Pub Date : 2022-02-28DOI: 10.35248/2161-0495-22.12.503
Chang-Yi Han, Yingjuan Liu, De-hui Li, Zhihua Du, Paniakina Ma, Lim-ping Wang, Liying Wei, Huan-fang Fan
Background Opioid-Induced Constipation (OIC) is one of the most common types of complications affecting patients following opioid treatment for cancer pain. Lactulose has been shown to be an effective drug for managing OIC symptoms in clinics. Acupuncture is a non-invasive approach for relieving constipation and pains. However, the co-applications of Acupuncture and Lactulose for OIC have been rarely evaluated. Materials and methods To confirm the advanced therapy effects of Acupuncture and Lactulose co-application, 80 OIC patients in Hebei Province Hospital of Chinese Medicine are included in the randomised clinical trial. Two groups were assigned, including the co-application group with Manual Acupuncture and oral lactulose (AC-LA group) and the control group of pure oral Lactulose Administration (LA group). Forty patients are allocated into each group randomly. Scores of pain, symptoms, and Quality Of Life (QOL) at Day 0 (the day before treatment), Day 7, and Day 14 of treatments are recorded to evaluate the outcomes of OIC therapy in both the AC-LA and LA group. Results Compared with pure oral lactulose treatment, the combined Manual Acupuncture sessions produced a higher effective rate after seven days (LA 60.53% vs. AC-LA 89.47%, P<0.001) and 14 days (LA 76.32% vs. AC-LA 92.11%, P=0.081) of treatment. The overall symptom scores of the AC-LA group reduced by more than the LA group following one week (LA 18.5% vs. AC-LA 33.6%, P<0.05) or two weeks (LA 39.5% vs. AC-LA 55.8%, P<0.05) of treatment with Manual Acupuncture. Along with the reduced overall symptom scores, the symptoms of defecation straining, harder stool, extended defecation time and intervals, and the feeling of incomplete defecation were relieved in both LA and AC-LA groups. Acupuncture enhanced the remission effects of each constipation sub-symptoms. Though the KPS quality of life scores did not improve significantly, additional acupuncture treatment helped relieve pain in cancer patients (Day 0 6.89 ± 1.66 vs. Day 14 6.05 ± 1.43, P=0.020). Discussion and conclusion As a non-invasive approach, acupuncture put on add-up effects for oral lactulose treatment in relieving Opioid-Induced Constipation symptoms. The co-application of acupuncture and lactulose is a considerably better strategy for pain and constipation management of cancer patients in clinics.
阿片类药物引起的便秘(OIC)是影响阿片类药物治疗癌症疼痛后患者最常见的并发症之一。乳果糖已被证明是临床上治疗OIC症状的有效药物。针灸是一种非侵入性的缓解便秘和疼痛的方法。然而，针灸和乳果糖在OIC中的联合应用很少被评估。材料与方法为证实针刺与乳果糖联合应用的先进治疗效果，选取河北省中医院80例OIC患者进行随机临床试验。分为两组，分别为手针联合口服乳果糖组(AC-LA组)和纯口服乳果糖对照组(LA组)。40例患者随机分为两组。记录治疗第0天(治疗前一天)、第7天和第14天的疼痛、症状和生活质量评分，以评估AC-LA组和LA组OIC治疗的结果。结果与单纯口服乳果糖治疗相比，手针联合治疗在治疗7 d (LA 60.53% vs AC-LA 89.47%， P<0.001)和14 d (LA 76.32% vs AC-LA 92.11%， P=0.081)的有效率更高。手针治疗1周(LA 18.5% vs AC-LA 33.6%， P<0.05)或2周(LA 39.5% vs AC-LA 55.8%， P<0.05)后AC-LA组总症状评分下降幅度大于LA组。LA组和AC-LA组在整体症状评分降低的同时，排便紧张、大便较硬、排便时间和间隔延长、排便不全感等症状均得到缓解。针刺对便秘各子症状的缓解效果均有增强作用。虽然KPS生活质量评分没有明显改善，但额外针灸治疗有助于缓解癌症患者的疼痛(第0天6.89±1.66 vs.第14天6.05±1.43,P=0.020)。讨论与结论针刺作为一种非侵入性的方法，对口服乳果糖治疗阿片类药物引起的便秘症状具有叠加效应。针灸和乳果糖联合应用是临床上治疗癌症患者疼痛和便秘的较好策略。
{"title":"Synergic Effects of Acupuncture and Clinical Lactulose Therapy on Opioid-Induced Constipation","authors":"Chang-Yi Han, Yingjuan Liu, De-hui Li, Zhihua Du, Paniakina Ma, Lim-ping Wang, Liying Wei, Huan-fang Fan","doi":"10.35248/2161-0495-22.12.503","DOIUrl":"https://doi.org/10.35248/2161-0495-22.12.503","url":null,"abstract":"Background Opioid-Induced Constipation (OIC) is one of the most common types of complications affecting patients following opioid treatment for cancer pain. Lactulose has been shown to be an effective drug for managing OIC symptoms in clinics. Acupuncture is a non-invasive approach for relieving constipation and pains. However, the co-applications of Acupuncture and Lactulose for OIC have been rarely evaluated. Materials and methods To confirm the advanced therapy effects of Acupuncture and Lactulose co-application, 80 OIC patients in Hebei Province Hospital of Chinese Medicine are included in the randomised clinical trial. Two groups were assigned, including the co-application group with Manual Acupuncture