Journal of toxicology. Clinical toxicology最新文献_第8页

Survival pattern in patients with acute organophosphate poisoning receiving intensive care. 急性有机磷中毒重症监护患者的生存模式。

Journal of toxicology. Clinical toxicology Pub Date : 2004-01-01 DOI: 10.1081/clt-120039539

U A D D Munidasa, I B Gawarammana, S A M Kularatne, P V R Kumarasiri, C D A Goonasekera

{"title":"Survival pattern in patients with acute organophosphate poisoning receiving intensive care.","authors":"U A D D Munidasa, I B Gawarammana, S A M Kularatne, P V R Kumarasiri, C D A Goonasekera","doi":"10.1081/clt-120039539","DOIUrl":"https://doi.org/10.1081/clt-120039539","url":null,"abstract":"Background: Approximately 35% of patients acutely poisoned with organophosphates (OP) in developing countries like Sri Lanka require intensive care and mechanical ventilation. However, death rates remain high.Objective: To study the outcomes and predictors of mortality in patients with acute OP poisoning requiring intensive therapy at a regional center in Sri Lanka over a period of 40 months.Methods: Retrospective analysis of all intensive care records of patients with acute OP poisoning admitted to the Intensive Care Unit (ICU) between March 1998 and July 2001.Results: During the study period, 126 subjects were admitted to the ICU with acute OP poisoning. Records of 10 patients were lost and those of 37 were incomplete and hence were excluded. All the remaining 71 patients (59 male) had required endotracheal intubation and mechanical ventilation for a period of four (median) days (range 1-27) in addition to gastric lavage and standard therapy with atropine and oximes and adequate hydration. Of these 71 patients, 36 (28 male) had died. Life table analysis demonstrated a steep decline in the cumulative survival to 67% during the first three days. Systolic blood pressure of < 100 mmHg and FiO2 of >40% to maintain a SpO2 of >92% within the first 24 h were recognized as poor prognostic indicators among mechanically ventilated patients.Conclusion: Mortality following OP poisoning remains high despite adequate respiratory support, intensive care, and specific therapy with atropine and oximes. One-third of the subjects needing mechanical ventilation and reaching intensive care units die within the first 72 h of poisoning. Systolic blood pressure of less than 100 mmHg and the necessity of a FiO2>40% to maintain adequate oxygenation are predictors of poor outcome in patients mechanically ventilated in the ICU.","PeriodicalId":17447,"journal":{"name":"Journal of toxicology. Clinical toxicology","volume":"42 4","pages":"343-7"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1081/clt-120039539","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40899268","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}

引用次数: 72

A meta-analysis of prognostic indicators to predict seizures, arrhythmias or death after tricyclic antidepressant overdose. 预测三环类抗抑郁药物过量后癫痫发作、心律失常或死亡的预后指标荟萃分析。

Journal of toxicology. Clinical toxicology Pub Date : 2004-01-01 DOI: 10.1081/clt-200035286

Benoit Bailey, Nicholas A Buckley, Devendra K Amre

{"title":"A meta-analysis of prognostic indicators to predict seizures, arrhythmias or death after tricyclic antidepressant overdose.","authors":"Benoit Bailey, Nicholas A Buckley, Devendra K Amre","doi":"10.1081/clt-200035286","DOIUrl":"https://doi.org/10.1081/clt-200035286","url":null,"abstract":"Objectives: To systematically review and summarize studies on the accuracy of ECG and tricyclic antidepressant (TCA) concentration as prognostic indicators of the risk of seizures, ventricular arrhythmia (VA) or death in patients with TCA overdose.Methods: Articles were identified with MedLine and Cochrane register of controlled clinical trials searches and review of medical toxicology textbooks. Quality of the included studies was assessed. Pooled estimates of sensitivity, specificity, likelihood ratios and Summary Receiver Operating Characteristics (SROC) curves were generated.Results: A total of 18 studies were included in the analysis. The pooled sensitivity (Se) and specificity (Sp) of the QRS for predicting seizures were 0.69 [95% CI 0.57-0.78] and 0.69 [95% CI 0.58-0.78] as compared to 0.75 [95% CI 0.61-0.85] and 0.72 [95% CI 0.61-0.81] for the TCA concentration. The Se and Sp of the QRS to predict VA were 0.79 [95% CI 0.58-0.91] and 0.46 [95% CI 0.35-0.59] compared to 0.78 [95% CI 0.56-0.90] and 0.57 [95% CI 0.46-0.67] for the TCA concentration. The Se and Sp of the QRS to predict death were 0.81 [95% CI 0.54-0.94] and 0.62 [95% CI 0.55-0.68] compared to 0.76 [95% CI 0.49-0.91] and 0.60 [95% CI 0.47-0.72] for the TCA concentration. Very few studies evaluated the accuracy of QTc, T 40 ms axis and the R/S ratio.Conclusions: Overall, the studies suggested that the ECG and TCA concentration have similar but relatively poor performance for predicting complications, such as seizures, VA or death, associated with TCA overdose.","PeriodicalId":17447,"journal":{"name":"Journal of toxicology. Clinical toxicology","volume":"42 6","pages":"877-88"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1081/clt-200035286","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24802980","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}

