Pub Date : 2021-01-01DOI: 10.1080/24734306.2021.1881231
T. Omi
Abstract Caffeine induces neurological effects at high doses. However, the duration and extent of neurological manifestations with respect to serum theophylline and caffeine concentrations is unknown. A 19-year-old woman suffering from severe caffeine overdose showed signs of neurological effects that persisted for more than 60 h despite hemodialysis and the normalization of caffeine and theophylline concentrations. Although serum theophylline and caffeine concentrations can be used to monitor the effect of severe caffeine overdose, central nervous system toxicity may persist after the concentrations normalize.
{"title":"Protracted effects of caffeine after hemodialysis for severe caffeine intoxication","authors":"T. Omi","doi":"10.1080/24734306.2021.1881231","DOIUrl":"https://doi.org/10.1080/24734306.2021.1881231","url":null,"abstract":"Abstract Caffeine induces neurological effects at high doses. However, the duration and extent of neurological manifestations with respect to serum theophylline and caffeine concentrations is unknown. A 19-year-old woman suffering from severe caffeine overdose showed signs of neurological effects that persisted for more than 60 h despite hemodialysis and the normalization of caffeine and theophylline concentrations. Although serum theophylline and caffeine concentrations can be used to monitor the effect of severe caffeine overdose, central nervous system toxicity may persist after the concentrations normalize.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"2 1","pages":"73 - 75"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75540849","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: 10.1080/24734306.2020.1870078
J. Clemons, Arvinder Jandu, B. Stein, Michael A. Chary
Abstract Diphenhydramine (DPH) is a lipophilic inverse agonist at the histamine receptor. Overdoses usually present with anticholinergic symptoms. Wide-complex tachycardia decompensating into cardiovascular collapse may occur in larger overdoses. Here we report a patient who developed ventricular dysrhythmias after ingestion of 83 mg/kg of diphenhydramine, went into cardiovascular collapse that was rescued with early administration of intravenous lipid emulsion.
{"title":"Early intravenous lipid emulsion therapy for diphenhydramine overdose: a case report","authors":"J. Clemons, Arvinder Jandu, B. Stein, Michael A. Chary","doi":"10.1080/24734306.2020.1870078","DOIUrl":"https://doi.org/10.1080/24734306.2020.1870078","url":null,"abstract":"Abstract Diphenhydramine (DPH) is a lipophilic inverse agonist at the histamine receptor. Overdoses usually present with anticholinergic symptoms. Wide-complex tachycardia decompensating into cardiovascular collapse may occur in larger overdoses. Here we report a patient who developed ventricular dysrhythmias after ingestion of 83 mg/kg of diphenhydramine, went into cardiovascular collapse that was rescued with early administration of intravenous lipid emulsion.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"7 1","pages":"15 - 18"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89517755","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: 10.1080/24734306.2021.1898161
J. Peck, S. Salhanick
Abstract Midodrine is a prodrug metabolized to the peripheral acting alpha agonist desglymidodrine and is used to treat orthostatic hypotension. Reports of overdose are rare, consequently there is little guidance regarding treatment of overdose. We report a case of toxicity following midodrine overdose and describe clinical findings and response to treatment. We also review the prior reported cases to determine what clinical findings are consistent and suggest a therapeutic approach. A 65-year-old man ingested 500 milligrams of midodrine. The patient presented to the emergency department within 45 min of the ingestion asymptomatic but with a blood pressure of 246/151 mmHg and heart rate of 69 beats per minute. The patient was treated for approximately 24 h with intravenous nitroglycerine with decrease in blood pressure. The patient recovered without apparent adverse sequelae. Midodrine overdose produces marked hypertension and relative bradycardia. These effects occur rapidly and resolve. Nitroglycerin appears to be safe and effective in controlling blood pressure following midodrine overdose.
