1
|
Patel A, Chavan G, Nagpal AK. Navigating the Neurological Abyss: A Comprehensive Review of Organophosphate Poisoning Complications. Cureus 2024; 16:e54422. [PMID: 38510851 PMCID: PMC10951431 DOI: 10.7759/cureus.54422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/18/2024] [Indexed: 03/22/2024] Open
Abstract
Organophosphate poisoning is a significant global health concern with implications for both occupational and environmental settings. This comprehensive review thoroughly explores the biochemical basis, clinical presentation, diagnostic methods, treatment strategies, and long-term effects of organophosphate exposure. The acute phase is characterized by cholinergic crisis, respiratory distress, and neurological manifestations, while delayed complications include the intermediate syndrome and organophosphate-induced delayed neuropathy. Diagnostic approaches involve clinical evaluation, cholinesterase-level assessments, and imaging studies. Treatment strategies encompass decontamination, antidotes such as atropine and pralidoxime, and supportive care. Long-term effects may include cognitive and neurological sequelae, necessitating rehabilitation approaches such as physical and occupational therapy. Prevention strategies include stringent occupational safety guidelines, sustainable agricultural practices, and public awareness initiatives. The implications for clinical practice underscore the importance of a multidisciplinary approach. At the same time, the call to action emphasizes the need for collaborative efforts in prevention and awareness to mitigate the impact of organophosphate poisoning on public health and the environment.
Collapse
Affiliation(s)
- Aniket Patel
- Emergency Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Gajanan Chavan
- Emergency Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Anmol K Nagpal
- Emergency Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| |
Collapse
|
2
|
Qasim Z, Perrone J, Delgado MK. The Value of Not Intubating Comatose Patients With Acute Poisoning. JAMA 2023; 330:2253-2254. [PMID: 38019975 DOI: 10.1001/jama.2023.22462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Affiliation(s)
- Zaffer Qasim
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jeanmarie Perrone
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - M Kit Delgado
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| |
Collapse
|
3
|
Wang L, Wang Y, Zhang RY, Wang Y, Liang W, Li TG. Management of acute carbamazepine poisoning: A narrative review. World J Psychiatry 2023; 13:816-830. [DOI: 10.5498/wjp.v13.i11.816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/23/2023] [Accepted: 10/11/2023] [Indexed: 11/17/2023] Open
Abstract
Standard management protocols are lacking and specific antidotes are unavailable for acute carbamazepine (CBZ) poisoning. The objective of this review is to provide currently available information on acute CBZ poisoning, including its management, by describing and summarizing various therapeutic methods for its treatment according to previously published studies. Several treatment methods for CBZ poisoning will be briefly introduced, their advantages and disadvantages will be analyzed and compared, and suggestions for the clinical treatment of CBZ poisoning will be provided. A literature search was performed in various English and Chinese databases. In addition, the reference lists of identified articles were screened for additional relevant studies, including non-indexed reports. Non-peer-reviewed sources were also included. In the present review, 154 articles met the inclusion criteria including case reports, case series, descriptive cohorts, pharmacokinetic studies, and in vitro studies. Data on 67 patients, including 4 fatalities, were reviewed. Based on the summary of cases reported in the included articles, the cure rate of CBZ poisoning after symptomatic treatment was 82% and the efficiency of hemoperfusion was 58.2%. Based on the literature review, CBZ is moderately dialyzable and the recommendation for CBZ poisoning is supportive management and gastric lavage. In severe cases, extracorporeal treatment is recommended, with hemodialysis as the first choice.
Collapse
Affiliation(s)
- Luan Wang
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yang Wang
- Department of General Surgery, The 4th Affiliated Hospital of China Medical University, Shenyang 110032, Liaoning Province, China
| | - Ruo-Ying Zhang
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yao Wang
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Wei Liang
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Tie-Gang Li
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| |
Collapse
|
4
|
Zhou Y, Tong JL, Peng AH, Xu SY. Comparison of drug concentrations in blood and gastric lavage fluid before and after gastric lavage: A case report. World J Clin Cases 2023; 11:7680-7683. [DOI: 10.12998/wjcc.v11.i31.7680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/02/2023] [Accepted: 10/17/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Gastric lavage (GL) is one of the most important early therapies to remove unabsorbed toxins from the gastrointestinal tract. However, the details of performing gastric lavage remain to be established. There is controversy in clinical practice regarding individual choice of the timing of GL and its efficiency.
