Toxicology of Medications for Diabetes Mellitus
Medications used to treat diabetes mellitus are heterogeneous, with widely differing safety profiles in therapeutic use and in overdose. Insulin overdose may produce severe and prolonged hypoglycemia. Sulfonylurea poisoning should be treated with octreotide, sparing intravenous dextrose where possible. Acute metformin overdose may lead to life-threatening acidosis with elevated lactate concentrations, which may require hemodialysis. Glucagon-like peptide 1 agonists and dipeptidyl peptidase 4 inhibitors are benign in overdose in diabetic patients but may produce profound hypoglycemia in nondiabetic patients. Euglycemic diab...
Source: Critical Care Clinics - May 28, 2021 Category: Intensive Care Authors: Kevin Baumgartner, Jason Devgun Source Type: research
Iatrogenic Toxicities in the Intensive Care Unit
This article reviews several types of iatrogenic toxicities associated with medications that are commonly used in critically ill patients. The mechanism of the iatrogenic toxicities, clinical presentation, and diagnosis, as well as management are discussed. (Source: Critical Care Clinics)
Source: Critical Care Clinics - May 28, 2021 Category: Intensive Care Authors: Lama H. Nazer, Anne Rain T. Brown, Wedad Awad Source Type: research
Toxic Alcohols
This article reviews the background, metabolism, clinical effects, and treatment of toxic alcohols, specifically ethylene glycol, methanol, diethylene glycol, propylene glycol, and isopropyl alcohol. This article also reviews the importance of an anion gap metabolic acidosis in relation to toxic alcohols and explores both the utility and the limitations of the osmole gap in patient management. (Source: Critical Care Clinics)
Source: Critical Care Clinics - May 28, 2021 Category: Intensive Care Authors: Jennifer A. Ross, Heather A. Borek, Christopher P. Holstege Source Type: research
Carbon Monoxide Poisoning
Carbon monoxide is a colorless, odorless, highly toxic gas primarily produced through the incomplete combustion of organic material. Carbon monoxide binds to hemoglobin and other heme molecules, causing tissue hypoxia and oxidative stress. Symptoms of carbon monoxide poisoning can vary from a mild headache to critical illness, which can make diagnosis difficult. When there is concern for possible carbon monoxide poisoning, the diagnosis can be made via blood co-oximetry. The primary treatment for patients with carbon monoxide poisoning is supplemental oxygen, usually delivered via a nonrebreather mask. Hyperbaric oxygen ca...
Source: Critical Care Clinics - May 28, 2021 Category: Intensive Care Authors: James A. Chenoweth, Timothy E. Albertson, Matthew R. Greer Source Type: research
Management of Organophosphorus Poisoning
Organophosphorus (OP) compounds remain a leading cause of self-poisoning and mortality, especially in South East Asia, China, and Africa. Organophosphorus causes an acute cholinergic syndrome by inhibiting acetylcholinesterase. Atropine remains the mainstay of treatment, but recently some promising therapies are in the pipeline. Oximes are used widely in the management of organophosphorus poisoning, however clinical efficacy remains to be established. Magnesium sulfate, calcium channel blockers (nimodipine), plasma alkalinizing agents, β-2 agonists, nicotinic receptor antagonists, clonidine, and lipid emulsions are promis...
Source: Critical Care Clinics - May 28, 2021 Category: Intensive Care Authors: Sakib Aman, Shrebash Paul, Fazle Rabbi Chowdhury Source Type: research
Antithrombotic and Antiplatelet Drug Toxicity
Anticoagulant and antiplatelet drugs target a specific portion of the coagulation cascade or the platelet activation and aggregation pathway. The primary toxicity associated with these agents is hemorrhage. Understanding the pharmacology of these drugs allows the treating clinician to choose the correct antidotal therapy. Reversal agents exist for some of these drugs; however, not all have proven patient-centered outcomes. The anticoagulants covered in this review are vitamin K antagonists, heparins, fondaparinux, hirudin derivatives, argatroban, oral factor Xa antagonists, and dabigatran. The antiplatelet agents reviewed ...
