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Biomedical subjects

R Mrvos

Publications and source records attributed to R Mrvos.

At least 19 recordsLinked to original sources
PubMed2004

Mass sociogenic illness--real and imaginary.

Mass sociogenic illness is the occurrence of a group of nonspecific physical symptoms for which no organic cause can be determined and is often transmitted by 'line of sight'. The fear of bioterrorism can also lead to panic and produce cases of mass sociogenic illness, in which people develop symptoms in response to an imaginary threat. Poison centers are faced with resolving the dilemma of sociogenic vs poison related symptoms. We report 2 situations of mass sociogenic illnesses involving school age children where multiple victims exhibited similar symptoms prompted by the presence or suggestion of fumes. Symptoms resolved spontaneously. When clusters of unexplained illness occur, a sociogenic etiology should be considered in the differential diagnosis. As fears about bioterrorism increase, the frequency of such incidents and the anxiety generated may increase.

Child↗
PubMed2001

Toxidromes associated with the most common plant ingestions.

Toxicology and botanical references describe a myriad of symptoms associated with the ingestion of plants. The symptoms are based largely on a limited number of case and anecdotal reports or the personal experience of authors: there is little consistency between and among the references. This project compiled a list of symptoms associated with common plant ingestions. Exposure data from the American Association of Poison Control Centers were queried to identify the 20 most commonly ingested plants and the most frequent symptoms associated with those ingestions; 768,284 plant exposures were analyzed and symptoms occurred in 53,081 patients. The 20 most frequently ingested plants accounted for 54.2% of the reported symptoms. Most plant ingestions were not associated with the development of symptoms.

Diagnosis, Differential↗
PubMed2000

Transdermal drug delivery system exposure outcomes.

Transdermal drug delivery systems are increasingly popular, yet few data exist regarding medical outcomes after exposures. Using data collected through a Regional Poison Information System, this retrospective study identified 61 cases of transdermal drug delivery system exposures reported over a recent 5-year period. Exposure routes included dermal (48 patients), oral (10 patients), combined oral and dermal (one patient), parenteral use of gel residue (one patient), and combined oral and parenteral (one patient). Forty-four exposures (72%) were managed by home telephone consultation only. Eleven of 17 patients (18%) evaluated in health care facilities were admitted, including eight (13%) to intensive care units. Hospital admission correlated statistically with clonidine and fentanyl exposures, oral exposures, and drug abuse. Clonidine exposure also correlated statistically with intensive care admission. One fatality was recorded, and all other patients recovered uneventfully. Transdermal drug delivery system exposures are infrequently reported to our regional poison information center but are associated with a significant hospital use and admission rate.

Administration, Oral↗
PubMed2000

A profile of methylphenidate exposures.

INTRODUCTION: Methylphenidate is prescribed commonly for children with attention deficit hyperactivity disorder. An estimated 2.8% of US youths aged 5 to 18 years use it for the management of this disorder. Despite the widespread use of methylphenidate, the demographics and outcome of intentional and unintentional exposures to methylphenidate have not been described. METHODS: To profile human exposures to methylphenidate, a retrospective review of all reports to a certified regional poison information center during 1998 was conducted. Data analysis included patient demographics, reason for the exposure, dose ingested, clinical effects, and patient outcome. RESULTS: There were 113 methylphenidate human exposures. The following table summarizes the values for selected parameters that were investigated: [table in text] CONCLUSIONS: The majority of exposures in children < or = 12 years of age involved unintentional ingestion of a sibling's medication, self-administration of an excessive therapeutic dose, or the administration of an inadvertent dose given by a caregiver. Methylphenidate abuse was common among adolescents and adults. Regardless of the reason for the exposure, the amount ingested, or treatment, all exposures had a favorable outcome. Pediatric doses of less than 1 mg/kg were not associated with adverse events.

Adolescent↗
PubMed2000

The poison center role in biological and chemical terrorism.

