- Written by Ethan Abbott
Toxicology Literature of Note
Severe alcohol withdrawal can be complex and difficult to treat, especially when the patient is resistant to BZD. The follow study looks at the use of ketamine as an adjunct to lorazepam for patients admitted to the ICU for ETOH withdrawal. As ketamine is a NMDA receptor antagonist, it may play a role in treatment of withdrawal in combination with BZDs.
We would like to think that we can trust our lab results. But, as we all know, nothing in medicine is absolute and patients do not read the textbook . . .
The following case report looks at a false positive salicylate concentration by the compound dinitrophenol (DNP) after an intentional ingestion. DNP is a rare, but often fatal, toxin with different management when compared with salicylate.
As with any lab result, always look at the clinical context! We treat patients, not numbers (or poisons!)
Have you ever sent a patient up to the ICU and continued to follow their clinical course, but saw that the intensivists decided against certain elements of specialist recommendations. This paper tries to assess why this is done, specifically looking at high dose insulin euglycemic therapy for CCB overdose.
Toxicology in the News
Last week in Connecticut there were over 70 cases of synthetic cannabinoid overdose IN ONE DAY, possibly adulterated with fentanyl. This article mentions that “patients who didn’t respond to naloxone (an overdose reversal drug) administered on the Green showed some improvement after receiving higher doses over a period of time at the hospitals.” The utilization of resources in this community was massive, with the only good thing being that there were no deaths reported.
With summer coming to a close, there will be fewer ice cream trucks coming around the block. This unfortunate story is of the wife of an ice cream salesman who died when the dry ice used to keep the ice cream cold was not properly ventilated. Dry ice is the solid form of carbon dioxide, which when exposed to a temperature above it’s triple point (-109 F!!!) sublimates to gas. In an enclosed space, the heavier than air carbon dioxide gas displaces oxygen and leads to an environment without the O2 necessary to breath. It is a simple asphyxiant and can lead to death rapidly. So whether you need dry ice to cool your ice cream, or make that Halloween pumpkin smoke, always remember to have the area well ventilated.
A man in Michigan kept a albino monocled cobra as a pet, and not surprisingly was bitten. Some may think, no big deal, just give the patient some antivenom and watch him recover. Sadly, this is easier said than done. The standard CroFab antivenom is ineffective for cobra envenomations, and a species specific antivemon is often difficult to come by (and usually expired.) Luckily, antivemon specific to this snake was found in Florida and flown to the patient in Detroit.
Toxicology Toxin of the Month
Last week I gave a lecture on GI decontamination and enhanced elimination and just briefly touched on the use of hemodyalisis with the poisoned patient.
I would like to direct everyone to the following Tox and the Hound post by Dr Diane Calello, which goes deeper on this important topic. . . Dialyze This. And if you want to take a deep nerd dive, you can read more about whole bowel irrigation from our very own Dr Howard Greller in The Purge.