Medicine › Emergency Medicine

Poisoning and overdose treatments

Works Count: 66295

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This cluster of papers focuses on the management of poisoning and toxic exposures, including surveillance systems for toxic exposures, treatment guidelines for specific poisonings such as methanol and ethylene glycol, pharmacological considerations for substances like bupropion, and the use of interventions like activated charcoal and extracorporeal treatments. It also covers the epidemiology, clinical features, and prognostic signs of various poisonings.

Keywords

Poison Control Centers; Toxic Exposure Surveillance; Methanol Poisoning; Bupropion Pharmacology; Activated Charcoal; Ethylene Glycol Poisoning; Calcium Channel Blocker Toxicity; Aluminium Phosphide Poisoning; Pediatric Pharmaceutical Poisoning; Extracorporeal Treatments

Methanol and Ethylene Glycol Poisonings

1986-10-01

Dag Jacobsen , Kenneth E. McMartin

Clarke's analysis of drugs and poisons

2003-01-01

AC Moffat , Osselton , B Widdop

Clarke's analysis of drugs and poisons , Clarke's analysis of drugs and poisons , کتابخانه دیجیتال جندی شاپور اهواز Clarke's analysis of drugs and poisons , Clarke's analysis of drugs and poisons , کتابخانه دیجیتال جندی شاپور اهواز

Goldfrank's Toxicologic Emergencies.

1986-08-01

Lewis R. Goldfrank

Essential for all emergency physicians, this updated reference presents complete coverage of the clinical management of the poisoned patient. Filled with case studies, the Seventh Edition contains new chapters on … Essential for all emergency physicians, this updated reference presents complete coverage of the clinical management of the poisoned patient. Filled with case studies, the Seventh Edition contains new chapters on Chemical and Biological Terrorism, Sports Toxicology, Forensic Toxicology, and the Development of Drugs.

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Emergency Medicine: Concepts and Clinical Practice.

1988-03-01

Peter Rosen

Part I: General Concepts. Resuscitation. Practice of Emergency Medicine. Anesthesia and Pain Management. EMS. Part II: Trauma. General Concepts. Head and Spinal Trauma. Chest Trauma. Abdominal Trauma. Orthopedic Trauma. Soft … Part I: General Concepts. Resuscitation. Practice of Emergency Medicine. Anesthesia and Pain Management. EMS. Part II: Trauma. General Concepts. Head and Spinal Trauma. Chest Trauma. Abdominal Trauma. Orthopedic Trauma. Soft Tissue Trauma. Part III: Environmental Disorders. Part IV: Selected Pediatric Problems. General Concepts, Cardiopulmonary Disorders. Gastrointestinal Disorders. Neurological Disorders. Part V: Toxicologic Problems. Part VI: Systemic Disorders. Respiratory Disorders. Cardiac Disorders. Vascular Disorders. Gastrointestinal Disorders. Hematologic and Oncologic Disorders. Neurologic Disorders. Genitourinary Disorders. Pregnancy. Metabolic and Endocrine Problems. Systemic Infections. Head and Neck Problems. Immunologic and Inflammatory Disorders. Part VII: Behavioural and Societal Problems.

Clinical Management of Poisoning and Drug Overdose

1984-03-01

Lester M. Haddad , James F. Winchester

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew … Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Journals JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2024 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal

Medical Toxicology: Diagnosis and Treatment of Human Poisoning.

1988-03-01

Matthew J. Ellenhorn , Donald G. Barceloux

General Approach to the Poisoned Patient Introduction and Initial Evaluation. Diagnostic Services. Gut Decontamination. Enhancement and Elimination. Antidotes. Supportive Care. Pharmacokinetics. Toxic Exposure During Pregnancy. Therapeutic Drugs Acetaminophen. Anti-Arrhythmic Agents. … General Approach to the Poisoned Patient Introduction and Initial Evaluation. Diagnostic Services. Gut Decontamination. Enhancement and Elimination. Antidotes. Supportive Care. Pharmacokinetics. Toxic Exposure During Pregnancy. Therapeutic Drugs Acetaminophen. Anti-Arrhythmic Agents. Anti-Coagulants. Anti-Convulsants. Anti-Hypertensive Drugs. Anti-Infective Drugs. Anti-Depressants. Disulfiram. H 2 -Receptor Antagonists. Hypoglycemics and Insulin. Muscle Relaxants. Neuroleptic Drugs. Non-Steroidal Anti-Inflammatory Drugs. (NSAID's). Over-the-counter Products. Salicylates. Sedative-Hypnotics. Theophylline. Thyroid Hormones. Drugs of Abuse Amphetamines. Cocaine. Lysergic Acid Diethylamide (LSD). Marijuana. Opiates. Opioids and Designer Drugs. Phencyclidine (PCP). Chemical Products Alcohols and Glycols. Airborne Toxins. Household Products. Hydrocarbon Products. Metals and Related Compounds. Pesticides. Natural Toxins Envenomations from Bites and Stings. Reptiles. Anthropods. Insects. Fish. Foodborne Toxins. Plants - Mycotoxins - Mushrooms.

ANTICOAGULANT DRUGS IN THE TREATMENT OF PULMONARY EMBOLISM

1960-06-01

D W Barritt , S.C. Jordan

Position Statement: Single-Dose Activated Charcoal

1997-01-01

Peter A. Chyka , Donna Seger

In preparing this Position Statement, all relevant scientific literature was identified and reviewed critically by acknowledged experts using agreed criteria. Well-conducted clinical and experimental studies were given precedence over anecdotal … In preparing this Position Statement, all relevant scientific literature was identified and reviewed critically by acknowledged experts using agreed criteria. Well-conducted clinical and experimental studies were given precedence over anecdotal case reports and abstracts were not usually considered. A draft Position Statement was then produced and subjected to detailed peer review by an international group of clinical toxicologists chosen by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists. The Position Statement went through multiple drafts before being approved by the boards of the two societies and being endorsed by other societies. The Position Statement includes a summary statement for ease of use and is supported by detailed documentation which describes the scientific evidence on which the Statement is based. Single-dose activated charcoal should not be administered routinely in the management of poisoned patients. Based on volunteer studies, the effectiveness of activated charcoal decreases with time; the greatest benefit is within 1 hour of ingestion. The administration of activated charcoal may be considered if a patient has ingested a potentially toxic amount of a poison (which is known to be adsorbed to charcoal) up to 1 hour previously; there are insufficient data to support or exclude its use after 1 hour of ingestion. There is no evidence that the administration of activated charcoal improves clinical outcome. Unless a patient has an intact or protected airway, the administration of charcoal is contraindicated.

A Syndrome produced by Diverse Nocuous Agents

1936-07-01

Hans Selye

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2002 annual report of the American association of poison control centers toxic exposure surveillance system

2003-09-01

William A. Watson , Toby Litovitz , George C. Rodgers +5 more

Goldfrank’s Toxicologic Emergencies

2007-02-27

Daniel E. Rusyniak

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor … Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal

A Syndrome Produced by Diverse Nocuous Agents

1998-05-01

Hans Selye

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2001 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System

2002-09-01

Toby Litovitz , Wendy Klein‐Schwartz , George C. Rodgers +6 more

The geochemistry of iodine — a review

1986-06-01

R. Fuge , Christopher C. Johnson

A Medical Treatment for Diacetylmorphine (Heroin) Addiction

1965-08-23

Vincent P. Dole

A group of 22 patients, previously addicted to diacetylmorphine (heroin), have been stabilized with oral methadone hydrochloride. This medication appears to have two useful effects: (1) relief of narcotic hunger, … A group of 22 patients, previously addicted to diacetylmorphine (heroin), have been stabilized with oral methadone hydrochloride. This medication appears to have two useful effects: (1) relief of narcotic hunger, and (2) induction of sufficient tolerance to block the euphoric effect of an average illegal dose of diacetylmorphine. With this medication, and a comprehensive program of rehabilitation, patients have shown marked improvement; they have returned to school, obtained jobs, and have become reconciled with their families. Medical and psychometric tests have disclosed no signs of toxicity, apart from constipation. This treatment requires careful medical supervision and many social services. In our opinion, both the medication and the supporting program are essential.

Goldfrank's toxicologic emergencies

1995-11-01

Cathleen Clancy

STUDIES ON ADAPTATION

1937-03-01

Hans Selye

In a preliminary publication (1) attention has been called to a syndrome which appears when a severe injury is inflicted upon the organism. This syndrome is independent of the nature … In a preliminary publication (1) attention has been called to a syndrome which appears when a severe injury is inflicted upon the organism. This syndrome is independent of the nature of the damaging agent and represents rather a response to damage as such. Exposure to cold, traumatic injuries, excessive muscular exercise, spinal shock, acute infections, and intoxications with various drugs will evoke this syndrome if they damage the organism sufficiently. The course of this reaction, which we have interpreted as an expression of general defence, may be divided into three stages. During the first, or acute stage, observed in the rat ordinarily 6 to 48 hours after the initial injury, one notes a rapid decrease in the size of the thymus, spleen, lymph glands and liver; disappearance of fat tissue; edema formation, especially in the thymus and loose retroperitoneal connective tissue; accumulation of pleural and peritoneal transudate; loss of muscular tone; fall of body temperature; formation of acute erosions in the digestive tract, particularly in the stomach, small intestine and appendix; loss of cortical lipoids and chromaffin substance from the adrenals; and sometimes hyperemia of the skin, exophthalmos, increased lachrymation and salivation.

Methanol and Formic Acid Toxicity: Biochemical Mechanisms

1991-09-01

Jyrki Liesivuori , And Heikki Savolainen

Abstract: Metabolism of methanol, methyl ethers, esters and amides give rise to formic acid. This acid is an inhibitor of the mitochondrial cytochrome oxidase causing histotoxic hypoxia. Formic acid is … Abstract: Metabolism of methanol, methyl ethers, esters and amides give rise to formic acid. This acid is an inhibitor of the mitochondrial cytochrome oxidase causing histotoxic hypoxia. Formic acid is a weaker inhibitor than cyanide and hydrosulphide anions. The body burden of formate in methanol poisoning is high enough to cause acidosis, and other clinical symptoms. Part of the protons can be attributed to formic acid whereas the most significant acid load results from the hypoxic metabolism. The acidosis causes e.g. dilatation of cerebral vessels, facilitation of the entry of calcium ions into cells, loss of lysosomal latency and deranged production of ATP. The latter effect seems to impede parathormone‐dependent calcium reabsorption in the kidney tubules. Besides, urinary acidification is affected by formic acid. Its excretion causes continuous recycling of the acid by the tubular cell Cl − /formate exchanger. This sequence of events may partially explain an accumulation of formate in urine. Occupational exposure to vapours of methanol and formic acid can be quantitatively monitored by urinary formic acid determinations. Formic acid toxicity may prove a suitable model for agents causing histotoxic hypoxia.

Oxidation of polyethylene glycols by alcohol dehydrogenase

1989-01-01

David A. Herold , Katherine Keil , David E. Bruns

Patterns and problems of deliberate self-poisoning in the developing world

2000-11-01

Michael Eddleston

Deliberate self‐harm is a major problem in the developing world, responsible for around 600 000 deaths in 1990. The toxicity of available poisons and paucity of medical services ensure that … Deliberate self‐harm is a major problem in the developing world, responsible for around 600 000 deaths in 1990. The toxicity of available poisons and paucity of medical services ensure that mortality from self‐poisoning is far greater in the tropics than in the industrialized world. Few data are available on the poisons most commonly used for self‐harm in different parts of the world. This paper reviews the literature on poisoning, to identify the important poisons used for self‐harm in these regions. Pesticides are the most important poison throughout the tropics, being both common and associated with a high mortality rate. In some regions, particular pesticides have become the most popular method of self‐harm, gaining a notoriety amongst both health‐care workers and public. Self‐poisoning with medicines such as benzodiazepines and antidepressants is common in urban areas, but associated with few deaths. The antimalarial chloroquine appears the most significant medicine, self‐poisoning being common in both Africa and the Pacific region, and often fatal. Paracetamol (acetaminophen) is used in many countries but in few has it reached the popularity typical of the UK. Domestic and industrial chemicals are responsible for significant numbers of deaths and long‐term disabilities world‐wide. Self‐poisoning with plant parts, although uncommon globally, is locally popular in some regions. Few of these poisons have specific antidotes. This emphasizes the importance of determining whether interventions aimed at reducing poison absorption actually produce a clinical benefit, reducing death and complication rates. Future research to improve medical management and find effective ways of reducing the incidence of self‐harm, together with more widespread provision of interventions proven to be effective, could rapidly reduce the number of deaths from self‐poisoning in the developing world.

