Pub Date : 2022-02-27DOI: 10.1080/24734306.2022.2040148
David Loughran, D. Calello, Lewis Nelson
Abstract Acute aluminum toxicity is encountered rarely in clinical practice but carries a high risk for morbidity and mortality. Despite this risk, our understanding of aluminum toxicity and its treatment is relatively limited. Due to decreased clearance, patients with renal failure have increased risk for significant aluminum-related central nervous system (CNS) toxicity. Medical advances have limited chronic aluminum exposure in these patients, but they are still at increased risk for acute toxicity from certain aluminum-based interventions such as alum bladder irrigation. We report a case of an 87-year-old man with end-stage renal disease on hemodialysis who developed acute aluminum toxicity from alum bladder irrigation. He was treated with daily deferoxamine infusions followed by dialysis with subsequent resolution of his encephalopathy. This case report uniquely documents trending of blood aluminum concentration (blood [Al]) during treatment providing insight into how aluminum blood concentrations shift during chelation therapy.
{"title":"Treatment of acute aluminum toxicity due to alum bladder irrigation in a hemodialysis patient: a case report","authors":"David Loughran, D. Calello, Lewis Nelson","doi":"10.1080/24734306.2022.2040148","DOIUrl":"https://doi.org/10.1080/24734306.2022.2040148","url":null,"abstract":"Abstract Acute aluminum toxicity is encountered rarely in clinical practice but carries a high risk for morbidity and mortality. Despite this risk, our understanding of aluminum toxicity and its treatment is relatively limited. Due to decreased clearance, patients with renal failure have increased risk for significant aluminum-related central nervous system (CNS) toxicity. Medical advances have limited chronic aluminum exposure in these patients, but they are still at increased risk for acute toxicity from certain aluminum-based interventions such as alum bladder irrigation. We report a case of an 87-year-old man with end-stage renal disease on hemodialysis who developed acute aluminum toxicity from alum bladder irrigation. He was treated with daily deferoxamine infusions followed by dialysis with subsequent resolution of his encephalopathy. This case report uniquely documents trending of blood aluminum concentration (blood [Al]) during treatment providing insight into how aluminum blood concentrations shift during chelation therapy.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"310 1","pages":"35 - 38"},"PeriodicalIF":0.0,"publicationDate":"2022-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74965609","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 : 2022-02-02DOI: 10.1080/24734306.2022.2031565
R. Stewart, Verity Newman, M. Harvey, Mingtan Tang, Zimei Wu, G. Cave
Abstract Introduction Our study investigated whether lipid emulsion therapy could act as an antidote for intravenous amiodarone toxicity in a rat model. Methods 20 rats were randomised to receive lipid emulsion (ILE) or saline. Rats were infused with amiodarone at 1 mg/kg/min for 20 min. ILE rats then received 6 mL/kg of IV 20% ILE, with controls receiving saline. Amiodarone infusion then recommenced at 0.25 mg/kg/minute for 15 min. Heart rate and mean arterial pressure (MAP) were recorded at the commencement and end of the first amiodarone infusion, and every 5 min during the second amiodarone infusion until experiment termination. Blood was sampled for amiodarone concentration at the conclusion of each infusion. Results At experiment termination MAP was greater for the ILE group (85 vs 60 mmHg, p = 0.01), with no difference in heart rate between groups (224 vs 232 bpm, p = 0.19). Amiodarone concentration decreased after saline treatment and was stable after ILE (change −6.4 micromol/L saline, 0.11 micromol/L lipid p < 0.001) Conclusions ILE therapy mitigated intravenous amiodarone-induced hypotension in this rat model. While amiodarone was retained in lipid treated blood the quantum of this increase did not support the “lipid sink” hypothesis. Further research is required to evaluate the clinical relevance of these findings.