CASE SUMMARY We report the case of a young woman who presented to the Emergency Department with drug intoxication for four hours. We used the latest toxicological screening techniques to compare drug concentrations in the patient's blood and gastric lavage fluid before and after gastric lavage. The results confirmed that gastric lavage was effective in reducing drug concentrations in the stomach; a small amount of drug remained in the stomach at the end of gastric lavage.
CONCLUSION Gastric lavage is effective in reducing drug concentrations in the stomach, with a small amount of drug remaining in the stomach at the end of gastric lavage.
Collapse
Affiliation(s)
- Yue Zhou
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Disaster Medical Center, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jia-Le Tong
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Disaster Medical Center, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ai-Hua Peng
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Disaster Medical Center, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Shu-Yun Xu
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Disaster Medical Center, Sichuan University, Chengdu 610041, Sichuan Province, China
| |
Collapse
|
5
|
The In Vitro Efficacy of Activated Charcoal in Fecal Ceftriaxone Adsorption among Patients Who Received Intravenous Ceftriaxone. Antibiotics (Basel) 2023; 12:antibiotics12010127. [PMID: 36671328 PMCID: PMC9854876 DOI: 10.3390/antibiotics12010127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Broad-spectrum antibiotics can kill both pathogens and gut microbiota. Reducing exposure to excess intestinal antibiotics could theoretically protect gut microbiota homeostasis. Recently, engineered charcoals, gel microparticles, and resin beads have demonstrated efficacy in intestinal antibiotic adsorption in animal studies. We report the first in vitro study evaluating human fecal antibiotic adsorption efficacy of conventional activated charcoal (AC). We collected fecal samples from eight patients who received intravenous (IV) ceftriaxone after admission to King Chulalongkorn Memorial Hospital, Thailand, during January−March 2020. Fecal ceftriaxone was measured by indirect competitive enzyme-linked immunoassays. Three different doses of AC were mixed with fecal samples under a specified protocol. The geometric mean reduction in fecal ceftriaxone concentration when mixed with AC 30 mg/g feces was 0.53 (95% CI 0.33−0.85, p-value < 0.001), meaning 47% adsorption efficacy. Increased adsorption was found with higher doses, 71% and 87% for AC 150 and 500 mg/g feces, respectively. In conclusion, the usual food-poisoning-care dose of conventional AC, 30 mg/g feces, demonstrated dose-dependent and significant fecal ceftriaxone adsorption. Conventional oral AC might be a pragmatic and inexpensive option for the protection of gut microbiota in patients receiving IV ceftriaxone. However, in vivo studies and microbiome analysis are needed for further evidence.
Collapse
|
6
|
Chen J, Cheng F, Luo D, Huang J, Ouyang J, Nezamzadeh-Ejhieh A, Khan MS, Liu J, Peng Y. Recent advances in Ti-based MOFs in biomedical applications. Dalton Trans 2022; 51:14817-14832. [PMID: 36124915 DOI: 10.1039/d2dt02470e] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Currently, metal-organic frameworks (MOFs), basically inorganic-organic hybrid materials, have gained tremendous attention due to their vast applications. MOFs have shown enormous applications in almost every research field. However, the area of designing MOF materials for their biological applications is still an emerging field that needs attention. Titanium-based metal-organic framework (Ti-MOF) materials are used in many research areas due to their structural advantages, such as small particle size and large effective surface area. On the other hand, they have also shown unique advantages such as good biocompatibility, excellent catalytic oxidation and photocatalytic properties and ease of functionalization. This study reviews the recent research progress on Ti-MOFs in therapeutic areas such as antibacterial, oncology, anti-inflammation, and bone injury, which will provide new directions for further research in this biomedical field. Therefore, this article will help scientists working in the particular field to enhance their understanding of Ti-based MOFs for functional biomedical applications.
