salicylates and Poisoning

Topics: Acid-Base Imbalance; Charcoal; Diagnosis, Differential; Fluid Therapy; History, 19th Century; Humans; Poisoning; Renal Dialysis; Salicylates; Therapeutic Irrigation

Although most poisoning deaths are not preventable with current medical technology, in some cases different management decisions may have prevented fatal outcomes.. This study aims to review reported poisoning-related deaths for preventability to provide insight to improve future care.. Fatality abstracts published in the US National Poison Data System (NPDS) Annual Reports (2008-2012) were analyzed. Preventability was graded using a Likert scale of 1 (definitely non-preventable) to 6 (definitely preventable). Two medical toxicologists screened all cases. Cases deemed definitely not preventable (score 1) by both reviewers were excluded from further review and considered to be "non-preventable". All cases considered at least possibly preventable by either screener were reviewed by a multidisciplinary panel of 5 physicians for preventability scoring. Differences were resolved by consensus. Cases determined to be "preventable" (scores 4-6) were characterized by type of improvement issue involved (diagnosis, treatment, monitoring, other) and recurring scenarios.. Of 390 published abstracts, 78 (20.0%) deaths were considered at least possibly preventable by at least one screener. Of these, 34 (8.7%) deaths were determined to be "preventable" by the panel. Inter-observer agreement by weighted kappa analysis was 0.58 for screening, 0.24 for preventability, and 0.44 for specific aspects of care. The most common toxicants were salicylates (n = 9), opioids (n = 4), toxic alcohols (n = 3), fluoride containing product (n = 3), and bupropion (n = 3). The most common improvement opportunities involved treatment and monitoring.. Most of the ingested substances in preventable deaths have delayed GI absorption or require metabolic activation to produce a delayed effect (such as salicylates, opioids, and toxic alcohols), and therefore provide an opportunity for early recognition and successful interventions. Most improvement opportunities are clearly described in the literature but may be not recognized.. Based on an analysis of published NPDS data, a considerable number of poisoning-related deaths reaching medical attention may be preventable. The most common scenarios involved in potentially preventable poisoning fatalities related to monitoring and treatment. Salicylates and opioids were the most common agents involved in preventable deaths.

Topics: Adult; Analgesics, Opioid; Bupropion; Databases, Factual; Female; Fluoride Poisoning; Humans; Information Systems; Male; Middle Aged; Observer Variation; Poison Control Centers; Poisoning; Salicylates; Young Adult

Serious toxicity can result from exposure to small amounts of methyl salicylate. Methyl salicylate is widely available as a component in many over-the-counter brands of creams, ointments, lotions, liniments and medicated oils intended for topical application to relieve musculoskeletal aches and pains. Among the most potent forms of methyl salicylate is oil of wintergreen (98% methyl salicylate). Other products with varying concentrations of methyl salicylate are ubiquitous throughout many parts of the world, including a number of products marketed as Asian herbal remedies. The toxic potential of all of these formulations is often underestimated by health care providers and the general public. A comprehensive review of the existing medical literature on methyl salicylate poisoning was performed, and data compiled over the past two decades by the American Association of Poison Control Centers (AAPCC) was examined. Methyl salicylate continues to be a relatively common source of pediatric exposures. Persistent reports of life-threatening and fatal toxicity were found. In children less than 6 years of age, a teaspoon (5 mL) or less of oil of wintergreen has been implicated in several well-documented deaths. More needs to be done to educate both health care providers and the general public regarding the dangers of these widely available formulations.

Topics: Child, Preschool; Fixatives; Humans; Infant; Nonprescription Drugs; Phytotherapy; Poisoning; Salicylates

Although aspirin (acetylsalicylic acid) has become widely available without prescription, cases of self-poisoning due to overdose of salicylates are quite uncommon, with a low reported mortality. However, severe poisoning with these preparations is life threatening. Besides the aspirin, there are other sources of salicylate poisoning, such as an excessive application of topical agents, ingestion of salicylate containing ointments, use of keratolytic agents or agents containing methyl salicylate (e.g. oil of wintergreen). Most of these preparations are liquid, highly concentrated and lipid soluble, and, therefore, they are able to provoke a severe, rapid salicylate poisoning. On the basis of clinical and metabolic features or salicylate concentration in plasma it is very important to diagnose severe poisoning with salicylates in time and prescribe an adequate treatment. In the present review article various aspects of salicylate poisoning and its treatment are discussed: epidemiology, pharmacokinetics and pharmacodynamics of salicylates, clinical manifestations of their toxicity, management, enhanced elimination and prognosis.

Topics: Acute Disease; Adult; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Child; Child, Preschool; Diagnosis, Differential; Drug Interactions; Drug Overdose; Fixatives; Humans; Ointments; Poisoning; Prognosis; Pulmonary Edema; Salicylates; Time Factors

More than 50% of the toxic-exposure calls to US poison centers involve children. Although most of these exposures are nontoxic, there are several products and medications that are widely available to the pediatric population that can lead to severe toxicity or even death. With some of these medications, death or severe symptoms can occur with the ingestion of only a small amount. It is important that the clinician be familiar with presenting signs and symptoms of potentially toxic ingestions and is able to initiate a therapeutic and life-saving intervention. This article reviews some of the deadlier ingestions that children may be exposed to.

Topics: Alcohols; Analgesics, Opioid; Antidepressive Agents, Tricyclic; Calcium Channel Blockers; Child; Child Welfare; Clonidine; Emergency Service, Hospital; Emergency Treatment; Humans; Hypoglycemic Agents; Poisoning; Salicylates; United States

The acutely poisoned patient remains a common problem facing doctors working in acute medicine in the United Kingdom and worldwide. This review examines the initial management of the acutely poisoned patient. Aspects of general management are reviewed including immediate interventions, investigations, gastrointestinal decontamination techniques, use of antidotes, methods to increase poison elimination, and psychological assessment. More common and serious poisonings caused by paracetamol, salicylates, opioids, tricyclic antidepressants, selective serotonin reuptake inhibitors, benzodiazepines, non-steroidal anti-inflammatory drugs, and cocaine are discussed in detail. Specific aspects of common paediatric poisonings are reviewed.

Topics: Acetaminophen; Acute Disease; Anti-Inflammatory Agents, Non-Steroidal; Antidepressive Agents, Tricyclic; Antidotes; Benzodiazepines; Child; Diagnostic Tests, Routine; Emergency Treatment; Gastric Lavage; Humans; Narcotics; Poisoning; Risk Factors; Salicylates; Selective Serotonin Reuptake Inhibitors

Numerous diagnostic tests may be useful to clinicians caring for poisoned patients. Clinicians should not order a broad range of tests indiscriminately,but rather thoughtfully consider appropriate tests. The results'of the tests should be reviewed in the context of the clinical scenario.

Topics: Acetaminophen; Analgesics, Non-Narcotic; Anti-Inflammatory Agents, Non-Steroidal; Blood Chemical Analysis; Decision Support Techniques; Decision Trees; Electrocardiography; Emergency Treatment; Humans; Poisoning; Salicylates; Toxicology; Urinalysis

Antimalarials, camphor, clonidine, methyl salicylates, and sulfonylureas all may result in serious poisonings and are potentially fatal in small doses in toddlers. Early recognition and appropriate management, including antidotal and supportive care, may prevent poor outcomes in these patients.

Topics: Administration, Oral; Antidotes; Antimalarials; Camphor; Child; Child, Preschool; Clonidine; Dose-Response Relationship, Drug; Humans; Poisoning; Salicylates; Sulfonylurea Compounds; United States

More than 97% of pediatric exposures reported to the AAPCC in 2001 had either no effect or mild clinical effects. Despite the large number of exposures, only 26 of the 1074 reported fatalities occurred in children younger than age 6. These findings reflect the fact that, in contrast to adolescent or adult ingestions, pediatric ingestions are unintentional events secondary to development of exploration behaviors and the tendency to place objects in the mouth. Ingested substances typically are nontoxic or ingested in such small quantities that toxicity would not be expected. As a result, it commonly is believed that ingestion of one or two tablets by a toddler is a benign act and not expected to produce any consequential toxicity. Select agents have the potential to produce profound toxicity and death, however, despite the ingestion of only one or two tablets or sips. Although proven antidotes are a valuable resource, their value is diminished if risk after ingestion is not adequately appreciated and assessed. Future research into low-dose, high-risk exposures should be directed toward further clarification of risk, improvements in overall management strategies,and, perhaps most importantly, prevention of toxic exposure through parental education and appropriate safety legislation.

Topics: Alcohols; Algorithms; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Antidepressive Agents, Tricyclic; Antidotes; Antihypertensive Agents; Atropine; Calcium Channel Blockers; Camphor; Child; Child, Preschool; Clonidine; Decision Trees; Diagnosis, Differential; Diphenoxylate; Drug Combinations; Emergency Medicine; Emergency Treatment; Gastrointestinal Agents; Humans; Infant; Pediatrics; Poisoning; Salicylates; Sulfonylurea Compounds; United States

Intoxications present in many forms including: known drug overdose or toxic exposure, illicit drug use, suicide attempt, accidental exposure, and chemical or biological terrorism. A high index of suspicion and familiarity with toxidromes can lead to early diagnosis and intervention in critically ill, poisoned patients. Despite a paucity of evidence-based information on the management of intoxicated patients, a rational and systematic approach can be life saving.

Topics: Acidosis; Amphetamines; Carbon Monoxide Poisoning; Critical Illness; Hospitalization; Humans; Insecticides; Methemoglobinemia; Organophosphorus Compounds; Osmolar Concentration; Poisoning; Salicylates

Urine alkalinization is a treatment regimen that increases poison elimination by the administration of intravenous sodium bicarbonate to produce urine with a pH > or = 7.5. Experimental and clinical studies confirm that urinary alkalinization increases salicylate elimination, although the mechanisms by which this occurs have not been elucidated. The conventional view is that ionisation of a weak acid, such as salicylic acid, is increased in an alkaline environment. Since the ionisation constant (pKa) is a logarithmic function then, theoretically, a small change in urine pH will have a disproportionately larger effect on salicylate clearance. Hence, elimination of salicylic acid by the kidneys is increased substantially in alkaline urine. However, as salicylic acid is almost completely ionised within physiological pH limits, alkalinization of the urine could not, therefore, significantly increase the extent of ionisation further and the conventional view of the mechanism by which alkalinization is effective is patently impossible. Further experimental studies are required to clarify the mechanisms by which urine alkalinization enhances salicylate elimination.

Topics: Adolescent; Adult; Animals; Female; Half-Life; Humans; Hydrogen-Ion Concentration; Male; Metabolic Clearance Rate; Middle Aged; Poisoning; Salicylates; Sodium Bicarbonate

Topics: Antidepressive Agents, Tricyclic; Antidotes; Carbon Monoxide Poisoning; Ethylene Glycol; Hemoperfusion; Humans; Methanol; Poisoning; Renal Dialysis; Salicylates

Intoxications frequently perturb acid-base and electrolyte status, intravascular volume, and renal function. In selected cases, extracorporeal techniques effectively restore homeostasis and augment intoxicant removal. The use of 4-methylpyrazole, an inhibitor of alcohol dehydrogenase, is a new and effective treatment for patients exposed to toxic alcohols. In this section, practical approaches to commonly encountered intoxicants and the use of extracorporeal techniques are critically reviewed.

Topics: Alcohols; Humans; Lithium Compounds; Poisoning; Salicylates; Sorption Detoxification; Substance-Related Disorders; Theophylline

Poisoning with agricultural toxins is well known in the adult environment, but is rarely seen in children. Vancouver, British Columbia, borders on a large agricultural area, and the British Columbia Children's Hospital is the provincial referral center for major pediatric emergencies. In our experience, children from farming communities are vulnerable to a range of agriculturally related injuries, and exposure to toxic chemicals requiring hospitalization is not rare.. This is a case report with literature review.. A child presenting in a coma proved later to have been exposed to a toxic agent. The agent, dinitrophenol, is a widely used agricultural herbicide and insecticide. The diagnosis resulted from a detailed history and physical examination, which revealed symptoms and signs that suggested poisoning. A search of the farm resulted, and the parents located open dinitrophenol containers. The toxic effects of dinitrophenol described in adults by Poison Control matched those present in the child, and specific treatment interventions existed that could be implemented to positively influence outcome.. Awareness of the possibility of exposure to dinitrophenol is required, as death can result from exposure, and milder cases may go unrecognized. Appropriate treatment can improve outcome. Injuries with toxic agricultural agents are wholly preventable if the materials are handled appropriately in the farm environment, and parents whose children live on or visit farms are aware of the risks involved and take appropriate precautions.

Topics: Adult; Child; Contraindications; Dinitrophenols; Fungicides, Industrial; Humans; Male; Poisoning; Salicylates; Uncoupling Agents

In preparing this Position Statement, all relevant scientific literature was identified and reviewed critically by acknowledged experts using agreed criteria. Well-conducted clinical and experimental studies were given precedence over anecdotal case reports and abstracts were not usually considered. A draft Position Statement was then produced and subjected to detailed peer review by an international group of clinical toxicologists chosen by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists. The Position Statement went through multiple drafts before being approved by the boards of the two societies and being endorsed by other societies. The Position Statement includes a summary statement for ease of use and is supported by detailed documentation which describes the scientific evidence on which the Statement is based. Gastric lavage should not be employed routinely in the management of poisoned patients. In experimental studies, the amount of marker removed by gastric lavage was highly variable and diminished with time. There is no certain evidence that its use improves clinical outcome and it may cause significant morbidity. Gastric lavage should not be considered unless a patient has ingested a potentially life-threatening amount of a poison and the procedure can be undertaken within 60 minutes of ingestion. Even then, clinical benefit has not been confirmed in controlled studies. Unless a patient is intubated, gastric lavage is contraindicated if airway protective reflexes are lost. It is also contraindicated if a hydrocarbon with high aspiration potential or corrosive substance has been ingested.

