Retrospective analysis of ingestions of iron containing products in the united states: are there differences between chewable vitamins and adult preparations?

Iron is the one of the leading causes of pediatric poisoning deaths in the United States. Most cases of serious iron overdose reported in the medical literature have resulted from adult formulations of iron. To begin evaluating the possibility that differences in toxicity exist between iron preparations, we performed a retrospective evaluation of all exposures to pediatric and adult iron products reported to the American Association of Poison Control Centers' (AAPCC) Toxic Exposure Surveillance System (TESS) from 1983 to 1998.

Refining the level for anticipated hepatotoxicity in acetaminophen poisoning.

Treatment of an acetaminophen overdose with N-acetyl cysteine usually is based on the position of the 4-h acetaminophen (APAP) level on the Rumack-Matthew nomogram; however, there is disagreement on the level at which clinically relevant hepatotoxicity occurs. A retrospective review of all acute adult formulation APAP exposures reported to our poison center between 1986 and 1993 was performed and cases corresponding to the "possible risk or toxicity" range on the nomogram were identified. Our current poison center protocol for APAP poisoning does not recommend treatment with N-acetylcysteine (NAC) in low-risk patients if the 4-h serum APAP level or the extrapolated equivalent falls within the possible toxicity range on the nomogram.

Hypermagnesemia following an acute ingestion of Epsom salt in a patient with normal renal function.

Hypermagnesemia is a rare condition that commonly follows excessive therapeutic administration of magnesium sulfate to treat eclampsia of pregnancy. Signs and symptoms of this condition include extreme muscle weakness, loss of deep tendon reflexes, mental status depression, and cardiac dysrhythmias. Clinically significant hypermagnesemia following oral or rectal administration of magnesium containing products in patients with normal renal function is rare.

Iron overdose and detection of gastrointestinal bleeding with the hemoccult and gastroccult assays.

Study Objective: To determine the ability of the Hemoccult and Gastroccult tests (SmithKline Diagnostics) to detect blood in vitro in whole-bowel irrigation (WBI) solution.

Interventions: One tablet of ferrous gluconate 324 mg, ferrous sulfate 325 mg, or ascorbic acid 500 mg; or one Materna prenatal vitamin tablet (Lederle Laboratories) was dissolved in 30 mL of Colyte. Colyte alone and each test solution were tested with Hemoccult and Gastroccult slides, then retested at pH values of 3 and 8.

Ciguatera fish poisoning. A southern California epidemic.

Ciguatera fish poisoning results from the bioconcentration of a variety of toxins produced by marine dinoflagellates. Signs and symptoms vary widely, but it usually presents as gastrointestinal and neurologic complaints beginning shortly after the ingestion of fish containing the toxins. Symptoms may persist for months and sometimes even years.

Raising the decontamination level for thyroid hormone ingestions.

Ninety-two pediatric cases (age < or = 6 years) of acute thyroid hormone ingestions that were reported over a 20-month period to one American Association of Poison Control Centers (AAPCC)-certified regional poison center were reviewed to determine whether significant toxicity in pediatric patients is associated with acute ingestions of < or = 5 mg levothyroxine (T4) equivalent of thyroid hormone and the highest-tolerated milligram-per-kilogram dose. Parameters evaluated included patient weight, amount ingested, drug preparation, treatment type, outcome, management site, and relevant comments. Eight patients had mild symptoms requiring no specific medical intervention and there was no correlation between the amount ingested and symptoms observed.

Cholinergic toxicity resulting from ocular instillation of echothiophate iodide eye drops.

A patient developed a severe cholinergic syndrome from the use of echothiophate iodide ophthalmic drops, presented with profound muscle weakness and was initially given the diagnosis of myasthenia gravis. Red blood cell and serum cholinesterase levels were severely depressed and symptoms resolved spontaneously following discontinuation of the eye drops.

Sunlight and the plant: a toxic combination: severe phytophotodermatitis from Cneoridium dumosum.

A severe case of phytophotodermatitis occurred in a patient who had spent several hours walking through an area densely populated with Cneoridium dumosum. This patient's co-worker experienced a similar reaction after undergoing patch testing of an area of skin and exposing it to sunlight. Voluntary patch testing by one of the authors produced a reaction consistent with the other two cases.

Characterization of the enzymatic lesion in inherited phosphofructokinase deficiency in the dog: an animal analogue of human glycogen storage disease type VII.

Mammalian phosphofructokinase (PFK; ATP:D-fructose-6-phosphate 1-phosphotransferase, EC 2.7.1.