{"title":"Acute midodrine overdose: a case report","authors":"J. Peck, S. Salhanick","doi":"10.1080/24734306.2021.1898161","DOIUrl":"https://doi.org/10.1080/24734306.2021.1898161","url":null,"abstract":"Abstract Midodrine is a prodrug metabolized to the peripheral acting alpha agonist desglymidodrine and is used to treat orthostatic hypotension. Reports of overdose are rare, consequently there is little guidance regarding treatment of overdose. We report a case of toxicity following midodrine overdose and describe clinical findings and response to treatment. We also review the prior reported cases to determine what clinical findings are consistent and suggest a therapeutic approach. A 65-year-old man ingested 500 milligrams of midodrine. The patient presented to the emergency department within 45 min of the ingestion asymptomatic but with a blood pressure of 246/151 mmHg and heart rate of 69 beats per minute. The patient was treated for approximately 24 h with intravenous nitroglycerine with decrease in blood pressure. The patient recovered without apparent adverse sequelae. Midodrine overdose produces marked hypertension and relative bradycardia. These effects occur rapidly and resolve. Nitroglycerin appears to be safe and effective in controlling blood pressure following midodrine overdose.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"10 1","pages":"82 - 84"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83001652","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: 10.1080/24734306.2020.1864967
K. Cumpston, Natasha Tobarran, Lindsay A Taylor, B. Wills
Abstract The evaluation of a patient after Crotalinae envenomation requires assessment of local and systemic signs and symptoms in conjunction with laboratory data. Point-of-care ultrasound (POCUS) is an emerging modality used to evaluate soft tissue changes associated with snake envenomations around the world. However, more data are needed to characterize sonographic findings of snake envenomation. Our study used POCUS to evaluate the depth of soft tissue injury, involvement of the muscles/tendons, and the proximal edge of envenomation. This was a prospective observational study evaluating the sonographic characteristics of Crotalinae envenomation. The eight patients enrolled in the study included one envenomated by a Western diamondback (Crotalus atrox), and the others were envenomated by copperheads (Agkistrodon contortrix). All the patients demonstrated initial subcutaneous cobblestoning on POCUS at the bite site. All digit envenomations revealed edema in the tendon or tendon sheath. None of these cases required acute surgical intervention. There were no sonographic signs of envenomation found below fascia or muscle. Four of the eight patients had POCUS findings of cobblestoning proximal to the edge of envenomation palpated on the extremity. The clinical significance of this is unknown.
{"title":"Sonographic extremity assessment of crotalinae envenomation","authors":"K. Cumpston, Natasha Tobarran, Lindsay A Taylor, B. Wills","doi":"10.1080/24734306.2020.1864967","DOIUrl":"https://doi.org/10.1080/24734306.2020.1864967","url":null,"abstract":"Abstract The evaluation of a patient after Crotalinae envenomation requires assessment of local and systemic signs and symptoms in conjunction with laboratory data. Point-of-care ultrasound (POCUS) is an emerging modality used to evaluate soft tissue changes associated with snake envenomations around the world. However, more data are needed to characterize sonographic findings of snake envenomation. Our study used POCUS to evaluate the depth of soft tissue injury, involvement of the muscles/tendons, and the proximal edge of envenomation. This was a prospective observational study evaluating the sonographic characteristics of Crotalinae envenomation. The eight patients enrolled in the study included one envenomated by a Western diamondback (Crotalus atrox), and the others were envenomated by copperheads (Agkistrodon contortrix). All the patients demonstrated initial subcutaneous cobblestoning on POCUS at the bite site. All digit envenomations revealed edema in the tendon or tendon sheath. None of these cases required acute surgical intervention. There were no sonographic signs of envenomation found below fascia or muscle. Four of the eight patients had POCUS findings of cobblestoning proximal to the edge of envenomation palpated on the extremity. The clinical significance of this is unknown.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"80 1","pages":"1 - 5"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90574671","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: 10.1080/24734306.2021.1903777
R. Hendrickson, Adrienne R. Hughes, S. Kusin, A. Lopez
Abstract Smoking botanical cannabis often produces tachycardia. However, infrequent reports describe bradycardia, particularly with edibles, concentrates, and resins. We compared the rate of tachycardia in patients with acute cannabis exposures from ingestion versus inhalation and botanical versus resins/concentrates/edibles. Prospective data collection instrument inserted into the case notes of the Oregon/Alaska Poison Center over a 17-month period. We excluded cases without a recorded heart rate. 101 patients met inclusion/exclusion criteria. Patients who inhaled cannabis products were more likely than those who ingested cannabis to have tachycardia (84% v 59%; p = 0.024). Amongst ingestions, tachycardia was more frequent with cannabis edibles than resins/concentrates (63% v 40%; p = 0.044). Amongst resin/concentrate exposures, inhalation more often produced tachycardia than ingestion (90% v 40%; p = 0.014). There was no difference in frequency of tachycardia amongst children (<12 years; 48%; 12/25) or adolescents (12-18 years; 77%; 20/26) when compared to adults (>18 years; 66%; 33/50). Six percent of patients had bradycardia, and all had significant symptoms of cannabis toxicity. The effects of cannabis exposure on heart rate are variable. Tachycardia is less common after ingestion of cannabis. Bradycardia occurs rarely after cannabis exposure, is associated with severe symptoms, and occurs in all age groups.
