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Becam J, Zoccarato AM, Roux G, Doudon E, Richez M, Pourriere C, Lacarelle B, Solas C, Fabresse N. Le premier « trip » d’un enfant de 26 mois documenté par CL-SMHR. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2022. [DOI: 10.1016/j.toxac.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Becam J, Zoccarato AM, Lacarelle B, Solas C, Fabresse N. Prise accidentelle de LSD chez un enfant de 26 mois. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2021. [DOI: 10.1016/j.toxac.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Tung RC, Thornton SL. Characteristics of Laboratory Confirmed Ethylene Glycol and Methanol Exposures Reported to a Regional Poison Control Center. Kans J Med 2018; 11:67-69. [PMID: 30206465 PMCID: PMC6122883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Ethylene glycol (EG) and methanol (MET) exposures are rare but can cause significant morbidity and mortality. Though frequently treated similarly, EG and MET exposures have characteristics that are not well differentiated in the literature. We sought to describe the clinical characteristics of EG and MET exposures, confirmed with quantitative serum levels. METHODS An IRB-approved retrospective review of the University of Kansas Health System Poison Control Center database from July 2005 to July 2015 identified all EG/MET exposures evaluated at a health care facility. Initial measurements were EG/MET levels, serum pH, serum creatinine, anion gap, serum ethanol level, max anion gap, max osmolar gap, therapy performed (hemodialysis, fomepizole, ethanol) and death. RESULTS The search identified 75 cases, with 59 cases having only detectable EG levels and 15 cases having only detectable MET levels. The average EG level was 126 mg/dL (range 5 - 834). The average detectable methanol level was 78 mg/dL (range 5 - 396). The average maximum anion gap of the EG positive group was 20 mEq/L (range 8 - 35). The average maximum anion gap of the MET positive group was 14 mEq/L (range 6 - 34). One death was reported in the EG positive group, with an initial level of 266 mg/dL. CONCLUSIONS In this study of EG/MET exposures, EG exposures were more common than MET exposures, but they had similar demographics, laboratory findings, and interventions. Continued studies are warranted to characterize these uncommon exposures further.
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Affiliation(s)
- Robert C. Tung
- University of Kansas School of Medicine-Wichita, Kansas City, KS
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Dayasiri KC, Jayamanne SF, Jayasinghe CY. Patterns of acute poisoning with pesticides in the paediatric age group. Int J Emerg Med 2017; 10:22. [PMID: 28695492 PMCID: PMC5503850 DOI: 10.1186/s12245-017-0148-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 07/03/2017] [Indexed: 12/04/2022] Open
Abstract
Background Pesticides are identified as one of the dangerous poisons globally in children and are associated with increased short- and long-term morbidity. Pesticide poisoning is the most common method of self-poisoning among adults in rural Sri Lanka, and the clinical management is associated with significant healthcare costs to the country. There is however little data published on acute pesticide poisoning among children in rural Sri Lanka. The current study aimed to comprehensively evaluate clinical profiles, harmful first aid measures, emergency clinical management, complications and outcomes related to acute pesticide poisoning among children in the rural community of Sri Lanka. Methods This multicenter study was conducted in the North Central Province of Sri Lanka involving all children with acute pesticide poisoning and who were between 9 months and 12 years of age. Data were collected over 7 years (2007–2014), and children from 36 hospitals were recruited. Data collection was carried out by pretested, multi-structured, interviewer-administered questionnaires to identify clinical profiles of children, harmful first aid measures, emergency clinical management, reasons for delayed management, complications and outcomes of pesticide poisoning events. Results Among 1621 children with acute poisoning, 9.5% (155) comprised children with acute pesticide poisoning. Male children outnumbered female children, and the majority of children were less than 5 years. Most common pesticides implicated in poisoning of children were organophosphates and carbamates. Gastrointestinal and neurological symptoms were predominant clinical features. Limited transport and lack of concern regarding urgency among caregivers were leading reasons for delayed management. Most common location for poisoning was cultivation lands. Harmful first aid measures were practiced in 32.4%. 7.1% had intentional pesticide poisoning. The case fatality rate of all pesticide poisonings in the study was 1.9%. 58.1% of patients were transferred between regional hospitals and teaching hospital. Cardiac and respiratory arrests, aspiration pneumonia and convulsions were among the reported complications. Conclusions Acute pesticide poisoning in paediatric age group (<12 years) is a relatively uncommon yet significant cause of child health-related morbidity and mortality in rural Sri Lanka. Patterns of poisoning represent the pattern of pesticide use by the rural community. The practice of harmful first aid measures by caregivers and delay in attending the emergency department may negatively impact patient outcomes.