Topics: Acetaminophen; Adolescent; Adult; Animals; Antidepressive Agents, Tricyclic; Barbiturates; Child; Clinical Trials as Topic; Contraindications; Gastric Lavage; Humans; Poisoning; Salicylates

Salicylate poisoning continues to be an important cause of drug related mortality. The zero order kinetics of salicylates at high doses is responsible in part for cases of iatrogenic poisoning. Serum levels tend to correlate with severity of poisoning in acute overdose cases only. Clinical manifestations include involvement of nervous system, hepatic and pulmonary systems along with metabolic disturbances. Measures at enhancing elimination and reducing absorption, while providing supportive care form the basis of management.

Topics: Absorption; Adult; Aged; Child; Drug Overdose; Humans; Poisoning; Salicylates; Sorption Detoxification

Although many studies in animals and volunteers have demonstrated that multiple-dose activated charcoal increases drug elimination significantly, this therapy has not been shown in a controlled study in poisoned patients to reduce morbidity and mortality. Further clinical studies are required to establish its role and the optimum dosage regimen of charcoal to be administered. Based on current evidence, multiple-dose activated charcoal should only be considered if a patient has ingested a life-threatening amount of phenobarbital (phenobarbitone), carbamazepine, theophylline, quinine, dapsone or salicylate. In all of these cases there are data to confirm enhanced elimination, though no controlled studies have demonstrated clinical benefit.

Topics: Charcoal; Drug Interactions; Humans; Pharmacokinetics; Poisoning; Salicylates; Salicylic Acid

Topics: Acute Disease; Female; Humans; Ichthyosis, Lamellar; Infant; Ointments; Poisoning; Salicylates

Poisoning with salicylic acid and its derivatives is a quite common event, leading to possibly life-threatening complications. A case of fatal intoxication of a sixty-year old patient with acetylsalicylic acid is described and the therapeutic options are discussed. In acute poisoning it is mandatory to initiate simple and effective measures first. This gives time for discussing and planning the more laborious procedures. The initial treatment of salicylate poisoning is based on the prevention of further absorption by a sufficiently large quantity of orally administered activated charcoal (approximately 1 g/kg b.w.). Given repeatedly, activated charcoal may enhance non-renal clearance of salicylates. Intravenously administered sodium bicarbonate counteracts the metabolic acidosis. Moreover, bicarbonate therapy limits tissue distribution of the drug and enhances its renal excretion. The availability of glycine for salicylic acid metabolism may be limited in poisoning because glycine has been used for forming the conjugation product salicyluric acid. Glycine may be administered orally to overcome this bottleneck. Gastric lavage has been proven to be of limited efficacy. This efficacy is further diminished if gastric lavage is performed late after drug ingestion. When it is performed, however, activated charcoal should be administered before and after gastric lavage. Whenever the more simple treatment options fail, hemodialysis or hemoperfusion should be additionally considered since these procedures are effective in removing salicylates from the body.

Topics: Aspirin; Charcoal; Coma; Fatal Outcome; Female; Fever; Gastric Lavage; Glycine; Hemoperfusion; Humans; Middle Aged; Poisoning; Renal Dialysis; Salicylates; Sodium Bicarbonate

Knowledge of the toxicologic nature of ingested substances provides a proper framework for general and specific therapies best suited to meet the needs of the patient. Monitoring and direct observation provided in the PICU can aid proper therapy for many intoxicants. Good supportive care coupled with specific pharmacotherapy will provide the best chance for a successful outcome.

Topics: Acetaminophen; Antidepressive Agents, Tricyclic; Child; Child, Preschool; Clonidine; Humans; Hydrocarbons; Infant; Insecticides; Iron; Organophosphorus Compounds; Poisoning; Salicylates

Topics: Alcohols; Ethylene Glycols; Female; Hemoperfusion; Humans; Middle Aged; Poisoning; Renal Dialysis; Salicylates; Theophylline; United States

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

Topics: Acetaminophen; Barbiturates; Chlormethiazole; Clinical Laboratory Techniques; Colorimetry; Diagnostic Errors; Drug-Related Side Effects and Adverse Reactions; Humans; Immunoassay; Pharmaceutical Preparations; Phenothiazines; Poisoning; Salicylates; Spectrophotometry, Ultraviolet; Toxicology

Topics: Acetazolamide; Acid-Base Equilibrium; Amino Acids; Bicarbonates; Blood Coagulation Disorders; Child; Exchange Transfusion, Whole Blood; Gastric Lavage; Glucose; Humans; Ipecac; Ketones; Peritoneal Dialysis; Poisoning; Potassium; Renal Dialysis; Salicylates; Serum Albumin; Water-Electrolyte Balance

Topics: Age Factors; Amphetamine; Amphetamines; Atropine Derivatives; Barbiturates; Charcoal; Child; Child, Preschool; Gastric Lavage; Humans; Imipramine; Infant; Ipecac; Mushroom Poisoning; Opium; Organophosphate Poisoning; Phenothiazines; Poisoning; Poisons; Salicylates; Tranquilizing Agents

Topics: Analgesics; Animals; Antidepressive Agents; Aspirin; Barbiturates; Charcoal; Child; Child, Preschool; Dextropropoxyphene; Digestive System; Dogs; Gastrointestinal Motility; Humans; Hypnotics and Sedatives; Infant; Intestinal Absorption; Poisoning; Rats; Salicylates; Time Factors; Tranquilizing Agents

Topics: Acidosis; Animals; Bicarbonates; Biotransformation; Blood; Brain Chemistry; Carbon Dioxide; Carbon Isotopes; Dogs; Emetics; Extracorporeal Circulation; Gastric Lavage; Humans; Hydrogen-Ion Concentration; Liver; Mice; Muscles; Poisoning; Rats; Renal Dialysis; Salicylates

Topics: Acute Kidney Injury; Barbiturates; Blood Volume; Child; Child, Preschool; Costs and Cost Analysis; Heart Failure; Humans; Hyperkalemia; Hypocalcemia; Hypotension; Intestinal Obstruction; Intestinal Perforation; Kidney Failure, Chronic; Metabolic Diseases; Methods; Nutrition Disorders; Peritoneal Dialysis; Poisoning; Renal Dialysis; Salicylates; Time Factors

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: Acidosis, Respiratory; Acute Disease; Age Factors; Animals; Central Nervous System; Hyperventilation; Oxidative Phosphorylation; Poisoning; Rabbits; Rats; Salicylates

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

Topics: Albumins; Barbiturates; Carbon; Cellulose; Collodion; Creatinine; Embolism; Hemadsorption; Microscopy, Electron, Scanning; Poisoning; Salicylates; Thrombocytopenia; Uremia

Topics: Acute Kidney Injury; Barbiturates; Brain Edema; Humans; Hyperkalemia; Methanol; Methods; Osmolar Concentration; Osmotic Pressure; Peritoneal Dialysis; Poisoning; Pulmonary Edema; Salicylates; Time Factors; Uremia

Topics: Acetaminophen; Acid-Base Equilibrium; Acidosis; Acute Kidney Injury; Alkalosis, Respiratory; Aspirin; Calcium; Coma; Dehydration; Fever; Gastric Lavage; Hemorrhage; Humans; Hydrogen-Ion Concentration; Infusions, Parenteral; Poisoning; Salicylamides; Salicylates; Seizures; Tetany; Vomiting

Topics: Antidotes; Apomorphine; Barbiturates; Blood Proteins; Cell Membrane Permeability; Charcoal; Cyanides; Dialysis; Diuresis; Emetics; Gastric Lavage; Glycine; Intestinal Absorption; Ipecac; Poisoning; Salicylates; Skin Absorption; Time Factors; Vomiting

Topics: Acetaminophen; Adult; Alcohols; Aniline Compounds; Arsenic Poisoning; Barbiturates; Carbon Tetrachloride Poisoning; Chelating Agents; Child; Chloral Hydrate; Fluoride Poisoning; Glutethimide; Glycols; Humans; Infant; Iron; Lead Poisoning; Male; Mercury Poisoning; Methaqualone; Phenacetin; Poisoning; Renal Dialysis; Salicylates

Topics: Analgesics; Analgesics, Non-Narcotic; Anti-Bacterial Agents; Antipyretics; Arsenic; Bismuth; Cadmium; Carbon Tetrachloride Poisoning; Contrast Media; Glycols; Gold; Heat Exhaustion; Insecticides; Kidney Diseases; Lead Poisoning; Mercury Poisoning; Metals; Poisoning; Radiation Injuries; Salicylates; Sulfonamides; Toxicology; Uranium; Venoms

Topics: Acute Kidney Injury; Ascites; Dialysis; Ethanol; Methanol; Nephritis; Peritoneal Cavity; Peritoneal Dialysis; Poisoning; Renal Dialysis; Renal Insufficiency; Salicylates; Toxicology

Topics: Absorption; Acetazolamide; Bicarbonates; Child; Dialysis; Exchange Transfusion, Whole Blood; Fluid Therapy; Humans; Infusions, Parenteral; Ipecac; Kidney; Kidneys, Artificial; Metabolism; Poisoning; Propylene Glycols; Renal Dialysis; Salicylates; Toxicology; Tromethamine

This study assesses whether oral multiple-dose charcoal therapy (MDC) or whole-bowel irrigation (WBI) enhances the excretion of previously absorbed salicylate.. A controlled, randomized, three-limbed crossover protocol was used in nine humans who ingested aspirin. Salicylate levels were measured in serial serum specimens and 32-hour urine collections and kinetic parameters were calculated.. There were no differences among the control (CTL), MDC, or WBI groups for area under the serum concentration vs time curve (CTL, 2320 +/- 501 mg/L.h MDC, 2040 +/- 454 mg/L.h; WBI, 2093 +/- 418 mg/L.h) or for urinary salicylates (CTL, 54.9% +/- 9.4%; MDC, 50.9% +/- 8.0%, WBI, 52.4% +/- 13.7% of ingested dose).. Our data do not support the use of either MDC or WBI to enhance the excretion of previously absorbed salicylate in poisoned patients. In patients with drug overdoses, a clear rectal effluent remains as the endpoint for WBI.

Topics: Administration, Oral; Adult; Aspirin; Charcoal; Female; Humans; Intestinal Absorption; Intestines; Male; Poisoning; Salicylates; Salicylic Acid; Therapeutic Irrigation

Topics: Administration, Oral; Barbiturates; Charcoal; Clinical Trials as Topic; Hepatic Encephalopathy; Humans; Kidney Failure, Chronic; Poisoning; Renal Dialysis; Salicylates

Topics: Acid-Base Equilibrium; Calcium; Diuresis; Emetics; Glucose; Humans; Hydrogen-Ion Concentration; Ipecac; Mannitol; Poisoning; Potassium; Salicylates; Sodium

Topics: Gastric Lavage; Humans; Infant; Ipecac; Methods; Poisoning; Salicylates; Vomiting

Topics: Abdomen; Acidosis; Diagnosis, Differential; Humans; Infant; Lethargy; Male; Poisoning; Renal Dialysis; Respiratory Insufficiency; Salicylates; Tachypnea

Suspected ingestions are a common chief complaint to the emergency department although the majority of ingestions by children are insignificant.. Assess the utility of screening laboratory tests and Electrocardiograms (ECGs) in unintentional asymptomatic pediatric poisonings.. Retrospective chart review at a tertiary care children's hospital and a regional poison center of patients less than 12 years of age using ICD-9 codes from January 2005 through December 2008. Laboratory or ECG results requiring intervention and/or direct treatment, a non-RPC subspecialty consultation, and/or prolonged Emergency Department stay was considered changed management.. Five hundred ninety five suspected ingestions met our criteria. The median age was 2.6 years (IQR 1.6, 3.0 years) and 56% were male. One laboratory test or ECG was obtained in 233 patients (39%). Of 24 screening ECGs, 32 complete blood counts and 34 blood gases, none were clinically significant. Fifty-two patients received screening metabolic panels, 3 were abnormal and 2 changed management (anion gap metabolic acidosis with unsuspected salicylate ingestions). None of the 127 (21%) screening acetaminophen levels changed management. Two of sixty-five (13%) screening salicylate levels changed management. Three screening urine toxicology tests on patients with altered mental status were positive without ingestion history. No patient under the age of 12 years with normal vital signs and normal mental status had positive screening tests.. Screening laboratory tests and ECGs were of limited utility and rarely changed management despite being ordered in a significant number of patients. Screening tests are rarely indicated in unintentional overdoses in children who are asymptomatic.

Topics: Acetaminophen; Asymptomatic Diseases; Blood Cell Count; Blood Chemical Analysis; Child; Child, Preschool; Clinical Enzyme Tests; Drug Overdose; Electrocardiography; Emergency Service, Hospital; Female; Humans; Infant; Male; Poisoning; Retrospective Studies; Salicylates; Urinalysis

There is currently limited literature regarding the use of hemodialysis after acute pediatric and adolescent poisoning.. We sought to characterize the use of hemodialysis (HD) and other extracorporeal removal techniques (ECR) in the treatment of acutely poisoned children and adolescents reported to a state poison control system over a 10-year period.. After institutional review board approval, a state poison control system database was queried for all cases coded for hemodialysis and other ECR after pediatric and adolescent (0-19 years old) poisoning. We also analyzed National Poison System Data to determine national trends.. Ninety patients were reviewed after exclusions for errors in coding or incomplete documentation. HD was the principle method of ECR employed. One case of hemoperfusion and hemofiltration was reported. HD was used, on average, nine times per year. ECR was used predominantly in adolescent patients (age ≥ to 12 years) (84 patients, 93%) for intentional ingestions (82 patients, 91%). Fifteen different toxins were encountered, with salicylates (29 patients) and ethylene glycol (23 patients) most commonly encountered. Ethylene glycol and methanol blood levels were not available before initiation of hemodialysis in all but one case.. All salicylate-poisoned patients who underwent HD demonstrated clinical findings indicative of toxicity even in the absence of elevated levels advocated by some as indication for HD. HD and other ECR are rarely used in the management of pediatric and adolescent poisoning.

