Huntington and Pennington’s recent article on a case of Fatal Methaeglobinaemia Due To Intentional Sodium Nitrate Poisoning was very interesting, is a useful overview of initial diagnosis and management, and has helped remind the readers of this potentially life
We report a case of fatal methaemoglobinaema resulting from sodium nitrite poisoning. A 28 year old woman arrested in the emergency department following collapse. During resuscitation a venous blood gas revealed a methaemoglobin percentage of 81%. Following treatment with methylene blue, sodium bicarbonate and adrenaline, the methaemoglobin decreased. Prior to transfer to intensive care, a CT head revealed extensive hypoxic brain injury. Two days later brain death was confirmed on brainstem testing. Severe methaemoglobinaemia is rapidly fatal, with fast diagnosis and treatment associated with improved outcomes.
Fatal Methaemoglobinaemia Due To Intentional Sodium Nitrite Poisoning Read More
Accidental and intentional poisoning from prescribed, illicit and organic substances remains a major cause of morbidity and mortality worldwide and accounts for just under 1% of the total number of NHS hospital admissions, or around 170,000, a year in the UK. A knowledge of the constellation of signs and symptoms that constitute specific poisonings (referred to as toxidromes) may enable early empirical decontamination, antidote administration, enhanced elimination and supportive care, and may also help to predict the clinical course. This paper presents a series of clinical vignettes to demonstrate emerging presentations in toxicology to help inform the practice of Acute Physicians, who alongside colleagues in Emergency Medicine and Critical Care, are at the front line of diagnosing and treating poisoned patients.
Case based review: Toxicology on the Acute Medical Unit Read More
Abstract
We present a case of paracetamol overdose in a 34-year-old female with a history of depression and alcoholism. Following treatment with N-acetylcysteine (Parvolex®) our patient developed ventricular tachycardia resulting in cardiac arrest from which she was successfully resuscitated. Subsequent ECG demonstrated prolongation of the QTc interval and repeat blood tests revealed a significant fall in serum potassium from 4.2mmol/l on admission to 2.2mmol/l. The possible mechanisms contributing to the development of hypokalaemia after overdose with paracetamol are discussed. The existing literature relating to paracetamol-induced hypokalaemia is briefly reviewed.
Cardiac arrest following paracetamol overdose complicated by hypokalaemia Read More
Abstract
Although uncommon, lead poisoning should be considered as a differential diagnosis in cases of unexplained acute abdominal pain in both adults and children. We present the case of a 35-year-old Asian male who presented with abdominal pain and constipation secondary to lead poisoning. Initially, the source of lead exposure was not apparent; this was later found to be due to ingestion of an Ayurvedic herbal medicine for the treatment of infertility. Lead poisoning due to the ingestion of Ayurvedic remedies is well described. We discuss the diagnosis, pathophysiology and treatment of lead poisoning. This case illustrates one of the rarer medical causes of acute abdominal pain and emphasizes the need to take a thorough history (including specific questioning regarding the use of over-the-counter and traditional/ herbal remedies) in cases of suspected poisoning or drug toxicity.
Acute abdominal pain and constipation due to lead poisoning Read More
Abstract
We report two recent cases of tricyclic antidepressant (TCA) overdose complicated by the development of acute respiratory distress syndrome (ARDS). The previous literature documenting an association between TCAs and ARDS is reviewed. We propose that the respiratory complications of TCA overdose should be more widely publicised and included in national toxicology databases.
Tricyclic Antidepressant Overdose causing Acute Respiratory Distress Syndrome Read More
Abstract
Poisoning is a common presentation to hospital acute medical units, and can produce a variety of clinical scenarios. This review discusses the epidemiology of poisoning, a framework for managing patients with drug toxicity and considerations in the diagnosis of toxicity with unknown substances. The commonest substances seen in toxicity in the UK – paracetamol, antidepressants, sedatives and opioids are discussed in more detail.
Poisoning And Toxicological Emergencies – Current Trends And Practice Read More
Abstract
The acute presentation of an unconscious individual is a common scenario and it indicates a severe pathological insult. Aetiology may not be apparent at initial assessment and maximal use of available resources should be made to identify the cause. Initial management should be directed towards resuscitation and stabilisation of the individual, followed by further clinical assessment. The prevention of secondary brain injury is essential and so respiratory, circulatory and metabolic abnormalities should be treated aggressively. Early involvement of critical care physicians may be required. Detailed aspects of acute management and specific care of head injured, intoxicated and post-cardiac arrest patients is discussed.
Coma – emergency management of the unconscious patient Read More