Source: Critical Care Clinics - May 28, 2021 Category: Intensive Care Authors: David B. Liss, Michael E. Mullins Source Type: research
Toxicology of Psychoactive Substances
This article provides a summary of the toxicologic features of commonly used and abused PADs: antidepressants, antipsychotics, mood stabilizers, hallucinogens, NPSs, caffeine, nicotine, and cannabis. (Source: Critical Care Clinics)
Source: Critical Care Clinics - May 28, 2021 Category: Intensive Care Authors: Lara Prisco, Aarti Sarwal, Mario Ganau, Francesca Rubulotta Source Type: research
Inhalants
Toxic inhalants include various xenobiotics. Irritants cause upper and lower respiratory tract injuries. Highly water-soluble agents injure the upper respiratory tract, while low water-soluble inhalants injure the lower track. Asphyxiants are divided into simple asphyxiants and chemical asphyxiants. Simple asphyxiants displace oxygen, causing hypoxia, while chemical asphyxiants also impair the body ’s ability to use oxygen. Cyanide is a classic chemical asphyxiant. Treatment includes hydroxocobalamin. Electronic cigarette or vaping use-associated lung injury (EVALI) is a relatively new illness. Patients present with resp...
Source: Critical Care Clinics - May 28, 2021 Category: Intensive Care Authors: Evan S. Schwarz Source Type: research
Toxicology
CRITICAL CARE CLINICS (Source: Critical Care Clinics)
Source: Critical Care Clinics - May 28, 2021 Category: Intensive Care Authors: Janice L. Zimmerman Source Type: research
Copyright
ELSEVIER (Source: Critical Care Clinics)
Source: Critical Care Clinics - May 28, 2021 Category: Intensive Care Source Type: research
Contributors
JOHN A. KELLUM, MD, MCCM (Source: Critical Care Clinics)
Source: Critical Care Clinics - May 28, 2021 Category: Intensive Care Source Type: research
Contents
Janice L. Zimmerman (Source: Critical Care Clinics)
Source: Critical Care Clinics - May 28, 2021 Category: Intensive Care Source Type: research
Forthcoming Issues
Acute Respiratory Distress Syndrome (Source: Critical Care Clinics)
Source: Critical Care Clinics - May 28, 2021 Category: Intensive Care Source Type: research
Pathophysiology of Acute Respiratory Distress Syndrome and COVID-19 Lung Injury
The pathophysiology of acute respiratory distress syndrome (ARDS) is marked by inflammation-mediated disruptions in alveolar-capillary permeability, edema formation, reduced alveolar clearance and collapse/derecruitment, reduced compliance, increased pulmonary vascular resistance, and resulting gas exchange abnormalities due to shunting and ventilation-perfusion mismatch. Mechanical ventilation, especially in the setting of regional disease heterogeneity, can propagate ventilator-associated injury patterns including barotrauma/volutrauma and atelectrauma. Lung injury due to the novel coronavirus SARS-CoV-2 resembles other ...
Source: Critical Care Clinics - May 28, 2021 Category: Intensive Care Authors: Kai Erik Swenson, Erik Richard Swenson Source Type: research
Pathophysiology of ARDS and COVID-19 Lung Injury
Acute respiratory distress syndrome (ARDS) is a rapidly developing non-cardiogenic pulmonary edema caused by pulmonary and systemic infections or sterile tissue injuries that evoke a severe lung-damaging host inflammatory response. The lung loses its normal gas exchange efficiency with disruption of the tight permeability characteristics of the alveolar capillary barrier. Interstitial and subsequent alveolar edema lead to alveolar collapse/de-recruitment, reduced lung compliance and greater pulmonary vascular resistance, often with marked regional heterogeneity in severity. Regional heightened stress applied to surrounding...
Source: Critical Care Clinics - May 28, 2021 Category: Intensive Care Authors: Kai E. Swenson, Erik R. Swenson Source Type: research
