cardiovascular-agents and Poisoning

Intravenous lipid emulsion (ILE) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are being used together or in close succession in the management of circulatory failure secondary to cardiotoxic drug poisoning. There have been reports of mechanical problems, including fat emulsion agglutination, clogging, increased blood clot formation and even cracking of parts of the machine, in patients concurrently receiving VA-ECMO and ILE as part of parenteral nutrition.. To ascertain the adverse effects associated with the combined use of ILE and ECMO in the poisoned patient.. PubMed and OVID (1966 to 9 June 2014) and EMBASE (1947 to 9 June 2014) were searched to identify publications relating to studies and/or case reports where ILE had been used at the same time when VA-ECMO was used - 7 were identified. In addition, the abstracts published between 2006 and 2013 inclusive of those from the North American Congress of Clinical Toxicology and the congresses of the European Association of Poisons Centres and Clinical Toxicologists were searched to identify additional cases and 2 were found. Finally all cases posted on lipidrescue.org were reviewed to determine if they related to the use of ILE with VA-ECMO and no new cases were identified. In vitro study. An in vitro study involving the continuous infusion of 20% ILE at 3 mL/h for 24 h demonstrated layering (separation of intact fat emulsion from blood) and agglutination (clumping resulting in little or no flow of fat emulsion through the circuit) in all circuits within 30 min of starting the fat emulsion infusion.. An observational study based in 42 centres that regularly used 'fat emulsion' during VA-ECMO treatment reported cracking of stopcocks (the valve which restricts flow in the VA-ECMO tubing) (n = 10, 23.8%); fat emulsion agglutination (n = 11, 26.2%); clogging and associated malfunction of the membrane oxygenator (n = 2, 4.8%); and increased blood clot formation in the circuits (n = 2, 4.8%). In a prospective observational study of 9 neonates on VA-ECMO receiving intravenous nutrition, layering and agglutination were seen in four sets of VA-ECMO tubing and blood clots were found in seven circuits. Nine case reports were identified where ILE was used with VA-ECMO for the management of circulatory failure/instability secondary to cardiotoxic drug poisoning. In two of these case reports, the authors specifically stated that ILE did not cause any mechanical complications with the VA-ECMO; the other seven reports made no comment as to whether there were any complications or not.. There is in vitro and clinical evidence that the combined use of ILE and extracorporeal membrane oxygenation may be associated with fat deposition in the VA-ECMO circuits and increased blood clot formation. Clinicians managing poisoned patients with both of these novel treatment modalities should be aware of these potential complications.

Topics: Adolescent; Adult; Cardiovascular Agents; Cardiovascular Diseases; Combined Modality Therapy; Equipment Design; Equipment Failure; Extracorporeal Membrane Oxygenation; Fat Emulsions, Intravenous; Female; Humans; Infant; Male; Middle Aged; Poisoning; Risk Factors; Shock; Treatment Outcome; Young Adult

This is the second of a three-part series that reviews the generalized care of poisoned patients in the ICU. This article focuses on specific agents grouped into categories, including analgesics, anticoagulants, cardiovascular drugs, dissociative agents, carbon monoxide, cyanide, methemoglobinemia, cholinergic agents, psychoactive medications, sedative-hypnotics, amphetamine-like drugs, toxic alcohols, and withdrawal states. The first article discussed the general approach to the toxicology patient, including laboratory testing; the third article will cover natural toxins.

Topics: Analgesics; Anticoagulants; Carbon Monoxide Poisoning; Cardiovascular Agents; Cyanides; Humans; Intensive Care Units; Poisoning; Toxicology

Calcium channel blockers continue to be used for the management of a wide variety of adult and pediatric conditions including hypertension, angina pectoris, atrial arrhythmias, Raynaud phenomenon, and migraine headaches. With increased use comes increased potential for misuse and abuse. This article serves as a review of calcium channel blocker physiology with emphasis on presentation and management of the pediatric patient with calcium channel blocker toxicity.