Collapse
Affiliation(s)
- Jinyi Chen
- The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, China. .,Guangdong Provincial Key Laboratory of Research and Development of Natural Drugs, and School of Pharmacy, Guangdong Medical University, Guangdong Medical University Key Laboratory of Research and Development of New Medical Materials, Dongguan, 523808, China
| | - Fan Cheng
- Guangdong Provincial Key Laboratory of Research and Development of Natural Drugs, and School of Pharmacy, Guangdong Medical University, Guangdong Medical University Key Laboratory of Research and Development of New Medical Materials, Dongguan, 523808, China
| | - Dongwen Luo
- The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, China. .,Guangdong Provincial Key Laboratory of Research and Development of Natural Drugs, and School of Pharmacy, Guangdong Medical University, Guangdong Medical University Key Laboratory of Research and Development of New Medical Materials, Dongguan, 523808, China
| | - Jiefeng Huang
- The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, China. .,Guangdong Provincial Key Laboratory of Research and Development of Natural Drugs, and School of Pharmacy, Guangdong Medical University, Guangdong Medical University Key Laboratory of Research and Development of New Medical Materials, Dongguan, 523808, China
| | - Jie Ouyang
- Department of Breast Surgery, Dongguan Tungwah Hospital, Dongguan, China.
| | | | - M Shahnawaz Khan
- Department of Chemistry, Aligarh Muslim University, Aligarh, 202002, India
| | - Jianqiang Liu
- The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, China. .,Guangdong Provincial Key Laboratory of Research and Development of Natural Drugs, and School of Pharmacy, Guangdong Medical University, Guangdong Medical University Key Laboratory of Research and Development of New Medical Materials, Dongguan, 523808, China
| | - Yanqiong Peng
- The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, China.
| |
Collapse
|
7
|
Alshaya OA, Alhamed A, Althewaibi S, Fetyani L, Alshehri S, Alnashmi F, Alharbi S, Alrashed M, Alqifari SF, Alshaya AI. Calcium Channel Blocker Toxicity: A Practical Approach. J Multidiscip Healthc 2022; 15:1851-1862. [PMID: 36065348 PMCID: PMC9440664 DOI: 10.2147/jmdh.s374887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022] Open
Abstract
Calcium channel blockers (CCBs) are widely prescribed medications for various clinical indications in adults and children. They are available in both immediate and long-acting formulations and are generally classified into dihydropyridines and nondihydropyridines, with nondihydropyridines having more cardioselectivity. CCB toxicity is common given the widespread use which leads to serious adverse clinical outcomes, especially in children. Severe CCB toxicities may present with life-threatening bradycardia, hypotension, hyperglycemia, and renal insufficiency. Dihydropyridine toxicity, however, may present with reflex tachycardia instead of bradycardia. Initial patient evaluation and assessment are crucial to identify the severity of CCB toxicity and design the best management strategy. There are different strategies to overcome CCB toxicity that requires precise dosing and close monitoring in various patient populations. These strategies may include large volumes of IV fluids, calcium salts, high insulin euglycemia therapy (HIET), and vasopressors. We hereby summarize the evidence behind the management of CCB toxicity and present a practical guide for clinicians to overcome this common drug toxicity.
Collapse
Affiliation(s)
- Omar A Alshaya
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Pharmaceutical Care, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Correspondence: Omar A Alshaya, Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 3660, Riyadh, 11481, Saudi Arabia, Email
| | - Arwa Alhamed
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sara Althewaibi
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Lolwa Fetyani
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Shaden Alshehri
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Fai Alnashmi
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Shmeylan Alharbi
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Pharmaceutical Care, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammed Alrashed
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Pharmaceutical Care, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmacy Department, Northwest Medical Center, Tucson, AZ, USA
| | - Saleh F Alqifari
- Department of Pharmacy Practice, College of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | - Abdulrahman I Alshaya
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Pharmaceutical Care, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
8
|
Nasif MA, Falana HH, Hamed HKH, Yousef QGH, Jaradat MA. Severe Carbamazepine Toxicity Treated with Continuous Venovenous Hemofiltration at Palestine Medical Complex: Two Case Reports. Int Med Case Rep J 2022; 15:205-208. [PMID: 35465260 PMCID: PMC9022740 DOI: 10.2147/imcrj.s358084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/12/2022] [Indexed: 12/23/2022] Open
Abstract
Carbamazepine intoxication is not uncommon and accounts for many cases of poisoning among anticonvulsive medications users. Since there is no specific antidote for carbamazepine overdose, management is limited to gastric decontamination and supportive therapy. With its high protein binding, the role of extracorporeal elimination in carbamazepine intoxication is still questionable. Here two cases of severe carbamazepine intoxication are presented; the cases were brought to the emergency department after the ingestion of 12,000 mg of controlled release carbamazepine for the first case, and unknown amounts of the same drug for the second case. Both cases were presented with altered mental status, convulsion, and high serum carbamazepine levels of more than 20 mcg/mL. They were intubated and treated with continuous venovenous hemofiltration, after which carbamazepine levels declined significantly along with subsequent clinical improvement and complete neurological recovery. Both cases were discharged home for further psychiatric care.
