Journal of toxicology. Clinical toxicology最新文献

{"title":"Characteristics of patients with no underlying toxicologic syndrome evaluated in a toxicology clinic.","authors":"Jerrold B Leikin,&nbsp;Mark B Mycyk,&nbsp;Sean Bryant,&nbsp;Kirk Cumpston,&nbsp;Stephen Hurwitz","doi":"10.1081/clt-200026960","DOIUrl":"https://doi.org/10.1081/clt-200026960","url":null,"abstract":"<p><strong>Background: </strong>A significant number of patients seek medical evaluation for chronic subjective symptoms they presume to be associated with a single toxic trigger. This report describes our clinic experience with these patients.</p><p><strong>Case series: </strong>Twenty patients (of a total of 261 patients) with a mean age of 41 years (median age 42 years; range: 4 to 65 years) were evaluated over an 8 month period. All describe a single past toxic exposure triggering their nonspecific (usually vaguely neurologic) symptoms. Zero of 20 (0%) describe other chemical sensitivities; 2/20 (10%) report ongoing exposure, 18/20 (90%) had a limited exposure dating 1 month to 6 yrs prior to toxicology clinic evaluation; 9/20 (45%) are currently employed; 6/20 (30%) sought alternative medical therapy prior to toxicologist evaluation; 6/20/(30%) have attempted litigation.</p><p><strong>Conclusion: </strong>Despite repeatedly normal toxicologic and medical evaluations, all data refuting an underlying toxic cause are not accepted by this series of patients, and their search for a diagnostic linkage persists. Specific toxin identification or treatment for these patients is unlikely to occur.</p>","PeriodicalId":17447,"journal":{"name":"Journal of toxicology. Clinical toxicology","volume":"42 5","pages":"643-8"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1081/clt-200026960","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40901023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Forearm compartment syndrome after intravenous mannitol extravasation in a carbosulfan poisoning patient.","authors":"Ahmet Eroglu,&nbsp;Halil Uzunlar","doi":"10.1081/clt-200026975","DOIUrl":"https://doi.org/10.1081/clt-200026975","url":null,"abstract":"<p><p>We report a case of forearm compartment syndrome caused by extravasation of mannitol in an intoxicated patient. The pathophysiology and management of a forearm compartment syndrome from extravasation of mannitol are discussed in this case.</p>","PeriodicalId":17447,"journal":{"name":"Journal of toxicology. Clinical toxicology","volume":"42 5","pages":"649-52"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1081/clt-200026975","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40901024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paradoxical cerebral cortical hyperexcitability following flupirtine overdose.","authors":"Olaf Hoffmann,&nbsp;L Rolf Gommert,&nbsp;Martin Egert","doi":"10.1081/clt-200035096","DOIUrl":"https://doi.org/10.1081/clt-200035096","url":null,"abstract":"<p><p>We report the case of a patient with increased cerebral cortical excitability following intoxication with flupirtine, a centrally acting analgesic and antispastic drug. Typically, flupirtine exerts membrane stabilizing and hyperpolarizing effects through activation of neuronal G-protein regulated inwardly rectifying potassium channels (GIRK). Based on these properties, GIRK activators have been suggested as candidates for antiepileptic drug development. In contrast, our observation suggests that these substances may also display unexpected proconvulsant effects in vivo.</p>","PeriodicalId":17447,"journal":{"name":"Journal of toxicology. Clinical toxicology","volume":"42 6","pages":"913-6"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1081/clt-200035096","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24802899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lack of toxic effects following acute overdose of cellcept (mycophenolate mofetil).","authors":"Vikhyat S Bebarta,&nbsp;Kennon Heard,&nbsp;Craig Nadelson","doi":"10.1081/clt-200035101","DOIUrl":"https://doi.org/10.1081/clt-200035101","url":null,"abstract":"<p><p>Mycophenolate mofetil is an immunosuppressive drug used for prevention of graft rejection following solid organ transplant and for treatment of autoimmune disorders. We report a case of a 24-year-old female with lupus nephritis that presented following ingestion of 10 grams of mycophenolate in a suicide gesture. Serum levels confirmed ingestion. The patient was treated with decontamination and supportive care and recovered with no adverse effect.