and oral lactulose (AC-LA group) and the control group of pure oral Lactulose Administration (LA group). Forty patients are allocated into each group randomly. Scores of pain, symptoms, and Quality Of Life (QOL) at Day 0 (the day before treatment), Day 7, and Day 14 of treatments are recorded to evaluate the outcomes of OIC therapy in both the AC-LA and LA group. Results Compared with pure oral lactulose treatment, the combined Manual Acupuncture sessions produced a higher effective rate after seven days (LA 60.53% vs. AC-LA 89.47%, P<0.001) and 14 days (LA 76.32% vs. AC-LA 92.11%, P=0.081) of treatment. The overall symptom scores of the AC-LA group reduced by more than the LA group following one week (LA 18.5% vs. AC-LA 33.6%, P<0.05) or two weeks (LA 39.5% vs. AC-LA 55.8%, P<0.05) of treatment with Manual Acupuncture. Along with the reduced overall symptom scores, the symptoms of defecation straining, harder stool, extended defecation time and intervals, and the feeling of incomplete defecation were relieved in both LA and AC-LA groups. Acupuncture enhanced the remission effects of each constipation sub-symptoms. Though the KPS quality of life scores did not improve significantly, additional acupuncture treatment helped relieve pain in cancer patients (Day 0 6.89 ± 1.66 vs. Day 14 6.05 ± 1.43, P=0.020). Discussion and conclusion As a non-invasive approach, acupuncture put on add-up effects for oral lactulose treatment in relieving Opioid-Induced Constipation symptoms. The co-application of acupuncture and lactulose is a considerably better strategy for pain and constipation management of cancer patients in clinics.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88103343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.35248/2161-0495.21.11.484
Àlex, ra M Amaducci, A. Koons, C. Lenivy, R. Cannon
We report the case of a 56 year old male patient who presented to the Emergency Department (ED) with altered mental status and reported Amanita muscaria mushroom ingestion. Amanita muscaria or fly agaric mushrooms are known to be poisonous to humans and hallucinogenic by nature. However, the prognosis of the poisoning is generally minor and short-lived, lasting less than 24 hours.
{"title":"A Prolonged Course of Amanita muscaria Mushroom Poisoning","authors":"Àlex, ra M Amaducci, A. Koons, C. Lenivy, R. Cannon","doi":"10.35248/2161-0495.21.11.484","DOIUrl":"https://doi.org/10.35248/2161-0495.21.11.484","url":null,"abstract":"We report the case of a 56 year old male patient who presented to the Emergency Department (ED) with altered mental status and reported Amanita muscaria mushroom ingestion. Amanita muscaria or fly agaric mushrooms are known to be poisonous to humans and hallucinogenic by nature. However, the prognosis of the poisoning is generally minor and short-lived, lasting less than 24 hours.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"1 s1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91427321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.35248/2161-0495.21.11.477
S. Higami, S. Morita, M. Sugita, Rie Yamamoto, Takeshi Saito, Y. Nakagawa
Fluoroacetate poisoning, usually caused by exposure to sodium monofluoroacetate and fluoroacetamide, competitively inhibits aconitase in the tricarboxylic acid cycle. There are no effective antidotes, and treatment is symptomatic and supportive. The effectiveness of hemodialysis in alleviating fluoroacetate poisoning remains unclear, and no study has reported changes in the blood concentration of fluoroacetate after hemodialysis. A 71-year-old man with a history of chronic kidney disease and on maintenance hemodialysis had findings suggestive of acute fluoroacetate poisoning. He presented with tachycardia, tachypnea, renal dysfunction, hyperammonemia, and hyponatremia. He was intubated with a nasogastric tube and administered intravenous fluids, and direct hemoperfusion and hemodialysis were performed on successive days to reduce blood fluoroacetate concentrations. He recovered without organ failure and was transferred for rehabilitation. This is the first study to report a case wherein treatment with hemodialysis reduced fluoroacetate concentrations, suggesting hemodialysis can be an effective treatment strategy for fluoroacetate poisoning.