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Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning

1997-10-08

George C. Rodgers

Since the publication of the first edition of this tome in 1988, it has been my major reference text of clinical toxicology, far surpassing in utility, in my opinion, any … Since the publication of the first edition of this tome in 1988, it has been my major reference text of clinical toxicology, far surpassing in utility, in my opinion, any other single volume. Like many others in my field, I have anxiously awaited the second edition. Unfortunately, the new edition has now become a memorial to its primary editor and driving force, Matthew J. Ellenhorn, MD, who died before its publication. In the preface, Dr Ellenhorn relates the difficulties of writing a comprehensive toxicology text and his philosophy of doing so. Much of the clinical toxicology literature embodies anecdotal reports or uncontrolled case series, therefore much of our understanding of toxicology is derived from animal experimentation. In this edition, as with the first, Dr Ellenhorn has tried to limit his references to animal studies and is very selective in his use of anecdotal reports. As with the first edition, the

OXIDANT MECHANISMS IN TOXIC ACUTE RENAL FAILURE*

1999-01-01

Radhakrishna Baliga , Norishi Ueda , Patrick D. Walker +1 more

Over the last decade, there is accumulating evidence for a role of reactive oxygen metabolites in the pathogenesis of a variety of renal diseases, including gentamicin, glycerol, cisplatin, and cyclosporine … Over the last decade, there is accumulating evidence for a role of reactive oxygen metabolites in the pathogenesis of a variety of renal diseases, including gentamicin, glycerol, cisplatin, and cyclosporine A models of toxic acute renal failure. Gentamicin has been shown both in in vitro and in vivo studies to enhance the generation of reactive oxygen metabolites. Iron is important in models of tissue injury, presumably because it is capable of catalyzing free-radical formation. Gentamicin has been shown to cause release of iron from renal cortical mitochondria. Scavengers of reactive oxygen metabolites as well as iron chelators provide protection in gentamicin-induced nephrotoxicity. In glycerol-induced acute renal failure, an animal model of rhabdomyolysis, there is enhanced generation of hydrogen peroxide, and scavengers of reactive oxygen metabolites and iron chelators provide protection. Although the dogma is that the myoglobin is the source of iron, recent studies suggest that cytochrome P450 may be an important source of iron in this model. In addition, there are marked alterations in antioxidant defenses, such as glutathione, as well as changes in heme oxygenase. Several recent in vitro and in vivo studies indicate an important role of reactive oxygen metabolites in cisplatin-induced nephrotoxicity. Thus, catalytic iron is increased both in vitro and in vivo by cisplatin, and iron chelators as well as hydroxyl radical scavengers have been shown to be protective. Recent studies indicate that cytochrome P450 may also be an important source of the catalytic iron in cisplatin nephrotoxicity. Cyclosporine A has been shown to enhance generation of hydrogen peroxide in vitro and enhance lipid peroxidation in vitro and in vivo. Antioxidants have been shown to be protective in cyclosporine A nephrotoxicity. This collective body of evidence suggests an important role for reactive oxygen metabolites in toxic acute renal failure and may provide therapeutic opportunities of preventing or treating acute renal failure in humans.

Multidisciplinary utilization of dimethyl sulfoxide: pharmacological, cellular, and molecular aspects

