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1.
BMJ Case Rep ; 15(5)2022 May 18.
Article in English | MEDLINE | ID: covidwho-1854261

ABSTRACT

Superwarfarin (long-acting anticoagulant rodenticide) poisoning should be suspected in unexplained bleeding with prolonged prothrombin time, especially in the absence of another explanation. Diagnosis and treatment of this intoxication remain a challenge as the direct analysis of superwarfarin in serum is not always possible. Therefore, toxin bioavailability remains unknown and close monitoring and treatment for long periods are required to avoid serious bleeding complications. Here, we discuss a case of suspected superwarfarin poisoning to highlight the challenges in early diagnosis and the challenges we encountered in treatment management and ensuring compliance for long periods.


Subject(s)
4-Hydroxycoumarins , Blood Coagulation Disorders , Poisoning , Rodenticides , Anticoagulants , Blood Coagulation Disorders/chemically induced , Humans , Poisoning/therapy
2.
J Med Toxicol ; 17(4): 333-362, 2021 10.
Article in English | MEDLINE | ID: covidwho-1415107

ABSTRACT

The Toxicology Investigators Consortium (ToxIC) Registry was established by the American College of Medical Toxicology in 2010. The registry collects data from participating sites with the agreement that all bedside and telehealth medical toxicology consultation will be entered. This eleventh annual report summarizes the Registry's 2020 data and activity with its additional 6668 cases. Cases were identified for inclusion in this report by a query of the ToxIC database for any case entered from January 1 to December 31, 2020. Detailed data was collected from these cases and aggregated to provide information which included demographics, reason for medical toxicology evaluation, agent and agent class, clinical signs and symptoms, treatments and antidotes administered, mortality, and whether life support was withdrawn. Gender distribution included 50.6% cases in females, 48.4% in males, and 1.0% identifying as transgender. Non-opioid analgesics were the most commonly reported agent class, followed by opioid and antidepressant classes. Acetaminophen was once again the most common agent reported. There were 80 fatalities, comprising 1.2% of all registry cases. Major trends in demographics and exposure characteristics remained similar to past years' reports. Sub-analyses were conducted to describe race and ethnicity demographics and exposures in the registry, telemedicine encounters, and cases related to the COVID-19 pandemic.


Subject(s)
Congresses as Topic , Hazardous Substances/toxicity , Poisoning/diagnosis , Poisoning/therapy , Registries/statistics & numerical data , Research Report , Toxicology/statistics & numerical data , Adult , Aged , Aged, 80 and over , COVID-19 , Canada , Female , Humans , Israel , Male , Middle Aged , Pandemics/statistics & numerical data , SARS-CoV-2 , Thailand , United States
3.
Am J Emerg Med ; 44: 479.e1-479.e2, 2021 06.
Article in English | MEDLINE | ID: covidwho-1245819

ABSTRACT

Previous case reports describe the inadvertent administration of methylergonovine to newborns resulting in rare, life-threatening events including neonatal death. To our knowledge, no case reports exist detailing inadvertent methylergonovine administration in the emergency medicine literature. A newborn infant presented to the emergency department (ED) at hour five of life following methylergonovine administration with periods of apnea and cyanosis. The infant required intubation, mechanical ventilation, and a seven day neonatal intensive care stay. This rare case describes the potential for this error to occur in the community and heightens the vigilance of emergency medicine providers when caring for newborns in their first hours of life.


Subject(s)
Emergency Service, Hospital , Medication Errors , Methylergonovine/poisoning , Poisoning/diagnosis , Poisoning/therapy , Female , Humans , Infant, Newborn , Intensive Care Units, Neonatal
4.
J Med Toxicol ; 17(3): 250-256, 2021 07.
Article in English | MEDLINE | ID: covidwho-1202856

ABSTRACT

INTRODUCTION: Between early March 2020 and the end of May 2020, Italy issued strict measures to limit further spread of coronavirus disease 2019 (COVID-19) and became the first European country that imposed a lockdown on the population. The aim of this study was to assess the impact of these restricted conditions on the activity of the Poison Control Center (PCC) of Policlinico Umberto I Hospital-Sapienza University of Rome. METHODS: This was a retrospective analysis of calls received by the PCC during the lockdown period March 9, 2020 through May 31, 2020 compared to the same time period in year 2019 (reference). RESULTS: We observed a reduction in calls from hospitals and emergency departments and an increase in calls from private citizens about exposures to products or intoxications during the lockdown. There were increases in unintentional exposures and exposures to hand and surface sanitizers among household and cleaning products. There was a decrease in calls concerning medications, which were mostly from hospitals and emergency departments. We observed increases in exposures requiring clinical observations among adults and referral to the emergency department among pre-school children. CONCLUSIONS: Public health protection measures against COVID-19 to improve hygiene and maintain clean environments can increase exposures to hazardous products in the domestic environment. We observed an increase in unintentional exposures to household and cleaning products during the lockdown and an increase in ED referrals for pre-school children compared to the previous year. Our data suggest the need for improvements in public campaigns that promote safer handling of household products and prevent unnecessary exposures during a lockdown. The public health promotion activity can benefit the community after the pandemic and prepare the community for lockdowns in the future.


