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Zhang Y, Zhu S, Wang C, Shi J, He J, Chen J, Liang L, Jiang F. Polymerase chain reaction-based methods for the rapid identification of Amanita exitialis. Food Chem 2024; 448:139086. [PMID: 38520990 DOI: 10.1016/j.foodchem.2024.139086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/04/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024]
Abstract
Amanita exitialis, a deadly mushroom found in eastern Asia, causes the highest death rates among all poisonous mushrooms in China. The aim of the present study was to develop an efficient, accurate, and user-friendly PCR-based method for identifying A. exitialis that could facilitate the prevention, diagnosis, and treatment of associated food poisoning. A. exitialis-specific primers and probes were designed based on the internal transcribed spacer region variations of 27 mushroom species. Specificity was confirmed using conventional and real-time PCR for 23 non-target mushroom species, including morphologically similar and closely related species. Compared to conventional PCR, real-time PCR was more sensitive (detectable DNA concentration: 1.36 × 10-2 ng/μL vs. 1.36 × 10-3) and efficient (analysis time: 1 h vs. 40 min). Furthermore, the real-time PCR results could be immediately visualized using amplification curve analysis. The results present two robust PCR-based methods for A. exitialis identification that can facilitate food safety.
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Affiliation(s)
- Yu Zhang
- Chinese Academy of Inspection and Quarantine, Beijing 100176, China.
| | - Shuifang Zhu
- Chinese Academy of Inspection and Quarantine, Beijing 100176, China.
| | - Chaonan Wang
- Chinese Academy of Inspection and Quarantine, Beijing 100176, China; Department of Plant Pathology, College of Plant Protection, Henan Agricultural University, Zhengzhou 450002, China.
| | - Junxia Shi
- Chinese Academy of Inspection and Quarantine, Beijing 100176, China.
| | - Jiayao He
- Chinese Academy of Inspection and Quarantine, Beijing 100176, China.
| | - Jian Chen
- Zhongshan Customs Technology Center, Zhongshan, Guangdong 528403, China.
| | - Liang Liang
- Academy of Agricultural Planning and Engineering, MARA, Beijing 100125, China.
| | - Fan Jiang
- Chinese Academy of Inspection and Quarantine, Beijing 100176, China.
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2
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Kumar S, Dabbas S, Manisha F, Akta H, Al Jaber E. Isopropyl Alcohol Intoxication Treated With Hemodialysis: A Case Report and Short Review. Cureus 2024; 16:e52580. [PMID: 38371041 PMCID: PMC10874632 DOI: 10.7759/cureus.52580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/20/2024] Open
Abstract
Isopropyl alcohol (IPA) is a common constituent of rubbing alcohol, household cleaning agents, and antiseptic agents. Ingestion of IPA usually leads to self-resolving mild symptoms in most cases but can result in severe symptoms, including central nervous system depression or hemodynamic instability. Treatment is mainly supportive, and hemodialysis is generally reserved for severe intoxication. Limited data are available on the use of hemodialysis to treat IPA intoxication. We are presenting a case of accidental ingestion of IPA in an elderly female with dementia leading to severe intoxication requiring hemodialysis at relatively non-toxic serum levels of IPA. The patient had a prompt recovery without any post-procedural or hospital-acquired complications.
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Affiliation(s)
- Sagar Kumar
- Pulmonary Critical Care, University of South Alabama University Hospital, Mobile, USA
| | - Sarah Dabbas
- Internal Medicine, Springhill Hospital, Mobile, USA
| | - Fnu Manisha
- Internal Medicine, Peoples University of Health Sciences, Nawab Shah, PAK
| | - Huma Akta
- Internal Medicine, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Emad Al Jaber
- Nephrology, University of South Alabama College of Medicine, Mobile, USA
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Erginel B, Kaba M, Karadag CA, Yildiz A, Demir M, Sever N. Foley catheter technique for the extraction of coins lodged in the upper esophagus of children. BMC Pediatr 2023; 23:605. [PMID: 38031091 PMCID: PMC10687970 DOI: 10.1186/s12887-023-04328-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Coins are the most commonly ingested foreign bodies in children. They usually become lodged in the upper oesophagus and should be managed immediately. The aim of the present study was to evaluate the characteristics and outcomes of patients with coins lodged in the upper oesophagus, who underwent coin removal using a silicone Foley balloon catheter without fluoroscopy or anaesthesia and evaluate the safety of the procedure. MATERIALS AND METHODS Patients who were admitted from January 2007 to December 2022 for coins lodged in the oesophagus and extracted with silicone Foley balloon catheter without anestehesia were evaluated retrospectively. We focused on the patient characteristics and clinical presentations, and the treatment safety, efficacy, and outcomes. RESULTS 773 patients (416 male, 357 female), with a mean age of 3.5 years (range 6 months to 16 years), who ingested coin and extracted with Foley catether is included. The majority of patients (n = 728, 94.17%) were successfully managed by silicone Foley balloon catheter extraction. Our overall success was 94.17%, with 88.30% of coins retrieved and 5.9% pushed into the stomach. Patients who were successfully treated with Foley catheter were discharged on the same day except for 7 (0.90%) who had minimal bleeding. Only 45 (5.82%) patients required oesophagoscopy in the operating room and these patients were kept overnight for clinical follow-up, without any further interventions. CONCLUSION A Foley balloon catheter can be used to safely and effectively remove coins that are lodged in the upper oesophagus avoiding the risk of general anesthesia.
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Affiliation(s)
- Basak Erginel
- Istanbul Medical Faculty, Department of Pediatric Surgery, Istanbul University, Istanbul, Turkey.
| | - Meltem Kaba
- Department of Pediatric Surgery, Sarıyer Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Cetin Ali Karadag
- Department of Pediatric Surgery, Sarıyer Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Abdullah Yildiz
- Department of Pediatric Surgery, Sarıyer Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mesut Demir
- Department of Pediatric Surgery, Sarıyer Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Nihat Sever
- Department of Pediatric Surgery, Sarıyer Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Yao Q, Wu Z, Zhong J, Yu C, Li H, Hu Q, He J, Du J, Sun C. A network system for the prevention and treatment of mushroom poisoning in Chuxiong Autonomous Prefecture, Yunnan Province, China: implementation and assessment. BMC Public Health 2023; 23:1979. [PMID: 37821850 PMCID: PMC10568813 DOI: 10.1186/s12889-023-16042-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/02/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Mushroom poisoning is a major public health issue in China. The integration of medical resources from different institutes of different levels is crucial in reducing the harm of mushroom poisoning. However, few studies have provided comprehensive implementation procedures and postimplementation effectiveness evaluations. To reduce the harm caused by mushroom poisoning, a network system for the prevention and treatment of mushroom poisoning (NSPTMP) was established in Chuxiong, Yunnan Province, a high-risk area for mushroom poisoning. METHODS The NSPTMP consists of three types of institutions, namely, centers for disease prevention, hospitals, and health administration departments, with each kind of institution comprising prefecture, county/city, town, and village levels. After three years of implementation, the network was evaluated by comparing the indices before and after network implementation using data from the "Foodborne Disease Outbreak Surveillance System" and 17 hospitals in Chuxiong. The indices included the fatalities caused by mushroom poisoning, the composition ratios of different types of mushrooms for both outpatients and inpatients and the hospitalization rates. RESULTS Compared to the average fatality rate of mushroom poisoning from 2015 to 2017, the average fatality rate from 2018 to 2020 significantly decreased from 0.57 to 0.06% (P < 0.001). Regarding the poisonous genus containing lethal mushrooms, the outpatient and inpatient composition ratios significantly decreased for Amanita (9.36-2.91% and 57.23-17.68%, respectively) and Russula (15.27-8.41%) (P < 0.05). Regarding poisonous mushrooms that caused mild symptoms, the outpatient and inpatient composition ratios significantly increased for Scleroderma (5.13-13.90% and 2.89-18.90%, respectively) and Boletaceae (19.08-31.71%) (P < 0.05), and the hospitalization rates significantly increased for Scleroderma (6.33-18.02%) and Boletaceae (5.65-12.71%) (P < 0.05). CONCLUSIONS These findings suggest that the NSPTMP effectively reduced the harm caused by mushroom poisoning. In addition to the integration of medical resources, the development of poisonous mushroom identification, hierarchical treatment systems in hospitals, public education, and professional training also played important roles in improving the system's effectiveness. The establishment and evaluation of the NSPTMP in Chuxiong Prefecture can provide valuable insights and serve as a model for other regions facing similar challenges in managing mushroom poisoning.
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Affiliation(s)
- Qunmei Yao
- Department of Emergency Medicine, The People's Hospital of Chuxiong Yi Autonomous Prefecture, Chuxiong, 675000, Yunnan, China
| | - Zhijun Wu
- National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Jiaju Zhong
- Department of Emergency Medicine, The People's Hospital of Chuxiong Yi Autonomous Prefecture, Chuxiong, 675000, Yunnan, China
| | - Chengmin Yu
- Department of Emergency Medicine, The People's Hospital of Chuxiong Yi Autonomous Prefecture, Chuxiong, 675000, Yunnan, China
| | - Haijiao Li
- National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Qiuling Hu
- Chuxiong Yi Minority Autonomous Prefecture Center for Disease Control and Prevention, Chuxiong, 675000, Yunnan, China
| | - Jianrong He
- Chuxiong Health Commission, Chuxiong, 675000, Yunnan, China
| | - Jianping Du
- Dayao People's Hospital, Dayao, 675400, Yunnan, China
| | - Chengye Sun
- National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, 100050, China.
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Kohara S, Kamijo Y, Seki S, Hasegawa E. Poisoning by abnormally high blood phenobarbital concentration treated with extracorporeal therapy. Am J Emerg Med 2023; 72:221.e5-221.e7. [PMID: 37635049 DOI: 10.1016/j.ajem.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 07/27/2023] [Accepted: 08/18/2023] [Indexed: 08/29/2023] Open
Abstract
Phenobarbital poisoning, which may cause circulatory collapse as well as respiratory arrest in severe cases, has one of the highest mortality rates among acute drug poisonings. A 58-year-old man arrived at the emergency room in a deep coma (Glasgow Coma Scale E1V1M1) after taking an unknown dose of phenobarbital which had been prescribed for his cat's seizures. Venous blood gas analysis revealed hypercapnia (PvCO2: 113.0 mmHg) and a blood phenobarbital concentration of 197.3 μg/mL. Shortly after his arrival, respiratory arrest and circulatory collapse occurred. Mechanical ventilation after intubation, intravenous noradrenaline infusion, and multiple-dose activated charcoal through a nasogastric tube was started. Six hours after arrival, blood phenobarbital concentration was abnormally elevated to 356.8 μg/mL with circulatory collapse requiring an increased dose of intravenous noradrenaline infusion (up to 0.13 μg/kg/min). Continuous renal replacement therapy including high flow continuous hemodialysis was performed until hospital day 5, during which blood phenobarbital concentration decreased to 96.2 μg/mL on hospital day 4, resulting in a sufficient resumption of spontaneous breathing and full improvement of circulatory collapse. A search of the literature revealed that the peak phenobarbital concentration in the present case exceeded those of fatal cases, as well as those of survivors of acute phenobarbital poisoning. However, the patient was successfully treated with continuous renal replacement therapy. Among modalities of extracorporeal treatment, continuous renal replacement therapy could be considered if a patient's circulation is unstable.
