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J Investig Med High Impact Case Rep 2022 Jan-Dec;10:23247096221106760

Medical University of South Carolina, Charleston, USA.

Toxic ingestions are an increasing concern among pediatric patients in the United States. Less common, but troubling, are those patients with persistent toxicity symptoms despite stabilization, resuscitative, and decontamination efforts. We report a case of refractory serotonin toxicity in an adolescent for whom endoscopic removal of medication remnants led to the resolution of his clinical course. Read More

Aust Crit Care 2022 Apr 27. Epub 2022 Apr 27.

Grand Ouest Poison Control and Toxicovigilance Center, Angers University Hospital, 4 Rue Larrey, 49933, Angers, France; UNIV Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S1085, F-49000, Angers, France.

Background: Whole-bowel irrigation (WBI) is a strategy of gastrointestinal decontamination, recommended by several European and American learned societies, which may be used in the management of the poisoned patients.

Objectives: The objectives of this study were to describe the feasibility and tolerability of this technique and to compare the clinical outcome of a group of poisoned patients treated with WBI versus that of an untreated group.

Methods: This was a retrospective and observational study of data recorded by the Angers Poison Control Centre (PCC) between 2012 and 2018. Read More

Clin Toxicol (Phila) 2021 Nov 23;59(11):963-968. Epub 2021 Mar 23.

Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Australia.

Objective: Severe toxicity from ingestions of oral sustained-release potassium is rare. While acute hyperkalaemia requires urgent intervention given the risk of cardiac toxicity, there is a lack of clinical consensus on optimal management. The aim of this study was to characterise the clinical manifestations of acute potassium overdose and its management approach. Read More

Arch Iran Med 2020 08 1;23(8):542-547. Epub 2020 Aug 1.

School of Medicine, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: The incidence of smuggling and illegal transport of substances by internal concealment, also known as body packing, is increasing. The clinical approach to body packers has changed significantly over the past two decades. In addition, the mortality of body packers is an important issue in patient management. Read More

Clin Toxicol (Phila) 2021 Mar 1;59(3):200-207. Epub 2020 Jul 1.

University of Kansas Medical Center, Kansas City, KS, USA.

Objective: We sought to examine ADHD modified release (MR) and immediate release (IR) stimulant ingestion exposures reported to the National Poison Data System (NPDS) to characterize the nature of the exposures and the outcomes associated with them.

Methods: The NPDS was queried for all single-substance exposures to MR and IR ADHD preparations between January 1, 2007 and December 31, 2017. MR and IR preparations were identified by a generic code of "amphetamine and related compounds" or "methylphenidate" and specific product name containing XR, CD, ER, LA, and SR. Read More

Am J Emerg Med 2020 10 23;38(10):2246.e1-2246.e2. Epub 2020 May 23.

Intensive Care Unit, Sanatorio Franchin, Buenos Aires, Argentina.

Dapsone intoxication can be a life-threatening condition due its enterohepatic recirculation pharmacokinetics, and therefore, persistent methemoglobinemia development. We describe a case of a 17-year-old girl who was admitted 4 h after ingesting 5 g of dapsone. She presented methemoglobinemia (39%) and showed clinical signs of toxicity (cyanosis and altered mental status) despite mechanical ventilation. Read More

Intern Med 2020 05 19;59(10):1343. Epub 2020 Feb 19.

General Medicine, Juntendo University, Japan.

Clin Toxicol (Phila) 2020 09 8;58(9):881-885. Epub 2020 Jan 8.

Maryland Poison Center, University of Maryland School of Pharmacy, Baltimore, MD, USA.

To date, very little literature describes the outcomes of acute unintentional ingestions of lithium in young children. This study aimed to describe the clinical effects and outcomes reported in these patients reported to the National Poison Data System (NPDS). This is a retrospective observational study of acute unintentional lithium ingestions in children <6 years of age. Read More

Swiss Med Wkly 2019 Dec 17;149:w20164. Epub 2019 Dec 17.

Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Switzerland.

Aims Of The Study: To describe the characteristics of cases presenting at the emergency department due to (suspected) poisoning for which consultation on patient management with the national Poisons Information Centre was required.

Methods: Retrospective study at the emergency department of Bern University Hospital, Switzerland, from May 2012 to December 2017. Cases were identified in the electronic patient database using appropriate full-text search terms. Read More

Am J Emerg Med 2020 02 12;38(2):325-328. Epub 2019 Sep 12.

University of California, San Diego, Department of Emergency Medicine, San Diego, CA, United States of America; California Poison Control System - San Diego Division, San Diego, CA, United States of America.