{"title":"A Case of Fluoroacetamide Poisoning Alleviated by Hemodialysis","authors":"S. Higami, S. Morita, M. Sugita, Rie Yamamoto, Takeshi Saito, Y. Nakagawa","doi":"10.35248/2161-0495.21.11.477","DOIUrl":"https://doi.org/10.35248/2161-0495.21.11.477","url":null,"abstract":"Fluoroacetate poisoning, usually caused by exposure to sodium monofluoroacetate and fluoroacetamide, competitively inhibits aconitase in the tricarboxylic acid cycle. There are no effective antidotes, and treatment is symptomatic and supportive. The effectiveness of hemodialysis in alleviating fluoroacetate poisoning remains unclear, and no study has reported changes in the blood concentration of fluoroacetate after hemodialysis. A 71-year-old man with a history of chronic kidney disease and on maintenance hemodialysis had findings suggestive of acute fluoroacetate poisoning. He presented with tachycardia, tachypnea, renal dysfunction, hyperammonemia, and hyponatremia. He was intubated with a nasogastric tube and administered intravenous fluids, and direct hemoperfusion and hemodialysis were performed on successive days to reduce blood fluoroacetate concentrations. He recovered without organ failure and was transferred for rehabilitation. This is the first study to report a case wherein treatment with hemodialysis reduced fluoroacetate concentrations, suggesting hemodialysis can be an effective treatment strategy for fluoroacetate poisoning.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"60 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80563295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.35248/2161-0495.21.11.487
Min Li, Y. Mei, Jingeng Liu, Kaikai Fan, X. Gu, Xu Zhang, Jitian Xu, Yuebai Li, HaifengZhang, G. Jin, Yang Mi
Arsenite (NaAsO2) is a potent toxin that significantly contributes to human pathogenesis. Chronic exposure to arsenite results in various diseases. The physiologically important biological target(s) of arsenite exposure is largely unknown. Here we found that transient sodium arsenite treatment (1) blocks nigericin or Rotenone induced IL- 1β secretion; (2) inhibits mitochondrial respiration with complex I-linked substrate; (3) induces Heme oxygenase-1 (HO-1) in myocardial tissue, (4) attenuates the myocardial ischemia-reperfusion injury in an in vivo model of rats. The causal relationship among these activities needs further investigation.
{"title":"Inhibition of IL-1β Secretion and Mitochondria Respiration by Arsenite which acts on Myocardial Ischemia-Reperfusion Injury","authors":"Min Li, Y. Mei, Jingeng Liu, Kaikai Fan, X. Gu, Xu Zhang, Jitian Xu, Yuebai Li, HaifengZhang, G. Jin, Yang Mi","doi":"10.35248/2161-0495.21.11.487","DOIUrl":"https://doi.org/10.35248/2161-0495.21.11.487","url":null,"abstract":"Arsenite (NaAsO2) is a potent toxin that significantly contributes to human pathogenesis. Chronic exposure to arsenite results in various diseases. The physiologically important biological target(s) of arsenite exposure is largely unknown. Here we found that transient sodium arsenite treatment (1) blocks nigericin or Rotenone induced IL- 1β secretion; (2) inhibits mitochondrial respiration with complex I-linked substrate; (3) induces Heme oxygenase-1 (HO-1) in myocardial tissue, (4) attenuates the myocardial ischemia-reperfusion injury in an in vivo model of rats. The causal relationship among these activities needs further investigation.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"7 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81841432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.35248/2161-0495.21.11.483
Brannon L. Inman, Lloyd Tannenbaum, J. Maddry, Sarah Bridsong
Acetaminophen is a common toxic ingestion and the leading cause of acute liver failure in the United States. There exists a relative paucity of evidence in guiding management of acetaminophen Extended-Release ingestions compared to immediate-release ingestions. Many case reports involving Extended-Release acetaminophen ingestion are confounded by co-ingestion, resulting in a delayed peak acetaminophen level. Few reports have been published involving pure acetaminophen Extended-Release ingestion with a late crossing of the Rumack-Matthew nomogram. We present a case of witnessed isolated acetaminophen Extended-Release ingestion in an 18-year-old male, resulting in an acetaminophen level crossing the Rumack-Matthew nomogram treatment threshold at 21 hours post-ingestion.