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Affiliation(s)
- Saeko Kohara
- Department of Clinical Toxicology, Saitama Medical University, 38 Morohongo, Moroyama-cho, Iruma-gun, Saitama, 355-0495, Japan; Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midoricho, Tachikawa, Tokyo, 190-0014, Japan.
| | - Yoshito Kamijo
- Department of Clinical Toxicology, Saitama Medical University, 38 Morohongo, Moroyama-cho, Iruma-gun, Saitama, 355-0495, Japan
| | - Satoshi Seki
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midoricho, Tachikawa, Tokyo, 190-0014, Japan
| | - Eiju Hasegawa
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midoricho, Tachikawa, Tokyo, 190-0014, Japan
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Gona SR, Rosenberg J, Fyffe-Freil RC, Kozakiewicz JM, Money ME. Review: Failure of current digoxin monitoring for toxicity: new monitoring recommendations to maintain therapeutic levels for efficacy. Front Cardiovasc Med 2023; 10:1179892. [PMID: 37465455 PMCID: PMC10350506 DOI: 10.3389/fcvm.2023.1179892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/14/2023] [Indexed: 07/20/2023] Open
Abstract
The current recommendations for monitoring digoxin, a narrow therapeutic index drug, are limited to confirming medication use or investigating suspicion of toxicity and fail our oath to do no harm. Numerous meta-analyses evaluating digoxin use consistently recommend frequent monitoring to maintain the level of 0.5 to ≤1.0 ng/ml because higher levels lead to increased morbidity and mortality without benefit. Data from the United States National Poison Control Center (2012-2020) show annual deaths due to digoxin of 18-36 compared to lithium's 1-7, and warfarin's 0-2 respectively. The latter drugs also have narrow therapeutic indexes like digoxin yet are more carefully monitored. Recognition of digoxin toxicity is impaired as levels are not being routinely checked after medications are added to a patient's regimen. In addition, providers may be using ranges to guide treatment that are no longer appropriate. It is imperative that monitoring guidelines and laboratory therapeutic levels are revised to reduce morbidity and mortality due to digoxin. In this review, we provide a comprehensive literature review of digoxin monitoring guidelines, digoxin toxicity, and evidence to support revising the ranges for serum digoxin monitoring.
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Affiliation(s)
- Sridhar Rao Gona
- Department of Pharmacy, Meritus Medical Center, Hagerstown, MD, United States
| | - Joel Rosenberg
- MedStar Cardiology Associates, Washington, DC, United States
| | - Ria C. Fyffe-Freil
- Division of Clinical Biochemistry & Immunology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | | | - Mary E. Money
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Medicine, Meritus Medical Center, Hagerstown, MD, United States
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Roversi M, Martini M, Musolino A, Pisani M, Zampini G, Genuini L, Bottari G, Di Nardo M, Stoppa F, Marano M. Drug self-poisoning in adolescents: A report of 267 cases. Toxicol Rep 2023; 10:680-685. [PMID: 37304378 PMCID: PMC10247951 DOI: 10.1016/j.toxrep.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/17/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction The current study aims at describing a sample of adolescents admitted to a tertiary referral pediatric hospital for drug self-poisoning and to identify variables that could explain and predict a higher severity of intoxication. Methods We retrospectively reviewed the cases of drug self-poisoning in adolescents admitted to the Bambino Gesù Children's Hospital between January 2014 and June 2022 requiring consultation by the local Pediatric Poison Control Center (PPCC). We reported the type and class of drug ingested and correlated the clinical characteristics of the patients with their Poison Severity Score. Results The data of 267 patients were reported. Most patients were female (85.8 %), with a median age of 15.8 years at presentation. Half of the patients were symptomatic at admission (44.2 %), and most had at least one psychiatric comorbidity (71.1 %). Most patients were hospitalized (79.6 %), 16.6 % of cases required antidote administration and a minority required intensive care. Most patients received a PSS score of 0 (59.6 %). The most frequently ingested drug was acetaminophen (28.1 %) followed by ibuprofen (10.1 %) and aripiprazole (10.1 %). Antipsychotics as a class were the most abused drugs (33.1 %). The correlation of clinical variables with the PSS showed that older and male patients were more prone to be severely intoxicated. Conclusions This single-center study identifies the most commonly ingested drugs in a large sample of adolescents with voluntary drug self-poisoning, also showing that older and male patients are more susceptible to severe intoxication.
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Affiliation(s)
- Marco Roversi
- Clinical Trial Area, Development and Implementation of Drugs, Vaccines, and Medical Devices for pediatric use, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Matteo Martini
- Pediatric Poison Control Centre, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonio Musolino
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Mara Pisani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giorgio Zampini
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Leonardo Genuini
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Gabriella Bottari
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Francesca Stoppa
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Marco Marano
- Pediatric Poison Control Centre, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Al-Namnakani B, Zell-Kanter M. Bupropion: Does Its Efficacy Outweigh Potential Morbidity and Lethality? Pediatr Ann 2023; 52:e178-e179. [PMID: 37159067 DOI: 10.3928/19382359-20230307-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Bupropion is a structurally and biochemically unique antidepressant that inhibits the neuronal uptake of dopamine and norepinephrine. Often prescribed for children and adolescents, bupropion displays both neurologic and cardiac toxicities in overdose more serious than toxicities resulting from poisonings by tricyclic antidepressants and selective serotonin reuptake inhibitors. Bupropion was briefly removed from the market in the 1980s. The incidence of bupropion poisonings in the United States, and resultant morbidity and mortality in children and adolescents, has been steadily increasing since 2012. Antidepressants less toxic than bupropion in overdose should be considered in the vulnerable 6- to 19-year-old patient population. [Pediatr Ann. 2023;52(5):e178-e180.].
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Greene SC, Wyatt K, Cates AL, Weiss S. Anticonvulsant fatalities reported to the American Association of Poison Control Centers 2000 - 2019. Seizure 2023; 106:1-6. [PMID: 36682209 DOI: 10.1016/j.seizure.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Anticonvulsants are frequently prescribed, and exposures are commonly reported to American Association of Poison Control Centers sites. The purpose of this study was to describe the epidemiology of fatalities associated with oral anticonvulsant use, including patient demographics, specific medications, and the circumstances surrounding the deaths. METHODS This was a retrospective analysis of cases coded with oral anticonvulsants as a single substance and associated with a fatal outcome reported to the AAPCC National Poison Data System from 2000 to 2019. Polydrug ingestions and parenteral exposures were excluded. Patient characteristics, circumstances of the ingestion, specific medication, and chronicity of use were described. RESULTS We identified 126 cases that were classified as fatalities associated with single anticonvulsant use. The five most implicated anticonvulsants were carbamazepine, gabapentin, lamotrigine, phenytoin, and valproic acid. The majority (68.3%) of fatal cases were suicides. Phenytoin was implicated in eight (89%) adverse reactions and seven (70%) therapeutic errors. Valproic acid caused one (11.1%) adverse reaction and was associated with one (10%) therapeutic error. Three (75%) unintentional fatalities were caused by carbamazepine. The plurality (42.1%) of fatal ingestions occurred in acute-on-chronic use. An additional 40 (31.7%) were acute. Chronic use accounted for 15 (11.9%) of fatal exposures, including 5/10 of fatalities attributed to therapeutic error. The chronicity of medication use was unknown in 18 (14.3%) of fatal ingestions. Narrative summaries were available in 14 cases. Four of the patients presented to the emergency department with minimal symptoms. The other 10 had varying degrees of central nervous system (CNS) depression. Seizures were observed in six cases. Hyperammonemia was reported in seven of nine valproic acid ingestions. CONCLUSIONS Fatalities associated with isolated anticonvulsant use are uncommon and typically occur following intentional overdoses. Fatal adverse reactions and therapeutic errors are most associated with phenytoin use and disproportionately affect elderly patients.
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Affiliation(s)
- Spencer C Greene
- Department of Clinical Sciences, University of Houston College of Medicine, 4349 Martin Luther King Blvd, Houston, TX 77004, United States.
| | - Kimberly Wyatt
- Department of Biological Sciences, Good Samaritan College, 375 Dixmyth Ave, Cincinnati, OH, 45220, United States
| | - Alexis L Cates
- Albert Einstein Health Network, Department of Emergency Medicine, Division of Medical Toxicology, 5501 Old York Road, Philadelphia, PA 19141, United States
| | - Sarah Weiss
- Department of Emergency Medicine, Reading Hospital, 420 S 5th Ave, West Reading, PA 19611, United States
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Meisel EM, Morgan B, Schwartz M, Kazzi Z, Cetin H, Sahin A. Two Cases of Severe Amanita Muscaria Poisoning Including a Fatality. Wilderness Environ Med 2022; 33:412-416. [PMID: 36210279 DOI: 10.1016/j.wem.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/02/2022] [Accepted: 06/19/2022] [Indexed: 11/21/2022]
Abstract
Ingestion of Amanita muscaria mushrooms results in transient central nervous system excitation and depression mediated by its components, ibotenic acid and muscimol. The mushroom is distributed worldwide and ingestions occur with some frequency. Although these ingestions have traditionally been considered benign, serious complications can occur. We present 2 cases of serious toxicity, including a fatality. The first case was a 44-y-old man who presented to the emergency department (ED) after cardiopulmonary arrest approximately 10 h after ingesting 4 to 5 dried A muscaria mushroom caps, which he used for their mind-altering effects. Despite successful resuscitation, he remained unresponsive and hypotensive and died 9 days later. The second case was a 75-y-old man who presented to the ED after accidentally consuming one large A muscaria mushroom cap he foraged in Eastern Turkey. The patient initially presented to the ED with hallucinations followed by lethargy, and he was intubated for airway protection. The patient's condition gradually improved, and he made a full recovery. A muscaria ingestion should not be considered benign as serious outcomes do occur. An understanding of how the main neuroactive chemicals, ibotenic acid and muscimol, affect the brain can help anticipate outcomes. Several high-risk features that portend a more serious course are identified.