Topics: Adult; Assisted Circulation; Calcium Channel Blockers; Calcium Channels, L-Type; Calcium Chloride; Cardiovascular Agents; Cardiovascular Diseases; Charcoal; Child, Preschool; Combined Modality Therapy; Drug Overdose; Enema; Extracorporeal Circulation; Fat Emulsions, Intravenous; Fluid Therapy; Glucagon; Heart; Humans; Hyperglycemia; Infant; Muscle, Smooth, Vascular; Plasmapheresis; Poisoning; Practice Guidelines as Topic

Intravenous fat emulsions (IFE) are traditionally used as a component of parenteral nutrition therapy. Recently, IFE was used to resuscitate severe local anesthetic drug toxicity. This review focuses on the potential role of IFE in treatment of toxicity due to local anesthetics and other lipid-soluble drugs. The general properties of IFE, metabolic fate, and associated adverse events are described. Cases of local anesthetic toxicity treated with IFE are presented along with a discussion of the possible antidotal mechanisms. Initial investigations into the antidotal use of IFE for lipophilic central nervous and cardiovascular drug toxicity are also reviewed.

Topics: Anesthetics, Local; Animals; Antidotes; Cardiovascular Agents; Central Nervous System Agents; Fat Emulsions, Intravenous; Humans; Poisoning

Poisoning is a significant problem in the elderly. The majority of poisonings in older people are unintentional and may result from dementia and confusion, improper use of the product, improper storage or mistaken identities. Depression is also common in the elderly and suicide attempts are more likely to be successful in this age group. The elderly patient's recuperative abilities may be inadequate as a result of numerous factors including impaired hepatic or renal function as well as chronic disease processes. General management of poisoning in the elderly parallels management of younger adults, but it is especially important to ascertain underlying medical conditions and concurrent medications. In most poisonings, activated charcoal and cathartic are sufficient. Haemodialysis or haemoperfusion may be required at lower plasma drug concentrations in elderly patients. While the specific indications for antidotes are the same for all age groups, dosage alterations and precautions may need to be considered in the elderly. Drugs most often implicated in poisonings in the elderly include psychotherapeutic drugs, cardiovascular drugs, analgesics and anti-inflammatory drugs, oral hypoglycaemics and theophylline. Cardiovascular and neurological toxicities occur with overdoses of neuroleptic drugs and, more frequently and severely, with cyclic antidepressants. Patients with pre-existing cardiovascular disease are at particular risk of worsening ischaemic heart disease and congestive heart failure. Benzodiazepines only appear to produce significant toxicity during long term administration or in combination with other CNS depressants. Digoxin can cause both chronic and acute intoxication, most seriously cardiac toxicity including severe ventricular arrhythmias, second or third degree heart block or severe refractory hyperkalaemia. Immune Fab antibody is indicated for the management of digoxin toxicity, although patients dependent on the inotropic effect of digoxin may develop heart failure after digoxin Fab antibody administration. Nitrates can cause toxicity including headache, vomiting, hypotension and tachycardia from excessive sublingual, transdermal or intravenous doses. Conduction disturbances and hypotension occur with overdoses of antihypertensive drugs; these effects are mild with angiotensin converting enzyme (ACE) inhibitors, occasionally severe with beta-blockers and of significant concern with calcium channel antagonists. The elderly commonly use aspir

Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Cardiovascular Agents; Humans; Hypoglycemic Agents; Poisoning; Psychotropic Drugs; Theophylline

Topics: Analgesics; Anti-Bacterial Agents; Barbiturates; Cardiovascular Agents; Evaluation Studies as Topic; Humans; Hypnotics and Sedatives; Minerals; Pesticides; Poisoning; Renal Dialysis