吸食植物大麻常引起心动过速。然而，很少有报道描述心动过缓，特别是食用、浓缩物和树脂。我们比较了急性大麻摄入与吸入、植物性与树脂/浓缩物/可食用大麻暴露患者的心动过速率。前瞻性数据收集工具插入俄勒冈/阿拉斯加中毒中心的案例笔记超过17个月的时间。我们排除了没有记录心率的病例。101例患者符合纳入/排除标准。吸入大麻产品的患者比摄入大麻的患者更容易发生心动过速(84% vs 59%;p = 0.024)。在摄入中，可食用大麻比树脂/浓缩大麻更容易发生心动过速(63% vs 40%;p = 0.044)。在树脂/浓缩物暴露中，吸入比摄入更容易产生心动过速(90% vs 40%;p = 0.014)。两组儿童的心动过速频率无差异(18岁;66%;33/50)。6%的患者患有心动过缓，所有患者都有明显的大麻毒性症状。大麻对心率的影响是可变的。摄取大麻后心动过速较不常见。接触大麻后很少发生心动过缓，与严重症状有关，并发生于所有年龄组。
{"title":"Variation in heart rate after acute cannabis exposure","authors":"R. Hendrickson, Adrienne R. Hughes, S. Kusin, A. Lopez","doi":"10.1080/24734306.2021.1903777","DOIUrl":"https://doi.org/10.1080/24734306.2021.1903777","url":null,"abstract":"Abstract Smoking botanical cannabis often produces tachycardia. However, infrequent reports describe bradycardia, particularly with edibles, concentrates, and resins. We compared the rate of tachycardia in patients with acute cannabis exposures from ingestion versus inhalation and botanical versus resins/concentrates/edibles. Prospective data collection instrument inserted into the case notes of the Oregon/Alaska Poison Center over a 17-month period. We excluded cases without a recorded heart rate. 101 patients met inclusion/exclusion criteria. Patients who inhaled cannabis products were more likely than those who ingested cannabis to have tachycardia (84% v 59%; p = 0.024). Amongst ingestions, tachycardia was more frequent with cannabis edibles than resins/concentrates (63% v 40%; p = 0.044). Amongst resin/concentrate exposures, inhalation more often produced tachycardia than ingestion (90% v 40%; p = 0.014). There was no difference in frequency of tachycardia amongst children (<12 years; 48%; 12/25) or adolescents (12-18 years; 77%; 20/26) when compared to adults (>18 years; 66%; 33/50). Six percent of patients had bradycardia, and all had significant symptoms of cannabis toxicity. The effects of cannabis exposure on heart rate are variable. Tachycardia is less common after ingestion of cannabis. Bradycardia occurs rarely after cannabis exposure, is associated with severe symptoms, and occurs in all age groups.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"20 1","pages":"88 - 92"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81716412","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: 10.1080/24734306.2021.1940753
G. Adamo, T. Jiranantakan, R. Auld, D. Roberts, C. McDonald, C. Harper, J. Brown
Background: Covid-19 resulted in a sharp increase in the use of, demand and supply for alcohol-based hand sanitisers. A dramatic increase in calls to the NSW Poisons Information Centre (PIC) regarding hand sanitiser exposures prompted this investigation into increased risks of hand sanitisers. Methods: This prospective observational study aims to evaluate hand sanitiser products resulting in calls to the NSW PIC from April to July 2020. Photos and extra information of products including brand, alcohol type and percent, bottle size, formulation, country of manufacture, amount ingested and symptoms were obtained during normal NSWPIC operation. Follow-up phone calls were made following caller’s permission to determine outcome of exposures. Two specialists in poisons information critically reviewed all images for compliance. First step determined whether the products classify as therapeutic goods or cosmetic goods in accordance with therapeutic good regulations. Second determined appropriateness of labelling and packaging respectively against its category. Results: 309 images were received from callers for 124 separate hand sanitisers. Review of images revealed 105 products (84.7%) classified as cosmetic goods, 17 made claims that classify them as therapeutic goods, of which 14 did not comply with regulations. NSWPIC reported these 14 products to the TGA and prompted relevant regulatory bodies and industry representatives. Only 3 of 124 products had ARTG number on the packaging. 18 products had packaging similar to drink/ beverage containers or cosmetics. Community members reported concerns of inappropriate packaging for another 15 products. There was a 2.2-times increase in calls to NSWPIC regarding hand-sanitisers from January to July 2020 (1095 cases) when compared to the same period in 2019 (504 cases). Most patients were children under 5 years old and had minor illness. No death was observed in our patients. Discussion: A significant number of hand sanitiser products in this study were misclassified by the manufactures and had inappropriate containers and labelling. Safety measures must be critically taken in timely manner to achieve safe hand sanitiser use. Poisons Information Centre has played an important role enacting prompt data collections and public health interventions leading to modification of the regulations and recommendations.
