Clinical toxicology : the official journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists
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Clin Toxicol (Phila) · Jun 2007
Case ReportsReversal of salicylate-induced euglycemic delirium with dextrose.
Salicylate poisoning inhibits Krebs cycle enzymes and uncouples oxidative phosphorylation. Under these circumstances, we hypothesize that CNS glucose supply is sometimes unable to keep up with demand resulting in hypoglycorrhacia and delirium even in the face of serum euglycemia. Supporting this conjecture, we report two euglycemic patients with salicylate-induced delirium who responded to boluses of concentrated dextrose with a prompt improvement in mental status.
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Clin Toxicol (Phila) · Jun 2007
Case ReportsSuccessful organ transplantation after treatment of fatal cyanide poisoning with hydroxocobalamin.
Cyanide-poisoned patients are potential organ donors provided that organs are not damaged by the poison or by antidotal treatment. ⋯ Anoxic cardiac arrest following acute cyanide poisoning treated with hydroxocobalamin (5 g + 5 g) was not a contraindication to organ transplantation after confirmed encephalic death in this patient.
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Clin Toxicol (Phila) · Jun 2007
Development and implementation of an emergency department observation unit protocol for deliberate drug ingestion in adults - preliminary results.
Patients presenting after reported overdose are typically precluded from admission to emergency department observation units (EDOU). The purpose of this study was to describe the initial experience with an EDOU overdose protocol. ⋯ Although initial numbers are too small for meaningful analysis, the results suggest that prolonged observation of this problematic patient subset within an EDOU is feasible.
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The case of a 46-year-old woman who survived after a brodifacoum poisoning is presented. The patient was admitted due to a severe coagulopathy. Initial prothrombin time and activated partial thromboplastin time were both greater than 110 seconds and the patient suffered severe gastric and pulmonary hemorrhage requiring fresh frozen plasma transfusion and parenteral phytonadione administration (up to 100 mg per day). ⋯ Brodifacoum elimination showed a first order kinetic and a 56-day half-life. Investigation of superwarfarin should be considered in any patient with vitamin K dependent coagulation disorder. It would be also useful to obtain periodic brodifacoum levels and build the corresponding elimination curve to help direct phytonadione therapy in poisoned patients.
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Clin Toxicol (Phila) · Jun 2007
Case ReportsUrinary serotonin level is associated with serotonin syndrome after moclobemide, sertraline, and citalopram overdose.
Altered mental status, autonomic dysfunction, and neuromuscular abnormalities are a characteristic triad of serotonin syndrome. No laboratory tests confirm the diagnosis of serotonin syndrome. ⋯ The urinary serotonin level is increased in serotonin syndrome due to a monoamine oxidase inhibitor and selective serotonin-reuptake inhibitors overdose. It is possible that urinary serotonin concentration could be used as a biochemical marker of serotonin syndrome.