Archive for September 2011

Propofol as a drug of abuse

September 30, 2011, 1:26 pm

In the trial of Dr. Conrad Murray for involuntary manslaughter in the death of Michael Jackson, there has been much discussion about propofol, the powerful hypnotic agent that killed the pop star. More technical issues about the drug will surely arise in the days (and possibly weeks) to come as both prosecution and defense call on expert witnesses.  To read my 2009 Emergency Medicine News column about propofol as a drug of abuse, click here.

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Is high-dose insulin better than vasopressors in treating toxin-induced cardiogenic shock?

September 29, 2011, 10:29 pm


High-dose insulin: A consecutive case series in toxin-induced cardiogenic shock. Holger JS et al. Clin Toxicol 2011;49:653-658.


This observational case series, from Regions Hospital in St. Paul MN, retrospectively reviewed charts of patients seen by the toxicology service and treated for toxin-induced cardiogenic shock over an approximately 3 year period (February 2007 – March 2010). Cardiogenic shock was diagnosed …

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Did Michael Jackson swallow a fatal dose of propofol?

September 28, 2011, 11:27 am

From pre-trial hearings and yesterday’s opening arguments in court, it is apparent that the defense team for Dr. Conrad Murray — the physician accused of manslaughter in the death of Michael Jackson — plans to argue that Jackson administered the fatal dose of propofol to himself, possibly by swallowing it. This contention is certainly based in part on the forensic

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Bath salts: calls to poison centers in Louisiana and Kentucky

September 27, 2011, 1:17 pm

★★★½☆ Clinical experience with and analytical confirmation of “bath salts” and “legal highs” (synthetic cathinones) in the United States. Spiller HA et al. Clin Toxicol 2011 Jul;49:499-505.


The title of this article grossly overstates what it contains.  It is a retrospective review of “bath salt” exposure not in the “United States”, but rather as reported to two state-wide poison control …

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Deaths from phosphine gas exposure

September 23, 2011, 12:07 am


Unintentional Fatal Phosphine Gas Poisoning of a Family. Lemoine TJ et al. Pediatr Emer Care 2011;27:869-871.


This interesting case report from Utah describes 2 children — 4 years and 15-months — who suddenly decompensated and died after exposure to phosphine gas from aluminum phosphide (AlP) pellets placed in burrows around their house in an attempt to kill rodents.  Notable …

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Methemoglobinemia and intravascular hemolysis after aluminum phosphide exposure

September 21, 2011, 8:18 pm

Fumitoxin (aluminium phosphide)


Unusual complication of aluminum phosphide poisoning: Development of hemolysis and methemoglobinemia and its successful treatment. Soltaninejad K et al. Indian J Crit Care Med 2011 Apr-Jun ;15:117-119.

Full text 


The pesticide aluminum phosphide (AlP), although inexpensive and effect as a fumigant and insecticide, is a lethal poison combining the worst characteristics of a caustic agent and …

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Dozen arrested in NYC for sale of illegal, highly toxic rat poison

September 20, 2011, 7:38 pm

Twelve people were arrested yesterday in New York City yesterday as part of an ongoing investigation into the sale of illegal, highly toxic rat poison, the New York Times reported this morning.

The investigation began last year when a woman — mistaking the rodenticide for medication — developed a severe bleeding disorder and reportedly lost “tow-thirds of her blood volume. …

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Review of aluminum phosphide pesticide poisoning

September 20, 2011, 5:40 pm


Managing aluminum phosphide poisonings. Gurjar M et al. J Emerg Trauma Shock 2011 Jul-Sep;4:378-384.


This review article has 82 references, but the authors seem to have read very few of these critically.  In discussing treatment of aluminum phosphide (ALP) exposure, they repeat every intervention that might have theoretical benefit, or has been mentioned in a case report, without bothering …

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Report: overdoses now kill more people than traffic accidents

September 18, 2011, 4:34 pm

There are now more deaths in he United States caused by drugs than by automobile accidents, according to a story in this morning’s Los Angeles Times. The claim is based on preliminary 2009 figures from the Centers for Disease Conrtol and Prevention.

This development can be attributed to a rise in fatalities associated with powerful prescription analgesics such as …

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