ED sedation with droperidol is relatively safe and effective
This study has shown that droperidol is relatively safe and effective for the management of violent and aggressive patients in the ED and that there was no increased risk of QT prolongation and torsades de points according to a large cohort of cases.”
The “Editor’s Capsule Summary” that accompanies the article is even more emphatic*:
How this is relevant to clinical practice
Droperidol is safe even with the high doses used in this study.
The authors note that the study does not rule out that droperidol may be associated with rare cases of torsades. But the agitated, delirious ED patient may be a dan...
Source: The Poison Review - May 20, 2015 Category: Toxicology Authors: Leon Tags: Best of TPR Medical black box warning droperidol FDA food and drug administration QT prolongation torsades de pointes Source Type: news
Lipid rescue therapy and ECMO in the poisoned patient — can they be used together?
3 out of 5 stars
What are the adverse effects associated with the combined use of intravenous lipid emulsion and extracorporeal membrane oxygenation in the poisoned patient? Lee HM et al. Clin Toxicol 2015;53:145-150.
Abstract
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is often used in the neonatal and pediatric intensive care units on children who are also receiving intravenous lipid emulsion (LE) for nutritional support. Complications reported in patients receiving both interventions include lipid agglutination, clogging, occurrence of blood clots, and cracking of parts of the ECMO circuit.
There is inc...
Source: The Poison Review - May 16, 2015 Category: Toxicology Authors: Leon Tags: Medical antidote ECMO extracorporeal membrane oxygenation intralipid lipid emulsion lipid rescue therapy poisoned patient Source Type: news
Hemodialysis in metformin poisoning
3.5 out of 5 stars
Extracorporeal Treatment fo Metformin Poisoning: Systematic Review and Recommendations From the Extracorporeal Treatments in Poisoning Workshop. Calello DP et al. Crit Care Med 2015 Apr 9 [Epub ahead of print]
Abstract
Metformin is now the oral drug most commonly prescribed to treat non-insulin-dependent diabetes in the United States. The drug is large eliminated by the kidneys. Toxicity presents with severe lactic acidosis, and can occur when decreasing renal function causes accumulation of therapeutic doses, or in the case of acute deliberate overdose. According to some reports metformin poiso...
Source: The Poison Review - May 8, 2015 Category: Toxicology Authors: Leon Tags: Medical continuous renal replacement therapy extracorporeal treatment extrip glucophage hemodialysis metformin Source Type: news
Severe reactions to “Spice” on rise, some associated with drug MAB-CHMINACA
AB-CHMINACA
3 out of 5 stars
In vitro and in vivo human metabolism of the synthetic cannabinoid AB-CHMINACA Erratico C et al. Drug Test Analysis 2015 Apr 12 [Epub ahead of print]
Abstract
The New York Times reported today on the recent dramatic increase in emergency department visits related to use of synthetic cannabinoids (call colloquially, but somewhat inaccurately, “Spice”). This phenomenon has been seen in many states, especially Mississippi, Pennsylvania, and New York.
According to reports, patients often present with agitation, delirium, and hallucinations. Medical complications have included rhabdo...
Source: The Poison Review - April 25, 2015 Category: Toxicology Authors: Leon Tags: Medical CHMINACA spice synthetic cannabinoid Source Type: news
Even Dr. Oz can’t rebut John Oliver
Dr. Oz’s rebuttal yesterday to the letter from ten self-described “distinguished physicians” who demanded that Columbia Medical School cancel his faculty appointment was absolutely brilliant — recasting the narrative from the selling of snake oil to standing up for free speech and against the juggernaut agricultural-industrial complex.
But there’s no rebuttal to John Oliver.
See also Michael Specter’s New Yorker blog post on this issue, as well as his superb profile of Dr. Oz in the magazine. (Source: The Poison Review)
Source: The Poison Review - April 24, 2015 Category: Toxicology Authors: Leon Tags: Medical columbia dr. oz john oliver Source Type: news
Proton pump inhibitors increase risk of acute kidney injury
3 out of 5 stars
Proton pump inhibitors and the risk of acute kidney injury in older patients: a population-based cohort study. Antoniou T et al. CMAJ Open 2015;Apr;3:E166-E171.