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Affiliation(s)
- Ethan M Meisel
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA; Department of Emergency Medicine, Atlanta VA Healthcare System, Atlanta, GA.
| | - Brent Morgan
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
| | - Michael Schwartz
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA; United States Department of Health and Human Services Chemical Medical Countermeasures Branch/Biomedical Advanced Research and Development Authority/Assistant Secretary for Preparedness and Response/HHS, Washington, DC
| | - Ziad Kazzi
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
| | - Huseyin Cetin
- The Council of Forensics Medicine, Trabzon Chairmanship, Trabzon, Turkey
| | - Aynur Sahin
- Department of Emergency Medicine, Karadeniz Technical University, Trabzon, Turkey
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Adolescent Occupational Exposures Reported to United States Poison Centers, 2011–2020. J Occup Environ Med 2022; 64:869-873. [DOI: 10.1097/jom.0000000000002593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Colom Gordillo A, Martínez Sánchez L, Pretel Echaburu C, Trenchs Sainz de la Maza V, Gotzens Bersch J, Luaces Cubells C. Unintentional poisoning by cough and cold medications: Drugs with little usefulness and potential toxicity. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2022; 97:326-332. [PMID: 36153206 DOI: 10.1016/j.anpede.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/12/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The use of medications to relieve the symptoms of the "common cold" in children is very frequent. In addition to the lack of scientific evidence supporting its usefulness, there is evidence of potential toxicity, and serious and even fatal cases of intoxication have been described. The objective was to describe the clinical and epidemiological characteristics of the patients treated in a paediatric emergency department (PED) for suspected unintentional intoxication by a cold medicine. MATERIAL AND METHODS Observational and analytical study of patients aged less than 18 years managed in a PED for suspected unintentional poisoning by a cold medicine between July 2012 and June 2020. We classified severity according to the Poisoning Severity Score (PSS): PSS-0 = no toxicity; PSS-1 = mild toxicity; PSS-2 = moderate; PSS-3 = severe; PSS-4 = lethal. If the intoxication occurred while the patient was in active treatment with the drug, we determined whether the patient's age was in the applicable range established in the therapeutic indications provided in the summary of product characteristics. RESULTS The study included data for 63 cases. The drugs involved were decongestants and mucolytics (31; 49.2%), antitussives (26; 41.2%) and oral bronchodilators (6; 9.5%). The distribution by severity was 40 cases with PSS-0 (63.5%), 21 with PSS-1 (33.3%), 1 with PSS-2 (1.6%) and 1 with PSS-3 (1.6%). In 29 patients (46.0%) there was a history of therapeutic use; in 15 of these cases (51.7%) the age was lower than recommended in the summary of product characteristics. In 14 patients (22.2%) the intoxication was due to administration of the wrong dose by caregivers. CONCLUSION Although scientific evidence does not support the use of cold medicines in children, unintentional intoxications by these drugs keep happening, in some cases causing moderate or severe symptoms.
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Affiliation(s)
| | - Lidia Martínez Sánchez
- Área de Urgencias, Hospital Sant Joan de Déu, Barcelona, Spain; Influencia del entorno en el bienestar del niño y del adolescente, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.
| | | | - Victoria Trenchs Sainz de la Maza
- Área de Urgencias, Hospital Sant Joan de Déu, Barcelona, Spain; Influencia del entorno en el bienestar del niño y del adolescente, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain; Departamento de Cirugía y Especialidades Médico-quirúrgicas, Facultad de Medicina i Ciencias de la Salud, Universidad de Barcelona, Barcelona, Spain
| | | | - Carles Luaces Cubells
- Área de Urgencias, Hospital Sant Joan de Déu, Barcelona, Spain; Influencia del entorno en el bienestar del niño y del adolescente, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain; Departamento de Cirugía y Especialidades Médico-quirúrgicas, Facultad de Medicina i Ciencias de la Salud, Universidad de Barcelona, Barcelona, Spain
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13
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Aldy K, Du T, Weaver MM, Roth B, Cao DJ. Seniors and single-use detergent sacs (SUDS): a review of the National Poison Data System from 2012 to 2020. Clin Toxicol (Phila) 2022; 60:1039-1043. [PMID: 35603994 DOI: 10.1080/15563650.2022.2074856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Exposure to single-use detergent sacs (SUDS), or laundry pods, have declined in the pediatric population between 2015 and 2018. Older adult exposures are less well described, and it is unclear if there is an increased risk of unintentional exposure to SUDS in older adults, especially in those with dementia. This study aims to review SUDS exposures in adults greater than 60-year-old between 2012 and 2020. METHODS Using the National Poison Data System (NPDS), a query was performed for cases involving an acute single substance exposure with substance coded as "laundry detergent unit dose" (Generic code: 0201181, 0201182, and 0201183) in adults greater than 60-years-old between January 1, 2012 and December 31, 2020. Exclusion criteria included unknown age, age less than 60 years, any multi-substance exposure, and chronic or acute-on-chronic acuity. The distribution of cases was analyzed for demographics, exposure circumstances, management, clinical effects, and medical outcome. RESULTS SUDS exposure reported to NPDS increased from 46 cases in 2012 to 219 cases in 2020. Among the 1289 total reported cases, 94.9% (n = 1223) were unintentional exposures with an average age of 75-year-old. The majority of exposures occurred in females (69%, n = 883). More than 1 exposure route was reported in 90 cases (7%), and the most common route of exposure was ingestion (64.9%, n = 836). Major effects were identified in 1% (n = 13) of exposures, and 0.5% (n = 7) of cases resulted in death. CONCLUSIONS Despite a declining incidence of pediatric SUDS exposure, older adult exposures have increased over 400% between 2012 and 2020.
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Affiliation(s)
- Kim Aldy
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tony Du
- Baylor College of Medicine, Houston, TX, USA
| | - Mary Madison Weaver
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brett Roth
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,North Texas Poison Center, Parkland Health and Hospital System, Dallas, TX, USA
| | - Dazhe James Cao
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,North Texas Poison Center, Parkland Health and Hospital System, Dallas, TX, USA
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Tarhani F, Nezami A, Heidari G, Hosseinizadeh-Salavati N. Epidemiological Study of Acute Unintentional Poisoning Among Children in Iran. Drug Res (Stuttg) 2022; 72:306-311. [PMID: 35605968 DOI: 10.1055/a-1819-6453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The occurrence of different types of poisoning and early diagnosis is important for therapeutic measures. In this study, we investigate the epidemiological causes of acute poisoning in children.In this retrospective descriptive study, children presented with acute poisoning during 2010-2019 to Shahid Madani Hospital were included. The Electronic Medical Record system of the hospital was accessed to obtain the data of the patients. The data included was demographic information, type of poisoning, clinical findings, complications, duration of hospitalization, parents' education status, and mortality status.Of 336 patients included in the study, the mean age of patients was 4.90±3.27 years (range: 1-12 years). There was a significant correlation between the age of the child and the type of poisoning, p=0.001. The most frequent age group was 5 years and less (69.6%). The most frequent sex group was male (58.6%). However, there was no significant correlation between the sex of the child and the type of poisoning. Parents' education and ICU admission were also associated significantly with the type of poisoning, p=0.001, respectively. The most common type of poisoning in children was medication (60.6%) which was mainly due to methadone. The mortality rate in the study was 1.2%.Our study showed that pharmacological drugs are the main cause of poisoning in our population. Age of the children is likely to be associated with the type of poisoning however, no gender difference was found in this regard was found in our study.
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Affiliation(s)
- Fariba Tarhani
- Department of Pediatric, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Alireza Nezami
- Department of Pediatric, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ghobad Heidari
- Department of Pediatric, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
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15
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Trinder R, Greensmith T, Cole L, Cortellini S. The use of haemodialysis for the treatment of phenobarbitone intoxication 30 h after ingestion. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Richard Trinder
- Department of Clinical Science and Services The Royal Veterinary College University of London North Mymms Hertfordshire UK
| | - Thomas Greensmith
- Department of Clinical Science and Services The Royal Veterinary College University of London North Mymms Hertfordshire UK
| | - Laura Cole
- Department of Clinical Science and Services The Royal Veterinary College University of London North Mymms Hertfordshire UK
| | - Stefano Cortellini
- Department of Clinical Science and Services The Royal Veterinary College University of London North Mymms Hertfordshire UK
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16
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Colom Gordillo A, Martínez Sánchez L, Pretel Echaburu C, Trenchs Sainz de la Maza V, Gotzens Bersch J, Luaces Cubells C. Intoxicación no intencionada por anticatarrales: medicamentos poco útiles y potencialmente tóxicos. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Compton J, Masoud JA, McCray E, Singh A, Terala H, Mohomed F. Hypoglycemia and Ketosis in the Setting of Pediatric Ethanol Intoxication: A Case Report. Cureus 2022; 14:e24538. [PMID: 35651389 PMCID: PMC9138564 DOI: 10.7759/cureus.24538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/15/2022] Open
Abstract
Acute alcohol intoxication is a common presentation to emergency departments. The intoxication of young pediatric patients is extremely rare. We present a case of a two-year-old female who presented to the emergency department with altered mentation, incontinence, and hypoglycemia. Over the next two days, the patient was treated with fluid replacement, and her hypoglycemia was managed. She was then discharged with no complications. While infant ethanol intoxication has a relatively low mortality rate, it can still be potentially fatal due to complications. Few studies have examined the morbidity associated with these presentations. This case demonstrates the importance of prompt identification and management to avoid a catastrophic outcome. Further research on the enzyme kinetics and long-term effects of early ethanol exposure resulting in hypoglycemia and ketosis is warranted.
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18
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Inhalation aiguë de chlore. Mise au point pour le médecin du travail. ARCH MAL PROF ENVIRO 2022. [DOI: 10.1016/j.admp.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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19
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Osimitz TG, Sioris K, Gualtieri J, Filandrinos D, Seaverson R, Carlson AM, Droege W, Kingston R. Retrospective analysis of adverse effects associated with pyrethrins-containing products. TOXICOLOGY RESEARCH AND APPLICATION 2022. [DOI: 10.1177/23978473211052700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The Pyrethrins Stewardship Program (PSP) was established to better understand adverse effects following exposure to pyrethrins-containing insecticide products. Running from April 2010 through December 2016, symptomatic dermal and inhalation exposures were entered into Phase I of the PSP and analyzed for exposure details and nature of the effects reported. Phase II consisted of an in-depth telephone interview using an enhanced questionnaire to investigate additional exposure details. Phase III scored the association between exposure and reported effects. Based on the data collected and analyzed, we conclude that: (1) Both in absolute number and relative to the wide distribution and use by consumers, adverse respiratory or dermal events after product exposure were rare; (2) Most outcomes for the reported events involving either dermal or respiratory effects were of minor severity and self-limiting; (3) None of the data collected and analyzed indicate that pyrethrins-containing products, including those formulated with synthetic pyrethroids and/or synergists, pose a significant risk of serious dermal or respiratory reactions even in cases where the exposed individual reported having allergies or asthma; (4) No additional label warnings or other mitigation techniques are warranted with pyrethrins-containing products formulated with or without synthetic pyrethroids and/or synergists.
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Affiliation(s)
| | - Kelly Sioris
- SafetyCall International, LLC, Minneapolis, MN, USA
- Department of Experimental and Clinical Pharmacology (ECP), College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - John Gualtieri
- SafetyCall International, LLC, Minneapolis, MN, USA
- Department of Experimental and Clinical Pharmacology (ECP), College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Dean Filandrinos
- SafetyCall International, LLC, Minneapolis, MN, USA
- Department of Experimental and Clinical Pharmacology (ECP), College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | | | | | | | - Rick Kingston
- SafetyCall International, LLC, Minneapolis, MN, USA
- Department of Experimental and Clinical Pharmacology (ECP), College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
- Division of Professional Education, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
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20
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Forrester MB. Pediatric Lamp Oil Injuries Treated in US Emergency Departments. Pediatr Emerg Care 2022; 38:e165-e169. [PMID: 32665508 DOI: 10.1097/pec.0000000000002194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Ingestion and aspiration of lamp oil may result in serious adverse effects and even death. The objective of this study was to describe pediatric lamp oil-related injuries treated at US emergency departments (EDs). METHODS Cases were lamp oil-related injuries among patients aged 0 to 5 years reported to the National Electronic Injury Surveillance System during 2001-2018. The distribution of the number of cases and national estimate were determined for selected variables. RESULTS A total of 317 pediatric lamp oil-related injuries treated at US EDs during 2001-2018 were identified, resulting in a national estimate of 9501 injuries (95% confidence interval, 6937-12,065). The national estimate declined from 1599 in 2001 to 59 in 2014 before increasing once more to 596 in 2017. The patients were 5.4% aged less than 1 year; 62.2%, 1 year; 23.0%, 2 years; 6.6%, 3 years; 2.2%, 4 years; and 0.6%, 5 years; 68.6% of the patients were boys and 31.4% were girls. Ingestions accounted for 91.9% of the injuries, and 82.1% occurred at home. The disposition of the patient was treated or examined and released (68.2%), treated and transferred to another hospital (13.2%), treated and admitted for hospitalization (14.4%), held for observation (4.2%), and not recorded (0.1%). CONCLUSIONS Although the estimated number of lamp oil-related injuries declined during 2000-2014, it increased during 2015-2017. Most of the patients were aged 1 to 2 years and boys. The majority of the injuries occurred by ingestion and at home. Most of the patients were treated or evaluated and released from the ED.