Topics: Adolescent; California; Child; Child, Preschool; Cyclooxygenase Inhibitors; Databases, Factual; Ethylene Glycol; Humans; Infant; Infant, Newborn; Poison Control Centers; Poisoning; Salicylates; Sorption Detoxification; Transportation of Patients; Young Adult

Topics: Adult; Caffeine; Dietary Supplements; Female; Humans; Hypokalemia; Nonprescription Drugs; Poisoning; Salicylates; Weight Loss

Topics: Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Humans; Poisoning; Salicylates

Topics: Age Factors; Anti-Inflammatory Agents, Non-Steroidal; Choline; Drug Combinations; Female; Gels; Humans; Infant; Male; Pain; Poisoning; Salicylates; Tooth Eruption

A 4-year-old Indian girl was seen in our emergency department for unintentional ingestion of topical medication oil with subsequent salicylate poisoning. Serum levels were 52 mg/dL at 12 hours after ingestion.She was started on urine alkalization therapy to enhance salicylate elimination. This was achieved by a bicarbonate bolus of 1 mEq/kg for an hour and a continuous bicarbonate-potassium-dextrose combination infusion. The infusion regimen was modified from adult recommendations to tailor for pediatric physiological requirements in a young child. This consisted of a combination solution of dextrose 5%-sodium bicarbonate-potassium chloride with similar sodium content as half-strength (0.45%) saline and supplemental potassium, which is crucial for effective urine alkalinization. The combination fluid was administered at a rate 1.5 times her maintenance fluid requirement to achieve a urine output of 1.5 to 2 mL/kg per hour and a urine pH of 7.5 to 8.5. This regimen was well tolerated with good outcome.Many pediatricians and toxicologists achieve urine alkalinization by giving multiple bicarbonate boluses and have separate hydration fluids with dextrose and supplemental potassium. These regimens may involve complex calculations and multiple infusions that may lead to increased risk of calculation and medication errors especially in the busy emergency department setting. This case report highlights the use of a simple modified urine alkalinization regimen for moderate salicylate poisoning in a young child in the emergency department.

Topics: Bicarbonates; Child, Preschool; Emergency Service, Hospital; Emergency Treatment; Female; Humans; Hydrogen-Ion Concentration; Poisoning; Salicylates; Severity of Illness Index; Urine

Aspirin should not be used in children except for specific therapeutic reasons. We report on a severely ill infant who had ingested aspirin contained in a traditional medicine and review 21 other patients with pre-admission non-therapeutic salicylate exposure.. We reviewed laboratory, clinical and poisons unit records to determine how many children were admitted to our hospital over an 18-month period with evidence of salicylate ingestion not prescribed for therapeutic reasons. We determined the source of the salicylate, elapsed time between ingestion and laboratory assay, morbidity and mortality and final diagnosis.. Twenty-one children meeting our criteria, including 9 under 6 months of age, were admitted during this period. The most prevalent source of salicylate was over-the-counter (OTC) aspirin, but some had reportedly only been given traditional medicines. Nineteen were seriously ill, 4 died and 3 had severe brain injury. Two, initially diagnosed with Reye's syndrome, probably had inherited metabolic disorders. Only 2 patients had salicylate levels that at the time of measurement are normally considered toxic; however, the literature suggests that lower levels may exacerbate illness severity in young children.. We found inappropriate use of OTC aspirin in children that requires explanation. There may be policy implications for the content and presentation of patient information; the incorporation of pharmaceuticals in traditional medicines merits further study. Salicylate toxicity should be considered in children with unexplained metabolic acidosis out of keeping with the severity of their acute illness.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Nonprescription Drugs; Poisoning; Retrospective Studies; Salicylates; South Africa

We present a 19-month-old boy with a history of asthma who presented to the pediatric emergency department with noisy breathing and tachypnea partially responsive to albuterol. He was discharged to routine care at home. His parents brought him back the next day for persistent respiratory distress despite routine home albuterol. A check of electrolytes showed a low bicarbonate level.

Topics: Acid-Base Equilibrium; Albuterol; Alkalosis, Respiratory; Aspirin; Asthma; Bicarbonates; Bites, Human; Child Abuse; Chlorides; Developmental Disabilities; Emergencies; Humans; Hyperventilation; Infant; Male; Poisoning; Recurrence; Salicylates

Despite little empiric evidence, mechanical ventilation (MV) in the setting of salicylate poisoning is considered by many to be harmful. When salicylate-poisoned patients are ventilated at conventional settings, the respiratory alkalosis is abolished, more salicylate is able to pass into the central nervous system (CNS), and neurotoxicity worsens. The objective of this study was to identify a relationship between MV, acidosis, and outcome in salicylate-poisoned patients.. The authors electronically searched a poison control center (PCC) database (2001-2007) for patients with salicylate poisoning, defined as a serum concentration > 50 mg/dL, who had MV listed as a therapy. For the 7-year study period, a total of 3,144 salicylate-poisoning cases were identified. Eleven patients met the inclusion criteria of having both salicylate concentrations > 50 mg/dL and required MV; only 7 of them had post-MV data available.. In all seven patients with post-MV blood gas data, the post-MV pH was < 7.4. In five of six patients with recorded PCO2, the post-MV PCO2 was > 50 mm Hg. Two of the seven patients in the study group died following intubation (two patients died within 3 hours [serum salicylate concentrations, 85 and 79 mg/dL, respectively]). Another patient sustained severe neurologic injury (serum salicylate concentration, 84 mg/dL). The other four patients were ultimately discharged home. In the three patients with the worst clinical outcome, deterioration was reported within hours of intubation.. Inadequate MV of patients with salicylate poisoning is associated with respiratory acidosis, acidemia, and clinical deterioration in this series of cases. This supports warnings about the danger of improper MV in patients with salicylate poisoning. A prospective study should be performed.

Topics: Acidosis; Humans; New York; Poisoning; Respiration, Artificial; Retrospective Studies; Salicylates; Treatment Outcome

Topics: Child, Preschool; Diabetic Ketoacidosis; Diagnosis, Differential; Female; Humans; Poisoning; Salicylates

A review of U.S. poison center data for 2004 showed over 40,000 exposures to salicylate-containing products. A guideline that determines the conditions for emergency department referral and pre-hospital care could potentially optimize patient outcome, avoid unnecessary emergency department visits, reduce health care costs, and reduce life disruption for patients and caregivers. An evidence-based expert consensus process was used to create the guideline. Relevant articles were abstracted by a trained physician researcher. The first draft of the guideline was created by the lead author. The entire panel discussed and refined the guideline before distribution to secondary reviewers for comment. The panel then made changes based on the secondary review comments. The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial out-of-hospital management of patients with a suspected exposure to salicylates by 1) describing the process by which a specialist in poison information should evaluate an exposure to salicylates, 2) identifying the key decision elements in managing cases of salicylate exposure, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research. This guideline is based on an assessment of current scientific and clinical information. The expert consensus panel recognizes that specific patient care decisions may be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all of the circumstances involved. This guideline does not substitute for clinical judgment. Recommendations are in chronological order of likely clinical use. The grade of recommendation is in parentheses: 1) Patients with stated or suspected self-harm or who are the victims of a potentially malicious administration of a salicylate, should be referred to an emergency department immediately. This referral should be guided by local poison center procedures. In general, this should occur regardless of the dose reported (Grade D). 2) The presence of typical symptoms of salicylate toxicity such as hematemesis, tachypnea, hyperpnea, dyspnea, tinnitus, deafness, lethargy, seizures, unexplained lethargy, or confusion warrants referral to an emergency department for evaluation (Grade C). 3) Patients who exhibit typical symptoms of salicylate toxicity or nonspecific symptoms such as unexplai

Topics: Evidence-Based Medicine; Humans; Poison Control Centers; Poisoning; Salicylates; Triage

Salicylate poisoning appears to result in death, despite supportive care, once a critical brain salicylate concentration is reached. The binding of salicylate to albumin is saturable; free plasma salicylate concentrations rise disproportionately to total drug levels. Because unbound salicylate distributes into the brain, the authors questioned whether an intravenous (i.v.) infusion of albumin would cause a redistribution of salicylate from the brain back into the plasma, which might allow enough time for hemodialysis to be instituted.. To determine if i.v. albumin infusion would lower brain salicylate concentrations through redistribution in a porcine model of acute salicylate poisoning.. In a randomized controlled trial, 17 swine under anesthesia and controlled ventilation received 400 mg/kg of sodium salicylate i.v. over 15 minutes. At 60 minutes, nine animals received 1.25 g/kg albumin (25% solution) i.v. over 15 minutes, while eight control animals received an equal volume of normal saline (5 mL/kg). Arterial pH was maintained between 7.45 and 7.55. Serial measurements of serum albumin as well as free and total salicylate concentrations were obtained, and urine was collected for measurement of total salicylate excretion. At 180 minutes, animals were killed and brains harvested for measurement of brain salicylate concentrations.. Average peak serum total salicylate concentrations of 105.5 and 109 mg/dL were achieved in control and albumin-treated animals, respectively. Albumin infusion was accompanied by statistically significant increases in serum total salicylate concentrations (median from 79.5 to 86.9 mg/dL at 75 minutes), while levels decreased slightly in control animals. Serum free salicylate concentrations decreased slightly in albumin-treated animals, but the difference was not statistically significant. Median brain salicylate concentrations were about 14% lower in the albumin treatment group (17.8 mg/100 g brain) compared with controls (20.5 mg/100 g brain); this approached statistical significance (p = 0.075). Median urinary salicylate excretion was higher in the albumin-treated group (0.83 vs. 0.48 g; p = 0.072), with similar urinary pH and volumes in both groups.. In this animal model of salicylate poisoning, i.v. infusion of 1.25 g/kg albumin was accompanied by a 14% decline in median brain salicylate concentrations, which approached statistical significance.

Topics: Albumins; Analysis of Variance; Animals; Brain; Infusions, Intravenous; Male; Poisoning; Random Allocation; Salicylates; Statistics, Nonparametric; Swine

To determine whether it is necessary to routinely measure serum salicylate levels in addition to serum paracetamol levels in alert overdose patients who deny ingestion of that substance.. Prospective observational study of overdose patients attending an urban emergency department.. A total of 171 patients attended with an alleged overdose. Thirty-seven patients were excluded; 24 patients had a reduced conscious level (Glasgow Coma Scale <15), nine patients could not recall the time of overdose and four patients had a staggered overdose. In all, 47.0% (63/134) claimed to have taken paracetamol and 5.2% (7/134) claimed to have taken salicylate. No patient who denied taking paracetamol or salicylate subsequently tested positive for them. In all, 51.5% (69/134) of patients reported that they had taken alcohol at the time of their overdose.. Given the relatively low clinical risk and evident symptoms and signs from salicylate overdose, routine testing may not be required for fully conscious asymptomatic patients who deny taking it. The risks of delayed toxicity and lack of initial symptoms in those ingesting paracetamol suggests that continued routine testing is necessary.

Topics: Acetaminophen; Drug Overdose; Emergency Service, Hospital; Humans; Poisoning; Prospective Studies; Salicylates

Topics: Acid-Base Equilibrium; Acidosis; Adenosine Triphosphatases; Analgesics; Cytochromes; Ethylene Glycol; Humans; Male; Poisoning; Propylene Glycol; Salicylates

Salicylate (SAL) produces mitochondrial membrane permeability transition (MPT) with resultant oxidative phosphorylation uncoupling. Cyclosporine A (CSA) inhibits SAL-induced MPT. This study determined if CSA pretreatment prolonged survival time in SAL-poisoned rats. Twenty-nine rats were randomized to receive pre-treatment with either 30 mg/kg CSA or equal volume of control diluent intraperitoneally (i.p.). Four hours later, all rats received 1700 mg/kg sodium salicylate i.p. Survival time, whole blood CSA ([CSA]), and serum sodium ([Na]), glucose and SAL ([SAL]) concentrations were determined. The results showed median survival time for controls was 18 min (95% CI 14-22 min) and for CSA animals was 14 min (95% CI 13-15 min). Univariate and multivariate analyses and Cox proportional hazard regression revealed CSA treatment was associated with higher [SAL], which was associated with shortened survival times. The CSA group also demonstrated shorter survival times for a given [SAL]. In conclusion, CSA pre-treatment shortened survival in SAL-poisoned rats.

Topics: Animals; Cyclosporine; Enzyme Inhibitors; Injections, Intraperitoneal; Male; Poisoning; Rats; Salicylates; Survival Rate; Treatment Outcome

Topics: Aged; Analgesics; Humans; Male; Medicine, Chinese Traditional; Oils; Poisoning; Salicylates

NMR spectroscopic investigation can be applied to a large variety of xenobiotics in acute poisoning cases (therapeutic agents, pesticides, solvents, alcohols). In a salicylate poisoning case, the three major metabolites of acetylsalicylic acid--salicylic, salicyluric, and gentisic acids--have been detected in crude urine. Valproic acid as glucuronoconjugated form was identified in urine samples from two poisoned patients. Paraquat (Gramoxone) was identified by its two aromatic signals at 8.49 and 9.02 ppm and quantitated in urine of two acutely poisoned patients (985 and 500 micromol/L). In an intentional poisoning case with tetrahydrofuran, this compound was characterized by its resonances at 1.90 and 3.76 ppm, and quantitated at 11.3 and 11.8 mmol/L in serum and urine samples, respectively. Methanol, ethylene glycol, and the corresponding metabolites formate and glycolate were detected in the same spectrum of serum samples from three poisoned patients. Detection and quantitation of many exogenous and endogenous compounds could be achieved by 1H HMR spectroscopy in biological fluids without any hypothesis on the chemical species.