Nuclear, biological and chemical (NBC) terrorism countermeasures are a major priority with municipalities, healthcare providers, and the federal government. Significant resources are being invested to enhance civilian domestic preparedness by conducting education at every response level in anticipation of a NBC terroristic incident. The key to a successful response, in addition to education, is integration of efforts as well as thorough communication and understanding the role that each agency would play in an actual or impending NBC incident. In anticipation of a NBC event, a regional counter-terrorism task force was established to identify resources, establish responsibilities and coordinate the response to NBC terrorism. Members of the task force included first responders, hazmat, law enforcement (local, regional, national), government officials, the health department, and the regional poison information center. Response protocols were developed and education was conducted, culminating in all members of the response task force becoming certified NBC instructors. The poison center participated actively in 3 incidents of suspected biologic and chemical terrorism: an alleged anthrax-contaminated letter sent to a women's health clinic; a possible sarin gas release in a high school: and a potential anthrax/ebola contamination incident at an international airport. All incidents were determined hoaxes. The regional response plan establishes the poison information center as a common repository for all cases in a biological or chemical incident. The poison center is one of several critical components of a regional counterterrorism response force. It can conduct active and passive toxicosurveillance and identify sentinel events. To be responsive, the poison center staff must be knowledgeable about biological and chemical agents. The development of basic protocols and a standardized staff education program is essential. The use of the RaPiD-T (R-recognition, P-protection, D-detection, T-triage/treatment) course can provide basic staff education for responding to this important but rare consultation to the poison center.

Biological Warfare↗
PubMed1999

Carboprost exposure in a newborn with recovery.

BACKGROUND: This case describes a newborn who was accidentally given carboprost (Hemabate) 250 micrograms intramuscularly, the largest amount ever reported in a normal newborn. CASE REPORT: A full-term newborn was inadvertently given carboprost rather than his prescribed hepatitis vaccine. Within 15 minutes, he was tachypneic and hypertensive followed by bronchospasms and dystonic movements and/or seizure activity of his upper extremities. He also was hyperthermic and had diarrhea stools. He recovered within 18 hours and was discharged. CONCLUSION: The manufacturer reports 2 infants who received lesser amounts and remained asymptomatic. This child exhibited symptoms associated with an overdose of a prostaglandin F2a, although complete recovery occurred within 18 hours.

Carboprost↗
PubMed1999

The media's influence on a poison center's call volume.

Although erratic at times, a poison center's (PC) call volume is generally predictable, but an emergent increase in call volume from an alarmed public can rapidly overwhelm existing personnel making it difficult to manage true emergencies. This is illustrated by a product recall concerning food allegedly contaminated with asbestos occurring in January 1998. Utilizing an on-line database, all calls over a 5-d period concerning this recall were reviewed and tabulated by both the date and time received. Corporate communications polled the print, radio and TV media to determine when the product recall stories were presented. This information was compared to and correlated with the Regional Poison Information Center (RPIC) call volume. Over a 5-d period the RPIC responded to 487 calls regarding the recall with 86.2% received in the first 33 h after the initial broadcast. During this 33-h period a total of 797 calls were documented at the RPIC indicating 52.7% of the call volume being related to the recall. Over the same period 4 local TV and radio stations broadcast the story 33 times with 1 station airing it 19 times in a 24-h period. Two newspaper stories were published. The public has a right to be alerted to potential health hazards, but a sudden increase in calls to a PC can be crippling. Based on this and similar experiences our PC developed a strategy, in concert with corporate communications, to respond to future incidents with the goal of reducing the adverse impact on PC call volume through the promotion of balanced and responsible information.

Asbestos↗
PubMed1997

Tacrolimus (FK 506) overdose: a report of five cases.

