Urinary Gadolinium Levels After Contrast-Enhanced MRI in Individuals with Normal Renal Function: a Pilot Study.

Introduction: Gadolinium-based contrast agents (GBCA) have been used to enhance magnetic resonance imaging (MRI) since 1985. Recently, the media and online groups have voiced concerns about gadolinium deposition in patients with normal renal function based on "elevated" urinary gadolinium levels. The determination of increased urinary gadolinium levels is based on reference ranges developed in individuals with normal renal function who were never exposed to GBCA.

Dinitrophenol (DNP) Fatality Associated with a Falsely Elevated Salicylate Level: a Case Report with Verification of Laboratory Cross Reactivity.

Introduction: 2,4-Dinitrophenol (DNP) is a known uncoupler of oxidative phosphorylation that clinically leads to hyperthermia, tachycardia, tachypnea, and metabolic acidosis. Intentional overdoses of DNP are often fatal. We present an analytically confirmed fatal case of DNP overdose with a falsely positive elevated salicylate concentration.

ACMT Position Statement: Alternative or Contingency Countermeasures for Acetylcholinesterase Inhibiting Agents.

First responders and health care providers must prepare to provide care for patients poisoned by acetylcholinesterase (AchE) inhibitor chemical warfare agents or pesticides. However, pre-deployed medical countermeasures (MCMs) may not be sufficient due to production and delivery interruption, rapid depletion of contents during a response, expiration of MCM components, or lack of local availability of approved MCMs. To augment supplies of community-based and forward-deployed nerve agent countermeasures, the American College of Medical Toxicology (ACMT) supports several strategies: (1) The use of expired atropine, diazepam, and pralidoxime auto-injectors and vials if non-expired drugs are unavailable; and (2) Investigation, development, and identification of alternative countermeasures-commonly stocked drugs that are not approved for nerve agent poisoning but are in the same therapeutic class as approved drugs.

Detection of ingested nitromethane and reliable creatinine assessment using multiple common analytical methods.

Aim: Nitromethane, found in fuels used for short distance racing, model cars, and model airplanes, produces a falsely elevated serum creatinine with standard creatinine analysis via the Jaffé method. Erroneous creatinine elevation often triggers extensive testing, leads to inaccurate diagnoses, and delayed or inappropriate medical interventions. Multiple reports in the literature identify "enzymatic assays" as an alternative method to detect the true value of creatinine, but this ambiguity does not help providers translate what type of enzymatic assay testing can be done in real time to determine if there is indeed false elevation.

Evaluation of toxicity after acute accidental methotrexate ingestions in children under 6 years old: a 16-year multi-center review.

Context: There is little data on the frequency of adverse events following acute methotrexate ingestions in pediatric patients. Likewise, recommendations for observation length, site and management strategies in this population are not well established. Therefore, most recommendations are modeled after management of chronic overdose in patients with underlying medical conditions.

Pilot Trial of Intravenous Lipid Emulsion Treatment for Severe Nifedipine-Induced Shock.

Animal studies and human case reports show promise in using lipid rescue to treat refractory calcium channel antagonist toxicity. However, the majority of research and clinical experience has focused on non-dihydropyridine agents. Thus, we sought to investigate the value of lipid emulsion (ILE) therapy for dihydropyridine-induced shock.

Clinical Features of Reported Ethylene Glycol Exposures in the United States.

Background: Ethylene glycol is highly toxic and represents an important cause of poisonings worldwide. Toxicity can result in central nervous system dysfunction, cardiovascular compromise, elevated anion gap metabolic acidosis and acute kidney injury. Many states have passed laws requiring addition of the bittering agent, denatonium benzoate, to ethylene glycol solutions to reduce severity of exposures.

Demographics and outcome of unintentional insulin overdoses managed by three poison centers.

Unlabelled: Insulin dosing errors are one of the most dangerous medication issues due to the risk of profound hypoglycemia. The incidence of insulin dosing errors is increasing and there is no standard of care for management location.

Objective: To determine the types of insulin, follow-up time, number of phone calls, incidence of hypoglycemia, and case outcomes for unintentional insulin overdoses managed by Poison Centers (PCs).

Laundry detergent "pod" ingestions: a case series and discussion of recent literature.

Objectives: The objectives of this study were to present and explore the clinical presentation of the increasingly common pediatric exposure to the widely available single-use laundry packets or "laundry pods."

Methods: This is a case report of 4 pediatric patients with significant toxicity due to laundry pod detergent exposure and a review of the available literature including abstract-only publications.