Topics: Acute Disease; Humans; Hydrogen; Magnetic Resonance Spectroscopy; Paraquat; Poisoning; Salicylates; Solvents; Valproic Acid; Xenobiotics

Oil of Wintergreen (methyl salicylate) is a common ingredient for liniments, ointments and essential oils used in self-treatment of musculoskeletal pain. Its pleasant smell also encourages its use to flavour confectionery. The toxic potential of this preparation is not always fully appreciated by the general public and physicians. To appreciate the danger of this oil it can be compared to aspirin tablets (325 mg dose): one teaspoon (5 ml) of Oil of Wintergreen is equivalent to approximately 7000 mg of salicylate or 21.7 adult aspirin tablets. Ingestion of as little as 4 ml in a child can be fatal. Prevention of accidental ingestion of methyl salicylate containing products can be achieved by keeping the products out of reach of children, using child resistant bottles, restricting the size of the openings of the bottles, appropriate labeling on products and reducing the salicylate content. Immediate action should be taken to treat a patient with accidental poisoning and hospitalisation is needed for monitoring and treatment. The danger of this product should be fully appreciated by both physicians and the general public. We present a case of Oil of Wintergreen poisoning with development of laryngeal oedema as a complication, general information and management issues will also be discussed.

Topics: Female; Humans; Infant; Laryngeal Edema; Poisoning; Salicylates

Rates of deliberate self-poisoning have increased in recent years. While over-the-counter availability and prescribing patterns may influence trends in substances used in overdose, these may also be related to clinical characteristics of patients. We investigate trends in substances used for self-poisoning and the influence of age, gender, suicidal intent and repetition status on the substances used.. Data collected by the Oxford Monitoring System for Attempted Suicide were used to review trends and patterns of self-poisoning between 1985 and 1997.. There were substantial increases in self-poisoning with paracetamol and antidepressants. While the increase in antidepressant self-poisoning closely paralleled local prescribing figures during 1995-97, SSRI antidepressant overdoses occurred somewhat more often than expected compared with tricyclic overdoses. Paracetamol overdoses were more common in first-timers and young people, whereas overdoses of antidepressants and tranquillizers were more common in repeaters and older people. Self-poisoning with gas and non-ingestible poisons was associated with high suicidal intent.. There have been marked changes in the substances used for self-poisoning, which seem primarily to reflect availability, as do the influences of age and repeater status on choice of substances used. Degree of suicidal intent may also influence choice of method of self-poisoning.

Topics: Acetaminophen; Adolescent; Adult; Age Distribution; Analgesics, Non-Narcotic; Antidepressive Agents; Drug Overdose; Female; Humans; Male; Middle Aged; Poisoning; Recurrence; Retrospective Studies; Salicylates; Self-Injurious Behavior; Sex Distribution; Suicide, Attempted; Tranquilizing Agents; United Kingdom

Because of the inconvenience and longer time required to punch out the tablets, strip packaging may reduce the number of tablets that can be readily swallowed by adults with self-poisonings. In fact, hospital-based studies of paracetamol poisoning in the U.K. and Hong Kong have shown that blister packs were associated with fewer tablets being ingested and large overdoses were mostly from loose preparations. In Australia, following the change in packaging for carbamazepine from bottles of tablets to blister packs, a marked decrease in the reported number of tablets ingested by patients was seen. Reducing the maximum number of tablets that can be available in individual preparations or prescriptions may also reduce the likelihood of severe poisonings. In France, but not in the UK, the content of each pack of paracetamol has been legally limited to 8 g. This was thought to be one reason why severe liver damage and deaths after paracetamol poisonings are less common in France than in the UK. Medicated oils containing methyl salicylate pose the threat of rapid-onset, severe salicylate poisoning if swallowed. To reduce the amount of methyl salicylate that can be readily swallowed, the methyl salicylate content and the size of the bottle and its opening should be restricted. In adults with Dettol poisoning, serious complications such as pulmonary aspiration are more likely if a large amount is ingested. Similarly, the risk may be reduced by restricting the size of bottle and its opening.

Topics: Acetaminophen; Adult; Analgesics, Non-Narcotic; Carbamazepine; Drug Packaging; Household Products; Humans; Poisoning; Salicylates; Suicide

Topics: Health Education; Humans; New York; Poison Control Centers; Poisoning; Salicylates

In view of the toxic potential of medicated oils containing methyl salicylate, we have studied the existing packaging of 10 commonly used preparations from Hong Kong and Singapore and identified areas for improvement with respect to the prevention of poisonings. They were all packed in translucent bottles without child-resistant closures. The methyl salicylate content ranged from 15 to 67%. Many preparations also contained other potentially toxic ingredients in significant amounts, such as turpentine oil and camphor. The contents of the larger bottles could generally be emptied more easily because of the greater size of their openings. The product with the highest methyl salicylate content also had the biggest opening of all. The threat from ingestion of medicated oils containing methyl salicylate can probably be 'reduced' by: (i) using child-restraint closures; (ii) restricting the size of both the openings and the bottles; and (iii) reducing the methyl salicylate content.

Topics: Camphor; Drug Packaging; Fixatives; Hong Kong; Poisoning; Product Surveillance, Postmarketing; Salicylates; Singapore; Solvents; Turpentine

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

Topics: Animals; Antidotes; Bicarbonates; Charcoal; Hydrogen-Ion Concentration; Metabolic Clearance Rate; Poisoning; Salicylates; Swine; Urine

Is universal screening of acetaminophen (APAP) and salicylate (SAL) necessary in patients with a suicidal ingestion or an altered mental status and suspected ingestion? This descriptive, retrospective chart review in an emergency department in a large urban county hospital examined all patients who presented with a history of suicidal ingestion or an altered mental status with a strong suspicion of ingestion from January 1992 through October 1993. APAP and SAL serum levels were measured in 1,820 patients, and charts of patients with APAP serum levels of > 1 microgram/mL or SAL serum levels of > 1 mg/dL were reviewed. The patient's history of ingesting APAP or SAL was recorded, as well as the clinician's interpretation of that level. Sixteen charts were not available. APAP levels of > 1 microgram/mL were found in 175 (9.6%) patients, 120 (6.5%) of whom were APAP history-positive and 55 (3%) APAP history-negative. None of the APAP history-negative group required therapy with N-acetylcysteine. Eight (0.3%) of the APAP history-negative group had potentially toxic levels of > 50 micrograms/mL. SAL levels of > 1 mg/dL were found in 155 (8.5%) patients, 44 (2.5%) of whom were SAL history-positive and 111 (6%) SAL history-negative. Three patients were SAL history-negative but had a significant chronic SAL intoxication. All these patients presented with an altered mental status and had an anion gap of > 20 mEq/L. Universal screening found that 0.3% of suicidal ingestions had a potentially toxic APAP intoxication not suggested by history. This incidence of infrequent but potentially life: threatening overdose should prompt clinicians to screen all of their patients with a suspected ingestion. Salicylate screening found that 0.16% of suicidal ingestions had a toxic SAL intoxication not suggested by history, although such intoxication should be suggested by an elevated anion gap and an altered mental status. Since this less severe intoxication is less frequent and usually suggested by commonly obtained laboratory data, universal screening is not indicated, but a more selective approach to screening could be taken.

Topics: Acetaminophen; Acid-Base Equilibrium; Adult; Aged; Analgesics, Non-Narcotic; Cognition Disorders; Drug Overdose; Female; Humans; Liver Function Tests; Male; Medical History Taking; Middle Aged; Poisoning; Retrospective Studies; Salicylates; Suicide, Attempted

We have previously showed that routine screening of all patients with acute poisoning for salicylates in Hong Kong is unnecessary. We suggested that plasma measurements should be restricted to those suspected of having ingested salicylates. Our results and suggestion have since been presented and discussed in our medical unit meetings. The impact of our suggestion on the use of our plasma salicylate assay service was determined in this follow-up study of 196 patients presenting between October 1994 and April 1995. In 24 patients (12%), ingestion of salicylates was suspected, and of these, 3 (12.5%) had detectable plasma salicylate concentrations (> or = 0.3 mmol/L). The incidence in those who had taken identifiable drugs, unidentifiable drugs but nature known, and topical medicaments was 20%, 0% and 29%, respectively. Urinary alkalinization was necessary in the only patient with moderate to severe symptoms. In 172 patients (88%), ingestion of salicylates was not suspected; 3 (1.7%) had plasma salicylate concentrations of 0.47-2.05 mmol/L but mild symptoms only. We confirmed that routine screening for salicylates in all patients with acute poisoning was unnecessary. Despite our suggestion, 88% of plasma salicylate measurements in this follow-up study (76% in January 1992-June 1993) involved patients not suspected of having ingested salicylates.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cohort Studies; Female; Follow-Up Studies; Hong Kong; Humans; Male; Middle Aged; Poisoning; Salicylates

Apart from isolated reports of severe salicylate poisoning after ingesting an unusually large amount of a medicinal oil, there are no published data on the threat arising from attempted suicide with topical medicaments containing methyl salicylate or wintergreen oil compared with aspirin tablets. In this retrospective study, the admission plasma salicylate concentrations and clinical presentations were compared in 80 subjects who had taken aspirin tablets (n = 42) or topical medicaments (n = 38). The proportions of subjects being symptomatic were similar in the two groups. Although the admission plasma salicylate concentrations were generally higher in subjects who had ingested aspirin tablets, the two highest readings (4.3 and 3.5 mmol/1) belonged to two of the subjects who had taken topical medicaments. Because of its liquid, concentrated form and lipid solubility, methyl salicylate poses the threat of severe, rapid-onset salicylate poisoning. The toxic potential of topical medicaments containing methyl salicylate or wintergreen oil should be fully appreciated by both physicians and the general public.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aspirin; Female; Humans; Male; Middle Aged; Poisoning; Retrospective Studies; Salicylates; Suicide, Attempted; Time Factors

Acute intoxications with salicylates are common. In a dosage of 150-300 mg/kg they are severe, and above 500 mg/kg potentially fatal. To commit suicide 4 patients ingested 375-460 mg/kg acetylsalicylic acid; 3-8 hours after ingestion salicylate blood levels of up to 760 mg/l were observed. The patients were treated for a period of 16 hours with oral charcoal and glycine (1 g/kg initially, followed every 4 hours by 0.5 g/kg, and 8 g initially, followed by 4 g, respectively). To increase urinary pH (7-9) they received i.v. NaHCO3. Blood levels of salicylic acid including its metabolites dropped initially with a virtual half-life of 2-4 hours. 18 hours after hospital admission every patient was in good general condition; none of them required hemodialysis. The urinary excretion of total salicylate reached only 6-14% of the dose within the first 12 hours of therapy, clearly indicating the importance of combined therapy with glycine and charcoal in achieving a good clinical outcome.

Topics: Adult; Aspirin; Charcoal; Female; Glycine; Humans; Male; Poisoning; Salicylates; Suicide, Attempted; Treatment Outcome

To study the effect of multiple-dose activated charcoal (MDAC) on salicylate clearance in pigs given high-dose i.v. aspirin.. In a crossover design, six fasted pigs received 300 mg/kg i.v. aspirin followed by no treatment or MDAC (1 g/kg hourly for 6 doses by gastrostomy). Serum salicylate samples were obtained every 30 minutes for 6 hours.. The mean peak salicylate concentrations were 47.4 +/- 6.2 mg/dL and 48.4 +/- 3.9 mg/dL (P = .74), and the areas under the time-serum salicylate concentration curve over 6 hours were 171,000 +/- 24,000 mg.minute/L and 188,000 +/- 18,000 mg.minute/L for the control and treatment arms, respectively (P = .22). This study had a 90% power to detect a 30% difference between arms.. MDAC does not enhance the clearance of salicylate after administration of high-dose i.v. aspirin.

Topics: Animals; Antidotes; Aspirin; Charcoal; Cross-Over Studies; Disease Models, Animal; Drug Evaluation, Preclinical; Metabolic Clearance Rate; Poisoning; Salicylates; Salicylic Acid; Swine; Time Factors

Identification of a case of acute salicylate intoxication using 300 MHz 1H NMR spectroscopy of a urine sample is reported. It has been achieved by using a combination of a one-dimensional experiment with water presaturation and a two-dimensional homonuclear J-resolved experiment. By these means, lysine and the three major metabolites of acetylsalicylic acid have been assigned in the crude urine. The results are compared with those obtained at 600 MHz and with classical biochemical methods. The use of this method for routine diagnosis in biological analysis is discussed.

