From Fixing Photos to Fixing Cyanide Poisoning: Herschel's “Hypo” or Sodium Thiosulfate

In 1819, a soon-to-be-knighted John Herschel (1792 to 1871) discovered that hyposulfite of soda could “fix” or make photographic images permanent by dissolving away unexposed and otherwise insoluble silver salts. This British genius soon coined terms for his astronomical or botanical images as “negatives” or “positives” and for the art as “photography.” Even after it was renamed sodi um thiosulfate, hyposulfite of soda retained photographers’ nickname for it: “hypo.” An antidote for cyanide poisoning, sodium thiosulfate was supplied in ampoules to physicians by Eli Lilly (above) and other pharmaceutical firms. Eventually, an editor-in-chief of Anesthesiology, Dr. John Michenfelder, would help popularize the antidotal availability of sodium thiosulfate for treating cyanide toxicity resulting from overdoses of antihypertensive infusions of sodium nitroprusside. (Copyright © the American Society of Anesthesiologists' Wood Library-Museum of Anesthesiology.)
Source: Anesthesiology - Category: Anesthesiology Source Type: research

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Glaucoma patient for trabeculectomy. Actually only found out postop when nurse noticed pt was odd. Altered cognition, imbalance, other non-focal neuro deficits Had a mild AKI from diuresis, bicarb low, LFTs ok Notably related onset of symptoms to within a day of starting diamox Also determined to be taking at least 2x (perhaps 4x) the prescribed dose -- immediately suspected OD, with much lower suspicion for ddx including cerebellar stroke Poison control center confirmed ssx c/w diamox... Diamox overdose
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Anesthesiology Source Type: forums
​A 32-year-old man presented to the emergency department complaining of eye pain and decreased vision. He worked for the city and was removing rust and graffiti from a wall with a power washer when the spray ricocheted off the surface and into his eye. He presented with a bottle of the chemical he used, which contained hydrofluoric acid (HF) and other chemicals. He rinsed his eyes with tap water, but experienced persistent decreased vision and pain in both eyes. His exam was remarkable for bilateral injected conjunctiva and excessive tearing.More than 7,000 ocular exposures were reported to U.S. poison control centers pe...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
We report three cases of women who experienced lidocaine and prilocaine poisoning after laser-assisted hair removal. Plasma levels of local anesthetics were assayed by a fully validated liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) method.Case reportsThe rules of application of the anesthetic cream were observed apart from the maximum dose and/or maximum surface area. One patient applied a higher dose than the maximum recommended dose (140 instead of 60  g) and all patients failed to comply with the maximum recommended surface area (600 cm2). The patients presented an unusual clinical pat...
Source: International Journal of Legal Medicine - Category: Medical Law Source Type: research
Abstract Opioid analgesics are recognized as a legitimate medical therapy for selected patients with severe chronic pain that does not respond to other therapies. However, opioids are associated with risks for patients and society that include misuse, abuse, diversion, addiction, and overdose deaths. Therapeutic success depends on proper candidate selection, assessment before administering opioid therapy, and close monitoring throughout the course of treatment. Risk assessment and prevention include knowledge of patient factors that may contribute to misuse, abuse, addiction, suicide, and respiratory depression. R...
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research
Purpose of review: The decision to provide intravenous lipid emulsion (ILE) therapy as a treatment modality for the reversal of various drug toxicity was discovered in the last decade. Numerous publications, in both humans and animals attest to its clinical use, but current supporting evidence is inconsistent. Recent findings: A recent systematic review reported evidence for benefit of ILE in bupivacaine toxicity. Human randomized trials, large observational studies as well as animal models of orogastric poisoning failed to report a clear benefit of ILE for nonlocal anesthetics poisoning. Summary: ILE can be used to resu...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Jurgen Schuttler Source Type: research
AbstractN-(1-Phenethylpiperidin-4-yl)-N-phenylacrylamide, or acryloylfentanyl (acrylfentanyl), is a synthetic opioid and a close structural analogue of fentanyl, which is widely used in medicine as an adjunct to general anaesthesia during surgery and for pain management. Until recently, acryloylfentanyl was known only from the scientific literature, but in 2016 this non-controlled substance became available on the illicit drug market as a powder and nasal spray in Europe and the USA. By the end of 2016, detection of acryloylfentanyl in six European countries, including 47 deaths associated with the drug, had been reported ...
Source: Forensic Toxicology - Category: Forensic Medicine Source Type: research
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Source: Healthy Living - The Huffington Post - Category: Consumer Health News Source Type: news
​Children like to put things in their mouth, ears, nose, and eyes. A 9-year-old boy superglued his right eye shut and came to our pediatric emergency department. He thought the glue was an over-the-counter eye lubricant and filled his entire eye with the glue.​​Overdoses and poisonings are a dangerous threat to children. In fact, unintentional poison overdose or ingestion has continued to claim hundreds of children's lives. More than 300 children in the United States ages 0 to 19 are seen at EDs for poisoning and two of them die each day. (CDC. April 28, 2016; http://bit.ly/2kjVmhO.)Not all toxic exposures are in...
Source: The Procedural Pause - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A survey conducted by Collier et al1 highlights the problem of drug dosing in obese children. The authors identify two aspects that require greater attention from paediatric practitioners: the identification of the obese child and the lack of use of ideal body weight (IBW) for drug calculation in that obese child. Both involve effort from prescribers to go beyond simply measuring total body weight (TBW). There remains a question about the benefits of using IBW compared with using TBW or any other measure of body mass. The lack of enthusiasm to calculate IBW obvious from the Collier et al survey is reflective of uncertainty...
Source: Archives of Disease in Childhood - Category: Pediatrics Authors: Tags: Obesity (nutrition), Child health, Other anaesthesia, Poisoning, Occupational and environmental medicine, Health education, Obesity (public health), Health promotion Drug therapy Source Type: research
ConclusionsOpioid poisoning codes have a predictive value of 81% to identify opioid overdoses, suggesting ICD opioid poisoning codes can be used to monitor overdose rates and evaluate interventions to reduce overdose. Further research to assess sensitivity, specificity, and negative predictive value are ongoing. Copyright © 2017 John Wiley &Sons, Ltd.
Source: Pharmacoepidemiology and Drug Safety - Category: Drugs & Pharmacology Authors: Tags: Original Report Source Type: research
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