2003-03-25

Nuno C. Santos , J. Figueira-Coelho , J. Martins‐Silva +1 more

The Major Medical Complications of Heroin Addiction

1967-07-01

Donald B. Louria

Article1 July 1967The Major Medical Complications of Heroin AddictionDONALD B. LOURIA, M.D., F.A.C.P., TERRY HENSLE, B.S., JOHN ROSE, B.S.DONALD B. LOURIA, M.D., F.A.C.P.Search for more papers by this author, TERRY … Article1 July 1967The Major Medical Complications of Heroin AddictionDONALD B. LOURIA, M.D., F.A.C.P., TERRY HENSLE, B.S., JOHN ROSE, B.S.DONALD B. LOURIA, M.D., F.A.C.P.Search for more papers by this author, TERRY HENSLE, B.S.Search for more papers by this author, JOHN ROSE, B.S.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-67-1-1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAn estimated 60,000 to 120,000 persons in the United States are addicted or habituated to opiates, the former defined as physical dependence on the drugs, the latter as chronic use without actual physical dependence. Additional thousands use opiates illicitly, intermittently or occasionally. Approximately 90% of the narcotic addicts or habitués take heroin, almost all the rest using hydromorphone (Dilaudid®), meperidine (Demerol®), metopon, morphine, codeine, or methadone (1). The heroin that reaches the illicit user usually originates in the mid-East or Far East, is converted into morphine, and then in illegal laboratories is acetylated to diacetylmorphine (heroin). From these laboratories, usually...References1. Traffic in Opium and Other Dangerous Drugs for the Year Ended Dec. 31, 1964. U. S. Government Printing Office, Washington, D. C., 1965. Google Scholar2. HELPERN M: Interim report on narcotic program, Aug. 12, 1963. Summarized in NAPAN (National Association for the Prevention of Addiction to Narcotics) Newsletter 2: no. 2, 1964. Google Scholar3. COHENKAYE DND: Staphylococcal endocarditis in a heroin addict with Marfan's syndrome. Report of a case. New York J. Med. In press. 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DOLENYSWANDER VPM: A medical treatment for diacetylmorphine (heroin) addiction. A clinical trial with methadone hydrochloride. JAMA 193: 646, 1965. CrossrefMedlineGoogle Scholar53. JAFFEBRILL JL: Cyclazocine, a long acting narcotic antagonist: its voluntary acceptance as a treatment modality by narcotics abusers. Int. J. Addict. 1: 99, 1966. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: New York, New YorkFrom the Infectious Disease Laboratory, Second (Cornell) Medical Division, Bellevue Hospital, and the Department of Medicine, Cornell University Medical College, New York, N. Y.This study was supported by grants U-1136 and U-1515, The Health Research Council of The City of New York, by grant AI-05281-04 and training grant AI 255, the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md., and by the Dr. Phillip Hanson Hiss, Jr., Memorial Fund, New York, N. Y.Dr. Louria was the recipient of investigatorship I-111, The Health Research Council of The City of New York.Requests for reprints should be addressed to Donald B. Louria, M.D., Second (Cornell) Medical Division, Bellevue Hospital, First Ave. at 26th St., New York, N. Y. 10016. 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Lymphoedème chronique et toxicomanie intraveineuse au long coursNeuronal adaptations, neuroendocrine and immune correlates of heroin self-administrationEvidence for the Nucleus Accumbens as a Neural Substrate of Heroin-Induced Immune AlterationsEmergency Room Use of Opioid Antagonists in Drug Intoxication and OverdoseOpioid Receptor Antagonist-Mediated Signaling in the Immune SystemCrack-Cocaine Use Accelerates HIV Disease Progression in a Cohort of HIV-Positive Drug UsersOpiates and OpioidsAppropriateness of antibiotic treatment in intravenous drug users, a retrospective analysisCan one Predict Outcome of Medical Coma?Live-Donor Organ TransplantationMyocardial Alterations in Drug AbusersRadiology of Recreational Drug AbuseConditioned effects of heroin on the expression of inducible nitric oxide synthase in the rat are susceptible to extinction and latent inhibitionLive-Donor Organ TransplantationObserved Patterns of Illicit Opiate Overdose Deaths in Chicago, 1999–2003Effects of Drugs of Abuse on Cytokine ResponsesPathology of Drug AbuseSyndrome des « grosses mains » des toxicomanes : intérêt des bandages peu élastiquesTrust and other Characteristics Associated with Health Care Utilization by Injection Drug UsersMorphine Withdrawal Lowers Host Defense to Enteric Bacteria: Spontaneous Sepsis and Increased Sensitivity to Oral Salmonella enterica Serovar Typhimurium InfectionNeuropeptide Y Y1 receptors mediate morphine-induced reductions of natural killer cell activityComparisons of Community-Associated Methicillin-Resistant Staphylococcus aureus (MRSA) and Hospital-Associated MSRA Infections in Sacramento, CaliforniaSuppression of natural killer cell activity by morphine is mediated by the nucleus accumbens shellModulation of Immune Function by Morphine: Implications for Susceptibility to InfectionEffects of mu, kappa or delta opioids administered by pellet or pump on oral Salmonella infection and gastrointestinal transitIncreased Sensitivity to Salmonella enterica Serovar Typhimurium Infection in Mice Undergoing Withdrawal from Morphine Is Associated with Suppression of Interleukin-12Bacterial Infections in Drug UsersMorphine Withdrawal Enhances Hepatitis C Virus Replicon ExpressionReview of Neuroendocrine Correlates of Chronic Opiate MisuseAssessing immunotoxicity: guidelinesMedical Examinations at Entry to Treatment for Drug Abuse as an Opportunity to Initiate Care for Hepatitis C Virus InfectionMorphine modulates inducible nitric oxide synthase expression and reduces pulmonary oedema induced by α-naphthylthioureaSuppression of morphine withdrawal syndrome by interleukin-2 and its geneHeroin-associated nephropathyAcute pain the immune system and opioimmunosuppressionVolumineux œdèmes des mains chez des patients toxicomanes intraveineux au long coursAcute Respiratory Failure from Abused SubstancesMorphine-induced alterations of immune status are blocked by the dopamine D2-like receptor agonist 7-OH-DPATCentral Nervous System Alterations in Drug AbuseStroke and Substance AbuseCocaine increases inducible nitric oxide synthase expression in rats: effects of acute and binge administrationSafer Injection Sites in New York City: A Utilization Survey of Injection Drug UsersOpioid-induced immunosuppression: is it centrally mediated or peripherally mediated?Microbial Infections, Immunomodulation, and Drugs of AbuseCentral Nervous System Infections in Cancer PatientsImproving access to primary health care for chronic drug users: An innovative systemic intervention for providersImproving Access to Primary Health Care for Chronic Drug UsersNew methods to investigate infectious disease transmission and pathogenesis — Staphylococcus aureus disease in drug usersMorphine-Induced Macrophage Apoptosis Modulates Migration of Macrophages: Use of in Vitro Model of Urinary Tract InfectionThoracic Complications of Illicit Drug Use: An Organ System ApproachBone and joint infections in injection drug usersOpioids, immunology, and host defenses of intravenous drug abusersSinopulmonary complications of illicit drug useThe Opiate-dependent Patient With Endocarditis: Addressing Pain and Substance Abuse WithdrawalIncreasing drug users’ adherence to HIV treatment: results of a peer-driven intervention feasibility studySatisfaction with access to health care among injection drug users, other drug users, and nonusersSelf-administration of heroin produces alterations in the expression of inducible nitric oxide synthaseSatisfaction with Access to Health Care among Injection Drug Users, Other Drug Users, and NonusersInjecting drug use: implications for skin and wound managementAppendixEffect of Opioids on Oral Salmonella Infection and Immune FunctionDestructive pulmonary embolism in a patient with community-acquired staphylococcal bacteremiaSafer Injection Facilities in North America: Their Place in Public Policy and Health InitiativesHeroin-Related Noncardiogenic Pulmonary EdemaAcute morphine treatment alters cellular immune function in the lungs of healthy ratsRisk Factors for Skin and Soft‐Tissue Abscesses among Injection Drug Users: A Case‐Control StudyInvolvement of substance P and central opioid receptors in morphine modulation of the CHS responseOpioids, opioid receptors, and the immune responseMorphine Modulation of the Contact Hypersensitivity Response: Characterization of Immunological ChangesPhysical injecting sites among injecting drug users in Sydney, AustraliaPRIMARY PREVENTIVE HEALTH CARE AMONG INJECTION DRUG USERS, OTHER SUSTAINED DRUG USERS, AND NON-USERSEarly Discharge of Patients with Presumed Opioid Overdose: Development of a Clinical Prediction RuleInvolvement of Central μ- but Not δ- or κ-Opioid Receptors in ImmunomodulationThe neuropathology of heroin abusePostoperative analgesia in patients with substance use disorders: Part IPharmacokinetics and cytokine production in heroin and morphine-treated miceAmpicillin/Sulbactam and Cefoxitin in the Treatment of Cutaneous and Other Soft-Tissue Abscesses in Patients With or Without Histories of Injection Drug AbuseInfective endocarditis in intravenous drug users: Does HIV status alter the presenting temperature and white blood cell count?Heroin modulates the expression of inducible nitric oxide synthasePhenotypic and functional assessments of immune status in the rat spleen following acute heroin treatmentBidirectional Heterologous Desensitization of Opioid and Chemokine ReceptorsEnhancement of the Contact Hypersensitivity Reaction by Acute Morphine Administration at the Elicitation PhaseMorphine reduces pulmonary inflammation in response to influenza infectionFood habits of drug‐using Puerto Rican women in inner‐city HartfordAcute Heroin OverdoseKarl A. Sporer, MDMorphine synergizes with lipopolysaccharide in a chronic endotoxemia modelHealth Care Need and Utilization: A Preliminary Comparison of Injection Drug Users, Other Illicit Drug Users, and NonusersOpioid SystemsDifferential tolerance to morphine's immunomodulatory effects following continuous administrationA comparison of the nutritional status and food security of drug-using and non-drug-using Hispanic women in Hartford, ConnecticutMU-opioid receptor-knockout mice: role of μ-opioid receptor in morphine mediated immune functionsEffects of prolonged exposure to morphine and methadone on in vivo parameters of immune function in ratsProfound circulatory shock following heroin overdoseA Comparison of the Need for Health Care and Use of Health Care by Injection-Drug Users, Other Chronic Drug Users, and Nondrug UsersOpiates and infectionOpioid mediated effects on the immune system: sympathetic nervous system involvementMorphine Accelerates the Progression of Sepsis in an Experimental Sepsis ModelCentrally-Mediated Opioid-Induced ImmunosuppressionPrinciples of management of the poisoned patientDoes Prolonged Oral Treatment with Sustained-Release Morphine Tablets Influence Immune Function?The effects of opiates on the lungEffect of morphine on lipopolysaccharide-induced tumor necrosis factor-α production in vivo: involvement of the sympathetic nervous systemOpioid Dependence and Methadone Maintenance Treatment during PregnancyRole of coagulase in a murine model of hematogenous pulmonary infection induced by intravenous injection of Staphylococcus aureus enmeshed in agar beadsManaging the Spectre of Death: the War against Drug Use and AIDS in AmericaFatal heroin 'overdose': a reviewThe impact of HIV infection on medical services in drug abuse treatment programsLong-Term Pharmacotherapy for Opiate (Primarily Heroin) Addiction: Opioid AgonistsInhibition of primary murine macrophage cytokine production in vitro following treatment with the K-opioid agonist U50, 488HPositive and negative immunomodulation by opioid peptidesBacterial Pneumonia in Persons Infected with the Human Immunodeficiency VirusNeuronal apoptosis in HIV infection in adultsThe epidemiology and transmission of AIDS: A hypothesis linking behavioural and biological determinants to time, person and placeMorphine modulates cathepsin B and L activity in isolated glomeruli and mesangial cellsClinical Neurotoxicological Concerns on Drugs of AbuseSevere Rhabdomyolysis Mimicking Transverse Myelitis in a Heroin AddictAbscesses secondary to parenteral abuse of drugs. A study of demographic and bacteriological characteristics.Psychotropic drug consumption and other factors associated with heroin overdoseSchmerztherapie bei Drogenabhängigen und opioidtoleranten PatientenDrugsClinical Management of HIV Disease in Intravenous Drug-UsersMacrophage functions in drugs of abuse-treated miceIncidence of listeriosis in Barcelona, Spain, in 1990Clinical symptoms associated with seroconversion for HIV-1 among misusers of intravenous drugs: comparison with homosexual seroconverters and infected and non-infected intravenous drug misusers.Effects of Opioids on Proliferation of Mature and Immature Immune CellsOpioids in Immunologic ProcessesMorphine inhibits signal transduction subsequent to activation of protein kinase C in mouse splenocytesInfection and injection drug usePneumococcal Disease during HIV Infection Epidemiologic, Clinical, and Immunologic PerspectivesEdward N. Janoff, MD, Robert F. Breiman, MD, Charles L. Daley, MD, Philip C. Hopewell, MDPavlovian conditioning of morphine-induced alterations of immune statusSpontaneous bacterial peritonitis caused byListeria monocytogenes: Two case reports and literature reviewOral Effects of Drug AbuseDIAGNOSIS AND TREATMENT OF SUBSTANCE USERS WITH HIV INFECTIONDrug AbusePulmonary diseaseEffect of high doses of morphine on Con-A induced lymphokine production in vitroSeptic arthritis in heroin addictsInjection drug use, mortality, and the AIDS epidemic.Endocrine Complications of AIDS and Drug AddictionOpiates, Human Peripheral Blood Mononuclear Cells, and HIVPulmonary complications of intravenous drug misuse. 1. Epidemiology and non-infective complications.Causes of Death in Hospitalized Intravenous Drug AbusersEndocarditis in Intravenous Drug AbusersOther Infectious Complications in Intravenous Drug UsersFalse Aneurysm Infected by Aspergillus Fumigatus: An Unusual Complication of Aortofemoral Bypass GraftHospitalization decision in febrile intravenous drug usersMedical complications of intravenous drug useMorphine inhibition of lymphocyte activity is mediated by an opioid dependent mechanismHIV-1-Related and Nonrelated Diseases among IV Drug Users and Sexual Partners“Cotton fever”: A benign febrile syndrome in intravenous drug abusersPulmonary Reactions from Illicit Substance AbuseMedical Complications of Substance AbuseSchmerztherapie bei Drogenabhängigen und opiattoleranten PatientenNon-HIV immunosuppressive factors in AIDS: A multifactorial, synergistic theory of aids aetiologyNon-HIV immunosuppressive factors in AIDS: A multifactorial, synergistic theory of AIDS aetiologyThe medical complications of drug abuseSpectrum and outcome of microbiologically documentedListeria monocytogenes infections in cancer patientsInfections Secondary to Intravenous Drug AbuseModes of death and types of cardiac diseases in opiate addicts: Analysis of 168 necropsy casesManifestaciones pulmonares como expresion clinica de endocarditis infecciosa en drogadictosImpact of the AIDS epidemic on morbidity and mortality among intravenous drug users in a New York City methadone maintenance program.Computerized Tomography and Neuropsychological Assessment in Long-term High-dose Heroin AddictsFixing into Intercostal Vessels: a new method among drug addictsListeriosis in the setting of malignant disease. Changing issues in an unusual infectionThe Periaqueductal Gray Matter Mediates Opiate-Induced ImmunosuppressionSuppression of natural killer cell activity by high-dose narcotic anesthesia in ratsPneumoniasIncreased Incidence of Infections in Intravenous Drug UsersDiet and Opiate Addiction: a quantitative assessment of the diet of non-institutionalized opiate addictsBrain, Endocrine and Immune Interactions: Implications in Intensive CareMethionine-enkephalin and β-endorphin levels in spleen and thymus gland of morphine tolerant-dependent and abstinent ratsThe Surgical Management of Empyema Thoracis in Substance Abuse Patients: A 5-Year ExperienceResults of a Prospective Statewide Reporting System for Infective EndocarditisFatal outcome in drug addictionA protocol for the treatment of severe infections of the handPathological Spectrum of the Lung in Cases of Violent Death: Part II. Clinicopathologic CorrelationA high proportion of sera of heroin addicts possesses anti-HLA class I and class II reactivityLow Occupational Risk of Human Immunodeficiency Virus Infection among Dental ProfessionalsAnalgosedierung opiat-, barbiturat- und benzodiazepinabhängiger PatientenAggravation by morphine and D-aspartic acid of pyelonephritis induced by i. v. inoculation of staphylococcus aureus in ratsLiver histopathology in autopsied drug-addictsInability to Predict Diagnosis in Febrile Intravenous Drug AbusersPAUL R. MARANTZ, M.D., MARK LINZER, M.D., CHERYL J. FEINER, M.P.H., STUART A. FEINSTEIN, M.D., ARTHUR M. KOZIN, M.D., GERALD H. FRIEDLAND, M.D.The place of elective vitrectomy in the management of patients withCandida endophthalmitisThe inhibition by morphine andd-aspartic acid of antibody production against Salmonella typhimurium antigen in rats: its antagonism byl-aspartic acidMethadone vs morphine: Comparison of their effect on phagocytic functionsIntravenous Drug Abusers and HIV Infections: A Consequence of Their ActionsNalbuphine-induced Pulmonary EdemaMethicillin-resistant staphylococcus aureus bacteremia linked to intravenous drug abusers using a “shooting gallery”BRONCHOSPASM AND INTRAVENOUS STREET HEROINOcular manifestations of drug abuseCandida Folliculitis in Heroin AddictsAlcohol and Opiate DependenceEffects of Morphine Opiates on Immune FunctionBrain stem mucormycosis in a narcotic addict with eventual recoveryBlood-borne pulmonary infection with Nocardia asteroides in a heroin addictRhabdomyolysis and concomitant neurological lesions after intravenous heroin abuse.Neumonias bacteriemicas por staphylococcus aureus en pacientes leucemicos con granulocitopeniaBotulism and Botulism-like Illness in Chronic Drug AbusersKRISTINE L. MacDONALD, M.D., GEORGE W. RUTHERFORD, M.D., STEPHEN M. FRIEDMAN, M.D., M.P.H., JOHN R. DIETZ, M.D., BRIAN R. KAYE, M.D., GEORGE F. McKINLEY, M.D., JAMES H. TENNEY, M.D., MITCHELL L. COHEN, M.D.Heroin myelopathy: a case reportDrug Abuse Effects on the Reticuloendothelial and Immune SystemsThe Comprehensive Evaluation of Cocaine and Opiate AbusersMorphine and methadone impact on human phagocytic physiologyEvidence for the activation of the endogenous opiate system in hamsters infected with human blood flukes,Heroin-Related Deaths: New Epidemiologic InsightsCardiac fungal infections: Review of autopsy findings in 60 patientsAccelerated development of pulmonary complications due to illicit intravenous use of pentazocine and tripelennamineThe Viral Aetiology of Rheumatoid ArthritisOPIATES, OPIOID PEPTIDES, AND IMMUNITYImmunological status in heroin addicts: Effects of methadone maintenance treatmentOPIOIDS AND GENERAL SEDATIVESFungal Cerebritis from Intravenous Drug AbuseInfectious Complications of Illicit Drug UseOverwhelming PneumoniaThe Immediate Management of OverdoseIntravenous Drug Addiction—Staphylococcal Septicemia—Pulmonary Embolism: A Triad Pathognomonic for Tricuspid Valve Endocarditis?Pneumonia and Lung AbscessDrug addiction: An updatePulmonary complications of drug addictionCardiac and vascular involvement in drug abuseNarcotic maintenance for chronic painDrug “Overdoses “among U.S. Soldiers in Europe, 1978-1979. II. Psychological Autopsies Following Deaths and Near-DeathsMale adolescent with subdural parietal abscessTenosynovitis in drug addictsCurrent concepts of cerebrovascular disease--stroke: stroke and drug abuse.Drug-Induced Interstitial Lung DiseasesAddict death rates during a four-year posttreatment follow-up.Heroin "Overdose" Death: Contribution of Drug-Associated Environmental CuesErkrankungen des EndokardsNonpharmacological bases of drug tolerance and dependenceCAUSES OF THE ADULT RESPIRATORY DISTRESS SYNDROME—CLINICAL RECOGNITIONImmunity and nutrition in heroin addictsNarcotic-Related Deaths in the District of Columbia: 1971–1979Acute myelopathy in associati

Heroin overdose: causes and consequences

2001-08-01

Matthew Warner‐Smith , Shane Darke , Michael T. Lynskey +1 more

Over the past decade fatal opioid overdose has emerged as a major public health issue internationally. This paper examines the risk factors for overdose from a biomedical perspective. While significant … Over the past decade fatal opioid overdose has emerged as a major public health issue internationally. This paper examines the risk factors for overdose from a biomedical perspective. While significant risk factors for opioid overdose fatality are well recognized, the mechanism of fatal overdose remains unclear. Losses of tolerance and concomitant use of alcohol and other CNS depressants clearly play a major role in fatality; howeve, such risk factors do not account for the strong age and gender patterns observed consistently among victims of overdose. There is evidence that systemic disease may be more prevalent in users at greatest risk of overdose. We hypothesize that pulmonary and hepatic dysfunction resulting from such disease may increase susceptibility to both fatal and non‐fatal overdose. Sequelae of non‐fatal overdose are recognized in the clinical literature but few epidemiological data exist describing the burden of morbidity arising from such sequelae. The potential for overdose to cause persisting morbidity is reviewed.

Undertreatment of Medical Inpatients with Narcotic Analgesics

1973-02-01

Richard M. Marks

Structured interviews of 37 medical inpatients being treated with narcotic analgesics for pain showed that 32% of the patients were continuing to experience severe distress, despite the analgesic regimen, and … Structured interviews of 37 medical inpatients being treated with narcotic analgesics for pain showed that 32% of the patients were continuing to experience severe distress, despite the analgesic regimen, and another 41% were in moderate distress. Chart review suggested significant undertreatment with narcotics: meperidine in doses of 50 mg every 3 to 4 hours or less (if needed) was prescribed for 63% of the 37 patients; a dose of more than 75 mg was prescribed for only 1 patient. The average amount actually received per day by the patients was 90 mg. A questionnaire survey of 102 house staff physicians in two New York teaching hospitals showed considerable misinformation about meperidine. Many physicians underestimated the effective dose range, overestimated the duration of action, and exaggerated the dangers of addiction for medical inpatients receiving meperidine in a therapeutic dosage range. Physicians who exaggerated the dangers of addiction were more likely to prescribe lower doses of drugs, even for patients with terminal malignancy. The authors suggest that such misconceptions probably lead to undertreatment with narcotic analgesics, causing much needless suffering in medical inpatients.

