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Clin Toxicol (Phila) 2020 Jul 1:1-8. Epub 2020 Jul 1.

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

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. 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 May 23. 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 Jan 8:1-5. 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

Ann Coloproctol 2013 Aug 29;29(4):160-6. Epub 2013 Aug 29.

Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.

Purpose: The usefulness of mechanical bowel preparation (MBP) in colon surgery was recently challenged by many multicenter clinical trials and meta-analyses. The objectives of this study were to investigate current national opinions about MBP and prophylactic antibiotics (PA) and to provide preliminary data for developing future Korean guidelines for MBP and PA administration in colorectal surgery.

Methods: A questionnaire was mailed to 129 colorectal specialists. Read More

Clin Toxicol (Phila) 2013 May 9;51(4):243-8. Epub 2013 Apr 9.

CHU Angers, Pôle Médecines Intensives et spécialisées, Centre antipoison et Toxicovigilance, Angers, France.

Objective: The objective of this study was to evaluate the effects of early digestive tract decontamination on the severity of acute-on-chronic lithium poisoning (acute poisoning in patients under long-term therapy).

Materials And Methods: This was an observational and retrospective study of acute-on-chronic lithium overdoses recorded by the Angers Poisons and Toxicovigilance Centre between February 2006 and September 2010. The cases of overdose were divided into two groups: those undergoing early decontamination (by sodium polystyrene sulphonate and/or whole bowel irrigation) and those in whom decontamination was delayed (> 12 h) or not performed. Read More

Clin Toxicol (Phila) 2013 Mar 13;51(3):134-9. Epub 2013 Feb 13.

European Association of Poison Centres and Clinical Toxicologists.

Context: An update of the first position paper on ipecac syrup from 1997 was published by the American Academy of Clinical Toxicology and the European Association of Poison Centres and Clinical Toxicologists in 2004. The aims of this paper are to briefly summarize the content of the 2004 Position Paper and to present any new data.

Methods: A systematic review of the literature from the year 2003 forward. Read More

Clin Toxicol (Phila) 2012 Jun;50(5):414-7

University of California-San Diego, Toxicology, San Diego, CA 92103, USA.

Background: Traditionally whole bowel irrigation (WBI) has been advocated for ingestions involving substances not bound with activated charcoal as well as extended release and enteric coated medications. Other than isolated case reports, little exists in the literature regarding the use of WBI in poisoned pediatric patients. The purpose of this study is to better understand the use of WBI in pediatric patients. Read More

CJEM 2012 May;14(3):193-7

Departmens of Medicine, Dalhousie University, Halifax, NS.

Tricyclic antidepressant (TCA) overdose is a leading cause of death among intentional overdoses. Intravenous lipid emulsion therapy is an emerging antidote for local anesthetic toxicity, and there is animal evidence that lipid therapy may be efficacious in TCA overdose. Furthermore, case reports in humans have described the use of lipid therapy to reverse the toxicity of other lipophilic drugs. Read More

Gastroenterology 2012 Mar 7;142(3):490-6. Epub 2011 Dec 7.

Department of Infectious Diseases, Helsinki University Central Hospital, Helsinki, Finland.

Background & Aims: Treatment of recurrent Clostridium difficile infection (CDI) with antibiotics leads to recurrences in up to 50% of patients. We investigated the efficacy of fecal transplantation in treatment of recurrent CDI.

Methods: We reviewed records from 70 patients with recurrent CDI who had undergone fecal transplantation. Read More

Emerg Med Australas 2011 Dec;23(6):769-72

New South Wales Poisons, The Children's Hospital at Westmead, New South Wales, Australia.

Potassium chloride poisoning can be potentially life-threatening, particularly in massive ingestions of sustained-release preparations. Profound hyperkalaemia, developing over several hours, can lead to cardiac arrhythmias and death. This case series reports three episodes of sustained-release potassium chloride poisoning in two individuals requiring whole bowel irrigation or haemodialysis. Read More

Int J Emerg Med 2011 Oct 12;4:65. Epub 2011 Oct 12.

Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, California, USA.

Objective: To define the role of gastrointestinal (GI) decontamination of the poisoned patient.

Data Sources: A computer-based PubMed/MEDLINE search of the literature on GI decontamination in the poisoned patient with cross referencing of sources.

Study Selection And Data Extraction: Clinical, animal and in vitro studies were reviewed for clinical relevance to GI decontamination of the poisoned patient. Read More

Case Rep Med 2011 12;2011:495938. Epub 2011 May 12.

Department of Pharmacy Services, University Health System, 4502 Medical Drive, San Antonio, TX 78229, USA.

Purpose. Fentanyl is available as a transdermal system for the treatment of chronic pain in opioid-tolerant patients; however, it carries a black box warning due to both the potency of the product and the potential for abuse. In this report, we describe a case of transbuccal and gastrointestinal ingestion of fentanyl patches and the management of such ingestion. Read More

Br J Clin Pharmacol 2011 Jul;72(1):125-32

School of Pharmacy, University of Otago, Dunedin, New Zealand.

Aims: To investigate the relationship between decontamination procedures and seizure events caused by venlafaxine overdose and to estimate the time at which 90% of patients would have had their first seizure in the presence and absence of decontamination.

Methods: Data were collected from 319 patients who took an overdose of venlafaxine on 436 occasions. Seizures occurred on 24 of 436 occasions (5%). Read More

EXS 2010 ;100:397-460

New York City Poison Control Center, New York University School of Medicine, New York, USA.

