Pub Date : 2021-01-01DOI: 10.1080/24734306.2021.1972691
Anita Mudan, J. Lebin, C. Smollin
Abstract Ingesting sodium nitrite as a suicide method appears to be gaining popularity, spurred by online suicide blogs and an easily obtainable product. However, the exact nature of this trend has not been studied. We conducted an 11-year retrospective review of intentional sodium nitrite ingestions reported to the National Poison Data System from January 1, 2009-December 31, 2019. We included all cases coded as “nitrite or nitrate” in the initial request. We requested full case records for the initial cohort to confirm details. NPDS recorded 390 individual “nitrite or nitrate” exposures during the study period, and 42 met inclusion criteria. We received full case records for 35/42 patients, and 17 were included in the final cohort (N = 17). The mean age was 23.2 years old. Visible cyanosis was present in 13/17 patients with a mean oxygen saturation of 85%. Methylene blue was administered in 14/17 cases with 8/17 requiring advanced cardiac life support. The overall mortality rate was 41% (7/17). All patients presented in the final two years of the study period. Intentionally ingesting sodium nitrite represents a novel, growing trend and carries a high mortality rate among young adults. Abbreviations: AAPCC, American Association of Poison Control Center; ACLS, Advanced Cardiac Life Support; CPCS, California Poison Control System; NPDS, National Poison Data System; PCC, Poison Control Center; SPI, Specialist in Poison Information.
{"title":"National Poison Data System (NPDS) review of intentional sodium nitrite ingestions 2009–2019","authors":"Anita Mudan, J. Lebin, C. Smollin","doi":"10.1080/24734306.2021.1972691","DOIUrl":"https://doi.org/10.1080/24734306.2021.1972691","url":null,"abstract":"Abstract Ingesting sodium nitrite as a suicide method appears to be gaining popularity, spurred by online suicide blogs and an easily obtainable product. However, the exact nature of this trend has not been studied. We conducted an 11-year retrospective review of intentional sodium nitrite ingestions reported to the National Poison Data System from January 1, 2009-December 31, 2019. We included all cases coded as “nitrite or nitrate” in the initial request. We requested full case records for the initial cohort to confirm details. NPDS recorded 390 individual “nitrite or nitrate” exposures during the study period, and 42 met inclusion criteria. We received full case records for 35/42 patients, and 17 were included in the final cohort (N = 17). The mean age was 23.2 years old. Visible cyanosis was present in 13/17 patients with a mean oxygen saturation of 85%. Methylene blue was administered in 14/17 cases with 8/17 requiring advanced cardiac life support. The overall mortality rate was 41% (7/17). All patients presented in the final two years of the study period. Intentionally ingesting sodium nitrite represents a novel, growing trend and carries a high mortality rate among young adults. Abbreviations: AAPCC, American Association of Poison Control Center; ACLS, Advanced Cardiac Life Support; CPCS, California Poison Control System; NPDS, National Poison Data System; PCC, Poison Control Center; SPI, Specialist in Poison Information.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"10 1","pages":"147 - 152"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88596948","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 : 2021-01-01Epub Date: 2021-02-10DOI: 10.1080/24734306.2020.1869899
Anand Upadhyaya, Laura R Marks, Evan S Schwarz, Stephen Y Liang, Michael J Durkin, David B Liss
Objectives: To define the care cascade for patients with serious injection drug use related infections (SIRI) in a tertiary hospital system and compare outcomes of those who did and did not participate in an opioid use disorder (OUD) treatment referral program.
Methods: The medical records of patients admitted with both OUD and SIRI including endocarditis, osteomyelitis, septic arthritis, epidural abscess, thrombophlebitis, myositis, bacteremia, and fungemia from 2016-2019 were retrospectively reviewed. Patient demographics, clinical covariates, 90-day readmission rates, and outcomes data were collected. We compared data from those who were successfully referred to outpatient care through Engaging Patients in Care Coordination (EPICC), a peer recovery specialist-run OUD treatment referral program, to those who did not receive outpatient referral.