INTRODUCTION: Tacrolimus (FK 506), a potent anti-T cell agent, has been shown to be effective in preventing the rejection of transplanted organs. Published research on tacrolimus has focused on effects associated with therapeutic use. Virtually no literature addresses the acute toxicity or the management of tacrolimus overdose. We report five cases of acute overdose with tacrolimus. CASE REPORTS: A 2-year-old female with no prior medical history ingested 10 mg of tacrolimus. She remained asymptomatic. A 2-year-old female with a history of multiple visceral organ transplants ingested 11 mg of her tacrolimus. She was admitted to the hospital and activated charcoal was administered. Her renal function was monitored and no changes were noted in a 24 h period. She was discharged. A 29-year-old male renal transplant patient took 150 mg of tacrolimus. He recovered with only a minimal creatinine elevation. A 23-year-old heart and lung transplant patient ingested 375 mg of tacrolimus. She had no effects from the overdose. A 34-year-old female experienced an acute/chronic overdose of 7-9 mg and remained asymptomatic. DISCUSSION: Tacrolimus is a neutral macrolide antibiotic that is extracted from the fermentation broth of the soil fungus Streptomyces tsukubaensis. Chronic oral dosing has been associated with numerous side effects. Although these patients ingested significant doses of tacrolimus, they suffered few toxic manifestations associated with tacrolimus. CONCLUSION: Little information is available regarding acute tacrolimus overdosage. In this small series of patients, tacrolimus did not produce acute physiologic incapacitation.

Adult↗
PubMed1994

A demographic profile of the Specialist in Poison Information.

In 1983 the first certification examination was administered to Specialists in Poison Information (SPI). This marked the first attempt to validate the status of professionals working in poison centers as a separate entity in the field of medicine and toxicology. Not all specialists are certified, therefore the process characterizes only a portion of those currently practicing. To establish a demographic profile of all SPI's currently practicing in poison centers, a questionnaire was developed and sent to all SPI utilizing the American Association of Poison Control Center's (AAPCC) mailing list. A 57-response survey encompassing a variety of topics affecting SPI's was developed and mailed to 607 currently practicing SPI's (288 Certified SPI's and 319 SPI's). Among the requested information were demographics such as age, educational degrees, years worked at the poison center, and percent of time spent answering poison calls. SPI's were also asked to identify whether their center was certified. Responses were then tabulated and analyzed. One-hundred eighty-three surveys were completed and returned. One-hundred twenty-nine (70%) were Certified SPI's and 54 (30%) were not, although 11 had taken the examination unsuccessfully. Fifty and three-tenths percent of the respondents had worked 1-5 y at a poison center, 35% 5-10 y and 14.7% had greater than 10 y experience. Fifty-six and three-tenths were nurses, 36.1% pharmacists, and 7.6% were classified as "other". This category included MD's, EMT's and those having educational degrees other than the aforementioned.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Air bags: lifesaving with toxic potential?

Federal Motor Vehicle Safety Standard No. 208, "Occupant Crash Protection", requires that all passenger cars manufactured after September 1, 1989 be equipped with automatic crash protection. Car manufacturers met this requirement by installing automatic safety belts or air bags. No chemical injuries have been reported as a result of air bag deployment in motor vehicle accidents (MVA). A 6-month retrospective study was conducted to evaluate the toxic effects of the white powdery residue from air bags, a combination of talc and sodium hydroxide, found in the driver compartment after an MVA. The study reviewed time to onset of symptoms, symptomatology, and treatment. The study included seven patients exposed to deployed air bags after an MVA. Four cases resulted in dermal burns and three patients were diagnosed with unrelated injuries. Three patients presented to an emergency department within 48 hours of the exposure complaining of burns to the skin. Two patients attempted home therapy but became concerned when the symptoms did not subside. One patient was discharged with the diagnosis of first degree burns of the chin and left hand. Another patient experienced bilateral hand erythema and blisters. Standard burn therapy was instituted in both instances. A third patient arrived 1 hour post-exposure to the emergency department complaining of a burning sensation to the hands, but the skin appeared normal. Thorough irrigation was initiated and Silvadene (Marion, Kansas City, MO) applied. One patient notified the poison center 1 hour post-exposure complaining of erythema and burning to his hands after an MVA.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗
PubMed1993

Home exposures to chlorine/chloramine gas: review of 216 cases.

