Management Theophylline Overdose

Labs Theophylline level, CBC, electrolytes, Ca, glucose, BUN, creatinine, clotting studies. Avoid P-mimetics (high heart rate, hypotension). Avoid ipecac and most antiemetics, especially phenothiazines (increased arrhythmias and required seizure threshold). Gastrointestinal decontamination Gastric emptying No ipecac, granisetron > ondansetron (5-HT blockers) > metoclo-pramide for severe vomiting hemoperfusion for refractory vomiting. Orogastric lavage Best to...

Staph Enterotoxin B SEB

Microbiology SEB-1 is a super-antigenic bacterial toxin that produces profound activation of the immune system when either inhaled or ingested. Microbiology Brucella is a small gram-negative coccobacillus with a zoonotic reservoir in domestic livestock cattle (B. abortus), pigs (B. suis), and goats (B. melitensis). Pathology A very low inoculum of Brucella may be inhaled (< 1 week incubation) or ingested (7-60 day incubation) and causes a nonspecific illness characterized by prolonged...

Theophylline Enhanced Elimination

Acute charcoal hemoperfusion indications Theophylline level > 90 mcg mL at any time. Theophylline level > 40 mcg mL when combined with Seizures Hypotension, refractory to fluid loading Ventricular dysrhythmias Protracted vomiting, refractory to antiemetics Chronic theophylline toxicity Risks increase with advancing age, intercurrent illnesses infections, and reduced hepatic perfusion. No role for either emesis or orogastric lavage, unless to instill AC via orogastric tube. AC and MDAC for...

Carefully Edible Mushrooms Conclusions

Lepiota Subclypeolaria

There are old mushroom hunters, and bold mushroom hunters, but no old, bold mushroom hunters. Avoid pure white mushrooms, little and large brown mushrooms, red- or pink-pored boletes Boletus species , and all decomposing mushrooms. Cook all wild mushrooms. Cooking does not inactivate all mushroom toxins, and even edible mushrooms, if allowed to age or deteriorate, may become toxic. Select mushrooms at the grocery, not in the woods. Figure 14.6 Lepiota subclypeolaria amatoxic lepiota . An...

Acute Marijuana Toxicity

Physiological effects Dose-related tachycardia, blood pressure remains stable, increased appetite, dry cotton mouth, conjunctival injection, reduced intra-ocular pressure, bronchodilation, weakness, muscle tremors, urinary retention, low testosterone levels impotence. Psychological effects Dose-related euphoria, relaxation, sensory alterations. Preexisting psychopathology may predispose to transient, acute psychotic reactions with paranoid delusions and hallucinations. Management of Marijuana...

Chronic Marijuana Toxicity

Marijuana is an oily, dried fibrous material obtained from the Indian hemp plant, Cannabis sativa. The most commonly used illegal substance in the United States. The most commonly abused substance in the world after nicotine, alcohol, and caffeine. Considered a gateway drug by the DEA, NIDA, and the Substance Abuse and Mental Health Services Administration SAMHSA . Tolerance and dependence Resulting from repeated use. Withdrawal syndrome Irritability, restlessness, Congenital toxicity Neonatal...

C

FIGURE 1.6 Michaelis-Menten Kinetics. The rate of a drug's elimination is initially by first-order kinetics, and then switches to zero-order kinetics when the drug's hepatic metabolizing enzyme system becomes saturated to capacity. Area under the curve AUC of concentration C x time t FIGURE 1.7 Plasma clearance. Plasma clearance is reflected by the area under the curve of a drug's plasma concentration over time, or clearance the rate of elimination plasma concentration x time. Area under the...

Differential Diagnosis of Sympathetic Toxidromes

Poisoning Pulmonary Edema

Figure 9.4 Noncardiogenic Pulmonary Edema Crack Cocaine Injection. Frontal chest radiograph that demonstrates normal size and configuration of the cardio-mediastinal silhouette and bilateral diffuse pulmonary edema following the intravenous injection of crack cocaine. Noncardiogenic pulmonary edema may also follow opioid overdoses with the same radiographic patterns. Courtesy of Carlos R. Gimenez, M.D., Professor of Radiology, LSU School of Medicine, New Orleans, LA. Figure 9.4 Noncardiogenic...

Scombroid Fish Poisoning

Agents Toxic decomposition metabolites collectively called scombrotoxins the scombro-toxins are not bioaccumulated dinoglagellate or diatom exotoxins. Toxins Scombrotoxins histamine and its primary N-methylhistamine metabolite, saurine. LD50 No known human fatalities. Mechanism Scombrotoxins form during gut bacteria-catalyzed, normothermic decarbox-ylation Proteus, Klebsiella, Lactobacillus, E. coli, Enterobacter species of muscle L-histidine in decomposing finfish dangling on commercial long...

Info

A large therapeutic index reflects a large therapeutic window in which large doses of a drug are relatively safe to administer, unless drug allergy exists. Ex. penicillin. FIGURE 1.4b Small therapeutic Index. A small therapeutic index reflects a small therapeutic window in which drug toxicity is possible even at low doses. Ex. digoxin, warfarin. The rate of a drug's elimination is directly proportional to its plasma concentration. The higher the...

Cardio Fluorosis

Radiopacity Crack Cocaine

Soft tissues Half-life weeks to months figure 3.1 Ingested lead distributes in a three-compartment model. Ingested lead is distributed in a three-compartment model in which the heavy metal is initially distributed to a central circulatory compartment then to a highly perfused visceral organ compartment and finally to the least perfused third compartment composed of bone, teeth, nails, and hair. FIGURE 3.2 Ingested lead distributes in a five-compartment model. Ingested lead is distributed in a...

Electrolyte Disturbances

Tall Peak Wave

Hyperkalemia Tall tented T waves with progressive widening of the QRS complex see Figure 3.13a . Hypokalemia Progressive decrease in T wave amplitude with inverted T waves, U waves, and eventual fusion of T and U waves see Figure 3.13b . Hypercalcemia Short QT and ST intervals antacids, vitamins A and D, hydrochlorothiazide HCTZ containing diuretics see Figure 3.14a . Hypocalcemia Prolonged QT and ST intervals fluoride, hydrofluoric acid, calcitonin, ethyl-ene glycol, phosphates see Figure...

Theophylline Overdose Supraventricular Tachycardia

Astemizole terfenadine overdose or CYP 34A Interactions torsades de pointes, prolonged QT intervals, and VT. FIGURE 3.18 Electrocardiographic Evidence of Chloral Hydrate Toxicity. Electrocardiogram ECG tracing in a patient sedated with oral chloral hydrate for a magnetic resonance imaging procedure that demonstrates the ventricular ectopic or premature beats premature ventricular contractions characteristic of chlorinated hydrocarbon toxicity from chloral hydrate or halogenated hydrocarbon...