Results: During the study period 334 persons who inject opioids were admitted with SIRI. Fourteen admitted patients died and were excluded from the analysis. The all-cause readmission rate was lower among patients referred to the EPICC program (18/76 [23.7%]) compared to those not referred to EPICC (100/244 [41.0%]) (OR 0.44; 95% CI 0.25 - 0.80).
Conclusion: An OUD care cascade evaluation for patients with SIRI demonstrated that referral to peer recovery services with outpatient OUD treatment was associated with reduced 90-day readmission rate.
目的:定义三级医院系统中严重注射药物使用相关感染(SIRI)患者的护理级联，并比较参加和未参加阿片类药物使用障碍(OUD)治疗转诊计划的患者的结果。方法:回顾性分析2016-2019年收治的心内膜炎、骨髓炎、脓毒性关节炎、硬膜外脓肿、血栓性静脉炎、肌炎、菌血症和真菌血症患者的病历。收集患者人口统计学、临床协变量、90天再入院率和结局数据。我们比较了通过参与患者护理协调(EPICC)(同伴康复专家运行的OUD治疗转诊项目)成功转诊到门诊的患者和没有转诊到门诊的患者的数据。结果:在研究期间，334名注射阿片类药物的人接受了SIRI。14例入院患者死亡，并被排除在分析之外。接受EPICC治疗的患者的全因再入院率(18/76[23.7%])低于未接受EPICC治疗的患者(100/244 [41.0%])(OR 0.44;95% ci 0.25 - 0.80)。结论:一项针对SIRI患者的OUD护理级联评估表明，转诊到同行康复服务机构接受门诊OUD治疗与降低90天再入院率相关。
{"title":"Care cascade for patients with opioid use disorder and serious injection related infections.","authors":"Anand Upadhyaya, Laura R Marks, Evan S Schwarz, Stephen Y Liang, Michael J Durkin, David B Liss","doi":"10.1080/24734306.2020.1869899","DOIUrl":"https://doi.org/10.1080/24734306.2020.1869899","url":null,"abstract":"<p><strong>Objectives: </strong>To define the care cascade for patients with serious injection drug use related infections (SIRI) in a tertiary hospital system and compare outcomes of those who did and did not participate in an opioid use disorder (OUD) treatment referral program.</p><p><strong>Methods: </strong>The medical records of patients admitted with both OUD and SIRI including endocarditis, osteomyelitis, septic arthritis, epidural abscess, thrombophlebitis, myositis, bacteremia, and fungemia from 2016-2019 were retrospectively reviewed. Patient demographics, clinical covariates, 90-day readmission rates, and outcomes data were collected. We compared data from those who were successfully referred to outpatient care through Engaging Patients in Care Coordination (EPICC), a peer recovery specialist-run OUD treatment referral program, to those who did not receive outpatient referral.</p><p><strong>Results: </strong>During the study period 334 persons who inject opioids were admitted with SIRI. Fourteen admitted patients died and were excluded from the analysis. The all-cause readmission rate was lower among patients referred to the EPICC program (18/76 [23.7%]) compared to those not referred to EPICC (100/244 [41.0%]) (OR 0.44; 95% CI 0.25 - 0.80).</p><p><strong>Conclusion: </strong>An OUD care cascade evaluation for patients with SIRI demonstrated that referral to peer recovery services with outpatient OUD treatment was associated with reduced 90-day readmission rate.</p>","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"5 1","pages":"6-10"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/24734306.2020.1869899","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25499670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1080/24734306.2020.1871550
S. Ebrahimi, H. Hassanian‐Moghaddam
Dear Editor We read with interest a recently published article by Rasimas et al. [1]. We agree that flumazenil is safe and effective, and we use it in our practice. However, we differ with the auth...