{"title":"Proceedings of the Toxicology and Poisons Network Australasia (TAPNA) 2021 Scientific Meeting","authors":"G. Adamo, T. Jiranantakan, R. Auld, D. Roberts, C. McDonald, C. Harper, J. Brown","doi":"10.1080/24734306.2021.1940753","DOIUrl":"https://doi.org/10.1080/24734306.2021.1940753","url":null,"abstract":"Background: Covid-19 resulted in a sharp increase in the use of, demand and supply for alcohol-based hand sanitisers. A dramatic increase in calls to the NSW Poisons Information Centre (PIC) regarding hand sanitiser exposures prompted this investigation into increased risks of hand sanitisers. Methods: This prospective observational study aims to evaluate hand sanitiser products resulting in calls to the NSW PIC from April to July 2020. Photos and extra information of products including brand, alcohol type and percent, bottle size, formulation, country of manufacture, amount ingested and symptoms were obtained during normal NSWPIC operation. Follow-up phone calls were made following caller’s permission to determine outcome of exposures. Two specialists in poisons information critically reviewed all images for compliance. First step determined whether the products classify as therapeutic goods or cosmetic goods in accordance with therapeutic good regulations. Second determined appropriateness of labelling and packaging respectively against its category. Results: 309 images were received from callers for 124 separate hand sanitisers. Review of images revealed 105 products (84.7%) classified as cosmetic goods, 17 made claims that classify them as therapeutic goods, of which 14 did not comply with regulations. NSWPIC reported these 14 products to the TGA and prompted relevant regulatory bodies and industry representatives. Only 3 of 124 products had ARTG number on the packaging. 18 products had packaging similar to drink/ beverage containers or cosmetics. Community members reported concerns of inappropriate packaging for another 15 products. There was a 2.2-times increase in calls to NSWPIC regarding hand-sanitisers from January to July 2020 (1095 cases) when compared to the same period in 2019 (504 cases). Most patients were children under 5 years old and had minor illness. No death was observed in our patients. Discussion: A significant number of hand sanitiser products in this study were misclassified by the manufactures and had inappropriate containers and labelling. Safety measures must be critically taken in timely manner to achieve safe hand sanitiser use. Poisons Information Centre has played an important role enacting prompt data collections and public health interventions leading to modification of the regulations and recommendations.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"2013 1","pages":"119 - 135"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82609443","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: 10.1080/24734306.2020.1869898
H. A. Abo El-Atta, Amany El-Hawary
Abstract Nowadays, exposures to some environmental chemicals may contribute to obesity in children. The aim of the current work is to assess the association between the environmental pollutants cadmium, malaoxon and malathion dicarboxylic acid (MDCA) and obesity in children. Authors conducted a case-control study on 80 children. We recruited 40 obese children and 40 normal-weight children. For each child, we measured urinary concentrations of cadmium (by ICP), malaoxon (by LC/MS/MS), and MDCA (by LC/MS/MS). Results: Malaoxon concentrations were slightly higher among non-obese group B children (median = 0, IQR 0 to 10.29 mg/g) than in obese group A children (median = 0, IQR = 0 to 2.14). There were no significant differences in creatinine-adjusted MDCA or Cadmium.
