Archive for July 2011

Is the initial lactate level helpful in managing patients with carbon monoxide poisoning?

July 30, 2011, 2:13 pm


The value of initial lactate in patients with carbon monoxide intoxication: in the emergency department. Moon JM et al. Hum Exp Toxicol 2011 Aug;30:836-843.


The strange placement of the colon in the title is only the beginning of the problems with this paper.

The authors set out to determine whether initial elevated lactate levels were associated with poor outcomes …

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Evolution of a Jellyfish Sting

July 28, 2011, 11:39 pm

The New England Journal of Medicine has posted an interesting series of photographs in their “Images in Clinical Medicine” feature, illustrating the progression of a jellyfish sting (species unknown) over the course of 10 days. Treatment included steroids, antihistamines, and antibiotics.…

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Neurological changes and hip prosthesis: consider cobalt toxicity

July 26, 2011, 10:22 pm


Neurotoxicity of cobalt. Catalani S et al. Hum Exp Toxicol 2011 Jul 5. [Epub ahead of print]


It is important that clinicians be important with the neurological manifestations of cobalt toxicity, since some metal-on-metal hip protheses can deteriorate releasing large amounts of the metal into surrounding tissues and the blood.  Pain at the site of hip replacement can …

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An Anatomy of Addiction: Freud, William Halsted, and Cocaine

July 24, 2011, 3:43 pm

In the lead review of today’s New York Times Book Review, Sherwin Nuland discusses Howard Markel’s An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine.

Markel, a professor of medical history at the University of Michigan, presents alternating chapters on the role cocaine — newly arrived in Europe and the United States — played in …

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How to avoid rare but devastating N-acetylcysteine overdose

July 22, 2011, 7:55 pm


Massive acetylcysteine overdose associated with cerebral edema and seizures. Heard K, Schaeffer TH. Clin Toxicol 2011 Jun;49:423-425.


Dosing errors in administering N-acetylcysteine (NAC) for acetaminophen overdose are relatively common when using the 21-hour IV protocol. Usually these occur during the initial loading dose of 150 mg/kg over 60 minutes and do not have severe clinical consequences. This …

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New York Times on bath salts

July 16, 2011, 10:08 pm

Although the New York Times’ story on bath salts is a little late to the dance and doesn’t have much to add to what TPR has been reporting since last August, it is worth reading for some statitistics and anecdotes. The article reports that in the first six months of 2011 Poison Centers in the United States have received 3470 …

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Help! My child has swallowed a firecracker!

July 15, 2011, 9:18 pm

Mike Christian and Tim Erickson have a good quick take on the toxicology of fireworks ingestion in the current issue of Emergency Physicians Monthly. As they point out, the toxic ingredients of fireworks include:

  • Barium – Profound hypokalemia induced by barium causes muscle weakness, respiratory failure, and ventricular dysrhythmias. Treatment includes respiratory support, potassium repletion, and hemodialysis if

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Lithium toxicity? Neuroleptic malignant syndrome? Serotonin syndrome?

July 14, 2011, 11:24 pm


Acute lithium intoxication? properly directing an index of suspicion. South Med J 2011 May;104:371-2.


This case report, although somewhat incoherent, nevertheless makes a valid point. The case involves a 48-year-old woman who presented with 2 days of altered mental status and not much additional history. Physical exam and lab workup revealed a normal temperature, mild tachycardia, decreased responsiveness, upper …

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Coronary computerized tomographic angiography and cocaine-associated chest pain

July 12, 2011, 10:57 pm


CTA and cocaine-associated Chest Pain: More Evidence is Needed. Livshits Z, Hoffman RS. Acad Emerg Med oi: 10.1111/j.1553-2712.2011.01107.x. [Epub ahead of print]

No abstract available online

This letter, from Drs. Livshits and Hoffman at the NYC Poison Control Center, takes issue with a recent article in Academic Emergency Medicine and with the entire notion of using coronary computerized tomographic angiography …

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