Journal of toxicology. Clinical toxicology
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J. Toxicol. Clin. Toxicol. · Jan 2003
Case ReportsMassive caffeine overdose requiring vasopressin infusion and hemodialysis.
Massive caffeine overdose is associated with life-threatening hemodynamic complications that present challenges for clinicians. We describe the highest-reported serum concentration of caffeine in a patient who survived and discuss the first-reported use of vasopressin and hemodialysis in a caffeine-poisoned patient. ⋯ Hemodialysis and vasopressin infusions may be of benefit in the management of caffeine-intoxicated patients who fail to respond to standard therapies.
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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.
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There is an enormous diversity and complexity of venoms and poisons in marine animals. Fatalities have occurred from envenoming by sea snakes, jellyfish, venomous fish such as stonefish, cone snails, and blue-ringed octopus. Deaths have also followed ingestion of toxins in shellfish, puffer fish (Fugu), and ciguatoxin-containing fish. ⋯ This unprecedented rapid onset of cardiotoxicity in clinical envenoming suggests that antivenom may need to be given very early (within minutes) and possibly in large doses if a life is to be saved. Forty years of anecdotal experience supports the beneficial effect of stonefish antivenom in relieving the excruciating pain after stonefish spine penetration. It remains uncertain whether stonefish antivenom is efficacious in stings from spines of other venomous fish, and the recommendation of giving the antivenom intramuscularly needs reassessment.
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J. Toxicol. Clin. Toxicol. · Jan 2003
ReviewGlucagon in beta-blocker and calcium channel blocker overdoses: a systematic review.
Glucagon is usually accepted as part of the standard treatment in the management of patients with beta-blocker and calcium channel blocker overdoses. ⋯ The evidence supporting the use of glucagon in the management of patients with beta-blocker and calcium channel blocker overdoses is limited to animal studies.