Biomedical subjects

Jeffrey N Love

Publications and source records attributed to Jeffrey N Love.

4 recordsLinked to original sources

PubMed2006

Are one or two dangerous? Phenothiazine exposure in toddlers.

Traditionally, pediatric phenothiazine exposures are considered dangerous even at low doses. The actual risk of exposure to 1-2 tablets is unclear. In an attempt to determine this risk, the authors performed a literature search, review of the American Association of Poison Control Center data, and evaluation of related resources (e.g., textbooks, bibliographies of relevant papers). This review reveals only sparse data from case reports regarding morbidity and mortality in the pediatric population despite years of clinical experience. Serious toxicity from exposure to low doses is rare and nearly always the result of chlorpromazine ingestion. Although the risk to the toddler ingesting 1-2 tablets seems to be extremely low, several factors should be considered when determining the need for triage to a health care facility.

Administration, Oral↗

PubMed2004

Are 1-2 tablets dangerous? Beta-blocker exposure in toddlers.

The common use and wide availability of beta-adrenergic blocking agents make them frequent ingestants for small children. Yet, there are no clear guidelines in the literature to direct the care of the toddler with the history of ingesting 1-2 tablets. With 40 years of extensive clinical experience, not one documented case of death or serious cardiovascular morbidity as a direct result of a beta-blocker exposure is to be found in an English language review for children under 6 years of age. As with children on chronic beta-blocker therapy, several cases of symptomatic hypoglycemia associated with a single acute propranolol exposure suggest a vulnerability to this complication. Though the risk to the toddler exposed to 1-2 tablets appears to be extremely small, several factors mitigate the actual risk to the child and the need for triage to a health care facility.

Administration, Oral↗

PubMed2004

Are one or two dangerous? Camphor exposure in toddlers.

Serious pediatric toxicity resulting from exposure to small amounts of camphor-containing products has long been a problem. Twenty years ago the United States Food and Drug Administration took several actions in an attempt to ameliorate this risk. Despite these changes, camphor remains commonly available in many nonprescription vaporized or topical "cold" medications, topical musculoskeletal anesthetic "rubs" and "cold sore" preparations, though its efficacy is largely unproven. Data from the American Association of Poison Control Centers demonstrate that camphor continues to be a common source of pediatric exposures. A review of the literature reveals persistent reports of toxicity resulting from exposure to relatively small amounts. In the pediatric population, exposure to as little as 500 mg is cited as a cause of mortality. More commonly, 750 to 1000 mg are associated with the development of seizures and death. Currently available products with 10% camphor contain 500 mg in 5 mL. It is concluded that small doses are dangerous. In children less than 6 years of age, exposure to 500 mg or more requires rapid triage to the closest health care facility.

Animals↗

PubMed2002

Electrocardiographic changes associated with beta-blocker toxicity.

STUDY OBJECTIVE: We sought to characterize the ECG changes associated with symptomatic beta-blocker overdose. METHODS: The study population consisted of a prospective cohort of patients reporting to 2 regional poison centers with beta-blocker overdose. Each patient received an ECG on presentation and a structured follow-up. The inclusion criteria for symptomatic overdose included heart rate of less than 60 beats/min or systolic blood pressure of less than 90 mm Hg; symptoms consistent with decreased end-organ perfusion; therapeutic intervention with cardioactive medication; and corroboration by 2 of the authors that this was a clear-cut case of symptomatic beta-blocker overdose with cardiovascular toxicity. Exclusion criteria included cardioactive coingestants, age younger than 6 years, and no available ECG. RESULTS: Of 167 patients, 13 were determined to have symptomatic exposures. First-degree heart block (>200 ms) was the most common ECG finding (10/12) and also had the greatest likelihood ratio (5.31) when comparing those with symptomatic exposures with those with asymptomatic exposures. Comparing the asymptomatic with the symptomatic groups, the mean PR interval was 167 ms (95% confidence interval [CI] 162 to 171 ms) versus 216 ms (95% CI 193 to 238 ms), the mean QRS interval was 89 ms (95% CI 87 to 91 ms) versus 112 ms (95% CI 92 to 132 ms), the mean QTc interval was 422 ms (95% CI 417 to 428) versus 462 ms (95% CI 434 to 490 ms), and the mean heart rate was 72 beats/min (95% CI 69 to 74 beats/min) versus 66 beats/min (95% CI 59 to 73 beats/min). Two cases of symptomatic acebutolol exposure appeared unique by demonstrating disproportionate prolongation of the QTc interval, an RaVR height of 3 mm or greater, and associated ventricular tachydysrhythmia. CONCLUSION: The majority of clinically significant beta-blocker intoxications demonstrate negative dromotropic effects on ECG. Several ECG differences in acebutolol intoxication might reflect unique pathophysiologic processes relative to other beta-blockers.

Acebutolol↗