Poisoning Severity Score. Grading of Acute Poisoning

1998-01-01

Hans Persson , Gunilla Sjöberg , John A. Haines +1 more

Background; A standardized and generally applicable scheme for grading the severity of poisoning allows a qualitative evaluation of morbidity and facilitates comparability of data. Working from a simple grading scale … Background; A standardized and generally applicable scheme for grading the severity of poisoning allows a qualitative evaluation of morbidity and facilitates comparability of data. Working from a simple grading scale proposed by the European Association of Poisons Centres and Clinical Toxicologists, a Poisoning Severity Score has been developed jointly with the International Programme on Chemical Safety and the European Commission. Methods: The Poisoning Severity Score has been elaborated, tested, and gradually revised during a project running 1991-1994. Fourteen poisons centers from various countries have participated. Each center independently graded 371 cases of acute poisoning by ten different toxic agents. The data were then analyzed and compared. Results: The concordance in grading the severity increased during the study period, and in the last phase there was an acceptable concordance among centers in 80% or more of the cases. Given the condition and quality of the original case records, this result was considered satisfactory and agreement was reached on the scoring scheme presented here. The Poisoning Severity Score grades severity as (0) none, (1) minor, (2) moderate, (3) severe, and (4) fatal poisoning. It is intended to be an overall evaluation of the case, taking into account the most severe clinical features. Use of the Poisoning Severity Score normally requires a follow-up of all cases, but may be used on admission or other times during the course of poisoning if this is clearly stated when data are presented. Conclusions: A Poisoning Severity Score has been developed and found applicable for grading the severity of poisoning. It is foreseen that the Poisoning Severity Score will meet the expectations and be used in practice, but its future use and evaluation may result in some further revision and refinement.

American Academy of Clinical Toxicology Practice Guidelines on the Treatment of Methanol Poisoning

2002-01-01

T. To , Donald G. Barceloux , G. Randall Bond +3 more

Epidemiology: Almost all cases of acute methanol toxicity result from ingestion, though rarely cases of poisoning have followed inhalation or dermal absorption. The absorption of methanol following oral administration is … Epidemiology: Almost all cases of acute methanol toxicity result from ingestion, though rarely cases of poisoning have followed inhalation or dermal absorption. The absorption of methanol following oral administration is rapid and peak methanol concentrations occur within 30–60 minutes. Mechanisms of Toxicity: Methanol has a relatively low toxicity and metabolism is responsible for the transformation of methanol to its toxic metabolites. Methanol is oxidized by alcohol dehydrogenase to formaldehyde. The oxidation of formaldehyde to formic acid is facilitated by formaldehyde dehydrogenase. Formic acid is converted by 10-formyl tetrahydrofolate synthetase to carbon dioxide and water. In cases of methanol poisoning, formic acid accumulates and there is a direct correlation between the formic acid concentration and increased morbidity and mortality. The acidosis observed in methanol poisoning appears to be caused directly or indirectly by formic acid production. Formic acid has also been shown to inhibit cytochrome oxidase and is the prime cause of ocular toxicity, though acidosis can increase toxicity further by enabling greater diffusion of formic acid into cells. Features: Methanol poisoning typically induces nausea, vomiting, abdominal pain, and mild central nervous system depression. There is then a latent period lasting approximately 12–24 hours, depending, in part, on the methanol dose ingested, following which an uncompensated metabolic acidosis develops and visual function becomes impaired, ranging from blurred vision and altered visual fields to complete blindness. Management: For the patient presenting with ophthalmologic abnormalities or significant acidosis, the acidosis should be corrected with intravenous sodium bicarbonate, the further generation of toxic metabolite should be blocked by the administration of fomepizole or ethanol and formic acid metabolism should be enhanced by the administration of intravenous folinic acid. Hemodialysis may also be required to correct severe metabolic abnormalities and to enhance methanol and formate elimination. For the methanol poisoned patient without evidence of clinical toxicity, the first priority is to inhibit methanol metabolism with intravenous ethanol or fomepizole. Although there are no clinical outcome data confirming the superiority of either of these antidotes over the other, there are significant disadvantages associated with ethanol. These include complex dosing, difficulties with maintaining therapeutic concentrations, the need for more comprehensive clinical and laboratory monitoring, and more adverse effects. Thus fomepizole is very attractive, however, it has a relatively high acquisition cost. Conclusion: The management of methanol poisoning includes standard supportive care, the correction of metabolic acidosis, the administration of folinic acid, the provision of an antidote to inhibit the metabolism of methanol to formate, and selective hemodialysis to correct severe metabolic abnormalities and to enhance methanol and formate elimination. Although both ethanol and fomepizole are effective, fomepizole is the preferred antidote for methanol poisoning.

Acetaminophen Poisoning and Toxicity

1975-06-01

Barry H. Rumack , Henry Matthew

Acetaminophen (paracetamol in British literature) is a metabolite of phenacetin which has become increasingly popular as a substitute for salicylates.1 The popularity of acetaminophen has been encouraged by the medical … Acetaminophen (paracetamol in British literature) is a metabolite of phenacetin which has become increasingly popular as a substitute for salicylates.1 The popularity of acetaminophen has been encouraged by the medical profession because it is allegedly safer than aspirin.2 However, experience in Britain indicates that acute acetaminophen overdosage is both common and significantly more toxic than of salicylates.3-7 Although it is widely used in the United States, only one report describing a single American patient has appeared in the literature.8 This is a puzzling situation. It is axiomatic that if you do not look for something you will not diagnose it. This may provide the answer as there is apparently a general lack of knowledge in the United States concerning the toxicity of acetaminophen. Indeed, one of us (B.H.R.) contacted nine American University poison services in the spring of 1973 and discovered that none had clinical experience or analytical methods in operation. During the past year, however, with a high index of suspicion in Denver, 156 ingestions with four fatalities have been recorded. Because of the nonspecific initial features of acute overdosage, the lack of coma, the delay in onset of jaundice and the rapid fall in detectable plasma levels of acetaminophen, the cause-and-effect relationship may be missed in even a floridly ill or dying patient. Hepatoxicity is the most remarkable feature and the question must be raised as to how many cases of "jaundice of unknown etiology" are actually due to this drug. This review is intended to provide an understanding of the current knowledge of this drug. It should be noted that although toxicity and fatalities have occurred in the adolescent age group, only one death in younger children has been recorded.

Discovery of 1-(4-Methoxyphenyl)-7-oxo-6-(4-(2-oxopiperidin-1-yl)phenyl)-4,5,6,7-tetrahydro- 1<i>H</i>-pyrazolo[3,4-<i>c</i>]pyridine-3-carboxamide (Apixaban, BMS-562247), a Highly Potent, Selective, Efficacious, and Orally Bioavailable Inhibitor of Blood Coagulation Factor Xa

2007-10-03

Donald Pinto , Michael J. Orwat , Stephanie C. Koch +7 more

Efforts to identify a suitable follow-on compound to razaxaban (compound 4) focused on modification of the carboxamido linker to eliminate potential in vivo hydrolysis to a primary aniline. Cyclization of … Efforts to identify a suitable follow-on compound to razaxaban (compound 4) focused on modification of the carboxamido linker to eliminate potential in vivo hydrolysis to a primary aniline. Cyclization of the carboxamido linker to the novel bicyclic tetrahydropyrazolopyridinone scaffold retained the potent fXa binding activity. Exceptional potency of the series prompted an investigation of the neutral P1 moieties that resulted in the identification of the p-methoxyphenyl P1, which retained factor Xa binding affinity and good oral bioavailability. Further optimization of the C-3 pyrazole position and replacement of the terminal P4 ring with a neutral heterocycle culminated in the discovery of 1-(4-methoxyphenyl)-7-oxo-6-(4-(2-oxopiperidin-1-yl)phenyl)-4,5,6,7-tetrahydro-1H-pyrazolo[3,4-c]pyridine-3-carboxamide (apixaban, compound 40). Compound 40 exhibits a high degree of fXa potency, selectivity, and efficacy and has an improved pharmacokinetic profile relative to 4.

2008 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 26th Annual Report

2009-12-01

Alvin C. Bronstein , Daniel A. Spyker , Louis R. Cantilena +3 more

Background: This is the 26th Annual Report of the American Association of Poison Control Centers (AAPCC; http://www. aapcc.org) National Poison Data System (NPDS). During 2008, 60 of the nation's 61 … Background: This is the 26th Annual Report of the American Association of Poison Control Centers (AAPCC; http://www. aapcc.org) National Poison Data System (NPDS). During 2008, 60 of the nation's 61 US poison centers uploaded case data automatically. The median upload time was 24 [7.2, 112] (median [25%, 75%]) minutes creating a real-time national exposure and information database and surveillance system.

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Opioids in renal failure and dialysis patients

2004-10-26

Mervyn Dean

This article reviews the literature pertaining to the metabolism of several of the commonly used opioids, and the known activity of their metabolites. The effect of renal failure on the … This article reviews the literature pertaining to the metabolism of several of the commonly used opioids, and the known activity of their metabolites. The effect of renal failure on the pharmacokinetics of these drugs and metabolites is then reviewed. Finally, the effect of renal dialysis on opioid drugs and metabolites is reviewed. Based on the review, it is recommended that morphine and codeine are avoided in renal failure/dialysis patients; hydromorphone or oxycodone are used with caution and close monitoring; and that methadone and fentanyl/sufentanil appear to be safe to use. Note is made that the “safe” drugs in renal failure are also the least dialyzable.

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Position Statement and Practice Guidelines on the Use of Multi-Dose Activated Charcoal in the Treatment of Acute Poisoning

1999-01-01

In preparing this Position Statement, all relevant scientific literature was identified and reviewed critically by acknowledged experts using agreed criteria.Citation Well-conducted clinical and experimental studies were given precedence over anecdotal … In preparing this Position Statement, all relevant scientific literature was identified and reviewed critically by acknowledged experts using agreed criteria.Citation Well-conducted clinical and experimental studies were given precedence over anecdotal case reports and abstracts were not usually considered. A draft Position Statement was then produced and subjected to detailed peer review by an international group of clinical toxicologists chosen by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists. The Position Statement went through multiple drafts before being approved by the Boards of the two societies.

FATAL BENZYL ALCOHOL POISONING IN A NEONATAL INTENSIVE CARE UNIT

1982-05-01

WilliamJ. Brown , NeilR.M. Buist , HeleneT. Cory Gipson +2 more

Therapeutic and toxic blood concentrations of nearly 1,000 drugs and other xenobiotics

2012-07-26

Martin Schulz , Stefanie Iwersen‐Bergmann , Hilke Andresen +1 more

Abstract Introduction In order to assess the significance of drug levels measured in intensive care medicine, clinical and forensic toxicology, as well as for therapeutic drug monitoring, it is essential … Abstract Introduction In order to assess the significance of drug levels measured in intensive care medicine, clinical and forensic toxicology, as well as for therapeutic drug monitoring, it is essential that a comprehensive collection of data is readily available. Therefore, it makes sense to offer a carefully referenced compilation of therapeutic and toxic plasma concentration ranges, as well as half-lives, of a large number of drugs and other xenobiotics for quick and comprehensive information. Methods Data have been abstracted from original papers and text books, as well as from previous compilations, and have been completed with data collected in our own forensic and clinical toxicology laboratory. The data presented in the table and corresponding annotations have been developed over the past 20 years and longer. A previous compilation has been completely revised and updated. In addition, more than 170 substances, especially drugs that have been introduced to the market since 2003 as well as illegal drugs, which became known to cause intoxications, were added. All data were carefully referenced and more than 200 new references were included. Moreover, the annotations providing details were completely revised and more than 100 annotations were added. Results For nearly 1,000 drugs and other xenobiotics, therapeutic ("normal") and, if data were available, toxic and comatose-fatal blood-plasma concentrations and elimination half-lives were compiled in a table. Conclusions In case of intoxications, the concentration of the ingested substances and/or metabolites in blood plasma better predicts the clinical severity of the case when compared to the assumed amount and time of ingestion. Comparing and contrasting the clinical case against the data provided, including the half-life, may support the decision for or against further intensive care. In addition, the data provided are useful for the therapeutic monitoring of pharmacotherapies, to facilitate the diagnostic assessment and monitoring of acute and chronic intoxications, and to support forensic and clinical expert opinions.

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Toxic Alcohol Ingestions

2007-11-29

Jeffrey A. Kraut , Ira Kurtz

Alcohol-related intoxications, including methanol, ethylene glycol, diethylene glycol, and propylene glycol, and alcoholic ketoacidosis can present with a high anion gap metabolic acidosis and increased serum osmolal gap, whereas isopropanol … Alcohol-related intoxications, including methanol, ethylene glycol, diethylene glycol, and propylene glycol, and alcoholic ketoacidosis can present with a high anion gap metabolic acidosis and increased serum osmolal gap, whereas isopropanol intoxication presents with hyperosmolality alone. The effects of these substances, except for isopropanol and possibly alcoholic ketoacidosis, are due to their metabolites, which can cause metabolic acidosis and cellular dysfunction. Accumulation of the alcohols in the blood can cause an increment in the osmolality, and accumulation of their metabolites can cause an increase in the anion gap and a decrease in serum bicarbonate concentration. The presence of both laboratory abnormalities concurrently is an important diagnostic clue, although either can be absent, depending on the time after exposure when blood is sampled. In addition to metabolic acidosis, acute renal failure and neurologic disease can occur in some of the intoxications. Dialysis to remove the unmetabolized alcohol and possibly the organic acid anion can be helpful in treatment of several of the alcohol-related intoxications. Administration of fomepizole or ethanol to inhibit alcohol dehydrogenase, a critical enzyme in metabolism of the alcohols, is beneficial in treatment of ethylene glycol and methanol intoxication and possibly diethylene glycol and propylene glycol intoxication. Given the potentially high morbidity and mortality of these intoxications, it is important for the clinician to have a high degree of suspicion for these disorders in cases of high anion gap metabolic acidosis, acute renal failure, or unexplained neurologic disease so that treatment can be initiated early.

