Archive for October 2009

Is Ricin a Weapon of Mass Destruction?

October 17, 2009, 6:36 pm




Ricin, a toxic chemical derived form the castor bean plant Ricinus communis, is often called one of the most deadly chemicals in nature. It also often on the short list of substances that could be used as …

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Contaminated Dietary Supplements

October 16, 2009, 5:10 pm

A “Perspective” piece in the current issue of the New England Journal of Medicine discusses the issue of some “natural” dietary supplements and weight-loss products being contaminated with potentially dangerous drugs such as amphetamines, sedatives, antidepressants, and other unlisted medications.  These products are covered by the 1994 Dietary Supplement Health and Education Act (DSHEA), which makes the manufacturer solely …

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Did Salicylates Increase the Death Toll in the 1918 Influenza Pandemic?

October 13, 2009, 1:54 pm




This absolutely fascinating — but somewhat speculative — article hypothesizes that overuse of aspirin was responsible for some of the deaths in the 1918 flu pandemic.  The author — who wrote one of the early papers on Reyes Syndrome and …

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Clinical and ECG Effects of Escitalopram Overdose

October 12, 2009, 10:27 pm


CLINICAL AND ECG EFFECTS OF ESCITALOPRAM OVERDOSE van Gorp et al.  Ann Emerg Med September 2009;54:404-408.


This Australian study reviewed 79 presentations (68 patients) of patients admitted to a toxicology unit with escitalopram overdose.  in 46 of these, there were no significant co-ingestants.  Ingested doses of escitalopram ranged from 20 – 560 mg.  In this group there was no …

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The Greatest Tox Scene in Opera

October 11, 2009, 2:20 pm

httpv:// There is an amazing toxicology-themed scene in the finale to Act I of Mozart's Cosi Fan Tutte. In the opera, two young friends -- Ferrando and Guglielmo -- make a bet with an older cynic -- Don Alfonso -- that their fiances -- Fiordiligi and Dorabella -- will remain ever faithful. (If you're having trouble sorting out these characters at home, you're in good company. Apparently, Mozart at times confused them in the manuscript to the opera.) Keeping with the

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Clozapine-Induced Acute Megacolon

October 10, 2009, 4:37 pm


Case Records of the Massachusetts General Hospital: A 26-Year-Old Man with Abdominal Distention and Shock.

N Engl J Med October8, 2009;361:1487-1496

The very interesting CPC presentation in the current issue of New England Journal of Medicine involves a case of acute megacolon (Ogilvie’s Syndrome) caused by the atypical antipsychotic agent clozapine.  Because chronic clozapine use can cause agranulocytosis and myocarditis, …

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Irukandji Syndrome Case Series From Australia’s Tropical Northern Territory

October 4, 2009, 10:14 pm

[Rating: 3.0] Irukandji Syndrome Case Series From Australia's Tropical Northern Territory Ann Emerg Med Sept 2009;54:395-403. Abstract Irukandji sydrome is caused by the sting of a tiny (20-mm) jellyfish (Carukia barnesi) found predominantly in the waters off northern Australia. It is characterized by a relatively mild sting injury, followed within minutes or hours by severe manifestations of cathecholamine storm: hypertension, tachycardia, EKG changes, and occasional cardiomhyopathy. Fatalities are rare, but have been associated with subarchnoid hemorrhage secondary to marked hypertension. Similar syndromes caused by jellyfish stings have been seen as far away as Florida, although it is not clear if C. barnesi is the culprit in these cases. The key elements in treating these stings are general support and adequate analgesia with opiates. Dowsing the affected area with vinegar will deactivate the jellyfishes stinging cells (nematocysts) that have not yet fired. The Travel Channel's Bite Me with Dr. Mike has an entertaining -- if overdramatized -- segment on C. barnesi and the more toxic box jellyfish, Chironex fleckeri. httpv:// Although this article discusses application of vinegar as a first aid measure, it doesn't mention a commonly cited alternative for many jellyfish stings, which is urinating on the wound. An episode of the sitcom Friends was based on this well-known -- but to my knowledge still unstudied -- intervention. httpv://

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Comparison of the 20-Hour Intravenous and 72-Hour Oral Acetylcysteine Protocols for the Treatment of Acute Acetaminophen Poisoning

October 3, 2009, 9:07 pm

[Rating: 2.0] Yarema MC et al. Comparison of the 20-Hour Intravenous and 72-Hour Oral Acetylcysteine Protocols for the Treatment of Acute Acetaminophen Poisoning Ann Emerg Med October 2009;54:606-614. This is a big paper in many ways: 4048 patients analyzed! Data spanning 30 years! 19 authors! Loads of fancy statistics! And yet . . . there is no useful information that can be gleaned from this study.

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Intravenous Lipid Emulsion as Antidote (review)

October 2, 2009, 3:14 pm


Intravenous Lipid Emulsion as Antidote Beyond Local Anesthetic Toxicity: A Systematic Review Cave G, Harvey M. Acad Emerg Med Sept. 2009;16:815-824.

BACKGROUND: Use of intravenous lipid emulsion (ILE) has gained acceptance among anesthesiologists for treatment of life-threatening local anesthetic toxicity.  In recent years,  animal studies and case reports have been published suggesting that ILE may also be effective in …

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