{"title":"Delayed Toxicity in an Isolated Extended-Release Acetaminophen Ingestion: A Case Report","authors":"Brannon L. Inman, Lloyd Tannenbaum, J. Maddry, Sarah Bridsong","doi":"10.35248/2161-0495.21.11.483","DOIUrl":"https://doi.org/10.35248/2161-0495.21.11.483","url":null,"abstract":"Acetaminophen is a common toxic ingestion and the leading cause of acute liver failure in the United States. There exists a relative paucity of evidence in guiding management of acetaminophen Extended-Release ingestions compared to immediate-release ingestions. Many case reports involving Extended-Release acetaminophen ingestion are confounded by co-ingestion, resulting in a delayed peak acetaminophen level. Few reports have been published involving pure acetaminophen Extended-Release ingestion with a late crossing of the Rumack-Matthew nomogram. We present a case of witnessed isolated acetaminophen Extended-Release ingestion in an 18-year-old male, resulting in an acetaminophen level crossing the Rumack-Matthew nomogram treatment threshold at 21 hours post-ingestion.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"5 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78945903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.35248/2161-0495.21.S18.004
K. Chamara, R. Higgoda, K. Ellepola, B. Premarathne, K. Jayasinghe, K. Maduwage
Accidental poisoning with Angel’s trumpet (Brugmansia suaveolens) is an uncommon plant poisoning reported in Sri Lanka. Toxic substances like atropine and scopolamine give rise to clinical manifestation of toxicity which is mainly anticholinergic effects. We report a rare case of accidental poisoning of Angel’s trumpet of 73-year-old patient who had clinical manifestations of anticholinergic effects. The patient started his symptoms following consuming leaves of angel’s trumpet accidentally. He developed anticholinergic symptoms such as delirium, altered level of consciousness, dilated pupils and tachycardia. Patient successfully recovered with symptomatic management. We recommend to be aware about uncommon types of plant poisoning and different presentations of their toxic effects, not only for timely diagnosis and treatment of such patients, but also to educate the public about the toxicity of plants in order to prevent morbidity and mortality related to accidental poisoning.
{"title":"Angelandrsquo;s Trumpet (Brugmansia suaveolens) Poisoning Presenting with Anticholinergic Toxidrome","authors":"K. Chamara, R. Higgoda, K. Ellepola, B. Premarathne, K. Jayasinghe, K. Maduwage","doi":"10.35248/2161-0495.21.S18.004","DOIUrl":"https://doi.org/10.35248/2161-0495.21.S18.004","url":null,"abstract":"Accidental poisoning with Angel’s trumpet (Brugmansia suaveolens) is an uncommon plant poisoning reported in Sri Lanka. Toxic substances like atropine and scopolamine give rise to clinical manifestation of toxicity which is mainly anticholinergic effects. We report a rare case of accidental poisoning of Angel’s trumpet of 73-year-old patient who had clinical manifestations of anticholinergic effects. The patient started his symptoms following consuming leaves of angel’s trumpet accidentally. He developed anticholinergic symptoms such as delirium, altered level of consciousness, dilated pupils and tachycardia. Patient successfully recovered with symptomatic management. We recommend to be aware about uncommon types of plant poisoning and different presentations of their toxic effects, not only for timely diagnosis and treatment of such patients, but also to educate the public about the toxicity of plants in order to prevent morbidity and mortality related to accidental poisoning.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"20 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76750188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.35248/2161-0495.21.S18.002
Bo Liang, Xudong Yuan, Gang Wei, Wen Wang, Ming Zhang, Peng Haizhou, Juan Carlos Hernaiz-Leonardo, A. Javer, M. Mendenhall, Justin Jul, er, Sammi Huang, H. Michail, Yong Lu, Qianming Zhu, J. Baldwin