Full Text
Previous studies have suggested that use of proton pump inhibitors (PPIs) increases risk of acute interstitial nephritis, especially in elderly patients. Using information from several large computerized databases containing medical information about patients in Ontario, Canada, the authors carried out a population-based cohort study of patients in Ontario aged 66 years and older who were newly prescribed PPIs, compared with match...
Source: The Poison Review - April 23, 2015 Category: Toxicology Authors: Leon Tags: Medical acute kidney injury interstitial nephritis lansoprazole omeprazole proton pump inhibitor Source Type: news
Poisonous birds: what’s new
3 out of 5 stars
Poisonous birds: A timely review. Ligabue-Braun R, Carlini CR. Toxicon 2015 Mar 31;99:102-108.
Abstract
It was just over two decades ago that Dumbacher et al published their landmark paper describing the presence of the alkaloid batrachotoxin (BTX, “frog poison”) in the skin and feathers of three species of Pitohui bird in New Guinea. This toxin binds to voltage-gated sodium channels maintaining them in the open position. This action causes depolarization of nerves and myocardial cells. This may serve the bird by acting as a “chemical defense” against large predators, or as a ...
Source: The Poison Review - April 21, 2015 Category: Toxicology Authors: Leon Tags: Medical batrachotoxin bird catharidin coturnism hoopoe pitohui bird poison quail rhabdomyolysis spur-winged goose toxicity Source Type: news
27 fatalities from laboratory-confirmed exposure to PMMA (“Dr. Death”)
4 out of 5 stars
Deaths from exposure to paramethoxymethamphetamine in Alberta and British Columbia, Canada: a case series. Nicol JJE et al. CMAJ Open. 2015 Jan 13;3(1):E83-9
Full Text
From June 2011 through April 2012, 27 deaths in the Canadian provinces of Albert and British Columbia were attributed to the hallucinogenic stimulant para-methoxy-N-methylamphetamine (PMMA) as the primary toxic agent based postmortem examination and toxicology results. PMMA is so dangerous that it is known on the street as “Death” and “Dr. Death.” This paper constitutes a retrospective review of those cases based on r...
Source: The Poison Review - April 18, 2015 Category: Toxicology Authors: Leon Tags: Best of TPR Medical alberta bath salt british columbia canada death dr. death ecstasy fatality hyperthermia mdma PMMA serotonin syndrome synthetic designer drug Source Type: news
Predicting delirium tremens in patients with alcohol withdrawal seizures
2 out of 5 stars
Clinical predictors for delirium tremens in patients with alcohol withdrawal seizures. Kim DW et al. Am J Emerg Med 2015 Feb 23 [Epub ahead of print]
Abstract
Being able to predict which patients with alcohol withdrawal seizures will go on to develop delirium tremens (DTs) may lead to improved clinical outcomes and decreased morbidity and mortality. The goal of this retrospective Korean study was to identify clinical and laboratory findings in emergency department (ED) patients with seizures attributed to alcohol withdrawal and would predict progression to delirium tremens.
ED patients presenting to 4 te...
Source: The Poison Review - April 14, 2015 Category: Toxicology Authors: Leon Tags: Medical alcohol withdrawal seizures delirium tremens DT homocysteine platelet count Source Type: news
Risk of completed suicide after initial hospitalization for deliberate overdose
3.5 out of 5 stars
Risk of Suicide Following Deliberate Self-poisoning. Finkelstein Y et al. JAMA Psychiatry 2015 Apr 1 [Epub ahead of print]
Abstract
The authors primary objective was to determine the risk of subsequent successful suicide in patients discharged from hospital after a first suicide attempt. They used multiple healthcare databases to identify patients hospitalized for first suicide attempt in Ontario, Canada from April 2002 through December 2010. Subjects identified were followed through the end of 2011. For each subject a control patient without history of self-poisoningt was selected, matched for age, gend...