Drug overdose is a common occurrence which accounts for up to 25% of medical inpatient admissions. Intentional overdose or attempted suicide is the most common cause of overdose, but there are other types of overdose which are often unrecognised as are the effects caused by these overdoses. Iatrogenic overdose occurs frequently and is often unavoidable. Many patients will make mistakes with their treatment and unwittingly suffer from the toxic effects of the drugs they are taking. About 7% of intentional overdose patients who are admitted to hospital have taken the drug for some psychological effect they have been seeking and have taken too much. This group is described as those who take 'drugs for kicks'. As many of the drugs taken cross the blood-brain barrier and exert some toxic effect on the cerebral cortex, secondary psychological disturbances frequently occur in all of these groups of patients, and can sometimes be the only sign of dangerous toxicity. It is important to recognise the patient's gross disturbances of behaviour, thinking and perception as a manifestation of drug toxicity which can be life threatening and often requires intense medical treatment. The range of the psychological response is somewhat limited and there is not a specific psychological disturbance characteristic of the toxicity of each group of drugs. However, there are some reactions which, coupled with the physical symptoms shown by the patient, can help to identify the patient as suffering from the toxic effects of drugs and even give some indication as to the type of drugs taken. This article describes the various psychiatric syndromes caused by drugs in overdose and attempts to identify these with most of the commonly encountered groups of drugs.

Topics: Analgesics; Anti-Anxiety Agents; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Inflammatory Agents; Anticonvulsants; Antidepressive Agents; Antiparkinson Agents; Antipsychotic Agents; Behavior; Cardiovascular Agents; Central Nervous System Stimulants; Histamine H1 Antagonists; Humans; Hypnotics and Sedatives; Poisoning; Steroids; Suicide; Time Factors

Topics: Analgesics; Antidepressive Agents, Tricyclic; Barbiturates; Cardiovascular Agents; Hemoperfusion; Humans; Hypnotics and Sedatives; Poisoning; Tranquilizing Agents

Topics: Alcohols; Analgesics; Animals; Anti-Infective Agents; Antidepressive Agents; Antineoplastic Agents; Barbiturates; Cardiovascular Agents; Hemoperfusion; Humans; Hypnotics and Sedatives; Pesticides; Pharmaceutical Preparations; Poisoning; Solvents; Tranquilizing Agents

Topics: Cardiovascular Agents; Digoxin; Drug-Related Side Effects and Adverse Reactions; Humans; Immunoglobulin Fab Fragments; Poisoning

For acute digoxin poisoning, it has been recommended to give bolus doses of 10-20 vials or potentially larger than needed doses calculated from dose ingested or the measured concentration. However, a recent revision of internal Poisons Information Centre guidelines prompted a change of our recommendations, specifically instead of large boluses, to use titrating repeated low doses of digoxin antibodies(Digoxin-Fab) based on bedside assessment of cardiac toxicity.. This is a prospective observational study of patients with acute digoxin poisoning identified through two Poisons Information Centres and three toxicology units. Patient demographics, signs and symptoms of digoxin toxicity, doses and response to Digoxin-Fab, free and bound serum digoxin concentrations. Outcomes were recorded and analysed.. From September 2013 to September 2020, 23 patients with 25 presentations (median age 56 years, females 56%) were recruited. Median dose ingested was 13 mg(IQR: 9.5-25). Median heart rate (HR) was 41 beats/min before treatment. Initial median digoxin and potassium concentrations were 14.5 nmol/L (IQR: 10.9-20) [11.2 µg/L(IQR: 8.4-15.4)] and 5 mmol/L (IQR: 4.5-5.4 mmol/L), respectively. Gastrointestinal symptoms and acute kidney injury were present in 22 patients (88%) and 5 patients (20%), respectively. Four patients received an initial bolus dose of Digoxin-Fab of 5-20 vials. Twenty-one patients received repeated titrated doses (1-2 vials) of Digoxin-Fab and the median total dose was 4 vials (IQR: 2-7.5). Median maximal change in HR post-Digoxin-Fab was 19 beats/min. The median potassium concentration decrease post-Digoxin-Fab was 0.3 mmol/L. Total dose used in the titration group was 25% and 35% of the predicted doses based on the amount of digoxin ingested or measured serum concentration, respectively. Twelve had free digoxin concentrations measured. Free digoxin concentrations dropped to almost zero after any dose of Digoxin-Fab. Ten patients had a rebound of digoxin >2.6 nmol/L (2 µg/L). There were no deaths from acute digoxin toxicity.. The new practice of using small, titrated doses of Digoxin-Fab led to a considerable reduction in total usage and major savings. The clinical response to titrated doses was safe and acceptable in acute digoxin poisoning.

