Best paper yet on screening suspected body packers
Body packer
4.5 out of 5 stars
Body packing: a review of general background, clinical and imaging aspects. Bert FH et al. Radiol Med 2014 Oct 10 [Epub ahead of print]
Abstract
I’d say this is the best article on imaging suspected body packers we’re likely to see, but with the rapid evolution of radiological technology it will likely need to be updated every year or so. Nevertheless, it is the best review of the topic available, and has spectacular illustrations.
The five authors rely on their experience as radiologists in major European cities, as well as published medical literature, to review test character...
Source: The Poison Review - December 3, 2014 Category: Toxicology Authors: Leon Tags: Medical body packer body pusher cocaine drug smuggling heroin mule Source Type: news
Infants eliminate ethanol at rate comparable to that in adults
2.5 out of 5 stars
Accidental Acute Alcohol Intoxication in Infants: Review and Case Report. Minera G, Robinson E. J Emerg Med 2014;47:524-526
Abstract
This case report describes a 9-week-old 9.5 kg boy who was brought to the emergency department when he was observed to be “acting strangely.” He smelled of alcohol.
History revealed that the grandmother had inadvertently prepared the infant’s formula with vodka instead of water.
The child’s respiratory rate was 22/min and oxygen saturation 99% on room air. Fingerstick glucose was 167 mg/dL on admission and serum alcohol level was 330 mg/dL. Repe...
Source: The Poison Review - December 1, 2014 Category: Toxicology Authors: Leon Tags: Medical Alcohol ethanol elimination rate ethanol intoxication infant pediatric Source Type: news
Haff Time: fish-induced rhabdomyolysis
Buffalo fish (Ictiobus cyprinellus)
3 out of 5 stars
Haff Disease: Rhabdomyolysis After Eating Buffalo Fish. Herman LL, Bies C. West J Emerg Med 2014 Sept;15:664-6.
Abstract
Haff Disease was first described in 1924 after an outbreak of acute muscle rigidity accompanied by dark urine among patients living near the Königsberger Haff shores along the Baltic Coast. Similar cases occurred in the following summers along the haff (a shallow lagoon.) Most victims gave a history of recently ingesting various fish — burbot, eel, pike, etc.
Cases of rhabdomyolysis after ingesting fish were not reported in the United States u...
Source: The Poison Review - November 24, 2014 Category: Toxicology Authors: Leon Tags: Medical fish poisoning haff disease palytoxin rhabdomyolysis Source Type: news
Tox Tunes #90: Junco Partner (The Clash)
//www.youtube.com/watch?v=RZOPte4hlqE
“Tox Tunes” has previously featured versions of “Junco Partner” by Dr. John and Professor Longhair. I love this reggae/punk take on the song from The Clash’s 1980 triple album Sandanista!. According to Dr. John, by the 1950s the song was known as an “anthem of the dopers, the whores, the pimps, the cons.” Joe Strummer of The Clash had already recorded “Junco Partner” with the previous band, the 101ers.
By the way, the best use of the name “The Clash” in someone else’s song undoubtedly occurs in Richard Thompson&...
Source: The Poison Review - November 23, 2014 Category: Toxicology Authors: Leon Tags: Medical junco partner sandanista the clash tox tunes Source Type: news
Pop quiz: cardiac arrhythmia from an herbal medicine
3 out of 5 stars
Life-threatening cardiovascular toxicity following ingestion of Chinese herbal medicine. Martinez A et al. Emerg Med Australas 2014 Oct;26:512-13.
Abstract
This case report describes a 46-year-old Chinese woman in Melbourne who presented with peri-oral and facial paresthesias, gastronintestinal disturbance (nausea, vomiting, diarrhea, abdominal pain,) tachycardia and hypotension. She also had decreased level of consciousness and ventricular tachycardia. Symptoms started 30 minutes after ingesting a Chinese herbal medicine.
The following is a pop quiz based on this presentation. Click on the question to r...