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Intoxication involontaire aux amphétamines chez un nourrisson de 11 mois. Arch Pediatr 2016; 23:820-2. [DOI: 10.1016/j.arcped.2016.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 02/10/2016] [Accepted: 05/11/2016] [Indexed: 11/19/2022]
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Tshala-Katumbay DD, Ngombe NN, Okitundu D, David L, Westaway SK, Boivin MJ, Mumba ND, Banea JP. Cyanide and the human brain: perspectives from a model of food (cassava) poisoning. Ann N Y Acad Sci 2016; 1378:50-57. [PMID: 27450775 DOI: 10.1111/nyas.13159] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 05/29/2016] [Accepted: 06/01/2016] [Indexed: 11/26/2022]
Abstract
Threats by fundamentalist leaders to use chemical weapons have resulted in renewed interest in cyanide toxicity. Relevant insights may be gained from studies on cyanide mass intoxication in populations relying on cyanogenic cassava as the main source of food. In these populations, sublethal concentrations (up to 80 μmol/l) of cyanide in the blood are commonplace and lead to signs of acute toxicity. Long-term toxicity signs include a distinct and irreversible spastic paralysis, known as konzo, and cognition deficits, mainly in sequential processing (visual-spatial analysis) domains. Toxic culprits include cyanide (mitochondrial toxicant), thiocyanate (AMPA-receptor chaotropic cyanide metabolite), cyanate (protein-carbamoylating cyanide metabolite), and 2-iminothiazolidine-4-carboxylic acid (seizure inducer). Factors of susceptibility include younger age, female gender, protein-deficient diet, and, possibly, the gut functional metagenome. The existence of uniquely exposed and neurologically affected populations offers invaluable research opportunities to develop a comprehensive understanding of cyanide toxicity and test or validate point-of-care diagnostic tools and treatment options to be included in preparedness kits in response to cyanide-related threats.
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Affiliation(s)
- Desire D Tshala-Katumbay
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon. .,Department of Neurology, University of Kinshasa, Kinshasa, Congo. .,National Nutrition Program, Ministry of Health, and Kinshasa School of Public Health, Kinshasa, Congo.
| | | | - Daniel Okitundu
- Department of Neurology, University of Kinshasa, Kinshasa, Congo
| | - Larry David
- Department of Biochemistry and Proteomic Share Resource, Oregon Health & Science University, Portland, Oregon
| | - Shawn K Westaway
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Michael J Boivin
- Department of Psychiatry and Neurology/Ophthalmology, Michigan State University, East Lansing, Michigan
| | - Ngoyi D Mumba
- Department of Tropical Medicine, University of Kinshasa, Kinshasa, Congo.,Institut National de Recherches Biomédicales (INRB), Kinshasa, Congo
| | - Jean-Pierre Banea
- National Nutrition Program, Ministry of Health, and Kinshasa School of Public Health, Kinshasa, Congo
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Pediatric cyanide poisoning by fire smoke inhalation: a European expert consensus. Toxicology Surveillance System of the Intoxications Working Group of the Spanish Society of Paediatric Emergencies. Pediatr Emerg Care 2013; 29:1234-40. [PMID: 24196100 DOI: 10.1097/pec.0b013e3182aa4ee1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Most fire-related deaths are attributable to smoke inhalation rather than burns. The inhalation of fire smoke, which contains not only carbon monoxide but also a complex mixture of gases, seems to be the major cause of morbidity and mortality in fire victims, mainly in enclosed spaces. Cyanide gas exposure is quite common during smoke inhalation, and cyanide is present in the blood of fire victims in most cases and may play an important role in death by smoke inhalation. Cyanide poisoning may, however, be difficult to diagnose and treat. In these children, hydrogen cyanide seems to be a major source of concern, and the rapid administration of the antidote, hydroxocobalamin, may be critical for these children.European experts recently met to formulate an algorithm for prehospital and hospital management of adult patients with acute cyanide poisoning. Subsequently, a group of European pediatric experts met to evaluate and adopt that algorithm for use in the pediatric population.
