DEVELOPMENT OF HEPATIC FAILURE DESPITE USE OF INTRAVENOUS ACETYLCYSTEINE AFTER A MASSIVE INGESTION OF ACETAMINOPHEN AND DIPHENHYDRAMINE. Schwartz EAet al. Ann Emerg Med Sept. 2009;54:421-423.
This uncommonly interesting case report describes a 48-year-old woman who ingested 150 tablets of Tylenol PM, each containing 500 mg acetaminophen and 25 mgdiphenhydramine. On arrival at hospital, she had clear signs of anticholinergic overdose (tachycardia, dry skin, encephalopathy) but normal liver enzymes and INR. The initial 4 hour acetaminophen (APAP) level — 104 mcg/ml — was below the treatment line on the Rumack-Mathew nomogram, but since the history was initially unclear intravenous N-acetylcysteine (IV-NAC) was started. However, the APAP level continued to rise for almost two days, crossing clearly into the treatment area of the nomogram . . .
Thanks to the Australian medical blog “Life in the Fast Lane” for pointing out this BBC clip on YouTube about TPR’s favorite fish, the candiru, or toothpick fish:
The candiru is a tiny Amazonian catfish that, according to legend, will swim up the stream of urine
This important observational case series describes 55 methamphetamine body stuffers whose cases were referred to the Oregon Poison Center for consultation over a 6.5 year period. Body stuffing was defined as ingestion of free or packaged methamphetamine that was not for recreational purposes nor for…
FROM RUSSIA WITH LOVE — INGESTION OF A PURPLE POWER. McKeown NJ et al. Pediatr Emerg Care 2009;25:423.
This case report, from the Oregon Poison Center in Portland, describes a 3-year-old child who ingested a purple powder — from a bottle labelled in Russian — used as a topical antiseptic. The substance was identified as potassium permanganate, which is…
