Acute exposure to hydrazine reported to four United States regional poison centers: reconsidering a paradigm.

Introduction: Exposures to hydrazines occur during aeronautic and space operations and pose a potential risk to personnel. Historically, extensive preparatory countermeasures have been taken due to concern for severe toxicity. This study seeks to better understand manifestations of acute occupational exposures to hydrazine to guide recommendations for management.

Management of Acetaminophen Poisoning in the US and Canada: A Consensus Statement.

Importance: The US and Canada currently have no formal published nationwide guidelines for specialists in poison information or emergency departments for the management of acetaminophen poisoning, resulting in significant variability in management.

Objective: To develop consensus guidelines for the management of acetaminophen poisoning in the US and Canada.

Evidence Review: Four clinical toxicology societies (America's Poison Centers, American Academy of Clinical Toxicology, American College of Medical Toxicology, and Canadian Association of Poison Control Centers) selected participants (n = 21).

Angiotensin II Use in Treatment of Refractory Shock Due to Benazepril and Amlodipine Toxic Ingestion.

Calcium channel blockers (CCB) are a leading cause of ingestion-associated fatality. Angiotensin-converting enzyme inhibitor (ACEi) overdose as part of co-ingestion is common and associated with refractory shock. Treatment options to manage this profound vasoplegia are limited.

Massive Nonfatal Hydroxychloroquine Ingestion in a Pediatric Patient.

Background: Hydroxychloroquine overdose is rare but potentially lethal. Hydroxychloroquine overdose symptoms are characterized by central nervous system toxicity, cardiac toxicity, and hypokalemia. Recommended treatment consists of epinephrine, high-dose diazepam, and careful potassium repletion.

Cannabis and acute myocardial infarction.

Marijuana is one of the most commonly consumed psychotropic drugs in the world. It has been associated with adverse cardiovascular reactions including acute coronary syndrome, but this information is not widely known among emergency medicine clinicians. This article describes cannabis use as a contributing factor to acute myocardial infarction in a young woman with chest pain.

Melia Azedarach Ingestions Reported to Texas Poison Centers.

Background: Melia azedarach, also known as the chinaberry tree, is native to Southeast Asia and northern Australia but has become an invasive species in the United States. M. azedarach contains limonoid tetranotriterpenes, found in highest concentrations in its berries.

Cycas revoluta (sago cycad) exposures reported to Texas poison centers.

Background: Cycas revoluta (sago cycad or palm) is a popular ornamental plant in the United States. All parts of the plant contain toxins such cycasin and beta-methylamino-l-alanine, the ingestion of which can be harmful to humans and animals. The objective of this study was to characterize C.

exposures reported to Texas poison centers.

, commonly known as pencil cactus, is a member of the Euphorbiaceae family that produces a milky, white latex substance that can cause local irritation if ingested or comes in contact with the skin or eyes. This study characterized exposures reported to a large, statewide poison center network. Cases were exposures reported to the Texas Poison Center Network (TPCN) during 2000-2018.

Anticoagulation Reversal.

Today a variety of anticoagulants and antiplatelet agents are available on the market. Given the propensity for bleeding among patients prescribed these medications, the emergency medicine physician must be equipped with a working knowledge of hemostasis, and anticoagulant and antiplatelet reversal. This article reviews strategies to address bleeding complications occurring secondary to warfarin, low-molecular-weight heparin, and direct oral anticoagulant therapy.

Intraosseous line placement for antidote injection by first responders and receivers wearing personal protective equipment.

Study Objective: Early antidotal therapy may be lifesaving in hazardous materials victims. Intravenous line placement is difficult while wearing personal protective equipment (PPE). We assessed the ability of protected, experienced first responders and limited-experience first receivers to place intraosseous (IO) lines for antidote administration.

Hemodynamics after intraosseous administration of hydroxocobalamin or normal saline in a goat model.

Study Objective: Hydroxocobalamin may be lifesaving in cyanide (CN) poisoning, but personal protective equipment (PPE) wear, rescue, and decontamination may delay intravenous administration. Intraosseous (IO) lines may be rapidly placed even when wearing PPE. We assessed the hemodynamics of hydroxocobalamin (OHCo) and normal saline (NS) by the IO route.

High-dose montelukast exposures in a 3-year-old and a 5-year-old child.

The leukotriene receptor antagonists (LTRAs) is a relatively new class of asthma medication with a lack of toxicity for unintentional poisoningsituations. This makes it difficult to determine which exposures require aggressive decontamination or simple monitoring in the home setting: prompting the question, "What LTRA dose is likely to produce significant toxicity?" We report a case of an unintentional poisoning with 80 mg montelukast in a 3-y-o asthmatic child that was managed in the home with observation alone and a second case of untentional 135 mg montelukast poisoning in a 5-y-o asthmatic child managed in an emergency department. In both cases, symptoms were not observed.

High-dose loratadine exposure in a six-year-old child.

Loratadine is a long-acting antihistamine indicated for the treatment of seasonal allergic rhinitis and chronic idiopathic urticaria in patients 6 years of age and older. The literature contains little information on high-dose loratadine exposures; as a consequence, poison centers are unsure of the loratadine dose that can be managed with observation and the dose that requires treatment. We report an intentional ingestion of 300 mg loratadine by a 6-y-old child that resulted in minor elevation of blood pressure and heart rate when managed with supportive care only.

Botulism-like syndrome after injections of botulinum toxin.

Botulinum type A toxin (BTA) is an orphan drug used to treat several disorders of muscle spasticity. We report the first known case of systemic botulism-like syndrome induced by BTA therapy which resulted in respiratory arrest. Clinicians should be aware that systemic effects may occur with localized BTA therapy and may be life-threatening.

Successful treatment of valproic acid overdose with hemodialysis.

A 43-year-old woman took a large amount of depakote (divalproex, a slow-release form of valproate), became comatose, and developed severe hypotension refractory to fluid resuscitation and high-dose vasopressors. The serum valproic acid (VPA) concentration on admission was 1,380 microgram/mL (therapeutic range, 50 to 100 microgram/mL). She also had metabolic acidosis, thrombocytopenia, and normal renal and liver functions.