Critical care clinics
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Critical care clinics · Jul 2021
ReviewManagement of Organophosphorus Poisoning: Standard Treatment and Beyond.
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. ⋯ Magnesium sulfate, calcium channel blockers (nimodipine), plasma alkalinizing agents, β-2 agonists, nicotinic receptor antagonists, clonidine, and lipid emulsions are promising treatment alternatives. However, large phase III trials are required to establish their efficacy.
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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. ⋯ 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 diabetic ketoacidosis may develop in critically ill patients taking sodium-glucose co-transporter 2 inhibitors.
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Critical care clinics · Jul 2021
ReviewPharmacokinetic and Pharmacodynamic Principles for Toxicology.
Pharmacokinetic and pharmacodynamic interactions between drugs and the body play a vital role in the therapeutic effects of drugs as well as their toxicity. Toxic effects may evolve from high doses of drugs or from alterations in the absorption, distribution, metabolism, and excretion of those drugs. The effective dose of a drug is influenced by the initial dose, route of administration, drug formulation, and bioavailability. This effective dose, in conjunction with the frequency of dosing, duration of exposure, and pharmacodynamic variability, directly affects the toxicity experienced in the body.
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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. ⋯ The primary treatment for patients with carbon monoxide poisoning is supplemental oxygen, usually delivered via a nonrebreather mask. Hyperbaric oxygen can also be used, but the exact indications are controversial.
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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.