{"title":"Re: Antagonizing the errors of history: bedside experience with flumazenil","authors":"S. Ebrahimi, H. Hassanian‐Moghaddam","doi":"10.1080/24734306.2020.1871550","DOIUrl":"https://doi.org/10.1080/24734306.2020.1871550","url":null,"abstract":"Dear Editor We read with interest a recently published article by Rasimas et al. [1]. We agree that flumazenil is safe and effective, and we use it in our practice. However, we differ with the auth...","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"2 1","pages":"60 - 60"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87031155","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: 10.1080/24734306.2021.1918898
Eric Y. Du, Aditya Nellore, C. Pfeifer, Gershom Norfleet, A. Scalzo, Sarah B Riley
Abstract Taxus baccata (yew) is an easily accessible plant that can cause rapidly fatal cardiotoxicity upon ingestion. While it has been documented as both a method of suicide and homicide, such cases may be underreported due to the difficulty of recognition. Toxicity of the yew is due to the alkaloids Taxine A and Taxine B, both of which form 3,5-dimethoxyphenol metabolite. Neither alkaloids nor the metabolite is detected by routine drug screening. Here, we present a case of suicide by yew ingestion. 3,5-dimethoxyphenol was detected in gastric contents, postmortem blood and urine by two mass spectrophotometric techniques including high resolution mass spectrometry. The gastric contents contained a green, needlelike substance consistent with the yew plant. Utilizing broad spectrum screening by mass spectrometry along with comprehensive history may result in early detection of yew toxicity, facilitate treatment of cardiotoxicity, and improve survival.
{"title":"Dying to be with yew","authors":"Eric Y. Du, Aditya Nellore, C. Pfeifer, Gershom Norfleet, A. Scalzo, Sarah B Riley","doi":"10.1080/24734306.2021.1918898","DOIUrl":"https://doi.org/10.1080/24734306.2021.1918898","url":null,"abstract":"Abstract Taxus baccata (yew) is an easily accessible plant that can cause rapidly fatal cardiotoxicity upon ingestion. While it has been documented as both a method of suicide and homicide, such cases may be underreported due to the difficulty of recognition. Toxicity of the yew is due to the alkaloids Taxine A and Taxine B, both of which form 3,5-dimethoxyphenol metabolite. Neither alkaloids nor the metabolite is detected by routine drug screening. Here, we present a case of suicide by yew ingestion. 3,5-dimethoxyphenol was detected in gastric contents, postmortem blood and urine by two mass spectrophotometric techniques including high resolution mass spectrometry. The gastric contents contained a green, needlelike substance consistent with the yew plant. Utilizing broad spectrum screening by mass spectrometry along with comprehensive history may result in early detection of yew toxicity, facilitate treatment of cardiotoxicity, and improve survival.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"58 1","pages":"109 - 111"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85727781","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: 10.1080/24734306.2020.1870077
H. Spiller, Hannah L. Hays, M. Casavant
Abstract We reevaluate the treatment of mercury poisoning, incorporating recent advances in understanding of mercury toxicity and the mercury:selenium interaction. This review focuses on: 1) the role, limitations and benefits of chelation (Unithiol, succimer and N-Acetylcysteine); 2) the role of selenium supplementation; and 3) how the different forms of mercury are impacted by use of chelation and selenium. Unithiol and succimer produce increases in urinary excretion of mercury and to a lesser degree blood and total body mercury. The primary role of N-acetylcysteine is increasing renal mercury excretion, similar to the thiol-chelators. Additional unique features of acetylcysteine include increased efflux of methylmercury from the brain, and reduced oxidative stress via increased glutathione production. The role of selenium includes: 1) restoration of selenoprotein activity, 2) protection against mitochondrial injury and DNA damage, 3) demethylation of methylmercury, 4) sequestering of mercury via Hg:Se complexes, and 5) redistribution of Hg inside organisms. Selenium may increase blood Hg, via a “sink” effect, causing a redistribution of mercury away from the brain. A combined approach for mercury poisoning treatment was developed focusing on restoration of selenoprotein function, reduction of oxidative stress and increased mercury elimination.
