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Biomedical subjects

T Litovitz

Publications and source records attributed to T Litovitz.

34 records · Page 2Linked to original sources
PubMed1987

Cimetidine toxicity: an assessment of 881 cases.

We reviewed 881 documented cimetidine overdoses. The data were compiled and analyzed retrospectively from 2,612,236 poisoning cases reported to two nationwide poison surveillance systems from 1978 through 1985. Only cases of cimetidine exposures without coingestants were included. Age, sex, symptom occurrence, treatment site, reason and route of exposure, and medical outcome data were evaluated. Eight hundred eighty-one cases met the criteria and were analyzed. Children between 12 and 35 months of age accounted for 43% of the cases and 97% of all exposures were acute. Intentional overdosage accounted for 21%; 76% were accidental in nature. Gastric emptying was performed in 34%. No symptoms were observed in 79% of the cases, which included ingestions of up to 15 g of cimetidine. Only three patients had moderate clinical manifestations. No patients had major medical complications and there were no fatalities. Even patients in the moderate category experienced no life-threatening toxic manifestations. Cimetidine appears to have an extremely high therapeutic index in both children and adults and demonstrates a remarkable safety profile following acute overdose.

Accidents, Home↗
PubMed1986

Miniature battery foreign bodies in auditory and nasal cavities.

A series of cases involving button batteries lodged in the ear or nasal cavity is presented. All produced tissue destruction. Injuries were generally severe, and included tympanic membrane perforation (three patients) or total destruction (three), marked necrosis of dermis of the external ear canal with exposed bone (seven), documented further impairment of hearing (three), destruction of ossicles (two), facial nerve paralysis and chondritis (one), nasal septal perforation (one), and superficial burns of nasal mucosa (one). Otic and nasal drops must be withheld as they provide an external electrolyte bath for the battery, enhancing leakage and generation of an external current, with subsequent tissue electrolysis and hydroxide formation. Instead, batteries lodged in the ear or nose must be removed promptly.

Aged↗
PubMed1986

The alcohols: ethanol, methanol, isopropanol, ethylene glycol.

More than 6 per cent of poisonings involve alcohols and glycols, reflecting their availability in a wide range of household products, including aftershave, brake fluid, gas line antifreeze, model airplane fuel, mouthwash, rubbing alcohol, and windshield washing solution. Diagnosis involves recognition of an osmolal gap and variable degrees and delays in development of an anion gap metabolic acidosis. Therapeutic modalities are similar for methanol and ethylene glycol, both cases requiring ethanol-blocking of alcohol dehydrogenase and hemodialysis. More often, treatment of ethanol and isopropanol poisoning is limited to supportive care.

1-Propanol↗
PubMed1985

Azalea toxicity: an overrated problem?

One-hundred-and-fifty-two azalea ingestions reported to two regional poison centers over a three year period are reviewed. Twenty-eight exposures were the result of sucking nectar from the flower; the remainder involved ingestion of leaves or flowers. Nine patients developed symptoms, but these were minor or probably unrelated in eight. A single patient was significantly symptomatic, experiencing repeated vomiting and transient hypertension. Emergency department treatment was rendered in 9.2% of patients, and hospital admission for less than 24 hours was required in only one case. Ingestion of moderate amounts of azalea pose little toxic hazard.

Adolescent↗
PubMed1984

Button battery ingestion: assessment of therapeutic modalities and battery discharge state.

Button batteries immersed in a simulated gastric environment (0.1N hydrochloric acid) demonstrated less crimp dissolution (corrosion of the metal can) after the addition of neutralizing doses of eight of nine antacids tested. Of 64 ingestion episodes in dogs, clinical manifestations of button battery-induced injury were limited to a single animal developing guaiac-positive stools. Endoscopic lesions included only mild gastritis, occurring with a frequency comparable to that observed in dogs prior to battery ingestion. After ingestion blood mercury levels were not significantly elevated. Crimp dissolution was absent in discharged cells, implying a decreased risk of electrolyte leakage or subsequent tissue injury in patients who ingest spent cells. No protective effect of metoclopramide, cimetidine, or magnesium citrate could be demonstrated in the canine model.

Animals↗
PubMed1984

Poison information providers: an assessment of proficiency.

An analysis of the results of a national certification examination for poison information specialists administered by the American Association of Poison Control Centers is presented. The failure rate in nonregional centers was more than double that in regional centers, and presents a strong argument for regionalization. Poison information specialists with prior training as pharmacists or registered nurses performed significantly better than those who were high school or college graduates in other fields, emergency medical technicians, or licensed practical nurses. Poison information specialists in centers receiving more than 15,000 calls each year had significantly higher scores. Individual total work experience also had a small but significant correlation with score. The mean score for emergency physicians serving as a control group was 57.0% compared with 77.1% for poison information specialists. The data suggest that telephone consultations for poison emergencies are done best by those who do them on a specialized full-time basis. Calls should be referred to the appropriate regional poison control center.

Certification↗
PubMedDate not supplied

Implication of dispensing cups in dosing errors and pediatric poisonings: a report from the American Association of Poison Control Centers.

OBJECTIVE: To characterize reports to poison centers involving liquid medication errors associated with the use of dispensing cups. DESIGN: Case series reported by 16 US poison centers over an eight-day period. SETTING: Calls to poison control centers, predominantly but not exclusively from homes. PATIENTS: Children and adults. RESULTS: Of 34 reported cases, most (79 percent) involved a two- to threefold dosing error, and most (94 percent) involved an error in a single dose of medication. Cough and cold preparations were implicated in 65 percent; acetaminophen elixirs in 18 percent. Three major causes of dosing errors were identified, including teaspoon/tablespoon confusion, assumption that the dispensing cup was the unit of measure, and assumption that the full dispensing cup was the actual dose. CONCLUSIONS: Dispensing cup markings should use a single unit of measure, and a uniform labeling system should be implemented. Teaspoon/tablespoon abbreviations should be avoided, and dispensing cup lettering should be more legible. Consumer education is essential to correct the misimpression that the full cup is always the recommended dose.

Child↗
PubMedDate not supplied

Health implications of petroleum distillate ingestion.

The authors discuss the clinical approach to the management of hydrocarbon ingestions, including the role, implementation, and type of gastric decontamination utilized; the extent of medical evaluation, observation or hospitalization required; and the appropriate therapy for hydrocarbon pneumonitis. An appendix covers myocardial sensitization following inhalation abuse of hydrocarbons.

Adrenal Cortex Hormones↗