Laboratory assessment of poisoning with a carbamate insecticide

We discuss a case of a 17-year-old white male who intentionally ingested a tick and flea insecticide and was admitted to the emergency room unconscious, with signs and symptoms of cholinergic toxicity. Capillary gas chromatography and electron-impact mass fragmentographic analysis of the patient's urine and serum demonstrated the presence of poly-ethylene glycol and propoxur (o-isopropoxyphenyl N-methyl-carbamate), a carbamate-based cholinesterase inhibitor commonly used in insecticides. The patient fully recovered, but only after a complicated hospital course. We also discuss the laboratory assessment and clinical treatment of poisoning with carbamate and organophosphate insecticides.     

Pontine myelinolysis after correction of hyponatremia during burn resuscitation

Central pontine myelinolysis is a neurologic disease produced by the rapid correction of hyponatremia. This report describes the occurrence of central pontine myelinolysis in a patient with burns. The natural history of this paralyzing condition and suggestions for its prevention are discussed. Severely burned and hyponatremic patients are at risk for this disorder because a large amount of sodium ion is typically required for the treatment of burn shock. Awareness of this phenomenon and avoidance of rapid correction of hyponatremia are essential to its prevention.     

Maprotiline poisoning in a child

A 6-year-old girl presented with tonic-clonic seizures and generalized convulsions lasting several minutes. A serum drug screen revealed maprotiline, and the estimated intake was 12 mg/kg. Despite initial neurologic impairment on discharge, follow-up 6 months later showed normal neurologic function in the patient. This report describes that case and discusses the toxicity associated with maprotiline and its management.     

Gitaloxin poisoning in a child

Gitaloxin is a digitalis glycoside used for the same indications as digoxin and digitoxin. The successful outcome for a 2 1/2-year-old boy who accidentally ingested 3 mg of gitaloxin (100 times the normal therapeutic dose) is reported. At admission the child presented with irregular heart rhythm. He subsequently started vomiting, even after continuous gastric feeding. Only 48 h after ingestion of gitaloxin he became somnolent and development bradyarrhythmia. The symptoms disappeared 96 h later; the bradyarrhythmia, however, (second-degree atrioventricular block) decreased progressively only after 120 h. The initial clinical presentation of gitaloxin poisoning may be mis-leading and careful observation in a pediatric intensive care unit is mandatory. A cross-reaction between the fluorescence polarization immunoassay for digitoxin and the radioimmunoassay for gitaloxin was found and was used as a helpful, but rough, estimate of the severity of gitaloxin poisoning, in the absence of a specific measurement of gitaloxin.     

1例氨气中毒患儿的护理

<正>氨是高溶解度刺激性气体,短时间内吸人高浓度氨气或直接接触液氨可立即发病,引起眼和上呼吸道刺激症状,严重者引起化学性支气管炎、肺炎、肺水肿、呼吸窘迫综合征并伴有眼、皮肤灼伤及心、肝等脏器损害。中毒者病残率和死亡率极高,能     

1例地高辛中毒患儿的护理

总结1例急性地高辛中毒患儿的治疗与护理。通过严密观察患儿生命体征,重点监测心率、心律的变化,及时给予洗胃、灌肠、血浆置换治疗,以彻底清除毒物,恢复正常心率及心律。经过精心治疗,患儿康复出院。     

Mortality rate and pattern following carbamate methomyl poisoning. Comparison with organophosphate poisoning of comparable toxicity

Context. Methomyl is a widely used carbamate insecticide. It is known that mortality rate is generally low in carbamate poisoning, but fatalities from methomyl poisoning have been reported. Nevertheless, there is no reported comparative outcome of methomyl and organophosphate poisoning of comparable toxicity concerning mortality rate and mortality pattern. Objective. This study aims to compare the mortality rate and pattern following methomyl poisoning with those after organophosphate poisoning of comparable toxicity. Material and methods. A retrospective study was conducted on patients with cholinesterase inhibitor poisoning admitted to our institution. Among a diverse group of cholinesterase inhibitors, we included patients who presented after ingesting methomyl or World Health Organisation hazard Class I organophosphate compounds. Patients were divided into two groups; the methomyl group and the Class I organophosphate group. Results. The methomyl group consisted of 17 patients, and the Class I organophosphate group consisted of 42 patients. Seven patients (41.2%) in the methomyl group presented with cardiac arrest, while none presented with cardiac arrest in the Class I organophosphate group (p < 0.001). In the methomyl group, patients who had not experienced cardiac arrest at presentation survived to discharge from hospital. Among the seven patients who presented with cardiac arrest, three died from multiple organ dysfunction syndrome after resuscitation from cardiac arrest. In the Class I organophosphate group, four patients died from pneumonia and complicating acute respiratory distress syndrome. Therefore, the mortality rate was 17.6% in the methomyl group and 9.5% in the Class I organophosphate group (p = 0.399). Conclusion. The mortality rate of methomyl poisoning was comparable to that of World Health Organisation Class I organophosphate poisoning. All died patients in the methomyl group experienced cardiac arrest, and died from multiple organ dysfunction syndrome after resuscitation from cardiac arrest.     

1例地芬尼多中毒小儿的救治及护理

1　病例介绍　　患儿 ,男 ,3岁 ,因走路不稳 ,晕倒 1h于 2 0 0 3年 10月 12日来我院就诊。家属诉患儿于发病前误服地芬尼多糖衣片 18片 (每片 2 5mg) ,当时无异常表现 ,半小时后发现患儿走路不稳 ,晕倒 ,并有阵发性全身发抖 ,呼之不应 ,手足抽动。查体 :体温 3 8.6℃、脉搏 12     

Orphenadrine poisoning in a child: clinical and analytical data

Orphenadrine is an anticholinergic drug used mainly in the treatment of Parkinson's disease. It has a peripheral and central effect and a known cardiotoxic effect when taken in large doses. We report the successful outcome of the treatment of a 2 1/2-year-old girl who accidentally ingested 400 mg of orphenadrine hydrochloride (Disipal). One hour after ingestion she presented neurological symptoms: confusion, ataxic walking, and periods of severe agitation. Generalized tonic-clonic seizures appeared resistant to the administration of multiple antiepileptics. They ceased after a supplementary dose of intravenous diazepam, endotracheal intubation, and mechanical ventilation. An episode of ventricular tachycardia responded well to i. v. lidocaine. Physostigmine was administered in three successive doses. The initial orphenadrine plasma level (3,55 μg/ml) was in the toxic range, associated with high mortality. The calculated elimination half-life was 10.2 h and the molecule and/or its metabolites were found up to 90 h after ingestion. Received: 11 August 1998/Final revision received: 11 April 1999/Accepted: 13 April 1999     

Open air carbon monoxide poisoning in a child swimming behind a boat

Carbon monoxide (CO) poisoning is the most common fatal poisoning in the United States. The circumstances often involve an unsuspected increase of CO in an enclosed environment. Victims often are unaware that their activity or environment placed them at risk for CO poisoning. The possibility of open air CO poisonings was first reported in 1987. We present a case of open air CO poisoning resulting in neurologic depression and a markedly elevated carboxyhemoglobin level in a child who had been swimming behind a house boat. Emergency physicians and pediatricians should be aware of the possibility of accidental open air CO poisoning in children and adults who swim around recreational boats.