salicylates and Alcoholic-Intoxication

Topics: Acetaminophen; Alcoholic Intoxication; Antidepressive Agents, Tricyclic; Child; Humans; Iron; Kinetics; Monitoring, Physiologic; Pharmaceutical Preparations; Phenobarbital; Phenytoin; Poisoning; Salicylates; Salicylic Acid; Theophylline

Most reports of interactions involving analgesics deal with their effects on the actions of other drugs rather than vice versa. Aspirin and ethanol have synergistic effects on the development of gastritis, gastrointestinal bleeding, and chronic gastric ulcer. This must be the most common and most important interaction affecting analgesic toxicity. Combined overdosage of aspirin with central nervous system depressants may be particularly hazardous because suppression of the salicylate-induced respiratory stimulation further shifts the disordered acid-base balance towards acidosis. The toxicity of acetaminophen (paracetamol) depends primarily on the balance between the rate of formation of the hepatotoxic metabolite and the rate of glutathione synthesis in the liver. In animals, prolonged pretreatment with ethanol increases the metabolic activation and acute toxicity of acetaminophen, and there is some evidence that chronic alcoholics are more susceptible to hepatotoxicity following acute overdosage. It has been assumed that this sensitivity in chronic alcoholics is due to microsomal enzyme induction with enhanced metabolic activation of acetaminophen. However, the metabolic activation of acetaminophen, as judged by the urinary excretion of its cysteine and mercapturic acid conjugates, is not increased in heavy drinkers or in patients induced by long-term treatment with anticonvulsants or rifampicin. Microsomal enzyme induction is complex. There are important species differences and different agents may selectively induce different variants of the multiple forms of cytochrome P-450. The acute administration of ethanol greatly reduces the metabolic activation of acetaminophen in heavy drinkers with more than a 50 percent decrease in cysteine and mercapturic acid conjugate production. Thus ingestion of ethanol should reduce the risk of liver damage following acetaminophen overdosage. Cimetidine, which inhibits the oxidative metabolism of some drugs, reduces the hepatotoxicity and increases the dose of acetaminophen in mice required to kill 50 percent of the animals. However, contrary to expectations, cimetidine does not inhibit the oxidative metabolism of acetaminophen in man. Salicylamide competes with acetaminophen for sulphate conjugation but is unlikely to potentiate toxicity following overdosage since sulphate conjugation is rapidly saturated anyway. Animal studies suggest that the hepatotoxicity of acetaminophen after overdosage may be increased by othe

Topics: Acetaminophen; Alcoholic Intoxication; Alcoholism; Animals; Anti-Inflammatory Agents, Non-Steroidal; Chemical and Drug Induced Liver Injury; Drug Interactions; Ethanol; Humans; Salicylates

Topics: 1-Propanol; Alcoholic Intoxication; Amphetamine; Carbon Monoxide Poisoning; Chloral Hydrate; Chlordiazepoxide; Dextropropoxyphene; Diazepam; Ethchlorvynol; Glutethimide; Heroin; Humans; Meprobamate; Methadone; Methanol; Morphine; Orphenadrine; Paraldehyde; Pentazocine; Phenothiazines; Phenytoin; Poisoning; Quinine; Salicylates; Toxicology; Tranquilizing Agents

Topics: Acids; Alcoholic Intoxication; Alkalies; Antidotes; Arsenic Poisoning; Atropa belladonna; Barbiturates; Benzene; Carbon Monoxide Poisoning; Humans; India; Kerosene; Mercury Poisoning; Opium; Organophosphate Poisoning; Petroleum; Phenothiazines; Plants, Medicinal; Plants, Toxic; Poisoning; Salicylates; Sulfonamides; Tranquilizing Agents

