Pulse steroid therapy in adult respiratory distress syndrome following petroleum naphtha ingestion

A Multidrug Therapy for Hydrocarbon Aspiration With Acute Respiratory Distress Syndrome After Exposure to Oral Benzine Intake: A Case Report

Oral benzine intake with suicidal tendencies is an uncommon life-threatening respiratory emergency without a treatment regimen.

 A 50-year-old man attempted suicide with 100 ml of oral benzine intake and developed severe acute respiratory distress syndrome (ARDS) with hydrocarbon aspiration. He received mechanical ventilation with placement in the prone position and low tidal volume, neuromuscular blocking agents, bronchoalveolar lavage, steroid pulse therapy, antibiotics, and sivelestat sodium hydrate. He was transferred to the psychiatric hospital five days after admission without any adverse events.

ARDS associated with oral benzine intake could be treated with general treatments for ARDS.

A case of fatal intoxication by ingestion of an herbicide formulation containing fluroxypyr-meptyl and triclopyr

Fluroxypyr-meptyl and triclopyr are synthetic auxin-like herbicides that are used to control woody and broadleaf weeds. Herein, we report a case of fatal intoxication involving fluroxypyr-meptyl and triclopyr. A 61-year-old man was found dead at his farm with several suicide notes, and a white plastic bottle and a plastic cup with traces of white emulsion were found next to him. The plastic bottle was labeled as an herbicide formulation containing fluroxypyr-meptyl and triclopyr. Forensic toxicological screening of the stomach contents revealed the presence of fluroxypyr-meptyl, fluroxypyr and triclopyr. However, no fluroxypyr-meptyl was detected in blood owing to its rapid hydrolysis to fluroxypyr. In this study, fluroxypyr and triclopyr in blood were extracted using solid-phase extraction, and analyzed by liquid chromatography-tandem mass spectrometry. The analytical method was validated in terms of linearity, precision, accuracy, recovery and matrix effect, and the acceptable criteria were satisfied. Toxicological analysis showed that fluroxypyr and triclopyr concentrations were 19.7 μg/mL and 137.4 μg/mL in peripheral blood and 16.5 μg/mL and 147.8 μg/mL in heart blood, respectively. Based on these toxicological results and autopsy findings, the cause of death was determined to be acute fatal intoxication by ingestion of the pesticide containing fluroxypyr-meptyl and triclopyr. This is the first report of the determination of fluroxypyr and triclopyr in a fatal intoxication case.

The Combined Use of Inhaled and Intravenous Steroids for Children With Chemical Pneumonitis After Ingestion of Paint Thinner

Background

Some studies in the literature support the use of either inhaled or systemic steroids for the treatment of chemical pneumonitis; however, no data have been published on the combined use of inhaled and intravenous (IV) steroids.

Objectives

This brief report describes the effective use of inhaled plus systemic steroids in managing six critical pediatric patients.

Patients and Methods

Medical records of patients were analyzed retrospectively.

Results

Of the six patients, 83.3% (n = 5) were male and 16.7% (n = 1) were female, with a mean age of 2.1 ± 0.49 years. The most common clinical signs were dyspnea (83.3%), fever (66.6%), and vomiting (66.6%). Owing to supportive treatments and the combined steroid treatment, respiratory distress diminished and there was no need for oxygen in any of the patients after 5 days. All patients were discharged without any sequelae.

Conclusions

The use of steroids in treating hydrocarbon pneumonias is still controversial. However, we suggest that the combined use of inhaled and intravenous steroids had positive effects on the clinical and radiological recovery of our patients.