The treatment of patients poisoned with drugs and pharmaceuticals can be quite challenging. Diverse exposure circumstances, varied clinical presentations, unique patient-specific factors, and inconsistent diagnostic and therapeutic infrastructure support, coupled with relatively few definitive antidotes, may complicate evaluation and management. The historical approach to poisoned patients (patient arousal, toxin elimination, and toxin identification) has given way to rigorous attention to the fundamental aspects of basic life support--airway management, oxygenation and ventilation, circulatory competence, thermoregulation, and substrate availability. Read More

Can J Surg 2009 Oct;52(5):417-21

Department of Surgery, Charing Cross Hospital, Fulham Palace Road, London, UK.

Background: International smuggling of cocaine by internal concealment is a serious and growing problem. People who engage in this practice are commonly referred to as body packers or mules. The most serious risks associated with body packing include intestinal obstruction and death from cocaine intoxication. Read More

Clin Pharmacol Ther 2009 Oct 15;86(4):403-10. Epub 2009 Jul 15.

School of Pharmacy, University of Otago, Dunedin, New Zealand.

The aim of this work was to investigate the pharmacokinetics (PK) of venlafaxine in overdose and the effects of single-dose activated charcoal (SDAC) and whole-bowel irrigation (WBI), alone or in combination, as methods of decontamination. The data included 339 concentration-time points from 76 venlafaxine overdose events (median dose 2,625 (150-13,500 mg)); 69 were slow-release doses. SDAC, WBI, a combination of both, or no decontamination were administered to patients as decided by the treating clinician. Read More

Ther Umsch 2009 May;66(5):331-4

Schweizerisches Toxikologisches Informationszentrum, Zürich.

In acute poisoning the maintenance or reconstitution of vital functions is the first and most critical action. All subsequent therapies and the prognosis depend on the identification of the causative agent and on information about substance-specific toxicity. Despite incomplete evidence the concept of harm reduction by decreased absorption of the toxicants and by shortening the course of illness is consistent with toxicokinetic-dynamic principles and is therefore still used by clinical toxicologists. Read More

BMJ Case Rep 2009 8;2009. Epub 2009 May 8.

Pediatric Intensive Care Unit, Odense University Hospital, Odense, Denmark.

An 18-month-old previous healthy girl who had ingested 442 mg elemental iron/kg was admitted to a paediatric intensive care unit. The child was treated with gastric lavage, whole bowel irrigation and intravenous deferoxamine. After 2 h of standard therapy serum iron had risen threefold to 1362 µg/dl (244 µmol/l). Read More

Clin Toxicol (Phila) 2008 Dec;46(10):1102-3

J Med Toxicol 2008 Sep;4(3):170-2

Department of Emergency Medicine, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA.

Background: Lithium toxicity is associated with electrocardiogram (ECG) changes, but changes suggestive of an ST segment elevation myocardial infarction have not been reported.

Case Report: A 46-year-old incarcerated man suffering from diabetes, hypertension, and schizoaffective/bipolar disorder was treated with lithium 1,200 mg twice daily. Two days prior to presentation the patient became confused, ataxic, and anorexic in jail. Read More

J Emerg Med 2010 Feb 9;38(2):171-4. Epub 2008 Jul 9.

The Toxikon Consortium at Cook County Hospital, Chicago, Illinois 60612, USA.

Sustained-release calcium channel blocker (CCB SR) overdoses are potentially life-threatening ingestions. These patients may not become hemodynamically unstable until many hours after ingestion. On theoretical grounds, some have suggested that whole bowel irrigation (WBI) with polyethylene glycol electrolyte lavage solution may be of value in the management of these cases. Read More

Clin Toxicol (Phila) 2008 Nov;46(9):919

Arch Dis Child 2008 Apr;93(4):321-2

Pediatric Intensive Care Unit, Afdeling V, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C., Denmark.

An 18-month-old previous healthy girl who had ingested 442 mg elemental iron/kg was admitted to a paediatric intensive care unit. The child was treated with gastric lavage, whole bowel irrigation and intravenous deferoxamine. After 2 h of standard therapy serum iron had risen threefold to 1362 microg/dl (244 micromol/l). Read More

Pediatr Emerg Care 2008 Mar;24(3):176-86; quiz 187-9

Department of Emergency Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH 45429, USA.

Gastrointestinal decontamination has been a historically accepted modality in the emergency management of oral intoxicants. Theoretically, gastric and whole-bowel emptying procedures hinder absorption, remove toxic substances, prevent clinical deterioration, and hasten recovery. This article presents a current overview of gastrointestinal decontamination. Read More

Acute Med 2008 ;7(1):39-42

Imperial College Healthcare NHS Trust Department of Medicine Praed Street London W2 1NY Tel: 07941346678.

A 54 year gentleman was admitted to hospital within four hours of taking an overdose of modified release felodipine tablets, with a total dose of approximately 250 mg. The initial management comprised fluid resuscitation, calcium chloride and glucagon. He remained hypotensive and was commenced on hyperinsulinaemia-euglycaemic therapy. Read More

J Med Toxicol 2005 Dec;1(1):18-22

Departments of Clinical Toxicology, Prince of Wales Hospital and Westmead Hospital, Sydney, Australia.

Introduction: Effective whole bowel irrigation may be difficult in the presence of drug-induced ileus. Neostigmine, which inhibits the enzymatic degradation of acetylcholine, has been suggested to improve drug-induced ileus. We present two poisoning cases in which neostigmine was used to facilitate gut decontamination complicated by ileus. Read More

Chudoku Kenkyu 2007 Oct;20(4):358-60