Lipid rescue therapy for local anesthetic toxicity: is less more
DISCUSSION: Most of the “adverse events” associated with lipid rescue therapy have occurred after administration of relatively high doses. Although there have been no good studies demonstrating the maximum “safe” dose of intralipid for lipid rescue therapy, many authors recommended limiting the dose to that recommended by the FDA for nutritional support: 12.5 mL/kg (lean body mass) per day total. In specific cases it may be reasonable to consider extending the infusion beyond this, but such situations are likely rare. In this patient, who did not appear to have cardiovascular instability, it is not...
Source: The Poison Review - May 25, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical adverse event intralipid lipid rescue therapy local anesthetic toxicity mepivacaine Source Type: news
Hemodialysis and the intubated salicylate-toxic patient
3.5 out of 5 stars
The association of hemodialysis and survival in intubated salicylate-poisoned patients. McCabe DJ, Lu JJ. Am J Emerg Med 2017 Apr 10 [Epub ahead of print]
Abstract
[Disclosure: the co-authors of this paper are members of the Toxikon Consortium in Chicago, as am I.]
This retrospective observational study looked at cases from the Illinois Poison Center over 12 years (2003 thru 2015) to identify intubated patients with recorded serum salicylate levels > 50 mg/dL. The goal was “to describe the impact of hemodialysis on survival rates of salicylate-intoxicated patients . . .”
The authors id...
Source: The Poison Review - May 20, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical aspirin poisoning enhanced elimination hemodialysis salicylate toxicity Source Type: news
Hemp seed oil may possibly (but not probably) cause cannabinoid poisoning
2.5 out of 5 stars
Cannabinoid Poisoning by Hemp Seed Oil in a Child. Chinello M et al. Pediatr Emerg Care 2017;33:344-345.
Abstract
This interesting but non-dispositive short case report from Italy suggests that, in rare instances, commercially marketed hemp seed oil can cause mild cannabinoid toxicity. A 2-year-7-month old male was brought to hospital with altered mental status and several hours of “decreased alertness, refusal to walk, and no verbal response.” Additional findings included: “paleness, stupor, [and] low reactivity to stimulation.” Pulse rate was 129 bpm. There was no ataxia.
The p...
Source: The Poison Review - May 10, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical cannabinoid cannabis hemp seed oil pediatric subacute poisoning Source Type: news
Tox Tunes #110: Nutmeg (John Legend & Stephen Colbert)
Started thinking about this song again earlier in the week as I prepared to take part in an hour-long discussion of the spice on Connecticut Public Radio’s Colin McEnroe Show. The discussion touched on many aspects the spice: historical, economic, culinary, medicinal, and toxicological.
To listen to the show, click here.
To read my 2011 Emergency Medicine News column about nutmeg, click here. (Source: The Poison Review)
Source: The Poison Review - May 7, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical john legend nutmeg stephen colbert tox tunes Source Type: news
TPR Podcast Episode #14: VX and the Assassination of Kim Jong-Nam
On February 13, 2017 Kim Jong Nam — half-brother to North Korean leader Kim Jong Un — was attacked by two women in Malaysia’s Kuala Lumpur International airport. The attacks smeared some substance on his face. Within 10 or 15 minutes Mr. Kim collapsed in the airport medical clinic and died apparently in the ambulance on way to hospital.
Days later, Malaysian authorities announced that the nerve agent VX was detected in samples taken from Mr. Kim’s face.
Security camera footage from the airport showing the attack on Mr. Kim and its aftermath can be viewed here. In the video, the attack can be se...