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Peir GH, Boggs KM, Soto PH, Weinstock J, Sharron MP, Sami I, Dean T. Case study: Cinnamon aspiration in a toddler causing severe ARDS requiring surfactant and extracorporeal membrane oxygenation. Pediatr Pulmonol 2022; 57:325-329. [PMID: 34710278 DOI: 10.1002/ppul.25738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 11/08/2022]
Abstract
As many as 6% of reported cinnamon poisonings cause significant clinical effects, however, descriptions of pulmonary toxicity have not yet been reported. Here, we present a pediatric patient's hospital course following powdered cinnamon aspiration. The early presentation with hypercapnia and lower airways obstruction evolved to hypoxemic respiratory failure and severe pediatric acute respiratory distress syndrome requiring a 7-day course of veno-venous extracorporeal membrane oxygenation, 16 ventilator-days, and three diagnostic and therapeutic bronchoscopies with two applications of surfactant therapy. The sum of these modalities contributed to this patient's survival and subsequent return to respiratory baseline 6 months post-hospitalization.
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Affiliation(s)
- Gene Hwan Peir
- Division of Critical Care Medicine, Children's National Hospital, Washington, District of Columbia, USA
| | - Kaitlyn Maureen Boggs
- Department of Pediatrics, Children's National Hospital, Washington, District of Columbia, USA
| | - Pelayia H Soto
- Department of Emergency Medicine, National Capital Poison Center, George Washington School of Medicine, Washington, USA
| | - Jered Weinstock
- Division of Pediatric Pulmonology, Children's National Hospital, Washington, District of Columbia, USA
| | - Matthew P Sharron
- Division of Critical Care Medicine, Children's National Hospital, Washington, District of Columbia, USA
| | - Iman Sami
- Division of Pediatric Pulmonology, Children's National Hospital, Washington, District of Columbia, USA
| | - Terry Dean
- Division of Critical Care Medicine, Children's National Hospital, Washington, District of Columbia, USA
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22
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Elzeneini WM, Cusick E. Endoscopic retrieval of ingested magnets in children and role of magnetic retrievers. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00128-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract
Background
Various high-powered magnetic toy sets constitute a major hazard as the small magnets can be easily swallowed or aspirated by young children. Multiple ingested magnets or the ingestion of a magnet with another metallic object can pose a serious threat as this may lead to bowel perforation, fistulation, intestinal volvulus, bowel obstruction and death.
Main body
Retrieval of ingested magnets from the stomach is routinely performed endoscopically but can become a painstaking quest involving many tedious attempts to secure the magnet(s). Historically, pre-routine endoscopy, magnetic retrievers were used under fluoroscopic control for the removal of metallic objects in the stomach. With the advent of endoscopic retrieval instruments, they fell out of favour and are no longer readily available on the market. Despite this, conventional endoscopic instruments are likely to be less effective than endoscopic-assisted magnetic retrievers due to confounding weak bonds which form between the metal retrieval device and the magnet.
Preoperative testing, and selection of the retrieval instrument with the strongest coupling effect with a magnet, might be beneficial. A simple, endoscopic-assisted magnetic retriever created in theatre can allow for more effective, time-efficient and safe removal of ingested magnets under direct vision.
Conclusion
Urgent removal of multiple ingested magnets or a single ingested magnet coupled with another ingested metallic object should be highlighted. Stricter implementation of a widespread ban over loose magnetic toys is needed. Standardised protocols for the surgical management of ingested magnets should be available in every hospital.
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23
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Desai NM, Mistry RD, Brou L, Boehnke ME, Lee JS, Wang GS. Pediatric Exposures Reported to the Toxicology Investigators Consortium, 2010-2015. Pediatr Emerg Care 2021; 37:e1039-e1043. [PMID: 31464880 DOI: 10.1097/pec.0000000000001893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Poisoning is the leading cause of injury death in pediatric patients. Hospital and provider readiness, including pharmacy stocking, depends on reliable surveillance data describing local patterns of age-specific clinically significant exposures and the therapeutic modalities employed in their treatment. We aimed to characterize trends in clinically significant toxic exposures and their management. METHODS We performed a retrospective review of patients 18 years or younger in the American College of Medical Toxicology's Toxicology Investigators Consortium (ToxIC) Registry, a self-reporting database completed by bedside consulting medical toxicologists. We reviewed cases from January 1, 2010, through December 31, 2015. In 2015, ToxIC included 101 health care facilities. Data collected included demographics, geographic region, encounter and exposure details, survival, and therapeutic modalities employed, including antidotes, antivenoms, gastric decontamination, enhanced elimination, hyperbaric oxygen therapy, and extracorporeal membrane oxygenation. RESULTS From 2010 to 2015, 11,616 consults were recorded in ToxIC. Pediatric consultations increased from 934 (23.7%) in 2010 to 2425 (29.9%) in 2015 (P < 0.001). Exposures were most commonly reported in females (57.8%) and adolescents (59.4%). Intentional ingestions (55.5%) comprised the majority of cases. The most frequent agents of exposure were analgesics (21.0%). There were 38 deaths reported (0.9%). The antidote used most commonly was N-acetylcysteine (11.0%). Geographic variation was demonstrated in prevalence of envenomations and heavy metal exposures, their respective treatments, and overall use of decontamination. CONCLUSIONS Toxicology consultations for pediatric exposures increased from 2010 to 2015. Understanding which pediatric exposures require toxicologist management, the therapies most frequently employed, and geographical patterns is paramount to facility-level planning, pharmacy stocking, and provider education.
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Affiliation(s)
- Neil M Desai
- From the Section of Pediatric Emergency Medicine, British Columbia Children's Hospital, Vancouver, BC, Canada
| | | | - Lina Brou
- Department of Family Medicine, University of Colorado, Aurora, CO
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Dunn SE, Reed JE, Neumann C. Letter to the editor regarding the article "The global distribution of acute unintentional pesticide poisoning: estimations based on a systematic review". BMC Public Health 2021; 21:1944. [PMID: 34702221 PMCID: PMC8549228 DOI: 10.1186/s12889-021-11940-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 10/07/2021] [Indexed: 11/22/2022] Open
Abstract
We read with interest the article entitled “The global distribution of acute unintentional pesticide poisoning: estimations based on a systematic review”. We wholeheartedly agree that it is important to evaluate the extent of this issue. We would like to understand the numbers provided in this article, which appear to overestimate the global burden of pesticide poisonings. We also feel that addressing the benefits of these chemistries is important for a complete evaluation.
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Affiliation(s)
- S Eliza Dunn
- Bayer, Division of Crop Science, 700 Chesterfield Parkway W, Chesterfield, MO, 63017, USA
| | - Jennifer E Reed
- Bayer, Division of Crop Science, 700 Chesterfield Parkway W, Chesterfield, MO, 63017, USA
| | - Christoph Neumann
- CropLife International AISBL, Avenue Louise 326, Box 35, 1050, Brussels, Belgium.
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Ali SHK, Raja KWA, Irfan N, Habeeb M, Ismail Y. Antioxidants Supplementation in Acute Amitriptyline Abuse for Pain. Appl Biochem Biotechnol 2021; 194:556-569. [PMID: 34699040 DOI: 10.1007/s12010-021-03721-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/08/2021] [Indexed: 11/28/2022]
Abstract
The fundamental aim of this study is to establish the role of antioxidant supplementation in alleviating acute amitriptyline induced oxidative stress. The effect of supplementation was compared on treatment of acute amitriptyline intoxication cases for pain management, with alpha lipoic acid (ALA) alone or with vitamin C, with that of healthy individuals (group I), and those receiving only routine standard treatment (RST) as control (group II). A total of 132 human subjects divided into 5 groups were supplemented with either placebo, RST, RST with vitamin C, RST with ALA, or RST with vitamin C, and ALA. Results of this study revealed that the decrease in the level of oxidative stress and enzyme activity was observed among those supplemented with either alpha lipoic acid alone or along with vitamin C, with a slightly more decrease in the latter group. P value of < 0.001 was considered statistically significant. The percentage of benefit of treatment on supplementation with vitamin C and alpha lipoic acid showed a marked increase in group V cases after supplementation with both in combination. The results provided that the oxidative stress induced by acute amitriptyline poisoning is comparatively decreased by supplementation with antioxidants like alpha lipoic acid and vitamin C, than those only on routine standard treatment.
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Affiliation(s)
- S Hameed Kadar Ali
- School of Social Sciences, BSA Crescent Institute of Science and Technology, Chennai, 600048, India.
| | - K Wasim Ali Raja
- Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, 605502, India
| | - N Irfan
- Crescent School of Pharmacy, BSA Crescent Institute of Science and Technology, Chennai, 600048, India
| | - Mohammad Habeeb
- Crescent School of Pharmacy, BSA Crescent Institute of Science and Technology, Chennai, 600048, India
| | - Y Ismail
- Crescent School of Pharmacy, BSA Crescent Institute of Science and Technology, Chennai, 600048, India
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Al-Mousa FA, Gado AM, Attia AM, Tammam HG. Medical toxicology experience: Poisoning consultations cases registry in Saudi Ministry of Health -2020 annual report. Toxicol Rep 2021; 8:1558-1564. [PMID: 34430218 PMCID: PMC8371147 DOI: 10.1016/j.toxrep.2021.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/25/2021] [Accepted: 07/30/2021] [Indexed: 11/23/2022] Open
Abstract
Saudi poison control centers received 20,513 poisoning consultations calls in the year 2020. Most of calls were from Riyadh City, less than 6 years old. The majority of toxic exposures were accidental oral poisoning requesting help within one hour from poisons exposure. Household substances toxic exposure represented about one third of toxic cases. We recommended widespread awareness of the poisons risk. The significant role of poison control centers that play in time management and saving lives in poisoning cases.
Introduction Saudi poison control centers provide surveillance data that should be used to determine the magnitude of poisoning exposures and the level of public awareness that is to evaluate control measures. This work aimed to review and assess the characteristics of toxic events received by toxicological information center's hotline all over Saudi Arabia during 2020. Patients and Methods Data were collected from the poison control centers in Saudi Arabia. Cases of poisonings were studied during the period from 1st January to 31st December 2020. Results and Discussion The poison control center received 20,513 calls in the year 2020. Most of calls were from Riyadh city (40.9 %) and from public places (92.9 %). Regarding the patients, most of the cases were less than 6 years old and more than half of them were males. The majority of toxic exposures were accidental oral poisoning. About 84 % of patients (84.3 %) called for help within one hour from poisons exposure. Household substances toxic exposure represented about one third of toxic cases. Chemicals and alcohol sanitizers' poisoning were the highest among house hold substances toxicities (39.3 % and 17.7 % respectively of all household substances toxicity). In addition, the most frequently ingested drugs were vitamins poisoning. Conclusion Household chemicals represented the highest risk in exposures among children below 6 years. Finally, we recommended widespread awareness of the poisons risk and the importance of poison control that play a great role in time management and saving lives.
