Pub Date : 2020-01-01DOI: 10.35248/2161-0495.20.10.E129
S. Shammas
{"title":"Future of Cancer Treatment and Genomic Toxicity","authors":"S. Shammas","doi":"10.35248/2161-0495.20.10.E129","DOIUrl":"https://doi.org/10.35248/2161-0495.20.10.E129","url":null,"abstract":"","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"22 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79934506","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 : 2020-01-01DOI: 10.35248/2161-0495.20.10.459
A. Alqahtani, M. Molla, Faisal M Alshiban
Background: Hypernatremia due to salt poisoning is clinically rare and standard care procedures have not been established. We report this case of pediatric salt poisoning due to chronic craving for table salt. Immediate recognition of salt toxicity and aggressive resuscitative measures are critical in the treatment of this lethal poisoning. Despite heroic measures, pediatric deaths due to salt toxicity still occur from irreversible neurological damage. Case presentation: A 6-year-old boy presented to our pediatric emergency department referred from other hospital with fatigue, polyuria and polydipsia and remarkable hypernatremia with a serum sodium concentration of 203 mmol/L. The initial lab work showed blood glucose 5.7 mmol/l, Serum Sodium (203 mmol/l) from referring hospital) and venous blood gases showed PH 7.26 PCO2 47 mmHg HCO3 21.5 mmol/l. We reduced his serum sodium level slowly over 84 hours, as its toxicity happened over a period of 2 months. Conclusion: After reviewing instances of resuscitation following salt intoxication, aggressive rapid correction of serum sodium concentration should only be considered in acute phases of hypernatremia within a few hours from ingestion.
{"title":"Salt Poisoning in a 6-year-old Child: A Case Report","authors":"A. Alqahtani, M. Molla, Faisal M Alshiban","doi":"10.35248/2161-0495.20.10.459","DOIUrl":"https://doi.org/10.35248/2161-0495.20.10.459","url":null,"abstract":"Background: Hypernatremia due to salt poisoning is clinically rare and standard care procedures have not been established. We report this case of pediatric salt poisoning due to chronic craving for table salt. Immediate recognition of salt toxicity and aggressive resuscitative measures are critical in the treatment of this lethal poisoning. Despite heroic measures, pediatric deaths due to salt toxicity still occur from irreversible neurological damage. Case presentation: A 6-year-old boy presented to our pediatric emergency department referred from other hospital with fatigue, polyuria and polydipsia and remarkable hypernatremia with a serum sodium concentration of 203 mmol/L. The initial lab work showed blood glucose 5.7 mmol/l, Serum Sodium (203 mmol/l) from referring hospital) and venous blood gases showed PH 7.26 PCO2 47 mmHg HCO3 21.5 mmol/l. We reduced his serum sodium level slowly over 84 hours, as its toxicity happened over a period of 2 months. Conclusion: After reviewing instances of resuscitation following salt intoxication, aggressive rapid correction of serum sodium concentration should only be considered in acute phases of hypernatremia within a few hours from ingestion.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"68 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75430482","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 : 2020-01-01DOI: 10.35248/2161-0495.20.10.437
B. Nathan
Cardiac glycosides are found in various plant products. Here we report a case of poisoning due to Cryptostegia grandiflora which was prescribed for a particular skin disease by a herbal medicine practitioner. This patient presented with nausea and was found to have second degree AV block. It was initially suspected to be a case of yellow oleander poisoning which is common in the southern part of our country, but was later found to be poisoning due to Cryptostegia grandiflora which also contains cardiac glycosides. A field visit and examination of the plant by a botanist confirmed the same. The patient required temporary pacing for the arrhythmia and was discharged after a week.
{"title":"A Mimicker of Yellow Oleander Poisoning","authors":"B. Nathan","doi":"10.35248/2161-0495.20.10.437","DOIUrl":"https://doi.org/10.35248/2161-0495.20.10.437","url":null,"abstract":"Cardiac glycosides are found in various plant products. Here we report a case of poisoning due to Cryptostegia grandiflora which was prescribed for a particular skin disease by a herbal medicine practitioner. This patient presented with nausea and was found to have second degree AV block. It was initially suspected to be a case of yellow oleander poisoning which is common in the southern part of our country, but was later found to be poisoning due to Cryptostegia grandiflora which also contains cardiac glycosides. A field visit and examination of the plant by a botanist confirmed the same. The patient required temporary pacing for the arrhythmia and was discharged after a week.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"66 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81747282","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 : 2020-01-01DOI: 10.35248/2161-0495.20.10.448
A. Sathe, A. Thiemann, Sara Toulouie, E. Durant
Context: To describe a case of massive bupropion overdose leading to cardiac toxicity and seizures in an adolescent suicide. Case: A 19 year old female presented to the emergency department with an estimated bupropion overdose of 28.2 grams with possible oxcarbazepine consumption. The patient was unresponsive and was treated for intermittent seizures and cardiogenic shock but could not be resuscitated and died within 48 hours. Discussion: Several existing reports regarding bupropion overdose describe sinus tachycardia and seizures corrected by symptomatic treatment. However, to our knowledge, this case documents the highest ingestion of bupropion recorded thus far in literature and demonstrates the rapid onset of cardiac dysfunction.