Source: The Poison Review - April 11, 2015 Category: Toxicology Authors: Leon Tags: Medical overdose risk self-poisoning suicide Source Type: news
Less is more: fatal C. difficile colitis after empiric antibiotics
Aspiration pneumonitis
4 out of 5 stars
Antibiotics “Just-In-Case” in a Patient With Aspiration Pneumonitis. Joundi RA et al. JAMA Intern Med 2015 Apr 1;175:489-490
Reference
This very brief but very important case report contains more key points than most papers 10 times as long. The case describes a 50-year-old man with cerebral palsy and a known seizure disorder who had several witnessed tonic-clonic seizure episodes treated with a benzodiazepine. Subsequent chest x-ray revealed multiple bibasilar opacities consistent with aspiration.
The patient was started on piperacillin-tazobactam. Although he showed si...
Source: The Poison Review - April 9, 2015 Category: Toxicology Authors: Leon Tags: Medical adverse drug event aspiration pneumonia aspiration pneumonitis clostridium difficile colitis Source Type: news
Factors associated with emergency department opioid-related adverse drug events
This study has a number of limitations, which the authors discuss candidly. For example, the study design would miss capturing a patient who received an opioid in the emergency department, was admitted, and died from respiratory depression on the floor. Nevertheless, this is a valuable reminder of the patient, provider, and systems factors that should raise red flags of caution when administering opioids in the emergency department. Worth reading.
(Source: The Poison Review)
Source: The Poison Review - April 8, 2015 Category: Toxicology Authors: Leon Tags: Medical adverse drug events dilaudid emergency department hydromorphone opiates opioids Source Type: news
“Flakka”: one of the most bizarre drugs yet
South Florida has recently seen a number of cases associated (at least by history) by exposure to a street drug called “Flakka”:
In Lake Worth, a naked man brandishing a handgun stood on the roof of an apartment building, shouting “I feel delusional, and I’m hallucinating.”
In Fort Lauderdale, a man tried to kick in the door of the local police station because he thought he was being chased by automobile seeking to do him harm.
And 2 weeks ago, also in Fort Lauderdale, a man impaled himself on a spiked fence around a police station apparently in thrall to a paranoid delusion:
It is no wonder...
Source: The Poison Review - April 4, 2015 Category: Toxicology Authors: Leon Tags: Medical alpha-PVP bath salts flakka gravel Source Type: news
Do we know the best treatment for jellyfish stings?
2.5 out of 5 stars
What is the Most Effective Treatment for Relieving the Pain of a Jellyfish Sting? Ostermayer DG, Koyfman A. Ann Emerg Med 2015 Apr;65:432-433.
Reference
This short article manages to pack a maximum amount of confusion into a very small space. The authors perform a literature search to find evidence that would answer their title question, but come up with only a single relevant randomized controlled trial that included exclusively stings from a specific jellyfish, the bluebottle (Physalia).
That study involved 96 subjects with apparent bluebottle stings, and compared immersion of the affected body part...
Source: The Poison Review - April 2, 2015 Category: Toxicology Authors: Leon Tags: Medical bluebottle jellyfish peeing physalia portuguese man of war sting treatment urine vinegar Source Type: news
3 die in Rochester NY after smoking cocaine/fentanyl combination
Several days ago, WHEC NBC news in Rochester NY reported that in the previous week at least 3 people in the area died after smoking a mixture of cocaine and fentanyl. There may have been as many as 4 additional recent deaths associated with this combination.
Late last year, there were 3 similar deaths in North Carolina.
HT: @VPharmER for the heads-up on this story. (Source: The Poison Review)
Source: The Poison Review - April 1, 2015 Category: Toxicology Authors: Leon Tags: Medical cocaine death fatality fentanyl rochester NY Source Type: news