Chlorine and chloramine gas are frequently produced in the home when cleaning products are mixed. These gases are strong irritants with the potential for tissue damage. Numerous literature citations report industrial exposures to chlorine/amine gas, but there are few reports regarding home exposures. The purpose of this study was to determine symptoms, treatment, and outcome in individuals exposed to these gases in the home. All exposures to chlorine/amine gas produced as a result of mixing cleaning products in the home and reported to a Regional Poison Information Center (RPIC) over a 12-month period were reviewed. All calls were documented and follow-up was done at appropriate intervals. All patients with respiratory embarrassment either at the initial contact or on follow-up were referred to a medical facility. Of the 216 patients (ages 12 to 81 years), 200 had resolution of symptoms within 6 hours, whereas only 16 had symptoms for more than 6 hours after exposure; 145 patients were treated at home and 71 received further medical care. Ten symptoms were identified, with the majority of patients experiencing more than one. Emergency room treatment included oxygen (62 patients), bronchodilators (9 patients), and steroid therapy (3 patients). Of the 70 patients who had chest x-ray films, only one had a positive finding; 41 had arterial blood gas measurements done, and all were within normal limits. Only one patient in the study group required admission for continued respiratory distress, but he had a preexisting chronic respiratory problem as well as an upper respiratory tract infection at the time of exposure. Although the gas produced by mixing cleaning products in the home can cause severe respiratory irritation, most of the patients exposed to chlorine and chloramine gas can safely be treated at home with comfort measures. Appropriate follow-up must be done to determine resolution of symptoms.

Adolescent↗
PubMed1993

Illiteracy: a contributing factor to poisoning.

It is estimated that over 60 million Americans (1/3 of the adult population) are functionally or marginally illiterate. To recognize and gain an understanding of illiteracy and its impact on poisoning, we determined if the illiterate in our community could recognize potential poisons. A prospective study involving 29 male and 21 female adult illiterates was undertaken. A personal interview was conducted to determine their ability to purchase medication and household products, their understanding of the uses and associated dangers of medications, and their manner of storage of these products in their homes. Of the participants, 66% were at reading levels of 0-3rd grade and 34% were at 3rd through 6th grade reading level. Each participant was shown 3 separate products and asked to distinguish and interpret caution statements and directions. In the 0-3rd grade group, 30% were unable to identify any of the products and none could explain the cautions or directions. In the second group (3rd-6th grade), all were able to identify the products and 76% could explain the cautions; everyone in this group correctly read the directions. We concluded that a large percentage of the adult population are potential poisoning victims due to their inability to read and comprehend label instructions. Poison Centers should recognize illiteracy as a contributing factor in poisonings and consider education and prevention programs for this segment of our population.

Adolescent↗
PubMed1992

Orthotopic liver transplants necessitated by acetaminophen-induced hepatotoxicity.

BACKGROUND: Acetaminophen-induced hepatotoxicity has been recognized since 1966. Patients experiencing a massive hepatic insult due to acetaminophen (APAP) may recover with minimal residual complications or develop fulminant hepatic necrosis. We report 3 patients with hepatic failure due to an APAP overdose who received orthotopic liver transplants and survived. CASE REPORTS: An 18-y-o female ingested 60 500 mg APAP tablets (30 g). She presented with tachycardia and lethargy stating that she had taken amoxipine, carbamazepine, and lorazepam. She began to recover but on day 2 experienced an upper gastrointestinal bleed and became hypotensive and hyperpyrexic. She developed hepatic encephalopathy and it was then determined she had ingested APAP. Her APAP level was 13 micrograms/ml 96 h post-ingestion. She was successfully transplanted 19 d post-ingestion with recovery. A 40-y-o female was admitted for flu-like symptoms persisting for 7 d. She was jaundiced, hyperventilating and hypotensive. She admitted ingesting approximately 17 g APAP over 36 h. Her APAP level was 12.2 micrograms/ml. Her condition worsened and on day 3 she was in grade IV coma. She was successfully transplanted 4 d post-arrival with recovery. A 16-y-o female ingested an unknown amount of APAP. She presented approximately 24 h post-ingestion with a serum APAP level of 130 micrograms/ml. Her condition deteriorated and she became encephalopathic with grade IV coma. She was successfully transplanted on day 7 post-arrival. DISCUSSION: Hepatotoxicity can occur as a result of either acute or chronic APAP overdose. Although n-acetylcysteine (NAC) is effective antidotal therapy, it must be used within 8-12 h post-ingestion to be optimally effective. Inaccurate patient histories may prevent NAC administration resulting in hepatotoxicity. CONCLUSION: Liver transplantation is a viable option to be considered in those APAP overdose patients who experience rapidly progressing encephalopathy, hemolysis, and hepato-renal failure.