</p>","PeriodicalId":17447,"journal":{"name":"Journal of toxicology. Clinical toxicology","volume":"42 6","pages":"917-9"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1081/clt-200035101","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24802900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Duodenal perforation after ibuprofen overdose.","authors":"Simon F J Clarke,&nbsp;Nandini Arepalli,&nbsp;Catherine Armstrong,&nbsp;Paul I Dargan","doi":"10.1081/clt-200041767","DOIUrl":"https://doi.org/10.1081/clt-200041767","url":null,"abstract":"","PeriodicalId":17447,"journal":{"name":"Journal of toxicology. Clinical toxicology","volume":"42 7","pages":"983-5"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1081/clt-200041767","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24897189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methamphetamine toxicity secondary to intravaginal body stuffing.","authors":"John Kashani,&nbsp;Anne-Michelle Ruha","doi":"10.1081/clt-200042554","DOIUrl":"https://doi.org/10.1081/clt-200042554","url":null,"abstract":"<p><strong>Background: </strong>People who ingest packets of illicit drugs or insert them into body cavities in an attempt to smuggle them are termed body packers. People who do this in an attempt to hide the drugs when encountered by law enforcement are called body stuffers. Severe toxicity and death occurs in body packers and body stuffers, and this is usually secondary to leaking of drug from packets in the gastrointestinal tract. This is well reported with cocaine and heroin and occurs less commonly with methamphetamine. We report an unusual case of intravaginal body stuffing that lead to severe methamphetamine toxicity in a young woman.</p><p><strong>Case report: </strong>A 20-year old female, who was in police custody, developed multiple seizures, altered mental status, tachycardia and hypertension shortly after admitting to having drugs enclosed in plastic bags in her vagina. She was hospitalized for 4 days with gradual improvement in her symptoms with the exception of a resting tachycardia. Gas chromatography and mass spectrometry of the urine at this time confirmed the presence of methamphetamine and the amphetamine metabolite, co-intoxicants were excluded based on comprehensive urine drug screening using GCMS. Quantitative serum levels of methamphetamine and amphetamine were 3100 ng/ml and 110 ng/ml, repectively.</p><p><strong>Conclusion: </strong>We report an unusual case of intravaginal body stuffing that lead to severe methamphetamine toxicity in a young woman. This case highlights the potential for severe methamphetamine poisoning secondary to intravaginal stuffing. If either body packing or stuffing is suspected, a vaginal exam may be warranted.</p>","PeriodicalId":17447,"journal":{"name":"Journal of toxicology. Clinical toxicology","volume":"42 7","pages":"987-9"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1081/clt-200042554","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24897190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of promotility agents to limit the gut bioavailability of extended-release acetaminophen.","authors":"Christopher S Amato,&nbsp;Richard Y Wang,&nbsp;Robert O Wright,&nbsp;James G Linakis","doi":"10.1081/clt-120028748","DOIUrl":"https://doi.org/10.1081/clt-120028748","url":null,"abstract":"<p><strong>Background: </strong>Erythromycin and neostigmine have both been shown to act as gastrointestinal promotility agents.</p><p><strong>Objectives: </strong>The purpose of this study was to determine whether either erythromycin or neostigmine, administered parenterally, would result in lower serum levels of a recently ingested drug, when compared with placebo.</p><p><strong>Methods: </strong>Ten volunteers ingested 1300 mg of extended-release acetaminophen on each of three occasions. They were then given an intravenous dose of erythromycin (200 mg), neostigmine (2 mg), or placebo. Each volunteer received all three treatments in a counterbalanced fashion, each separated from the next by at least two weeks. Blood for serum acetaminophen concentration was drawn at 1, 2, 4, 6 and 8 h after treatment, and the serum acetaminophen elimination curves were compared for the three treatments.</p><p><strong>Results: </strong>The elimination phase of the curves did not differ among the treatments as a result of administration of the prokinetic agents.</p><p><strong>Conclusions: </strong>Under the present conditions, administration of erythromycin and neostigmine as prokinetic agents failed to alter the kinetics of an ingested dose of sustained-release acetaminophen.</p>","PeriodicalId":17447,"journal":{"name":"Journal of toxicology. Clinical toxicology","volume":"42 1","pages":"73-7"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1081/clt-120028748","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24467185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective study of centipede bites in Australia.","authors":"Corrine R Balit,&nbsp;Mark S Harvey,&nbsp;Julianne M Waldock,&nbsp;Geoffrey K Isbister","doi":"10.1081/clt-120028743","DOIUrl":"https://doi.org/10.1081/clt-120028743","url":null,"abstract":"<p><strong>Background: </strong>There are limited reports of definite bites by centipedes with expert identification, which are required for attribution of particular clinical effects to different species.</p><p><strong>Objective: </strong>To describe the clinical effects of centipede bites in Australia.</p><p><strong>Methods: </strong>Prospective study of calls regarding centipede exposures to a state poison information center, from December 2000 to March 2002. Information collected included demographics, details of the exposure, local effects, systemic effects, and treatment. Collected centipedes were identified by an expert. All subjects were followed until clinical effects had resolved.