Biomedical subjects
Publications and source records attributed to M J Ellenhorn.
A case is presented in which a 7-month-old child developed central nervous system depression, urinary abnormalities and a large anion-gap acidosis after the accidental oral administration of clove oil. Supportive care and gastric lavage were sufficient for total recovery of the patient. Possible mechanisms of the depression and acidosis are discussed, and suggestions for treatment are presented.
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The records of 46 patients who were admitted to a general hospital with the diagnosis of phenytoin toxicity were retrospectively studied to identify factors present at the time of admission which correlated with severity of illness and which would therefore be of prognostic value. Length of hospital stay was used as a measure of severity of illness. Correlations were made between the length of hospital stay and 18 variables studied at the time of admission, including severity of symptoms, use of other drugs (sedative hypnotics, anticonvulsants and phenothiazines), history (seizures, cardiac arrhythmias, and alcohol abuse), laboratory evidence of liver disease or renal disease, electrolyte abnormalities, coagulopathies, prior suicide attempts, glucose levels, and white blood cell counts. Significant correlations related the length of hospital stay with the severity of symptoms, concurrent phenothiazine usage, and the presence of abnormal liver function tests on admission, but not with other factors studied. Admission phenytoin serum levels following an overdose were not a useful predictor of length of hospital stay in this series of patients.
Records of all patients admitted to an urban teaching hospital from 1977-1987 with a diagnosis of phenytoin toxicity were reviewed in order to determine indications for admission and discharge, and to assess the need for therapeutic intervention and monitoring. Of 94 patients identified, 57 were male and 37 were female. Ages ranged from 19 mo to 84 yr. Serum phenytoin levels ranged from 21.4-90 micrograms/ml, with a mean level 44.4 +/- 12.5 micrograms/ml. Ataxia was observed in 59/94 patients (63%), and of these 18 patients had fallen; 9 had suffered injury from falling sufficient to require medical care. No other factors were associated with morbidity. No hemodynamic instability was seen in any of the cases. Electrocardiographic records were available for 71/94 cases (76%). There were no abnormalities due to phenytoin. Symptoms of toxicity resolved with supportive care. There were no deaths in this series. Phenytoin is a relatively safe medication even in the toxic range as determined by baseline phenytoin levels. Hospital admission is indicated in symptomatic cases until a declining serum phenytoin level is observed and ataxia resolves. The data in this series do not support routine electrocardiographic monitoring in cases of phenytoin toxicity.
The medicolegal medical toxicologist is described: What they do, what toxicology is, how the toxicologist moves in a world of regulations, chemicals, differential diagnosis, and treatment of poisoning; his or her knowledge as an expert witness in evaluation of serious adverse drug reactions, medical malpractice, and poisoning cases; and the toxicologist's awareness of the role of alcohol, the problem of causation of death, and the limitations of the laboratory are discussed.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.