Medical Aspects of the Persistent Vegetative State

1994-06-02

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Fomepizole for the Treatment of Methanol Poisoning

2001-02-08

Jeffrey Brent , Kenneth E. McMartin , Scott Phillips +2 more

Methanol poisoning may result in metabolic acidosis, blindness, and death. The inhibition of alcohol dehydrogenase is fundamental to the treatment of methanol poisoning. We performed a multicenter study to evaluate … Methanol poisoning may result in metabolic acidosis, blindness, and death. The inhibition of alcohol dehydrogenase is fundamental to the treatment of methanol poisoning. We performed a multicenter study to evaluate fomepizole, an inhibitor of alcohol dehydrogenase, in the treatment of patients with methanol poisoning.

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Rational Intravenous Doses of Theophylline

1973-09-20

Paul A. Mitenko , Richard I. Ogilvie

Physiologic responses to intravenously administered theophylline were determined in nine hospitalized asthmatic subjects. In each patient incremental theophylline plasma concentration plateaus were attained at which pulmonary-function changes related to drug … Physiologic responses to intravenously administered theophylline were determined in nine hospitalized asthmatic subjects. In each patient incremental theophylline plasma concentration plateaus were attained at which pulmonary-function changes related to drug administration were examined. Continuous improvement in vital capacity and first-second forced expiratory volume was observed over the plasma range of theophylline concentration of 5 to 20 mg per liter. The improvement varied directly with the logarithm of the plasma concentration. A safe and effective dosage regimen for intravenous theophylline can be based on these observations. After a loading dose of aminophylline, 5.6 mg per kilogram given intravenously, 0.9 mg per kilogram per hour can be given as a maintenance dose. This amount will result in a plasma theophylline concentration of approximately 10 mg per liter for 95 per cent of patients and in recovery from some 30 to 40 per cent of reversible pulmonary-airway obstruction. (N Engl J Med 289:600–603, 1973)

2011 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 29th Annual Report

2012-12-01

Alvin C. Bronstein , Daniel A. Spyker , Louis R. Cantilena +2 more

Background: This is the 29th Annual Report of the American Association of Poison Control Centers’ (AAPCC) National Poison Data System (NPDS). As of 1 July 2011, 57 of the nation's … Background: This is the 29th Annual Report of the American Association of Poison Control Centers’ (AAPCC) National Poison Data System (NPDS). As of 1 July 2011, 57 of the nation's poison centers (PCs) uploaded case data automatically to NPDS. The upload interval was 8.43 [6.29, 13.7] (median [25%, 75%]) minutes, creating a near real-time national exposure and information database and surveillance system.Methodology: We analyzed the case data tabulating specific indices from NPDS. The methodology was similar to that of previous years. Where changes were introduced, the differences are identified. Poison center cases with medical outcomes of death were evaluated by a team of 38 medical and clinical toxicologist reviewers using an ordinal scale of 1–6 to assess the Relative Contribution to Fatality (RCF) of the exposure to the death.Results: In 2011, 3,624,063 closed encounters were logged by NPDS: 2,334,004 human exposures, 80,266 animal exposures, 1,203,282 information calls, 6,243 human confirmed nonexposures, and 268 animal confirmed nonexposures. Total encounters showed an 8.3% decline from 2010, while health care facility exposure calls increased by 4.8%. Human exposures with less serious outcomes decreased by 3.4% while those with more serious outcomes (moderate, major or death) increased by 6.8%. All information calls decreased by 17.9% and health care facility (HCF) information calls decreased by 2.9%, Medication identification requests (Drug ID) decreased by 24.1%, and human exposures reported to US poison centers decreased by 2.2%.The top 5 substance classes most frequently involved in all human exposures were analgesics (11.7%), cosmetics/personal care products (8.0%), household cleaning substances (7.0%), sedatives/hypnotics/antipsychotics (6.1%), and foreign bodies/toys/miscellaneous (4.1%). Analgesic exposures as a class increased most rapidly (10,134 calls/year) over the last 11 years. The top 5 most common exposures in children aged 5 years or less were cosmetics/personal care products (14.0%), analgesics (9.9%), household cleaning substances (9.2%), foreign bodies/toys/miscellaneous (6.9%), and topical preparations (6.6%). Drug identification requests comprised 59.5% of all information calls. NPDS documented 2,765 human exposures resulting in death with 1,995 human fatalities judged related (RCF of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory).Conclusions: These data support the continued value of poison center expertise and need for specialized medical toxicology information to manage the more severe exposures, despite a decrease in calls involving less severe exposures. Unintentional and intentional exposures continue to be a significant cause of morbidity and mortality in the US. The near real-time, always current status of NPDS represents a national public health resource to collect and monitor US exposure cases and information calls. The continuing mission of NPDS is to provide a nationwide infrastructure for public health surveillance for all types of exposures, public health event identification, resilience response and situational awareness tracking. NPDS is a model system for the nation and global public health.

2010 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 28th Annual Report

2011-12-01

Alvin C. Bronstein , Daniel A. Spyker , Louis R. Cantilena +3 more

Background: This is the 28th Annual Report of the American Association of Poison Control Centers' (AAPCC) National Poison Data System (NPDS). All US poison centers upload case data automatically with … Background: This is the 28th Annual Report of the American Association of Poison Control Centers' (AAPCC) National Poison Data System (NPDS). All US poison centers upload case data automatically with a median time interval of 19.0 [11.9, 40.6] (median [25%, 75%]) minutes, creating a near real-time national exposure and information database and surveillance system.Methodology: We analyzed the case data tabulating specific indices from NPDS. The methodology was similar to that of previous years. Where changes were introduced, the differences are identified. Poison center cases with medical outcomes of death were evaluated by a team of 33 medical and clinical toxicologist reviewers using an ordinal scale of 1 (Undoubtedly responsible) – 6 (Unknown) to determine Relative Contribution to Fatality (RCF) of the exposure to the death.Results: In 2010, 3,952,772 closed encounters were logged by NPDS: 2,384,825, human exposures, 94,823 animal exposures, 1,466,253 information calls, 6537 human confirmed nonexposures, and 334 animal confirmed nonexposures. Total encounters showed a 7.7% decline from 2009 while health care facility calls increased by 2.7%. Human exposures with more serious outcomes (minor, moderate, major or death) increased 4.5% while those with less serious outcomes (all other medical outcome categories) decreased 5.9%. All information calls decreased 12.6% and health care facility (HCF) information calls decreased 13.6%, Drug ID calls decreased 10.9%, and human exposures decreased 3.8%. The top 5 substance classes most frequently involved in all human exposures were analgesics (11.5%), cosmetics/personal care products (7.7%), household cleaning substances (7.3%), sedatives/hypnotics/ antipsychotics (6.0%), and foreign bodies/toys/miscellaneous (4.2%). Analgesic exposures as a class increased the most rapidly by 32.8% over the last decade. The top f ve most common exposures in children age 5 years or less were cosmetics/personal care products (13.2%), analgesics (9.4%), household cleaning substances (9.2%), foreign bodies/toys/miscellaneous (7.2%), and topical preparations (6.8%). THC homolog and designer amphetamine ("Bath Salts") exposures were identified as emerging public health threats. Drug identification requests comprised 64.3% of all information calls. NPDS documented 1730 human exposures resulting in death with 1146 human fatalities judged related with an RCF of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory.Conclusions: These data support the continued value of poison center expertise and need for specialized medical toxicology information to manage the more severe exposures, despite a decrease in calls involving less severe exposures. Unintentional and intentional exposures continue to be a significant cause of morbidity and mortality in the US. The near real-time, always current status of NPDS represents a national public health resource to collect and monitor US exposure cases and information calls. The continuing mission of NPDS is to provide a nationwide infrastructure for public health surveillance for all types of exposures, public health event identification, resilience response and situational awareness tracking. NPDS is a model system for the nation and global public health.

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2012 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 30th Annual Report

2013-12-01

James B. Mowry , Daniel A. Spyker , Louis R. Cantilena +2 more

This is the 30(th) Annual Report of the American Association of Poison Control Centers' (AAPCC) National Poison Data System (NPDS). As of July 1, 2012, 57 of the nation's poison … This is the 30(th) Annual Report of the American Association of Poison Control Centers' (AAPCC) National Poison Data System (NPDS). As of July 1, 2012, 57 of the nation's poison centers (PCs) uploaded case data automatically to NPDS. The upload interval was 7.58 [6.30, 11.22] (median [25%, 75%]) min, creating a near real-time national exposure and information database and surveillance system.We analyzed the case data tabulating specific indices from NPDS. The methodology was similar to that of previous years. Where changes were introduced, the differences are identified. Poison center cases with medical outcomes of death were evaluated by a team of 34 medical and clinical toxicologist reviewers using an ordinal scale of 1-6 to assess the Relative Contribution to Fatality (RCF) of the exposure to the death.In 2012, 3,373,025 closed encounters were logged by NPDS: 2,275,141 human exposures, 66,440 animal exposures, 1,025,547 information calls, 5,679 human confirmed nonexposures, and 218 animal confirmed nonexposures. Total encounters showed a 6.9% decline from 2011, while healthcare facility (HCF) exposure calls increased by 1.2%. All information calls decreased by 14.8% and HCF information calls decreased by 1.7%, medication identification requests (Drug ID) decreased by 22.0%, and human exposures reported to US PCs decreased by 2.5%. Human exposures with less serious outcomes have decreased by 3.7% per year since 2008, while those with more serious outcomes (moderate, major, or death) have increased by 4.6% per year since 2000. The top five substance classes most frequently involved in all human exposures were analgesics (11.6%), cosmetics/personal care products (7.9%), household cleaning substances (7.2%), sedatives/hypnotics/antipsychotics (6.1%), and foreign bodies/toys/miscellaneous (4.1%). Analgesic exposures as a class increased the most rapidly (8,780 calls/year) over the last 12 years. The top five most common exposures in children aged 5 years or less were cosmetics/ personal care products (13.9%), analgesics (9.9%), household cleaning substances (9.7%), foreign bodies/toys/ miscellaneous (7.0%), and topical preparations (6.3%). Drug identification requests comprised 54.4% of all information calls. NPDS documented 2,937 human exposures resulting in death with 2,576 human fatalities judged related (RCF of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory).These data support the continued value of PC expertise and need for specialized medical toxicology information to manage the more severe exposures, despite a decrease in calls involving less severe exposures. Unintentional and intentional exposures continue to be a significant cause of morbidity and mortality in the US. The near real-time, always current status of NPDS represents a national public health resource to collect and monitor US exposure cases and information calls. The continuing mission of NPDS is to provide a nationwide infrastructure for public health surveillance for all types of exposures, public health event identification, resilience response, and situational awareness tracking. NPDS is a model system for the nation and global public health.