Collapse
Affiliation(s)
- Mowaffaq A Nasif
- Intensive Care Unit, Palestine Medical Complex, Ramallah, Palestine
| | - Hiba H Falana
- Department of Pharmacy, Birzeit University, Ramallah, Palestine
- Correspondence: Hiba H Falana, Department of Pharmacy, Birzeit University, PO Box 14, Birzeit, Ramallah, Palestine, Tel +970-595193486, Fax +970-2-2982017, Email
| | - Heba K H Hamed
- Intensive Care Unit, Palestine Medical Complex, Ramallah, Palestine
| | - Qusai G H Yousef
- Internal Medicine Department, Al-Quds University, Jerusalem, Palestine
| | | |
Collapse
|
9
|
Koliastasis L, Lampadakis I, Milkas A, Strempelas P, Sourides V, Kakava K, Tsioufis P, Papaioannou S. Refractory Shock from Amlodipine Overdose Overcomed with Hyperinsulinemia. Cardiovasc Toxicol 2021; 22:63-66. [PMID: 34643856 PMCID: PMC8511611 DOI: 10.1007/s12012-021-09699-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/27/2021] [Indexed: 11/28/2022]
Abstract
Intoxication from calcium channel blockers exhibits almost 50% mortality rates. Amlodipine is a long-acting dihydropyridine and inappropriate dosage poses a great threat for profound vasodilation, hypotension, and refractory vasopressor-resistant shock. A 72-year-old woman with unremarkable medical history presented to the emergency department due to amlodipine overdose after a suicide attempt attributed to COVID-19 pandemic severe anxiety disorder. Vital signs at presentation: heart rate 82 beats/ min, arterial pressure 72/55 mmHg, and oxygen saturation 98%. Resuscitation was initiated with intravenous infusion of normal saline 0,9%, noradrenaline, and calcium chloride, while activated charcoal was orally administrated; however, blood pressure remained at 70/45 mmHg. Abruptly, she experienced acute pulmonary edema and was finally intubated. We commenced high-dose insulin infusion with Dextrose 10% infusion to maintain euglycemic hyperinsulinemia. Hemodynamic improvement occurred after 30 min, systolic blood pressure raised to 95 mmHg, and decongestion was achieved with intravenous furosemide. Insulin effect was dose-dependent and patient’s hemodynamic status improved after insulin uptitration. Eight days later, the patient was weaned from the mechanical ventilation and she was successfully discharged after 14 days. High-dose intravenous infusion of insulin up to 10 units/kg per hour appears as an inotropic agent possibly through alterations in myocardial metabolism of fatty acids and augmentation of insulin secretion and uptake. This regimen possibly exhibits additional vasotropic properties. We conclude that euglycemic hyperinsulinemia is a potentially advantageous treatment in CCB toxicity.
Collapse
Affiliation(s)
- L Koliastasis
- Cardiology Department, Athens Naval and Veterans Hospital, Mikras Asias 48, 11257, Athens, Greece.