Source: The Poison Review - March 30, 2017 Category: Toxicology Authors: Leon Gussow The Poison Review Tags: Podcast Source Type: news
Tox Tunes #109: I Killed Robert Johnson (The Stone Foxes)
More myths and legends are attached to the life of Robert Johnson (1911 – 1938) than surround any other American blues artist. It’s said that he sold his soul to the devil down at a Mississippi crossroads in return for the ability to play guitar with a technique that musicians like Eric Clapton are still trying to replicate. It’s said that his death at age 27 established a precedent for other great American musicians who also died at that same age, including Jimi Hendrix, Janis Joplin, Jim Morrison, and Al “Blind Owl” Wilson. And it is said that Johnson was poisoned with strychnine in Greenwoo...
Source: The Poison Review - March 6, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical american delta blues i killed robert johnson nux vomica sonte foxes strychnine tox tunes Source Type: news
Labetalol in acute cocaine toxicity: is it safe?
3 out of 5 stars
Acute Toxicity from Topical Cocaine for Epistaxis: Treatment with Labetalol. Richards JR et al. J Emerg Med 2017 Mar;52:311-313.
Abstract
There has long been a debate among toxicologists — still unresolved — as to whether it is safe to use a beta-blocker to treat cocaine-related hypertension and tachycardia. The (theoretical) concern is that since cocaine is both an α- and a β-agonist, blocking the β-receptors could lead to unopposed α stimulation with increased severe hypertension.
Some authors contend that in this setting, labetalol would be safe since it blocks both α and β receptors. Oth...
Source: The Poison Review - March 1, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical beta blocker cocaine epistaxis labetalol safety toxicity Source Type: news
Tox Tunes #108: Commit a Crime (Howlin ’ Wolf)
You put poison in my coffee, instead of milk or cream
You put poison in my coffee, instead of milk or cream
You bout the evilest woman, that I ever seen
You mixed my drinks with a can of Red Devil lye
You mixed my drinks with a can of Red Devil lye
Then you sit down, watch me, hopin’ that I might die
This is one of the great dysfunctional relationship songs in all of the blues. Howling’ Wolf (Chester Burnett 1910 – 1976) also recorded a great version of the song — under the title “What a Woman” and with Eric Clapton playing lead guitar — on the 1970 London Sessions album:
A recent cov...
Source: The Poison Review - February 26, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical commit a crime eric clapton howling' wolf london sessions rolling stones tox tunes Source Type: news
Did the nerve agent VX kill Kim Jong Nam?
Last night Malaysian authorities announced that they identified the nerve agent VX taken off the face of Kim Jong Nam, who was murdered on February 13 at Kuala Lumpur International Airport.
As the History Channel video above indicates, nerve agents are potent acetylcholinesterase inhibitors that utilize the same mechanism as organophosphate insecticides such as parathion. Conceptually, the effect of VX exposure is simple: wherever in the body acetylcholine acts as a neurotransmitter, nerve agents cause unregulated, chaotic activity. There are generally 3 such sites:
muscarinic sites: connections between nerves and secr...
Source: The Poison Review - February 24, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical assassination Kim Jong Nam Kuala Lumpur International Airport malaysia murder nerve agent North Korea VX Source Type: news
Must-watch: video showing murder of Kim Jong Nam
Discussion on toxicology discussion boards have brought up the following possibilities:
Tetramine: Tetramethylenedisulfotetramine (TETS) is a rat poison that has been banned since 1984 but which — according to Wikipedia — is still used in China. It is a white powder that is slightly soluble both in water and DMSO, a solvent that could accelerate dermal absorption. TETS is a neurotoxin that acts as a GABA antagonist causing refractory status epileptics, coma, and death. There is no specific antidote.
Aconite: This plant poison is used in several Chinese herbal medicines.Aconite is a sodium channel opener, causing gast...
Source: The Poison Review - February 22, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical assassination Kim Jong Nam Kuala Lumpur International Airport malaysia murder North Korea Source Type: news
Do not get a serum acetaminophen level less than 4 hours after an acute ingestion
4 out of 5 stars
Can a serum acetaminophen concentration obtained less than 4 hours post-ingestion determine which patients do not require treatment with acetylcysteine? Yarema MC et al. Clin Toxicol 2017 Feb;55:102-108.