Results: An unexpectedly severe clinical pattern was noted; 3 of the 4 children required intubation for management, airway injury was noted in 1 of them, and 2 of them had hospital courses of at least 1 week.

Is nurse interpretation of the ECG QRS width reliable?

Electrocardiogram (ECG) data are critical in formulating management strategies following sodium channel antagonist overdose. Poison centers frequently rely on verbal reports of the ECG obtained from bedside nurses. No previous study has addressed the quality of ECG data obtained in this manner.

A controlled evaluation of case clinical effect coding by poison center specialists for detection of WMD scenarios.

Background: Many public health entities employ computer-based syndromic surveillance to monitor for aberrations including possible exposures to weapons of mass destruction (WMD). Often, this is done by screening signs and symptoms reported for cases against syndromic definitions. Poison centers (PCs) may offer significant contributions to public health surveillance because of their detailed clinical effect data field coding and real-time data entry.

Unintentional poisoning in North Carolina: an emerging public health problem.

Unintentional poisoning is a fast-growing public health problem that once evoked an image of a street denizen injecting heroin or snorting cocaine. Today's victim is white, male, and middle-aged--and the drugs are prescribed. In North Carolina, unintentional poisoning is the second-leading cause of death due to unintentional injury, and injuries due to any cause are the leading cause of potential years of life lost.

The outcome of unintentional pediatric bupropion ingestions: a NPDS database review.

Unintentional bupropion pediatric exposures uncommonly report severe clinical effects such as seizures. We sought to determine the clinical effects and case outcomes for unintentional bupropion ingestions in children age View Article and Find Full Text PDF

The outcome of North American pediatric unintentional mushroom ingestions with various decontamination treatments: an analysis of 14 years of TESS data.

The optimum empiric decontamination therapy for unintentional pediatric mushroom ingestion is not known. We sought to determine case outcomes for unintentional mushroom ingestions in children by decontamination therapies utilized. The 1992-2005 American Association of Poison Control Centers Toxic Exposure Surveillance System was queried for cases of unintentional acute mushroom ingestions in children age <6 years.

Severe illness in furniture makers using a new glue: 1-bromopropane toxicity confounded by arsenic.

Objective: To describe the illnesses of four workers with high concentrations of serum bromide after exposure to glue containing 1-bromopropane (1-BP).

Methods: We reviewed all available clinical records, examined the workers, and obtained additional urinary arsenic values. We used standard autoanalyzer and other routine methods for blood and urinalysis.

False positive acetaminophen levels associated with hyperbilirubinemia.

Serum acetaminophen determination is frequently necessary in patients with hepatic failure. We observed two patients (#1, #2) with elevated serum total bilirubin levels (26.5 mg/dL and 40.

Stress testing in the medical evaluation for hazardous materials duty: results and consequences in three groups of candidates.

Objective: The objective of this study was to determine the yield of exercise stress testing (GXT) and other methods for evaluating candidates for HAZMAT duty.

Methods: The authors conducted an analysis of prior and current records of GXTs, medical examinations, blood tests, chest radiographs, spirometry, and audiometry in 190 candidates. The authors also conducted scrutiny of GXT results, using Duke Treadmill Score (DTS), Chronotropic Index (CI), and Heart Rate Recovery (HRR).

Severe puff adder (Bitis arietans) envenomation with coagulopathy.

Background: The puff adder (Bitis arietans) is a highly toxic venomous snake that is responsible for a large proportion of the venomous snakebites in sub-Saharan Africa, where it is indigenous. Puff adder bites in North America result from snakes in captivity. Although thrombolytic enzymes are present in puff adder venom, significant coagulopathy has not been previously reported with a confirmed puff adder envenomation.

Poison control in North Carolina.

Poison centers contribute importantly to public health. They provide expert emergency advice without charge, offer early telephone triage of poisoning cases, assist parents and caretakers in managing simple exposures at home, and recommended hospital evaluation for patients suspected of serious exposure. Their efforts lead to significant cost savings by averting unnecessary medical evaluations.

The therapeutic value of cranberries in treating and preventing urinary tract infections.

Studies bearing on the therapeutic value of cranberries in the prevention and/or treatment of urinary tract infections are reviewed. Research results are grouped to address the following questions: 1) Does cranberry juice ingestion acidify urine? 2) Does cranberry juice inhibit the adherence of bacteria to bladder cells? 3) What research evidence exists to support that cranberry juice is an effective intervention for urinary tract infections? And 4) Does cranberry ingestion enhance antibiotic effectiveness?