| | - I Lampadakis
- Cardiology Department, Athens Naval and Veterans Hospital, Mikras Asias 48, 11257, Athens, Greece
| | - A Milkas
- Cardiology Department, Athens Naval and Veterans Hospital, Mikras Asias 48, 11257, Athens, Greece.,Acute Cardiac Care Unit, Athens Naval and Veterans Hospital, Athens, Greece
| | - P Strempelas
- Cardiology Department, Athens Naval and Veterans Hospital, Mikras Asias 48, 11257, Athens, Greece
| | - V Sourides
- Cardiology Department, Athens Naval and Veterans Hospital, Mikras Asias 48, 11257, Athens, Greece
| | - K Kakava
- Cardiology Department, Athens Naval and Veterans Hospital, Mikras Asias 48, 11257, Athens, Greece
| | - P Tsioufis
- Cardiology Department, Athens Naval and Veterans Hospital, Mikras Asias 48, 11257, Athens, Greece
| | - S Papaioannou
- Cardiology Department, Athens Naval and Veterans Hospital, Mikras Asias 48, 11257, Athens, Greece
| |
Collapse
|
10
|
Rahimzadeh MR, Rahimzadeh MR, Kazemi S, Moghadamnia AA. Zinc Poisoning - Symptoms, Causes, Treatments. Mini Rev Med Chem 2021; 20:1489-1498. [PMID: 32286942 DOI: 10.2174/1389557520666200414161944] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/14/2019] [Accepted: 01/02/2020] [Indexed: 01/19/2023]
Abstract
Zinc poisoning has been reported from many parts of the world. It is one of the global health problems that affect many organs, if exposed by inhalation of zinc vapors or by consumption of contaminated food and water. Long term exposure to zinc compounds from different sources such as air, water, soil, and food, lead to toxic effects on body systems, especially digestive, respiratory, and nerve systems, and also causes cancer. Zinc levels can be determined in blood, urine, hair, and nails. Patients with zinc toxicity need chelating agents, other pharmacological treatment, protective lung ventilation, extracorporeal membrane oxygenation (ECMO), and supportive care.
Collapse
Affiliation(s)
- Mehrdad Rafati Rahimzadeh
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - Sohrab Kazemi
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ali Akbar Moghadamnia
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| |
Collapse
|
11
|
Shabani M, Kefayati M, Hassanian-Moghaddam H, Zamani N, McDonald R. Complications and hospital stay after endoscopic retrieval of drug baggies in body stuffers: an observational prospective study. Sci Rep 2021; 11:5359. [PMID: 33686170 PMCID: PMC7940431 DOI: 10.1038/s41598-021-84898-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 02/23/2021] [Indexed: 12/16/2022] Open
Abstract
Body stuffers routinely receive conservative treatment, i.e. administration of the laxative polyethylene glycol for the passage of ingested drug baggies and observation. Endoscopic baggie removal may offer a safe alternative that could result in shorter hospitalization. We aimed to compare complications, hospital stay, and final outcome in body stuffers assigned to endoscopy versus conservative treatment. This is an observational prospective study of body stuffers presenting to a clinical toxicology center in Tehran (Iran) in 2016-2019, irrespective of the drug ingested. Eligible patients had baggies in their upper gastrointestinal tract and presented without severe poisoning. Patients received either endoscopy or conservative treatment, and clinical outcomes were compared between the groups. A total of 69 patients were enrolled, with a median age of 29 years (range 18-64), among whom 1 was female (2%). Eighteen and 51 patients were endoscopically and conservatively managed, respectively. Drugs most commonly ingested were heroin in endoscopy patients (8/18 cases; 44%) and methamphetamine in the conservative group (28/51 cases; 55%). Endoscopy patients had a shorter hospital stay (median 1.5 vs. 2 days, P = 0.018). In the conservative group, one patient died, and the rate of complications was significantly higher, with more patients experiencing side effects (OR = 1.4, 95% CI = 1.2, 1.7) and requiring intubation (OR = 1.3, 95% CI = 1.1, 1.5). Endoscopic retrieval was associated with fewer complications and shorter hospitalization. Endoscopy may be a safe treatment for body stuffers without severe poisoning on presentation.
