Acute Renal Insufficiency Associated With Consumption of Hydrocodone- and Morphine-Adulterated Kratom (Mitragyna Speciosa).

Background: Kratom (Mitragyna speciosa), an evergreen tree native to Southeast Asia, contains alkaloids that cause both stimulant and opioid-like effects. In the United States, its use continues to grow. Kratom products, however, are unregulated and nonstandardized, and reports of adulteration have been described previously.

Cardiovascular risk of rosiglitazone: another perspective.

Rosiglitazone is an effective therapy for type 2 diabetes although concerns have grown about the incidence of oedema and cardiovascular adverse events in patients treated with the drug. The following review was conducted to evaluate further and complement the evidence linking rosiglitazone with an increased risk for cardiovascular adverse events by examining trials and case reports not included in recent meta-analyses. Rosiglitazone-related publications describing case reports and prospective and retrospective cohort analyses were identified using MEDLINE and EMBASE, from July 1999 to July 2007.

Contrast sensitivity in occupational and environmental neurotoxicology: what does it really mean?

Contrast sensitivity (CS) emerged more than 30 years ago as an alternative to traditional acuity testing, and recently it has become the focus of attention in the field of neurotoxicology. CS testing may be useful for detecting defects in oculoneural processing and therefore possible chemical-induced neurotoxicity, such as solvent-induced encephalopathy. The authors' objective in this article is to introduce the concept of CS and CS testing, summarize recent reports describing its use in occupational and environmental toxicology, and challenge the validity of CS testing in its present state as a toxicological assessment.

Insulin & C-peptide levels in sulfonylurea-induced hypoglycemia: a systematic review.

Objectives: We will describe insulin and C-peptide levels observed in sulfonylurea-induced hypoglycemia and determine whether these levels differed if obtained before or after hypoglycemic therapy.

Methods: We performed a systematic review of the English literature to identify Medline articles containing "sets" (glucose <60 mg/dL with insulin and C-peptide levels). These "sets" were categorized as being obtained BEFORE, AFTER, or UNKNOWN with respect to hypoglycemic therapy.

Incidence of Brugada electrocardiographic pattern and outcomes of these patients after intentional tricyclic antidepressant ingestion.

Brugada syndrome is a genetic dysfunction of the myocardial sodium channel that leads to ventricular dysrhythmias. The electrocardiographic (ECG) pattern of Brugada syndrome is occasionally seen after tricyclic antidepressant (TCA) ingestion; however, the outcome and complication risk for these patients is not clear. The objective of our study was to describe the incidence of Brugada ECG pattern (BEP) and serious complications of these patients in a large case series of intentional TCA ingestions.

Nonselective nonsteroidal antiinflammatory drugs and cardiovascular risk: are they safe?

Objective: To assess possible cardiovascular risks associated with use of nonselective nonsteroidal antiinflammatory drugs (NSAIDs).

Data Sources: MEDLINE and EMBASE were searched from January 1985 through April 2007 and relevant studies were retrieved.

Study Selection And Data Extraction: Peer-reviewed, prospective, double-blind, case-control, and cohort-design studies published in the English language literature were considered eligible for review.

Amitriptyline-induced Brugada pattern fails to respond to sodium bicarbonate.

This report describes a Brugada electrocardiographic pattern after tricyclic antidepressant intoxication that fails to resolve following sodium bicarbonate treatment. A 50-year-old male ingested 13.6 grams of amitriptyline and presented in cardiopulmonary arrest.

Pharmacology, pathophysiology and management of calcium channel blocker and beta-blocker toxicity.

Calcium channel blockers (CCB) and beta-blockers (BB) account for approximately 40% of cardiovascular drug exposures reported to the American Association of Poison Centers. However, these drugs represent >65% of deaths from cardiovascular medications. Yet, caring for patients poisoned with these medications can be extremely difficult.

Polymer fume fever-like syndrome due to hairspray inhalation.

Inhalation of fluoropolymer pyrolysis products causes a self-limited illness termed polymer fume fever; symptoms include fever, chills, myalgias and non-productive cough, and are easily mistaken for an acute viral illness. We report a 29-y-old male who developed fever and pneumonitis shortly after the inhalation of pyrolyzed hairspray. Chest x-rays showed pictures consistent with pneumonitis.

Hepatorenal solvent toxicology.

The liver and kidneys are tissues with a rich blood supply. Thus, with significant exposures, these tissues may be at risk for anatomic or pathophysiologic alterations. It is important to understand the gross, microscopic, and functional anatomy of these important organs to analyze potential adverse effects of solvents.

Solvents and vapor intrusion pathways.

Vapor intrusion must be recognized appropriately as a separate pathway of contamination. Although many issues resemble those of other forms of contamination (particularly its entryway, which is similar to that of radon seepage), vapor intrusion stands apart as a unique risk requiring case-specific action. This article addresses these issues and the current understanding of the most appropriate and successful remedial actions.

Biologic markers of exposure to chlorinated solvents.

This article presents the current knowledge and clinical applications of the use of biomarkers of exposure to the halogenated solvents 1,1,1 trichloroethane (methylchloroform), trichloroethylene, tetrachloroethylene (perchloroethylene), and 1,1 dichloroethylene (vinylidene chloride). Although some studies have shown that protein and DNA adducts may form with chlorinated hydrocarbons, their application has not been validated sufficiently to justify their use as biologic markers of exposure.

Acute, transient urinary retention from combined ecstasy and methamphetamine use.

Methamphetamine and 3,4-methylenedioxymethamphetamine (MDMA or "ecstasy") are synthetic amphetamine analogs that have become increasingly popular, particularly among adolescents and young adults. Many deleterious physiologic effects arising from the use of these agents have been well documented in the medical literature. Urinary retention, however, has rarely been reported as an effect of MDMA or methamphetamine use and is thought to occur as a result of alpha-adrenoceptor stimulation of the bladder neck.