Bromism: An overlooked and elusive toxidrome from chronic dextromethorphan abuse.

A 47 year old woman presented to the emergency department for an intentional overdose of an over the counter cough suppressant. She had been seen multiple times over the last several months with the same presentation. Her work up revealed a significantly elevated chloride level (125 mmol/L, normal 98-107) as well as an anion gap of 1.

Marked Hypofibrinogenemia and Gastrointestinal Bleeding After Copperhead (Agkistrodon contortrix) Envenomation.

Compared with other crotaline envenomations, copperhead envenomations have historically been reported as having less severe hematologic venom effects and rarely hemorrhage. We report a case of clinically significant gastrointestinal bleeding after a copperhead (Agkistrodon contortrix) envenomation. A 52-year-old woman with a history of systemic lupus erythematosus was bitten on her right medial ankle after which hypofibrinogenemia and hematochezia developed.

Time to antivenom administration is not associated with total antivenom dose administered in a copperhead-predominant snakebite population.

Objectives: To prevent unnecessary antivenom administration in crotaline snakebite, observation for progression is recommended for the patient with minor envenomation whose condition is stable and not progressing. The objective of this study was to determine the association between the time from bite to initial antivenom administration (Time(AV)) and the total amount of antivenom administered (Total(AV)) and to determine what proportion of patients did not have progression of the envenomation syndrome and did not receive antivenom.

Methods: This was a retrospective chart review of patients presenting with crotaline snakebite within 24 hours from 2009 through 2012.

Toxicity of weight loss agents.

Introduction: With the rise of the obesity epidemic in the United States over the last several decades and the medical complications seen with it, weight loss and dieting have become a national public health concern.

Discussion: Because of their increased use and availability through internet sales, several different dieting agents were reviewed for potential toxicity. These included: syrup of ipecac, cathartics, human chorionic gonadotropin hormone, 2,4 Dinitrophenol, guar gum, phenylpropanolamine, ma huang/ ephedra, caffeine, clenbuterol, fenfluramine, sibutramine, thyroid hormone, orlistat and cannabinoid antagonists.

Adaptation of EPEC-EM Curriculum in a Residency with Asynchronous Learning.

Objective: The Education in Palliative and End-of-life Care for Emergency Medicine Project (EPEC™-EM) is a comprehensive curriculum in palliative and end-of-life care for emergency providers. We assessed the adaptation of this course to an EM residency program using synchronous and asynchronous learning.

Methods: Curriculum adaptation followed Kern's standardized six-step curriculum design process.

Laboratory interferences with the newer cyanide antidote: hydroxocobalamin.

Cyanide poisoning occurs in many smoke inhalation victims. The newest FDA-approved treatment for acute cyanide intoxication is hydroxocobalamin (Cyanokit). However, hydroxocobalamin exhibits chemical properties that can disrupt several clinical laboratory tests.

Expression of Rsf-1, a chromatin-remodeling gene, in ovarian and breast carcinoma.

Rsf-1 protein is a member of a chromatin-remodeling complex that plays an important role in regulating gene expression and cell proliferation. Our previous study showed that Rsf-1 was an amplified gene that participated in the development of ovarian serous carcinoma. To further elucidate the role of Rsf-1 in ovarian cancer, we studied Rsf-1 immunoreactivity in 294 ovarian tumors of various histologic types.