Collapse
Affiliation(s)
| | - Marzieh Kefayati
- Department of Internal Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, South Karegar Street, Tehran, Iran.
| | - Nasim Zamani
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, South Karegar Street, Tehran, Iran
| | - Rebecca McDonald
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Addiction Sciences, London, UK
| |
Collapse
|
12
|
Rojas S, Guillou N, Horcajada P. Ti-Based nanoMOF as an Efficient Oral Therapeutic Agent. ACS APPLIED MATERIALS & INTERFACES 2019; 11:22188-22193. [PMID: 31140777 DOI: 10.1021/acsami.9b06472] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Despite the interest in (Zn, Fe, and Zr)-nanoscaled metal-organic frameworks (nanoMOFs) as intravenous drug nanocarriers, their most convenient oral administration has been almost unexplored. In this scenario, an uncharted Ti-nanoMOF is originally proposed here as an oral therapeutic agent, not as a drug delivery system but as an innovative and efficient oral detoxifying agent of the challenge and timeliness salicylate intoxication (e.g., aspirin). Thus, this orally robust and biosafe Ti-nanoMOF is the only porous nanomaterial, among the six tested MOFs, able to adsorb and retain aspirin under the whole gastrointestinal tract, overpassing the capabilities of the current treatment (i.e., activated charcoal). Further, the biodistribution and bioremoval of Ti-nanoMOF have been assessed, proving a bioprotective character with an intact and almost complete removal by feces.
Collapse
Affiliation(s)
- Sara Rojas
- IMDEA Energy , Av. Ramón de la Sagra 3 , 28935 Móstoles-Madrid , Spain
- Institut Lavoisier, CNRS UMR 8180, UVSQ, Université Paris-Saclay , 45, Avenue Des Etats Unis , 78035 Versailles Cedex , France
| | - Nathalie Guillou
- Institut Lavoisier, CNRS UMR 8180, UVSQ, Université Paris-Saclay , 45, Avenue Des Etats Unis , 78035 Versailles Cedex , France
| | | |
Collapse
|
13
|
Ye Y, Liu Z. Management of Amanita phalloides poisoning: A literature review and update. J Crit Care 2018; 46:17-22. [PMID: 29627659 DOI: 10.1016/j.jcrc.2018.03.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 01/08/2023]
Abstract
Amanita phalloides poisoning with a high mortality is a serious health problem in the world. The typical clinical manifestations are usually characterized by the absence of any symptoms followed by severe gastrointestinal disorders and acute liver failure. Inhibition of RNA polymeraseII (RNAP II) activity, apoptosis, and oxidative stress are considered as the major mechanism of amatoxins intoxication. The current treatment measures mainly include prevention of amatoxins absorption, elimination of absorbed amatoxins, potential antidotes therapy, and liver transplantation. Nevertheless, there are no widely accepted treatment criteria for Amanita phalloides poisoning. This paper will focus on the treatment measures based on the previous studies and provide the currently available information for clinicians.
Collapse
Affiliation(s)
- Yongzhuang Ye
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Zhenning Liu
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, China.
| |
Collapse
|
14
|
Brvar M, Chan MY, Dawson AH, Ribchester RR, Eddleston M. Magnesium sulfate and calcium channel blocking drugs as antidotes for acute organophosphorus insecticide poisoning – a systematic review and meta-analysis. Clin Toxicol (Phila) 2018; 56:725-736. [DOI: 10.1080/15563650.2018.1446532] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Miran Brvar
- Pharmacology, Toxicology, and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Toxicology and Pharmacology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ming Yin Chan
- Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital, Hong Kong, ROC
| | - Andrew H. Dawson
- Sydney Medical School, University of Sydney, Sydney, Australia
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Kandy, Sri Lanka
| | | | - Michael Eddleston
- Pharmacology, Toxicology, and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Kandy, Sri Lanka
| |
Collapse
|
15
|
50 Years Ago in The Journal of Pediatrics: Public Knowledge of Ipecac Syrup in the Management of Accidental Poisonings. J Pediatr 2017; 191:56. [PMID: 29173322 DOI: 10.1016/j.jpeds.2017.05.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
16
|
Tse J, Ferguson K, Whitlow KS, Erickson K. The use of intravenous lipid emulsion therapy in acute methamphetamine toxicity. Am J Emerg Med 2016; 34:1732.e3-4. [DOI: 10.1016/j.ajem.2015.12.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 12/18/2015] [Indexed: 12/19/2022] Open
|
17
|