引用次数: 57

Rapid cyanide detection using the Cyantesmo kit. 使用Cyantesmo试剂盒快速氰化物检测。

Journal of toxicology. Clinical toxicology Pub Date : 2004-01-01 DOI: 10.1081/clt-200035349

Joseph Rella, Steven Marcus, B J Wagner

{"title":"Rapid cyanide detection using the Cyantesmo kit.","authors":"Joseph Rella, Steven Marcus, B J Wagner","doi":"10.1081/clt-200035349","DOIUrl":"https://doi.org/10.1081/clt-200035349","url":null,"abstract":"Background: Sources of cyanide exposure are many, including combustion of plastic and vinyl, such as in a house fire, laboratory or industrial exposures including exposure in the electroplating industry both of printed circuit boards and in jewelry work. Rapid and definitive diagnosis of cyanide poisoning is unavailable in the emergency department setting. It is desirable to make a definitive diagnosis in order to prevent potential complications of empiric treatment of presumptive cyanide poisoning from the cyanide antidote kit currently approved by the US Food and Drug Administration (FDA). We investigated a technique to detect cyanide currently utilized by water treatment facilities to determine if it can be applied to rapidly detect concentrations of cyanide in the clinically important range.Methods: Varying standardized dilutions of KCN ranging from 0.25 microg/mL to 30 microg/mL were acidified with a drop of sulphuric acid in a closed system under a ventilation hood. Cyantesmo test strips were placed into the test tubes above the fluid level where liberated HCN gas interacted with the test strip to effect a color change. Color changes were compared to negative controls and to each other.Results: The test strips demonstrated an incrementally increasing deep blue color change over a progressively longer portion of the test strip in less than 5 minutes for each concentration of KCN including 1, 3, 10, and 30 microg/mL. The concentrations of 0.25, 0.5, and 0.75 required more than 2 hours to begin demonstration of any color change.Conclusion: The Cyantesmo test strips accurately and rapidly detected, in a semi-quantifiable manner, concentrations of CN greater than 1 microg/mL contained in each test sample. Future work to validate this test in blood and in clinical specimens is planned.","PeriodicalId":17447,"journal":{"name":"Journal of toxicology. Clinical toxicology","volume":"42 6","pages":"897-900"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1081/clt-200035349","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24802982","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}

引用次数: 10

Position paper: gastric lavage. 立场纸:洗胃。

Journal of toxicology. Clinical toxicology Pub Date : 2004-01-01 DOI: 10.1081/clt-200045006

J A Vale, K Kulig

引用次数: 91

Acetaminophen: the 150 mg/kg myth. 对乙酰氨基酚:150毫克/公斤的神话。

Journal of toxicology. Clinical toxicology Pub Date : 2004-01-01 DOI: 10.1081/clt-120030939

Milton Tenenbein

引用次数: 31

Unintentional ingestion of 60% hydrogen peroxide by a six-year-old child. 六岁儿童误食60%过氧化氢。

Journal of toxicology. Clinical toxicology Pub Date : 2004-01-01 DOI: 10.1081/clt-120030950

José Sansone, Nilda Vidal, Román Bigliardi, Ana Voitzuk, Vanina Greco, Karina Costa

引用次数: 6

Single-dose activated charcoal-backup and reassess. 单剂量活性炭备用并重新评估。

Journal of toxicology. Clinical toxicology Pub Date : 2004-01-01 DOI: 10.1081/clt-120028754

Donna Seger

引用次数: 33

Effect of anticholinergic drugs on the efficacy of activated charcoal. 抗胆碱能药物对活性炭功效的影响。

Journal of toxicology. Clinical toxicology Pub Date : 2004-01-01 DOI: 10.1081/clt-120037426