Subject(s)
COVID-19/epidemiology , Poison Control Centers , Poisoning/therapy , SARS-CoV-2 , Adolescent , Adult , Aged , COVID-19/prevention & control , Child , Child, Preschool , Emergency Service, Hospital , Household Products , Humans , Italy/epidemiology , Middle Aged , Poisoning/prevention & control , Public Health , Retrospective Studies , Young Adult
5.
Prehosp Disaster Med ; 36(2): 145-162, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1164744

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) pandemic influences health care facilities world-wide. The flow rate, type, and severity of cases presented to emergency departments varied during the pandemic in comparison to the past years. However, this change has not been well-described among the cases of hospital admission due to toxic exposure. STUDY OBJECTIVE: Recognition of the pattern of toxic exposure among the cases refereed to Tanta Poison Control Center (TPCC; Tanta, Egypt) during the past five years, and furthermore, exploration of the impact of lockdown due to the COVID-19 pandemic on the pattern of presented cases. METHODS: The current study is a five-year retrospective, comparative cross-sectional study carried out among acutely intoxicated patients admitted to TPCC during the spring months (March through May) of 2016-2020. A total of 1,916 patients with complete medical records were recruited. The type and manner of toxic exposure, demographic, clinical data, and outcomes were analyzed. RESULTS: The current study noted that there were delays in time from toxic exposure to emergency services during the lockdown period. This was reflected in significant lower recovery rates (884.8/1,000 population; z = -3.0) and higher death rates (49.4/1,000 population; z = 2.1) despite the marked decrease in the total number of hospital admissions in comparison to the past four years. The lockdown period showed significantly higher phosphides (z = 3.5; χ2 = 34.295; P <.001) and antipsychotics exposure (z = 3.6; χ2 = 21.494; P <.001) than the previous years. However, predominance of female exposure and intentional self-poisoning was maintained over the past five years, including the lockdown. CONCLUSION: COVID-19-associated lockdown greatly reformed the usual intoxication pattern of the cases admitted to emergency room. Also, it played a role in delaying time of hospital arrival, which was reflected as lower recovery rates and higher death rates.


Subject(s)
COVID-19/epidemiology , Drug Overdose/therapy , Emergency Service, Hospital , Poisoning/therapy , Adolescent , Adult , Aged , Child , Child, Preschool , Cross-Sectional Studies , Egypt/epidemiology , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2
6.
Clin Toxicol (Phila) ; 59(11): 1009-1014, 2021 11.
Article in English | MEDLINE | ID: covidwho-1146385

ABSTRACT

BACKGROUND: The advent of COVID-19 increased attention to hand hygiene in prevention of disease transmission. To meet the increased demand for hand sanitizer during the pandemic, the US FDA issued an Emergency Use Authorization allowing new manufacturers and importers to enter the market. Some of the newly introduced hand sanitizer products contained methanol in lieu of ethanol or isopropanol. We describe five patients with fatal methanol poisoning resulting from hand sanitizers improperly containing methanol. CASE SUMMARY: Comparing a 5-month period from 2019 to the same time frame in 2020, the Arizona Poison and Drug Information Center has seen an increase of 124% in exposures to hand sanitizer. Of these cases, 28% involved methanol-contaminated hand sanitizer. Five of these patients died from methanol poisoning. All five cases had similar clinical features with severe high anion gap metabolic acidosis and, in four patients, elevated osmolal gap. Methanol concentrations were consistently very elevated, but these results were not available before the patients succumbed. Four of the patients received fomepizole and adjunctive care. Two patients received emergency extracorporeal therapy. All five died despite maximal treatment efforts. CONCLUSION: During the pandemic in 2020, there was a proliferation of alcohol-based hand sanitizers which contained methanol. Exposure to these products, which failed to meet regulatory standards, led to increased harm and death. Challenges to treatment of methanol poisoning, especially in rural areas, include lack of access to timely laboratory measurement of methanol concentrations and lack of available emergency hemodialysis without transfer of the patient.