Household chemicals: management of intoxication and antidotes

Exposure to household products is very common, but in industrialized countries severe or fatal poisoning with household products is rare today, due to the legal restriction of sale of hazardous household products. The big challenge for physicians, pharmacologists and toxicologists is to identify the few exceptional life-threatening situations where immediate intervention is needed. Among thousands of innocuous products available for the household only very few are hazardous. Substances found in these products include detergents, corrosives, alcohols, hydrocarbons, and some of the essential oils. The ingestion of batteries and magnets and the exposure to cyanoacrylates (super glue) can cause complications in exceptional situations. Among the most dangerous substances still present in household products are ethylene glycol and methanol. These substances cause major toxicity only through their metabolites. Therefore, initial symptoms may be only mild or absent. Treatment even in asymptomatic patients has to be initiated as early as possible to inhibit production of toxic metabolites. For all substances not only the compound itself but also the route of exposure is relevant for toxicity. Oral ingestion and inhalation generally lead to most pronounced symptoms, while dermal exposure is often limited to mild irritation. However, certain circumstances need special attention. Exposure to hydrofluoric acid may lead to fatal hypocalcemia, depending on the concentration, duration of exposure, and area of the affected skin. Accidents with hydrocarbon pressure injectors and spray guns are very serious events, which may lead to amputation of affected limbs. Button batteries normally pass the gastrointestinal tract without problems even in toddlers; in rare cases, however, they get lodged in the esophagus with the risk of localized tissue damage and esophageal perforation.

Prediction of Prognosis for Acute Respiratory Distress Syndrome with Thin-Section CT: Validation in 44 Cases

PURPOSE

To retrospectively evaluate whether the thin-section computed tomographic (CT) appearance has prognostic value for prediction of mortality, number of ventilator-free days (ie, days without mechanical ventilation), and 28-day risk of barotrauma in patients with a clinically early stage of acute respiratory distress syndrome (ARDS) from diverse causes.

MATERIALS AND METHODS

Institutional review board approval and informed consent were obtained. Two independent observers who were blinded to patient outcomes retrospectively evaluated the thin-section CT scans obtained within 7 days after clinical ARDS onset in 26 survivors and 18 nonsurvivors. Of 44 patients, there were 37 men and seven women (mean age +/- standard deviation, 61.8 years +/- 15.6). CT findings were graded on a scale of 1-6 that corresponded with consecutive pathologic phases: score of 1, normal attenuation; score of 2, ground-glass attenuation; score of 3, consolidation; score of 4, ground-glass attenuation associated with traction bronchiolectasis or bronchiectasis; score of 5, consolidation associated with traction bronchiolectasis or bronchiectasis; and score of 6, honeycombing. An overall CT score was obtained by adding the six averaged scores (three zones in each lung). Multivariate regression analysis was used to assess the independent predictive value of the CT score.

RESULTS

The area of increased attenuation associated with traction bronchiolectasis or bronchiectasis (P = .002), as well as the overall CT score (P = .002), was smaller in survivors than in nonsurvivors. Results of multivariate regression analysis revealed that CT score was independently associated with mortality (P = .006). A CT score of less than 230 enabled prediction of survival with 73% sensitivity and 75% specificity and was associated with both a greater number of ventilator-free days (P = .018) and a lower incidence of barotrauma (P = .013) within 28 days after ARDS onset.

CONCLUSION

Extensive thin-section CT abnormalities indicative of fibroproliferative changes were independently predictive of poor prognosis in patients with a clinically early stage of ARDS.

Assessment and management of acute poisoning by petroleum products

Petroleum products are highly complex chemical mixtures consisting predominantly of hydrocarbons. Their composition varies with source and intended use of the product. Virtually all are blended products that come into contact with man in a wide range of circumstances. Their toxicity for man is generally low and the use of additives rarely affects the toxicity of the final product. Because products are blended to meet performance, and not chemical specifications, their composition varies significantly. Management of toxicity benefits from simplified guidelines that consider the product by its type. Management in most cases is symptomatic, but the doctor needs to be aware of the potential for development of sequelae such as aspiration pneumonia and central nervous system (CNS) depression. Local and systemic effects of exposure to hydrocarbons are reviewed, as are immediate assessment and recommended management of acute exposure to petroleum products. Because of the large scope of this subject, this paper limits itself to acute toxicity of petroleum products encountered inthe public domain. It does not address topics such as chronic toxicity, solvent abuse, petrochemicals, or pesticides.

Acute myocardial infarction and renal failure following naphtha ingestion

We present a case of a non-Q wave myocardial infarction and acute renal failure following an ingestion of naphtha, a petroleum distillate composed primarily of hydrocarbons. The patient's renal, metabolic, and cardiac status improved over several days with aggressive volume replacement and bicarbonate therapy. Acute cardiotoxic effects of hydrocarbon exposure generally manifest as dysrhythmias, secondary to myocardial sensitization to circulating catecholamines, or, possibly, coronary vasospasm. Ischemia from associated hypotension or direct myocardial toxicity are other potential causes of naphtha-related cardiac injury.