Clinical toxicology : the official journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists
-
Clin Toxicol (Phila) · Jun 2013
Case ReportsMetformin overdose-induced hypoglycemia in the absence of other antidiabetic drugs.
Lactic acidosis is a well-recognized consequence of metformin. Hypoglycemia has been reported previously in metformin overdose, but the presence of other co-ingestions (e.g., a sulfonylurea) was not definitively excluded. ⋯ Metformin overdose can cause severe hypoglycemia in the absence of other antidiabetic drugs. Potential mechanisms of metformin-induced hypoglycemia include decreased hepatic glucose production, decreased glucose absorption, and poor oral intake.
-
Clin Toxicol (Phila) · Jun 2013
Comparative StudyHypertonic sodium bicarbonate versus intravenous lipid emulsion in a rabbit model of intravenous flecainide toxicity: no difference, no sink.
The use of intravenous lipid emulsion (ILE) as an antidote in non-local, anaesthetic drug toxicity has generated considerable interest. Flecainide is a lipophilic anti-arrhythmic with a significant cardiotoxic profile, with blockade of sodium and potassium channels causing arrhythmias and shock in severe toxicity. ILE has been proposed as a treatment option in severe flecainide toxicity refractory to other modalities. ⋯ In this study, no differences were observed between an active control of hypertonic sodium bicarbonate and ILE for the primary endpoint of MAP at 15 min nor for QRS duration at any timepoint. There was a transient rapid increase in blood pressure seen in the sodium bicarbonate group that was not sustained. No increase was seen in blood concentration of flecainide in the ILE group, suggesting no 'lipid sink' for flecainide in this model. More research is warranted to define any role for ILE in flecainide toxicity.
-
Clin Toxicol (Phila) · Jun 2013
Case ReportsLead toxicity and endoscopic removal of ingested firearm cartridges.
Lead toxicity from the ingestion of a lead foreign body has been described in several case reports. Management of ingested live ammunition presents its own challenges due to the risk of accidental discharge. A safe and effective method of retrieving a live cartridge must be considered. ⋯ These cases illustrate a diagnostic dilemma in both the diagnosis of lead toxicity and the removal of live ammunition from the stomach.
-
Clin Toxicol (Phila) · Jun 2013
ReviewExtracorporeal membrane oxygenation in the treatment of poisoned patients.
Although extracorporeal membrane oxygenation (ECMO) was used in many patients following its introduction in 1972, most hospitals had abandoned this experimental treatment for adult patients. Recently, improvements in the ECMO circuitry rendered it more biocompatible. The surprisingly low mortality in patients with severe acute respiratory distress syndrome who were treated with ECMO in the influenza A/H1N1 pandemic of 2009 resurrected interest in ECMO in many intensive care units around the world. ⋯ In the last decade, ECMO equipment has improved considerably, rendering it more biocompatible, and it has been used more frequently as an assist device for patients needing oxygenation as well as circulatory support. ECMO is considered a good salvage therapy for patients who are severely poisoned with ARDS or refractory circulatory shock.
-
Clin Toxicol (Phila) · Jun 2013
Multicenter StudyA multicenter retrospective survey on a suicide trend using hydrogen sulfide in Japan.
In Japan, suicide by inhaling hydrogen sulfide (H2S) by mixing commercial products escalated into a nationwide trend in April 2008. ⋯ Mortality (58%) among patients who attempted H2S suicide was very high, likely resulting from inhaling high concentrations of H2S after mixing commercial products in a sealed and confined space.