{"title":"Is childhood obesity a result of toxic exposure to cadmium or malathion? An observational pilot Egyptian study","authors":"H. A. Abo El-Atta, Amany El-Hawary","doi":"10.1080/24734306.2020.1869898","DOIUrl":"https://doi.org/10.1080/24734306.2020.1869898","url":null,"abstract":"Abstract Nowadays, exposures to some environmental chemicals may contribute to obesity in children. The aim of the current work is to assess the association between the environmental pollutants cadmium, malaoxon and malathion dicarboxylic acid (MDCA) and obesity in children. Authors conducted a case-control study on 80 children. We recruited 40 obese children and 40 normal-weight children. For each child, we measured urinary concentrations of cadmium (by ICP), malaoxon (by LC/MS/MS), and MDCA (by LC/MS/MS). Results: Malaoxon concentrations were slightly higher among non-obese group B children (median = 0, IQR 0 to 10.29 mg/g) than in obese group A children (median = 0, IQR = 0 to 2.14). There were no significant differences in creatinine-adjusted MDCA or Cadmium.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"13 1 1","pages":"11 - 14"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78253357","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: 10.1080/24734306.2021.1928366
Tomoki Hanazawa, Y. Kamijo, Tomohiro Yoshizawa, Kiyotaka Usui
Abstract The number of acute caffeine poisoning cases have increased in Japan. We can use serum caffeine concentrations to evaluate the severity of caffeine poisoning and determine whether or not we should perform hemodialysis. In this study, we sought to develop a rapid method for measuring serum caffeine concentrations. We used liquid chromatography-tandem mass spectrometry (LC-MS/MS) in the new method. We chose caffeine-d9 as the internal standard, and we used the standard addition method to quantify caffeine concentrations. We collected six blood samples from three patients with acute caffeine poisoning to measure serum caffeine concentrations. In our method, retention time for caffeine was 0.4 min, and the time required for the total LC-MS/MS analysis was 1 min per sample. We obtained accurate serum caffeine concentrations 7 min after injection into the LC-MS/MS instrument. Further, time-consuming sample pretreatment was not required because each sample was diluted 10,000-fold. As a result, we could obtain serum caffeine concentrations for each patient in a total of 40 min. Our findings suggest that rapid, accurate measurement of serum caffeine concentrations by LC-MS/MS could contribute to real-time evaluation of poisoning severity and determination of appropriate therapeutic strategies in acute clinical settings.
{"title":"Rapid measurement of serum caffeine concentrations in acuteclinical settings","authors":"Tomoki Hanazawa, Y. Kamijo, Tomohiro Yoshizawa, Kiyotaka Usui","doi":"10.1080/24734306.2021.1928366","DOIUrl":"https://doi.org/10.1080/24734306.2021.1928366","url":null,"abstract":"Abstract The number of acute caffeine poisoning cases have increased in Japan. We can use serum caffeine concentrations to evaluate the severity of caffeine poisoning and determine whether or not we should perform hemodialysis. In this study, we sought to develop a rapid method for measuring serum caffeine concentrations. We used liquid chromatography-tandem mass spectrometry (LC-MS/MS) in the new method. We chose caffeine-d9 as the internal standard, and we used the standard addition method to quantify caffeine concentrations. We collected six blood samples from three patients with acute caffeine poisoning to measure serum caffeine concentrations. In our method, retention time for caffeine was 0.4 min, and the time required for the total LC-MS/MS analysis was 1 min per sample. We obtained accurate serum caffeine concentrations 7 min after injection into the LC-MS/MS instrument. Further, time-consuming sample pretreatment was not required because each sample was diluted 10,000-fold. As a result, we could obtain serum caffeine concentrations for each patient in a total of 40 min. Our findings suggest that rapid, accurate measurement of serum caffeine concentrations by LC-MS/MS could contribute to real-time evaluation of poisoning severity and determination of appropriate therapeutic strategies in acute clinical settings.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"406 1","pages":"97 - 101"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76625393","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: 10.1080/24734306.2021.1918899
Sakshi Yadav, M. Ekka, P. Aggarwal, Nayer Jamshed, M. Yaseen
Abstract Organophosphate (OP) pesticide poisoning is one of the most common poisonings in India. Most self-poisoning involves pesticide ingestion. Parenteral pesticide poisoning is unusual. Here we report a case of a middle-aged man who presented with history of deliberate self-harm by injecting chlorpyrifos. The patient presented to the Emergency Department with cholinergic symptoms and blisters and ulcers on the right arm. This case represents an uncommon mode of OP pesticide toxicity and distinctive set of local complications secondary to injection.
