Characteristics of Patients with No Underlying Toxicologic Syndrome Evaluated in a Toxicology Clinic

Evaluating the Patient with Reported Gadolinium-Associated Illness

INTRODUCTION

Gadolinium-based contrast agents (GBCAs) have been increasingly used in clinical practice since their introduction in the 1980s. Recently, increased public attention has been given to patients who report new symptoms following GBCA exposure. This review details the current knowledge surrounding GBCAs, with a focus on the known and proposed disease states that may be associated with GBCAs. Recommendations for the appropriate clinical workup of a patient suspected of having symptoms attributable to gadolinium exposure are included.

DISCUSSION

GBCAs are known to precipitate the disease state nephrogenic systemic fibrosis (NSF), a syndrome characterized by skin thickening in patients with preexisting renal disease. An additional syndrome, termed gadolinium deposition disease, has been proposed to describe patients with normal renal function who develop an array of symptoms following GBCA exposure. While there is a potential physiologic basis for the development of this condition, there is no conclusive evidence to support a causal relationship between GBCA administration and the reported symptoms yet. Clinical evaluation revolves around focused history-taking and physical examination, given the absence of a reliable link between patient symptoms and measured gadolinium levels. There are no recommended treatments for suspected gadolinium deposition disease. Chelation therapy, which is not approved for this indication, carries undue risk without documented efficacy.

CONCLUSIONS

The extent to which GBCAs contribute to clinically relevant adverse effects remains an important and evolving field of study. NSF remains the only proven disease state associated with GBCA exposure. Additional data are required to evaluate whether other symptoms should be attributed to GBCAs.

Hair analysis in health assessment

BACKGROUND

Hair analysis is used for estimation of the nutritional status of individuals. In the present work, a systematic review on the relation between the mineral composition of hair and the physical or mental disorders is discussed. Detailed information of examined populations, methods of sample preparations and analytical techniques are presented.

METHODS

A systematic literature search in four electronic databases Scopus, PubMed, Web of Science and Medline (from 1997 to 2012/01/31) for English language articles was performed. In addition, a reference list and manual search was undertaken.

RESULTS

The following number of studies was included: 66. Most of the authors reported that there exists a correlation between deficiency or excess of some elements in hair and occurrence of some diseases, such as: autism, cancer, hypertension, myocardial infarction, kidney disease and diabetes mellitus. However, not all results were consistent.

CONCLUSIONS

Most of the authors concluded that the profile of hair mineral imbalance might be useful as a diagnostic tool for the early diagnosis of many diseases. However, it seems that there is a need to standardize sample preparation procedures, in particular washing and mineralization methods.

Reimbursement profile of a private toxicology practice

This article presents two years of billing and collection data for a bedside toxicology consultation service. The collections rate was 34% or dollars 26.19 per hour of consultative time. There was an inverse correlation between collection rates and patient acuity.

Perceived poisons

Perceived poisoning may manifest in numerous ways; however, all cases share certain characteristics. All are fostered by the wide availability of unreliable information about chemical safety, poor understanding of scientific principles, and ineffective risk communication. Although this problem is still incompletely understood, some approaches have been demonstrated to be useful, such as education about risk, appropriate reassurance, and empathy on the part of the practitioner. Successful management may curtail the spread or exacerbation of symptoms, whereas unsuccessful treatment may cause the problems to escalate, with detrimental effects on both society and patient.