Liu Y, Zhu H, Walline J, Wang M, Xu Q, Li Y, Yu X. The mastery of antidotes: A survey of antidote knowledge and availability among emergency physicians in registered hospitals in China. Hum Exp Toxicol 2016; 35:462-71. [PMID: 27022164 DOI: 10.1177/0960327116639364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To describe various types of Chinese hospitals' emergency department (ED) physicians' knowledge of antidotes and the comparative availability of toxicological treatments at these hospitals. METHODS We emailed a written survey to the ED doctors of 900 hospitals in China. The hospitals' names and addresses were obtained and randomly selected from the 6214 hospitals registered by the Chinese Medical Association. The survey included 23 questions on antidotes to commonly seen poisonings as well as questions on the availability of antidotes and decontamination techniques at each hospital. RESULTS Six hundred and fifty three hospital emergency directors responded to the survey 72.6% response rate). Overall knowledge of antidotes is not high and varied depending on antidote. Physicians in Eastern China, those working in tertiary-level hospitals and those working in hospitals with higher numbers of beds performed significantly better. On average, only 35.6% of the 23 antidotes were available in all reporting hospitals; 54.1% can get these antidotes from nearby hospitals and 42.0% can get them from a local CDC poison control center. However, only 57.3% can get a requested antidote within two hours. Gastric lavage is the most widely used decontamination procedure, and the availability of extracorporeal decontamination techniques is between 67.2% and 79.6% (depending on type). CONCLUSION Knowledge of specific antidotes correlated significantly with size, type, and region of hospital in China rather than with individual physician characteristics. Significant antidotes remain unavailable or unavailable within 2 h in about half of all hospitals surveyed, although all major acute decontamination treatments and techniques seem quite prevalent.
Collapse
Affiliation(s)
- Y Liu
- Emergency Department, Peking Union Medical College Hospital, Beijing, China
| | - H Zhu
- Emergency Department, Peking Union Medical College Hospital, Beijing, China
| | - J Walline
- Department of Emergency Medicine, Saint Louis University, Saint Louis, United States
| | - M Wang
- Department of Epidemiology and Biostatistics, Peking Union Medical College, Beijing, China
| | - Q Xu
- Department of Epidemiology and Biostatistics, Peking Union Medical College, Beijing, China
| | - Y Li
- Emergency Department, Peking Union Medical College Hospital, Beijing, China
| | - X Yu
- Emergency Department, Peking Union Medical College Hospital, Beijing, China
| |
Collapse
|
18
|
Amanita phalloides poisoning: Mechanisms of toxicity and treatment. Food Chem Toxicol 2015; 86:41-55. [PMID: 26375431 DOI: 10.1016/j.fct.2015.09.008] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 09/08/2015] [Accepted: 09/10/2015] [Indexed: 02/07/2023]
|
19
|
Abstract
Foreign body ingestion is a common pediatric complaint. Two case reports describe intestinal obstruction in children from an ingestion of a single superabsorbent water ball, requiring surgical removal. We describe nonsurgical management of an asymptomatic child who ingested approximately 100 superabsorbent water beads.Because of the risk for subsequent intestinal obstruction, the patient was admitted for whole bowel irrigation. This case report is the first describing use of whole bowel irrigation in the management of an asymptomatic patient with multiple water beads ingestion.
Collapse
|
20
|
Durand G, Clouzeau J, Jegou MJ, Gallart JC. Pharmacobézoard au cours d’une intoxication massive à la clomipramine. ANNALES FRANCAISES DE MEDECINE D URGENCE 2014. [DOI: 10.1007/s13341-014-0429-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
21
|
Zyoud SH, Al-Jabi SW, Bali YI, Al-Sayed AM, Sweileh WM, Awang R. Availability of treatment resources for the management of acute toxic exposures and poisonings in emergency departments among various types of hospitals in Palestine: a cross-sectional study. Scand J Trauma Resusc Emerg Med 2014; 22:13. [PMID: 24555427 PMCID: PMC3939642 DOI: 10.1186/1757-7241-22-13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 02/17/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Poisoning exposures continue to be a significant cause of morbidity and mortality worldwide. The lack of facilities, treatment resources, and antidotes in hospitals may affect the treatments provided and outcomes. This study aimed to determine the availability of gastrointestinal (GI) decontamination, stabilisation, elimination enhancement resources, and antidotes for the management of acute toxic exposures and poisonings in emergency departments (EDs) among various types of governmental and private hospitals in Palestine. METHODS A cross-sectional study using semi-structured questionnaire was performed. Data were collected based on hospital resources; GI decontamination, stabilisation, elimination enhancement resources and antidotes from Palestinian hospitals. RESULTS Eighteen hospitals (94.7%) have responded. Among them, paracetamol poisoning was the most frequently reported cases by EDs (mean frequency score = 7.6 ± 