Robert Green, Daniel S Sitar, Milton Tenenbein

{"title":"Effect of anticholinergic drugs on the efficacy of activated charcoal.","authors":"Robert Green, Daniel S Sitar, Milton Tenenbein","doi":"10.1081/clt-120037426","DOIUrl":"https://doi.org/10.1081/clt-120037426","url":null,"abstract":"Background: Although it is a commonly held belief that the ingestion of drugs with an anticholinergic action would prolong the duration of time after drug ingestion for effective gastrointestinal decontamination, data are lacking to support this belief. The purpose of this study is to determine whether activated charcoal is more effective in the presence of concurrent anticholinergic activity.Methods: A three-limbed randomized crossover study in 10 healthy volunteers was completed to determine the ability of a 50 g dose of activated charcoal to reduce the bioavailability of a simulated overdose of acetaminophen (12 x 325 mg tablets) in the presence and absence of a concurrently present anticholinergic drug, atropine (0.01 mg/kg I. M. administered 15 min prior to the acetaminophen ingestion).Results: After the acetaminophen ingestion, median Cmax occurred at 1 h for all three exposures but was lower in the atropine-treated study arm (31+/-19 mg/L) than in the control or charcoal alone intervention arms (49+/-13 and 51+/-16 mg/L, respectively) (P<0.05). Compared to the control area under the serum concentration vs. time curve, a single dose of activated charcoal 1 h after drug ingestion reduced acetaminophen bioavailability by 20% (95% CI 4-36%) and by 47% (95% CI 35-59%) in the presence of atropine (P<0.05 atropine plus charcoal vs. charcoal alone).Conclusions: Our data support the belief that activated charcoal is more effective in the presence of anticholinergic activity. Additional study is required to determine whether in patients with anticholinergic drug overdose, activated charcoal is effective at times beyond the recommendation for overdoses of drugs without this pharmacodynamic effect.","PeriodicalId":17447,"journal":{"name":"Journal of toxicology. Clinical toxicology","volume":"42 3","pages":"267-72"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1081/clt-120037426","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24677036","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}

引用次数: 26

N-acetylcysteine for the treatment of clove oil-induced fulminant hepatic failure. n -乙酰半胱氨酸治疗丁香油致暴发性肝衰竭。

Journal of toxicology. Clinical toxicology Pub Date : 2004-01-01 DOI: 10.1081/clt-120028751

Jeffrey S Eisen, Gideon Koren, David N Juurlink, Vicky L Ng

引用次数: 24

A rare ingestion of the Black Locust tree. 罕见地吞下了刺槐树。

Journal of toxicology. Clinical toxicology Pub Date : 2004-01-01 DOI: 10.1081/clt-120028752

Alan Hui, Jeanna M Marraffa, Christine M Stork

{"title":"A rare ingestion of the Black Locust tree.","authors":"Alan Hui, Jeanna M Marraffa, Christine M Stork","doi":"10.1081/clt-120028752","DOIUrl":"https://doi.org/10.1081/clt-120028752","url":null,"abstract":"Background: The Black Locust (Robinia Pseudoacacia) tree contain toxalbumins, robin and phasin, that exert their toxic effects by inhibition of protein synthesis. Despite the potential dangers of Black Locust intoxication, reports of human toxicity after ingestion are rare. We report the first human intoxication of Black Locust bark in North America in over one hundred years.Case report: An eight-year-old male was brought to the emergency department 6 hours after chewing and expelling the Black Locust bark. He presented with emesis, which began approximately 2.5 hours after exposure. His vital signs were as follows: oral temperature, 97.5 degrees F; blood pressure, 128/75 mmHg; heart rate, 114 beats per minute; respiratory rate, 15 breaths per minute. Initial treatment included 4 mg i.v. ondansetron, which resolved the vomiting, one dose of activated charcoal, and intravenous fluids. He was then admitted to the intensive care unit (ICU) for observation of signs of toxicity. Laboratory findings were unremarkable except for a white blood cell of 18.4 K/uL and an elevated alkaline phosphatase of 183 U/L. The patient remained asymptomatic throughout his stay in the ICU and was discharged on the fifth day of admission with a normal white blood cell of 4.1 K/uL and an alkaline phosphatase of 251 U/L.Conclusion: Patients with clinical toxicity following the ingestion of Black Locust are expected to do well with supportive care and observation.","PeriodicalId":17447,"journal":{"name":"Journal of toxicology. Clinical toxicology","volume":"42 1","pages":"93-5"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1081/clt-120028752","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24467189","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}

引用次数: 13