2013 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 31st Annual Report

2014-12-01

James B. Mowry , Daniel A. Spyker , Louis R. Cantilena +2 more

Background: This is the 31st Annual Report of the American Association of Poison Control Centers’ (AAPCC) National Poison Data System (NPDS). As of January 1, 2013, 57 of the nation's … Background: This is the 31st Annual Report of the American Association of Poison Control Centers’ (AAPCC) National Poison Data System (NPDS). As of January 1, 2013, 57 of the nation's poison centers (PCs) uploaded case data automatically to NPDS. The upload interval was 8.08 [7.10, 11.63] (median [25%, 75%]) minutes, creating a near real-time national exposure and information database and surveillance system.Methodology: We analyzed the case data tabulating specific indices from NPDS. The methodology was similar to that of previous years. Where changes were introduced, the differences are identified. Poison center (PC) cases with medical outcomes of death were evaluated by a team of 38 medical and clinical toxicologist reviewers using an ordinal scale of 1–6 to assess the Relative Contribution to Fatality (RCF) of the exposure to the death.Results: In 2013, 3,060,122 closed encounters were logged by NPDS: 2,188,013 human exposures, 59,496 animal exposures, 806,347 information calls, 6,116 human-confirmed nonexposures, and 150 animal-confirmed nonexposures. Total encounters showed a 9.3% decline from 2012, while health care facility human exposure calls were essentially flat, decreasing by 0.1%.All information calls decreased 21.4% and health care facility (HCF) information calls decreased 8.5%, medication identification requests (drug ID) decreased 26.8%, and human exposures reported to US PCs decreased 3.8%. Human exposures with less serious outcomes have decreased 3.7% per year since 2008 while those with more serious outcomes (moderate, major or death) have increased by 4.7% per year since 2000.The top five substance classes most frequently involved in all human exposures were analgesics (11.5%), cosmetics/personal care products (7.7%), household cleaning substances (7.6%), sedatives/hypnotics/antipsychotics (5.9%), and antidepressants (4.2%). Sedative/hypnotics/antipsychotics exposures as a class increased most rapidly (2,559 calls/year) over the last 13 years for cases showing more serious outcomes. The top five most common exposures in children of 5 years or less were cosmetics/personal care products (13.8%), household cleaning substances (10.4%), analgesics (9.8%), foreign bodies/toys/miscellaneous (6.9%), and topical preparations (6.1%). Drug identification requests comprised 50.7% of all information calls. NPDS documented 2,477 human exposures resulting in death with 2,113 human fatalities judged related (RCF of 1, undoubtedly responsible; 2, probably responsible; or 3, contributory).Conclusions: These data support the continued value of PC expertise and need for specialized medical toxicology information to manage the more severe exposures, despite a decrease in calls involving less severe exposures. Unintentional and intentional exposures continue to be a significant cause of morbidity and mortality in the United States. The near real-time, always current status of NPDS represents a national public health resource to collect and monitor US exposure cases and information calls. The continuing mission of NPDS is to provide a nationwide infrastructure for public health surveillance for all types of exposures, public health event identification, resilience response and situational awareness tracking. NPDS is a model system for the nation and global public health.

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2014 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 32nd Annual Report

2015-11-26

James B. Mowry , Daniel A. Spyker , Daniel E. Brooks +2 more

This is the 32nd Annual Report of the American Association of Poison Control Centers' (AAPCC) National Poison Data System (NPDS). As of 1 January 2014, 56 of the nation's poison … This is the 32nd Annual Report of the American Association of Poison Control Centers' (AAPCC) National Poison Data System (NPDS). As of 1 January 2014, 56 of the nation's poison centers (PCs) uploaded case data automatically to NPDS. The upload interval was 7.82 [7.02, 11.17] (median [25%, 75%]) minutes, creating a near real-time national exposure and information database and surveillance system.We analyzed the case data tabulating specific indices from NPDS. The methodology was similar to that of previous years. Where changes were introduced, the differences are identified. Poison center cases with medical outcomes of death were evaluated by a team of medical and clinical toxicologist reviewers using an ordinal scale of 1-6 to assess the Relative Contribution to Fatality (RCF) of the exposure to the death.In 2014, 2,890,909 closed encounters were logged by NPDS: 2,165,142 human exposures, 56,265 animal exposures, 663,305 information calls, 6,085 human confirmed nonexposures, and 112 animal confirmed nonexposures. US poison centers (PCs) also made 2,617,346 follow-up calls in 2014. Total encounters showed a 5.5% decline from 2013, while health care facility human exposure cases increased by 3.3% from 2013. All information calls decreased by 17.7% and health care facility (HCF) information calls were essentially flat, decreasing by 0.04%, medication identification requests (Drug ID) decreased 29.8%, and human exposures reported to US PCs decreased 1.1%. Human exposures with less serious outcomes have decreased 3.40% per year since 2008 while those with more serious outcomes (moderate, major or death) have increased by 4.29% per year since 2000. The top 5 substance classes most frequently involved in all human exposures were analgesics (11.3%), cosmetics/personal care products (7.7%), household cleaning substances (7.7%), sedatives/hypnotics/antipsychotics (5.9%), and antidepressants (4.4%). Sedative/Hypnotics/Antipsychotics exposures as a class increased the most rapidly (2,368 calls (12.2%)/year) over the last 13 years for cases showing more serious outcomes. The top 5 most common exposures in children age 5 years or less were cosmetics/personal care products (14.0%), household cleaning substances (11.0%), analgesics (9.3%), foreign bodies/toys/miscellaneous (6.7%), and topical preparations (5.8%). Drug identification requests comprised 43.3% of all information calls. NPDS documented 1,835 human exposures resulting in death with 1,408 human fatalities judged related (RCF of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory).These data support the continued value of PC expertise and need for specialized medical toxicology information to manage more serious exposures, despite a decrease in calls involving less serious exposures. Unintentional and intentional exposures continue to be a significant cause of morbidity and mortality in the US. The near real-time, always current status of NPDS represents a national public health resource to collect and monitor US exposure cases and information calls. The continuing mission of NPDS is to provide a nationwide infrastructure for surveillance for all types of exposures (e.g., foreign body, viral, bacterial, venomous, chemical agent, or commercial product), the identification of events of public health significance, resilience, response and situational awareness tracking. NPDS is a model system for the real-time surveillance of national and global public health.[Box: see text].

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2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report

2008-01-01

Alvin C. Bronstein , Daniel A. Spyker , Louis R. Cantilena +3 more

This report is the 25th Annual Report of the American Association of Poison Control Centers (AAPCC; http://www.aapcc.org) National Poison Data System (NPDS). During 2007, 60 of the nation's 61 U.S. … This report is the 25th Annual Report of the American Association of Poison Control Centers (AAPCC; http://www.aapcc.org) National Poison Data System (NPDS). During 2007, 60 of the nation's 61 U.S. Poison Centers upload case data automatically. The median upload time is 14 [5.3, 55] (median [25%, 75%]) min creating a real-time national exposure database and surveillance system.We analyzed the case data tabulating specific indices from NPDS. The methodology was similar to that of previous years. Where changes were introduced, the differences are identified. Fatalities were reviewed by a team of 29 medical and clinical toxicologists and assigned to 1 of 6 categories according to Relative Contribution to Fatality.Over 4.2 million calls were captured by NPDS in 2007: 2,482,041 human exposure calls, 1,602,489 information requests, and 131,744 nonhuman exposure calls. Substances involved most frequently in all human exposures were analgesics (12.5% of all exposures). The most common exposures in children less than age 6 were cosmetics/personal care products (10.7% of pediatric exposures). Drug identification requests comprised 66.8% of all information calls. NPDS documented 1,597 human fatalities.Poisoning continues to be a significant cause of morbidity and mortality in the United States NPDS represents a valuable national resource to collect and monitor U.S. poisoning exposure cases. It offers one of the few real-time surveillance systems in existence, provides useful data, and is a model for public health surveillance.

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2016 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 34th Annual Report

2017-11-26

David D. Gummin , James B. Mowry , Daniel A. Spyker +3 more

Introduction: This is the 34th Annual Report of the American Association of Poison Control Centers' (AAPCC) National Poison Data System (NPDS). As of 1 January 2016, 55 of the nation's … Introduction: This is the 34th Annual Report of the American Association of Poison Control Centers' (AAPCC) National Poison Data System (NPDS). As of 1 January 2016, 55 of the nation's poison centers (PCs) uploaded case data automatically to NPDS. The upload interval was 9.50 [7.33, 14.6] (median [25%, 75%]) min, facilitating a near real-time national exposure and information database and surveillance system.Methods: We analyzed the case data tabulating specific indices from NPDS. The methodology was similar to that of previous years. Where changes were introduced, the differences are identified. Cases with medical outcomes of death were evaluated by a team of medical and clinical toxicologist reviewers using an ordinal scale of 1–6 to assess the Relative Contribution to Fatality (RCF) of the exposure.Results: In 2016, 2,710,042 closed encounters were logged by NPDS: 2,159,032 human exposures, 54,019 animal exposures, 490,215 information cases, 6687 human confirmed non-exposures, and 89 animal confirmed non-exposures. US PCs also made 2,718,022 follow-up calls in 2016. Total encounters showed a 2.94% decline from 2015, while health care facility (HCF) human exposure cases increased by 3.63% from 2015. All information calls decreased by 12.5% but HCF information calls increased 0.454%, and while medication identification requests (Drug ID) decreased 29.6%, human exposure cases were essentially flat, decreasing by 0.431%. Human exposures with less serious outcomes have decreased 2.59% per year since 2008 while those with more serious outcomes (moderate, major or death) have increased by 4.39% per year since 2000.The top five substance classes most frequently involved in all human exposures were analgesics (11.2%), household cleaning substances (7.54%), cosmetics/personal care products (7.20%), sedatives/hypnotics/antipsychotics (5.84%), and antidepressants (4.74%). As a class, sedative/hypnotics/antipsychotics exposures increased most rapidly, by 10.7% per year (2088 cases/year), over the last 15 years for cases showing more serious outcomes. The top five most common exposures in children age 5 years or less were cosmetics/personal care products (13.3%), household cleaning substances (11.1%), analgesics (9.21%), foreign bodies/toys/miscellaneous (6.48%), and topical preparations (5.07%). Drug identification requests comprised 28.1% of all information calls. NPDS documented 1977 human exposures resulting in death; 1492 (75.5%) of these were judged as related (RCF of 1 – undoubtedly responsible, 2 – probably responsible, or 3 – contributory).Conclusions: These data support the continued value of PC expertise and need for specialized medical toxicology information to manage more serious exposures, despite a decrease in cases involving less serious exposures. Unintentional and intentional exposures continue to be a significant cause of morbidity and mortality in the US. The near real-time, always current status of NPDS represents a national public health resource for collecting and monitoring US exposure cases and information calls. The continuing mission of NPDS is to provide a nationwide infrastructure for surveillance for all types of exposures (e.g. foreign body, infectious, venomous, chemical agent, or commercial product), and the identification and tracking of significant public health events. NPDS is a model system for the real-time surveillance of national and global public health.

2018 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 36th Annual Report

2019-11-21

David D. Gummin , James B. Mowry , Daniel A. Spyker +5 more

Introduction: This is the 36th Annual Report of the American Association of Poison Control Centers' (AAPCC) National Poison Data System (NPDS). As of 1 January, 2018, 55 of the nation's … Introduction: This is the 36th Annual Report of the American Association of Poison Control Centers' (AAPCC) National Poison Data System (NPDS). As of 1 January, 2018, 55 of the nation's poison centers (PCs) uploaded case data automatically to NPDS. The upload interval was 7.72 [6.90, 12.0] (median [25%, 75%]) minutes, creating a near real-time national exposure and information database and surveillance system.Methods: We analyzed the case data tabulating specific indices from NPDS. The methodology was similar to that of previous years. Where changes were introduced, the differences are identified. Cases with medical outcomes of death were evaluated by a team of medical and clinical toxicologist reviewers using an ordinal scale of 1-6 to assess the Relative Contribution to Fatality (RCF) of the exposure.Results: In 2018, 2,530,238 closed encounters were logged by NPDS: 2,099,751 human exposures, 57,017 animal exposures, 368,025 information requests, 5,346 human confirmed nonexposures, and 99 animal confirmed nonexposures. United States PCs also made 2,621,242 follow-up calls in 2018. Total encounters showed a 2.96% decline from 2017, while health care facility (HCF) human exposure cases remained nearly steady with a slight decrease of 0.261%. All information requests decreased by 15.5%, medication identification (Drug ID) requests decreased by 30.2%, and human exposure cases decreased by 0.729%. Human exposures with less serious outcomes have decreased 2.33% per year since 2008, while those with more serious outcomes (moderate, major or death) have increased 4.45% per year since 2000.Consistent with the previous year, the top 5 substance classes most frequently involved in all human exposures were analgesics (10.8%), household cleaning substances (7.28%), cosmetics/personal care products (6.53%), sedatives/hypnotics/antipsychotics (5.53%), and antidepressants (5.22%). For cases with more serious outcomes, sedative/hypnotics/antipsychotics exposures were the class that increased most rapidly, by 1,828 cases/year (9.21%/year) over the past 18 years. Over just the past 10 years (for cases with the most serious outcomes) antidepressant exposures increased most rapidly, by 1,887 cases/year (7.02%/year).The top 5 most common exposures in children age 5 years or less were cosmetics/personal care products (12.1%), household cleaning substances (10.7%), analgesics (9.04%), foreign bodies/toys/miscellaneous (6.87%), and topical preparations (4.69%). Drug identification requests comprised 18.2% of all information requests. NPDS documented 3,111 human exposures resulting in death; 2,582 (83.0%) of these were judged as related (RCF of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory).Conclusions: These data support the continued value of PC expertise and need for specialized medical toxicology information to manage more serious exposures. Unintentional and intentional exposures continue to be a significant cause of morbidity and mortality in the US. The near real-time status of NPDS represents a national public health resource to collect and monitor US exposure cases and information requests. The continuing mission of NPDS is to provide a nationwide infrastructure for surveillance for all types of exposures (e.g., foreign body, infectious, venomous, chemical agent, or commercial product), and the identification and tracking of significant public health events. NPDS is a model system for the near real-time surveillance of national and global public health.

2004 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System

2005-09-01

William A. Watson , Toby Litovitz , George C. Rodgers +5 more

Goldfrank's Toxicologic Emergencies.

