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Biomedical subjects

D B Kunkel

Publications and source records attributed to D B Kunkel.

At least 19 recordsLinked to original sources
PubMed1996

Pool cue chalk: a source of environmental lead.

Lead compounds are used as coloring agents for numerous products. Two cases of children with elevated blood lead concentrations encountered by the authors suggested that pool cue chalk may serve as a source of environmental lead. The objective of this study was to determine lead content of various brands and colors of pool cue chalk. Atomic absorption analyses were conducted of 23 different types of pool cue chalk for lead content. Three of 23 types of pool cue chalk contained more than 7000 ppm (mg/kg) lead: one manufacturer's green and tangerine chalk and another manufacturer's green chalk. It was concluded that some brands of pool cue chalk contain relatively large amounts of lead and could contribute to childhood lead poisoning.

Arizona↗
PubMed1990

Acute lead poisoning in nursing home and psychiatric patients from the ingestion of lead-based ceramic glazes.

To our knowledge, acute inorganic lead poisoning from single ingestions of lead compounds has been only rarely reported. During a 14-month period, we were contacted regarding eight instances of acute ingestions of liquid lead-based ceramic glazes by mentally impaired residents of nursing homes or psychiatric facilities participating in ceramic arts programs. While some ingestions did not cause toxic effects, some patients developed acute lead poisoning characterized by abdominal pain, anemia, and basophilic stippling of red blood cells. In the blood of several patients, lead concentrations were far above normal (4 to 9.5 mumol/L). Urinary lead excretions were tremendously elevated during chelation therapy, with one patient excreting 535.9 mumol/L of lead during a 6-day period, the largest lead excretion ever reported in a patient suffering from acute lead poisoning, to our knowledge. All patients recovered following supportive care and appropriate use of chelating agents. Lead-based glazes are commonly found in nursing homes and psychiatric facilities. We suspect that acute or chronic lead poisoning from the ingestion(s) of lead-based ceramic glazes may be an unrecognized but not uncommon problem among such residents. We urge physicians to take ingestions of lead-based glazes seriously and to consider the diagnosis of lead poisoning in nursing home and psychiatric patients who have participated in ceramic crafts programs.

Acute Disease↗
PubMed1989

The legitimacy of rattlesnake bites in central Arizona.

Previous authors have classified poisonous snake bites as being legitimate or illegitimate, depending on whether the victim was taking unnecessary risks with a snake before being bitten. We reviewed medical records of 86 consecutive rattlesnake bite victims cared for at a single medical center to determine legitimacy of snake bites. A bite was considered illegitimate if, before being bitten, the victim recognized an encounter with a snake but did not attempt to move away from the snake. A legitimate bite was said to have occurred if a person was bitten before an encounter with a snake was recognized or was bitten while attempting to move away from a snake. The study group was made up of 75 male (87.2%) and 11 female (12.8%) victims. Seventy-four percent were 18 to 50 years old, and 15% had been bitten previously. Only 43.4% of all bites were considered legitimate, and pet (captive) snakes accounted for almost one third of all illegitimate bites. The ingestion of alcoholic beverages was associated with 56.5% of illegitimate bites versus 16.7% of legitimate bites (P less than .001). While 74.4% of bites were to upper extremities, only 27% of upper extremity bites were legitimate. All bites to the lower extremity were legitimate (P less than .001). Of 14 individuals bitten by pet snakes, all were men and 64.3% were under the influence of alcohol at the time of the bite.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Digital hydrofluoric acid burns: treatment with intraarterial calcium infusion.

Hydrofluoric acid (HF) produces a unique chemical burn due to tissue penetration by fluoride ion. Fluoride ion interferes with calcium activity in a variety of cell membranes and calcium-dependent processes, resulting in severe pain and deep tissue destruction. The currently accepted methods of treating HF burns include application of topical soaks or ointments with calcium or magnesium salts for minor burns and local injection of calcium gluconate for more severe burns. Digital burns also may require nail removal and direct injection into the nail bed. We present the cases of a series of patients with moderate to severe HF burns involving one or more fingers who were treated with selective intraarterial calcium infusion of dilute (1.66%) calcium salts. All patients had excellent relief of symptoms and marked improvement of the burn lesions following one to three four-hour infusions of calcium chloride or calcium gluconate. One patient required subsequent surgical intervention for grafting of a full-thickness burn, and one patient developed transient spasm at the site of percutaneous arterial line insertion. Intraarterial calcium infusion for the treatment of HF burns of the fingers provides many therapeutic advantages, including elimination of painful calcium injection directly into fingertips, avoidance of debilitating procedures such as fingernail removal, and assurance that all affected cells are receiving adequate amounts of calcium to replenish depleted stores and to complex with remaining free fluoride ion.