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Akyildiz BN, Kondolot M, Kurtoğlu S, Akin L. Organophosphate intoxication presenting as diabetic keto-acidosis. ACTA ACUST UNITED AC 2013; 29:155-8. [DOI: 10.1179/146532809x440789] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Nwosu ME, Golomb MR. Cerebral sinovenous thrombosis associated with isopropanol ingestion in an infant. J Child Neurol 2009; 24:349-53. [PMID: 19258296 DOI: 10.1177/0883073808322664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This report describes a 5-week-old female infant who presented with accidental ingestion of rubbing alcohol (which contains about 70% isopropanol), and was subsequently diagnosed with cerebral sinovenous thrombosis. Isopropanol is a clear, volatile 3-carbon alcohol found in varying concentrations in many solvents. Mislabeled rubbing alcohol was mixed with this patient's formula. After ingesting it, she presented with a 1-day history of uncontrolled fussiness and an episode of deviation of the eyes to the right for 30 minutes, followed by rhythmic movements of the arms and legs for 20 minutes. Cerebral imaging demonstrated sinovenous thrombosis. To our knowledge, there have been no reports describing cerebral sinovenous thrombosis as a complication of isopropanol ingestion. The possible association of isopropanol ingestion and sinovenous thrombosis is discussed.
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Affiliation(s)
- Michelle E Nwosu
- Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Geller RJ, Barthold C, Saiers JA, Hall AH. Pediatric cyanide poisoning: causes, manifestations, management, and unmet needs. Pediatrics 2006; 118:2146-58. [PMID: 17079589 DOI: 10.1542/peds.2006-1251] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Confirmed cases of childhood exposure to cyanide are rare despite multiple potential sources including inhalation of fire smoke, ingestion of toxic household and workplace substances, and ingestion of cyanogenic foods. Because of its infrequent occurrence, medical professionals may have difficulty recognizing cyanide poisoning, confirming its presence, and treating it in pediatric patients. The sources and manifestations of acute cyanide poisoning seem to be qualitatively similar between children and adults, but children may be more vulnerable than adults to poisoning from some sources. The only currently available antidote in the United States (the cyanide antidote kit) has been used successfully in children but has particular risks associated with its use in pediatric patients. Because hemoglobin kinetics vary with age, methemoglobinemia associated with nitrite-based antidotes may be excessive at standard adult dosing in children. A cyanide antidote with a better risk/benefit ratio than the current agent available in the United States is desirable. The vitamin B12 precursor hydroxocobalamin, which has been used in Europe, may prove to be an attractive alternative to the cyanide antidote kit for pediatric patients. In this article we review the available data on the sources, manifestations, and treatment of acute cyanide poisoning in children and discuss unmet needs in the management of pediatric cyanide poisoning.
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Affiliation(s)
- Robert J Geller
- Department of Pediatrics and the Medical Toxicology Fellowship Program, Emory University School of Medicine, Atlanta, Georgia, USA.
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Abstract
A 17-month-old toddler became critically ill after an accidental overdose with 'Ecstasy'. A single tablet was quickly retrieved intact from under her tongue, but within 5 min the child developed generalised tonic-clonic seizures requiring immediate transfer to hospital. She also had hyperthermia (38.5 degrees C), tachycardia (150 beats.min(-1)) and hypertension. Treatment to terminate the seizures necessitated intubation and ventilation, and cooling measures brought the temperature within normal limits. The child was admitted to the intensive care unit and made a rapid recovery. She was discharged to the ward 12 h later, and had no long-term sequelae.