Acetaminophen↗
PubMed1991

Philodendron/dieffenbachia ingestions: are they a problem?

Ingestions involving the philodendron/dieffenbachia members of the Arum family are allegedly associated with the development of intense irritation of mucous membranes, resulting in swelling of the tongue, lips and palate. Although numerous literature citations promote their toxicity, there are few case reports which substantiate a cause-effect relationship between ingestion and resultant symptomatology. To assess the toxic manifestations associated with the ingestion of these plants, a retrospective review of such cases reported to a Regional Poison Information Center was performed. 188 cases were identified and the integrity of the leaf had been broken in all cases. Philodendrons accounted for 67.5% and dieffenbachias for 32.5% of the cases. 72.8% involved children aged 4-12 months. Only 2.1% (4) of the patients were symptomatic (dieffenbachia-3; philodendron-1). In all cases, the symptoms occurred within 5 minutes of the exposure and were of short duration and the outcome was classified as minor. In this 24 month senses of 188 exposures, severe oral complications and the delayed development of symptoms were not observed.

Adolescent↗
PubMed1991

Contaminant identification: the importance of thorough interviewing techniques.

The exact name of a contaminant is of extreme importance to the poison information specialist (SPI) in order to make a correct assessment of the poisoning exposure and to recommend proper treatment modalities. Incorrect contaminant information could lead to a serious and possibly fatal mistake on the part of the SPI. Thorough and effective interviewing techniques must be employed to avoid errors. We conducted a prospective study to determine how often misinformation is provided to the SPI at the time of the initial contact with the poison center. Over a 6-mo period 159 calls were identified in which the original caller mistakenly identified the contaminant. Fifty-two (33%) of these calls were received from health care professionals and 107 (67%) were from the lay public. Drug names were improperly reported in 80 cases, cleaning products in 26, cosmetics 14 times, general products 19, chemicals 7, rodenticides 8, and plants were incorrectly identified in 5 cases. In 110 of these cases, proper identification of the contaminant changed the assessment and also the treatment recommendations made by the SPI. Errors in contaminant identification occurs more frequently than is realized by poison center professionals. It is imperative to have the caller clarify the contaminant name by checking the container, when available, and supplying the SPI with as much information as possible. It is equally important that the SPI employ precise interviewing techniques to obtain information to avoid a serious error in assessment and treatment of the poisoned victim.

Drug Contamination↗
PubMed1988

Clinical toxicology literature: where is it?

Acquiring and continuously updating current literature from medical journals for a poison information center's (PIC) reference file is an essential, but difficult and expensive, task. Due to budgetary concerns and limited space, it is not feasible to purchase and store a large number of periodicals at a PIC. To determine, for acquisition purposes, which journals provide the largest number of clinical toxicology manuscripts, an extensive review of non-toxicology journals specializing in emergency medicine, pediatrics, pharmacology, and general medicine was conducted. Twelve issues of each journal were evaluated to identify citations pertaining to clinical toxicology (original research, reviews, case reports, letters, abstracts, editorials). One hundred seventy-four citations were identified. Emergency medicine journals accounted for 63% of the clinical toxicology citations, general medicine 18%, pediatrics 12%, pharmacology 5%, and miscellaneous 2%. Review articles and case reports comprised the majority of citations followed by original research, and letters to the editor. Forty percent of the citations were in Annals of Emergency Medicine, 22% in the American Journal of Emergency Medicine, and 7% in the American Journal of Medicine. Only a limited number of non-toxicology medical journals have a sufficient number of clinical toxicology citations in them to justify their purchase for a PIC.

Periodicals as Topic↗