摘要:本研究探讨了脂质乳治疗是否可以作为静脉注射胺碘酮毒性大鼠模型的解毒剂。方法20只大鼠随机分为脂乳组和生理盐水组。大鼠以1 mg/kg/min的剂量注射胺碘酮，持续20 min。然后给ILE大鼠注射6 mL/kg 20% ILE，对照组注射生理盐水。然后重新开始以0.25 mg/kg/分钟的速度输注胺碘酮，持续15分钟。在第一次胺碘酮输注开始和结束时记录心率和平均动脉压(MAP)，第二次胺碘酮输注时每5 min记录一次心率和平均动脉压(MAP)，直至实验结束。每次输注结束时采血检测胺碘酮浓度。结果实验结束时，ILE组MAP更大(85 vs 60 mmHg, p = 0.01)，两组心率无差异(224 vs 232 bpm, p = 0.19)。经生理盐水处理后胺碘酮浓度下降，ILE后稳定(改变−6.4微mol/L生理盐水，0.11微mol/L脂质p < 0.001)结论ILE治疗减轻了静脉注射胺碘酮诱导的低血压。虽然胺碘酮保留在脂质处理后的血液中，但这种增加的量并不支持“脂质沉淀”假说。需要进一步的研究来评估这些发现的临床相关性。
{"title":"Lipid emulsion mitigates intravenous amiodarone toxicity in a rat model","authors":"R. Stewart, Verity Newman, M. Harvey, Mingtan Tang, Zimei Wu, G. Cave","doi":"10.1080/24734306.2022.2031565","DOIUrl":"https://doi.org/10.1080/24734306.2022.2031565","url":null,"abstract":"Abstract Introduction Our study investigated whether lipid emulsion therapy could act as an antidote for intravenous amiodarone toxicity in a rat model. Methods 20 rats were randomised to receive lipid emulsion (ILE) or saline. Rats were infused with amiodarone at 1 mg/kg/min for 20 min. ILE rats then received 6 mL/kg of IV 20% ILE, with controls receiving saline. Amiodarone infusion then recommenced at 0.25 mg/kg/minute for 15 min. Heart rate and mean arterial pressure (MAP) were recorded at the commencement and end of the first amiodarone infusion, and every 5 min during the second amiodarone infusion until experiment termination. Blood was sampled for amiodarone concentration at the conclusion of each infusion. Results At experiment termination MAP was greater for the ILE group (85 vs 60 mmHg, p = 0.01), with no difference in heart rate between groups (224 vs 232 bpm, p = 0.19). Amiodarone concentration decreased after saline treatment and was stable after ILE (change −6.4 micromol/L saline, 0.11 micromol/L lipid p < 0.001) Conclusions ILE therapy mitigated intravenous amiodarone-induced hypotension in this rat model. While amiodarone was retained in lipid treated blood the quantum of this increase did not support the “lipid sink” hypothesis. Further research is required to evaluate the clinical relevance of these findings.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"6 1","pages":"30 - 34"},"PeriodicalIF":0.0,"publicationDate":"2022-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81842049","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 : 2022-01-05DOI: 10.1080/24734306.2021.2006957
Constance A. Mackenzie, Emily Austin, M. Thompson, R. Tirona
Abstract Ingestion of amatoxin-containing mushrooms can lead to fulminant hepatotoxicity and death. Despite recent interest in therapeutic options for amatoxin-exposed patients, there is no single, recommended treatment for amatoxin poisoning. Alpha-amanitin, the principal toxin in amatoxin-containing mushrooms, requires entry into hepatocytes via organic anion transporting polypeptide (OATP) 1B3 before the cascade of cellular events occurs leading to hepatocyte necrosis, liver failure, and in severe cases liver transplantation or death. Three patients managed through a single poison centre with confirmed amatoxin-containing mushrooms ingestions were treated with intravenous cyclosporine, a known potent OATP1B3 inhibitor, along with supportive care. All patients presented with classic delayed symptoms of nausea, vomiting and diarrhea. No patient progressed to fulminant hepatic failure, although two patients developed a transient rise in liver transaminases. All recovered and were discharged from hospital. No patient had an adverse effect from cyclosporine. In addition, we performed an in-vitro study of the role of cyclosporine in cultured HEK293T cells and human hepatoma Huh7 cells. Cyclosporine effectively inhibited OATP1B3-mediated uptake of alpha-amanitin, and improved cell viability of alpha-amanitin exposed cultured Huh7 cells. We conclude that IV cyclosporine, a drug readily available in most hospitals, may be useful to reduce hepatotoxicity from amatoxin poisoning.