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Affiliation(s)
- Fawaz A Al-Mousa
- General Directorate of Poison Control Centers, Ministry of Health, Riyadh, Saudi Arabia
| | - Ali M Gado
- General Directorate of Poison Control Centers, Ministry of Health, Riyadh, Saudi Arabia.,Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Egypt
| | - Afaf M Attia
- General Directorate of Poison Control Centers, Ministry of Health, Riyadh, Saudi Arabia.,Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Mansoura University, Egypt
| | - Hany G Tammam
- General Directorate of Poison Control Centers, Ministry of Health, Riyadh, Saudi Arabia.,Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Al-Azhar University, Egypt
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Case Fatality as an Indicator for the Human Toxicity of Pesticides-A Systematic Scoping Review on the Availability and Variability of Severity Indicators of Pesticide Poisoning. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168307. [PMID: 34444056 PMCID: PMC8394312 DOI: 10.3390/ijerph18168307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 11/18/2022]
Abstract
Objective: To investigate if case fatality and other indicators of the severity of human pesticide poisonings can be used to prioritize pesticides of public health concern. To study the heterogeneity of data across countries, cause of poisonings, and treatment facilities. Methods: We searched literature databases as well as the internet for studies on case-fatality and severity scores of pesticide poisoning. Studies published between 1990 and 2014 providing information on active ingredients in pesticides or chemical groups of active ingredients were included. The variability of case-fatality-ratios was analyzed by computing the coefficient of variation as the ratio of the standard deviation to the mean. Findings: A total of 149 papers were identified of which 67 could be included after assessment. Case-fatality-ratio (CFR) on 66 active ingredients and additionally on 13 groups of active ingredients were reported from 20 countries. The overall median CFR for group of pesticides was 9%, for single pesticides 8%. Of those 12 active ingredients with a CFR above 20% more than half are WHO-classified as “moderately hazardous” or “unlikely to present acute hazard”. Two of seven pesticides considered “unlikely to present hazard in normal use” showed a CFR above 20%. The cross-study variability of reported case fatality was rather low. Studies most often utilized the Glasgow Coma Score for grading the severity of poisoning. Conclusion: Although human pesticide poisoning is a serious public health problem, an unexpectedly small number of publications report on the clinical outcomes within our study period. However, CFRs of acute human pesticide poisoning are available for several groups of pesticides as well as for active ingredients showing moderate cross-study variability. Our results underline that CFR is an indicator of the human toxicity of pesticides and can be utilized to prioritize highly hazardous pesticides especially since there is limited correspondence between the animal-test-based hazard classification and the human CFR of the respective pesticide. The reporting of available poisoning data should be improved, human case-fatality data are a reasonable tool to be included systematically in the periodic statutory review of pesticides and their regulation.
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Hendaus MA, Saleh M, Darwish S, Mostafa O, Eltayeb A, Al-Amri M, Siddiqui FJ, Alhammadi A. Parental perception of medications safe storage in the State of Qatar. J Family Med Prim Care 2021; 10:2969-2973. [PMID: 34660433 PMCID: PMC8483110 DOI: 10.4103/jfmpc.jfmpc_1259_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 12/01/2022] Open
Abstract
PURPOSE The purpose of this study is to identify parental perception of household medication storage. METHODS A prospective cross-sectional study utilizing a questionnaire was carried out at Hamad Medical Corporation, the solely tertiary pediatric hospital in the State of Qatar at the time of the study. Qatar is a young developing country with limited data on the awareness of medication storage among adults with children at home and on the safety practices regarding medication storage. RESULTS Three hundred and five questionnaires were completed. The vast majority of parents were married, one-third of them were males, and more than three quarters were college graduates and younger than 40 years of age. Almost 80% of the parents had more than three children but less than seven. In addition, 23% of participants were health-care workers. Almost 90% of the participants stored medications in a place that is easy to reach. However, the same percentage stated that those medications were stored in a locked place and that children did not have access to them. Approximately 10% of caregivers store multiple medications in one bottle, and the same percentage of participants do not check the expiration date on the medication labels. In terms of the most common medications stored at home, antihypertensives were on top of the list. Our study has shown that parental education and being a health-care worker were each associated with the difficulty in reaching medications (P = 0.006 and P = 0.011, respectively). Moreover, the percentage of participants who shared medications was significantly higher among those who were not working in the health-care section compared to those who were (P = 0.004). In addition, being a female parent and a college graduate was associated with the possibility of keeping excess or leftover medications at home (P = 0.025). CONCLUSION Parents residing in the State of Qatar have some deficiencies in knowledge about medication storage. Parent's attitudes and perceptions are deemed vital objectives for population's health intervention.
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Affiliation(s)
- Mohamed A. Hendaus
- Department of Pediatrics, Section of Academic General Pediatrics, Sidra Medicine, Doha, Qatar
- Department of Pediatrics, Section of Academic General Pediatrics, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Pediatrics, Weill-Cornell Medicine, Doha, Qatar
| | - Manar Saleh
- Department of Medical Education. Hamad Medical Corporation, Doha, Qatar
| | - Shereen Darwish
- Department of Medical Education. Hamad Medical Corporation, Doha, Qatar
| | - Omar Mostafa
- Department of Medical Education. Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Eltayeb
- Department of Medical Education. Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Al-Amri
- Department of Pediatrics, Section of Academic General Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | | | - Ahmed Alhammadi
- Department of Pediatrics, Section of Academic General Pediatrics, Sidra Medicine, Doha, Qatar
- Department of Pediatrics, Section of Academic General Pediatrics, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Pediatrics, Weill-Cornell Medicine, Doha, Qatar
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Mullins ME, Freeman WE, Baumgartner KT. Use of lay media for epidemiology of snakebite fatality. Am J Emerg Med 2021; 47:287-288. [PMID: 34083110 DOI: 10.1016/j.ajem.2021.05.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Michael E Mullins
- Division of Medical Toxicology, Department of Emergency Medicine, Washington University School of Medicine, Saint Louis, MO, United States of America.
| | - William E Freeman
- Division of Medical Toxicology, Department of Emergency Medicine, Washington University School of Medicine, Saint Louis, MO, United States of America
| | - Kevin T Baumgartner
- Division of Medical Toxicology, Department of Emergency Medicine, Washington University School of Medicine, Saint Louis, MO, United States of America
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Afify O, Suleiman ARM, Mohamed HG, Saaed O. Complete atrioventricular block due to ingestion of Visine eye drops. BMJ Case Rep 2021; 14:14/5/e241905. [PMID: 33980559 PMCID: PMC8118060 DOI: 10.1136/bcr-2021-241905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Visine eye drops are a commonly used topical drug for irritation of the eye. The active component in Visine eye drops is tetrahydrozoline. Tetrahydrozoline is an imidazoline derivative found in several ophthalmic and nasal decongestants. Exposure is common in young children, who unintentionally ingest it, but cases have been rising in the adult population. The main systemic effects are bradycardia and hypotension due to activation of the central alpha-adrenergic receptors. In this case report, a 76-year-old man presents with bradycardia after 24 hours following ingestion of 120 mL of 0.05% tetrahydrozoline (eight bottles of Visine eye drops) in a suicide attempt. His initial ECG demonstrated complete heart block and QT prolongation. Subsequent ECGs showed unremitting first-degree atrioventricular block and QT prolongation. Here, we are presenting the first case of complete heart block following tetrahydrozoline consumption.
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Affiliation(s)
- Omar Afify
- Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | | | - Hassan G Mohamed
- Internal Medicine, Detroit Medical Center/Wayne State University, Detroit, Michigan, USA
| | - Omar Saaed
- Internal Medicine, Detroit Medical Center/Wayne State University, Detroit, Michigan, USA
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Williams MA, Reddy G, Quinn MJ, Millikan Bell A. Toxicological assessment of electronic cigarette vaping: an emerging threat to force health, readiness and resilience in the U.S. Army. Drug Chem Toxicol 2021; 45:2049-2085. [PMID: 33906535 DOI: 10.1080/01480545.2021.1905657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The U.S. Army and U. S. Army Public Health Center are dedicated to protecting the health, and readiness of Department of the Army Service Members, civilians, and contractors. Despite implementation of health programs, policies and tobacco control interventions, the advent of electronic nicotine delivery systems (ENDS), including electronic cigarettes (e-cigs), represent unregulated and poorly defined systems to supplant or substitute use of conventional nicotine products (e.g., cigarettes and pipe tobacco). E-cigs present unique challenges to healthcare officials vested in preventive medicine. The health impact of an e-cig and vaping on an individual's acute or chronic disease susceptibility, performance and wellness, is fraught with uncertainty. Given the relatively recent emergence of e-cigs, high-quality epidemiological studies, and applied biological research studies are severely lacking. In sparsely available epidemiological studies of short-term cardiovascular and respiratory health outcomes, any attempt at addressing the etiology of acute and chronic health conditions from e-cig use faces incredible challenges. Until relatively recently, this was complicated by an absent national regulatory framework and health agency guidance on the manufacture, distribution, selling and use of e-cigs or similar ENDS devices and their chemical constituents. Two key issues underpin public health concern from e-cig use: 1) continued or emergent nicotine addiction and potential use of these devices for vaping controlled substances; and 2) inadvertent sudden-onset or chronic health effects from inhalational exposure to low levels of complex chemical toxicants from e-cig use and vaping the liquid. Herein, the health impacts from e-cig vaping and research supporting such effects are discussed.
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Affiliation(s)
- Marc A Williams
- Toxicology Directorate - Health Effects Program, U.S. Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Gunda Reddy
- Toxicology Directorate - Health Effects Program, U.S. Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Michael J Quinn
- Toxicology Directorate - Health Effects Program, U.S. Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Amy Millikan Bell
- Office of the Director - Medical Advisor, U.S. Army Public Health Center, Aberdeen Proving Ground, USA
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Piarroux R, Gabriel F, Grenouillet F, Collombon P, Louasse P, Piarroux M, Normand AC. Using MALDI-ToF mass spectrometry to identify mushroom species: Proof of concept analysis of Amanita genus specimens. Med Mycol 2021; 59:890-900. [PMID: 33891700 DOI: 10.1093/mmy/myab018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/18/2021] [Accepted: 03/09/2021] [Indexed: 11/15/2022] Open
Abstract
Food poisoning caused by toxic mushrooms, such as species in the Amanita genus, occurs frequently around the world. To properly treat these patients, it is important to rapidly and accurately identify the causal species. Matrix-assisted laser desorption/ionization time-of-flight (MALDI-ToF) mass spectrometry is a rapid technique that has been used in medical laboratories for the past three decades to identify bacteria, yeasts, and filamentous fungi.Matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-Tof MS) is a rapid method used for the past three decades to identify microorganisms. In this study, we created and internally validated a MALDI-Tof MS reference database comprising 15 Amanita species frequently encountered in France, and we challenged this database with 38 Amanita specimens from four French locations, using a free online application for MALDI-ToF spectra identifications.Assessment of the database showed that mass spectra can be obtained by analyzing any portion of a carpophore and that all portions enabled identification of the carpophore at the species level. Most carpophores were correctly identified using our database, with the exception of specimens from the Vaginatae section. Decay tests also demonstrated that decayed portions (like those found in the kitchen garbage can) of Amanita phalloides mushrooms could be properly identified using MALDI-ToF MS.Our findings provide important insight for toxicology laboratories that often rely on DNA sequencing to identify meal leftovers implicated in food poisoning. In future developments, this technique could also be used to detect counterfeit mushrooms by including other genera in the reference database. LAY SUMMARY MALDI-ToF MS is a powerful identification tool for microorganisms. We demonstrate that the technique can be applied to Amanita specimens. This will prevent food intoxications as a rapid and definite identification can be obtained, and it can also be used for food remnants.