Drug screens were performed for 434 adult patients who presented to the Parkland Memorial Hospital Emergency Department with suspected acute drug overdose. The screening consisted of analysis of urine by automated high performance liquid chromatography (REMEDi) in combination with qualitative EMIT immunoassays. Selected patients also had ethanol measured in blood, salicylate and acetaminophen measured in serum, and urine specimens analyzed qualitatively for cannabinoids. Most patients (83.4%), regardless of age, race, or gender, had evidence of consumption of at least one drug. The drugs detected most often were ethanol (30.0%) and cocaine (23.7%). At least one of the nine most common drugs-of-abuse (amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, ethanol, opiates, opioids, and phencyclidine) was detected in 64.5% of the specimens, and combinations of these drugs were present in 45.4%. For most drugs, age, gender, ethnicity, time of day, day of week, and indication for screening could not be used to predict the drug screen result.

Topics: Acetaminophen; Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Alcoholic Intoxication; Amphetamines; Analgesics, Non-Narcotic; Barbiturates; Cannabinoids; Chromatography, High Pressure Liquid; Cocaine; Drug Overdose; Enzyme Multiplied Immunoassay Technique; Ethanol; Female; Forecasting; Hallucinogens; Humans; Male; Middle Aged; Narcotics; Phencyclidine; Poisoning; Retrospective Studies; Salicylates; Substance-Related Disorders

A spectrum of quantitative and qualitative methods was adapted to the RA-1000/RA-XT selective analyser for the purpose of excluding or detecting common types of intoxication in the emergency laboratory of our primary care community hospital. Ethanol and salicylates (measured photometrically) and acetaminophen (measured immunologically by EMIT tox) were quantitatively analysed in serum. immunological group tests (EMIT tox) for barbiturates, benzodiazepines, tricyclic antidepressants and related compounds were used for qualitative analysis. Well established clinical chemical methods (aspartarte aminotransferase, alanine aminotransferase, creatine kinase, pseudocholinesterase, glucose and lactate) were applied to the serum samples using the same selective analyser. Within and between run precision, accuracy, recovery and detection ranges (linearity) fulfilled the recommendations of forefield toxicological analysis for all methods. Ethanol (g/l), measured photometrically with the RA-1000 analyser, agreed with the reference method (headspace gas-chromatography) with a correlation coefficient greater than 0.99 (y = 0.06 + 0.98x). Acetaminophen and salicylates showed correlation coefficients greater than 0.94 and greater than 0.99, when compared with manual colorimetric procedures (acetaminophen (mg/l): y = -3.22 + 0.896x; salicylates (mg/l): y = -2.1 + 1x). Qualitative group tests for barbiturates, benzodiazepines and tricyclic antidepressants measured with the RA-1000 analyser were in good agreement with the EMIT single test procedure. The ranges of the quantitative methods allowed quantification of analytes from therapeutic (non-toxic) to very high levels in undiluted samples (ethanol 0.05 up to 4 g/l; salicylates 32 up to 1200 mg/l and acetaminophen 1.9 up to 200 mg/l). The low detection limits of the qualitative tests allowed the recognition of compounds in plasma that were present in low concentrations and/or displayed only minor reactivity with the antibodies provided by the EMIT tox test kits. As a consequence, decision limits for all three group tests in serum were lowered to near the detection limit: (table: see text) For quantitative tests the lower limits of quantification were: (table: see text) The working reagents were stable for at least 14 days at 4-8 degrees C. Calibration curves were stable over the expiration period of reconstituted original reagents (6-12 weeks), also when working reagents were prepared in aliquots from stored reconstituted

Topics: Acetaminophen; Alcoholic Intoxication; Anti-Anxiety Agents; Antidepressive Agents, Tricyclic; Autoanalysis; Barbiturates; Benzodiazepines; Blood Chemical Analysis; Emergencies; Evaluation Studies as Topic; Humans; Poisoning; Salicylates; Sensitivity and Specificity; Toxicology

