Keywords: drug interactions, disulfiram, bactrim, tinidazole, metronidazole (PubMed Search)
Other common medications that produce this reaction:
1. Sulfonylureas: chlorpropamide, tolbutamide, glyburide
2. Cardiovascular medications: Isosorbide dinitrate, nitroglycerin
Weathermon R, Crabb DW. Alcohol and Medication Interactions. Alcohol Research and Health. 1999 (23);1:40-54.
Keywords: mercury, poisoning (PubMed Search)
Keywords: Salicylate, aspirin, metabolic acidosisM (PubMed Search)
First Line Therapy: Urine Alkalinization (pH >7.5) by administrating NaHCO3
Other Indications for Hemodialysis in Salicylate Poisoned Patient:
Keywords: lactic acidosis, metformin, renal failure (PubMed Search)
Perrone et al. Occult metformin Toxicity in Three patients with profound lactic acidosis. J Emerg Med 2008, June 18.
Keywords: drugs of abuse, heroin (PubMed Search)
Keywords: dapsone, methemoglobinemia, methylene blue (PubMed Search)
Keywords: coumadin, vitamin K, anticoagulation (PubMed Search)
Here is a short list of medications that will actually prevent a patient from being anticoagulated by coumadin. These medications will make it difficult for the patient to reach therapeutic levels and need to be warned about this drug-drug interaction with coumadin:
Reference: Goldfrank's Textbook of Toxicologic Emergencies, 6th Edition
Keywords: transdermal, fentanyl, clonidine (PubMed Search)
Trandermal Delivery Systems
Keywords: sedation, propofol, ketamine (PubMed Search)
"Ketofol" (Ketamine plus propofol)
Keywords: chlorine, pneumonitis (PubMed Search)
Pool Cleaner Toxicity - Chlorine Gas Exposure
The "shock" treatment that is utilized in pool cleaner is often contained in a large plastic container and is calcium hypochlorite. Chlorine gas accumulates in the small amount of airspace found in the container. If a future patient opens the container either in an enclosed space or within close proximity of the face that allows for large inhalational exposure.
Keywords: cyanide (PubMed Search)
Toxicology Trivia for $1000 - These are in fruits of the "rose" family and in some roots that contain cyanogenic glycosides and other cyanide containing compounds. It would actually take a fair amount of work to ingest enough to reach toxicity:
Bass. Sudden Sniffing Death. JAMA 1970.
Keywords: prolonged QT, arrhythmia, adverse effect, antiarrhythmics, antibiotics, antipsychotics (PubMed Search)
Other factors that are associated with prolonged QT include: bradycardia, female sex, genetics, and electrolyte abnormalities.
Kannakeril PJ, Roden DM. Drug-Induced long QT and torsade de pointes: recent advances. Current opinions in cardiology. Jan 2007;22(1):39-43.
Horn JR, Hansten PD. Drug Interactions and QT Interval Prolongation. Pharmacy Times Dec 2004. pp66.
Keywords: amanita, mushrooms, liver (PubMed Search)
How to recognize a truly toxic mushroom ingestion (remember one mushroom can be lethal!):
1) Onset of GI symptoms within 3 hours from time of ingestion: USUALLY NONTOXIC
- Control nausea and vomiting
- Look for toxidrome: hallucinations, muscarinic symptoms, lethargy
2) Onset of GI symptoms greater than 5 hrs is associated with more toxic mushrooms
- High degree of suspicion for a cyclopeptide mushroom (Amanita phylloides)
- Follow liver enzymes and consier referral to liver transplant center
Keywords: dialysis, lithium salicylate (PubMed Search)
Keywords: naloxone, opioids (PubMed Search)
1) No IV - Try naloxone in a nebulizer - Dose: 2-4 mg and saline in your nebulizer container.
2) When using naloxone IV, use following dose: 0.05 mg IV - you will find it reverses the respiratory depression without inducing withdrawal. Anesthesia doses naloxone in micrograms, we often overdose our patients. The effect is delayed and not as pronounced as the 0.4 mg blast that causes nausea, vomiting, diarrhea, agitation - all not desirable in the ED.
Keywords: antiepileptics, suicide, carbamezepine, felbamate, gabapentin, lamotrigine, levetiracetam, valproate, pregabalin (PubMed Search)
SUICIDE RISK WITH ANTIEPILEPTICS
Drugs in the analysis included:
Carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol XR)
Valproate (Depakote, Depakote ER, Depakene, Depacon)
Interestingly, other agents including varenicline (a partial nicotinic antagonist, for smoking cessation), levetiracetam (Keppra), zolpidem (Ambien), oseltamivir (Tamiflu), isotretinoin (Accutane), and other agents have been noted to have an increased rate of bizarre and aggressive behavior.
There is actually very little data that actually supports the administration of activated charcoal (AC) to the poisoned patient. AC works by binding the toxin and preventing its absorption from the GI tract. Here are some of the practical points:
Once you have assessed your risk:benefit ratio, then administer AC. Of note, it definitely works in the right situation as noted in a landmark article that showed a decrease in mortality following poisoning by oleander - a plant that contains a digoxin like substance.(1)
1 - de Silva HA, et al. Multiple-dose activated charcoal for treatment of yellow oleander poisoning: a single-blind, randomised, placebo-controlled trial. Lancet 2003: 361(9373):1935-8.
Keywords: heparin, chondroitin, toxicity (PubMed Search)
Heparin FDA Alert
In case you had not heard, there was a major recall of Baxter's Heparin. It was responsible for dozens of deaths in the USA and an investigation was launched. It has been found that the contaminant comes from manufacturing plants in China. The most concerning part is that it looks like it was chemically synthesized sulfated chondroitin. This brings the suspicion of intentional adulteration. First lead in toys now cartilage in our heparin - what's next?
Some fascinomas of Heparin:
News link for FDA Heparin Alert:
Keywords: sumatriptan, myocardial infarction, migraine (PubMed Search)