Background: Povidone Iodine (PVP-I) nasal solutions are effective against the SARS-CoV-2 virus, but are cleared rapidly from the nasal cavity, limiting its use. PVP-I gel forming solutions can circumvent this problem due to their higher viscosity and prolonged clearing time. Objective: Characterize the in vitro virucidal activity of long-acting PVP-I compositions developed using an in situ gel forming technology against the SARS-CoV-2 virus and test its safety using a rat model. Methods: We tested different dilutions of the PVP-I gel forming solution– full concentration, 90%, 50%, 28% and 9% of the original formulation concentration – at varying exposure times to assess virucidal activity against SARSCoV- 2 in VERO76 cells infected. Virucidal activity was recorded as the reduction of virus in formulation-treated test wells compared to virus controls as a log reduction value. We conducted a 28-day toxicity study using Sprague Dawley CD® IGS rats to determine the potential delayed toxicity of a PVP-I formulation. Results: The PVP-I gel-forming nasal spray rapidly inactivated SARS-CoV-2, inhibiting the viral infection of VERO76 cells. No toxicity was observed for the PVP-I formulations. Significant inactivation was noted with preincubation of the virus with this PVP-I formulation at the lowest concentrations tested. No delayed toxicity was observed in our animal model. Conclusions: PVP-I gel forming formulations inactivate SARS-CoV-2 in vitro within 30 seconds of exposure, with increasing effects seen at higher exposure times. These formulations could prove useful in a clinical setting for managing SARS-CoV-2 infected patients.
{"title":"In vitro Inactivation of SARS-Cov-2 by Povidone-Iodine In situ Gel FormingSolution","authors":"Bo Liang, Xudong Yuan, Gang Wei, Wen Wang, Ming Zhang, Peng Haizhou, Juan Carlos Hernaiz-Leonardo, A. Javer, M. Mendenhall, Justin Jul, er, Sammi Huang, H. Michail, Yong Lu, Qianming Zhu, J. Baldwin","doi":"10.35248/2161-0495.21.S18.002","DOIUrl":"https://doi.org/10.35248/2161-0495.21.S18.002","url":null,"abstract":"Background: Povidone Iodine (PVP-I) nasal solutions are effective against the SARS-CoV-2 virus, but are cleared rapidly from the nasal cavity, limiting its use. PVP-I gel forming solutions can circumvent this problem due to their higher viscosity and prolonged clearing time. Objective: Characterize the in vitro virucidal activity of long-acting PVP-I compositions developed using an in situ gel forming technology against the SARS-CoV-2 virus and test its safety using a rat model. Methods: We tested different dilutions of the PVP-I gel forming solution– full concentration, 90%, 50%, 28% and 9% of the original formulation concentration – at varying exposure times to assess virucidal activity against SARSCoV- 2 in VERO76 cells infected. Virucidal activity was recorded as the reduction of virus in formulation-treated test wells compared to virus controls as a log reduction value. We conducted a 28-day toxicity study using Sprague Dawley CD® IGS rats to determine the potential delayed toxicity of a PVP-I formulation. Results: The PVP-I gel-forming nasal spray rapidly inactivated SARS-CoV-2, inhibiting the viral infection of VERO76 cells. No toxicity was observed for the PVP-I formulations. Significant inactivation was noted with preincubation of the virus with this PVP-I formulation at the lowest concentrations tested. No delayed toxicity was observed in our animal model. Conclusions: PVP-I gel forming formulations inactivate SARS-CoV-2 in vitro within 30 seconds of exposure, with increasing effects seen at higher exposure times. These formulations could prove useful in a clinical setting for managing SARS-CoV-2 infected patients.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"45 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77637008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.35248/2161-0495.21.11.479
Julius J Schmidt, M. Busch, S. David, W. N. K. Velten, M. Hoeper, Jan TKielstein
Calcium Channel Blockers (CCBs) may cause profound vasopressor resistant hypotension in case of intoxication. Recently, the EXTRIP workgroup recommended against the use of Extra Corporeal Treatment Modalities (ECTM) for the elimination of amlodipine. Anecdotal evidence suggests that Veno-Arterial Extra Corporeal Membrane Oxygenation (VA-ECMO) may be beneficial in patients with severe shock due to amlodipine intoxication. We report a case of severe amlodipine poisoning (total amlodipine intake 625 mg), in which we used awake-VA- ECMO support for hemodynamic stabilization. A combination of a HCO dialyzer and the Cytosorb® adsorber was used to eliminate amlodipine in two consecutive treatment sessions. Amlodipine dialyzer clearance and Cytosorb® adsorber clearance were 13.8 (-2,3–20.4) mL/min and 17.5 (9.6–25.6) mL/min, respectively. Clearance levels varied depending on drug plasma levels. During this treatment, initial amlodipine levels fell by 48% and 15% with a total eliminated amount of 242 and 352 μg of amlodipine, respectively, in the dialysate. EXTRIP criteria for dialyzability could not be met by the investigated modalities. ECMO therapy was discontinued after three days and the patient fully recovered. In conclusion, VA-ECMO support can be used for hemodynamic stabilization of patients with severe amlodipine poisoning, while the extracorporeal elimination techniques used in this setting were unable to remove a meaningful amount of drug.