{"title":"Massive Bupropion and Oxcarbazepine Overdose","authors":"A. Sathe, A. Thiemann, Sara Toulouie, E. Durant","doi":"10.35248/2161-0495.20.10.448","DOIUrl":"https://doi.org/10.35248/2161-0495.20.10.448","url":null,"abstract":"Context: To describe a case of massive bupropion overdose leading to cardiac toxicity and seizures in an adolescent suicide. Case: A 19 year old female presented to the emergency department with an estimated bupropion overdose of 28.2 grams with possible oxcarbazepine consumption. The patient was unresponsive and was treated for intermittent seizures and cardiogenic shock but could not be resuscitated and died within 48 hours. Discussion: Several existing reports regarding bupropion overdose describe sinus tachycardia and seizures corrected by symptomatic treatment. However, to our knowledge, this case documents the highest ingestion of bupropion recorded thus far in literature and demonstrates the rapid onset of cardiac dysfunction.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"27 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89577196","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 : 2020-01-01DOI: 10.35248/2161-0495.20.10.447
J. Pelletier, S. Ie, P. Stromberg, J. Perkins
We describe a case of a 43-year-old female who was found unresponsive after an intentional overdose of bupropion and cyclobenzaprine. Upon transfer to our hospital she began to exhibit signs of Brain Death (BD). Electroencephalogram (EEG) showed burst suppression pattern, which has been documented in bupropion overdoses that mimic BD. We discuss mimics of BD and the need for caution before making this diagnosis when patients clinically present with signs of BD.
{"title":"Back from the Dead: A Case of Bupropion Overdose Mimicking Brain Death","authors":"J. Pelletier, S. Ie, P. Stromberg, J. Perkins","doi":"10.35248/2161-0495.20.10.447","DOIUrl":"https://doi.org/10.35248/2161-0495.20.10.447","url":null,"abstract":"We describe a case of a 43-year-old female who was found unresponsive after an intentional overdose of bupropion and cyclobenzaprine. Upon transfer to our hospital she began to exhibit signs of Brain Death (BD). Electroencephalogram (EEG) showed burst suppression pattern, which has been documented in bupropion overdoses that mimic BD. We discuss mimics of BD and the need for caution before making this diagnosis when patients clinically present with signs of BD.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"223 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75035795","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 : 2020-01-01DOI: 10.35248/2161-0495.20.10.451
M. Sasikumar, R. Gunaseelan, Anuusha Ss, R. Ajithkumar, S. ManuAyyan, N. Balamurugan
Introduction: Organophosphorus (OP) poisoning is one of the major public health concerns which accounts for about 30% suicide annually in India. Despite precautionary measures, intentional and occupational suicidal rates are higher in areas where OP is used. Though the toxidrome based approach is based on OP action on muscarinic and nicotinic receptors, it still can present in atypical ways too. Here, we describe a 37 years old male who presented with symptoms co-relating with Guillain-Barre syndrome but with discordant clinical signs. Some lacuna in the presenting symptoms prompted us to consider organophosphorus poisoning based on toxidrome which was further confirmed with plasma cholinesterase tox screen levels. Our case report highlights the importance of having a high index of suspicion for poisoning, if the clinical features are discordant with clinical history.