Source: The Poison Review - November 21, 2014 Category: Toxicology Authors: Leon Tags: Medical aconite cao wu cardiotoxicity Chinese herbal medicine chuan wu fu zi monkshood wolfsbane Source Type: news
What’s better for amatoxin poisoning: silibinin or leprechaun luck?
Amanita phalloides
2 out of 5 stars
Survival Following Investigational Treatment of Amanita Mushroom Poisoning: Thistle or Shamrock? Gores KM et al. Chest 2014 Oct 1 [Epub ahead of print]
Abstract
Amatoxins are potent RNA inhibitors, shutting down protein synthesis and producing hepatonecrosis and, occasionally, renal injury.
There is not generally accepted treatment for amatoxin-induced hepatotoxicity aside from supportive care, early multi dose activated charcoal, and liver transplant if indicated. There are, however, a number of unproven therapies that have been used and advocated in the past.
This case report, from th...
Source: The Poison Review - November 18, 2014 Category: Toxicology Authors: Leon Tags: Medical amanita phalloides amatoxin milk thistle mushroom poisoning silibinin Source Type: news
Crayola toxicology: life-threatening causes of bluish vomiting
This article does serve to remind us of 3 important not-to-miss ingestions on the differential when a patient shows up barfing blue. Unfortunately, the authors misses an obvious mnemonic: Cerulean Blue Puke = Copper sulfate, Boric acid, Paraquat.
Related posts:
Green urine
Propofol causes green urine
An elderly woman with purple urine (Source: The Poison Review)
Source: The Poison Review - November 14, 2014 Category: Toxicology Authors: Leon Tags: Medical blue vomit boric acid copper sulfate crayola toxicology emesis paraquat Source Type: news
Snorting bupropion
2.5 out of 5 stars
An 11-year review of bupropion insufflation exposures in adults reported to the California Poison Control System. Lewis JC et al. Clin Toxicol 2014 Nov;52:969-972.
Abstract
The abuse of bupropion by pulverizing and snorting the medication has been described at least as far back as 2002. Bupropion inhibits re-uptake of dopamine and norepinephrine, but apparently has little or no effect on serotonin. It is abused for its psychotropic effects that resemble those of amphetamine and cocaine..
A hallmark of overdose with sustained-release or extended-release bupropion formulations is delayed onset of seizures...
Source: The Poison Review - November 13, 2014 Category: Toxicology Authors: Leon Tags: Medical burpropion delayed seizures overdose toxicity Wellbutrin Zyban Source Type: news
Methoxphenidine: a designer dissociative drug
3 out of 5 stars
Acute toxicity associated with the recreational use of the novel dissociative psychoactive substance methoxphenidine. Hofer KE et al. Clin Toxicol 2014 Oct 28 [Epub ahead of print]
Abstract
Methoxphenidine (MXP) is a dissociative drug with actions apparently similar to those of phencyclidine (PCP), ketamine, and methoxetamine (MXE). It is often sold as a “research chemical” and labelled as “Not for Human Consumption.” The pharmacology and toxicology of MXP has not been well studied. Anecdotal reports on some drug forums describe anterograde amnesia and prolonged duration of effe...
Source: The Poison Review - November 12, 2014 Category: Toxicology Authors: Leon Tags: Medical case report designer drug dissociative ketamine methoxetamine pcp phencyclidine Source Type: news
Ban the Words: should the phrase “should be considered” be banished from the toxicology literature?
Interventions such as gastric lavage and whole bowel irrigation are labor intensive and associated with significant adverse effects. In addition, they have never been proven to improve clinical outcomes. Are we now at a point where we can stop discussing them, easing them into a dignified retirement along with ipecac-induced emesis? Many texts and review articles suggest that these interventions “should be considered” in selected toxicology cases. Should this phrase be banned from the literature?
I will be hosting a Twitter chat with @EM_News tomorrow from noon – 1 pm EST to talk about my November column ...
