Falsely elevated lithium levels in plasma samples obtained in lithium containing tubes.

CASE REPORT: We present a case of lithium poisoning in a 15-month-old child. Delayed elevation of the plasma lithium concentration at 13 hours after admission to a hospital was noted. This appeared to be factitiously related to the collection of samples in a speckled green top tube which contains lithium heparin as an anticoagulant. CONCLUSION: This type of false elevation has not been reported in the medical literature. A follow-up study in five healthy volunteers showed that the lithium concentrations of plasma samples obtained in speckled green top tubes are increased by approximately 1.5 mEq/L (1.5 mmol/L).

Successful heart transplantation from a victim of carbon monoxide poisoning.

Heart transplantation has become a highly successful, life-saving treatment for a number of otherwise fatal heart diseases. A major limiting factor in the growth of transplantation surgery has been the relative lack of suitable donor organs, and the appropriate criteria for selection of donor organs have been a topic of significant interest. Despite relatively favorable survival rates in the few patients who have received organs from victims of many types of poisonings and drug overdoses, patients dying of toxicologic causes are not usually considered suitable organ donors. Some centers routinely reject such individuals. Criteria for donor selection continue to be vague, unclear, or nonexistent in regard to organ transplantation from victims of all types of poisoning and toxic exposures. Carbon monoxide (CO) is a ubiquitous poison, and although victims of CO poisoning have occasionally served as suitable organ donors, heart transplantation in this scenario is still a very rare event. We describe the successful transplantation of the heart from a CO poisoning victim--to our knowledge, only the third such transplantation. Because the emergency department is a critical site for organ procurement, emergency physicians must be aware that patients dying of CO exposure may be acceptable organ donors.