{"title":"Curious Case of Dimethoate Poisoning with Early Onset Intermediate Syndrome, Cardiotoxicity and Hypothermia: A Case Report","authors":"M. Sasikumar, R. Gunaseelan, Anuusha Ss, R. Ajithkumar, S. ManuAyyan, N. Balamurugan","doi":"10.35248/2161-0495.20.10.451","DOIUrl":"https://doi.org/10.35248/2161-0495.20.10.451","url":null,"abstract":"Introduction: Organophosphorus (OP) poisoning is one of the major public health concerns which accounts for about 30% suicide annually in India. Despite precautionary measures, intentional and occupational suicidal rates are higher in areas where OP is used. Though the toxidrome based approach is based on OP action on muscarinic and nicotinic receptors, it still can present in atypical ways too. Here, we describe a 37 years old male who presented with symptoms co-relating with Guillain-Barre syndrome but with discordant clinical signs. Some lacuna in the presenting symptoms prompted us to consider organophosphorus poisoning based on toxidrome which was further confirmed with plasma cholinesterase tox screen levels. Our case report highlights the importance of having a high index of suspicion for poisoning, if the clinical features are discordant with clinical history.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"51 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89077910","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 : 2020-01-01DOI: 10.35248/2161-0495.20.10.436
Y. Mimura, Michitaka Funayama, Naoto Yoshida, Y. Tokuda, Taketo Takata, M. Mimura
Introduction: There have been no reports on poisoning with pyrazolate and propyrisulfron (Pyr/Pro), a type of herbicide. In this report, we present a case with severe Pyr/Pro poisoning signs, in particular, sustained convulsions. Case presentation: A 47-year-old man was transferred to emergency room in comatose state after he ingested the most possible amount of 500 ml of herbicide which contained 136.5 mg of Pyr and 8 mg of Pro Twelve hours after his admission, he suddenly developed generalized convulsions, which lasted for 2 days. Given no abnormal findings on his brain images or laboratory data, convulsions were considered to be caused by Pyr/Pro poisoning. His convulsions were well controlled under benzodiazepine treatments and he was able to be discharged without any complications. Discussion: This case report suggests that Pyr/ Pro poisoning has a higher risk for developing sustained convulsions and loss of consciousness. Conclusion: We recommend managing signs of central nervous system, including convulsion, in cases with Pyr/Pro poisoning.
{"title":"A Case Report: Convulsion After Poisoning of a herbicide containing Pyrazolate and Propyrisulfuron","authors":"Y. Mimura, Michitaka Funayama, Naoto Yoshida, Y. Tokuda, Taketo Takata, M. Mimura","doi":"10.35248/2161-0495.20.10.436","DOIUrl":"https://doi.org/10.35248/2161-0495.20.10.436","url":null,"abstract":"Introduction: There have been no reports on poisoning with pyrazolate and propyrisulfron (Pyr/Pro), a type of herbicide. In this report, we present a case with severe Pyr/Pro poisoning signs, in particular, sustained convulsions. Case presentation: A 47-year-old man was transferred to emergency room in comatose state after he ingested the most possible amount of 500 ml of herbicide which contained 136.5 mg of Pyr and 8 mg of Pro Twelve hours after his admission, he suddenly developed generalized convulsions, which lasted for 2 days. Given no abnormal findings on his brain images or laboratory data, convulsions were considered to be caused by Pyr/Pro poisoning. His convulsions were well controlled under benzodiazepine treatments and he was able to be discharged without any complications. Discussion: This case report suggests that Pyr/ Pro poisoning has a higher risk for developing sustained convulsions and loss of consciousness. Conclusion: We recommend managing signs of central nervous system, including convulsion, in cases with Pyr/Pro poisoning.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"50 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90291114","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 : 2020-01-01DOI: 10.35248/2161-0495.20.10.E130
Grace Albatros
{"title":"Uncommon Symptom of linezolid, Utilized in Numerous Medication Safe Diseases, Bone Marrow Gloom","authors":"Grace Albatros","doi":"10.35248/2161-0495.20.10.E130","DOIUrl":"https://doi.org/10.35248/2161-0495.20.10.E130","url":null,"abstract":"","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"187 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75605982","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 : 2020-01-01DOI: 10.35248/2161-0495.20.10.458
S. Fnu, Mukesh Kumar, H. Ahsan, Abbasi Abdul Rahman Ahemd
Introduction: Phencyclidine (PCP) is a least addictive drug due to its lack of CNS suppression like other drugs such as opioids, benzodiazepine and alcohol. Mortality from PCP is also not very common as it does not cause any direct toxic effects. However PCP intoxication is lethal through its secondary effects such, rhabdomyolysis, Acute renal failure, hyperkalemia and seizures. Case presentation: Toxicity from PCP is dose dependent with various levels of CNS excitement based on the dose. We describe a case of a patient who presented to the emergency department with cardiac arrest. Patient had prolonged cardiac arrest on initial evaluation; the patient had potassium of 11.9 with acute renal failure and rhabdomyolysis. Patient admitted to ICU after initial resuscitation. Patient had a complicated ICU course with compartment syndrome and multiple organ failure. Wife reports the patient takes some substance before this event patient urine came back positive for phencyclidine. Discussion: It is important to understand the lethality of phencyclidine. More commonly we discuss the high mortality from opioids with the patients but we do not discuss the mortality from other substances such as PCP, family and patients should be warn appropriately regarding the drugs which can cause death.
