Archive for April 2016

Cardiac effects of loperamide overdose

April 29, 2016, 5:59 pm


Not your regular high: cardiac dysrhythmias caused by loperamide. Wightman RS et al. Clin Toxicol 2016 Jun;54:454-458


Loperamide is an over-the-counter anti-diarrhea medication that is available without prescription under a variety of brand names including Imodium. In therapeutic doses, loperamide acts as a peripheral mu-opioid receptor agonist but doesn’t cross the blood-brain barrier (BBB). However, in massive …

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Bedside echocardiography findings in carbon monoxide-poisoned patients

April 28, 2016, 9:34 pm


Incidence and patterns of cardiomyopathy in carbon monoxide-poisoned patients with myocardial injury. Cha YS et al. Clin Toxicol 2016 Apr 11 [Epub ahead of print]


At last year’s Social Media and Critical Care (SMACC) conference in Chicago, I gave a talk remarking on how bedside ultrasound imaging in critically ill toxicology patients is underused and little studied. I suggested …

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Metronidazole-induced cerebellar syndrome

April 15, 2016, 3:45 pm


Metronidazole-Associated Encephalopathy. Farmakiotis D, Zeluff B. N Engl J Med 2016 Apr 14;374:1465

Full Text           

Exposure to metronidazole (Flagyl) can precipitate a subacute cerebellar syndrome, typically manifested with dysarthria and ataxia, with or without cognitive impairment. This adverse effect is uncommon and little-appreciated. Although usually associated with prolonged exposure to the antibiotic for treatment of conditions such as abscesses of …

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Vasculitis after snorting cocaine contaminated with levamisole

April 7, 2016, 2:28 pm

Lawrence et al. Allergy Rhinol (Providence) 2014 Copyright policy — open-access

Lawrence et al. Allergy Rhinol (Providence) 2014
Copyright policy — open-access


Cocaine-induced ecchymotic rash. Voore NK. Cleve Clin J Med 2016 Apr;3:252-253.

Full Text

Since at least 2010, a large percentage of cocaine samples seized in the United States has contained levamisole, a veterinary anti-worm medication.

Levamisole had previously used in humans as an anti-helminthic and also in some …

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Cocaine-associated cardiotoxicity: a systematic review yields no answers

April 6, 2016, 3:26 pm

Christopher Siesarchik/

Christopher Siesarchik/


Treatment of cocaine cardiovascular toxicity: a systematic review. Richards JR et al. Clin Toxicol 2016 Feb 26 [Epub ahead of print]


This paper is the most frustrating thing I’ve read since I force marched my way through the “Oxen of the Sun” chapter of James Joyce’s Ulysses. I must say that, despite its difficulties, …

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