Archive for November 2009

It ain’t tox, but . . .

November 30, 2009, 11:48 pm

Jerome Groopman’s article in a recent issue of New York Review of Books is well-worth reading.  It discusses various types of cognitive errors in medicine (e.g., anchoring, availability, and atrribution), referring to the landmark work of Tversky and Kahneman in the 1970s.  Dr. Groopman also notes how the increasingly prevalent factory or commodity model of medicine makes the occurrence of …

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Aspirin overdose deadly and unpredictable

November 30, 2009, 11:36 am

★★★½☆

DELAYED SALICYLATE TOXICITY WITH UNDETECTABLE INITIAL LEVELS AFTER LARGE-DOSE ASPIRIN INGESTION. Herres J et al.  Am J Emerg Med 2009;27:1173.e1-1173.e3.

Abstract

This interesting and cautionary case report describes a 53-year-old man who ingested cose to 200 325-mg aspirin tablets in a suicide attempt. Was relatively asymptomatic at presentation 45 minutes later, and had a salicylate level that was undetectable.  At …

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Hemodialysis and pregabalin toxicity

November 29, 2009, 12:46 pm

★★★☆☆

Abstract

TREATMENT OF PREGABALIN TOXICITY BY HEMODIALYSIS IN A PATIENT WITH KIDNEY FAILURE Yoo L et al.   Am J Kidney Dis Dec 2009;54:1127-30.

Pregabalin (Lyrica) is an anticonvulsant also used to treat diabetic neuropathy, post-herpetic neurolagia, and fibromyalgia.  This case report describe a dialysis patient who developed signs of mild pregabalin toxicity — myoclonus and muscular contractions — after having …

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Chemical Terrorism and the Emergency Department

November 27, 2009, 10:38 pm

★☆☆☆☆

Toxic chemical effects that might present in the ED. Goffman TE.  Am J Emerg Med 2009 Nov;27:1149-54.

This is a review of the various chemical agents that might cause a mass-casualty incident, including nerve agents, vesicants, pulmonary toxins. and cyanide.  It is an important topic, but unfortunately this letter is so poorly written and edited that it is really not …

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Box Jellyfish Sex (Mature Viewers Only)

November 26, 2009, 6:08 am

The New York Times has a beautiful picture of the mating ritual of the box jellyfish, Copula sivickisi. Their slide show also features a picture of a South African species, Craybdea branchi.

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Do serial serum cholinesterase levels indicate prognosis in organophosphate poisoned patients

November 25, 2009, 3:04 pm

★★★☆☆

Abstract

PROGNOSTIC VALUE OF SERIAL SERUM CHOLINESTERASE ACTIVITIES IN ORGANOPHOSPHATE POISONED PATIENTS. Chen H et al.  Amer J Emerg Med Nov 2009;27:1034-1039.

Organophosphates (OPs) deactivate the enzyme that breaks down actylcholine. A laboratory manifestation of this interaction is decresed serum cholinesterase (SChE) activity.  The deactivation, which will eventually “age” to become permanent, is — for a certain period of time

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Existentialists on Mescaline

November 24, 2009, 1:35 pm

Thanks to DoseNation for pointing out a great piece in the Sunday Times (U.K.) detailing the strange hallucinations (think crustaceans) that Jean-Paul Sartre developed while taking mescaline. In his new book Talking with Sartre, political scientist John Gerassi says that in conversations with him, Sartre revealed: “Yeah, after I took mescaline I started seeing crabs around me all the …

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The “Today” Show Discovers Huffing

November 23, 2009, 12:04 pm

Slate‘s Jack Shafer takes NBC’s “Today” show to task for its story on huffing, which hecalls the “stupid drug story of the week”.  While he is correct in stating that the story contained minor errors and that huffing is not — as “Today” implied — a new or rapidly growing phenomenon, it seems to me that Shafer’s attack …

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Ketamine and Lower Urinary Tract Injury

November 22, 2009, 8:59 pm

An article in the Guardian (U.K.) today describes the growing problem of urological injury attributed to abuse of ketamine.  I had not been aware of this connection.  Apparently, ketamine or a metabolite gets concentrated in the urine, causing inflammation, fibrosis, and decreased compliance of the urinary bladder.  Papillary necrosis has also been reported.  If scarring is extensive, severe hydronephrosis can …

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