Keywords: holly, berry, poinsettia, mistletoe, berries (PubMed Search)
Toxic Holiday Plants
Of the three plants listed, which is NOT poisonous?
1. Holly plant
Poinsettia plants were once thought to be very poisonous. Contrary to popular belief, poinsettias are safe to have in the home during the holidays.
Although there are reported cases of death with ingestion of Holly plants in older literature, recent experience shows gastrointestinal effects in small doses, and serious toxicity such as CNS depression in large ingestions.
Mistletoe ingestion of few of the berries would, at most, produce mild gastroenteritis; however, ingesting concentrated extracts of the plant, including the berries, may produce serious effects such as seizures, mental confusion, drowsiness, and hallucinations.
Keywords: Dabigatran, warfarin, anticoagulant, thrombin inhibitor (PubMed Search)
Pharmacist's Letter: November 2010; Vol: 26, No. 11
Category: Critical Care
Keywords: endotracheal intubation, medication, acls, resuscitation (PubMed Search)
EMS in Maryland has REMOVED endotracheal medication administration from its ADULT protocols
This is due to:
Keywords: Epinephrine, epi-pen, digital block, finger, ischemia (PubMed Search)
A recent study examined the effects of accidental digital epinephrine injection from auto-injectors. 127 cases with complete follow-up had the following effects:
Pharmacologic vasodilators were used in 23%. Four patients had possible digital ischemia. All patients had complete resolution of symptoms, most within 2 hours. No patient was admitted, received hand surgery consultation, or had surgical care.
Although this speaks for the safety of digital anesthesia using epinephrine, it underscores the importance of providing education to patients who are prescribed epinephrine auto-injectors.
Muck AE, Bebarta VS, Borys DJ, MOrgan DL. Six Years of Epinephrine Digital Injections: Absence of Significanct Local or Systemic Effects. Ann Em Med Sept 2010;56(3);270-4.
Singer AJ. Accidental Digital Self-Injection of Epinephrine: Debunking the Myth. Sept 2010;56(3):275-7.
Category: Infectious Disease
Keywords: rabies, vaccination, animal bite, racoon, bat (PubMed Search)
The number of rabies vaccines recommended by the ACIP (Advisory Committee on Immunization Practices) has been reduced from 5 to 4 doses for unvaccinated patients.
This was based on evidence from multiple source, including pathogenesis data, animal trials, clinical studies, and epidemiological surveillance. The first dose of the 4-dose regimen should be administered as soon as possible after exposure (day 0). Additional doses are then given on day 3, 7, and 14. The first dose of rabies vaccine should be administered with HRIG, infiltrating as much as possible into the wound, with the remainder given IM at a distant site from the vaccine.
This recommendation is not applicable to immunocompromised patients, who should continue to receive the full five doses.
Sullivan, DM. Update on Emerging Infections: News from the Centers for Disease Control and Prevention. Infectious disease/CDC Update. Ann Em Med July 2010;56(1):64-6.
Keywords: pediatrics, toxicology, antidepressant, antimalarial, antipsychotic, calcium channel, aspirin (PubMed Search)
There are a several classes of medications that can kill a toddler with a single dose. Toddlers are particularly susceptible due to their low weights and propensity to place everything in their mouths.
1. Calcium channel blockers
2. Camphor-containing rubs
4. Oil of wintergreen/ aspirin
5. Cyclic antidepressants
6. Topical blood pressure patches (clonidine)
7. Eye drops and nasal sprays (oxymetazoline)
9. Antimalarial drugs (cloroquine)
1. Morris-Kukowski, C. England AG. Toxicity, Deadly in a Single Dose. Emedicine, Pediatrics.
Keywords: Product recall, tylenol, zyrtec, motrin, pediatric, acetaminophen, ibuprofen, certirizine (PubMed Search)
It is likely that you will be asked questions about the huge recall by McNeil..
It stems from complaints received of black particles found in the pediatric liquid formulation, which are manufactured at one facility in Fort Washington, PA. The FDA inspected the plant and found inadequate quality standard testing and facilities. Either there were potential bacteria in one of the raw products (which did not make it to the final product), or the final concentrations were stronger than specified.
McNeil recalled forty-three formulations of pediatric liquid tylenol, zyrtec, motrin and benadryl. Generic versions are unaffected.
Complete recall information:
For more information and links:
Keywords: acetaminophen; acetylcysteine (PubMed Search)
Martello JL, Pummer TL, Krenzelok EP. Cost minimization analysis comparing enteral N-acetylcysteine to intravenous acetylcysteine in the management of acute acetaminophen toxicity. Clin Tox Jan 2010; 48(1):79-83
Keywords: Lavage, activated charcoal, hyperinsulinemia, intralipid, toxicology, narcan (PubMed Search)
| Cutting Edge || Old School |
|Hyperinsulinemia and Euglycemia||Supportive care, glucagon for beta blocker overdoses|
|Intralipid administration||Supportive care for anesthetic overdoses, TCAs, and other lipid soluble agents|
|Low dose or NO narcan||High dose narcan for opoid overdoses|
|Checking salicylates and tylenol levels for overdose||Tox screens for everyone|
Keywords: antibiotics, imipenem, meropenem, doripenem, ertapenem, colistin, amikacin, multiresistant (PubMed Search)
1. Lee S. Engel MD. Multidrug-Resistant Gram-Negative Bacteria: Trends, Risk Factors, and Treatments. Emerg Med 41(11):18, 2009.