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Affiliation(s)
| | - Frédéric Gabriel
- Centre Hospitalier Universitaire de Bordeaux, Service de Parasitologie Mycologie, F-33000, Bordeaux, France
| | - Frédéric Grenouillet
- Department of Parasitology and Mycology, University Hospital of Besançon, F-25000, Besançon, France
| | - Patrick Collombon
- Société de Mycologie de Provence, Laboratoire de Botanique - Faculté des Sciences Saint-Charles, F-13331, Marseille, France
| | | | - Martine Piarroux
- Ministère des armées, Centre d'épidémiologie et de santé publique des armées (CESPA), F-13014, Marseille, Paris, France
| | - Anne-Cécile Normand
- AP-HP, Groupe Hospitalier La Pitié-Salpêtrière, Service de Parasitologie Mycologie, F-75013, Paris, France
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NCPDP recommendations for standardizing dosing in metric units (mL) on prescription container labels of oral liquid medications, version 2.0. Am J Health Syst Pharm 2021; 78:578-605. [PMID: 33647100 PMCID: PMC7970405 DOI: 10.1093/ajhp/zxab023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Best practices and guidance are provided for standardizing dosing instructions on prescription container labels of oral liquid medications by eliminating use of U.S. customary (household) units and adopting metric units universally, with the goal of decreasing the potential for error and improving safety and outcomes when patients and caregivers take and administer these medications. SUMMARY Despite decades of best practice use of metric units in organized healthcare settings and advocacy by various professional societies, medication safety experts, and standards setting organizations, use of household units (e.g., teaspoon) on prescription container labeling instructions for oral liquid medications persists in community pharmacy settings. Five years after publication of the National Council for Prescription Drug Programs' (NCPDP's) original white paper advocating metric-only dosing, very few community pharmacy companies appear to require oral liquid dosing instructions be presented in metric-only units (mL). Error-prone dosing designations contribute to medication errors and patient harm. Use of both multiple volumetric units (e.g., teaspoonsful, tablespoonsful) and multiple abbreviations for the same volumetric units (e.g., mL, cc, mls; tsp, TSP, t) increases the likelihood of dosing errors. Opportunities for error exist with each administration of an oral liquid medication and, unless coordinated with dispensing of appropriate oral dosing devices and optimal counseling, can result in use of household utensils (e.g., uncalibrated teaspoons) or discordantly marked devices that can further exacerbate the risk of error. Since publication of NCPDP's original white paper, new standards have been adopted governing official liquid volume representation, calibrated dosing devices, and e-prescribing software which support the elimination of non-metric units to reduce use of dosing practices that are error-prone. In each case, U.S. customary (household) units have been eliminated in official standards and certification requirements. Therefore, use of non-metric units for oral dosing of liquid medications no longer is an acceptable practice. CONCLUSION Key factors contributing to dosing errors with oral liquid medications include use of multiple volumetric units and abbreviations; failure to institute policies and procedures that eliminate the use of non-metric (e.g., household) units and universally adopt metric-only dosing instructions in all settings; failure to coordinate dosing instructions with dosing device markings, appropriate type (oral syringe versus cup), and optimal volumes (e.g., 1-, 5-, or 10-mL devices); failure to adequately counsel patients about appropriate measurement and administration of oral liquid medication doses; and use or error-prone practices such as missing leading zeros and elimination of trailing zeros in prescriptions and container labels. Adoption of this white paper's recommendations will align dosing designations for oral liquid medications in all settings with current standards and attain universal metric-only practice.
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Gualano MR, Lo Moro G, Voglino G, Catozzi D, Bert F, Siliquini R. Wrong administration route of medications in the domestic setting: a review of an underestimated public health topic. Expert Opin Pharmacother 2021; 22:1051-1059. [PMID: 33491504 DOI: 10.1080/14656566.2021.1876027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Since medication errors related to incorrect administration routes are less common than other errors, they are rarely considered when assessing patient mistakes. The present review was performed to search for papers assessing incorrect route medication errors made by adult patients with the aim of providing an overview of this phenomenon.Areas covered: PubMed, Scopus, and EMBASE were searched up to October 2019 using free text and MeSH terms, returning 7609 results. Papers were considered eligible if they considered incorrect administration route errors by adult patients in domestic settings. Eleven papers were included, primarily from National Poison Centers (NPCs) or similar institutions from USA or Europe (observation period: 1985-2014). The data showed how an incorrect route of self-administration is a concern for patient safety and should be considered when evaluating medication errors. Moreover, one of the main observations that the results highlighted was the difficulty of obtaining clear and precise data regarding self-administration.Expert opinion: NPC reports are a reliable but not exhaustive tool due to high underreporting; reports should provide additional information or insights into these issues. Additionally, improvements in drug packaging and labeling, proper plain language instruction and patient education could reduce the frequency of such errors.
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Affiliation(s)
| | - Giuseppina Lo Moro
- Department of Public Health Sciences, University of Torino, Torino, Italy
| | - Gianluca Voglino
- Department of Public Health Sciences, University of Torino, Torino, Italy
| | - Dario Catozzi
- Department of Public Health Sciences, University of Torino, Torino, Italy
| | - Fabrizio Bert
- Department of Public Health Sciences, University of Torino, Torino, Italy.,A.O.U. City of Health and Science of Torino, Torino, Italy
| | - Roberta Siliquini
- Department of Public Health Sciences, University of Torino, Torino, Italy.,A.O.U. City of Health and Science of Torino, Torino, Italy
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Pediatric Methamphetamine Toxicity: Clinical Manifestations and Therapeutic Use of Antipsychotics-One Institution's Experience. J Med Toxicol 2021; 17:168-175. [PMID: 33442836 DOI: 10.1007/s13181-020-00821-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/04/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Methamphetamine toxicity is common in the Southwest region of the United States and presents diagnostic and treatment challenges in the pediatric population. The aim of our study was to characterize signs and symptoms of methamphetamine toxicity in pediatric patients, highlighting manifestations unique to this population. Additionally, our study sought to evaluate treatment modalities, specifically antipsychotics, in this population with the intent to characterize their adverse effects. METHODS This is a retrospective review of pediatric patients (age > 2 months ≤ 18 years) at a tertiary care pediatric hospital with ICD-9 or ICD-10 codes suggestive of stimulant exposure between September 1, 2010, and July 31, 2017. Patients with clinical manifestations of sympathomimetic toxicity and confirmation of methamphetamine on urine drug testing via GC/MS were included. Nature, source, and route of exposure along with clinical manifestations including signs, complications, treatments utilized, and adverse events related to treatment were recorded. Specifically, adverse effects following administration of antipsychotics were studied. RESULTS Seventy-nine patients met inclusion criteria: median age 2.0 years. Typical manifestations of sympathomimetic toxicity were common, including tachycardia (93.4%), hypertension (85.7%), agitation (79.7%), and abnormal motor activity (55.8%). The prominence of gastrointestinal signs (26.3%) and unique abnormal motor activity were notable. The most common treatments were intravenous fluids (96.1%) and benzodiazepines (77.9%). Antipsychotics were administered in 40.5% of cases, with haloperidol used in the majority. No patients developed seizures, dystonia, torsades de pointes, or hyperthermia after antipsychotic administration. CONCLUSIONS Pediatric patients with methamphetamine toxicity commonly manifest sympathomimetic signs. Antipsychotics were often used as an adjunct treatment in this cohort of patients, and no adverse events were reported. Clinicians should be aware of prominent gastrointestinal signs and abnormal motor activity and neurologic manifestations unique to pediatric patients that will assist in making the correct diagnosis in cases of suspected methamphetamine toxicity.
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Curran-Sills G, Wilson SM, Bennett R. A Review of Black Widow (Araneae: Theridiidae) Envenomation, Epidemiology, and Antivenom Utilization in Canada. JOURNAL OF MEDICAL ENTOMOLOGY 2021; 58:99-103. [PMID: 33432350 DOI: 10.1093/jme/tjaa148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Indexed: 06/12/2023]
Abstract
Two species of black widow spider (BWS-Latrodectus hesperus Chamberlin & Ivie and Latrodectus variolus Walckenaer) naturally occur in Canada and are capable of causing deleterious envenomation to humans. No Canadian literature exists on the frequency of envenomations by these species or the use of antivenom in the treatment of those patients. A review of primary Canadian arachnology data was undertaken to identify BWS populations. A retrospective review of the Health Canada Special Access Program records generated epidemiology and the utilization of antivenom for BWS envenomations in Canada. The geographical distribution of BWS species is limited to along the southern Canadian border. From January 2009 to December 2015, there were five BWS envenomations that required treatment with antivenom and all cases occurred in British Columbia. An average patient age of 41 yr ± 21 SD (range 7-59) was observed, along with three of the five patients being female. The average number of vials used for treatment was 2 ± 1 SD (range 1-3). BWS Antivenin was also obtained by facilities in Alberta, Ontario, and Nova Scotia, but not used in any of these jurisdictions. Further investigation is necessary to determine the annual incidence of BWS envenomations and if treatment with BWS antivenin is required.
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Affiliation(s)
- Gwynn Curran-Sills
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
- Captain, 15 Field Ambulance, Calgary Detachment, Canadian Armed Forces, Calgary, Alberta, Canada
| | - Steven M Wilson
- EmergeOrtho - Alternative Medicine and Rehabilitation Services, Shipyard Boulevard, Wilmington, NC
| | - Robb Bennett
- Royal British Columbia Museum, Victoria, British Columbia, Canada
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Yang NY, Pomerleau AC, Shieffelbien LM, Kunac DL, Braund R. Therapeutic errors captured by the New Zealand National Poisons Centre: a retrospective audit. J Prim Health Care 2021; 13:63-69. [PMID: 33785112 DOI: 10.1071/hc20066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/25/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Medication errors are one important cause of harm to patients. Information about medication errors can be obtained from diverse sources, including databases administered by poisons centres as part of their routine operation. AIM The aim of this study was to describe the data regarding therapeutic errors captured by the New Zealand National Poisons Centre (NZNPC). METHODS A retrospective study of calls made to the NZNPC between 1 September 2016 and 31 August 2018 was conducted, which involved human patients and were classified as 'therapeutic error' in the NZNPC database. Variables extracted and analysed included the demographics of the individual, the substance(s) involved, and site of exposure. RESULTS During the study period, a total of 43,578 calls were received by the NZNPC, including 5708 (13%) that were classified as 'therapeutic error'. Just over half of the exposures occurred in females, 3197 (56%) and 4826 (85%) of the calls involved a single substance. All age groups were affected and 2074 (37%) of the calls were related to children aged <12 years. A residential environment (n=5568, 97%) was the site of exposure for almost all reported therapeutic errors, most commonly in the patient's own home (n=5207, 91%). DISCUSSION This study provides insights into therapeutic error-related calls to the NZNPC. Almost all errors occurred in the residential setting. Over one-third of the calls involved children. Enhanced data capture and classification methods are needed to determine the types of errors and their possible causes to better inform prevention efforts.