Source: The Poison Review - November 10, 2014 Category: Toxicology Authors: Leon Tags: Medical ban the words Emergency Medicine News gastric lavage whole bowel irrigation Source Type: news
Saturday with SMACC: Weingart on sepsis in New York City
In this brilliant talk from smaccGOLD last March in Australia, Scott Weingart talks about lessons from the STOP Sepsis Collaborative project in New York City based on their experience with 15,000 severe sepsis patients.
In brief, the Collaborative achieved a 22% reduction of in-patient mortality in these patients by relatively simple measures that did not involve early goal-directed therapy or fancy invasive monitoring. The key steps in their protocol involved:
early recognition of the septic patient
source control
reasonable but not massive fluid administration
inotropes
early antibiotics
meticulous intubation (if indica...
Source: The Poison Review - November 9, 2014 Category: Toxicology Authors: Leon Tags: Medical Paul Marik Scott Weingart septic shock SMACC Chicago smaccGold STOP sepsis collaborative Source Type: news
Sun Tzu and the Art of Focusing in Medical Toxicology
The philosophy expressed in Sun Tzu’s classic The Art of War has been applied to everything from military strategy to business management. But what does it have to teach practitioners of emergency medicine and medical toxicology? In my current column for Emergency Medicine News I discuss a very important lesson from the book that will completely change the way you read recommendations about gastric lavage and whole bowel irrigation still included in many textbook chapters and review articles. The read the column, click here.
By the way, EM News will be hosting a Twitter Chat about the column to take place on Tuesday,...
Source: The Poison Review - November 7, 2014 Category: Toxicology Authors: Leon Tags: Medical gastric lavage should be considered sun tzu whole bowel irrigation Source Type: news
There is no real evidence on treating calcium channel blocker overdose
2.5 out of 5 stars
Treatment of calcium channel blocker poisoning: A systematic review. St-Onge M et al. Clin Toxicol 2014 Nov;52:926-944.
Abstract
This systematic review is massive, intimidating, and all but unreadable.
As a prelude to establishing a clinical guideline for treatment of calcium channel blocker (CCB) overdose, the 14 Canadian authors systematically searched and evaluated relevant literature. They initially identified 15,577(!) citations, from which two reviewers selected 216 for analysis. These included case reports, case series, animal trials, and observational studies. No eligible controlled trials were ...
Source: The Poison Review - November 7, 2014 Category: Toxicology Authors: Leon Tags: Medical calcium channel blocker overdose evidence systematic review therapy Source Type: news
Use of alkyl nitrite “poppers” can cause permanent visual impairment
Some poppers are sold as “Leather Cleaner” or “Acetone-free nail polish remover”
3.5 out of 5 stars
Poppers maculopathy. Gruener AM et al. Lancet 2014;384:1606
Full Text
This case report describes a 30-year-old man who developed central visual impairment after using alkyl nitrite “poppers” as a sexual aid.
Eye exam revealed diminished visual acuity bilaterally, yellow foveal spots and damage to the retinal photoreceptors. Six months later, the visual impairment had not resolved.
Previous cases of visual damaged associated with the use of alkyl nitrite poppers have been reported. (See,...
Source: The Poison Review - November 5, 2014 Category: Toxicology Authors: Leon Tags: Medical alkyl nitrite eye damage isobutyl nitrite isopropyl nitrite maculopathy poppers visual impairment Source Type: news
Position statement on bystander naloxone
4 out of 5 stars
Position Statement: Expanding access to naloxone in the United States. Doyon S et al Clin Toxicol 2014 Oct 15 [Epub ahead of print]
Reference
This position statement was endorsed by the American Academy of Clinical Toxicology, the American College of Medical Toxicology, and the American Association of Poison control Centers.
The authors start off by noting the marked increase in overdose deaths that have tripled over the last 30 years, and resulted in what the CDC calls an epidemic. They point out that in 2010 there were over 15,000 deaths from prescription opioid overdose. They also state — without cit...
Source: The Poison Review - November 5, 2014 Category: Toxicology Authors: Leon Tags: Medical bystander naloxone intranasal narcan narcotic opiate opioid overdose Source Type: news