{"title":"Cyclosporine as a novel treatment for amatoxin-containing mushroom poisoning: a case series","authors":"Constance A. Mackenzie, Emily Austin, M. Thompson, R. Tirona","doi":"10.1080/24734306.2021.2006957","DOIUrl":"https://doi.org/10.1080/24734306.2021.2006957","url":null,"abstract":"Abstract Ingestion of amatoxin-containing mushrooms can lead to fulminant hepatotoxicity and death. Despite recent interest in therapeutic options for amatoxin-exposed patients, there is no single, recommended treatment for amatoxin poisoning. Alpha-amanitin, the principal toxin in amatoxin-containing mushrooms, requires entry into hepatocytes via organic anion transporting polypeptide (OATP) 1B3 before the cascade of cellular events occurs leading to hepatocyte necrosis, liver failure, and in severe cases liver transplantation or death. Three patients managed through a single poison centre with confirmed amatoxin-containing mushrooms ingestions were treated with intravenous cyclosporine, a known potent OATP1B3 inhibitor, along with supportive care. All patients presented with classic delayed symptoms of nausea, vomiting and diarrhea. No patient progressed to fulminant hepatic failure, although two patients developed a transient rise in liver transaminases. All recovered and were discharged from hospital. No patient had an adverse effect from cyclosporine. In addition, we performed an in-vitro study of the role of cyclosporine in cultured HEK293T cells and human hepatoma Huh7 cells. Cyclosporine effectively inhibited OATP1B3-mediated uptake of alpha-amanitin, and improved cell viability of alpha-amanitin exposed cultured Huh7 cells. We conclude that IV cyclosporine, a drug readily available in most hospitals, may be useful to reduce hepatotoxicity from amatoxin poisoning.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"25 1","pages":"23 - 27"},"PeriodicalIF":0.0,"publicationDate":"2022-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86069015","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 : 2022-01-05DOI: 10.1080/24734306.2021.2015550
Natasha Tobarran, Emily K. Kershner, K. Cumpston, S. R. Rose, B. Wills
Abstract Cyanide poisoning most commonly occurs from smoke inhalation, less commonly by oral ingestion for suicide or homicide. There are rare cases of intravenous or subcutaneous parenteral cyanide. We report a fatal case of intramuscular cyanide used as a homicidal agent. A 35-year-old female was assaulted and injected with an unknown substance in her left buttock using a syringe. She was unresponsive at ED arrival and underwent immediate endotracheal intubation. After near normal vital signs at arrival (BP 130/83 mmHg, HR 102 bpm), she rapidly became hypotensive and bradycardic with worsening acidosis (pH 6.95, lactate 7.7 mmol/L). Despite vasopressors, hydroxocobalamin, and sodium thiosulfate, she succumbed. Plasma cyanide concentrations from blood drawn 1 and 4 h post exposure were both in the lethal range (3.4 and 4.1 mg/L, respectively). Our case demonstrates that intramuscular injection can result in fatal cyanide poisoning, resulting in rapid absorption, severe toxicity, and death.
{"title":"Homicide with intramuscular cyanide injection: a case report","authors":"Natasha Tobarran, Emily K. Kershner, K. Cumpston, S. R. Rose, B. Wills","doi":"10.1080/24734306.2021.2015550","DOIUrl":"https://doi.org/10.1080/24734306.2021.2015550","url":null,"abstract":"Abstract Cyanide poisoning most commonly occurs from smoke inhalation, less commonly by oral ingestion for suicide or homicide. There are rare cases of intravenous or subcutaneous parenteral cyanide. We report a fatal case of intramuscular cyanide used as a homicidal agent. A 35-year-old female was assaulted and injected with an unknown substance in her left buttock using a syringe. She was unresponsive at ED arrival and underwent immediate endotracheal intubation. After near normal vital signs at arrival (BP 130/83 mmHg, HR 102 bpm), she rapidly became hypotensive and bradycardic with worsening acidosis (pH 6.95, lactate 7.7 mmol/L). Despite vasopressors, hydroxocobalamin, and sodium thiosulfate, she succumbed. Plasma cyanide concentrations from blood drawn 1 and 4 h post exposure were both in the lethal range (3.4 and 4.1 mg/L, respectively). Our case demonstrates that intramuscular injection can result in fatal cyanide poisoning, resulting in rapid absorption, severe toxicity, and death.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"129 1","pages":"20 - 22"},"PeriodicalIF":0.0,"publicationDate":"2022-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79568002","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}
{"title":"Angel or devil? Medicinal history of poppy in traditional Chinese medicine","authors":"T. Communications","doi":"10.53388/20220202014","DOIUrl":"https://doi.org/10.53388/20220202014","url":null,"abstract":"","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"94 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75653585","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}