Introduction: Polyethylene glycol electrolyte lavage solution (PEG-ELS) is similar to pharmaceutical solvent propylene glycol and used following acute poisonings for whole bowel irrigation (e.g., "body stuffing"). Read More

Clin Pract Cases Emerg Med 2019 Nov 14;3(4):341-344. Epub 2019 Oct 14.

Wayne State University, Department of Emergency Medicine, Detroit, Michigan.

A 47-year-old schizophrenic male presented on three separate occasions with pancytopenia and sideroblastic anemia due to copper deficiency from massive zinc penny ingestion. The poisoning was treated differently on each visit: intravenous (IV) copper plus surgical decontamination and chelation with calcium disodium versenate (CaNa2EDTA); IV copper plus whole bowel irrigation; and IV copper with surgical decontamination only. Serum zinc half-lives were 80. Read More

Bull Emerg Trauma 2019 Jul;7(3):320-323

Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.

Ileus is a very rare complication of methamphetamine (MET) intoxication. We herein report a 15-year-old non-addict girl who ingested about 5 gr of MET. She suffered from bowel obstruction manifestations. Read More

Ann Saudi Med 2019 Jul-Aug;39(4):229-235. Epub 2019 Aug 5.

From the Department of Pediatrics, King Saud Medical City, Riyadh, Saudi Arabia.

Background: Poisoning among the pediatric population is an important public health concern that is responsible for frequent pediatric emergency department visits and hospital admissions. Surveillance of poisoning cases is essential for designing and implementing effective preventive strategies.

Objective: Describe the characteristics of acute poison exposure and related therapeutic interventions in children aged 12 years and younger. Read More

Am J Emerg Med 2019 09 21;37(9):1809.e1-1809.e3. Epub 2019 Jun 21.

Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa City, Tokyo 190-0014, Japan.

Half-life of the antipsychotic vegetamin is very long, partially due to the presence of phenobarbital, and mortality due to phenobarbital poisoning is high. Here, we present the case of a 22-year-old female admitted to the emergency department with disturbed consciousness due to vegetamin overdose. Her blood phenobarbital level was elevated to 123 μg/ml. Read More

Ned Tijdschr Geneeskd 2018;162:D1574

St Antonius Ziekenhuis, afd. Klinische Farmacie, Nieuwegein.

- A new guideline: 'Intoxication: initial approach in the hospital' will be published this year. This guideline sets out the latest insights on gastrointestinal decontamination in intoxication; the advice is summarized in a flowchart.- The advice is to generally administer activated charcoal, unless there are indications that the toxin will not bind to activated charcoal or that the amount of toxin that the patient has ingested is too great; in these cases gastric lavage can be considered. Read More

Pediatr Emerg Care 2019 Jun;35(6):426-427

From the Department of State Health Services, Austin, TX.

Objectives: There is concern that ingestion of superabsorbent polymer toys, which can absorb large amounts of fluid and increase greatly in volume, may pose a risk if swallowed by children.The intent of this study was to characterize pediatric Orbeez ingestions reported to a statewide poison center system.

Methods: Cases were Orbeez ingestions among patients 19 years or younger reported to Texas poison centers during January 2011 to June 2016. Read More

Clin Toxicol (Phila) 2018 Jan 26;56(1):69-73. Epub 2017 Jun 26.

c Department of Internal Medicine, Gastroenterology Unit , Ospedale dell'Angelo and Ospedale SS Giovanni e Paolo , Venice , Italy.

Background: Ingestion of elemental mercury (Hg0) is considered non-toxic. After massive ingestion, local intestinal complications may develop: retention within appendix is quite frequent but treatment is debated. We describe a case of intentional ingestion of Hg0 requiring multi-step decontamination and prophylactic appendectomy. Read More

Wilderness Environ Med 2017 Sep 17;28(3):246-248. Epub 2017 Jun 17.

Department of Emergency Medicine, Lehigh Valley Hospital/USF Morsani College of Medicine, Allentown, Pennsylvania. Electronic address:

For individuals who work outdoors in the winter or play winter sports, chemical hand warmers are becoming increasingly more commonplace because of their convenience and effectiveness. A 32-year-old woman with a history of chronic pain and bipolar disorder presented to the emergency department complaining of a "warm sensation" in her mouth and epigastrium after reportedly ingesting the partial contents of a chemical hand warmer packet containing between 5 and 8 g of elemental iron. She had been complaining of abdominal pain for approximately 1 month and was prescribed unknown antibiotics the previous day. Read More

J Med Toxicol 2016 12 13;12(4):391-395. Epub 2016 Jun 13.

Institute of Analytical Chemistry and Food Chemistry, Graz University of Technology, Graz, Austria.