Topics: Cardiovascular Agents; Digoxin; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Immunoglobulin Fab Fragments; Middle Aged; Poisoning; Potassium

Adults aged >65 years are susceptible to intentional and unintentional poisoning, with contributing factors that include polypharmacy, comorbidity, susceptibility to medication error, and gaps in research. Although toxicologists are often tasked with managing and preventing poisoning among older adults, little is known about sex differences in these poisonings. The aim of this study was to review sex differences in poisonings among older adults managed at the bedside by medical toxicologists.. All case subjects aged >65 years in the Toxicology Investigators Consortium (ToxIC) registry between January 2010 and December 2016 were reviewed. Data included reasons for exposure and consultation, exposure agents and routes, presenting clinical findings, and treatment provided. Cases missing age, sex, or primary reason for toxicology consultation data were excluded. We used χ. Among 51,441 total registry cases, 542 (1.05%) were excluded because of missing data. Among the remaining 50,899 cases, 2930 (5.8%) were included for age >65 years; 52.3% of older adults were female. Race was missing or unknown for 49.2% of cases. Adverse drug reactions were more commonly encountered in female subjects than in their male counterparts (9.6% vs 6.4%; P = 0.001). No statistically significant sex differences were observed for total numbers of intentional, unintentional pharmaceutical, and nonpharmaceutical exposures. The most common medications involved were cardiovascular (16.8%) and analgesics/opioids (14.8%). Female subjects were more likely than male subjects to be evaluated by a toxicologist for cardiovascular medications (18.7% vs 14.7%; P = 0.004) and analgesics/opioids (17.6% vs 11.8%; P < 0.001). Male subjects were more likely than female subjects to be evaluated for ethanol toxicity (7.4% vs 1%; P < 0.001) and for envenomations (4.2% vs 1.8%; P < 0.001). The most common route of exposure was oral ingestion (81.3%). Signs/symptoms were noted in 54.8% of cases, with the most common abnormal vital sign being bradycardia (17.2%). Pharmacologic support was the most common intervention and was more common in male subjects than in female subjects (17.7% vs 12.3%; P < 0.001). Deaths were reported in 38 female subjects (2.45%) and 46 male subjects (3.34%); there was no statistically significant difference in death rate according to sex (P = 0.148).. Older female adults were more commonly evaluated by a medical toxicologist for an adverse drug reaction than older male adults. Female patients were more likely than male patients to be evaluated for poisoning related to analgesic/opioids and cardiovascular medications, and older male patients more frequently received pharmacologic support than older female patients. No significant sex differences were observed in numbers of toxicology consultations for intentional, unintentional pharmaceutical, and nonpharmaceutical exposures.

Topics: Aged; Analgesics, Opioid; Bites and Stings; Cardiovascular Agents; Drug Overdose; Drug-Related Side Effects and Adverse Reactions; Ethanol; Female; Humans; Male; Medication Errors; Poisoning; Polypharmacy; Registries; Sex Factors; United States