钙通道阻滞剂(CCBs)在中毒的情况下可能引起深度抗利尿激素低血压。最近，EXTRIP工作组建议不要使用体外治疗方式(ECTM)来消除氨氯地平。轶事证据表明，静脉-动脉体外膜氧合(VA-ECMO)可能对氨氯地平中毒引起的严重休克患者有益。我们报告了一例严重氨氯地平中毒(氨氯地平总摄入量625mg)，我们使用清醒- va - ECMO支持来稳定血液动力学。在连续两个疗程中，使用HCO透析器和Cytosorb®吸附剂的组合来消除氨氯地平。氨氯地平透析器清除率和Cytosorb®吸附剂清除率分别为13.8 (-2,3 - 20.4)mL/min和17.5 (9.6-25.6)mL/min。清除水平取决于药物血浆水平。在此治疗期间，氨氯地平的初始水平下降了48%和15%，透析液中氨氯地平的总消除量分别为242和352 μg。所研究的模式不能满足透析性的EXTRIP标准。三天后停止ECMO治疗，患者完全康复。综上所述，VA-ECMO支持可用于严重氨氯地平中毒患者的血流动力学稳定，而在这种情况下使用的体外清除技术无法清除大量药物。
{"title":"Life-Threatening Amlodipine Over Dose Requiring ECMO Support Treated by High-Cut-Off Dialysis and Cytosorb","authors":"Julius J Schmidt, M. Busch, S. David, W. N. K. Velten, M. Hoeper, Jan TKielstein","doi":"10.35248/2161-0495.21.11.479","DOIUrl":"https://doi.org/10.35248/2161-0495.21.11.479","url":null,"abstract":"Calcium Channel Blockers (CCBs) may cause profound vasopressor resistant hypotension in case of intoxication. Recently, the EXTRIP workgroup recommended against the use of Extra Corporeal Treatment Modalities (ECTM) for the elimination of amlodipine. Anecdotal evidence suggests that Veno-Arterial Extra Corporeal Membrane Oxygenation (VA-ECMO) may be beneficial in patients with severe shock due to amlodipine intoxication. We report a case of severe amlodipine poisoning (total amlodipine intake 625 mg), in which we used awake-VA- ECMO support for hemodynamic stabilization. A combination of a HCO dialyzer and the Cytosorb® adsorber was used to eliminate amlodipine in two consecutive treatment sessions. Amlodipine dialyzer clearance and Cytosorb® adsorber clearance were 13.8 (-2,3–20.4) mL/min and 17.5 (9.6–25.6) mL/min, respectively. Clearance levels varied depending on drug plasma levels. During this treatment, initial amlodipine levels fell by 48% and 15% with a total eliminated amount of 242 and 352 μg of amlodipine, respectively, in the dialysate. EXTRIP criteria for dialyzability could not be met by the investigated modalities. ECMO therapy was discontinued after three days and the patient fully recovered. In conclusion, VA-ECMO support can be used for hemodynamic stabilization of patients with severe amlodipine poisoning, while the extracorporeal elimination techniques used in this setting were unable to remove a meaningful amount of drug.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"11 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84365381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.35248/2161-0495.21.S19.003
S. Ahmed, H. H. Baghdadi, Fatma Mohamady El Demerdash
Background: In the printing industry, volatile organic compounds main sources are the uses of organic solvents, fountain solutions and cleaning agents. Biological monitoring of exposure to toxic chemicals in the workplace is a fundamental tool to evaluate human health risks and to improve occupational safety. Aims and objectives: To investigate the effects of occupational exposure to organic solvents on some hepatic and hematological parameters among printing workers. Materials and methods: This study was conducted in local printing company with two groups; the control group included (26) male healthy volunteer donors and the second is the workers group included (26) male volunteer workers, who have been exposed to chemicals for long time (10 years). Statistical analysis was employed. Results: Hemoglobin and the red blood cell count of workers group were significantly lower than control group while, liver transaminases and lactate dehydrogenase enzymes were found significantly higher among printing workers as compare to the control group. Conclusions: This study observed that the printing workers developed biochemical alterations in hematological and the hepatic enzymes with time. However, regular follow-ups are required and further studies to get better insights into the results.