{"title":"Rethinking treatment of mercury poisoning: the roles of selenium, acetylcysteine, and thiol chelators in the treatment of mercury poisoning: a narrative review","authors":"H. Spiller, Hannah L. Hays, M. Casavant","doi":"10.1080/24734306.2020.1870077","DOIUrl":"https://doi.org/10.1080/24734306.2020.1870077","url":null,"abstract":"Abstract We reevaluate the treatment of mercury poisoning, incorporating recent advances in understanding of mercury toxicity and the mercury:selenium interaction. This review focuses on: 1) the role, limitations and benefits of chelation (Unithiol, succimer and N-Acetylcysteine); 2) the role of selenium supplementation; and 3) how the different forms of mercury are impacted by use of chelation and selenium. Unithiol and succimer produce increases in urinary excretion of mercury and to a lesser degree blood and total body mercury. The primary role of N-acetylcysteine is increasing renal mercury excretion, similar to the thiol-chelators. Additional unique features of acetylcysteine include increased efflux of methylmercury from the brain, and reduced oxidative stress via increased glutathione production. The role of selenium includes: 1) restoration of selenoprotein activity, 2) protection against mitochondrial injury and DNA damage, 3) demethylation of methylmercury, 4) sequestering of mercury via Hg:Se complexes, and 5) redistribution of Hg inside organisms. Selenium may increase blood Hg, via a “sink” effect, causing a redistribution of mercury away from the brain. A combined approach for mercury poisoning treatment was developed focusing on restoration of selenoprotein function, reduction of oxidative stress and increased mercury elimination.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"135 11 1","pages":"19 - 59"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82979628","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: 10.1080/24734306.2021.1997013
M. Scanlon, R. Marino, A. Sidlak
Abstract Folic acid is a proposed adjunct to alcohol dehydrogenase inhibitors and hemodialysis (HD) in the treatment of methanol toxicity. Although animal models have shown increased formate clearance, human data regarding its efficacy are lacking. We performed a 7-year retrospective chart review of patients with methanol concentrations >10 mg/dL. We compared patients receiving scheduled dosing of 50 mg of folic acid (folate group) to those receiving no folic/folinic acid or <50 mg folic or folinic acid (low/no folate). We excluded patients who did not require hospitalization, those with alternative causes of acidosis, and those who died prior to therapy. The primary outcome measures were worsening metabolic acidosis, length of stay (LOS), and half-life of methanol. Of 27 patient visits with methanol concentration >10 mg/dL, 14 visits (11 patients) met inclusion criteria. Initial pH and methanol concentrations were similar between the two groups. There was no difference in LOS. No patients had worsening metabolic acidosis during therapy. In patients treated with and without HD, median half-lives of methanol were similar in both groups. Folic acid treatment provided no additional benefit to standard therapy for methanol toxicity. We cannot exclude potential benefit of folic acid on formate clearance.
{"title":"Folic acid in methanol toxicity: a retrospective cohort study","authors":"M. Scanlon, R. Marino, A. Sidlak","doi":"10.1080/24734306.2021.1997013","DOIUrl":"https://doi.org/10.1080/24734306.2021.1997013","url":null,"abstract":"Abstract Folic acid is a proposed adjunct to alcohol dehydrogenase inhibitors and hemodialysis (HD) in the treatment of methanol toxicity. Although animal models have shown increased formate clearance, human data regarding its efficacy are lacking. We performed a 7-year retrospective chart review of patients with methanol concentrations >10 mg/dL. We compared patients receiving scheduled dosing of 50 mg of folic acid (folate group) to those receiving no folic/folinic acid or <50 mg folic or folinic acid (low/no folate). We excluded patients who did not require hospitalization, those with alternative causes of acidosis, and those who died prior to therapy. The primary outcome measures were worsening metabolic acidosis, length of stay (LOS), and half-life of methanol. Of 27 patient visits with methanol concentration >10 mg/dL, 14 visits (11 patients) met inclusion criteria. Initial pH and methanol concentrations were similar between the two groups. There was no difference in LOS. No patients had worsening metabolic acidosis during therapy. In patients treated with and without HD, median half-lives of methanol were similar in both groups. Folic acid treatment provided no additional benefit to standard therapy for methanol toxicity. We cannot exclude potential benefit of folic acid on formate clearance.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"s3-33 1","pages":"153 - 157"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90824496","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: 10.1080/24734306.2021.1913913
M. J. Lee, J. Cho, Haewon Jung, J. Park, Yun-Jeong Kim, J. Seo, Hanseok Chang, Si-Yeon Won
Abstract Acute poisoning may necessitate identification of the toxic agent; however, several acutely poisoned patients are treated with minimal laboratory assistance. We investigated whether focused reference to laboratory toxicology tests conducted during a pilot project for a subregional analytical toxicology service influences treatment decisions. Patients with acute poisoning presented to the level 1 regional emergency medical center from May 2018 to April 2019 were initially reviewed. Poison samples were referred to the subregional toxicological analytical service. In total, 253 substance samples were tested among 111 patients during the study. According to the reported drug levels, 3 (1.2%) samples contained lethal doses, 49 (19%) had toxic levels, and 28 (11%) contained detectable levels of a lethal toxin or pesticide. Disagreement between the clinical assessment and laboratory analyses was found for 62 patients (fair kappa = 0.24, 56%), and they often had lower Glasgow Coma Scale, higher severity scores, older age, and less likelihood of receiving gastrointestinal decontamination. The regional analytical toxicology services were helpful for diagnostic planning and therapeutic management of acute poisoning. For seriously poisoned patients with inconsistent histories, it is necessary to reevaluate the classic therapeutic process based on the medical history.