Adult↗
PubMed1985

Noninvasive vascular studies in management of rattlesnake envenomations to extremities.

Twenty-five consecutive patients suffering rattlesnake envenomation to an extremity underwent noninvasive vascular arterial studies using contralateral extremities as controls. All but one received antivenin, and none underwent early surgical decompression. Pulse volume amplitudes in the envenomated extremities, reflecting pulsatile arterial blood flow, were increased in 24 of 25 patients (P less than .02) in spite of edema and discoloration. Ischemia requiring surgical procedures developed in three of seven patients with decreased skin temperatures, as compared to none of 18 with increased or mixed skin temperatures on the envenomated extremity (P less than .02). One of 24 survivors suffered a functional deficit. Most victims of rattlesnake bites have increased arterial pulsatile blood flow in an envenomated extremity and do well with medical therapy. Noninvasive arterial studies help select those who are more likely to require special surgical intervention.

Adolescent↗
PubMed1984

Evaluating exposures to plants.

Most clinical problems due to plant exposures result from experimentation with or overt abuse of plant parts and extracts. Plant exposures may present as complex pharmacologic problems that challenge the diagnostic and therapeutic skills of the physician. Although specific physiologic antagonists (antidotes) may exist for specific intoxications, basic decontamination and supportive techniques are often all that may be offered.

Adult↗
PubMed1984

Evaluating exposures to plants.

Exposures to plants generate an exceptional amount of public concern, especially plant ingestions by children. Most clinical problems, however, involve older age groups as a result of experimentation with or overt abuse of plant parts and extracts. Of mounting concern is the sometimes uninformed and massive use of herbal preparations, currently widely available and in popular vogue. Plant exposures, from whatever source, may present as complex pharmacologic problems that may challenge the diagnostic and therapeutic skills of the physician. Although specific physiologic antagonists (antidotes) may exist for specific intoxications, basic decontamination and supportive techniques are many times all that may be offered.

Adult↗
PubMed1984

Bites of venomous reptiles.

Bites by venomous reptiles are statistically of minor importance in North America, especially as regards medically significant envenomations. However, they may assume a greater relative incidence in warmer regions and always manage to generate public and professional interest wherever they occur. Unproved and potentially hazardous first-aid and institutional therapies must be subjected to scrutiny in the future. Current research in the area of more specific and less reactive antivenin products is encouraging, and it appears that a consensus approach to the care of the bitten patient is emerging. Physicians are encouraged to consult with regional poison control centers in the care of these patients unless they are well experienced in this unique and complicated area.

Animals↗
PubMed1984

Arthropod envenomations.

Millions of arthropods surround us every day, but only a few are medically harmful. Knowledge of the habits and habitats of known venomous arthropods is certainly advisable for the prudent person in areas of known infestation as a preventive measure. Arthropod envenomations probably produce much less mortality than previously thought, but the potential for severe effects of direct envenomation or allergic response exists with some species, and these events must be approached as true medical emergencies.

Antivenins↗
PubMedDate not supplied

Envenomation by the scorpion Centruroides sculpturatus.

Envenomation by the scorpion C. sculpturatus can be life threatening. The action of the venom is to produce prolonged and excessive firing of neuronal axons which results in a wide variety of signs and symptoms. Records of 670 patients suffering from scorpion stings in central Arizona in 1982 were reviewed to characterize the clinical course of these patients. While adults appear to be stung more often than children, children are more likely to develop a severe illness requiring intensive supportive care. The intravenous administration of specific C. sculpturatus antivenom results in resolution of serious signs and symptoms within minutes, with patients completely asymptomatic within 1 1/2 hours. The administration of antivenom is recommended as the treatment of choice for severe envenomations after the initiation of appropriate supportive care.

Action Potentials↗