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) · Jan 2015
Comparative Study Observational StudyComparison of abdominal computed tomography with and without oral contrast in diagnosis of body packers and body stuffers.
Toxicity due to body packing/pushing/stuffing is a major concern in many countries. Of different imaging techniques, computed tomography (CT) scan is described as the method of choice in detecting body couriers, but there is no study to concomitantly compare with- and without-contrast abdominopelvic CTs to determine the more accurate one for this purpose. ⋯ There is a remarkable gap between detection of existence and number of packets/baggies reported by the radiologists and the real condition of the patients. A close teamwork between radiologists and toxicologists is needed to manage these problematic cases.
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Clin Toxicol (Phila) · Jan 2015
Case ReportsStart me up! Recurrent ventricular tachydysrhythmias following intentional concentrated caffeine ingestion.
Nearly pure caffeine is sold as a "dietary supplement," with instructions to ingest 1/64th to 1/16th of one teaspoon (50-200 mg). We report a patient with refractory cardiac dysrhythmias treated with defibrillation, beta-adrenergic blockade, and hemodialysis to highlight concentrated caffeine's dangers. ⋯ Severe caffeine toxicity can produce difficult to treat, life-threatening dysrhythmias. Concentrated caffeine, marketed for dietary supplementation, presents a substantial public health risk that demands action to limit consumer availability.
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Clin Toxicol (Phila) · Jan 2015
Randomized Controlled Trial Multicenter Study Comparative StudyComparison of F(ab')2 versus Fab antivenom for pit viper envenomation: a prospective, blinded, multicenter, randomized clinical trial.
Crotalidae Polyvalent Immune Fab (Ovine) has been the only antivenom commercially available in the US since 2007 for treatment of Crotalinae envenomation. Late coagulopathy can occur or recur after clearance of Fab antivenom, often after hospital discharge, lasting in some cases more than 2 weeks. There have been serious, even fatal, bleeding complications associated with recurrence phenomena. Frequent follow-up is required, and additional intervention or hospitalization is often necessary. F(ab')2 immunoglobulin derivatives have longer plasma half life than do Fab. We hypothesized that F(ab')2 antivenom would be superior to Fab in the prevention of late coagulopathy following treatment of patients with Crotalinae envenomation. ⋯ In this study, management of coagulopathic Crotalinae envenomation with longer-half-life F(ab')2 antivenom, with or without maintenance dosing, reduced the risk of subacute coagulopathy and bleeding following treatment of envenomation.
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Clin Toxicol (Phila) · Jan 2015
Multicenter Study Observational StudyAcetaminophen concentrations prior to 4 hours of ingestion: impact on diagnostic decision-making and treatment.
Consensus recommendations for acute acetaminophen exposure include plotting an acetaminophen concentration at ≥ 4 h post ingestion on the Rumack-Matthew nomogram to determine the need for acetylcysteine treatment. We studied the frequency of acetaminophen concentrations drawn within 4 h post ingestion and whether the Rumack-Matthew nomogram was properly used in making acetylcysteine treatment decisions. ⋯ Patients with a known exposure time and presenting within 4 h of acetaminophen ingestion had a pre-4-hour acetaminophen concentration obtained 62% of the time. Pre-4-hour acetaminophen concentrations cannot be used to determine the need for acetylcysteine therapy and are associated with an increased likelihood of not obtaining optimally timed acetaminophen concentrations and acetylcysteine management not based on the proper application of the Rumack-Matthew nomogram. Current practice results in additional cost, unnecessary treatment, potential adverse medication effects, and the possibility of non-treatment of patients at risk of hepatotoxicity.
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Clin Toxicol (Phila) · Jan 2015
Randomized Controlled TrialThe efficacy of prophylactic antibiotics in the management of children with kerosene-associated pneumonitis: a double-blind randomised controlled trial.
Hydrocarbons, especially kerosene (paraffin), are the most common agents causing childhood poisoning in low and middle income countries (LMICs). Aspiration of kerosene causes an inflammatory sterile chemical pneumonitis, which may increase susceptibility to secondary lower respiratory tract bacterial infection. This study aimed to assess the efficacy of prophylactic antibiotics in the management of kerosene-associated pneumonitis in children and to identify risk factors associated with severity or outcome. ⋯ Prophylactic antibiotics do not improve the outcome in children with mild respiratory illness after kerosene ingestion.