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December 1

By Anne Hart,2014-06-26 19:57
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December 1 ...

December 1

    Question:

    What compounds are used instead of ethylene glycol in “non-toxic” anti-freeze? Are

    they potentially harmful?

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    Answer: Antifreeze traditionally contains ethylene glycol, but some brands marketed as low toxicity or “non-toxic” use 1,2-propanediol (aka propylene glycol) or 1,3-

    propanediol (aka trimethylene glycol or 1,3-dihydroxypropane). Although less toxic than ethylene glycol, both compounds have been implicated as a cause of death with blood levels in the 400 mg/dL range. (Garg U, Frazee CC 3rd, Kiscoan M, Scott D, Peterson B, Cathcart D. A fatality involving 1,3-propanediol and its implications in measurement of other glycols. J Anal Toxicol. 2008 May;32(4):324-6)

December 2

    Question:

    What problem with measuring 1,3-propanediol by GC-MS requires clinicians to maintain a high level of suspicion for this toxicant?

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    Answer: 1,3-propanediol is used as the internal standard used in GC-MS for measuring glycols. So, a person poisoned by 1,3-propanediol won’t have a corresponding peak by

    GC-MS because it will be hidden with in the internal standard peak. The internal standard peak may seem unusually large which should prompt repeat GC-MS using a different standard. (Garg U, Frazee CC 3rd, Kiscoan M, Scott D, Peterson B, Cathcart D. A fatality involving 1,3-propanediol and its implications in measurement of other glycols. J Anal Toxicol. 2008 May;32(4):324-6)

December 3

    Question:

    Finding trichloroethanol on autopsy toxicology tests suggests abuse of what drug? Scroll down for the answer

    Answer: Chloral hydrate is metabolized to trichloroethanol and commonly causes positive trichloroethanol levels at autopsy.(Jones GR, Singer PP. An unusual trichloroethanol fatality attributed to sniffing trichloroethylene. J Anal Toxicol. 2008 Mar;32(2):183-6.)

December 4

    Question:

    Abuse of what substance can lead to positive trichloroethanol in the absence of exposure to chloral hydrate?

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    Answer: Sniffing or inhaling contact cement. Some contact cement products may contain trichloroethylene which is metabolized to trichloroethanol and may cause positive trichloroethanol levels at autopsy. (Jones GR, Singer PP. An unusual trichloroethanol fatality attributed to sniffing trichloroethylene. J Anal Toxicol. 2008 Mar;32(2):183-6)

December 5

    Question:

    Abuse of 1-benzylpiperazine (BZP), 1-(3-trifluoromethylphenyl)piperazine (3-TFMPP), and 1-(3-chlorophenyl)piperazine (3-CPP) is becoming increasingly popular in what setting?

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    Answer: These compounds have become popular as dugs of abuse at a variety of dance clubs where they may be marketed as legal alternatives to MDMA.

    (Elliot S, Smith C. Investigation of the first deaths in the United Kingdom involving the detection and quantitation of the piperazines BZP and 3-TFMPP. J Anal Toxicol. 2008 Mar;32(2):172-7.)

December 8

    Question:

    True or false........there are currently a wide variety of oximes available to practitioners for use in the United States in the treatment of organophosphate related toxicity. Scroll down for the answer

    Answer: False. While a number of different oxime compounds are indeed available in various different countries around the world. The only oxime available for use in the United States currently is pralidoxime chloride. (Roberts DM and Aaron CK. Management of acute organophosphate pesticide poisoning. 2007, Br Med J. 334:629-634

December 10

    Question:

    Which cancer has been associated with the use of diethylstilbestrol? Scroll down for the answer

    Answer: Diethylstilbestrol (DES) is a transplacental carcinogen. Maternal use of this synthetic estrogen has been associated with vaginal cancer (clear cell adenocarcinoma) in female offspring. Approximately 0.1% of DES exposed offspring develop vaginal cancer, typically after the onset of puberty. DES exposure is also associated with reproductive tract structural abnormalities, pregnancy complications, and infertility in female offspring. Noncancerous epididymal cysts have been observed in male offspring. (Newbold RR. Prenatal exposure to diethylstilbestrol (DES). Fertility and Sterility. 2008 Feb;89(2 Suppl):e55-6.)

December 11

    Question:

    What abnormalities have been associated with the use of fenfluramine-phentramine? Scroll down for the answer

    Answer: Valvular heart disease. In 1997, researchers at the Mayo Clinic presented a report on 24 patients who developed valvular insufficiency while taking the combination diet pill Fen-phen. The mitral valve was the most commonly affected valve, followed by the aortic valve. Patients with left sided valve dysfunction developed pulmonary hypertension. (Graham DJ, Green L. Further cases of valvular heart disease associated with fenfluramine-phentermine. N Engl J Med. 1997; 337: 6358)

December 12

    Question:

    What effect is associated with Coprinus atramentarius ingestion?