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Affiliation(s)
| | - Adam C Pomerleau
- National Poisons Centre, University of Otago, Dunedin, New Zealand
| | | | - Desirée L Kunac
- New Zealand Pharmacovigilance Centre, University of Otago, Dunedin, New Zealand
| | - Rhiannon Braund
- New Zealand Pharmacovigilance Centre, University of Otago, Dunedin, New Zealand
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Chen CK, Chan YL, Su TH. Incidence of intoxication events and patient outcomes in Taiwan: A nationwide population-based observational study. PLoS One 2020; 15:e0244438. [PMID: 33362242 PMCID: PMC7757892 DOI: 10.1371/journal.pone.0244438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intoxicated patients were frequently managed in the emergency departments (ED) with few studies at national level. The study aimed to reveal the incidence, outcomes of intoxications and trend in Taiwan. METHODS Adults admitted to an ED due to an intoxication event between 2006 and 2013 were identified using the Taiwan National Health Insurance Research Database. The rate of intoxication and severe intoxication events, mortality rate, hospital length of stay (LOS), and daily medical costs of these patients were analyzed. Changes over time were analyzed using Joinpoint models. Multivariable generalized regressions with GEE were used to assess the effect of sex, age, and presence of prior psychiatric illness. RESULTS A total of 20,371 ED admissions due to intoxication events were identified during the study period, and the incidence decreased with annual percentage change of 4.7% from 2006 to 2013. The mortality rate, hospital LOS, and daily medical costs were not decreased over time. Males and geriatric patients had more severe intoxication events, greater mortality rates, and greater daily medical costs. Patients with psychiatric illnesses had higher mortality rates and a longer hospital LOS, but lower daily medical expenses. CONCLUSION From 2006 to 2013, there was a decline in the incidence of ED admission for intoxication events in Taiwan. Males, geriatric patients, and those with psychiatric illnesses had greater risks for severe intoxication and mortality.
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Affiliation(s)
- Chun-Kuei Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ling Chan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tse-Hsuan Su
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- * E-mail:
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Boedeker W, Watts M, Clausing P, Marquez E. The global distribution of acute unintentional pesticide poisoning: estimations based on a systematic review. BMC Public Health 2020; 20:1875. [PMID: 33287770 PMCID: PMC7720593 DOI: 10.1186/s12889-020-09939-0] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Human poisoning by pesticides has long been seen as a severe public health problem. As early as 1990, a task force of the World Health Organization (WHO) estimated that about one million unintentional pesticide poisonings occur annually, leading to approximately 20,000 deaths. Thirty years on there is no up-to-date picture of global pesticide poisoning despite an increase in global pesticide use. Our aim was to systematically review the prevalence of unintentional, acute pesticide poisoning (UAPP), and to estimate the annual global number of UAPP. METHODS We carried out a systematic review of the scientific literature published between 2006 and 2018, supplemented by mortality data from WHO. We extracted data from 157 publications and the WHO cause-of-death database, then performed country-wise synopses, and arrived at annual numbers of national UAPP. World-wide UAPP was estimated based on national figures and population data for regions defined by the Food and Agriculture Organization (FAO). RESULTS In total 141 countries were covered, including 58 by the 157 articles and an additional 83 by data from the WHO Mortality Database. Approximately 740,000 annual cases of UAPP were reported by the extracted publications resulting from 7446 fatalities and 733,921 non-fatal cases. On this basis, we estimate that about 385 million cases of UAPP occur annually world-wide including around 11,000 fatalities. Based on a worldwide farming population of approximately 860 million this means that about 44% of farmers are poisoned by pesticides every year. The greatest estimated number of UAPP cases is in southern Asia, followed by south-eastern Asia and east Africa with regards to non-fatal UAPP. CONCLUSIONS Our study updates outdated figures on world-wide UAPP. Along with other estimates, robust evidence is presented that acute pesticide poisoning is an ongoing major global public health challenge. There is a need to recognize the high burden of non-fatal UAPP, particularly on farmers and farmworkers, and that the current focus solely on fatalities hampers international efforts in risk assessment and prevention of poisoning. Implementation of the international recommendations to phase out highly hazardous pesticides by the FAO Council could significantly reduce the burden of UAPP.
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Affiliation(s)
| | - Meriel Watts
- PAN Asia Pacific, P.O. Box 1170, 10850, Penang, Malaysia
| | | | - Emily Marquez
- PAN North America, 2029 University Ave., Suite 200, Berkeley, CA, 94704, USA
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Abstract
BACKGROUND Single-use detergent sacs (SUDSs) represent a relatively new household hazard to children. Brand differences and packaging changes may contribute to differential risks with accidental exposure. We sought to identify high-risk features from SUDS exposures in children and to assess whether product packaging changed trends in SUDS exposures reported to poison centers. METHODS In this institutional review board-approved, retrospective chart review of SUDS exposures from January 2013 to August 2015, deidentified case records of a large statewide poison control system were extracted and analyzed for clinical associations and trends. Clinical and demographic data were gathered, and outcomes were analyzed for differences by brand type, presenting complaints, and occurrence in relation to SUDS packaging changes. RESULTS There were 3502 SUDS exposures, with 3343 (95%) in children 5 years or younger. Metabolic, central nervous system, and pulmonary effects were significantly associated with moderate or severe outcome (P < 0.05). Forty patients received invasive procedures such as endoscopy, bronchoscopy, and/or endotracheal intubation, and more than half had mucosal lesions discovered by the diagnostic procedure. The presence of stridor, wheezing, drooling, lethargy, and exposure to the brand All Mighty Pacs were all significant predictors of moderate or severe outcome (P < 0.05). After the implementation of packaging changes, there was a transient decline in the number of exposures to the Tide Pods product. CONCLUSION Central nervous system and respiratory effects as well as certain brand types predict serious outcomes from SUDS exposures. Manufacturing changes had a brief beneficial effect on the volume of SUDS exposures reported between 2013 and 2015.
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Feldman R, Everton E. National assessment of pharmacist awareness of loperamide abuse and ability to restrict sale if abuse is suspected. J Am Pharm Assoc (2003) 2020; 60:868-873. [DOI: 10.1016/j.japh.2020.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/14/2020] [Accepted: 05/28/2020] [Indexed: 11/29/2022]
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Abstract
Peripheral neuropathies secondary to neurotoxicants are frequently considered but can be difficult to diagnose. Accurate diagnosis is important to avoid unnecessary testing, prevent further exposure, and initiate treatment when available. This article reviews key features of some of the more common or representative toxic neuropathies, including those caused by occupational and environmental exposure, medications, and chemotherapeutic agents.
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Affiliation(s)
- Michel Toledano
- Department of Neurology, Mayo Clinic, 200 1st Street, Rochester, MN 55905, USA.
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43
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Greene SC, Folt J, Wyatt K, Brandehoff NP. Epidemiology of fatal snakebites in the United States 1989-2018. Am J Emerg Med 2020; 45:309-316. [PMID: 33046301 DOI: 10.1016/j.ajem.2020.08.083] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND There are 5000-10,000 snake envenomations annually in the United States. Fortunately, few are fatal. In this study we review the epidemiology of fatal snakebites. METHODS Native snakebite cases from the American Association of Poison Control Centers (AAPCC) National Poison Data System from 1989 to 2018 were reviewed. Additional cases that were not reported to the AAPCC were identified by reviewing Wikipedia and by searching PubMed and online news outlets using various combinations of relevant keywords. RESULTS We identified 101 fatal bites from native snakes. Rattlesnakes accounted for 74 (90.2%) of the 82 deaths for which the species was known or which occurred where rattlesnakes are the only native crotalids. There were five fatalities attributed to copperheads, two due to cottonmouths, and one caused by an eastern coral snake. Males were disproportionately affected. The median age for victims was 40 years old. In cases for which data were available, many of the snake interactions were intentional, e.g. religious services, animal husbandry, and attempting to kill the snake. CONCLUSIONS Death following envenomation from a native U.S. snake is unlikely, particularly if medical attention is sought promptly. Rattlesnake envenomations are more likely to be fatal than bites from other species. Intentionally engaging with a venomous snake raises the risk of incurring a fatal bite, as does concurrent alcohol or drug use. Age less than 12 years old does not appear to be a risk factor for a fatal outcome, while elderly patients may have a slightly increased risk of death.
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Affiliation(s)
- Spencer C Greene
- Department of Emergency Medicine, Wright State University Boonshoft School of Medicine, 3525 Southern Blvd, Dayton, OH 45429, United States of America; Bayou City Medical Toxicology & Emergency Medicine Consultants, 6711 Stella Link Rd. #313, Houston, TX 77005, United States of America.
| | - Jason Folt
- Department of Emergency Medicine, Henry Ford Health System, 2799 West Grand Boulevard, CFP-258, Detroit, MI 48202, United States of America
| | - Kimberly Wyatt
- Department of Biological Sciences, University of Cincinnati, 614 Rieveschl Hall, Cincinnati, OH 45221-0006, United States of America
| | - Nicklaus P Brandehoff
- Rocky Mountain Poison and Drug Center, 1391 Speer Blvd #600, Denver, CO 80204, United States of America; Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, Aurora, CO 80045, United States of America
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44
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Greene S, Ruha AM, Campleman S, Brent J, Wax P. Epidemiology, Clinical Features, and Management of Texas Coral Snake (Micrurus tener) Envenomations Reported to the North American Snakebite Registry. J Med Toxicol 2020; 17:51-56. [PMID: 32803694 DOI: 10.1007/s13181-020-00806-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Few of the 5000-8000 snakebites reported to poison control centers annually in the USA are attributed to coral snakes. This study describes Texas coral snake envenomations reported to the North American Snakebite Registry. METHODS All Texas coral snake envenomation cases reported to the registry were identified for the period from January 1, 2015, through December 31, 2019. Data reviewed for this study included details regarding the snake encounter, patient demographics, signs and symptoms, treatment, and outcomes. Descriptive statistics were used to report results. RESULTS Ten men and four nonpregnant women reported coral snake bites. The median patient age was 15.5 (range 5-72 years). There were 12 upper extremity bites and two bites to the lower extremity. The most common symptoms reported were paresthesias and pain. All subjects had paresthesias, often described as an "electric" sensation. Seven patients described them as painful. The most common clinical findings were erythema and swelling. No patient developed tissue damage, hematotoxicity, rhabdomyolysis, hypotension, weakness, or respiratory symptoms. Thirteen subjects were treated with opioids. Six patients were treated with antiemetics: three prophylactically and two for opioid-induced nausea. One patient developed nausea and non-bloody, nonbilious emesis within 1 hour of the bite, prior to receiving opioids. No patients were treated with antivenom. Antibiotics were not administered to any patient, and no infections were reported. CONCLUSIONS Envenomations from M. tener in Southeast Texas are characterized by painful paresthesias. Mild swelling and erythema are common. Neurotoxicity necessitating antivenom or mechanical ventilation did not occur.