Subject(s)
COVID-19 , Hand Sanitizers/poisoning , Methanol/poisoning , Poisoning/etiology , Adult , Arizona/epidemiology , Female , Hand Sanitizers/chemistry , Humans , Male , Middle Aged , Poison Control Centers/statistics & numerical data , Poisoning/therapy , Syndemic
8.
J Am Soc Nephrol ; 31(10): 2475-2489, 2020 10.
Article in English | MEDLINE | ID: covidwho-982717

ABSTRACT

BACKGROUND: Although chloroquine, hydroxychloroquine, and quinine are used for a range of medical conditions, recent research suggested a potential role in treating COVID-19. The resultant increase in prescribing was accompanied by an increase in adverse events, including severe toxicity and death. The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup sought to determine the effect of and indications for extracorporeal treatments in cases of poisoning with these drugs. METHODS: We conducted systematic reviews of the literature, screened studies, extracted data, and summarized findings following published EXTRIP methods. RESULTS: A total of 44 studies (three in vitro studies, two animal studies, 28 patient reports or patient series, and 11 pharmacokinetic studies) met inclusion criteria regarding the effect of extracorporeal treatments. Toxicokinetic or pharmacokinetic analysis was available for 61 patients (13 chloroquine, three hydroxychloroquine, and 45 quinine). Clinical data were available for analysis from 38 patients, including 12 with chloroquine toxicity, one with hydroxychloroquine toxicity, and 25 with quinine toxicity. All three drugs were classified as non-dialyzable (not amenable to clinically significant removal by extracorporeal treatments). The available data do not support using extracorporeal treatments in addition to standard care for patients severely poisoned with either chloroquine or quinine (strong recommendation, very low quality of evidence). Although hydroxychloroquine was assessed as being non-dialyzable, the clinical evidence was not sufficient to support a formal recommendation regarding the use of extracorporeal treatments for this drug. CONCLUSIONS: On the basis of our systematic review and analysis, the EXTRIP workgroup recommends against using extracorporeal methods to enhance elimination of these drugs in patients with severe chloroquine or quinine poisoning.


Subject(s)
Chloroquine/poisoning , Coronavirus Infections/drug therapy , Hydroxychloroquine/poisoning , Pneumonia, Viral/drug therapy , Practice Guidelines as Topic , Quinine/poisoning , Renal Dialysis/methods , COVID-19 , Chloroquine/therapeutic use , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Female , Humans , Hydroxychloroquine/therapeutic use , Male , Outcome Assessment, Health Care , Pandemics/statistics & numerical data , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Poisoning/therapy , Quinine/therapeutic use , Renal Dialysis/statistics & numerical data , Risk Assessment , United States
10.
J Emerg Med ; 60(3): 359-364, 2021 03.
Article in English | MEDLINE | ID: covidwho-894016

ABSTRACT

BACKGROUND: Hydroxychloroquine (HCQ) poisoning is a life-threatening but treatable toxic ingestion. The scale of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (COVID-19) and the controversial suggestion that HCQ is a treatment option have led to a significant increase in HCQ use. HCQ poisoning should be at the top-of-mind for emergency providers in cases of toxic ingestion. Treatment for HCQ poisoning includes sodium bicarbonate, epinephrine, and aggressive electrolyte repletion. We highlight the use of hypertonic saline and diazepam. CASE REPORT: We describe the case of a 37-year-old man who presented to the emergency department after the ingestion of approximately 16 g of HCQ tablets (initial serum concentration 4270 ng/mL). He was treated with an epinephrine infusion, hypertonic sodium chloride, high-dose diazepam, sodium bicarbonate, and aggressive potassium repletion. Persistent altered mental status necessitated intubation, and he was managed in the medical intensive care unit until his QRS widening and QTc prolongation resolved. After his mental status improved and it was confirmed that his ingestion was not with the intent to self-harm, he was discharged home with outpatient follow-up. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: For patients presenting with HCQ overdose and an unknown initial serum potassium level, high-dose diazepam and hypertonic sodium chloride should be started immediately for the patient with widened QRS. The choice of hypertonic sodium chloride instead of sodium bicarbonate is to avoid exacerbating underlying hypokalemia which may in turn potentiate unstable dysrhythmia. In addition, early intubation should be a priority in vomiting patients because both HCQ toxicity and high-dose diazepam cause profound sedation.


Subject(s)
COVID-19/drug therapy , Diazepam/therapeutic use , Heart Block/chemically induced , Hydroxychloroquine/poisoning , Hypnotics and Sedatives/therapeutic use , Long QT Syndrome/chemically induced , Poisoning/therapy , Saline Solution, Hypertonic/therapeutic use , Adult , Electrocardiography , Emergency Service, Hospital , Heart Block/therapy , Humans , Long QT Syndrome/therapy , Male , SARS-CoV-2
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