{"title":"Biochemical Assessment of the Hepatic and Hematological Functions of Printing Workers","authors":"S. Ahmed, H. H. Baghdadi, Fatma Mohamady El Demerdash","doi":"10.35248/2161-0495.21.S19.003","DOIUrl":"https://doi.org/10.35248/2161-0495.21.S19.003","url":null,"abstract":"Background: In the printing industry, volatile organic compounds main sources are the uses of organic solvents, fountain solutions and cleaning agents. Biological monitoring of exposure to toxic chemicals in the workplace is a fundamental tool to evaluate human health risks and to improve occupational safety. Aims and objectives: To investigate the effects of occupational exposure to organic solvents on some hepatic and hematological parameters among printing workers. Materials and methods: This study was conducted in local printing company with two groups; the control group included (26) male healthy volunteer donors and the second is the workers group included (26) male volunteer workers, who have been exposed to chemicals for long time (10 years). Statistical analysis was employed. Results: Hemoglobin and the red blood cell count of workers group were significantly lower than control group while, liver transaminases and lactate dehydrogenase enzymes were found significantly higher among printing workers as compare to the control group. Conclusions: This study observed that the printing workers developed biochemical alterations in hematological and the hepatic enzymes with time. However, regular follow-ups are required and further studies to get better insights into the results.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"5 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82200797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.35248/2161-0495.21.S16.E004
K. Gişi, Murat Ispiroglu, E. Kılınç
Drug-Induced Liver Injury (DILI) may develop depending on the drug itself, its metabolites or the host immune system. Hydroxychloroquine (HQC) is used prevalently in treatment of the rheumatological diseases (especially SLE), and severe liver toxicities associated with this drug have been reported in the literature. We are presenting a 36-year-old patient who was using hydroxychloroquine due to adult Still’s disease (ASD) whose initial values were normal but arrived three weeks later with severely high liver enzyme and bilirubin levels. The diagnosis of the patient was made by eliminating other causes and conducting a liver biopsy. The patient recovered with steroid treatment. This should not be neglected as severe liver failure may develop, even though rarely, in patients using this drug, and this drug is prevalently being used in treatment of coronavirus disease-2019 (COVID-19) especially due to the recent pandemic of coronavirus.
{"title":"A Hydroxychloroquine-Related Acute Liver Failure Case and Review of the Literature","authors":"K. Gişi, Murat Ispiroglu, E. Kılınç","doi":"10.35248/2161-0495.21.S16.E004","DOIUrl":"https://doi.org/10.35248/2161-0495.21.S16.E004","url":null,"abstract":"Drug-Induced Liver Injury (DILI) may develop depending on the drug itself, its metabolites or the host immune system. Hydroxychloroquine (HQC) is used prevalently in treatment of the rheumatological diseases (especially SLE), and severe liver toxicities associated with this drug have been reported in the literature. We are presenting a 36-year-old patient who was using hydroxychloroquine due to adult Still’s disease (ASD) whose initial values were normal but arrived three weeks later with severely high liver enzyme and bilirubin levels. The diagnosis of the patient was made by eliminating other causes and conducting a liver biopsy. The patient recovered with steroid treatment. This should not be neglected as severe liver failure may develop, even though rarely, in patients using this drug, and this drug is prevalently being used in treatment of coronavirus disease-2019 (COVID-19) especially due to the recent pandemic of coronavirus.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"36 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77561236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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