Infantile methemoglobinemia associated with acute diarrheal illness.

A case of an infant with diarrhea and acidosis associated with methemoglobinemia is presented. Of interest is that the association of diarrhea and acidosis with methemoglobinemia is more common than previously thought and can produce dangerously high methemoglobin levels. A review of the literature of this unusual occurrence along with clues to making the diagnosis are discussed.

Acute oral hypoglycemic ingestions.

We reviewed the poison center records of 48 consecutive reports of oral hypoglycemic exposure reported to the Rush Poison Control Center between January 1988 and December 1989. The average age of ingestion was 15.0 y (range 1 to 75 y). Twenty-three of the patients (48%) were male, while 25 (52%) were female. Twenty-nine patients ingested glyburide, 10 chlorpropamide, 6 glipizide, 2 tolbutamide, and 1 each for tolazamide and phenformin. One patient ingested both glyburide and tolbutamide. Sixteen cases (33%) involved coingestants. Accidental cause was the primary reason for ingestion in 33 cases (69%) with suicidal intent being mentioned in an additional 11 cases (23%). Thirteen patients (27%) were treated and released from a health care facility, while the same percentage of patients were admitted. There was no adverse effect in 24 patients (50%) while 9 patients (19%) had minor effects without residual disability. Only 2 patients (4%) experienced a major effect. No deaths were reported. We conclude that oral hypoglycemic ingestions generally have a successful outcome and there does not appear to be a significant difference whether a short/long acting agent or first/second-generation product was ingested.

Hepatic abscess resulting from gastric perforation of a foreign object.

A case of a patient with a hepatic abscess secondary to a fish or chicken bone is presented. Of interest is the fact that the abscess resulted from gastrointestinal perforation of the foreign object. A review of the literature of this unusual occurrence along with clues to making the diagnosis are discussed.

Skeletal muscle relaxant ingestion.

We retrospectively analyzed 56 consecutive cases involving acute skeletal muscle relaxant exposure that were reported to the Poison Control Center over a 1-year period. The age range was 9 mo to 56 years (mean 18.9 +/- 13.1) with the site of exposure being the primary residence in 54 cases (96.4%). The reasons for inquiry to the Poison Center were reported to be intentional suicide in 26 cases (46.4%), accidental in 21 cases (37.5%), with intentional misuses in 5 cases (8.9%). No deaths were reported. Eighteen cases (32.1%) were reported with co-ingestants (average number of substances taken was 2.7 +/- 0.8). Of these cases 3 patients (16.7%) had major effects with life-threatening symptoms with 6 (33.3%) patients having no symptoms. Of the remaining 38 cases, 17 (44.7%) wer cyclobenzaprine, 6 (15.8%) were methocarbamol, 5 (13.2%) were carisoprodol, 5 (13.2%) were chlorzoxazone, 3 (7.89%) were Baclofen and the remainder were either life-threatening symptoms (2.6%), while 29 (74.3%) had no or minor effects with symptoms that subsided. We conclude that morbidity and mortality are low in pure skeletal muscle relaxant ingestion, however it may be increased in multiple ingestions.

Blood pressure decrease prior to initiating pharmacological therapy in nonemergent hypertension.

In order to characterize the decrease in blood pressure that occurs in the emergency department (ED) setting in cases of nonemergent hypertension before beginning pharmacological therapy, 94 consecutive cases of hypertension seen at the University of Illinois Hospital were reviewed. Each patient in the analysis had a triage blood pressure recorded by the nursing staff and second blood pressure reading taken between 10 minutes and 2 hours after the triage pressure before pharmacological therapy was begun. Patients with diastolic pressures less than 90 mm Hg were excluded, as were patients with acute end-organ pathology secondary to hypertension. In the remaining 54 cases, the mean arterial pressure fell by 6% (P less than .003), the systolic pressure fell by 6% (P less than .022), and the diastolic pressure fell by 6.4% (P less than .003), suggesting that in nonemergent hypertension, a significant decrease in blood pressure occurs in the ED before pharmacological therapy is begun. The blood pressure decrease was not statistically different when sex and age were considered, but when patients were grouped into those with diastolic pressures between 90 mm Hg and 114 mm Hg and those with diastolic pressures greater than or equal to 115 mm Hg, there was a statistically significant decrease in systolic, diastolic, and mean arterial pressures only in patients with diastolic pressures greater than or equal to 115 mm Hg. Our findings suggest that patients with nonemergent hypertension do not always require immediate and aggressive pharmacological intervention in the ED setting and are best observed for a short period and then reassessed before beginning pharmacological therapy.

The usefulness of the arterial blood gas in pure carbon monoxide poisoning.

In a retrospective study of 49 cases of carbon monoxide (CO) intoxication presented to the University of Illinois Hospital (UIH) Emergency Department between November 1986 and April 1988, we looked for a correlation between carboxyhemoglobin (COHb) as determined by a venous sample and the pH as determined by arterial blood gas analysis. The range of COHb levels in our study was 10-64% (mean 21.8% +/- 10.2%). Smoke inhalation cases (n = 3) were excluded from our study because they did not represent pure CO intoxication. Of the remaining 46 cases, 18 had arterial blood gases drawn. In none of these 18 cases (mean COHb 24.5% +/- 12.6%) did we find a correlation between COHb levels and the pH as determined by linear regression analysis. Also, in none of the 18 cases were there any therapeutic interventions associated with the arterial blood gas result. Additionally, in none of the remaining 28 cases were any therapeutic interventions performed with regards to patients' acidosis or ventilatory status (except 100% oxygen administration. We also retrospectively reviewed records of 104 cases who presented to Cook County Hospital Emergency Department with COHb levels over 10% during the period between March 1986 and May 1988. In these cases, we found no significant correlation between COHb level and arterial pH. We therefore conclude that arterial blood gases drawn in order to determine the degree of acidosis in mild CO intoxication without respiratory distress may not be useful in guiding therapeutic intervention and need not be routinely drawn.