Journal of toxicology. Clinical toxicology
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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.
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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.
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J. Toxicol. Clin. Toxicol. · Jan 1998
The effects of 4-aminopyridine and Bay K 8644 on verapamil-induced cardiovascular toxicity in anesthetized rats.
To determine the effects of 4-aminopyridine and Bay K 8644 on mean arterial pressure and heart rate in an anesthetized rat model of verapamil toxicity. ⋯ 4-Aminopyridine improved mean arterial pressure and heart rate in a dose-dependent fashion; however, the higher infusion rate (2 mg/kg/h) necessary to improve mean arterial pressure and heart rate resulted in convulsions and excessive secretions. The reversal effects of Bay K 8644 on mean arterial pressure were transient and did not affect heart rate.
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J. Toxicol. Clin. Toxicol. · Jan 1998
Case ReportsThe use of pamidronate for hypercalcemia secondary to acute vitamin D intoxication.
Pamidronate disodium, a bone resorption inhibitor through osteoclast mediation, has been used to treat chronic hypercalcemia secondary to malignancy and chronic renal failure. We report the use of pamidronate for acute, severe hypercalcemia secondary to iatrogenic vitamin D poisoning. ⋯ We report a case of the use of pamidronate for significant hypercalcemia secondary to acute vitamin D poisoning. Although evidence of congestive heart failure was evident, dialysis was avoided without significant sequelae. Pamidronate therapy should be considered in patients with hypercalcemia secondary to acute vitamin D poisoning.
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J. Toxicol. Clin. Toxicol. · Jan 1998
Historical ArticleLove potions and the ointment of witches: historical aspects of the nightshade alkaloids.
Nightshade plants (Solanaceae) have been utilized as hallucinogenic drugs since antiquity in nearly every culture. The Solanaceae alkaloids, atropine and scopolamine, were the active substances in ointment of witches and medieval anesthetics, and in modern poisons. They are still currently used as hallucinogenic drugs. ⋯ Respiratory depression and arrest at high doses confirm the use of scopolamine as a lethal poison. Despite this, the nightshade alkaloids were utilized in clinical medicine in the 19th century. This is an overview of the cultural history of the nightshade alkaloids.