Journal of toxicology. Clinical toxicology
-
J. Toxicol. Clin. Toxicol. · Jan 1998
Multicenter Study Clinical TrialGlycolate kinetics and hemodialysis clearance in ethylene glycol poisoning. META Study Group.
Toxic manifestations following ethylene glycol exposure are due to accumulation of metabolites, particularly glycolate. We characterized glycolate elimination kinetics and dialysis properties in a series of ethylene glycol poisonings. ⋯ Glycolate has a slow elimination rate and long half-life. Hemodialysis effectively clears glycolate. An increased anion gap correlates with the presence of glycolate. Hemodialysis is projected as useful for ethylene glycol-poisoned patients with anion gap acidosis and low ethylene glycol blood levels.
-
J. Toxicol. Clin. Toxicol. · Jan 1998
Review Case ReportsFatality resulting from intraventricular vincristine administration.
Inadvertent intrathecal administration of vincristine has been reported and is uniformly fatal except in two of three cases treated with spinal fluid exchange. We report a case of inadvertent direct intraventricular vincristine administration. ⋯ Despite aggressive and immediate therapy, intraventricular vincristine infusion produced neurologic toxicity, with progressive loss of mental function, followed by coma and death. Systems need to be developed to prevent inadvertent central nervous system administrations.
-
J. Toxicol. Clin. Toxicol. · Jan 1998
Comparative StudyUse of ondansetron and other antiemetics in the management of toxic acetaminophen ingestions.
Patients presenting with acetaminophen toxicity and vomiting are often treated with antiemetics so that orally administered N-acetylcysteine can be retained. The policy at the West Virginia Poison Center is to reserve ondansetron, an antiemetic with a higher cost than other antiemetics, as a second line agent for patients presenting within 8 hours of an acetaminophen ingestion. ⋯ Ondansetron should be utilized as a second-line agent in the management of acetaminophen toxic patients with vomiting. Because of its lower failure rate, ondansetron should be administered as a first-line agent in patients with a delay in N-acetylcysteine administration approaching 8 or more hours.
-
J. Toxicol. Clin. Toxicol. · Jan 1998
Case ReportsECG conduction delays associated with massive bupropion overdose.
Bupropion, a relatively new antidepressant, is highly regarded for its safety profile in therapeutic doses and in the overdose. Seizure is the primary adverse reaction associated with bupropion overdoses. Clinically significant cardiovascular complications are rare. ⋯ We report the case of an adult male who ingested 9 g bupropion and developed neurologic toxicity as well as intraventricular conduction disturbances on electrocardiogram. Cardiac monitoring of these patients should be considered.
-
J. Toxicol. Clin. Toxicol. · Jan 1998
Case ReportsProlonged severe withdrawal symptoms after acute-on-chronic baclofen overdose.
Baclofen is frequently used to treat muscle spasticity due to spinal cord injury and multiple sclerosis. Baclofen overdose can lead to coma, respiratory depression, hyporeflexia, and flaccidity. An abrupt decrease in the dose of baclofen due to surgery or a rapid tapering program may result in severe baclofen withdrawal syndrome manifesting hallucinations, delirium, seizures, and high fever. Severe baclofen withdrawal syndrome secondary to intentional overdose, however, has not received mention. ⋯ A 42-year-old male receiving chronic baclofen therapy, 20 mg/d, attempted suicide by ingesting at least 800 mg of baclofen. He was found in coma 2 hours postingestion with depressed respirations, areflexia, hypotonia, bradycardia, and hypotension. Treatment with intravenous fluids, atropine, dopamine, and hemodialysis was associated with restoration of consciousness within 2 days but disorientation, hallucinations, fever, delirium, hypotension, bradycardia, and coma developed during the following week. Baclofen withdrawal syndrome was not diagnosed until hospital day 9, when reinstitution of baclofen rapidly stabilized his condition. Oral overdosage of baclofen causes severe neurological and cardiovascular manifestations due to its GABA and dominant cholinergic effects. Severe baclofen withdrawal syndrome is manifest by neuropsychiatric manifestations and hemodynamic instability. Caution should be exercised after a baclofen overdose in patients receiving chronic baclofen therapy.