{"title":"Deliberate self-harm with parenteral chlorpyrifos: a case report","authors":"Sakshi Yadav, M. Ekka, P. Aggarwal, Nayer Jamshed, M. Yaseen","doi":"10.1080/24734306.2021.1918899","DOIUrl":"https://doi.org/10.1080/24734306.2021.1918899","url":null,"abstract":"Abstract Organophosphate (OP) pesticide poisoning is one of the most common poisonings in India. Most self-poisoning involves pesticide ingestion. Parenteral pesticide poisoning is unusual. Here we report a case of a middle-aged man who presented with history of deliberate self-harm by injecting chlorpyrifos. The patient presented to the Emergency Department with cholinergic symptoms and blisters and ulcers on the right arm. This case represents an uncommon mode of OP pesticide toxicity and distinctive set of local complications secondary to injection.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"36 1","pages":"112 - 114"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75377883","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: 10.1080/24734306.2021.1903725
M. O’Brien, Michael A. Chary, P. Moonsamy, M. Burns, A. Tom, G. Cudemus
Abstract Introduction Bupropion overdose can produce seizures, arrhythmias, and shock. The toxicokinetics of massive bupropion ingestions are not well characterized. Case report A 22-year-old female ingested an estimated 40.5 g (644 mg/kg) of extended release bupropion. Subsequently she experienced seizures, required intubation, developed torsades des pointes that progressed to cardiac arrest, and required cannulation with venous-arterial extracorporeal membrane oxygenation (VA-ECMO). Intravenous lipid emulsion was administered without adversely affecting the ECMO circuit. The patient was successfully decannulated after 84 h of ECMO support and discharged neurologically intact. Serial bupropion and hydroxybupropion serum concentrations were drawn every 6-12 h starting on hospital day one and continuing for seven days, for a total of 22 serum concentrations each. Discussion The patient’s first bupropion and hydroxybupropion serum concentrations were 4000 ng/mL and 5300 ng/mL, respectively. Clearance of bupropion followed first order kinetics (t ½ = 20.6 h) while hydroxybupropion had zero order kinetics (t ½ = 118.5 h). Conclusion This bupropion overdose was treated with VA-ECMO with 20% lipid emulsion therapy, without complications. In this patient, the toxicokinetics of bupropion were first-order.
{"title":"Successful use of ECMO and lipid emulsion for massive bupropion overdose: a case report","authors":"M. O’Brien, Michael A. Chary, P. Moonsamy, M. Burns, A. Tom, G. Cudemus","doi":"10.1080/24734306.2021.1903725","DOIUrl":"https://doi.org/10.1080/24734306.2021.1903725","url":null,"abstract":"Abstract Introduction Bupropion overdose can produce seizures, arrhythmias, and shock. The toxicokinetics of massive bupropion ingestions are not well characterized. Case report A 22-year-old female ingested an estimated 40.5 g (644 mg/kg) of extended release bupropion. Subsequently she experienced seizures, required intubation, developed torsades des pointes that progressed to cardiac arrest, and required cannulation with venous-arterial extracorporeal membrane oxygenation (VA-ECMO). Intravenous lipid emulsion was administered without adversely affecting the ECMO circuit. The patient was successfully decannulated after 84 h of ECMO support and discharged neurologically intact. Serial bupropion and hydroxybupropion serum concentrations were drawn every 6-12 h starting on hospital day one and continuing for seven days, for a total of 22 serum concentrations each. Discussion The patient’s first bupropion and hydroxybupropion serum concentrations were 4000 ng/mL and 5300 ng/mL, respectively. Clearance of bupropion followed first order kinetics (t ½ = 20.6 h) while hydroxybupropion had zero order kinetics (t ½ = 118.5 h). Conclusion This bupropion overdose was treated with VA-ECMO with 20% lipid emulsion therapy, without complications. In this patient, the toxicokinetics of bupropion were first-order.","PeriodicalId":23139,"journal":{"name":"Toxicology communications","volume":"52 1","pages":"85 - 87"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74087075","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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