Administrator Clintox - One

Nearly 5% of patients receiving idarucizumab for dabigatran reversal had this effect?   Pollack CV et al. reported that nearly 5% (24 patients) of patients receiving idarucizumab had thrombotic events including ischemic stroke, DVT and pulmonary embolism within 30 days of receiving idarucizumab. (Pollack CV…

A patient presents to the ED with altered mental status, ataxia, skin rash and cogwheel rigidity. Imaging reveals a leukoencephalopathy. What is a likely culprit?   Chronic ingestion of mothballs or toilet cakes containing paradichlorbenzene can result in leukoencephalopathy. (Dubey D et al. Para-dichlorobenzene toxicity…

Which agent is more likely to cause seizures in overdose: escitalopram or citalopram?   Citalopram. In a multi-center, retrospective observational study of 795 patients with overdose of either escitalopram or citalopram, seizures occurred more frequently with citalopram (8.0% vs. 0.2%, p< 0.001). Nausea was more…

In 2019, for the first time in years, the total drug overdose deaths decreased by 5% largely due to a decline in deaths from prescription opioids. What substance is being reported to have an increase in use?   In a recent study out of Denver,…

In late November 2019, a public health alert was sent about an emerging new synthetic opioid. What has been recently identified in blood specimens in the mid-west?   Isotonitazene has been identified in 8 post-mortem blood specimens in the Mid-West of the US since August…

Which drug with cardiorespiratory stimulant effects, has been demonstrated to reverse diaphgramatic blockade, bradypnea and bradycardia in a guinnea pig model of saxitoxin and tetrodotoxin toxicity?   4-Aminopyridine. The proposed mechanism is intracellular potassium channel blockade resulting in greater than normal calcium influx in presynaptic…

What is N-ethylpentylone or ephylone, and what is the most common manifestation of toxicity?   N-ethylpentylone is a synthetic cathinone. Recent case reports suggest that agitation is the most common manifestation of toxicity. Of note in this report, none of the patients reported using N-ethylpentylone…

Amygdalin is hydrolyzed by this enzyme into hydrogen cyanide, benzaldehyde and glucose.   Beta glucosidase. A recent case report by Shively et al. describe recurrent cyanide toxicity after ingestion of amygdalin. It is hypothesized that the hydrolysis of amygdalin to cyanide may follow zero order…

This supplement has been falsely touted to have antineoplastic effects and continues to be available online.   Amygdalin; sometimes known as Vitamin B17 or Laetrile. Amygdalin is a cyanogenic glycoside and hydrolyzed into hydrogen cyanide, benzaldehyde and glucose. (Shively RA et al. Rebound metabolic acidosis…

Glucose-insulin-potassium infusion resulted in lower in-hospital case fatality compared to supportive care alone after intentional ingestion of this fumigant?   In a recent open label study of 60 patients with aluminum phosphide poisoning, glucose-insulin-potassium infusions resulted in lower in-hospital case fatality compared with supportive care…