Topics: Adolescent; Aspirin; Female; Gentisates; Hippurates; Humans; Hydroxybenzoates; Magnetic Resonance Spectroscopy; Poisoning; Salicylates; Salicylic Acid

In this retrospective study, we evaluated the clinical value of screening for salicylates in 347 patients with acute poisoning presenting to the Prince of Wales Hospital, Hong Kong, between January 1992 and June 1993. In 83 patients (24%), ingestion of salicylates was suspected; the incidence of elevated plasma salicylate concentrations (> 0.1 mmol/L) in those who had taken identifiable drugs, unidentifiable drugs but known type, or topical medicaments was 71%, 16% and 61%, respectively. In 264 patients (76%), ingestion of salicylates was not suspected, and of these, 3 had elevated (0.2-0.4 mmol/L) plasma salicylate concentrations. Routine screening for salicylates in all patients with acute poisoning in Hong Kong appears unnecessary, especially as many authorities consider that 1 of the main indications for treating salicylate poisoning is clinical evidence of toxicity. Restricting plasma measurements to only those suspected of having ingested salicylates would have saved up to 76% of requests. All physicians should be aware of the high salicylate content of some Chinese proprietary topical medicaments.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Poisoning; Retrospective Studies; Salicylates

Topics: Aged; Alkalosis, Respiratory; Consciousness Disorders; Diagnosis, Differential; Fatal Outcome; Humans; Male; Poisoning; Salicylates

Topics: Acetaminophen; Acute Disease; Adult; Age Factors; Aged; Child; Humans; Infant; Poisoning; Prognosis; Salicylates; Time Factors

Topics: Adult; Critical Care; Diagnostic Errors; Female; Humans; Male; Poisoning; Salicylates; Time Factors

Topics: Acidosis; Adult; Alkalosis, Respiratory; Bicarbonates; Charcoal; Female; Humans; Poisoning; Salicylates; Sodium; Sodium Bicarbonate; Suicide, Attempted

Topics: Adult; Humans; Ontario; Poisoning; Salicylates

Invasive methods of active removal, i.e., hemodialysis and hemoperfusion, are indicated for severely poisoned patients with substances causing tissue damage. Both methods will only be efficacious if the relative contribution of the extracorporal clearance to the overall elimination for a given substance is high and if the toxin has a relatively low apparent volume of distribution and a low tissue binding. Hemodialysis is recommended in severe life threatening intoxications with methanol, ethylene glycol, isopropyl alcohol, salicylates and lithium. Hemoperfusion is effective in removing theophylline and barbiturates. Patients with severe acute theophylline intoxication will benefit from hemoperfusion. Despite the very high clearance rates of barbiturates that can be obtained with hemoperfusion, the clinical usefulness of hemoperfusion remains to be proven.

Topics: 1-Propanol; Barbiturates; Ethylene Glycols; Hemoperfusion; Humans; Hypnotics and Sedatives; Inactivation, Metabolic; Lithium; Methanol; Poisoning; Renal Dialysis; Salicylates; Theophylline

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

Topics: Aged; Diagnosis, Differential; Female; Frail Elderly; Hemiplegia; Humans; Hypoglycemia; Poisoning; Salicylates

A retrospective review of 150 cases determined the contribution of salicylate assays, tricyclic antidepressant (TCA) screens, and benzodiazepine screens to the diagnosis of overdose patients. Seventy percent of salicylate assays and 42% of TCA screens were ordered when there was no history of ingestion of clinical indication of overdose with these agents. In 12% of the cases benzodiazepine screens did not provide useful information. A positive history of salicylate ingestion, tinnitus and hyperventilation were the best predictive indicators of salicylate ingestion. The best predictors of TCA toxicity were a positive history of ingestion, a decreased level of consciousness, and a prolonged QRS interval. The combination of a positive history of ingestion and a decreased level of consciousness was a sensitive indicator of benzodiazepine toxicity. The annual cost of screens/assays which did not contribute to diagnosis was estimated to be $4649. Based on this study, a thorough history and clinical assessment of the overdose patient takes precedence over analytical screens in determining the drug(s) involved.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antidepressive Agents, Tricyclic; Benzodiazepines; Canada; Consciousness; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Poisoning; Salicylates; Sensitivity and Specificity

Topics: Acetaminophen; Acute Disease; Antidepressive Agents, Tricyclic; Barbiturates; Humans; Poisoning; Salicylates; Tranquilizing Agents

This salicylate-specific assay can be adapted for use with most discrete analyzers, for rapid emergency or routine testing with small serum or plasma sample volumes and a single calibration. The basis of this method is as follows: salicylate monooxygenase (EC 1.14.13.1) converts salicylate to catechol in the presence of NADH; the catechol then reacts with 4-aminophenazone under alkaline conditions, catalyzed by manganese ions, to produce a red dye. Incorporation of an NADH-regenerating system, involving glucose and glucose dehydrogenase, into the enzyme reagent ensures that the working reagent is stable for more than two weeks. The standard curve is linear over the drug concentration range 0 to 5 mmol/L. The CV was less than 4% over 20 days. Results correlated well with those by the Trinder colorimetric method and an HPLC method. We saw no interference by any of 80 drugs we tested at therapeutic concentrations or by endogenous compounds in serum.

Topics: Autoanalysis; Buffers; Catechols; Chromatography, High Pressure Liquid; Colorimetry; Emergencies; Humans; Hydrogen-Ion Concentration; Indicators and Reagents; Mixed Function Oxygenases; NAD; Poisoning; Salicylates; Surface-Active Agents

Topics: Alkalies; Diuresis; Humans; Poisoning; Salicylates

Topics: Female; Humans; Infant; Magnetic Resonance Spectroscopy; Poisoning; Salicylates

A review of all fatal cases of salicylate poisoning in Ontario during 1983 and 1984 disclosed that salicylates were the most common agent responsible for single-drug deaths (51 cases in two years). The patients' conditions on arrival at the hospital were variable: 31.4% of the patients were dead on arrival, 21.6% of the patients were comatose, and 45.1% of the patients were alert but symptomatic on arrival. Interestingly, the third group had the highest serum salicylate levels. The patients who were alive on arrival at the hospital died an average of 13 hours later. Autopsy results showed that 50% of patients had pulmonary abnormalities, 28% had lesions of the gastrointestinal tract, and 18% had nervous system abnormalities; 25.6% of patients on whom autopsies had been performed had no acute pathologic changes. Management difficulties occurred in establishing the diagnosis, administering activated charcoal, and using hemodialysis. Suggestions are offered for the improvement of the care provided to patients with severe salicylate poisoning.

Topics: Adult; Aged; Combined Modality Therapy; Critical Care; Humans; Length of Stay; Middle Aged; Ontario; Peritoneal Dialysis; Poisoning; Salicylates

Certain basic principles are applicable to most drug overdose emergencies. These include emptying the stomach, administering activated charcoal, supporting vital functions, protecting target organs and using specific antidotes in appropriate cases. There are certain steps to be taken automatically in an unconscious patient with an unknown overdose. Drug screens rarely affect management. Special situations involve overdoses of acetaminophen, salicylates, tricyclic antidepressants, anticholinergics and narcotics.

Topics: Acetaminophen; Acetylcysteine; Antidepressive Agents, Tricyclic; Arrhythmias, Cardiac; Cathartics; Charcoal; Humans; Hypnotics and Sedatives; Ipecac; Naloxone; Narcotics; Parasympatholytics; Poisoning; Salicylates

All children aged under 15 years admitted to hospital in Newcastle upon Tyne between 1974 and 1981 with a diagnosis of poisoning were studied. After the introduction in 1976 of child resistant containers for salicylates and paracetamol, salicylate poisonings fell dramatically. The other most important medicines to cause poisoning in young children were tricyclic antidepressants, benzodiazapines, Lomotil (diphenoxylate and atropine), and iron preparations; these should also be packaged in child resistant containers by regulation. Few children had symptoms after poisoning with household products, but bleach, turpentine, and paraffin might also be packaged in child resistant containers. The numbers of adolescent girls admitted after deliberate self poisoning and of teenage boys admitted after ingestion of alcohol increased over the study period.

Topics: Acetaminophen; Adolescent; Anti-Anxiety Agents; Antidepressive Agents, Tricyclic; Benzodiazepines; Child; Child, Preschool; England; Female; Hospitalization; Household Products; Humans; Infant; Iron; Male; Plants, Toxic; Poisoning; Salicylates; Sex Factors

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

Two distinct subpopulations in the pediatric age-group are particularly at risk for poisoning, and the substances likely to be ingested by each group differ. The method of critical care given here incorporates consideration of specific types of poisoning into an overall plan of general diagnostic and therapeutic measures.

Topics: Adolescent; Age Factors; Charcoal; Child; Child, Preschool; Emergency Medical Services; Female; Humans; Hydrocarbons; Infant; Ipecac; Male; Parasympatholytics; Poisoning; Risk; Salicylates

It was traditionally assumed that ethanol, as part of an intentional drug overdose, will increase morbidity and mortality. The authors prospectively studied the effect of ethanol on the outcome of intentional drug overdose in 468 adults, 196 of whom required hospital admission. Ethanol was detected in significantly fewer patients who required admission. Ethanol ingestion was not related to coma, impaired vital signs or mortality. Indeed, the duration of coma was significantly shorter in patients in whom ethanol was detected, but this group had a lesser incidence of multiple drug and nonbarbiturate hypnotic ingestion and a greater incidence of chronic ethanol use. Thus, it seems that ethanol is not associated with a worse clinical course if the drug overdose patient reaches medical care before an irreversible event.

Topics: Adolescent; Adult; Aged; Antidepressive Agents, Tricyclic; Barbiturates; Benzodiazepines; Coma; Diazepam; Drug Interactions; Ethanol; Female; Humans; Hypnotics and Sedatives; Male; Middle Aged; Nordazepam; Phenothiazines; Poisoning; Salicylates; Suicide, Attempted

In acute poisoning the main purpose of any therapeutic approach is a rapid removal of the drug or poison from body tissues. This approach suggested to undertake a study for the development of an uncoated activated carbon hemoperfusion column suitable for acute poisoning. Th clearances were significantly superior compared with a similar device manufactured using coated carbon. The microparticle generation, utilizing a spherical type of activated carbon, was undetectable with the adopted measuring method, well below the US and British Pharmacopeas limits and practically equal to a coated carbon column with identical geometry.

Topics: Acute Disease; Adsorption; Animals; Blood Glucose; Blood Urea Nitrogen; Carbon; Creatinine; Hemoperfusion; Humans; Inulin; Particle Size; Phenobarbital; Poisoning; Rabbits; Salicylates; Salicylic Acid; Uric Acid; Vitamin B 12

A novel hemoperfusion device was developed by embedding powered activated charcoal in thin (150 micrometer) films of cellulose nitrate. These films were sprinkled with small particles of granular charcoal and wound into spools, which were then placed in a plastic housing. The use of powdered charcoal exploits the enormous rate-of-uptake advantage of powered charcoal over the granular sorbents found in other hemoperfusion devices. The granular carbon sprinkled on the films was primarily to provide spacing between adjacent film layers for adequate fluid flow; the granules did enhance long-term uptake in addition. Clearance tests with this novel "thin-film adsorber," using sodium salicylate, sodium barbital, and creatinine, showed that its rate of solute adsorption, particularly at early times, was consistently very high. This type of hemoperfusion device is a promising alternative to the granular-sorbent types of devices currently available, especially when maximal solute removal during the early stages of treatment is mandated.

Topics: Adsorption; Animals; Biological Transport; Carbon; Cattle; Collodion; Hemoperfusion; Heparin; Humans; Membranes, Artificial; Particle Size; Poisoning; Salicylates

Drug assays in serum and urine of patients with drug poisoning are most often performed to identify the ingested substances. Semiquantitative screening tests are usually sufficient for this purpose, while serum drug level determinations for therapeutic monitoring require rapid, specific and precise laboratory techniques. Results should be interpreted in the light of various pharmacokinetic factors and especially the presence of active metabolites, which may influence the concentration-effect relationships. Critical concentration ranges are known for several drugs but, except in cases with paracetamol overdose, drug levels alone are rarely decisive for the therapeutic procedure. Further studies are necessary to define the potential benefit of routine serum level measurements in drug poisoning.

Topics: Acetaminophen; Barbiturates; Humans; Meprobamate; Poisoning; Salicylates

Topics: Antipsychotic Agents; Atropine; Child; Child, Preschool; Codeine; Drug-Related Side Effects and Adverse Reactions; Humans; Infant; Medication Errors; Poisoning; Salicylates

One hundred eleven cases of poisoning (over a 4 1/2-year period) were retrospectively reviewed at a military medical center. Results of the review included the following: (1) two peak age ranges for poisoning were identified: the 1 1/2- to 4-year-old child who accidently ingests both drugs and non-drugs, and the female adolescent who ingests drugs as a suicide attempt or gesture; (2) hydrocarbons and aspirin were the most common agents ingested; however, if grouped, drugs with anticholinergic effects would replace aspirin as the second most common poison; (3) emergency treatment included emesis or lavage in four fifths of poisonings except in ingestions of hydrocarbons or caustics where its use is controversial; (4) incidence of recurrence of poison ingestion was three percent, and morbidity and mortality combined were less than one percent; and (5) two thirds of patients were asymptomatic on admission and hospitalized primarily for observation.

Topics: Adolescent; Age Factors; California; Child; Child, Preschool; Female; Hospitals, Military; Humans; Hydrocarbons; Infant; Iron; Male; Parasympatholytics; Poisoning; Retrospective Studies; Salicylates; Sex Factors; Suicide, Attempted

In the 20 years 1958-77 598 deaths were registered as due to accidental poisoning in British children under the age of 10-343 boys and 255 girls. Drugs caused 484 deaths, non-medicinal products 111, and plants three. The annual number of deaths reached a peak in 1964 but fell steadily thereafter; 16 deaths occurred in 1977. After 1970 tricyclic antidepressants replaced salicylates as the most commonly fatal poison. The next ten drugs most often recorded in 1970-7 were, in order, opiates (including diphenoxylate/atropine (Lomotil)), barbiturates, digoxin, orphenadrine (Disipal), quinine, potassium, iron, fenfluramine (Ponderax), antihistamines, and phenothiazines. In 20 years paracetamol caused one death, and before 1976 deaths caused by aspirin had fallen to fewer than two a year. Thus the introduction in 1976 and 1977 of safety packaging of these drugs can be expected to have little impact on the mortality from them in childhood.