Fatal acute ethanol intoxication is frequently encountered in medicolegal practice. Although the vast majority of acute ethanol toxicity deaths follow the ingestion of conventional alcoholic beverages, ethanol can be obtained from a variety of commercial products, which often contain high levels of ethyl alcohol but are not manufactured or designed for consumption. Such products may be easily purchased in locales where statutory limitations restrict liquor availability on Sundays or during the early morning hours. Several acute ethanol fatalities have been encountered in New Mexico that were directly related to consumption of non-beverage ethanol-containing products, all of them occurring during times when alcoholic beverage sales were restricted. Despite the fact that manufacturers deliberately include compounds in these products that discourage ingestion, this policy apparently does little to deter individuals who are searching for a source of ethanol when no conventional beverages are available. The products that were consumed in these fatalities also contained other compounds which would be toxic at much greater concentrations, but which were inconsequential in their effects in comparison with the direct toxic effect of ethanol. Investigation of the scene and awareness that alcohol-containing products can be fatally abused are essential to detecting these unconventional ethanol sources.

Topics: Adult; Alcoholic Intoxication; Cause of Death; Drug Combinations; Female; Hair Preparations; Humans; Male; Mouthwashes; New Mexico; Salicylates; Terpenes

Data were collected on 176 consecutive cases of drug overdose evaluated in an emergency department. Quantitative serum toxic screening (TS) was performed for 164 (93%) of these patients; positive results were noted for 133 patients (81%). Six classes of drugs (ethanol, benzodiazepines, salicylates, acetaminophen, barbiturates, and tricyclic antidepressants) were responsible for nearly 70% of all drug detections and were associated with 80% of all admissions in this patient sample. Only two patients (1%) had drug-specific treatment initiated because of TS results. In 12 patients (7%), TS confirmed substances for which specific treatments had been initiated on clinical grounds. Four patients (2%) had drug-specific treatment discontinued because of TS results. Thirty-two patients (19%) were admitted to a medical service; however, only seven patients (4%) were admitted primarily because of TS results. All other patients were admitted because of clinical abnormalities that required inpatient care. It is concluded that only a few drugs are responsible for most drug overdoses. Moreover, TS results rarely change the treatment or disposition of overdose patients; these decisions are typically based on clinical parameters.

Topics: Acetaminophen; Alcoholic Intoxication; Antidepressive Agents, Tricyclic; Barbiturates; Blood Chemical Analysis; Diazepam; Drug Overdose; Emergencies; Humans; Retrospective Studies; Salicylates

A review of 737 limited toxicological screens performed in a municipal teaching hospital over one calendar year was conducted to determine the value of performing analyses for ethanol, salicylates, and barbiturates. Less than 5% of salicylate determinations and less than 2% of barbiturate tests yielded positive results. On the other hand, ethanol was present in over 70% of cases. The low number of positive results and the cost do not justify analyzing for salicylates or barbiturates unless their presence is suspected. Ethanol determinations should be limited to patients without an obviously consistent clinical presentation. Selective use of these tests in the emergency department is called for.

Topics: Alcoholic Intoxication; Barbiturates; Emergency Service, Hospital; Fees and Charges; Humans; Minnesota; Salicylates; Toxicology

Several variables must be considered in the treatment of a poisoned child, including the particular substance, the individual child, and the child's home environment. General principles of treatment are described, and the management of particular substances, including household cleaning products, petroleum distillate hydrocarbons, and salicylates, is detailed. The family should not leave the emergency room without instruction on prevention of poisoning.

Topics: Alcoholic Intoxication; Antidotes; Carbon Monoxide Poisoning; Cathartics; Child; Child, Preschool; Emergencies; Histamine H1 Antagonists; Household Products; Humans; Infant; Iron; Petroleum; Plant Poisoning; Poisoning; Salicylates; Sympathomimetics; Time Factors

Topics: Acetaminophen; Alcoholic Intoxication; Antidepressive Agents, Tricyclic; Barbiturates; Belladonna Alkaloids; Child; Child, Preschool; Gastric Lavage; Histamine H1 Antagonists; Humans; Infant; Iron; Paraffin; Phenothiazines; Poisoning; Salicylates