Abstract
For decades the decision whether or not to treat acute acetaminophen [APAP] toxicity with N-acetylcysteine (NAC) has been guided by a serum APAP level drawn 4 or more hours after ingestion. The thought was that before 4 hours the level might be misleading because absorption of the drug might not be complete.
This paper addresses the question of whether an earlier level can be sufficient to clea...
Source: The Poison Review - February 9, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical acetaminophen antidote APAP N-acetylcysteine rumack-matthew nomogram treatment Source Type: news
Amnesia and hippocampal ischemia in 4 opiate abusers: a case series
Hippocampus (wikipedia.org)
3.5 out of 5 stars
Complete, bilateral hippocampal ischemia: a case series. Small JE et al. Neruocase 2016 Oct;22:411-415.
Abstract
Last week, we reviewed an MMWR investigation into a cluster of 14 cases of acute anterograde amnesia with MRI evidence of bilateral hippocampal ischemia identified in Massachusetts during the years 2012-2016. This constellation of features is distinctly unusual — especially when symmetric and accompanied by scant pathology outside the hippocampus — but has in the past been associated with cocaine abuse and carbon monoxide poisoning.
The MMWR review conta...
Source: The Poison Review - February 1, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical amnesia hippocampus ischemia memory opiate abuse Source Type: news
Amnesia and hippocmpal ischemia in 4 opiate abusers: a case series
Hippocampus (wikipedia.org)
3.5 out of 5 stars
Complete, bilateral hippocampal ischemia: a case series. Small JE et al. Neruocase 2016 Oct;22:411-415.
Abstract
Last week, we reviewed an MMWR investigation into a cluster of 14 cases of acute anterograde amnesia with MRI evidence of bilateral hippocampal ischemia identified in Massachusetts during the years 2012-2016. This constellation of features is distinctly unusual — especially when symmetric and accompanied by scant pathology outside the hippocampus — but has in the past been associated with cocaine abuse and carbon monoxide poisoning.
The MMWR review conta...
Source: The Poison Review - February 1, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical amnesia hippocampus ischemia memory opiate abuse Source Type: news
Anterograde amnesia and bilateral hippocampus ischemia: is it caused by substance abuse?
Diffusion weighted MRI findings in patient with unusual amnestic syndrome — Massachusetts, 2012 [Source: MMWR]3.5 out of 5 stars
Cluster of an Unusual Amnestic Syndrome — Massachusetts, 2012-2016. Barash JA et al. MMWR Morb Mortal Wkly Rep 2017;66:76-79
Full Text
Late in 2015 a Boston neurologist reported a cluster of 4 cases of anterograde amnesia associated with MRI evidence of bilateral hippocampal ischemia. After a public health alert was issued an additional 10 cases were identified in the years 2012-2016, using the case definition of: “1) new onset amnesia in the absence of evidence to support a readily ...
Source: The Poison Review - January 27, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical amnestic syndrome e opioid overdose hippocampus ischemia opiat Source Type: news
Is commercial kratom being spiked with a naturally occurring potent opioid
3.5 out of 5 stars
Suspected Adulteration of Commercial Kratom Products with 7-Hydroxymitragynine. Lydecker AG et al. J Med Toxicol 2016;12:341-349.
Abstract
This well done paper provides — among other things — a helpful short review kratom, a psychoactive product derived from the Mitragyna speciosa plant.
M speciosa contains more than 40 distinct alkaloids. The primary alkaloid — mitragynine — is an opioid agonist at the mu and delta receptors. Mitragynine has about 33% the opioid potency of morphine.
A minor component of M speciosa — 7-hydroxymitragynine — is a much more potent opioid ag...
Source: The Poison Review - January 24, 2017 Category: Toxicology Authors: Leon Gussow Tags: Medical 7-hydroxymitragynine kratom mitragyna speciosa Source Type: news