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Affiliation(s)
- M R Duffy
- Department of Critical Care Medicine, Lawes Bridge, Torquay, Devon, TQ2 7AA, UK.
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Garcia-Algar O, López N, Bonet M, Pellegrini M, Marchei E, Pichini S. 3,4-methylenedioxymethamphetamine (MDMA) intoxication in an infant chronically exposed to cocaine. Ther Drug Monit 2006; 27:409-11. [PMID: 16044094 DOI: 10.1097/01.ftd.0000166041.97524.50] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Accidental ingestion of 3,4-methylenedioxymethamphetamine (MDMA, ecstasy) was detected in an infant admitted at the Pediatric Emergency Department by drug testing in urine. Concentrations of MDMA and its principal metabolite 4-hydroxy-3-methoxymethamphetamine (HMMA) in the infant's hydrolyzed urine were 11.7 mg/L and 34.4 mg/L, respectively. Apparent febrile convulsions and cardiovascular side effects resolved within 1 day after treatment with benzodiazepines. Chronic exposure to cocaine was evidenced by segmental hair analysis. Continuous maternal denial of the presence of any drug in the household made diagnosis of accidental ingestion of MDMA and chronic exposure to cocaine problematic. Periodic clinical and laboratory follow-ups were requested to check eventual long-term effects of exposure to illicit drugs and discontinuation of the child from exposure to dangerous environments.
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van Rijswijk CWE, Kneyber MCJ, Plötz FB. Accidental ecstasy intoxication in an 8-month-old infant. Intensive Care Med 2006; 32:632-3. [PMID: 16552617 DOI: 10.1007/s00134-005-0030-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 12/12/2005] [Indexed: 01/26/2023]
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Abstract
A 34-year-old male with a long-standing history of polysubstance abuse and depression was admitted for acute renal failure and hemodialysis secondary to ethylene glycol ingestion that occurred two days prior. The patient was admitted with documented ethylene glycol levels of 41.2 mg/dl, which fell to 25.0 mg/dl after 8 hours and to 6 mg/dl after 12 hours. One week later the patient presented to the outpatient eye clinic complaining of headaches and diplopia. On exam, vision in both eyes was 20/20. No afferent papillary defect was present. The patient had a left abducens palsy. The remainder of the anterior segment exam was normal. On dilated fundus exam the patient was found to have 3+ disc edema with hemorrhages in both eyes. A lumbar puncture revealed elevated intracranial pressure. In our opinion, the patient developed a left abducens nerve palsy and bilateral disc edema secondary to a transient rise in intracranial pressure after ingestion of ethylene glycol.
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Affiliation(s)
- Christina Delany
- Department of Ophthalmology, Loyola University Medical Center, Maywood, Illinois 60153, USA
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Metz CN, Gregersen PK, Malhotra AK. Metabolism and biochemical effects of nicotine for primary care providers. Med Clin North Am 2004; 88:1399-413, ix. [PMID: 15464104 DOI: 10.1016/j.mcna.2004.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Nicotine is a colorless and volatile liquid alkaloid naturally occurring in the leaves and stems of Nicotiana tabacum and Nicotiana rustica. Nicotine, the primary component of tobacco, is responsible for both tobacco product addiction (with chronic exposure) and the odor associated with tobacco. In addition to cigarettes, nicotine is found in chewing gum, transdermal patches, nasal spray, and sublingual tablets. Following its inhalation and absorption, nicotine and its metabolic products exert diverse physiologic and pharmacologic effects. This article covers the absorption and metabolism of nicotine, nicotine toxicity, pharmacologic effects of nicotine, nicotine-drug interactions, and the use of nicotine for the treatment of disease.
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Affiliation(s)
- Christine N Metz
- Laboratory of Medicinal Biochemistry, Center for Patient-Oriented Research, North Shore Long Island Jewish Research Institute, 350 Community Drive, Manhasset, NY 11030, USA.
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