1991-05-01

Chemical anatomy, physiology and pathology of extracellular fluid

1954-01-01

James L. Gamble

Quantitative analysis of ethylene glycol in human serum by liquid chromatography–tandem mass spectrometry with p-toluenesulfonyl isocyanate derivatization

2025-06-24

Shin Ogawa , Ryosuke Shiraki , Kengo Wakigawa +4 more | Forensic Toxicology

Petechial rash inflicted by self-damage in a pre-teen

2025-06-24

Elda Skenderi , Alberta Shkembi , Gjeorgjina Kuli-Lito +4 more | World Journal of Advanced Research and Reviews

A petechial rash in children is characterized by small, pinpoint, less than 2mm in diameter, non-blanching spots appearing over the skin and mucous membranes. They result from areas of hemorrhage … A petechial rash in children is characterized by small, pinpoint, less than 2mm in diameter, non-blanching spots appearing over the skin and mucous membranes. They result from areas of hemorrhage into the dermis. Petechial rash is common in children and result from infections, trauma and blood and clotting disorders. Here is presented the case of pre-teen girl with a petechial rash inflicted by self-damage.

Medication Update

2025-06-24

| The Nurse Practitioner

Intoxicación por metanol

2025-06-24

Camilo Ernesto Nemeguén Arias , Camilo Romero , Gonzalo La Rota Moscoso | Acta neurológica colombiana

Introducción: la intoxicación por metanol (IM) no es infrecuente en nuestro país. Las manifestaciones clínicas son variadas y con frecuente compromiso neurológico y del nervio óptico. Su diagnóstico temprano y … Introducción: la intoxicación por metanol (IM) no es infrecuente en nuestro país. Las manifestaciones clínicas son variadas y con frecuente compromiso neurológico y del nervio óptico. Su diagnóstico temprano y el tratamiento oportuno disminuyen la morbimortalidad asociada a la IM. Materiales y métodos: se realiza una revisión no sistemática de la literatura sobre la epidemiología, la toxicocinética, la fisiopatología, las manifestaciones clínicas, el diagnóstico, el tratamiento y el pronóstico de la IM. Resultados: la IM corresponde al 1,1?% de las intoxicaciones en Colombia. El conocimiento del metabolismo del metanol, del efecto toxico de sus metabolitos y de sus principales manifestaciones clínicas facilitan su diagnóstico y la instauración de tratamientos específicos. El fomepizol y la eritropoyetina (EPO) son fármacos que ayudan a disminuir el daño tisular por la IM. Uno de cada cinco pacientes con IM fallece y hasta el 40,0?% queda con secuelas neurológicas. Conclusiones: en Colombia, la IM es frecuente. La acumulación de metabolitos tóxicos produce acidemia y neurotoxicidad, sin embargo, se pueden disminuir sus consecuencias mediante el diagnóstico temprano y la instauración de medidas que inhiban su metabolismo y aceleren la eliminación del metanol y los metabolitos. La EPO (eritropoyetina) surge como alternativa para mejorar el pronóstico visual de los pacientes.

A Retrospective Descriptive Study of Maternal Morbidity Based on Mississippi Poison Control Center Data

2025-06-23

Laura Lee Beneke , Zariad Saran , Mallory Pullman +2 more | Deleted Journal

Poisonings treated in emergency departments of spanish hospitals (EPITOX Registry): knowing to prevent

2025-06-23

Florencia Giné , Eva E. Álvarez-León | Deleted Journal

ROLE OF CONVALESCENT PLASMA THERAPY IN PATIENTS WITH COVID-19 INFECTION- AN EXPERIENCE FROM A TERTIARY CARE CENTRE IN WESTERN U.P.

2025-06-23

Anurag Srivastava , Saurabh Srivastava , Md. Kausar Neyaz +3 more | Journal of Population Therapeutics and Clinical Pharmacology

Fentanyl

2025-06-21

| Reactions Weekly

Fentanyl

2025-06-21

| Reactions Weekly

Methanol poisoning in the emergency department: methanol blood levels, prognosis, and sequelae outcomes

2025-06-21

Kürşat Sarıbaş , Ayça Açıkalın , Pınar Efeoğlu +3 more | Irish Journal of Medical Science (1971 -)

Abstract Background Methanol poisoning is a critical condition marked by severe metabolic acidosis, shock, and organ failure, often leading to high morbidity, mortality, and sequelae such as permanent blindness. Aims … Abstract Background Methanol poisoning is a critical condition marked by severe metabolic acidosis, shock, and organ failure, often leading to high morbidity, mortality, and sequelae such as permanent blindness. Aims This study retrospectively analyzes methanol poisoning cases to provide insights into diagnosis, treatment, outcomes, and sequelae rates. Methods Patients diagnosed with methanol poisoning in a university-based emergency department between 2015 and 2023 were analyzed. Data on demographics, presenting complaints, diagnostics, treatments, hospitalization, outcomes, and sequelae were collected. Results Among 116 patients, the mean age was 48.3 ± 13.5 years, and 94.8% ( n = 110) were male. Alcohol poisoning accounted for 110 cases, while six involved other substances. Eighty-nine patients were discharged, and 27 died. Ocular findings predominated among survivors, while altered consciousness was the most common complaint in deceased patients. Deceased patients exhibited significantly lower pH and HCO 3 levels and higher base deficit, anion gap, and lactate levels. Blood methanol levels (mean, 64.5 ± 79.9 mg/dL) showed no correlation with mortality. Treatments included hemodialysis (89.7%), hemofiltration (19.8%), ethyl alcohol (77.6%), fomepizole (15%), and NaHCO 3 (78.1%). Visual sequelae developed in 33.7% of patients, while neurologic sequelae occurred in 6.2%. Conclusion Methanol poisoning remains a severe clinical issue with high morbidity and mortality. Low pH, HCO 3 , and high anion/lactate levels are poor prognostic indicators. Early treatment improves outcomes, yet disabling visual sequelae are frequent. Developing rapid diagnostic kits for methanol and formic acid detection is essential for improving early diagnosis and management.

Rapid Risk Assessment for Glycerol in Slushed Ice Drink Products

2025-06-20

| FSA research and evidence.

This rapid risk assessment evaluates the potential health risks associated with glycerol in slushed ice drinks. Glycerol prevents freezing, but can cause nausea, headaches, and vomiting when consumed in high … This rapid risk assessment evaluates the potential health risks associated with glycerol in slushed ice drinks. Glycerol prevents freezing, but can cause nausea, headaches, and vomiting when consumed in high amounts. Cases in children have reported hypoglycaemia and decreased consciousness. A baseline risk assessment was conducted following a reported incident in a toddler which compared exposure levels to a conservative pharmacological threshold of 125 mg/kg body weight per hour (the lowest end of a dose range causing side effects in some patients, where glycerol was used pharmaceutically) and a pragmatic threshold of 1000 mg/kg bw. Following this, the Food Standards Agency (FSA) advised against the consumption of slushed ice drinks by children aged 4 and under and advised reformulation to a maximum of 50,000 mg/L glycerol. Children under 10 were advised not to consume refills. Additional data prompted an expanded risk assessment, considering both the conservative and pragmatic thresholds, and included additional age groups and lower bodyweights. This indicated a risk of potential adverse effects in some individuals, particularly children with a lower bodyweight for their age, due to the high exceedance of both the pharmacological dose of 125mg/kg bw/hour and the pragmatic threshold based on an oral dose of 1000mg/kg bw, which underpins the current FSA voluntary guidance. It is therefore recommended that slushed ice drinks should not be consumed by children aged 6 years and under, and that children under 10 years should not consume refills. It was also concluded that idiosyncratic reactions in children of any age cannot be ruled out, as the mechanism of toxicity remains unknown. A qualitative assessment indicates that the frequency of adverse reactions in the general population is very low, the severity of illness is rated as moderate and, due to limited data and underreporting, the level of uncertainty is medium.

Medicolegal Aspects of Deaths Due to Poisoning Occurred In Cities of Punjab and the State Of Himachal Pradesh

2025-06-19

Kaur Pancham Preet , Prakash Bhavish | Journal of Forensic Science and Research

EPITOX Register of Intoxications in Spain. Year 2024

2025-06-19

August Supervía , Francisca Córdoba , Belén Ruíz Antorán +4 more | Deleted Journal

INTRODUCCIÓN. La Fundación Española de Toxicología Clínica implantó un cuestionario online, denominado EPITOX, con el objetivo de homogeneizar la recogida de las características de las intoxicaciones atendidas en servicios de … INTRODUCCIÓN. La Fundación Española de Toxicología Clínica implantó un cuestionario online, denominado EPITOX, con el objetivo de homogeneizar la recogida de las características de las intoxicaciones atendidas en servicios de urgencias (SU) de hospitales españoles. El objetivo de este trabajo es describir las características epidemiológicas de las intoxicaciones registradas en EPITOX en el año 2024. MATERIAL Y MÉTODOS. El cuestionario EPITOX recoge datos de filiación, tipo de intoxicación y de tóxico, características del episodio (intencionalidad, forma de llegada al hospital, lugar de la intoxicación), datos clínicos, analíticos y de tratamiento, así como el destino al alta de urgencias. Los datos son registrados de forma anonimizada por el investigador de cada centro. RESULTADOS. Se registraron 5.540 intoxicaciones. La edad media fue de 38,95 (SD 18) años, con un 55,7% de varones y un 65,5% de pacientes de procedencia española. El 57,1% acudió en ambulancia, el 33,7% se produjeron en un lugar público y el 44,4% en el domicilio del paciente. El 47,7% de las intoxicaciones fueron recreativas y un 28% tuvieron intencionalidad suicida. El alcohol etílico fue el tóxico más frecuentemente implicado (46,3%), seguido de los fármacos (38,3%), las drogas de abuso ilegales (28,7%) y los productos químicos (11,6%). El 81% de los pacientes intoxicados pudieron ser dados de alta directamente desde el SU, un 3,7% ingresaron en la unidad de cuidados intensivos, un 2,5% en Psiquiatría (un 7% adicional requirió traslado a un centro con psiquiatra H24 para valoración) y un 3,2% en una unidad de hospitalización convencional. La mortalidad fue del 0,5%. CONCLUSIONES. El perfil del paciente intoxicado atendido en los SU españoles es del de un varón joven de origen español. El tóxico más prevalente es el etanol, seguido de los fármacos y las drogas de abuso ilegales. La mayoría de las intoxicaciones son leves, pero hasta un 6,9% precisan ingreso.

Exogenous lipoid pneumonia associated with nasal decongestants use: A narrative review of an under recognized clinical entity

2025-06-17

Abdul Basit , T. Udaya Kiran , Fnu Shaista +2 more | World Journal of Respirology

Exogenous lipoid pneumonia is a rare and under recognized pulmonary disorder caused by the inhalation or aspiration of fat-like substances. Nasal decongestants containing mineral oils or paraffin are emerging as … Exogenous lipoid pneumonia is a rare and under recognized pulmonary disorder caused by the inhalation or aspiration of fat-like substances. Nasal decongestants containing mineral oils or paraffin are emerging as overlooked etiological agents. This review consolidates existing literature to delineate the clinical, radiological, and pathological features of exogenous lipoid pneumonia induced by nasal decongestants, highlight diagnostic challenges, and underscore the importance of thorough patient history in early diagnosis and management. This condition, while preventable, can result in serious pulmonary complications if not recognized early. It necessitates a multidisciplinary approach that incorporates careful history taking, high-resolution imaging, cytological assessment, and public health vigilance.

Epidemiology of Acute Poisonings in Northwestern Syria: A One-Year Study

2025-06-17

Wasim Zakaria , Ahmad Hmaideh , Ahmad Musa Alaaraj +5 more | Avicenna Journal of Medicine

Abstract Acute poisoning is a significant public health concern, leading to numerous emergency admissions globally. In northwestern Syria, understanding poisoning epidemiology is essential for targeted prevention efforts. This study examines … Abstract Acute poisoning is a significant public health concern, leading to numerous emergency admissions globally. In northwestern Syria, understanding poisoning epidemiology is essential for targeted prevention efforts. This study examines the causes and demographic characteristics of poisoning cases in the region. The study was conducted over 1 year (July 1, 2022–July 1, 2023) at six northwestern Syrian hospitals supported by humanitarian organizations. The study gathered information from patients aged 14 years and above who suffered from poisoning during the study period. Poisoning cases totaled 172 throughout the study period. Majority of patients were females aged between 14 and 24 (76.7 and 55.2%, respectively), most of them were married (65.1%). Most of the patients identified as housewives among the total patient population (52.9%) and had primary or middle school education. A large majority of the population (77.3%) were smokers while most poisoning incidents (77.3%) were reported in rural camps and villages. The study found oral ingestion as the most common route of poisoning at 88.4% and intentional poisonings made up 86% of all cases. The most prevalent toxic agents causing poisoning cases were drugs, 61.6%, with organophosphorus compounds ranking second, 14.5%. The symptom of vomiting appeared most often during acute poisoning cases (48.8%). The administration of specific antidotes took place in 11.6% of patients who needed hospital admission for 94.8% of these cases. The patients stayed in the hospital for an average duration of 33.1 hours. A total of 76.7% of patients achieved full recovery and 7.6% succumbed to their injuries. Acute poisoning presents as a major health problem across northwestern Syria mostly affecting young married females who live in rural regions. The unusually high number of cases of purposeful poisoning emphasizes the requirement for both psychiatric support and educational programs for the public.