We hypothesized that in chronic digoxin toxicity, anti-digoxin antibodies (Fab) would be efficacious in binding digoxin, but this may not translate into improved clinical outcomes.. This study aims to investigate changes in free digoxin concentrations and clinical effects on heart rate and potassium concentrations in chronic digoxin poisoning when anti-digoxin Fab are given.. This is a prospective observational study. Patients were recruited if they have been treated with anti-digoxin Fab for chronic digoxin poisoning. Data was entered into a standardised prospective form, supplemented with medical records. Their serum or plasma was collected, analysed for free and bound digoxin and free anti-digoxin Fab concentrations.. From September 2013 to February 2015, 36 patients (median age, 78 years; 22 females) were recruited from 18 hospitals. Median heart rate (HR) was 49 beats/min. Initial median digoxin and potassium concentrations were 4.7 nmol/L (3.6 μg/L) (range: 2.3-11.2 nmol/L) and 5.3 mmol/L (range: 2.9-9.2 mmol/L) respectively. Beta-blockers (n = 18), calcium antagonists (n = 6), spironolactone and/or angiotensin blocking agents (n = 24) were also used concomitantly. Renal impairment and gastrointestinal symptoms were present in 31 (86%) and 22 (63%) patients respectively. Five patients died from conditions unrelated to digoxin toxicity. Median change in HR was 8 beats/min post-Fab with no effect on blood pressure; they were 4, 10 and 17 beats/min for the 1, 2 and ≥3 vials of anti-digoxin Fab groups respectively. Concomitant treatments with potassium lowering agents (12/36) and inotropic drugs (7/36) were used. Gastrointestinal effects resolved in all 22 patients. The median decrease for potassium was 0.3 mmol/L. Digoxin concentration reduced from 3.8 to 0 nmol/L post-Fab. There was a rebound observed in the free digoxin concentration in 25 patients but none had associated clinical deterioration.. One to two vials of anti-digoxin Fab initially bound all free digoxin confirming Fab efficacy. However, this was associated with only a moderate improvement in HR and potassium, suggesting bradyarrhythmia and hyperkalaemia may be from other co-morbidities.

Topics: Aged; Aged, 80 and over; Bradycardia; Cardiovascular Agents; Chronic Disease; Digoxin; Drug Overdose; Female; Heart Rate; Humans; Hyperkalemia; Immunoglobulin Fab Fragments; Male; Middle Aged; Poisoning; Potassium; Prospective Studies

Infant and toddler poisonings are important to capture and may be challenging to manage. We aim to describe the Toxicology Investigators Consortium (ToxIC) Case Registry as a tool for toxico-surveillance of this problem in the United States. Using the ToxIC Case Registry database of the American College of Medical Toxicology, we identified infant and toddler poisonings over a 15-month period between April 1, 2010 and June 30, 2011 reported to the 31 Registry sites. Of 6,810 poisoning cases reported to the ToxIC registry, 248 (3.6 %) involved children younger than 2 years (51 % males). Fifty-four percent were hospital inpatients, 42 % were in the Emergency Department and 4 % were outpatients. Sixty-three percent were symptomatic. The most common ingested compounds were highly toxic-cardiac drugs (16 %), psychotropics (15 %), recreational drugs, alcohols, and controlled narcotic drugs (13 %), analgesics (9 %), and cleaning compounds (7 %). Fourteen percent of cases involved multiple agents. The ToxIC registry is a potentially useful toxico-surveillance tool to identify and trend clinically significant poisonings in young children, and potentially other populations. These data could be used to target specific preventive interventions.

Topics: Anticonvulsants; Antidepressive Agents; Antipsychotic Agents; Cardiovascular Agents; Cohort Studies; Drug-Related Side Effects and Adverse Reactions; Emergency Service, Hospital; Female; Hospitalization; Humans; Infant; Inpatients; Male; Outpatients; Poisoning; Prospective Studies; Psychotropic Drugs; Registries; Toxicology; United States

Cardiovascular medications (CVMs) are frequently prescribed for cardiovascular diseases. The unconscious use of cardiovascular drugs may lead to severe clinical manifestations, even to death, especially when in overdose. The objective of this study is to clarify the profile of CVM exposures admitted to Department of Emergency Medicine in Dokuz Eylul University Hospital (EMDEU) between 1993 and 2006. Case demographics, type of the medication, route and reason for exposure, clinical effects and outcome were recorded. Related to the CVM exposures, 105 poisoning cases were admitted. Mean age of children and adults were 12.8 ± 1.0 and 30.1 ± 1.8, respectively. Females were dominating (77.1%). Poisoning by accident occurred mainly among children in the 0-6 age group (64.3%) and suicide attempt was predominant in the 19-29 age group (47.8%). The most common ingested CVMs admitted to EMDEU were calcium channel blockers (19.7%), beta-blockers (17.3%), angiotensin converting enzyme inhibitors and diuretics (11.8%). Most of the patients were asymptomatic (59.1%). Frequently observed symptom was altered consciousness (18.6%). Antihypertensive drugs are responsible for the most of the CVM exposures. Prospectively designed multi-centered studies are needed to reflect the epidemiological properties of cardiovascular drug exposures throughout our country and would be very valuable for the determination of preventive measures.