{"title":"Analytical toxicology service model at the subregional center level for severe acute poisoning","authors":"M. J. Lee, J. Cho, Haewon Jung, J. Park, Yun-Jeong Kim, J. Seo, Hanseok Chang, Si-Yeon Won","doi":"10.1080/24734306.2021.1913913","DOIUrl":"https://doi.org/10.1080/24734306.2021.1913913","url":null,"abstract":"Abstract Acute poisoning may necessitate identification of the toxic agent; however, several acutely poisoned patients are treated with minimal laboratory assistance. We investigated whether focused reference to laboratory toxicology tests conducted during a pilot project for a subregional analytical toxicology service influences treatment decisions. Patients with acute poisoning presented to the level 1 regional emergency medical center from May 2018 to April 2019 were initially reviewed. Poison samples were referred to the subregional toxicological analytical service. In total, 253 substance samples were tested among 111 patients during the study. According to the reported drug levels, 3 (1.2%) samples contained lethal doses, 49 (19%) had toxic levels, and 28 (11%) contained detectable levels of a lethal toxin or pesticide. Disagreement between the clinical assessment and laboratory analyses was found for 62 patients (fair kappa = 0.24, 56%), and they often had lower Glasgow Coma Scale, higher severity scores, older age, and less likelihood of receiving gastrointestinal decontamination. The regional analytical toxicology services were helpful for diagnostic planning and therapeutic management of acute poisoning. For seriously poisoned patients with inconsistent histories, it is necessary to reevaluate the classic therapeutic process based on the medical history.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"32 1","pages":"102 - 108"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76017714","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: 10.1080/24734306.2021.2007602
D. Liss, Stephen M Roper, D. Dietzen, M. Mullins
Abstract Lithium poisoning remains common. Symptomatic lithium poisonings often require hemodialysis, especially when the patient has impaired renal function. An effective and non-invasive treatment to remove excess lithium would be desirable. We tested two recently approved, orally administered potassium binders in an in-vitro model. We used lithium-heparin tubes as both the source of lithium based prior studies showing the different volumes of serum in lithium-heparin tubes will produce apparent lithium concentrations in the range of toxicity (2.5 mmol/L and 5 mmol/L). We added three different volumes (0.5 mL, 0.75 mL, or 1.0 mL) of normal saline (NS) to the tubes. We calculated concentrations of sodium zirconium cyclosilicate (SZC, Lokelma®) and patiromer (Veltassa®) to simulate the ratio of drug to total body water for a 70 kg human. We prepared stock suspensions with different concentrations above and below the estimated ratios. We added varying concentrations of SZC or patiromer to tubes containing of NS. We measured sodium and lithium concentrations in duplicate for each concentration. Neither SZC nor patiromer reduced the lithium concentration across the range of concentrations in this in-vitro study.