{"title":"Exposure to sharp injuries among hospital medical waste handlers","authors":"A. Lateef","doi":"10.53388/20220202012","DOIUrl":"https://doi.org/10.53388/20220202012","url":null,"abstract":"","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"99 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76277940","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}
Xiaotong Duan, Shan-gao Li, Qiyi Wang, Jing-Xian Liu, Tianmu He, Liu Liu, Meichen Liu, Yun Liu, Rong Yan, Jianyong Zhang, Xiaofei Li
{"title":"Prediction of the mechanisms of liver injury of Epimedii Folium by network pharmacology and validation in HepaRG Cells","authors":"Xiaotong Duan, Shan-gao Li, Qiyi Wang, Jing-Xian Liu, Tianmu He, Liu Liu, Meichen Liu, Yun Liu, Rong Yan, Jianyong Zhang, Xiaofei Li","doi":"10.53388/2022020206","DOIUrl":"https://doi.org/10.53388/2022020206","url":null,"abstract":"","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"11 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91447067","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}
{"title":"Overview about toxicology of cannabis smoking","authors":"Omar Negm","doi":"10.53388/20220202011","DOIUrl":"https://doi.org/10.53388/20220202011","url":null,"abstract":"","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87164267","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}
Preeti Gautam, D. Ghanghas, P. Mittal, Vikas Gupta, Kanika Dhiman
{"title":"Regulatory framework of cosmetic in the European Union","authors":"Preeti Gautam, D. Ghanghas, P. Mittal, Vikas Gupta, Kanika Dhiman","doi":"10.53388/20220202013","DOIUrl":"https://doi.org/10.53388/20220202013","url":null,"abstract":"","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89429201","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 : 2022-01-01DOI: 10.1080/24734306.2021.2006524
Caitlin Thompson, B. Malcolm, J. Tegzes
Abstract The ‘kambô’ ritual involves application of Phyllomedusa Bicolor poison to superficial burns made on the user’s skin. Existing kambô literature describes case reports of severe harms. The objective of the current study was to better characterize typical observed responses to kambô administration. We performed a retrospective review of a kambô practitioner’s practice. Statistical analysis was descriptive, and characterized the number of kambô points or location of points administered as well as physical responses such as facial swelling, diaphoresis, immediate bowel movement, syncope, and occurrence of emesis. There were 147 unique participants that underwent 241 kambô rituals included. The mean number of points administered was 4.2 ± 2.2, while the median was 3 (range 1–11). Common physical responses included facial swelling (70.5%), diaphoresis (53.3%), bowel movement (45.2%), and syncope (10.4%). Higher number of points administered and receiving kambô at multiple locations appeared to increase facial swelling and diaphoresis. Responses to kambô are likely to be dose-dependent. No severe adverse effects were recorded in the sample, although some responses or components of the kambô ritual may promote risks of harm due to hyponatremia, asphyxiation from emesis, and injury due to syncope.
{"title":"Use of Phyllomedusa bicolour secretion during kambô ritual: observational responses, dosage, and risk of adverse events","authors":"Caitlin Thompson, B. Malcolm, J. Tegzes","doi":"10.1080/24734306.2021.2006524","DOIUrl":"https://doi.org/10.1080/24734306.2021.2006524","url":null,"abstract":"Abstract The ‘kambô’ ritual involves application of Phyllomedusa Bicolor poison to superficial burns made on the user’s skin. Existing kambô literature describes case reports of severe harms. The objective of the current study was to better characterize typical observed responses to kambô administration. We performed a retrospective review of a kambô practitioner’s practice. Statistical analysis was descriptive, and characterized the number of kambô points or location of points administered as well as physical responses such as facial swelling, diaphoresis, immediate bowel movement, syncope, and occurrence of emesis. There were 147 unique participants that underwent 241 kambô rituals included. The mean number of points administered was 4.2 ± 2.2, while the median was 3 (range 1–11). Common physical responses included facial swelling (70.5%), diaphoresis (53.3%), bowel movement (45.2%), and syncope (10.4%). Higher number of points administered and receiving kambô at multiple locations appeared to increase facial swelling and diaphoresis. Responses to kambô are likely to be dose-dependent. No severe adverse effects were recorded in the sample, although some responses or components of the kambô ritual may promote risks of harm due to hyponatremia, asphyxiation from emesis, and injury due to syncope.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"27 1","pages":"6 - 12"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83176374","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：