Topics: Accidents, Home; Child; Child, Preschool; Female; Humans; Iatrogenic Disease; Infant; Infant, Newborn; Male; Plant Poisoning; Poisoning; Salicylates; United Kingdom

Fifteen patients who were severely poisoned with either hypnotic drugs or salicylate were treated by charcoal haemoperfusion. The device contained 100g of activated charcoal immobilised by fixation to a polyester film. Two patients showed no response and eventually died. The remainder showed marked lightening of coma and recovered uneventfully. Complications of platelet loss and, in one patient, fibrinolysis were observed, but these had no serious consequences. No significant biochemical disturbances occurred with the exception of one patient who presented with hypocalcaemia and required intravenous calcium throughout the treatment. Drug clearance values were comparable with those obtained with columns containing 300 g of acrylic polymer coated charcoal.

Topics: Adolescent; Adult; Aged; Charcoal; Female; Hemoperfusion; Humans; Hypnotics and Sedatives; Male; Middle Aged; Poisoning; Salicylates

Toxic ingestions of acetaminophen and aspirin are clearly distinct in clinical presentations and in implications for laboratory medicine. In acetaminophen ingestion, the serum drug level is the single most important factor in the decision for or against therapy. In aspirin ingestion, the serum drug level is useful at its extremes--when so low as to indicate no need for therapy, and when so high as to indicate the need for dialysis. In the majority of infants and children with clinically significant salicylism, the serum drug level is in an intermediate range. For the management of these patients, the absolute level of salicylate in blood has much less significance than the laboratory assessment of the effects of salicylate on intermediary metabolism, acid-base status, and electrolyte and water balance.

Topics: Acetaminophen; Acetylcysteine; Acid-Base Imbalance; Aspirin; Child, Preschool; Female; Hepatic Encephalopathy; Humans; Infant; Liver; Male; Poisoning; Salicylates; Time Factors

Topics: Administration, Oral; Aspirin; Humans; Infant; Male; New Jersey; Poisoning; Salicylates

Topics: Acute Disease; Adult; Barbiturates; Female; Hemoperfusion; Humans; Poisoning; Salicylates

Topics: Age Factors; Dermatitis, Seborrheic; Diagnosis, Differential; Female; Humans; Infant; Poisoning; Salicylates; Skin Absorption

In 1967-76 the annual number of admissions to a poisoning treatment centre rose from 964 to 2134. The proportion of admissions caused by taking barbiturate hypnotics and methaqualone fell considerably while that caused by taking benzodiazepines and tricyclic antidepressants increased. As a result the proportion of patients admitted unconscious fell from 23% to 15%. The declining contributions of barbiturates and methaqualone and increased importance of tricyclic antidepressants were significant in all grades of coma. The change in drugs taken, however, has not yet reduced the percentage of unconscious patients needing endotracheal intubation or assisted ventilation, and hypothermia remains as common. Only hypotension has become less frequent as antidepressants replace barbiturates as the main cause of drug-induced coma. The use of salicylates for self-poisoning is declining slowly, and paracetamol poisoning is now as common.

Topics: Acetaminophen; Antidepressive Agents, Tricyclic; Barbiturates; Benzodiazepines; Humans; Hypotension; Methaqualone; Patient Admission; Poisoning; Salicylates; Suicide; Suicide, Attempted; Unconsciousness; United Kingdom

Topics: 2,4-Dichlorophenoxyacetic Acid; Barbiturates; Humans; Liver; Poisoning; Salicylates; Subtilisins

One hundred thirty cases of sudden infant death occurring in Wayne County, Michigan, (population 2.7 million) were analyzed for possible drugs. The toxicological protocol has been outlined. Six cases were found to be positive, and in five of these the drugs found had been prescribed for a variety of illnesses. In one case methadone was found in the blood of an infant whose mother was undergoing methadone treatment for drug addiction, the drug being transmitted through breast milk. In none of the 102 cases of sudden infant death syndrome (SIDS) included in the study did the toxicological results affect the diagnosis. In our study, toxicological analyses never contradicted an initial diagnosis of SIDS, and, therefore, we feel that this diagnosis should be made promptly based on investigative and autopsy findings.

Topics: Barbiturates; Ethanol; Humans; Infant; Methods; Narcotics; Poisoning; Salicylates; Sudden Infant Death

Three cases of self poisoning with tricyclic antidepressants (TAD) are reported, one of them with a potentially lethal dose. All three cases were treated with physostigmine salicylate (PS) and in two cases there was complete reversal of coma within a few minutes. In striking contrast to the reported high incidence of cardiac arrhythmias no cardiac complications were observed in any of the cases. Therefore we think that the use of PS should be considered when treating cases of TAD poisoning.

Topics: Acute Disease; Antidepressive Agents, Tricyclic; Antidotes; Female; Humans; Physostigmine; Poisoning; Salicylates; 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: Animals; Berylliosis; Beryllium; Female; Injections, Intravenous; Lethal Dose 50; Organ Specificity; Poisoning; Rats; Salicylates; Solubility; Sulfates; Tissue Distribution

Topics: Adolescent; Anorexia Nervosa; Child, Preschool; Diagnosis; Diagnosis, Differential; Dysautonomia, Familial; Female; Glomerular Filtration Rate; Humans; Infant; Intellectual Disability; Intestinal Polyps; Male; Osteoma; Ovarian Neoplasms; Poisoning; Salicylates; Sarcoma; Testicular Neoplasms; Uremia; Uterine Cervical Neoplasms; Vaginal Neoplasms; Wilms Tumor

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

1. The safety of a carbon haemoperfusion column, Haemocol, has been studies in beagle dogs. 2. only minor changes in physiology, haematology and plasma chemistry were detected, except those associated with an improvement in clinical status. 3. It is concluded that haemoperfusion through this column is a safe and simple procedure, which merits evaluation in the treatment of severe drug overdose in man.

Topics: Acetaminophen; Animals; Carbon; Charcoal; Chromatography, Gas; Dogs; Pentobarbital; Poisoning; Renal Dialysis; Salicylates; Time Factors

Topics: Adsorption; Animals; Blood Platelets; Charcoal; Disease Models, Animal; Dogs; Filtration; Kidneys, Artificial; Male; Particle Size; Phenobarbital; Poisoning; Renal Dialysis; Salicylates

Topics: Adult; Barbiturates; Charcoal; Ethchlorvynol; Female; Glutethimide; Humans; Kidneys, Artificial; Male; Meprobamate; Methaqualone; Middle Aged; Paraquat; Poisoning; Renal Dialysis; Salicylates; Substance-Related Disorders

Topics: Humans; Poisoning; Salicylates

Rats were injected intraperitoneally with lethal doses of sodium pentobarbital (115 mg/kg) or a lethal mixture of sodium salicylate (500 mg/kg) and sodium acetazolamide (25 mg/kg). Within about 20 min, part of each group was connected to an extracorporeal circuit containing uncoated activated charcoal and part to an empty control circuit. After a 90-min hemoperfusion, the treated groups showed a significantly decreased mortality (58% to 14% for pentobarbital; 100% to 0% for salicylate). Dogs were injected intravenously with lethal doses of sodium phenobarbital (175 mg/kg). One group was treated by hemoperfusion through an empty device in a control extracorporeal circuit, a second group was treated with loose-bed activated charcoal devices, and a third group with fixed-bed activated charcoal devices. For both the fixed and loose-bed devices, a 5-h hemoperfusion markedly decreased mortality (100% to less than or equal to 15%). The lethal combination of salicylate and closed-circuit methoxyflurane anesthesia was also successfully treated in dogs. This study clearly demonstrates the lifesaving potential of uncoated activated charcoal hemoperfusion.

Topics: Animals; Barbiturates; Charcoal; Disease Models, Animal; Dogs; Pentobarbital; Perfusion; Phenobarbital; Poisoning; Rats; Salicylates

Toxicological determinations are crucial to coroners' or medical examiners' judgments that drugs are significantly involved in a death. However, differences in laboratory procedures, thoroughness of screening, and limits of detection may result in artifactual differences in the toxicological results and the subsequent interpretations of them. To test this possibility, we conducted a toxicology proficiency-testing survey of nine collaborating laboratories. The results for the proficiency samples point out starting interlaboratory differences in accuracy and precision of detection of drugs. These observed variations in toxicological proficiency may introduce a significant source of error in drug-death statistics and in epidemiological deductions based on these statistics.

Topics: Ethanol; Forensic Medicine; Glutethimide; Humans; Narcotics; Pentobarbital; Phenobarbital; Poisoning; Quality Control; Salicylates; Secobarbital; Tranquilizing Agents

We have presented two cases of salicylate poisoning that demonstrate fluid retention in the face of adequate hydration, resembling the syndrome of inappropriate secretion of ADH. These cases necessitated marked alterations from normal fluid therapy. Mannitol was found to be an effective, albeit transient, diuretic for treating the acute symptoms associated with fluid retention, but only strict fluid restriction resulted in a prompt and satisfactory diuresis.

Topics: Adult; Bicarbonates; Body Fluids; Female; Humans; Infant; Male; Poisoning; Salicylates

Topics: Charcoal; Drug Interactions; Humans; Ipecac; Poisoning; Salicylates

Topics: Acidosis; Alkalosis; Alkalosis, Respiratory; Animals; Aspirin; Child; Child, Preschool; Dehydration; Fever; Humans; Hyperglycemia; Infant; Papio; Poisoning; Salicylates

Two and three Dow Cordis Hollow Fiber and Gambro Lundia artificial kidneys were used for high efficiency dialysis in large patients, intoxications, and for rapid ultrafiltration. BUN clearances of up to 240 ml/min were achieved. One episode of severe neuropathy occurred during high efficiency dialysis, and hypotensive episodes were more common. High efficiency dialysis has certain indications particularly in intoxication cases. However, because of possible side effects more experience is needed before its ultimate place in the treatment of uremia can be ascertained.

Topics: Barbiturates; Blood Urea Nitrogen; Body Weight; Calcium; Creatinine; Edema; Headache; Humans; Hypotension; Kidneys, Artificial; Nausea; Phenobarbital; Phenytoin; Poisoning; Primidone; Renal Dialysis; Salicylates; Substance-Related Disorders; Ultrafiltration; Uremia; Uric Acid

Following intravenous administration of physostigmine salicylate for tricyclic antidepressant poisoning in 21 patients, convulsions occurred in two patients, and severe cholinergic manifestations occurred in two others. Because of these untoward effects and the very short duration of its beneficial action, it is very doubtful that physostigmine has any place in the routine management of tricyclic antidepressant poisoning.

Topics: Acute Disease; Antidepressive Agents; Arousal; Drug Evaluation; Electroencephalography; Humans; Injections, Intravenous; Physostigmine; Poisoning; Salicylates; Seizures; Sympathetic Nervous System; Time Factors

Topics: Adsorption; Charcoal; Humans; Hypnotics and Sedatives; Poisoning; Salicylates

The drug levels in postmortem specimens from 12 cases of poisoning involving methadone have been determined using a general toxicological extraction method. In 8 of the cases, drugs other than methadone were also found. The relevant known case histories are described.

Topics: Adolescent; Adult; Amobarbital; Autopsy; Diazepam; Ethanol; Female; Humans; Male; Methadone; Methaqualone; Morphine; Poisoning; Salicylates; Secobarbital

Topics: Amphetamines; Barbiturates; Gastric Juice; Humans; Methods; Morphine Derivatives; Phenothiazines; Poisoning; Reagent Strips; Salicylates

The removal of salicylate by extracorporeal circulation of blood through a column of encapsulated activated charcoal (haemoperfusion) has been studied experimentally in intoxicated dogs (greyhounds). The average time taken to reduce the whole blood salicylate level to one-half of the initial equilibrium level in 30 kg dogs was 2 hrs. A half-life of 3 hrs is predicted for salicylate removal by haemoperfusion in a 70 kg man and this rate of removal is shown to be comparable to that reported for haemodialysis. No unacceptable adverse physiological, biochemical, or haematological effects were found to result from haemoperfusion. The possible use of this technique in the management of severe salicylate poisoning in man is discussed. Haemoperfusion is foreseen as providing a method of rapid removal of salicylate in circumstances where forced diuresis is contra-indicated or inadequate and haemodialysis is not readily available.

