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) · Nov 2016
Comparative Study Observational StudyAbsorption of salicylate powders versus tablets following overdose: a poison center observational study.
Salicylate absorption following overdose of aspirin (ASA) tablet formulations can be prolonged for greater than 24 h. Accordingly, serial serum concentrations are typically recommended to guide treatment. However, there are little published data on absorption following ingestion of powder ASA formulations, and it is not known if delayed ASA absorption occurs following overdose of powder formulations. The objective of this study is to compare the absorption characteristics of powder and tablet formulations of ASA in patients reported to a single poison center. ⋯ In contrast to persistent concentrations following overdose of tablets, the majority of serum salicylate concentrations declined following ingestion of powder formulations. In this small study population, these findings suggest that prolonged absorption is unlikely following ingestions of ASA powders.
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Clin Toxicol (Phila) · Nov 2016
Comparative StudyMethemoglobin measurements are underestimated by the Radical 7 co-oximeter: experience from a series of moderate to severe propanil poisonings.
In Asia methemoglobinemia (MetHb) is commonly caused through self-poisoning with the pesticide propranil. MetHb can cause hypoxia, coma and death, but usually responds to methylene blue. It is therefore vital to have accurate methods to measure blood MetHb to guide appropriate treatments. The gold standard to measure MetHb utilizes a spectrophotometer, but recent bedside tests have been developed e.g., pulse co-oximeter probe and blood color chart. ⋯ This small cohort highlights the potential for extreme inaccuracy of the Radical-7 co-oximeter, especially with a MetHb greater than 20%. Pulse co-oximeters should be required to be validated for the complete range of MetHb prior to regulatory approval.
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Apixaban is a novel oral anticoagulation agent that exerts its effect through direct factor Xa inhibition. We present a case of multi-drug overdose including apixaban with associated apixaban concentrations. ⋯ A case of apixaban overdose with associated apixaban concentrations is presented. There was rapid resolution of anticoagulation with no demonstrable benefit of currently available clotting factor replacement.
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Clin Toxicol (Phila) · Nov 2016
Pesticide-related poison center exposures in children and adolescents aged ≤19 years in Texas, 2000-2013.
Although national poison center data show that pesticides were the 8th most commonly reported substance category (3.27%) for children aged ≤5 years in 2014, there is limited information on childhood and adolescent pesticide exposures. ⋯ Through characterizing pesticide-related poison center exposures, future interventions can be designed to address groups with higher prevalence of exposure.
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Clin Toxicol (Phila) · Nov 2016
Stability of high-dose insulin in normal saline bags for treatment of calcium channel blocker and beta blocker overdose.
High-dose insulin has become a first-line therapy for treating severe calcium channel blocker and beta blocker toxicity. Insulin infusions used to treat other conditions (e.g., diabetic ketoacidosis) may be used, but this may lead to pulmonary compromise due to fluid volume overload. An obvious solution would be to use a more concentrated insulin infusion; however, data describing the stability of insulin in polyvinyl chloride bags at concentrations >1 unit/mL are not readily available. ⋯ Insulin at a concentration of 16 units/mL is stable for 14 days, the maximum timeframe currently allowed under US Pharmacopeia rules for compounding of sterile preparations. This stability data will allow institutions to issue beyond-use dating for intravenous fluids containing concentrated insulin and used for treating beta blocker and calcium channel blocker toxicity.