Archive for June 2011

Whole fentanyl patch ingestion: expect the worst

June 30, 2011, 2:12 pm

★★★☆☆

Whole Fentanyl Patch Ingestion: a multi-center case series. Mrvos R et al. J Emerg Med 2011 June 15. [Epub ahead of print]

Abstract

Fentanyl patches can be abused in a number of ways: dermal or buccal absorption, chewing the patch, rectal or vaginal insertion, and injection in insufflation of the drug.  Ingestion of the intact patch presents a unique challenge …

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Dramatic pictures: vasculitis caused by levamisole-contaminated cocaine

June 29, 2011, 11:20 am

★★★★☆

A novel cutaneous vasculitis syndrome induced by levamisole-contaminated cocaine. Gross RL et al. Clin Rheumatol 2011 June 25. [Epub ahead of print]

Abstract

In July 2009, the DEA reported that almost 70% of cocaine samples seized at U.S. borders contained levamisole, a veterinary antihelminthic agent. Although it is not clear why the drug is being added to cocaine, there are …

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It ain’t tox, but . . .

June 28, 2011, 10:00 am

Marcia Angell’s must-read essay on “The Illusions of Psychiatry” in the current issue of The New York Review of Books is somewhat sketchy and not well referenced, but presents a persuasive case that the role of recurrent updates of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is more an effort — generally successful …

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Serum verapamil levels after lipid infusion therapy

June 26, 2011, 10:52 pm

★★★☆☆

Serum verapamil concentrations before and after Intralipid® therapy during treatment of an overdose. French D et al. Clin Toxicol 2011;49:340-344.

Abstract

This case report describes a 47-year-old man who developed complete heart block and hypotension after ingesting 6300 mg of sustained-released verapamil. He received multiple forms of treatment, including norepinephrine, dopamine, calcium chloride, hyperinsulinemia-euglycemia, tranvenous pacing, phenylephrine, and vasopressin.  Nineteen …

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Make the Diagnosis, Sherlock!

June 24, 2011, 12:14 am

★★★☆☆

The Price of Perfection: A Teenaged Athlete with Elevated Serum Creatinine. Kowalski JM et al. Pediatr Emerg Care 2011 June;27:575-7.

Abstract

This toxicologic conundrum describes a 16-year-old football player who presents to the emergency department with weakness, nausea, and muscle cramps after a long practice session on a hot summer day.  Work-up is notable for a normal physical exam with …

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“Mad Honey” and History

June 23, 2011, 12:49 am

★★★☆☆

The Honey, The Poison, The Weapon. Gunduz A et al. Wilderness Environ Med 2011 June;22:182-4.

Abstract

“Mad honey” — made from pollen of Rhododenron species — contains a grayanotoxin that maintains sodium channels in an open start and holds excitable cells in a persistent state of depolarization. As TPR has reported before, “mad honey” is often ingested by middle-aged men

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Intranasal administration safe and effective for selected drugs

June 21, 2011, 12:59 pm

★★★★☆

Intranasal Drug Administration: An Innovative Approach to Traditional Care. Collopy KT, Snyder S. EMS World 2011 May;40:45-50.

Abstract

The intranasal (IN) route provides a safe, efficient way of delivering certain medications when an intravenous line is not in place. This review article is worth reading for an overview of the topic, despite some sketchiness in describing exact technique.

The nasal …

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Slate on Businessweek on Synthetic Highs

June 20, 2011, 10:50 pm

In Slate today, Jack Shafer gives his take on the Bloomberg Businessweek cover story about the business of synthetic highs that we reported on yesterday. The bottom line:

If the synthetic-cannabinoid market is a niche, and I think it is, let me offer a couple of conjectures (no predictions!) about the stuff. First, our culture has thousands of years of

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The Big Business of Synthetic Highs

June 19, 2011, 6:12 pm

The cover story of the current issue of Bloomberg Businessweek a long article in about the business aspects of synthetic highs such as “Spice”, “K2”, and bath salts, an industry estimated to gross many billions of dollars yearly.  The article focuses on one company — Pandora Potpourri of in Columbia MO – with two employees, four sales reps, and an …

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