Topics: Animals; Blood; Blood Platelets; Charcoal; Dogs; Half-Life; Humans; Kinetics; Male; Perfusion; Poisoning; Renal Dialysis; Salicylates

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

Topics: Adolescent; Adult; Age Factors; Aged; Antidepressive Agents; Barbiturates; Child; Child, Preschool; Depression; Ethanol; Female; Follow-Up Studies; Humans; Hypnotics and Sedatives; Infant; Infant, Newborn; Male; Methaqualone; Middle Aged; Periodicity; Phenothiazines; Poisoning; Psychotic Disorders; Salicylates; Scotland; Substance-Related Disorders; Suicide

Topics: Bronchi; Clinical Laboratory Techniques; Foreign Bodies; Inhalation; Medical History Taking; Physical Examination; Physician-Patient Relations; Poisoning; Salicylates

Topics: Female; Humans; Infant; Infant, Newborn; Male; Neurologic Manifestations; Poisoning; Prognosis; Salicylates

Topics: Cardiovascular System; Digestive System; Humans; Metabolism; Poisoning; Respiratory System; Retrospective Studies; Salicylates; South Africa

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: Adult; Aspirin; Blood Pressure; Cardiac Catheterization; Diagnosis, Differential; Female; Furosemide; Humans; Poisoning; Positive-Pressure Respiration; Pulmonary Artery; Pulmonary Edema; Radiography; Salicylates; Self Medication

Topics: Acid-Base Equilibrium; Acidosis; Alkalosis, Respiratory; Biotransformation; Blood Gas Analysis; Humans; Infant; Infant, Newborn; Poisoning; Protein Binding; Salicylates; Serum Albumin

Topics: Adolescent; Adult; Aged; Barbiturates; Benzodiazepinones; Family Characteristics; Female; Humans; Male; Mental Disorders; Middle Aged; Plant Poisoning; Plants, Toxic; Poisoning; Pregnancy; Salicylates; Scotland; Sex Factors; Socioeconomic Factors; Suicide

Topics: Accidents; Adolescent; Adult; Aged; Barbiturates; Child; Chloroquine; Dextropropoxyphene; Female; Glutethimide; Humans; Male; Meprobamate; Methadone; Middle Aged; Morphine; Poisoning; Pulmonary Edema; Salicylates; Suicide

Topics: Barbiturates; Bemegride; Diuresis; Drug Evaluation; Humans; Parenteral Nutrition; Peritoneal Dialysis; Poisoning; Renal Dialysis; Salicylates; Shock, Septic

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: Adolescent; Adult; Aged; Barbiturates; Female; Glutethimide; Heroin; Heroin Dependence; Humans; Iron; Male; Maryland; Middle Aged; Poisoning; Salicylates; Substance-Related Disorders; Suicide

Topics: Adult; Aspirin; Female; Fetal Death; Humans; Poisoning; Pregnancy; Pregnancy Complications; Salicylates

Topics: Acetazolamide; Animals; Bicarbonates; Carbon Dioxide; Diuresis; Dogs; Drug Combinations; Glomerular Filtration Rate; Hydrogen-Ion Concentration; Infusions, Parenteral; Magnesium; Partial Pressure; Poisoning; Potassium; Salicylates; Sodium; Time Factors

Topics: Aspirin; Blood Glucose; Blood Urea Nitrogen; Central Nervous System Diseases; Child, Preschool; Chlorides; Emetics; Gastric Lavage; Humans; Hypernatremia; Hypertonic Solutions; Male; Poisoning; Salicylates; Sodium; Sodium Chloride

Topics: Africa, Southern; Female; Humans; Infant, Newborn; Male; Poisoning; Salicylates

Topics: Amitriptyline; Barbiturates; Carbon Monoxide Poisoning; Coma; Electroencephalography; Fungi; Humans; Imipramine; Insecticides; Isoniazid; Poisoning; Resuscitation; Salicylates; Time Factors; Trichloroethylene

Topics: Acetaminophen; Antidepressive Agents; Barbiturates; Benzazepines; Chloral Hydrate; Chromatography, Thin Layer; Colorimetry; Desipramine; Emergencies; Hallucinogens; Humans; Hydrogen-Ion Concentration; Imipramine; Indicators and Reagents; Narcotics; Pharmaceutical Preparations; Phenothiazines; Poisoning; Psychoses, Substance-Induced; Salicylates; Solvents

Topics: Child; Child, Preschool; Female; Hospitalization; Humans; Infant; Male; Poisoning; Salicylates

Topics: Acetaminophen; Adult; Amphetamine; Antidepressive Agents; Caustics; Digitalis; Fenfluramine; Humans; Male; Monoamine Oxidase Inhibitors; Phenacetin; Plants, Medicinal; Plants, Toxic; Poisoning; Salicylates

Topics: Acidosis; Adult; Alkalosis, Respiratory; Anuria; Bicarbonates; Child; Gastric Lavage; Humans; Infusions, Parenteral; Poisoning; Potassium; Salicylates; Water-Electrolyte Balance

Topics: Age Factors; Antidepressive Agents; Appetite Depressants; Child, Preschool; Humans; Infant; Iron; Petroleum; Plant Poisoning; Poisoning; Salicylates

Topics: Adult; Barbiturates; Benzoates; Butylamines; Chlorine; Diuretics; Female; Furosemide; Humans; Injections, Intravenous; Male; Phenyl Ethers; Poisoning; Potassium; Salicylates; Sodium; Time Factors

Topics: Acetaminophen; Carbon Monoxide Poisoning; Humans; Poisoning; Salicylates

Topics: Acute Disease; Adult; Barbiturates; Charcoal; Coma; Emergency Service, Hospital; First Aid; Humans; Intensive Care Units; Poisoning; Psychology; Respiratory Function Tests; Salicylates; Shock; Vomiting

Topics: Adolescent; Adult; Age Factors; Aged; Antidepressive Agents; Barbiturates; Child; Coma; Diuresis; Female; Glutethimide; Humans; Hypnotics and Sedatives; Male; Middle Aged; Peritoneal Dialysis; Poisoning; Renal Dialysis; Salicylates; Sex Factors; Statistics as Topic; Time Factors; Tranquilizing Agents

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: Amines; Analgesics; Color; Female; Humans; Phenacetin; Phenols; Poisoning; Salicylates; Substance-Related Disorders

Topics: Acetazolamide; Acidosis; Adult; Bicarbonates; Child; Humans; Poisoning; Salicylates

Topics: Child, Preschool; Humans; Infant; Methods; Physician-Patient Relations; Poisoning; Salicylates

A review of the 637 out of a total of 941 consecutive cases of acute poisoning admitted to an acute medical unit without special facilities for the treatment of poisoning has shown that despite considerable limitations in the medical, nursing, and laboratory facilities available the results compare favourably with those reported from specialized units.

Topics: Adult; Aged; Antidepressive Agents; Carbon Monoxide Poisoning; Diuresis; Female; Gastric Lavage; Hospital Departments; Humans; Hypnotics and Sedatives; Infusions, Parenteral; Male; Middle Aged; Poisoning; Psychotherapy; Respiration, Artificial; Salicylates; Scotland; Suicide

The incidence of self-poisoning with drugs has doubled in Sheffield in the past 10 years. It now causes almost 1 in 10 of all medical admissions and one in five of all medical emergencies; it is the second most common reason for emergency admission to medical beds.The average age of the patients has fallen; one in five has previously been admitted to hospital with self-poisoning. The drugs used are normally prescribed by a doctor and the types employed reflect national prescribing trends. It is estimated that over 70,000 self-poisoning cases may be admitted to hospitals in the United Kingdom each year.

Topics: Adolescent; Adult; Age Factors; Aged; Barbiturates; England; Female; Hospitals; Humans; Length of Stay; Male; Mental Disorders; Middle Aged; Poisoning; Salicylates; Sex Factors; Substance-Related Disorders; Suicide; Tranquilizing Agents

Topics: Acetaminophen; Aminopyrine; Amitriptyline; Aspirin; Carbamazepine; Chlordiazepoxide; Chlorpromazine; Dextropropoxyphene; Diazepam; Heroin; Humans; Imipramine; Lithium; Pargyline; Pentazocine; Phenacetin; Phenelzine; Phenytoin; Poisoning; Primidone; Promazine; Renal Dialysis; Salicylates; Tranylcypromine; Trifluoperazine

Topics: Amitriptyline; Animals; Atropine; Bromides; Carbamates; Cholinesterase Inhibitors; Diphosphates; Drug Antagonism; Female; Fluorine; Guinea Pigs; Hydroxamic Acids; Isoflurophate; Lethal Dose 50; Nitrates; Nitrophenols; Nitroso Compounds; Organophosphonates; Organophosphorus Compounds; Orphenadrine; Oximes; Parasympatholytics; Physostigmine; Poisoning; Pyridinium Compounds; Rabbits; Rats; Salicylates; Scopolamine; Species Specificity; Sulfonic Acids; Sulfuric Acids; Thiazoles; Time Factors

Topics: Acute Disease; Antidotes; Charcoal; Child, Preschool; Copper; Dimercaprol; Edetic Acid; Humans; Mycotoxins; Nicotine; Petroleum; Poison Control Centers; Poisoning; Salicylates; Vomiting

Topics: Adult; Emetics; Gastric Lavage; Humans; Poisoning; Salicylates; Vomiting

Topics: Acidosis; Acute Disease; Aspirin; Humans; Poisoning; Prognosis; Salicylates

Topics: Acetazolamide; Adult; Bicarbonates; Half-Life; Humans; Hydrogen-Ion Concentration; Kidney; Lactates; Mannitol; Poisoning; Salicylates; Statistics as Topic

Topics: Aged; Child, Preschool; Female; Humans; Injections, Subcutaneous; Male; Physostigmine; Poisoning; Salicylates; Scopolamine

Topics: Adsorption; Aged; Blood Flow Velocity; Blood Platelets; Capsules; Charcoal; Creatinine; Embolism; Female; Glutethimide; Guanidines; Humans; Kidney Failure, Chronic; Kidneys, Artificial; Membranes, Artificial; Pentobarbital; Perfusion; Poisoning; Salicylates; Urea; Uric Acid; Water-Electrolyte Balance

Topics: Adolescent; Adult; Aged; Child; Drug-Related Side Effects and Adverse Reactions; Emergency Service, Hospital; England; Female; Hospitals, Teaching; Humans; Length of Stay; Male; Middle Aged; Poisoning; Poisons; Respiratory Care Units; Salicylates

Topics: Adult; Aged; Bone Diseases; Cadmium Poisoning; Chromatography, Gel; Electrophoresis, Disc; Humans; Middle Aged; Poisoning; Proteinuria; Salicylates; Trichloroacetic Acid

Topics: Adult; Central Nervous System Diseases; Electroencephalography; Humans; Male; Phenytoin; Poisoning; Primidone; Salicylates

Topics: Acute Disease; Amphetamine; Aspirin; Barbiturates; Dialysis; Diuresis; Gastric Lavage; Half-Life; Humans; Hydrogen-Ion Concentration; Intestinal Absorption; Poisoning; Salicylates; Vomiting

Topics: Acute Disease; Adult; Antidepressive Agents; Arrhythmias, Cardiac; Barbiturates; Body Temperature; Carbon Monoxide Poisoning; Child, Preschool; Female; Hospitalization; Humans; Hypnotics and Sedatives; Hypotension; Intensive Care Units; Intubation, Intratracheal; Male; Middle Aged; Poisoning; Rectum; Respiration; Salicylates; Seasons; Tranquilizing Agents; Unconsciousness

Topics: Barbiturates; Dialysis; Glutethimide; Humans; Poisoning; Salicylates

Topics: Child; Emergency Service, Hospital; Gastric Lavage; Home Nursing; Humans; Ipecac; Poisoning; Salicylates; Time Factors

Topics: Analgesics; Anticonvulsants; Antidotes; Barbiturates; Blood Chemical Analysis; Central Nervous System Stimulants; Child; Diuretics; Emetics; Glutethimide; Humans; Insecticides; Meprobamate; Parasympatholytics; Poisoning; Salicylates; Urine

Topics: Adult; Animals; Apomorphine; Barbiturates; Charcoal; Child; Dextropropoxyphene; Dogs; Glutethimide; Humans; Intestinal Absorption; Ipecac; Poisoning; Rats; Salicylates

Topics: Child; Humans; Poisoning; Salicylates

Topics: Acid-Base Equilibrium; Child; Gastric Lavage; Gastrointestinal Hemorrhage; Humans; Hypotonic Solutions; Poisoning; Salicylates; Vomiting

Topics: Acid-Base Equilibrium; Adult; Anesthesia, General; Humans; Hyperventilation; Male; Poisoning; Salicylates; Wounds and Injuries

Topics: Antidepressive Agents; Barbiturates; Humans; Hypnotics and Sedatives; Poisoning; Salicylates; Tranquilizing Agents

Topics: Adult; Animals; Barbiturates; Dogs; Female; Glutethimide; Humans; Ion Exchange; Ion Exchange Resins; Male; Methods; Middle Aged; Poisoning; Polystyrenes; Renal Dialysis; Salicylates

Topics: Alcohols; Antimony; Arsenic Poisoning; Barbiturates; Bismuth; Bromides; Carbon Monoxide Poisoning; Child; Coloring Agents; Humans; Indicators and Reagents; Iron; Kerosene; Lead Poisoning; Mercury Poisoning; Methods; Parathion; Phenothiazines; Poisoning; Quinidine; Quinine; Salicylates; Strychnine; Sulfanilamides

Topics: Antidepressive Agents; Barbiturates; Blood Circulation; Carbamates; Carbon Monoxide Poisoning; France; Humans; Hypoxia; Lung Diseases; Morphinans; Phenothiazines; Poisoning; Respiration; Salicylates; Seizures; Trichloroethylene; Vascular Diseases

Topics: Animals; Apomorphine; Aspirin; Charcoal; Child; Dogs; Gastric Lavage; Humans; Ipecac; Poisoning; Salicylates

Topics: Aspirin; Bicarbonates; Child, Preschool; Female; Humans; Male; Poisoning; Salicylates

Topics: Animals; Blood Flow Velocity; Blood Pressure; Dogs; Dopamine; Kidney; Phenobarbital; Poisoning; Salicylates

Topics: Barbiturates; Carbon Monoxide Poisoning; Female; Humans; Male; Poisoning; Resuscitation; Salicylates; Tranquilizing Agents

One hundred and twenty-nine patients (25.5%) out of 505 consecutive cases of self-poisoning admitted to a non-teaching poisoning treatment centre run as part of an acute medical unit are reviewed in detail. All of them were severely poisoned and would possibly have died without admission to hospital. Despite considerable limitations in the medical, nursing, and laboratory facilities available a very low mortality rate was achieved by practising intensive supportive and conservative care, supplemented on occasion by a forced alkaline diuresis.