</p><p><strong>Results: </strong>Of 48 centipede exposures, 3 were centipede ingestions with no adverse effects and one was a contact reaction to the centipede that resulted in erythema and delayed itchiness. Of 44 definite centipede bites, the centipedes obtained and formally identified in 14 cases were from the genera Scolopendra (5), Cormocephalus (6), and Ethmostigmus (3). Of these 14 bites, 13 occurred distally (hands or feet). Pain occurred in all 14 cases and was severe in 7 patients. Redness/red mark occurred in 53%, swelling/raised area in 43%, and itchiness in 14%. No systemic effects were reported. Ethmostigmus spp. and Scolopendra spp. caused more severe effects. Of the bites, 57% occurred indoors and 50% at night. Treatment consisted of supportive measures including ice packs and simple analgesia, and 4 patients reported pain relief after immersing the bite area in hot water. Similar clinical effects were reported in the other 30 definite centipede bites.</p><p><strong>Conclusions: </strong>Australian centipede bites cause minor effects with moderate to severe pain, associated with localized swelling and erythema in bites by the genera Ethmostigmus and Scolopendra. Hot water immersion may potentially be beneficial for centipede bites. The genus Scolopendra occurs worldwide and the results may have international applicability.</p>","PeriodicalId":17447,"journal":{"name":"Journal of toxicology. Clinical toxicology","volume":"42 1","pages":"41-8"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1081/clt-120028743","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24467281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Cycas seed poisoning in Taiwan.","authors":"Shy-Shin Chang,&nbsp;Yi-Ling Chan,&nbsp;Ming-Ling Wu,&nbsp;Jou-Fang Deng,&nbsp;Te- Fa Chiu,&nbsp;Jih-Chang Chen,&nbsp;Feng-Lin Wang,&nbsp;Ching-Ping Tseng","doi":"10.1081/clt-120028744","DOIUrl":"https://doi.org/10.1081/clt-120028744","url":null,"abstract":"<p><strong>Objective: </strong>The seeds of cycads contain cycasin and neocycasin, which belong to the family of cyanogenic glycosides. These glycosides of cycads are considered pseudocyanogenic with little potential to liberate hydrogen cyanide as other cyanogenic glycosides do. This study investigated the clinical spectrum of Cycas seed poisoning and its cyanogenic potential.</p><p><strong>Methods: </strong>This was a retrospective chart review conducted at the Poison Control Center in Taiwan (PCC-Taiwan) from 1990 to 2001.</p><p><strong>Results: </strong>Twenty-one cases of Cycas seed poisoning were identified. The reasons for seed ingestion were misuse as an edible food (70%), health promotion (10%), cancer prevention (10%), cosmetic use (5%), and gastrointestinal discomfort (5%). All patients had eaten the seeds after washing and cooking them. The time from ingestion to the onset of symptoms ranged from 30 min to 7 h (mean 2.8 h); patients had ingested between 1 to 30 seeds. Respiratory depression did not occur. Severe vomiting was the most striking symptom. All patients except one presented with gastrointestinal disturbance, and 90% sought medical care at the emergency department. Within 24 h, all patients had recovered. Six patients had blood cyanide or thiocyanate levels measured. Although the levels were higher than normal, they did not reach the toxic range.</p><p><strong>Conclusions: </strong>The cyanogenic potential of Cycas seeds is documented in our cases. The gastrointestinal symptoms were severe enough that most patients sought medical attention but recovery was quick and complete.</p>","PeriodicalId":17447,"journal":{"name":"Journal of toxicology. Clinical toxicology","volume":"42 1","pages":"49-54"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1081/clt-120028744","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24467282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Position paper: Ipecac syrup.","authors":"","doi":"10.1081/clt-120037421","DOIUrl":"https://doi.org/10.1081/clt-120037421","url":null,"abstract":"<p><p>Syrup of ipecac should not be administered routinely in the management of poisoned patients. In experimental studies the amount of marker removed by ipecac was highly variable and diminished with time. There is no evidence from clinical studies that ipecac improves the outcome of poisoned patients and its routine administration in the emergency department should be abandoned. There are insufficient data to support or exclude ipecac administration soon after poison ingestion. Ipecac may delay the administration or reduce the effectiveness of activated charcoal, oral antidotes, and whole bowel irrigation. Ipecac should not be administered to a patient who has a decreased level or impending loss of consciousness or who has ingested a corrosive substance or hydrocarbon with high aspiration potential. A review of the literature since the preparation of the 1997 Ipecac Syrup Position Statement revealed no new evidence that would require a revision of the conclusions of that Statement.</p>","PeriodicalId":17447,"journal":{"name":"Journal of toxicology. Clinical toxicology","volume":"42 2","pages":"133-43"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1081/clt-120037421","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24580101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}