Archive for September 2015

Hemodialysis in lithium poisoning: there is no evidence. Full stop.

September 29, 2015, 2:44 pm

0Lithium Carbonate, 300mg, 1,000 Capsules per Bottle McGuffMedical.com★★★½☆

Hemodialysis for lithium poisoning. Lavonas EJ, Buchanan J. Cochrane Database Sys Rev 2015 Sep 16 [Epub ahead of print]

Abstract

At a session at the ACEP Scientific Assembly last year, Jerry remarked: “Guidelines should regularly conclude that there is no evidence. Full stop.”

I really like this Cochrane review of hemodialysis in lithium poisoning because [SPOILER ALERT] that is exactly …

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Tox Tunes #102: Jake Leg Blues (The Mississippi Sheiks, 1930)

September 28, 2015, 1:58 am

 

“Jake Leg Blues”  by the Mississippi Sheiks is another song form the 1930s that describes the ravages wrought by Jamaica Ginger extract, an alcohol-containing patent medicine that was deliberately contaminated with the organophosphate compound tricresyl phosphate (TOCP) during prohibition. For a more complete description of this tragic episode of mass poisoning, and for references, see our previous post

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Case report: seizures after exposure to 25B-NBOMe (N-Bomb)

September 24, 2015, 12:34 am

Blue Batman pills (25C-NBOMe)

Blue Batman pills (25C-NBOMe)

★★★☆☆

Beware of blotting paper hallucinogens: severe toxicity with NBOMes. Isbister GK et al. Med J Aust 2015 Sep 21;203:266-267

Reference

The NBOMe series of drugs are substituted phenethylamines. They act as agonists at both the 5-HT2A receptors and the α-receptors. Because of these actions they can cause both hallucinations (5-HT2A effects) and the sympathomimetic

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Tox Tunes #101: Alcohol and Jake Blues (Tommy Johnson, 1930)

September 20, 2015, 10:44 pm

One of the most interesting, and tragic, episodes of mass poisoning in U.S. history involves “jake paralysis“. The first depiction in the medical literature was in a June 1930 New England Journal of Medicine article, that described an epidemic of motor neuropathy that occurred in the midwestern and southern states. As I explained in the “Toxicology Rounds” …

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Implications of obesity for pharmacology and toxicology

September 19, 2015, 12:53 am

★★★½☆

A Review of the Toxicologic Implications of Obesity. Zuckerman M et al. J Med Toxicol 2015 Sep;11(3):342-54

Abstract

The authors of this thought-provoking study propose that obese patients be considered a “special population” — similar to children, the elderly, and pregnant women — for matters of medical toxicology.

Obesity — defined as a body mass index (BMI) > 30 kg/m…

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Colchicine in acute gout: high-dose or low-dose or no-dose?

September 11, 2015, 6:37 pm

003206 Colchicine, 0.6mg, 1,000 Tablets per Bottle McGuffMedical.com★★★½☆

Does Colchicine Improve Pain in an Acute Gout Flare? Turner J, Cooper D. Ann Emerg Med 2015 sep;66:260-1.

Reference

The 7th edition of Tintinalli’s Emergency Medicine (2011) has this to say about using colchicine to treat gout:

Oral colchicine is typically administered in a dose of 0.6 milligrams/h until intolerable side effects (vomiting or diarrhea) or efficacy ensues.

This “typical” …

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Case report: use of ECMO in colchicine poisoning

September 11, 2015, 1:02 am

Colchicum autumnale (Autumn crocus)

Colchicum autumnale (Autumn crocus)

★★★½☆

Extracorporeal life support in the treatment of colchicine poisoning. Boisramé-Helms J et al. Clin Toxicol 2015;53:827-829.

Abstract

Colchicine toxicity occurs roughly in 3 phases. During the initial 24 hours, severe gastrointestinal symptoms — nausea, vomiting, and diarrhea — can cause hypotension and shock if fluid losses are not adequately replaced. During the second phase, severe toxicity …

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Case report: veno-venous ECMO as a bridge to lung transplantation in paraquat poisoning

September 9, 2015, 1:49 am

Paraquat
★★★☆☆

Successful extracorporeal membrane oxygenation therapy as a bridge to sequential bilateral lung transplantation for a patient after severe paraquat poisoning. Tang X et al.  Clin Toxicol 2015 Aug 28 [Epub ahead of print]

Abstract

Conceptually, extracorporeal membrane oxygenation (ECMO) seems a perfect technique for treating some of the sickest toxicology patients,  buying time until failing vital functions can recover.

With …

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Is ED use of flumazenil safe?

September 3, 2015, 10:24 pm

Flumazenil4★★☆☆☆

Lack of adverse effects from flumazenil administration: an ED observational study. Nguyen TT et al. Am J Emerg Med 2015 Jul 21 [Epub ahead of print]

Abstract

The use of the antidote flumazenil in patients with suspected benzodiazepine poisoning is controversial. The major concern is for inducing seizures in a patient who has a proconvulsant medication on board, is tolerant …

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