{"title":"Cardiac Arrest in Patient with Phencyclidine (PCP) Intoxication","authors":"S. Fnu, Mukesh Kumar, H. Ahsan, Abbasi Abdul Rahman Ahemd","doi":"10.35248/2161-0495.20.10.458","DOIUrl":"https://doi.org/10.35248/2161-0495.20.10.458","url":null,"abstract":"Introduction: Phencyclidine (PCP) is a least addictive drug due to its lack of CNS suppression like other drugs such as opioids, benzodiazepine and alcohol. Mortality from PCP is also not very common as it does not cause any direct toxic effects. However PCP intoxication is lethal through its secondary effects such, rhabdomyolysis, Acute renal failure, hyperkalemia and seizures. Case presentation: Toxicity from PCP is dose dependent with various levels of CNS excitement based on the dose. We describe a case of a patient who presented to the emergency department with cardiac arrest. Patient had prolonged cardiac arrest on initial evaluation; the patient had potassium of 11.9 with acute renal failure and rhabdomyolysis. Patient admitted to ICU after initial resuscitation. Patient had a complicated ICU course with compartment syndrome and multiple organ failure. Wife reports the patient takes some substance before this event patient urine came back positive for phencyclidine. Discussion: It is important to understand the lethality of phencyclidine. More commonly we discuss the high mortality from opioids with the patients but we do not discuss the mortality from other substances such as PCP, family and patients should be warn appropriately regarding the drugs which can cause death.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"05 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86297393","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 : 2020-01-01DOI: 10.35248/2161-0495.20.10.435
N. Cao, T. Tran, N. Huynh, Nguyen Ngọc Tung, M-L Wu
Background: Arsenic poisoning from repeated exposure to burning herbal products containing realgar has not been reported in the literature. We report a case of arsenic poisoning from repeated exposure to burning traditional Chinese herbal products containing realgar for more than one year. Case details: A 39-year-old male developed intermittent fever, loss of appetite, hair loss and bluish discoloration of the trunk and limbs one year before admission, followed by diffuse thickening of soles and palms and gradually worsened tingling and numbness of distal parts of limbs and weakness of extremities over the course of the year prior to hospital admission. Characteristic clinical presentation of arsenic poisoning included hyperpigmentation, spotty raindrop pigmentation, Mees’ lines and high arsenic levels in the blood, urine and hair confirmed the diagnosis. Patient’s signs and symptoms significantly improved following termination of arsenic exposure and treatment. Conclusion: Inhalation of pyrolyzed herbal products containing realgar resulted in arsenic poisoning. Our patient showed significant clinical improvement following termination of arsenic exposure and treatment. The adverse health effects of burning herbal products containing realgar are a serious public health issue.
{"title":"Arsenic Poisoning from Repeated Exposure to Burning Herbal Products Containing Realgar: A Case Report","authors":"N. Cao, T. Tran, N. Huynh, Nguyen Ngọc Tung, M-L Wu","doi":"10.35248/2161-0495.20.10.435","DOIUrl":"https://doi.org/10.35248/2161-0495.20.10.435","url":null,"abstract":"Background: Arsenic poisoning from repeated exposure to burning herbal products containing realgar has not been reported in the literature. We report a case of arsenic poisoning from repeated exposure to burning traditional Chinese herbal products containing realgar for more than one year. Case details: A 39-year-old male developed intermittent fever, loss of appetite, hair loss and bluish discoloration of the trunk and limbs one year before admission, followed by diffuse thickening of soles and palms and gradually worsened tingling and numbness of distal parts of limbs and weakness of extremities over the course of the year prior to hospital admission. Characteristic clinical presentation of arsenic poisoning included hyperpigmentation, spotty raindrop pigmentation, Mees’ lines and high arsenic levels in the blood, urine and hair confirmed the diagnosis. Patient’s signs and symptoms significantly improved following termination of arsenic exposure and treatment. Conclusion: Inhalation of pyrolyzed herbal products containing realgar resulted in arsenic poisoning. Our patient showed significant clinical improvement following termination of arsenic exposure and treatment. The adverse health effects of burning herbal products containing realgar are a serious public health issue.","PeriodicalId":15433,"journal":{"name":"Journal of Clinical Toxicology","volume":"19 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84624018","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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