2. Journal of Antimicrobial Chemotherapy, 2004;Vol 54(6) Pp. 1155-1157
Keywords: DMSA, succimer, lead, arsenic, mercury (PubMed Search)
Keywords: Diabetes; incretin; dipeptidyl peptidase; dpp (PubMed Search)
NEW TREATMENT in diabetes
It was discovered that glucose given ORALLY caused more insulin release than glucose administered INTRAVENOUSLY. This led to the discovery of the incretin hormones, which are secreted by the gut (INtestinal SECRETion of INsulin), GIP and GLP-1.
The incretin-based therapies increase levels of GLP-1, either by providing an incretin mimetic (exenatide and liraglutide), or by inhibiting their breakdown by DPP-4 (sitagliptin, saxagliptin, vilagliptin)
Their administration results in:
STAY TUNED FOR DOSING AND ADVERSE EVENTS!
Barnett AH. New Treatment in type 2 Diabetes: A Focus on the Incretin-Based Therapies. Clinical Endocrinology Sep 2008;70(3):343-53.
Keywords: Iron; Poisoning; Deferoxamine (PubMed Search)
|Checking TIBC to determine if treatment is necessary||Checking iron levels...If peak is > 500 mcg/dl, or the patient shows signs of systemic toxicity, treat with deferoxamine|
|Deferoxamine challenge... no longer recommended!||Using WBI for ingestion of 20 mg/kg iron, if visible iron pills on x-ray, or symptoms of mild toxicity (for treatment of severe toxicity see above)|
|Platform shoes||Strappy sandals|
WBI: whole bowel irrigation
Reminder from Poisondex:
OVERDOSE: SEVERE: Stupor, shock, acidosis, GI bleed, coagulopathy, hepatotoxicity, and coma. MILD/MODERATE: Nausea, vomiting, diarrhea, lethargy, leukocytosis, and hyperglycemia. Clinical phases: (1) 0-2 hours: Nausea, vomiting, diarrhea, and abdominal pain. Lethargy, shock, GI bleeding, and acidosis if severe; (2) Apparent recovery; (3) 2-12 hours: Acidosis, hypotension; (4) 2-4 days: Hepatotoxicity; (5) days-weeks: GI strictures.
Balmadrid C, Bono M. Recognizing and Managing Iron Toxicity. Emergency Medicine May 2009;14-21.
Keywords: Menthol, camphor, vicks, seizure (PubMed Search)
Vicks VapoRub Toxicity
With the removal of OTC product indications for children under the age of 2 for cough and colds, more parents are turning to other agents such as Vicks VapoRub for the relief of cough and cold symptoms. Unfortunately these agents are also associated with toxicities and the potential exists for an increased number of poisonings. The primary components of these agents are:
Menthol is used to relieve symptoms of chest congestion. There is NO data to support efficacy, and paradoxically, studies have indicated increased airflow resistance with application. There is a case report of an 18 month old who developed respiratory distress after application. Symptoms associated with overdose, or inappropriate route (mucosal, oral) are:
Camphor in products with higher concentrations such as Campho-phenique can cause additional toxicity with effects:
Treatment for both is supportive.
"Vicks VapoRub Safety in Children" Pharmacists Letter: Detail Document 250306, March 2009
Keywords: Oseltamivir,tamiflu,h1n1,influenza (PubMed Search)
For complete indications and dosing: www.cdc.gov/h1n1flu/recommendations.htm
Keywords: ethanol,fomepizole,toxic alcohols,ethylene glycol,methanol (PubMed Search)
Keywords: Clevidipine, calcium channel antagonist, calcium channel blocker, antihypertensive (PubMed Search)
1. Anon. The Medical Letter. Sept 22 2008;50(1295)73-4.
Keywords: Clopidogrel, DVT, thrombosis, stents (PubMed Search)
Keywords: Cocaine, stroke, crack lung, headache, seizures, hyperthermia, stroke (PubMed Search)
Although we tend to think of ACS with cocaine use, there are many other serious complications, including:
1. Glauser J, Queen JR. Non-Cardiac Cocaine Toxicity. JEM Feb 2007;32(2):181-6.
Keywords: Fat emulsion, intralipid, local anesthetic (PubMed Search)
1. Felice, Kristen. Schumann, Heather. J Med Toxicol. 4(3):184-91, 2008 Sept 4(3):184-91, 2008 Sep.