Poisons

2025-06-17

| CABI eBooks

Incidence of and risk factors for mortality in children with mushroom poisoning

2025-06-17

Jie Cheng , Ya Liu , Shaojun Li +3 more | International Journal of Emergency Medicine

Abstract Objective We aimed to evaluate the incidence of and risk factors for mortality in children with mushroom poisoning. Methods Sixty-seven children with mushroom poisoning who were hospitalized at the … Abstract Objective We aimed to evaluate the incidence of and risk factors for mortality in children with mushroom poisoning. Methods Sixty-seven children with mushroom poisoning who were hospitalized at the Children’s Hospital of Chongqing Medical University were retrospectively enrolled. The clinical characteristics of the children in the surviving and non-surviving groups were compared. Variables with a P value < 0.1 in the univariate logistic regression analysis were included in the multivariate logistic regression analysis. A receiver operating characteristic (ROC) curve was generated to determine the optimal cutoff point. Results The mortality rate of children with mushroom poisoning was 23.88% (16/67), and the incidence of death during hospitalization was 35.02 per 1,000 person-days. The median pediatric sequential organ failure assessment (pSOFA) score was 1.00 (interquartile range [IQR] 0.00–3.00). Logistic regression analysis revealed that the pSOFA score was independently associated with mortality (odds ratio [OR] 4.92, 95% confidence interval [CI] 1.59–62.21; P = 0.040). The optimal cutoff point of the pSOFA score for predicting mortality was 2.00, with an area under the curve (AUC) of 0.84 (95% CI 0.71–0.88, P < 0.001*). Conclusions In this study, the incidence of death among children with mushroom poisoning was retrospectively evaluated. The pSOFA score may serve as a good prognostic indicator in children with mushroom poisoning, and children with a pSOFA score ≥ 2 have a significantly increased risk of mortality.

Simple and rapid low-cost assays to investigate ethylene glycol and diethylene glycol contamination in raw materials and medicinal syrups

2025-06-16

Bevin Gangadharan , Edi Dharmana , Isabelle Legge +7 more | Research Square (Research Square)

<title>Abstract</title> There have been hundreds of child deaths due to contamination of medicinal syrups with diethylene glycol (DEG) and ethylene glycol (EG). Detection of DEG and EG is usually performed … <title>Abstract</title> There have been hundreds of child deaths due to contamination of medicinal syrups with diethylene glycol (DEG) and ethylene glycol (EG). Detection of DEG and EG is usually performed by gas chromatography, a method that is costly, laborious, time-consuming, and the device is not readily available in many low- and middle-income countries (LMICs). Thin-layer chromatography is relatively lower cost and is portable but, as with gas chromatography, requires time and trained personnel. Alternative rapid, low-cost and simple methods to determine DEG/EG contamination are desirable. We tested the suitability of enzymatic, chemical and antibody-based assays to determine DEG/EG. Assays using alcohol dehydrogenase and aldehyde dehydrogenase alone as well as in combination with glycolate oxidase could determine EG in raw materials and at less than 0.1% m/m in some finished products. Saliva and breast milk alcohol test strips containing alcohol oxidase and costing $1 could determine EG with a detection limit of 0.5 to 2% m/m in under 2 minutes. Disposable breathalysers also costing only $1 could determine both DEG and EG from other alcohols in only 10 seconds. The methods described provide simple, rapid and low-cost assays to help determine DEG and EG. By repurposing the breathalysers and alcohol test strips, these disposable tests could have helped to prevent many of the hundreds of infant deaths in 2022 and offer low-cost and rapid approaches for LMICs to screen for DEG and EG.

Poisons and antidotes

2025-06-16

Anthony Archdeacon | Routledge eBooks

CLINICAL AND TOXICOLOGICAL CHARACTERISTICS OF ETHYLENE AND DIETHYLENE GLYCOL POISONINGS

2025-06-16

Paskar N.G. | Medical & pharmaceutical journal Pulse

This article is a comprehensive study of the toxicological properties and clinical manifestations of poisoning with ethylene glycol (EG) and diethylene glycol (DEG), industrially valuable but extremely dangerous polyatomic alcohols … This article is a comprehensive study of the toxicological properties and clinical manifestations of poisoning with ethylene glycol (EG) and diethylene glycol (DEG), industrially valuable but extremely dangerous polyatomic alcohols for humans. The work provides a detailed analysis of the physico-chemical characteristics of these compounds, including temperature parameters, solubility and other properties that determine both their industrial use and high toxicological hazard. Special attention is paid to the mechanisms of toxic action of ethylene glycol and diethylene glycol. The processes of metabolism of these substances in the human body are examined in detail, highlighting the formation of highly toxic metabolites (glycolic, glyoxylic, oxalic and 2-hydroxyethoxyacetic acids), which trigger a cascade of pathological reactions. The article describes in detail the three-stage clinical picture of intoxication, including the main symptoms characteristic of poisoning with ethylene glycol or diethylene glycol: metabolic acidosis, renal, liver failure and neurological disorders. The problem is becoming particularly relevant due to the widespread practice of using industrial liquids containing ethylene glycol and diethylene glycol as surrogate alcohol. The article emphasizes that the sweetish taste of these compounds and their relative availability create an extremely high risk of both accidental and intentional poisoning, especially among socially vulnerable segments of the population. It is pointed out that there is a need for an integrated approach to poisoning prevention, including increased control over the turnover of industrial liquids containing ethylene and diethylene glycol, active public awareness of the risks associated with the use of these substances, as well as strict compliance with safety measures when working with glycols.

Acute medication poisoning in children at Alexandria Poison Centre, Egypt: an educational intervention

2025-06-15

Mostafa A. Arafa , Esraa Abd El-Aziz , Mohamed Mostafa Tahoun +1 more | Egyptian Pediatric Association Gazette

Case report: Levosimendan as a possible inotropic drug for acute aluminum phosphide toxicity

2025-06-13

Meray Medhat Shokry Zaghary , Sofia Ali , John Medhat Shokry Zaghary +2 more | Deleted Journal

Background: Aluminum phosphide is a severe poisoning that can lead to death. Easy availability with no specific antidote is the leading cause of the higher mortality with it. Case report: … Background: Aluminum phosphide is a severe poisoning that can lead to death. Easy availability with no specific antidote is the leading cause of the higher mortality with it. Case report: The study represents a case report of a 5-year-old male who came after oral ingestion of aluminum phosphide and presented with vomiting, sleep, low blood pressure of 80/20, and a regular and rapid pulse of about 140 per minute. Gastric lavage was done rapidly with 3 bottles of paraffin oil, then 1 bottle was given every 1 h for 4 cycles. Complete laboratory investigations were performed for the patient, such as arterial blood gas, liver enzymes, electrolytes, full blood count, and renal function, which showed normal function except for metabolic acidosis with overcompensated respiratory alkalosis. The patient was transferred to the pediatric intensive care unit, where we gave a dose of 1 mEq sodium bicarbonate per kg with N-acetylcysteine 150 mg/kg in 100 mL of 5% glucose for 2 h under coverage of hydrocortisone and Avil. Antiemetics and proton pump inhibitors were given regularly every 12 h. After discussion with the pediatric specialist, the ejection fraction of the child by echocardiography was low, about 40%, and levosimendan was recommended to be given to the patient. The patient was given a bolus dose of 6 µg/kg over 10 min, followed by an infusion of 0.1 µg/kg/min with excellent response for 48 h. After admission for one week, the patient recovered completely, the ejection fraction became 55%, and the patient was discharged safely to home. Conclusion: Acute accidental exposure to AlP, either accidentally or suicidally or rarely homicidally, presents a significant threat to human life with many toxic effects, especially on the heart. Levosimendan is a drug that is used in decompensated heart failure and can be used as an inotropic agent in acute AlP toxicity.

Outcomes of benzonatate exposures reported to a single United States poison center: a 20-year review

2025-06-13

Corey D. Cicci , Jillian Theobald , Matthew Stanton +1 more | Clinical Toxicology

Benzonatate is an antitussive with sodium channel blocking properties that may cause seizures, dysrhythmias, and death in overdose. Limited data describe the medical outcomes of benzonatate exposures, and no standard … Benzonatate is an antitussive with sodium channel blocking properties that may cause seizures, dysrhythmias, and death in overdose. Limited data describe the medical outcomes of benzonatate exposures, and no standard treatment guidelines exist for managing benzonatate toxicity. We characterized clinical outcomes and management of benzonatate exposures over a 20-year period at the Wisconsin Poison Center. This retrospective case review examined all benzonatate exposures reported to a single regional poison center from January 1, 2000 through December 31, 2019. Exposures were excluded if the medical record was incomplete. The primary outcome was the rate of serious adverse effects, defined as seizure, electrocardiogram changes, coma or central nervous system depression, or death. Potential life-saving treatments (antiepileptics, antidysrhythmics, vasopressors, sodium bicarbonate, or intravenous lipid therapy) were also assessed. A total of 313 calls were received with 48 exposures excluded, leaving 265 exposures included for analysis. Most exposures were female (162/265; 61%) with a median age of 19 years (IQR: 4-39 years). Sixteen exposures were adverse reactions only. Of intentional exposures (106/265; 40%), 23 (22%) experienced at least one serious adverse effect and 40 (38%) were hospitalized. Of unintentional exposures (143/265, 54%), one (0.7%) experienced a serious adverse effect and three (2%) were hospitalized. Regarding 77 unintentional pediatric exposures, none experienced a serious adverse effect, with two (2/77; 3%) hospitalized. Two deaths (0.8%) occurred during the study period; both were intentional exposures. While severe outcomes are possible after intentional exposures, unintentional exposures rarely exhibited serious toxicities. No therapeutic interventions beyond supportive care were consistently employed. Intentional exposures to benzonatate more commonly warranted significant therapeutic interventions and caused a higher incidence of serious toxicity. Unintentional exposures did not result in clinically significant adverse effects. Although benzonatate can result in serious toxicity, adults with unintentional exposures may be candidates for home management.

Schwere und letale Vergiftungsfälle im Rettungsdienst – eine 5-Jahres-Analyse des Giftinformationszentrum-Nord

2025-06-13

Markus Roessler , Sarah Anja Müller , Andreas Schaper | Die Anaesthesiologie

Prevalencia de migraña y consumo de medicamentos analgésicos en la población adulta española. Perspectiva de género y factores asociados

2025-06-13

Radu Mihai Istrate , Pilar Carrasco‐Garrido , Valentín Hernández‐Barrera +1 more | Pharmaceutical Care España

Introducción: En este estudio se analiza la prevalencia de migraña y el uso asociado de analgésicos en la población adulta española, considerando diferencias por sexo y factores sociodemográficos. Además, se … Introducción: En este estudio se analiza la prevalencia de migraña y el uso asociado de analgésicos en la población adulta española, considerando diferencias por sexo y factores sociodemográficos. Además, se estudian las comorbilidades, el consumo de otros medicamentos y el uso de los recursos sanitarios, con el fin de comprender el perfil del paciente migrañoso. Método: Se realizó un estudio epidemiológico observacional, descriptivo y transversal utilizando la Encuesta Europea de Salud en España (EESE) del año 2020, que incluyó a 22.072 individuos. Se analizaron como variables dependientes la migraña y el consumo de analgésicos, mientras que la edad, el sexo, el estado civil, el nivel educativo y los ingresos económicos como variables independientes. Resultados: La prevalencia de migraña en España fue del 7,8%, con una mayor proporción en mujeres (11,2% frente al 4% en hombres). Se observaron tasas más altas en personas sin estudios, con ingresos bajos y en situación de desempleo. El 79,5% de los pacientes con migraña consumió medicamentos analgésicos, de los cuales el 12,5% fue sin prescripción médica. Además, un alto porcentaje consumía otros medicamentos como tranquilizantes o antidepresivos. Conclusiones: El estudio confirma una mayor prevalencia de migraña entre las mujeres y su asociación con factores sociodemográficos y comorbilidades. Se destaca el uso frecuente de analgésicos, a menudo sin supervisión médica, lo que podría contribuir a la cronificación de la patología.

DAMAGE TO THE ADRENAL GLANDS IN THE SIMULATION OF SUICIDE POISONING IN AN EXPERIMENT

2025-06-10

Vladimir G. Izatulin , Olga A. Makarova , N. V. Akudovich +1 more | Baikal Medical Journal

Appropriateness of antidotes administered in Spanish pediatric emergency departments.

2021-12-01

Idoia Serrano , María García García , Santiago Mintegi +1 more