Topics: Adolescent; Adult; Cardiovascular Agents; Child; Child, Preschool; Cross-Sectional Studies; Humans; Infant; Poison Control Centers; Poisoning; Seasons; Turkey; Young Adult

Topics: Acetaminophen; Acute Disease; Analgesics, Non-Narcotic; Antidepressive Agents; Cardiovascular Agents; Central Nervous System Depressants; Ethanol; Humans; Poison Control Centers; Poisoning; Psychotropic Drugs

Acute poisonings with cardiotoxicants are responsible of significant morbidity and incompressible mortality, mainly among youths. Their incidence is increasing. Death mainly results from cardiac failure refractory to pharmacological treatments as well as sudden cardiac arrest refractory to cardiopulmonary resuscitation. Determination of the exact mechanism of shock is essential to guide adequate treatments. Treatment is supportive including high-dosage catecholamines and may require antidotes. Administration of other inotropic agents (including glucagon, phosphodiesterase inhibitors, calcium salts, and euglycemic insulin) may be discussed, although their efficacy is still not clearly established. Extracorporeal life support allows organ perfusion until reversal of cardiac dysfunction and elimination of the toxicant. Several cases of survival using this exceptional technique were reported in the literature. Thus, based on these reports, extracorporeal life support has gained a recognized place in the therapeutic arsenal of acute poisonings.

Topics: Cardiovascular Agents; Extracorporeal Circulation; Humans; Poisoning

The aim of our research was retrospective analysis of poisoning with cardiovascular drugs (T46 according to ICD 10 classification) in patients over 59 years old, hospitalized in Province Poisoning Centre in Lublin, in the period from 1995 to 2001. There were hospitalized 288 patients at this time age, over 59 years old. Among this 16 persons were poisoned with cardiovascular drugs (one accidental and 15 suicidal intoxications), and 3 of them died. Different kinds of cardiovascular medications were used e.g. digoxin, nitrates, hypotensive drugs (as single and multiplied drug poisonings). At 3 of the patients depression was diagnosed.

Topics: Aged; Aged, 80 and over; Cardiovascular Agents; Cardiovascular Diseases; Catchment Area, Health; Depressive Disorder, Major; Female; Hospitalization; Humans; Male; Middle Aged; Poison Control Centers; Poisoning; Poland; Retrospective Studies

In the seven year period 1978-1984, 40,847 registered cases of poisonings were treated in hospital wards in Finland. 73.9% of the poisonings were due to drugs and 26.1% were due to technochemical products. The patients were primarily treated in internal medicine wards (65%) and in pediatric wards (16.3%). Seasonal variation was seen for agents such as oils, carbon monoxide, solvents, psychotropics, mushrooms and pesticides. Poisonings due to psychotropic drugs occurred at a steady rate during the period. For example, in 1984 there were 21.3 admissions per 100,000 inhabitants per year. Neuroleptics were the most common psychotropic drugs. Antidepressants caused fewer poisonings than did sleeping pills, which increased steadily to 13.9/100,000 inhabitants. Poisonings due to cardiovascular drugs declined, paralleling a decrease in digoxin prescriptions. During the period studied there were 13 to 14 admissions/100,000 inhabitants/year due to alcohol. The rate of cases of corrosive and solvent intoxication was steady at about 3 admissions/100,000 inhabitants/year.