From 3,548 drug overdose or abuse cases presenting at 21 Metropolitan Toronto hospitals' Emergency departments, data concerning demographic and medical characteristics, investigative and management procedures, drug analysis services, and disposition of patients were collected. Of the 3,548 cases, 2,723 (77%) were acute overdose and 816 (23%) were drug abuse. Drug overdose was more common than drug abuse for both sexes, but was more characteristic of females. The drugs most frequently alleged ingested were benzodiazepines (34%), ethanol (32%), salicylates (16%), and barbiturates (14%). The frequency with which particular classes of drugs are alleged in overdose corresponds closely to the frequency of prescribing these drugs in Ontario.

Topics: Adult; Alcoholic Intoxication; Barbiturates; Benzodiazepines; Emergencies; Female; Humans; Male; Middle Aged; Ontario; Salicylates; Substance-Related Disorders; Suicide, Attempted

Topics: Accidents, Home; Alcoholic Intoxication; Antidepressive Agents, Tricyclic; Atropine; Child; Child, Preschool; Diphenoxylate; Drug Packaging; Drug Storage; Education; Humans; Hydrocarbons; Iron; Paraquat; Pneumonia; Poisoning; Salicylates

Topics: Accidents; Alcoholic Intoxication; Antidepressive Agents; Barbiturates; Carbon Monoxide Poisoning; Diagnosis, Differential; Female; Foodborne Diseases; Germany, West; Glutethimide; Humans; Hypnotics and Sedatives; Insecticides; Lead Poisoning; Male; Mercury Poisoning; Methanol; Poisoning; Salicylates; Solvents; Suicide; Tranquilizing Agents

Topics: Adolescent; Adult; Aftercare; Aged; Alcoholic Intoxication; Barbiturates; Female; Humans; Intensive Care Units; Male; Middle Aged; Poisoning; Psychotherapy; Resuscitation; Salicylates; Suicide

Topics: Adolescent; Adult; Aged; Alcoholic Intoxication; Analgesics; Antidepressive Agents; Barbiturates; England; Ethnicity; Female; Forensic Medicine; Humans; Hypnotics and Sedatives; Lead Poisoning; Male; Marriage; Metals; Middle Aged; Motivation; Poisoning; Salicylates; Scotland; Solvents; Suicide; Tranquilizing Agents

Topics: Accidents; Adolescent; Adult; Age Factors; Alcoholic Intoxication; Antidepressive Agents; Child; Child, Preschool; Depression; Drug Prescriptions; Employment; Family Characteristics; Female; Humans; Hypnotics and Sedatives; Male; Marriage; Ontario; Poisoning; Salicylates; Sex Factors; Suicide; Tranquilizing Agents

Topics: Alcoholic Intoxication; Barbiturates; Carbon Monoxide Poisoning; Clinical Laboratory Techniques; Digitoxin; Digoxin; Humans; Lead Poisoning; Poisoning; Salicylates

Topics: Adult; Alcoholic Intoxication; Barbiturates; Bromides; Coma; Diagnosis, Differential; Diazepam; Erythema; Female; Humans; Male; Salicylates; Skin Manifestations; Substance-Related Disorders

Topics: Adult; Alcoholic Intoxication; Female; Histamine H1 Antagonists; Humans; Salicylates

Topics: Acidosis; Aged; Alcoholic Intoxication; Alkalosis; Alkalosis, Respiratory; Arrhythmias, Cardiac; Coma; Diabetic Ketoacidosis; Diagnosis, Differential; Encephalitis, Arbovirus; Humans; Male; Myocardial Infarction; Poisoning; Salicylates; Stomach Neoplasms; Sweating

Topics: Adolescent; Adult; Aged; Alcoholic Intoxication; Barbiturates; Child; Diuresis; Fluoride Poisoning; Humans; Metals; Middle Aged; Peritoneal Dialysis; Poisoning; Quinine; Renal Dialysis; Salicylates