Topics: Adolescent; Adult; Aged; Alkalies; Antidepressive Agents; Barbiturates; Child; Diuresis; Female; Humans; Hypnotics and Sedatives; Male; Mental Disorders; Middle Aged; Poisoning; Salicylates; Scotland; Suicide; Tranquilizing Agents; Unconsciousness

Topics: Barbiturates; Glutethimide; Humans; Mannitol; Peritoneal Dialysis; Poisoning; Renal Dialysis; Salicylates

Topics: Aminopyrine; Aniline Compounds; Animals; Aspirin; Chlordiazepoxide; Gastric Lavage; Levorphanol; Mecamylamine; Phenobarbital; Poisoning; Quinine; Rats; Renal Dialysis; Salicylates; Sulfadiazine; Sulfanilamides

Topics: Aspirin; Child, Preschool; Female; Humans; Male; Poisoning; Salicylates; Seizures

Topics: Child; Female; Humans; Infant; Male; Poisoning; Salicylates

Topics: Adenosine Triphosphate; Child, Preschool; Creatine Kinase; Gastroenteritis; Humans; L-Lactate Dehydrogenase; Male; NAD; Poisoning; Salicylates; Transaminases

Topics: Adolescent; Adult; Age Factors; Aged; Barbiturates; Carbon Monoxide Poisoning; Child; Child, Preschool; Female; Hospitalization; Humans; Infant; Infant, Newborn; Male; Middle Aged; Poisoning; Salicylates; Seasons; Sex Factors; Wales

Topics: Adolescent; Adult; Aged; Alcohols; Analgesics; Barbiturates; Carbon Monoxide Poisoning; Cardiac Glycosides; Emergency Medical Services; Humans; Middle Aged; Paris; Pesticides; Poisoning; Resuscitation; Salicylates; Trichloroethylene

Topics: Acute Disease; Antidotes; Barbiturates; Diuretics; Humans; Poisoning; Salicylates; Tranquilizing Agents

Topics: Acute Kidney Injury; Adolescent; Adult; Aged; Barbiturates; Child; Female; Glutethimide; Humans; Kidney Function Tests; Male; Methods; Middle Aged; Norway; Poisoning; Renal Dialysis; Salicylates; Statistics as Topic; Time Factors

Topics: Blood Pressure; Female; Femoral Artery; Heparin; Humans; Infant; Kidneys, Artificial; Male; Pentobarbital; Poisoning; Pulse; Renal Dialysis; Salicylates

Topics: Adsorption; Aluminum Silicates; Charcoal; Dextroamphetamine; Ethanol; Humans; Hydrogen-Ion Concentration; Iron; Pentobarbital; Poisoning; Poisons; Salicylates; Tripelennamine

Topics: Adolescent; Adult; Aged; Barbiturates; Carbon Monoxide Poisoning; Child; Child, Preschool; Female; Humans; Infant; Male; Mental Disorders; Middle Aged; Poisoning; Salicylates; Stress, Physiological; Suicide; Wales

Topics: Adolescent; Adult; Chicago; Child; Deferoxamine; Female; Humans; Iron; Lead Poisoning; Male; Poisoning; Salicylates; Social Conditions

Topics: Acute Disease; Acute Kidney Injury; Humans; Poisoning; Renal Dialysis; Salicylates; Suicide

Topics: Accidents; Aspirin; Boric Acids; Camphor; Emetics; Humans; Iron; Lead Poisoning; Mercury Poisoning; Petroleum; Poisoning; Salicylates

Topics: Acute Disease; Antidotes; Atropine; Barbiturates; Carbon Monoxide Poisoning; Chlorpromazine; Deferoxamine; England; Gastric Lavage; Heart Massage; Humans; Meperidine; Morphine; Oxygen; Paraldehyde; Phenobarbital; Poisoning; Salicylates; Suicide; Wales

Topics: Antidotes; Apomorphine; Barbiturates; Gastric Lavage; Glutethimide; Humans; Hypnotics and Sedatives; Ipecac; Monoamine Oxidase Inhibitors; Phenothiazines; Poisoning; Renal Dialysis; Resuscitation; Salicylates; Tranquilizing Agents

Topics: Animals; Aspirin; Barbiturates; Central Nervous System Stimulants; Drug Synergism; Imipramine; Poisoning; Salicylates

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

A method is described to provide a rapid screening technique for the presence of barbiturates, glutethimide, carbromal, meprobamate, salicylate, phenothiazine derivatives, bromide, carbon monoxide, and alcohol. Phenothiazines are detected by a spot urine test. The first four drugs are identified, within 60 minutes of blood collection, on thin-layer chromatoplates of microscope slide dimensions. The estimations of bromide, salicylate, carbon monoxide, and of alcohol levels are started in that period so the overall time for the screening is less than two hours, and the amount of blood required is only 10 ml.

Topics: Barbiturates; Blood Chemical Analysis; Bromides; Butyrates; Carbon Monoxide; Chromatography, Thin Layer; Ethanol; Glutethimide; Humans; Hypnotics and Sedatives; Meprobamate; Methods; Phenothiazines; Poisoning; Salicylates; Substance-Related Disorders; Urea

Topics: Barbiturates; Electrocardiography; Glycols; Humans; Hypnotics and Sedatives; Kidneys, Artificial; Methanol; Poisoning; Quinine; Salicylates

Topics: Barbiturates; Gastric Lavage; Humans; Intubation, Gastrointestinal; Poisoning; Salicylates

Topics: Aspirin; Blood Chemical Analysis; Hypoglycemia; Infant; Insulin; Poisoning; Salicylates; Toxicology

Topics: Acetates; Acid-Base Equilibrium; Acidosis; Amino Acid Metabolism, Inborn Errors; Amino Acids; Blood Chemical Analysis; Butyrates; Child; Citrates; Fumarates; Humans; Infant; Malates; Poisoning; Pyruvates; Renal Aminoacidurias; Salicylates; Succinates; Toxicology; Urine

Topics: Acid-Base Equilibrium; Aspirin; Child; Diagnosis; Drug Therapy; Emetics; Gastric Lavage; Humans; Poisoning; Salicylates; Toxicology

Topics: Acidosis; Acute Kidney Injury; Alcoholism; Anuria; Child; Diabetes Mellitus; Dialysis; Humans; Hypertension; Hypertension, Malignant; Hyponatremia; Malaria; Peritoneal Dialysis; Poisoning; Renal Dialysis; Renal Insufficiency; Salicylates; Uremia

Topics: Antidotes; Barbiturates; Cholinesterase Inhibitors; Glutethimide; Humans; Hypoventilation; Meprobamate; Morphine; Myasthenia Gravis; Poisoning; Pulmonary Atelectasis; Pulmonary Edema; Respiration, Artificial; Respiratory Insufficiency; Salicylates; Tetanus; Therapeutics; Toxicology; Tracheotomy

Topics: Adolescent; Aspirin; Poisoning; Salicylates; Toxicology

Topics: Diagnosis; Geriatrics; Neurologic Manifestations; Poisoning; Salicylates; Toxicology

Topics: Aspirin; Drug-Related Side Effects and Adverse Reactions; Eosinophils; Leukocyte Count; Poisoning; Psychoses, Substance-Induced; Salicylates; Toxicology

Topics: Adolescent; Barbiturates; Carbon Monoxide Poisoning; Central Nervous System Stimulants; England; Gastric Lavage; Geriatrics; Hospitals, General; Humans; London; Mental Disorders; Poisoning; Salicylates; Statistics as Topic; Stomach; Suicide; Suicide, Attempted

Topics: Acute Kidney Injury; Barbiturates; Dialysis; Kidneys, Artificial; Peritoneal Dialysis; Peritoneum; Poisoning; Renal Dialysis; Renal Insufficiency; Salicylates; Toxicology

Topics: Child; Humans; Poisoning; Salicylates; Toxicology

Topics: Acute Kidney Injury; Aspirin; Blood Chemical Analysis; Bronchopneumonia; Coma; Diagnosis, Differential; Diuresis; Gastric Lavage; Heart Arrest; Heart Failure; Humans; Infusions, Parenteral; Kidney; Kidneys, Artificial; Phenacetin; Poisoning; Pulmonary Edema; Renal Insufficiency; Salicylates; Statistics as Topic; Toxicology

Topics: Acidosis; Alkalosis; Aspirin; Bicarbonates; Blood Chemical Analysis; Diuretics; Gastric Lavage; Humans; Infusions, Parenteral; Kidney Function Tests; Kidneys, Artificial; Mannitol; Poisoning; Potassium; Renal Dialysis; Salicylates; Sodium; Stomach; Toxicology; Urea; Urinary Catheterization; Urine

Topics: Aspirin; Child; Glucose; Glucose Tolerance Test; Humans; Hypoglycemia; Infant; Infusions, Parenteral; Neurologic Manifestations; Pancreatic Diseases; Poisoning; Salicylates; Toxicology

Topics: Accidents; Child; Chlorpromazine; Diagnosis; Drug Therapy; Hypnotics and Sedatives; Infant; Pharmaceutical Preparations; Pharmacology; Poisoning; Psychoses, Substance-Induced; Salicylates; Toxicology

Topics: Child; Gastric Lavage; Pediatrics; Poisoning; Salicylates; Toxicology

The causes of injury to 17,141 children brought to the emergency department of a large pediatric hospital in one year were studied. The leading causes of injury were: falls, 5682; cuts or piercings, 1902; poisonings, 1597; and transportation accidents, 1368. Included in these are 587 falls on or down stairs, 401 cuts due to glass, 630 poisonings from household or workshop substances, 510 poisonings from salicylate tablets, and 449 accidents involving bicycles or tricycles. Other findings included 333 injuries to fingers or hands in doors, usually car doors; 122 instances of pulled arms; 384 ingestions and 53 inhalations of foreign bodies; 60 alleged sexual assaults, 58 chemical burns, 127 wringer injuries, and four attempted suicides. A rewarding opportunity in accident prevention exists for hospitals that undertake to compile and distribute pertinent source data.

Topics: Accident Prevention; Accidents; Accidents, Traffic; Adolescent; Biometry; Bites and Stings; Burns; Burns, Chemical; Canada; Child; Craniocerebral Trauma; Emergency Service, Hospital; Eye Injuries; Foreign Bodies; Hospitals, Pediatric; Humans; Infant; Male; Poisoning; Salicylates; Sports Medicine; Statistics as Topic

Topics: Aspirin; Child; Coma; Diabetic Coma; Diagnosis; Diagnosis, Differential; Humans; Hyperglycemia; Infant; Parent-Child Relations; Parents; Poisoning; Salicylates; Toxicology; Urine

Topics: Barbiturates; Humans; Poisoning; Salicylates; Tromethamine; Urinary Calculi

Topics: Aspirin; Humans; Poisoning; Salicylates

Topics: Barbiturates; Glutethimide; Humans; Kidney; Kidneys, Artificial; Poisoning; Salicylates

Topics: Humans; Imipramine; Medical Records; Poisoning; Salicylates

Topics: Child; Infant; Poisoning; Salicylates

Topics: Diabetes Complications; Diabetic Ketoacidosis; Diagnosis, Differential; Humans; Poisoning; Salicylates

Topics: Humans; Poisoning; Salicylates

Topics: Child; Humans; Infant; Poisoning; Salicylates

Topics: Blood Transfusion; Child; Exchange Transfusion, Whole Blood; Flavoring Agents; Humans; Infant; Oils, Volatile; Plant Extracts; Poisoning; Salicylates

Topics: Acid-Base Equilibrium; Child; Humans; Infant; Poisoning; Salicylates

Topics: Child; Humans; Infant; Poisoning; Salicylates

Topics: 17-Hydroxycorticosteroids; Adrenal Cortex; Adrenal Cortex Hormones; Blood; Humans; Poisoning; Rheumatic Diseases; Salicylates

Topics: Aspirin; Barbiturates; Humans; Poisoning; Salicylates

Topics: Child; Humans; Infant; Poisoning; Salicylates

Topics: Humans; Poisoning; Salicylates

Topics: Child; Humans; Infant; North Carolina; Poisoning; Salicylates

Topics: Carbohydrate Metabolism; Glycogen; Glycogenolysis; Poisoning; Salicylates

Topics: Aspirin; Child; Humans; Infant; Poisoning; Salicylates

Topics: Diagnosis, Differential; Ear, Inner; Hearing; Hearing Disorders; Hearing Tests; Humans; Meniere Disease; Poisoning; Salicylates

Topics: Administration, Cutaneous; Berylliosis; Poisoning; Salicylates

Topics: 17-Hydroxycorticosteroids; Adrenal Cortex; Adrenal Cortex Hormones; Aspirin; Blood; Humans; Poisoning; Salicylates

Topics: Acid-Base Equilibrium; Humans; Poisoning; Salicylates

Topics: Humans; Poisoning; Salicylates

Topics: Humans; Poisoning; Salicylates; Sodium Salicylate

Topics: Aspirin; Child; Humans; Infant; Poisoning; Salicylates

Topics: Animals; Aurintricarboxylic Acid; Beryllium; Coloring Agents; Gentisates; Poisoning; Salicylates

Topics: Aspirin; Child; Humans; Infant; Poisoning; Salicylates

Topics: Aspirin; Child; Drug Overdose; Humans; Infant; Poisoning; Salicylates

Topics: Child; Humans; Infant; Poisoning; Salicylates

Topics: Child; Humans; Infant; Poisoning; Salicylates

Topics: Aspirin; Child; Humans; Infant; Poisoning; Salicylates

Topics: Child; Humans; Poisoning; Rheumatic Diseases; Salicylates

Topics: Accidents; Biomedical Research; Child; Humans; Infant; Poisoning; Salicylates