Assessing the Role of Initial Serum Calcium Concentration in Patients with Ethylene Glycol Poisoning.

Introduction: Assays for ethylene glycol (EG) with a rapid turn-around time are not routinely available. Clinicians must rely on historical features and readily available clinical tests, combined with clinical acumen, to guide the initial management of suspected EG poisoning. Hypocalcemia has been suggested as a clue supporting the diagnosis of EG poisoning in patients presenting with an unexplained high anion gap metabolic acidosis (HAGMA).

Predictors of severe outcome following opioid intoxication in children.

Introduction: While the opioid crisis has claimed the lives of nearly 500,000 in the U.S. over the past two decades, and pediatric cases of opioid intoxications are increasing, only sparse data exist regarding risk factors for severe outcome in children following an opioid intoxication.

Monoamine oxidase A inhibition by toxic concentrations of metaxalone.

Serotonin toxicity is a reported complication associated with both therapeutic use and overdose of metaxalone while on therapeutic doses of serotonergic drugs such as serotonin reuptake inhibitors. Monoamine oxidase A (MAO-A) inhibition by metaxalone has been proposed as the etiology of this toxicity. Metaxalone concentrations reported with cases of serotonin toxicity range from 31 to 61 mcg/ml (140-276 µM).

Fentanyl- and fentanyl analog-related deaths across five counties in Central New York between 2013 and 2017.

Deaths due to drug overdose in the US in 2017 amounted to approximately 72,000, an increase of 12% from the previous year. There was a near tenfold increase in deaths involving synthetic opioids from 3,105 in 2013 to approximately 30,000 in 2017. Recent data from the United States (US) Centers for Disease Control and Prevention (CDC) identified fentanyl as most frequently involved in overdose deaths in the US as of 2016.

Can elevated lactate and LDH produce a false positive enzymatic ethanol result in live patients presenting to the emergency department?

Background: There have been allegations in the courtroom that elevated serum lactic acid in trauma victims can yield a falsely elevated serum ethanol assay. Most hospitals utilize an indirect method of ethanol measurement where a serum sample is added to a mix of alcohol dehydrogenase and oxidized nicotinamide adenine dinucleotide (NAD+). This allows any ethanol in the patient's serum to be metabolized to acetaldehyde, and in the process results in the reduction of NAD + to NADH.

Serum Calcium Concentration in Ethylene Glycol Poisoning.

Introduction: The diagnosis of ethylene glycol intoxication can be challenging. Definitive testing for ethylene glycol is not readily available and clinical decisions are often based on clinical suspicion and the results of more readily available tests. One of these findings is hypocalcemia, presumable through complexation with the ethylene glycol metabolite oxalate.

The Influence of Polyethylene Glycol Solution on the Dissolution Rate of Sustained Release Morphine.

Introduction: Whole bowel irrigation (WBI) is a management option for overdose of medications poorly adsorbed to activated charcoal, with modified release properties, or for body packers. Polyethylene glycol (PEG) is a mixture of ethylene oxide polymers of varying molecular weight. PEG with an average molecular weight of 3350 g/mol is used for WBI.

Serotonin syndrome following metaxalone overdose and therapeutic use of a selective serotonin reuptake inhibitor.

Unlabelled: Metaxalone has only recently been associated with serotonin syndrome. The mechanism of action of this centrally acting muscle relaxant is unknown; however, the observation of serotonin syndrome in patients with metaxalone overdose suggests a role in the serotonergic pathway.

Case Report: (Case 1) A 29-year-old woman with overdose of metaxalone presented to the emergency department with altered mental status, seizure-like activity, hyperthermia, rigidity in the lower extremities, myoclonus, and hyperreflexia.

A review of acetaminophen poisoning.

Acetaminophen poisoning remains one of the more common drugs taken in overdose with potentially fatal consequences. Early recognition and prompt treatment with N-acetylcysteine can prevent hepatic injury. With acute overdose, the Rumack-Matthew nomogram is a useful tool to assess risk and guide management.

Baclofen overdose mimicking brain death.

Context: Brain death guidelines should be used with caution in patients with drug intoxication. It is often suggested that physicians use five half-lives of a drug when observing a patient with an overdose. We report two cases of baclofen intoxication where brain death was entertained as an explanation for prolonged coma, with arousal seen days later, suggesting that routine use of a 5-half-life observation period is insufficient with baclofen intoxication.

Seizure and coma following Kratom (Mitragynina speciosa Korth) exposure.

Reports of toxicity secondary to Kratom are rare and lack of diagnostic testing in human specimens has prevented confirmatory explanation of observed clinical effects. We present a novel case of serious human toxicity following Kratom use confirmed via quantitative analysis of urine by high performance liquid chromatography coupled to electrospray tandem mass spectrometry. A 64 year-old male was witnessed to have a seizure at home following kratom consumption.

Profound metabolic acidosis and oxoprolinuria in an adult.

Introduction: Profound metabolic acidosis in critically ill adults sometimes remains unexplained despite extensive evaluation.

Case Report: A 58-year-old female presented in a confused state to the emergency department; she had been confused for several days. Laboratory evaluation revealed a high anion gap metabolic acidosis and modestly elevated acetaminophen level.

Diethylene glycol: widely used solvent presents serious poisoning potential.

Objective: To describe the serious toxicity of a readily available solvent, diethylene glycol (DEG). We describe a case of intentional ingestion of a wallpaper stripper containing DEG resulting in severe multi-system organ failure.

Case Report: A 27-year-old male presented to the Emergency Department (ED) one day after ingesting wallpaper stripper containing DEG.