{"title":"In-vitro study of lithium binding by sodium zirconium cyclosilicate (Lokelma®) or patiromer (Veltassa®)","authors":"D. Liss, Stephen M Roper, D. Dietzen, M. Mullins","doi":"10.1080/24734306.2021.2007602","DOIUrl":"https://doi.org/10.1080/24734306.2021.2007602","url":null,"abstract":"Abstract Lithium poisoning remains common. Symptomatic lithium poisonings often require hemodialysis, especially when the patient has impaired renal function. An effective and non-invasive treatment to remove excess lithium would be desirable. We tested two recently approved, orally administered potassium binders in an in-vitro model. We used lithium-heparin tubes as both the source of lithium based prior studies showing the different volumes of serum in lithium-heparin tubes will produce apparent lithium concentrations in the range of toxicity (2.5 mmol/L and 5 mmol/L). We added three different volumes (0.5 mL, 0.75 mL, or 1.0 mL) of normal saline (NS) to the tubes. We calculated concentrations of sodium zirconium cyclosilicate (SZC, Lokelma®) and patiromer (Veltassa®) to simulate the ratio of drug to total body water for a 70 kg human. We prepared stock suspensions with different concentrations above and below the estimated ratios. We added varying concentrations of SZC or patiromer to tubes containing of NS. We measured sodium and lithium concentrations in duplicate for each concentration. Neither SZC nor patiromer reduced the lithium concentration across the range of concentrations in this in-vitro study.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"33 1","pages":"161 - 164"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79130111","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: 10.1080/24734306.2021.1925443
Inês Ferraz de Oliveira, Jean-Baptiste Mesland, P. Laterre, P. Hantson
Abstract A 26-year-old man presented to the Emergency Department with lower urinary tract symptoms. He had a history of chronic ketamine abuse by sniffing over the last 6 years, with a recent increase in ketamine consumption. Acute kidney injury was related to bilateral hydronephrosis with dilatation of both ureters and irregularly thickened bladder walls. Laboratory investigations also revealed a marked hyponatremia and a major increase in liver enzymes consistent with a cholestatic injury. Finally, a pneumomediastinum was also diagnosed on the thoracic computed tomography. All these manifestations regressed after cessation of ketamine exposure. Chronic ketamine abuse may be associated with multiorgan toxicity. In particular, ketamine cystitis may be followed by obstructive complications leading to acute renal failure.
{"title":"Triad of obstructive uropathy, cholestasis, and pneumomediastinum associated with chronic ketamine abuse: a case report","authors":"Inês Ferraz de Oliveira, Jean-Baptiste Mesland, P. Laterre, P. Hantson","doi":"10.1080/24734306.2021.1925443","DOIUrl":"https://doi.org/10.1080/24734306.2021.1925443","url":null,"abstract":"Abstract A 26-year-old man presented to the Emergency Department with lower urinary tract symptoms. He had a history of chronic ketamine abuse by sniffing over the last 6 years, with a recent increase in ketamine consumption. Acute kidney injury was related to bilateral hydronephrosis with dilatation of both ureters and irregularly thickened bladder walls. Laboratory investigations also revealed a marked hyponatremia and a major increase in liver enzymes consistent with a cholestatic injury. Finally, a pneumomediastinum was also diagnosed on the thoracic computed tomography. All these manifestations regressed after cessation of ketamine exposure. Chronic ketamine abuse may be associated with multiorgan toxicity. In particular, ketamine cystitis may be followed by obstructive complications leading to acute renal failure.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"112 1","pages":"115 - 118"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85126864","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: 10.1080/24734306.2021.1973818
Jamie Prashek, Adham M. Mohamed, Tyler E. Barnes, Andrew B. Schlachter
Abstract Ethylene glycol toxicity can be fatal without prompt treatment. Treatment options may include ethanol, fomepizole, and intermittent hemodialysis (IHD). IHD is usually preferred; however, depending on a patient’s clinical presentation continuous renal replacement therapy (CRRT) for the removal of ethylene glycol may be desirable. A 36-year-old male presented after transfer from a referring hospital with coma, severe acidosis, and elevated osmolal gap. With suspicion of toxic alcohol poisoning, an ethylene glycol serum concentration was ordered and eventually resulted at 163 mg/dL. The care team decided to initiate treatment with fomepizole and IHD. Due to severe hypotension requiring vasopressors, the patient underwent CRRT in lieu of IHD. We further describe the rapid clearance of ethylene glycol with concurrent fomepizole and CRRT. High flow rate continuous venovenous hemodiafiltration (CVVHDF) combined with fomepizole, removes ethylene glycol from the body in a timely manner.
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