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Affiliation(s)
- Spencer Greene
- Department of Emergency Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA. .,Unviersity of Texas Health Science Center Cizik School of Nursing, 6711 Stella Link Rd, Houston, TX, 77005, USA.
| | - Anne-Michelle Ruha
- Department of Medical Toxicology, Banner, University Medical Center Phoenix, Phoenix, AZ, USA
| | | | - Jeffrey Brent
- University of Colorado School of Medicine, Denver, CO, USA
| | - Paul Wax
- American College of Medical Toxicology, Phoenix, AZ, USA.,Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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45
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Richmond SA, Pike I, Maguire JL, Macpherson A. E-cigarettes: A new hazard for children and adolescents. Paediatr Child Health 2020; 25:317-321. [PMID: 32765168 DOI: 10.1093/pch/pxaa078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/29/2020] [Indexed: 11/12/2022] Open
Abstract
Objectives Electronic cigarettes and fluid (e-cigarettes, e-fluid) are hazardous materials that when inhaled or ingested may pose significant health risks to children and adolescents. The objective of this work was to explore the spectrum of injury related to e-cigarette exposure among Canadian children and adolescents. Methods A one-time survey was sent to all paediatricians in Canada. Information was collected on children and adolescents who presented with e-cigarette exposure (inhalation and ingestion cases) in the previous 12 months. Questions included the number of injuries and symptoms, in addition to age, sex, treatment setting, intentional e-cigarette use, and how the products were accessed. Results A total of 520 surveys were completed and returned, identifying 35 cases. Symptoms related to inhalation were present in 30 cases and in 5 ingestion cases (5 unintentional, 0 intentional). For inhalation cases, most were male, ages 15 to 19 years, who sought treatment for nausea/vomiting, cough, throat irritation, or acute nicotine toxicity in an outpatient clinic/office. Most inhalation cases reported e-cigarette use 2 to 3 days/week, and e-cigarettes purchases from a mall kiosk/store. For ingestion cases, most were male, ages 1 to 4 years presenting to an emergency department with nausea/vomiting, cough, or respiratory irritation. Younger cases accessed e-fluid at home, older cases purchased in a mall kiosk/store. E-fluid flavours reported consumed were fruit, candy, and tobacco. Conclusions E-cigarettes, recently introduced into the North American market are hazardous to children and adolescents. Given the low response rate to the survey, further investigation into the true burden of injury, as well as the risks that e-cigarettes pose, together with ways to reduce exposure, is needed.
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Affiliation(s)
| | - Ian Pike
- Faculty of Health, York University, Toronto, Ontario
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46
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Della Porta A, Bornstein K, Coye A, Montrief T, Long B, Parris MA. Acute chloroquine and hydroxychloroquine toxicity: A review for emergency clinicians. Am J Emerg Med 2020; 38:2209-2217. [PMID: 33071096 PMCID: PMC7369162 DOI: 10.1016/j.ajem.2020.07.030] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/11/2020] [Accepted: 07/11/2020] [Indexed: 02/08/2023] Open
Abstract
Background Acute chloroquine and hydroxychloroquine toxicity is characterized by a combination of direct cardiovascular effects and electrolyte derangements with resultant dysrhythmias and is associated with significant morbidity and mortality. Objective This review describes acute chloroquine and hydroxychloroquine toxicity, outlines the complex pathophysiologic derangements, and addresses the emergency department (ED) management of this patient population. Discussion Chloroquine and hydroxychloroquine are aminoquinoline derivatives widely used in the treatment of rheumatologic diseases including systemic lupus erythematosus and rheumatoid arthritis as well as for malaria prophylaxis. In early 2020, anecdotal reports and preliminary data suggested utility of hydroxychloroquine in attenuating viral loads and symptoms in patients with SARS-CoV-2 infection. Aminoquinoline drugs pose unique and significant toxicological risks, both during their intended use as well as in unsupervised settings by laypersons. The therapeutic range for chloroquine is narrow. Acute severe toxicity is associated with 10–30% mortality owing to a combination of direct cardiovascular effects and electrolyte derangements with resultant dysrhythmias. Treatment in the ED is focused on decontamination, stabilization of cardiac dysrhythmias, hemodynamic support, electrolyte correction, and seizure prevention. Conclusions An understanding of the pathophysiology of acute chloroquine and hydroxychloroquine toxicity and available emergency treatments can assist emergency clinicians in reducing the immediate morbidity and mortality associated with this disease.
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Affiliation(s)
- Alessandra Della Porta
- University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Emergency Medicine, Jackson Memorial Health System, Miami, Florida, USA; Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, USA; Emergency Department, Jackson South Medical Center, Miami, Florida, USA
| | - Kasha Bornstein
- University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Emergency Medicine, Jackson Memorial Health System, Miami, Florida, USA; Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, USA; Emergency Department, Jackson South Medical Center, Miami, Florida, USA
| | - Austin Coye
- University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Emergency Medicine, Jackson Memorial Health System, Miami, Florida, USA; Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, USA; Emergency Department, Jackson South Medical Center, Miami, Florida, USA
| | - Tim Montrief
- University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Emergency Medicine, Jackson Memorial Health System, Miami, Florida, USA; Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, USA; Emergency Department, Jackson South Medical Center, Miami, Florida, USA
| | - Brit Long
- University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Emergency Medicine, Jackson Memorial Health System, Miami, Florida, USA; Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, USA; Emergency Department, Jackson South Medical Center, Miami, Florida, USA.
| | - Mehruba Anwar Parris
- University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Emergency Medicine, Jackson Memorial Health System, Miami, Florida, USA; Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, USA; Emergency Department, Jackson South Medical Center, Miami, Florida, USA.
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47
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Boadu O, Gombolay GY, Caviness VS, El Saleeby CM. Intoxication From Accidental Marijuana Ingestion in Pediatric Patients: What May Lie Ahead. Pediatr Emerg Care 2020; 36:e349-e354. [PMID: 29406477 DOI: 10.1097/pec.0000000000001420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Marijuana is the most commonly used illicit drug. In young children, there are relatively few reports in the literature of acute marijuana intoxication. Here, we describe the case of a previously healthy 2-year-old girl who presented with clinical seizures. A urine toxicology screen showed elevated levels of tetrahydrocannabinol. The source of the drug was not identified. After a short stay in the hospital, the patient fully recovered with only supportive measures. In this report, we also summarize all domestic and international cases of marijuana intoxication in children younger than 6 years, in conjunction with the number of exposures in children of similar age identified by the US National Poison Data System. This report highlights what is becoming a more common problem. As cannabis continues to be decriminalized across the United States with its increasingly diverse modes of delivery, the potential for accidental exposure in infants and young children also rises. Clinicians should now routinely consider marijuana intoxication in children who present with acute neurological abnormalities.
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Affiliation(s)
- Osei Boadu
- From the University of Rochester School of Medicine and Dentistry, Rochester, NY
| | | | | | - Chadi M El Saleeby
- Department of Pediatrics.,Hospital Medicine.,Infectious Diseases, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA
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48
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Hall AH, Jacquemin D, Henny D, Mathieu L, Josset P, Meyer B. Corrosive substances ingestion: a review. Crit Rev Toxicol 2020; 49:637-669. [PMID: 32009535 DOI: 10.1080/10408444.2019.1707773] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Corrosive chemical substance ingestions are a major problem, especially in developing countries, but also in developed countries such as the United States, France, and Belgium. Ingestions may be deliberate as suicide attempts (mostly in adolescents and adults) or accidental (mostly in children). The results can be devastating in terms of individual suffering and disability, but also in terms of resource utilization and costs. In developing countries, outcomes may be worse because of limited medical/surgical resources. Common sequelae include gastrointestinal (GI) tract (esophagus, stomach, pylorus, and duodenum) stricture formation, GI tract perforation, and hemorrhage. Systemic effects may also occur, such as disseminated intravascular coagulation (DIC), multi-organ system failure, and sepsis. Various interventions in the acute phase to reduce the severity of injury have been attempted, but there are no large controlled clinical trials to demonstrate efficacy. Dilation therapy in various forms is commonly used for the treatment of strictures and a variety of surgical procedures including esophagectomy and delayed replacement may be required in severe corrosive injury cases.
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Affiliation(s)
- Alan H Hall
- Toxicology Consulting and Medical Translating Services, Azle and Springtown, TX, USA.,Colorado School of Public Health, University of Colorado-Denver, Denver, CO, USA
| | | | | | | | - Patrice Josset
- Department of Pathology, Hôpital d'Enfants Armand Trousseau, Director of the Teaching Program of the History of Medicine, Université Pierre et Marie Curie, Paris, France
| | - Bernard Meyer
- Department of Otorhinolaryngology, Université Pierre et Marie Curie, Groupe Hospitalier Pieté-Salpêtrière, Paris, France
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49
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Rasimas JJ, Kivovich V, Sachdeva KK, Donovan JW. Antagonizing the errors of history: bedside experience with flumazenil. TOXICOLOGY COMMUNICATIONS 2020. [DOI: 10.1080/24734306.2020.1752551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Joseph James Rasimas
- PinnacleHealth Toxicology Center, Harrisburg, PA, USA
- Department of Emergency Medicine, Penn State College of Medicine, Hershey, PA, USA
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - Violetta Kivovich
- Department of Internal Medicine, New York Presbyterian Hospital –Weill Cornell Medical Center, New York, NY, USA
| | | | - Joseph Ward Donovan
- PinnacleHealth Toxicology Center, Harrisburg, PA, USA
- Department of Emergency Medicine, Penn State College of Medicine, Hershey, PA, USA
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50
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Vajda J, McAdams RJ, Roberts KJ, Zhu M, McKenzie LB. Cosmetic-Related Injuries Treated in US Emergency Departments: 2002 to 2016. Clin Pediatr (Phila) 2019; 58:1493-1501. [PMID: 31203655 DOI: 10.1177/0009922819850492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A retrospective analysis was conducted by using data from the National Electronic Injury Surveillance System for children <5 years who were treated in US emergency departments (EDs) from 2002-2016) for a cosmetic-related injury. An estimated 64 686 (95% confidence interval = 53 037-76 335) children were treated in EDs for cosmetic-related injuries during the 15-year study period. There was no significant change in the rate (slope = 1.1 per 10 000 children per year, P = .95) of injuries over the study period. Injuries were most commonly associated with nail care (28.3%), hair care (27.0%), skin care (25.0%), and fragrance (12.7%) products. Children aged <2 years were most frequently injured (59.3%), and poisoning was the most common diagnosis (86.2%). To our knowledge, this is the first study to use a nationally representative sample to describe the epidemiology of cosmetic-related injuries among children aged <5 years. Unintentional exposure to cosmetics is an important source of injury for young children.
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Affiliation(s)
- Jordan Vajda
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Rebecca J McAdams
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Kristin J Roberts
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Motao Zhu
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,The Ohio State University College of Medicine, Columbus, OH, USA
| | - Lara B McKenzie
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,The Ohio State University College of Medicine, Columbus, OH, USA
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