Poison Center, MacKay Memorial Hospital

2023年6月12日星期一

Amphetamine poisoning

Substance

Amphetamine

Common name

安仔, 安公子 [1]

Involving system and Presentation

- CV: flushing, diaphoresis, hypertension, vasoconstriction, lung edema, heart failure, shock. Tachycardia [1]

- Neuro and psychiatric: agitation, delusion, hyperactivity, tremor, delirium, rigidity, acute psychosis [2], paranoid schizophrenia, hallucination. [1] Toxic encephalopathy. [3].

- Hyperthermia, rhabdomyolysis, myoglobinuria. [1]

- Acute kidney injury. [1]

- acute porphyria. [4].

Antidote / Treatment

- ACLS or shock, arrhythmia, hypertension, tachycardia.

- Intubation when respiratory failure [1]

- GI decontamination within 1 hour. Activated charcoal, 1gm/kg with laxative agent [1]

- Benzodiazepine, barbiturate for seizure, delirium. [1]

- Fever: sedative and external cooling. [1]

- Rhabdomyolysis – hydration to keep urine output 1—2 ml./kg BW/hour. [1]

- VPC – benzodiazepine +/- lidocaine. [1]

- - hypotension – fluid challenge or inotropic agent. [1]

Disposition

- PCO2 ≥ 51 mmHg, serum bicarbonate ≤ 22.6 mEq/L, and loss of consciousness on admission could be considered as prognostic factors of mortality [5]

- The mortality rate was 5.4% [5]

References

[1]急性中毒救命術三版急診急診醫學會p.119-128.

[2]. Bramness JG, Rognli EB. Psychosis induced by amphetamines. Curr Opin Psychiatry. 2016 Jul;29(4):236-41. doi: 10.1097/YCO.0000000000000254. PMID: 27175554.

[3]. Bojsen JA, Lunau L, Nguyen NT, Rasmussen BSB. [Amphetamine-induced toxic encephalopathy]. Ugeskr Laeger. 2022 May 23;184(21):V12210924. Danish. PMID: 35656615.

[4]. Kiew CK, Lam ASEL. Unexpected presentation of acute porphyria. BMJ Case Rep. 2021 Jun 29;14(6):e241580. doi: 10.1136/bcr-2021-241580. PMID: 34187794; PMCID: PMC8245470.

[5] Rahimi M, Lookzadeh S, Sadeghi R, Soltaninejad K, Shadnia S, Pajoumand A, Hassanian-Moghaddam H, Zamani N, Latifi-Pour M. Predictive Factors of Mortality in Acute Amphetamine Type Stimulants Poisoning; a Review of 226 Cases. Emerg (Tehran). 2018;6(1):e1. Epub 2018 Jan 10. PMID: 29503826; PMCID: PMC5827041.

Edited by Yu-Jang Su June 12, 2023

2023年5月1日星期一

Glufosinate

Substance

Glufosinate-Ammonium 13.5%SL

Common name / Trade name

強手(固殺草); 草銨膦

Involving system

- Mechanism: glutamine synthetase-inhibiting [1]

- Interferes with glutamate synthetase activity [2]

- Neurotoxicity.

- Mental disturbances [3]

- Hematological changes

- Gastrointestinal effects [3], nausea.

Presentation

- Altered mental status [4] amnesia [2]

- Fever [2]

- Arrhythmia, [2]

- Seizure, 31.5% [5]

- higher initial ammonia levels. [6]

- respiratory failure. [7]

- Vasogenic edema in striatum [8]

- Shock [2]

Antidote and Treatment

- Activated charcoal, Carbomix [2].

- IVF, monitoring urine output.

- Intubation if respiratory failure

- Monitoring.

- supportive care.

- benzodiazepine for seizure

- Without antidote.

- Hemodialysis [2]

Disposition

- Observe 48 hours, [2]

- Age > 70 years and GCS score < 9 at triage could be predictors of mortality in patients. [4]

- An initial serum ammonia level >151 µg/dL was an independent early predictor of in-hospital mortality [9]

- Older age (≥ 61 years; adjusted OR 4.9) and larger amount of glufosinate ingestion (≥ 13.9 grams; adjusted OR 25.2) were positively associated with the development of severe toxicity [10].

- 6.1% to 17.7% died following deliberate glufosinate ingestion. [2, 10]

References

[1]. https://pubmed.ncbi.nlm.nih.gov/36963955/

[2].Goldfrank’s Toxicology Emergencies p1478—79. 11^th ed.

[3] https://pubmed.ncbi.nlm.nih.gov/9491336/

[4] https://pubmed.ncbi.nlm.nih.gov/34392143/

[5]. https://pubmed.ncbi.nlm.nih.gov/28421825/

[6] https://pubmed.ncbi.nlm.nih.gov/36399183/

[7]. https://pubmed.ncbi.nlm.nih.gov/24044532/

[8] https://pubmed.ncbi.nlm.nih.gov/19581091/

[9]. https://pubmed.ncbi.nlm.nih.gov/31146590/

[10] https://pubmed.ncbi.nlm.nih.gov/22480254/

Edited by Yu-Jang Su May 1st, 2023.

2023年4月12日星期三

Inoxicated / Poisoning-Related Coma Blister

Inoxicated / Poisoning-Related Coma Blister
Year	Country	Age	Gender	Substance	References
2022	US	82	F	lorazepam for insomnia	1
2012	Brazil	45	F	clonazepam, promethazine, oxcarbazepine and quetiapine	2
2009	UK			barbiturate	3
2007	UK	53	F	Acetaminophen 500mg, codeine 30mg	4
2002	Germany			theophylline toxicity	5
2002	Canada			amitriptyline overdose	6
1991	Australia	25	M	carbon monoxide	7
1990	Ichilov	75		200 mg oxazepam	8
1972				BARBITURATE	9

1. https://pubmed.ncbi.nlm.nih.gov/35180064/

2. https://pubmed.ncbi.nlm.nih.gov/22892778/

3. https://pubmed.ncbi.nlm.nih.gov/19359256/

4. https://pubmed.ncbi.nlm.nih.gov/17952753/

5. https://pubmed.ncbi.nlm.nih.gov/12198361/

6. https://pubmed.ncbi.nlm.nih.gov/12447625/

7. https://pubmed.ncbi.nlm.nih.gov/1743385/

8. https://pubmed.ncbi.nlm.nih.gov/2231838/

9. https://pubmed.ncbi.nlm.nih.gov/4116178/

edited by Yu-Jang Su April 12, 2023.

2023年3月25日星期六

BVT, Bidirectional ventricular tachycardia in poisoning

Bidirectional ventricular tachycardia in poisoning – recent nine articles

- QRS axis shifts 180 degrees from left to right with each alternate beat

- Causes: severe digoxin toxicity; or familial catecholaminergic polymorphic ventricular tachycardia (CPVT), herbal aconite poisoning. Caffeine poisoning.

Year	Country	age	gender	Substance	References
2021	USA	78	F	Dogoxin	1
2019	Japan	27	F	Caffeine	2
2016	China	45	F	Aconitine	3
2014	Italy	83	F	Digoxin	4
2012	Japan	43	F	Aconitine	5
2009	Belgium	54	M	Digoxin	6
2005	France	86	F	Digoxin	7
2005	USA	59	F	Aconite	8
1992	Japan	69	M	Aconite	9