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    Answer: Disulfram effect. The Coprinus atramentarius mushroom contains the toxin coprine. Coprine and its major metabolite both inhibit aldehyde dehydrogenase. If the Coprinus atramentarius mushroom is ingested with ethanol, the accumulation of acetaldehyde will cause flushing, nausea, and vomiting. (Carlsson A, et al. On the disulfram-like effect of coprine, the pharmacologically active principle of Coprinus atramentarius. Acta Pharmacol Toxicol (Copenh). 1978 Apr;42(4):292-7)

December 15

    Question:

    What condition is associated with “chasing the dragon?”

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    Answer: Toxic spongiform leukoencephalopathy (TSL). “Chasing the dragon,” or “chinesing” is a method of inhaling opium or heroin. Users heat the powdered drug on

    aluminium foil and inhale the smoke. TSL is a disease of the white matter that causes vacuolization of the oligodendroglia. The clinical features of TSL include memory loss, dementia, coma, and death. (Hill MD, Cooper PW, Perry JR. Chasing the dragon - neurological toxicity associated with inhalation of heroin vapour: case report CMAJ. 2000 Jan;162(2):236-8)

December 16

    Question:

    What electrocardiogram abnormality has been associated with arsenic trioxide (Trisenox) use?

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    Answer: QTc prolongation. Arsenic trioxide causes QTc prolongation by blocking the delayed rectifier K+ current. (Drolet B, Simard C, Roden DM. Unusual effects of a QT-prolonging drug, arsenic trioxide, on cardiac potassium currents. Circulation. 2004 Jan 6;109(1):26-9.)

December 17

    Question:

    What mineral, other than amphibole asbestos, has been causally linked to mesothelioma? Scroll down for the answer

    Answer: Erionite. Erionite is a fibrous mineral found in zeolite stones used to build houses in the Cappadocia region of Turkey. (Baris YI, Sahin AA, Ozesmi M, et al. An outbreak of pleural mesothelioma and chronic fibrosing pleurisy in the village of Karain/Urgup in Anatolia. Thorax 1978; 33:181192.).

December 18

    Question:

    What is the major risk factor for the development of allopurinol hypersensitivity syndrome?

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    Answer: Renal insufficiency. Allopurinol hypersensitivity syndrome (AHS) is a potentially life-threatening cutaneous adverse reaction. It has been hypothesized that the accumulation of allopurinol, or its metabolites, in patients with renal insufficiency is the major cause for allopurinol hypersensitivity syndrome. (Lee HY, Ariyasinghe JT, Thirumoorthy T. Allopurinol hypersensitivity syndrome: a preventable severe cutaneous adverse reaction? Singapore Med J. 2008 May;49(5):384-7.)

December 19

    Question:

    What laboratory finding is suggestive for the diagnosis of bromism?

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    Answer: Negative anion gap with hyperchloremia. Bromides produce a falsely elevated chloride level, which leads to a negative anion gap calculation. A chloride level greater than 115 meq/L is suggestive of bromide ingestion. (Horowitz BZ. Bromism from excessive cola consumption. Journal of Toxicology: Clinical Toxicology. 1997;35(3):315-20.

December 22

    Question:

    What characteristics differentiate rodenticide superwarfarins from warfarin? Scroll down for the answer

    Answer: (1)Greater affinity for vitamin K12-3-epoxide reductase; (2) the ability to disrupt the vitamin K1-epoxide cycle at more than one point; (3) hepatic accumulation; and (4) unusually long biological half-lives due to high lipid solubility and enterohepatic circulation have been credited for the greater potency and duration of action of the long-acting anticoagulant rodenticides. Watt, B. E., A. T. Proudfoot, et al. (2005). "Anticoagulant rodenticides." Toxicol Rev 24(4): 259-69.

December 23

    Question:

    True or false, pediatric ingestions of clonidine commonly results in delayed (>6 hours) toxicity?

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    Answer: False. In one series of clonidine ingestions in 113 children under twelve, onset of full clinical effects was complete within 4 hours in all cases. In addition, in the 61 children who ingested less than 0.3 mg, none had coma, respiratory depression or hypotension. Spiller, H. A., W. Klein-Schwartz, et al. (2005). "Toxic clonidine ingestion in children." J Pediatr 146(2): 263-6.

December 24

    Question:

    In one series of tricyclic antidepressant overdoses, all patients had sinus tachycardia, a corrected QT interval of > 418 ms, and a terminal QRS vector between 130 and 270 degrees. How common is this constellation of findings in cardiograms performed in the Emergency Department?

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    Answer: Using the above criteria, a computer aided search of >15,000 ECGs found the likelihood of meeting all criteria to be 1%. The positive and negative predictive values of the above criteria were subsequently found to be 66% and 100% in a population of 299 overdose patients. Niemann, J. T., H. A. Bessen, et al. (1986). "Electrocardiographic criteria for tricyclic antidepressant cardiotoxicity." Am J Cardiol 57(13): 1154-9.

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