Introduction: Whole bowel irrigation (WBI) is a management option for overdose of medications poorly adsorbed to activated charcoal, with modified release properties, or for body packers. Polyethylene glycol (PEG) is a mixture of ethylene oxide polymers of varying molecular weight. PEG with an average molecular weight of 3350 g/mol is used for WBI. Read More

Br J Clin Pharmacol 2016 Mar 30;81(3):453-61. Epub 2015 Oct 30.

Monash Health Clinical Toxicology and Addiction Medicine Service, Monash Health, Dandenong Hospital, David Street, Dandenong, VIC, 3175, Australia.

Management of cardiovascular instability resulting from calcium channel antagonist (CCB) or beta-adrenergic receptor antagonist (BB) poisoning follows similar principles. Significant myocardial depression, bradycardia and hypotension result in both cases. CCBs can also produce vasodilatory shock. Read More

Pediatr Emerg Care 2015 Aug;31(8):605-7

From the Children's Mercy Hospital and Clinics, Kansas City, MO.

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. Read More

Turk J Med Sci 2015 ;45(2):404-8

Background/aim: Even though polyethylene glycol-electrolyte lavage (PEG-EL)-based regimes have become the gold standard in recent years, to finish drinking 4 L of PEG-EL solution can be difficult. The quality of sennoside-based bowel-cleansing regimes used in Turkey has been known for some time. Therefore, we aimed to investigate the efficacy of both bowel-cleansing regimes. Read More

Lakartidningen 2014 Sep 17-23;111(38):1576-7

A 20-year-old woman was found semiconscious on the floor in a pool of black diarrhea with an empty 100 jar of ferrous sulphate beside her (100 mg Fe2+/tablet), 160 mg/kg. She was brought to the hospital an estimated 4 hours after ingestion and presented with irritability and a fluctuating CNS depression. Her blood pressure was 190/85 mmHg and pulse 130 bpm. Read More

J Med Toxicol 2015 Sep;11(3):309-16

Department of Internal Medicine, Tulane University Medical Center, New Orleans, LA, USA,

Prisoners have a high prevalence of substance misuse and abuse, but few studies have examined symptomatic exposures among incarcerated populations. We sought to further characterize the nature of these exposures among this population using the California Poison Control System data. Keyword searches identified inmate cases in 2011-2013 for patients 20+ years old exposed to a single substance and taken to hospital from jail, prison, or police custody. Read More

Clin Toxicol (Phila) 2015 Jan 16;53(1):5-12. Epub 2014 Dec 16.

European Association of Poisons Centres and Clinical Toxicologists , Brussels , Belgium.

Context: A position paper on the use of whole bowel irrigation (WBI) was first published in 1997 by the American Academy of Clinical Toxicology (AACT) and the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) and updated in 2004. The aims of this paper are to briefly summarize the content of the 2004 Position Paper and to present any new data and recommendations.

Methods: A systematic review of the literature from January 2003 to February 28, 2013 was conducted using multiple online databases for articles concerning WBI for gastrointestinal decontamination. Read More

Toxicol Rep 2014 22;1:209-213. Epub 2014 May 22.

Residente de Toxicología Hospital Angeles Lomas, Vialidad de la Barranca No. 14, Colonia Valle de las Palmas, Huixquilucan, Estado de México CP 52787, Mexico.

Background: Reported cases of potassium overdoses have shown that this condition could generate several morbidities, mainly related to cardiac dysrhythmias even with fatal outcomes in some cases. Potassium salts in extended release tablets could form pharmacobezoars if a large amount is ingested. In relation to the above, when the patient has a pharmacobezoar, clinical findings may be delayed and may persist. Read More

J Emerg Med 2014 Mar 7;46(3):351-4. Epub 2013 Oct 7.

Department of Emergency Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia; Department of Pharmacy, Carilion Roanoke Memorial Hospital, Roanoke, Virginia.

Background: Hyperkalemia is a potentially life-threatening electrolyte abnormality commonly seen in the emergency department (ED). Intentional overdose of potassium supplements is an uncommon occurrence.

Objective: This case illustrates a novel approach to treatment of pharmacobezoar with esophagogastroduodenoscopy (EGD) and demonstrates its effectiveness in the setting of extended-release potassium chloride overdose. Read More

Clin Toxicol (Phila) 2013 Nov 18;51(9):846-9. Epub 2013 Sep 18.

Department of Emergency Medicine, Iwate Medical University, School of Medicine , Morioka, Iwate , Japan.

Context: In acute glufosinate poisoning, sudden respiratory arrest and convulsion can occur after a latent period of 4-60 h. There is still no factor that accurately predicts the occurrence of these symptoms.

Objective: To elucidate the predictors of severe effects following acute glufosinate poisoning. Read More