2.1), followed by bee stings (mean = 6.9 ± 2.7) and organophosphate poisoning (mean = 6.7 ± 2.7). The availabilities of most resources related to GI decontamination items varied substantially with hospital type, but these differences were not statistical significant. The availability of stabilisation resources was not significantly different between hospitals types. For the availability of techniques used to enhance the elimination of toxic substances, there were variations between the hospitals types. However, these differences were not statistical significant, except for haemodialysis (p = 0.003) which was more available in governmental hospitals. For the availability of antidotes, none of the hospitals had sufficient stock of all antidotes listed. In relation to hospital type, there was variability in the availability of antidotes, but this did not reach statistical significance, except for deferoxamine (p < 0.001), which was available in all governmental hospitals but none of the private hospitals. CONCLUSIONS The availability of treatment resources and antidotes in Palestinian hospitals was not adequate except for stabilisation resources. The availability of such resources acts as a marker for the level of readiness of hospital EDs in Palestine for the management of acute toxic exposure and poisoning. The implementation of a minimum list of antidotes and treatment resources would be useful to increase the level of resources. Coordination between Palestinian poison control and drug information centre and hospitals is also important.
Collapse
Affiliation(s)
- Sa’ed H Zyoud
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- Department of Pharmacology and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), Penang, Malaysia
| | - Samah W Al-Jabi
- Department of Clinical and Comunity Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Yara I Bali
- PharmD Program, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Afnan M Al-Sayed
- PharmD Program, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Waleed M Sweileh
- Department of Pharmacology and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Rahmat Awang
- WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), Penang, Malaysia
| |
Collapse
|
22
|
Abstract
The objectives of this chapter are to provide a brief understanding of the following:Clinical evaluation of infectious diseases and altered immune disorders, including physical examination and laboratory studies Various infectious disease processes, including etiology, pathogenesis, clinical presentation, and management Commonly encountered altered immune disorders, including etiology, clinical presentation, and management Precautions and guidelines that a physical therapist should implement when treating a patient with an infectious disease process or altered immunity
Collapse
|
23
|
Miyauchi M, Hayashida M, Yokota H. Successful retrieval using ultrathin transnasal esophagogastroduodenoscopy of a significant amount of residual tricyclic antidepressant following serious toxicity: a case report. Int J Emerg Med 2013; 6:39. [PMID: 24148152 PMCID: PMC3853774 DOI: 10.1186/1865-1380-6-39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 09/16/2013] [Indexed: 12/24/2022] Open
Abstract
Background In Japan, ultrathin transnasal esophagogastroduodenoscopy (EGD) with a 4.9-mm diameter endoscope (Olympus XP260) is routinely used to examine the upper gastrointestinal tract. This procedure does not require sedation and does not affect vital signs. Gastric lavage is not empirically employed in the management of all poisoning patients. It is considered only for potentially life-threatening overdoses when the procedure can be performed within 1 h of ingestion of the poison. However, there are no absolute indications for gastric lavage. EGD may increase the indications, efficiency and safety of gastric lavage in poisoning patients. Findings A 35-year-old female was admitted to our emergency department 2 h after ingesting multiple drugs, including a critical dose of the tricyclic antidepressant (TCA) amitriptyline, at which time she was confused and had a Glasgow Coma Scale score of 8 (E1V2M5). Endotracheal intubation was performed. To confirm the type of TCA and in order to determine whether gastric lavage was required, we decided to perform EGD. Endoscopy demonstrated adherence of residual drugs to the stomach wall, in a soluble form and not as a mass. Hence, gastric lavage was performed via the EGD to avoid passage of these drugs into the small bowel. The patient was extubated on day 2, without the development of complications such as aspiration pneumonia, and was discharged on day 5. Conclusion EGD may be useful in poisoning patients for determining the amount of residual drug in the stomach, also allowing direct observation of the effectiveness of gastric lavage.
Collapse
Affiliation(s)
- Masato Miyauchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
| | | | | |
Collapse
|