Topics: Adolescent; Adult; Age Factors; Aged; Alcoholic Intoxication; Cardiovascular Agents; Child; Child, Preschool; Female; Finland; Humans; Length of Stay; Male; Middle Aged; Poisoning; Psychotropic Drugs; Seasons; Sex Factors

Topics: Cardiovascular Agents; Central Nervous System Agents; Central Nervous System Depressants; Elements; Hemoperfusion; Humans; Kinetics; Pharmaceutical Preparations; Poisoning; Renal Dialysis

Topics: Analgesics; Analgesics, Opioid; Cardiovascular Agents; Child; Child, Preschool; Drug Packaging; Household Products; Humans; Infant; Netherlands; Poisoning; Psychotropic Drugs; Risk

Topics: Cardiovascular Agents; Digitalis; Digitalis Glycosides; Poisoning; Suicidal Ideation; Suicide; Toxicology

Topics: Cardiovascular Agents; Digitalis; Digitalis Glycosides; Poisoning; Toxicology

Topics: Cardiovascular Agents; Child; Digitalis; Digitalis Glycosides; Electrocardiography; Poisoning; Toxicology

Topics: Cardiovascular Agents; Humans; Muscle Relaxants, Central; Poisoning; Seizures; Strychnine; Suicidal Ideation; Suicide; Toxicology

Topics: Cardiovascular Agents; Digitalis; Digitalis Glycosides; Electrocardiography; Gastrointestinal Diseases; Humans; Neurologic Manifestations; Poisoning; Toxicology

Topics: Cardiovascular Agents; Drug-Related Side Effects and Adverse Reactions; Electrocardiography; Poisoning; Quinine; Toxicology

Topics: Cardiovascular Agents; Drug-Related Side Effects and Adverse Reactions; Pharmacology; Poisoning; Quinine; Toxicology

Topics: Cardiovascular Agents; Child; Digitalis; Infant; Plant Extracts; Poisoning

Topics: Bismuth; Cardiovascular Agents; Drug-Related Side Effects and Adverse Reactions; Heavy Metal Poisoning; Humans; Infant; Metals, Heavy; Methemoglobinemia; Nitrates; Poisoning

Topics: Anticonvulsants; Cardiovascular Agents; Humans; Meprobamate; Muscle Relaxants, Central; Poisoning

Topics: Agaricales; Amanita; Cardiovascular Agents; Glycosides; Liver; Mushroom Poisoning; Poisoning

Topics: Amines; Cardiovascular Agents; Humans; Mental Disorders; Muscle Relaxants, Central; Poisoning; Psychoses, Substance-Induced; Psychotic Disorders

Topics: Animals; Cardiovascular Agents; Cattle; Cattle Diseases; Eating; Plants; Poisoning; Silybum marianum

Topics: Arrhythmias, Cardiac; Cardiovascular Agents; Digitalis; Humans; Poisoning

Topics: Cardiovascular Agents; Epidemics; Ergot Alkaloids; Ergotism; Oxytocics; Poisoning

Topics: Amblyopia; Cardiovascular Agents; Drug-Related Side Effects and Adverse Reactions; Humans; Poisoning; Quinine

Topics: Cardiovascular Agents; Child; Humans; Infant; Muscarinic Antagonists; Muscle Relaxants, Central; Poisoning

Topics: Cardiovascular Agents; Digitalis; Drug-Related Side Effects and Adverse Reactions; Humans; Poisoning

Topics: Amblyopia; Cardiovascular Agents; Drug-Related Side Effects and Adverse Reactions; Humans; Poisoning; Quinine

Topics: Cardiovascular Agents; Drug-Related Side Effects and Adverse Reactions; Humans; Nitrates; Poisoning

Topics: Cardiovascular Agents; Drug-Related Side Effects and Adverse Reactions; Humans; Nitrates; Poisoning; Potassium; Potassium Compounds; Suicide; Suicide, Attempted

Topics: Cardiovascular Agents; Drug-Related Side Effects and Adverse Reactions; Electrocardiography; Humans; Poisoning; Quinine

Topics: Barbiturates; Cardiovascular Agents; Ergot Alkaloids; Humans; Oxytocics; Poisoning