Journal of toxicology. Clinical toxicology
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J. Toxicol. Clin. Toxicol. · Jan 2003
Stability of atropine sulfate prepared for mass chemical terrorism.
Preparedness for chemical terrorism includes the procurement of the appropriate pharmacological antagonists. A large emphasis has been placed on having a sufficient quantity of atropine available to treat patients exposed to acetylcholinesterase inhibitors such as sarin. Severe exposures may necessitate the administration of large amounts of atropine and dictate the need to prepare significant quantities of extemporaneously compounded atropine solution to respond to mass numbers of casualties over the first 24-48 hours postexposure. ⋯ The amount of atropine necessary to treat hundreds to thousands of victims of a chemical attack is immense. The extemporaneous preparation of atropine solution from pharmaceutical-grade powder eliminates concerns about the storage of excessive quantities of atropine. A 1 mg/mL solution is stable for at least 3 days, allowing for use during the most critical treatment periods after exposure.
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J. Toxicol. Clin. Toxicol. · Jan 2003
Case ReportsIrreversible ischemic hand following intraarterial injection of zolpidem powder.
Intraarterial injections of crushed oral formulations of drugs may cause acute, severe ischemia, and gangrene. A 24-yr-old woman developed severe ischemia of the right hand following arterial self-injection of a crushed zolpidem tablet. ⋯ Zolpidem tablets contain microcrystalline cellulose, an approved structural element in tablets for humans that has also been found to be a potent embolic agent. Microvascular embolization related to the microcrystalline cellulose may have contributed to the ischemia of the patient's hand.
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J. Toxicol. Clin. Toxicol. · Jan 2003
Case ReportsEnvenomation by the Mexican beaded lizard: a case report.
Envenomations by venomous lizards are rare. A single report of envenomation by a Mexican beaded lizard (Heloderma horridum) has been published. Further, anaphylaxis secondary to lizard envenomation has only been reported with the Gila monster. We report an envenomation that resulted in both systemic toxicity and anaphylaxis. ⋯ Significant envenomations by members of the Helodermatidae family are rare. Systemic toxicity usually resolves within one to two days with supportive care. Prior envenomations may predispose patients to anaphylactic reactions.
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J. Toxicol. Clin. Toxicol. · Jan 2003
Case ReportsBaclofen withdrawal following removal of an intrathecal baclofen pump despite oral baclofen replacement.
Intrathecal baclofen is used as a muscle relaxant and antispasmodic in cases of spasticity resulting from central nervous system trauma. The baclofen withdrawal syndrome may include hyperthermia, tachycardia, hypertension, seizures, altered mental status, and psychomotor agitation. We report a case in which the removal of a baclofen pump lead tothe development of severe withdrawal symptoms despite oral baclofen replacement therapy. In order to avoid the development of withdrawal, adequate doses of GABA agonist agents should be administered immediately prior to, and following, baclofen pump removal.