hospital personnel. We also identified suboptimal PC response in the application of the emergency operation procedure. We encourage every poison center in cooperation with local zoos to perform a similar exercise.


Assuntos
Mordeduras de Serpentes/terapia , Antivenenos/uso terapêutico , Serviço Hospitalar de Emergência , Humanos , Fatores de Tempo
18.
Clin Toxicol (Phila) ; 50(1): 57-64, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22165838

RESUMO

INTRODUCTION: Selenium is an essential trace element, but can be toxic in excess. In May 2008, US FDA reported 201 individuals with adverse reactions to liquid nutritional supplements containing excess selenium and chromium resulting in the largest epidemic of selenosis in the history of the United States. OBJECTIVE: To describe the clinical features, biomonitoring data of selenium levels, and the estimated total dose of selenium ingestions of nine patients with selenium toxicity who presented after use of a liquid dietary supplement with a formulation error. METHODS: A retrospective observational case series was performed on nine patients presenting to our medical toxicology clinic between March 2008 and May 2008 with symptoms of selenosis after consuming a nutritional supplement. Institutional IRB approval was obtained for this case series. RESULTS: Supplement testing revealed almost 200 times the reported amount of selenium. There were 5 males and 4 females and their ages ranged from 15 to 57 years (median 46 years, mean 44.2 years). The mean estimated cumulative dose of selenium ingested in our patients was 1.3 gram over a mean period of 37.5 days (10-60 days). In each case, the symptoms of selenium toxicity manifested within 1 week from the start of ingestion. Initial symptoms included alopecia, dystrophic fingernail changes, GI symptoms, and memory difficulties. The initial whole blood selenium concentrations ranged from 150 to 732 mcg/L (reference mean range 123-193 mcg/L) at an average of 27 days post cessation of the formula. The urinary selenium concentrations ranged from 41 to 220 mcg/g Creat (reference < 25 mcg/g Creatinine). None of the patients required more than supportive care for symptoms and none required hospitalization. CONCLUSION: Selenium is an essential element, which can result in significant toxicity if ingested in large amounts.


Assuntos
Suplementos Nutricionais/envenenamento , Selênio/envenenamento , Adolescente , Adulto , Alopecia/induzido quimicamente , Exantema/induzido quimicamente , Feminino , Cabelo/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Unha/induzido quimicamente , Selênio/sangue , Selênio/urina
20.
West J Emerg Med ; 12(3): 293-5, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21731784

RESUMO

INTRODUCTION: Poisoning is an increasingly important cause of injury in the United States. In 2009 poison centers received 2,479,355 exposure reports, underscoring the role of poison centers in intentional and unintentional injury prevention. Antiretroviral (ARV) agents are commonly prescribed drugs known to cause toxicity, yet the frequency of these incidents is unknown. The objectives of this study were to quantify the number of reported cases of toxicity secondary to ARV agents at a regional poison center, and to describe the circumstances and clinical manifestations of these poisonings. METHODS: We conducted a retrospective review of poison center records between December 1, 2001, and January 7, 2010. RESULTS: One hundred sixty-two exposures to ARV agents were reported to the poison center, of which 30% were intentional and 70% were unintentional. Three patients developed major toxicity and no deaths occurred. The remaining patients developed moderate and minor effects as defined by poison center guidelines. CONCLUSION: ARV drug toxicity appears to be infrequently reported to the poison center. Fatal and major toxicities are uncommon, and intentional overdoses are associated with a more serious toxicity. Educational efforts should encourage clinicians to report toxicities related to the use of ARV agents to poison centers in order to better study this problem.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA