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Biomedical subjects

W Klein-Schwartz

Publications and source records attributed to W Klein-Schwartz.

52 records · Page 3Linked to original sources
PubMed1985

Ipecac administration in children younger than 1 year of age.

The efficacy of ipecac syrup in the induction of emesis and safety of its administration was studied in 105 poison-exposed infants 6 through 11 months of age (study subjects) and compared prospectively with 302 poison-exposed infants and children 12 through 35 months of age who served as age controls. Of the 105 study subjects 101 (96.2%) vomited. The failure of ipecac to induce emesis in six patients (four of 105 study subjects two of 302 age control subjects) is comparable with ipecac failure rates reported elsewhere. The frequency of side effects caused by ipecac syrup did not differ between study and control subjects. There were no serious medical complications resulting from the administration of ipecac syrup. When not readily available at home, ipecac administration was delayed an additional 21.8 minutes if obtained from a pharmacy and 38.4 minutes if obtained from an emergency department. Because of the time delay and the increased health care cost, home rather than emergency department administration of ipecac should be advised. These data demonstrate that ipecac syrup effectively induces emesis and is safe for home administration to poisoned infants 6 to 11 months old.

Age Factors↗
PubMed1984

Jimsonweed intoxication in adolescents and young adults.

Seventy-three jimsonweed exposures reported to a regional poison center over a five-year period were reviewed. The ingestors' mean age was 17.3 years (range, 11 to 28 years). The most common route of exposure was oral, and the circumstance was drug abuse or experimentation in the majority of the cases. Although 11 callers remained at home, 59 required medical care in an emergency department or were admitted to the hospital. Treatment consisted of gastrointestinal decontamination, supportive care, and physostigmine salicylate administration. Almost 40% of the medically treated patients received physostigmine for severe hallucinations. One of the 59 medically treated patients had seizures develop. Calls to the poison center regarding jimsonweed differed from other calls in several respects. Jimsonweed abuse is a potentially serious form of substance abuse in adolescents and young adults.

Adolescent↗
PubMed1984

Continuous naloxone infusion in pediatric narcotic overdose.

A 31-month-old girl required constant intravenous (IV) infusion of naloxone hydrochloride to treat codeine-induced respiratory and CNS depression. The infusion rate was 0.4 mg/hr (27 micrograms/kg/hr) over nine hours, without apparent side effects or evidence of toxic effects, for a total naloxone hydrochloride dose of 4.1 mg (280 micrograms/kg). Constant naloxone hydrochloride infusion at an initial rate of 0.4 mg/hr in pediatric narcotic poisoning should be considered if the patient responds inadequately to an initial 0.01-mg/kg bolus, requires repeated administration to reverse narcotic-induced effects, or has ingested long-acting agents. Continuous IV naloxone infusion is a convenient, safe, and effective method to treat narcotic overdose.

Acetaminophen↗
PubMed1984

Ipecac use in the elderly: the unanswered question.

An elderly patient experienced an intracerebral bleed temporally related to the administration of syrup of ipecac. The experience of the certified regional poison centers of the American Association of Poison Control Centers shows that this is an uncommon event. The use and safety of ipecac in the elderly has not been adequately addressed in the past.

Adult↗
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↗
PubMed1984

Warning labels. A source of toxicity information for parents.

The Hazardous Substances Act specifies that warning labels for household products contain specific signal words. This study was designed to determine whether this warning label format provides enough information for parents to accurately assess product toxicity. One hundred forty-two parents from two different sites (community health clinic, private pediatrician's office) were asked to rate the toxicity of four common household products (Crystal Drano, Lysol Basin/Tub and Tile Cleaner, Clorox Bleach, Tempera Poster Paint) and four imaginary products based on the warning labels found on them. Parents had a fairly accurate perception of the toxicity of products and the toxicity to be anticipated based on the warning label. There was considerable variability in response for products which were less toxic or nontoxic. Confusion was noted regarding the meaning of the term nontoxic.

Adolescent↗
PubMed1984

Poison prevention in the elderly.

Poison exposures in the elderly are largely unintentional and, therefore, amenable to prevention techniques. Based on an analysis of the major causes of unintentional exposures in persons age 60 years and older, injury control strategies are applied to poisoning. These strategies address pre-event, event, and post-event phases. Ideas for specific changes to protect the elderly, especially in the areas of labeling and packaging, are presented.

Accident Prevention↗
PubMed1983

Poisoning in the elderly.

A prospective evaluation of poison exposure calls, in reference to persons greater than or equal to 60 years of age, was performed at the Maryland Poison Center during a six-month period in 1981. Each call was examined with respect to location of exposure, caller, circumstance, treatment location, and final outcome. The study group consisted of 237 persons, of whom 66 per cent were women. The majority of callers were not medical personnel, and the most common location for exposure was the home. Most exposures occurred by the oral route and were the result of an accident (83.1 per cent) as opposed to suicide (14.8 per cent) or drug abuse (1.7 per cent), which are more frequent in younger adults. Although only 27.4 per cent of the study population received treatment in an emergency room or required hospital admission, the probability of admission for the elderly person seen in the emergency room was significantly greater than that for younger adults and the children. Of the four fatalities that occurred, three were classified as suicides and one as an accident.

Accidents↗
PubMed1983

Lunar cycle and poison center calls.

An analysis of calls to the Maryland Poison Center was performed to assess whether a relationship exists between the moon periods and poison exposure calls. A given period was defined as the day of the lunar event +/- 2 days. Thirteen lunar cycles in which 22,079 calls occurred were analyzed. A larger proportion of total calls to the center and unintentional poisoning calls occurred during the full moon period. A significantly larger number of unintentional poisonings occurred in the full moon period compared to suicide attempts and drug abuse which occurred most frequently during the new moon period. The lunar cycle had no effect on the distribution of victim's age or sex or the location of treatment.

Adolescent↗
PubMed1981

Adsorption of oral antidotes for acetaminophen poisoning (methionine and n-acetylcysteine) by activated charcoal.

An in vitro experiment was performed to assess the degree of adsorption of oral antidotes for acetaminophen poisoning, methionine and N-acetylcysteine, by activated charcoal. Results indicate that activated charcoal effectively adsorbs both methionine and N-acetylcysteine. Since these agents must be absorbed from the GI tract to prevent acetaminophen hepatotoxicity, concurrent administration of methionine or N-acetylcysteine and activated charcoal would be expected to markedly diminish their antidotal effectiveness.

Acetaminophen↗
PubMedDate not supplied

Three fatal sodium azide poisonings.

We report 3 cases and review the published literature on sodium azide ingestion. A 38-year-old man intentionally ingested 2 tablespoonsful of sodium azide in water and developed seizures, coma, hypotension and fatal ventricular arrhythmias within 2 hours. A 33-year-old male ingested an unknown quantity of sodium azide. In the emergency department he was unconscious and underwent immediate intubation and gastric lavage. Nitrite therapy was instituted without improvement. He remained acidotic despite bicarbonate therapy and developed hypotension which was unresponsive to pressor agents. He died approximately 8 hours after admission despite resuscitative efforts. A 52-year-old male ingested 1.5 to 2g of sodium azide and survived for 40 hours. Nitrite therapy was ineffective. The role of sodium nitrite in treating sodium azide toxicity by producing methaemoglobin which complexes with azide is discussed.

Adult↗
PubMedDate not supplied

Donepezil overdose: a tenfold dosing error.

OBJECTIVE: To report toxicity resulting from donepezil administration following a tenfold dosing error. CASE SUMMARY: A 79-year-old white nursing home patient with a history of Alzheimer disease and hypertension was inadvertently given 50 mg of donepezil instead of her usual 5-mg dose. She presented to the emergency department with nausea, vomiting, and persistent bradycardia (HR in the 40s). Routine laboratory studies were all within normal limits. Basilar rales were noted five hours after arrival. She was treated with atropine 0.2 mg as needed for bradycardia (HR <50 beats/min); a total of 3.0 mg was administered over 18 hours. Each bolus kept her HR >60 beats/min for one-half to two hours. No further vomiting or evidence of pulmonary edema occurred after her initial episodes. She returned to baseline by day 2 (HR in the 70s) and was returned to the nursing home. DISCUSSION: Donepezil is a centrally acting, reversible cholinesterase inhibitor that is used in the treatment of Alzheimer disease. Donepezil is highly specific for neural acetylcholinesterases, preferentially binding acetylcholinesterase by greater than three orders of magnitude over butyrylcholinesterases. This specificity minimizes peripheral adverse effects at therapeutic doses. Our patient mainly experienced bradycardia and had minimal secretory effects compared with what is usually seen with nonspecific cholinesterase inhibition. Medication errors like the one that produced this overdose are a common but preventable cause of morbidity in healthcare facilities. CONCLUSIONS: A tenfold dosing error caused donepezil toxicity. The main effect of this overdose was bradycardia, which responded to atropine therapy.

Aged↗
PubMedDate not supplied

Public awareness survey: the Maryland Poison Center and Mr. Yuk, 1981 and 1975.

A telephone survey of residents of metropolitan Baltimore was conducted in 1981 to assess awareness of the Maryland Poison Center and a program based on the Mr. Yuk poisoning warning symbol. The results of 280 telephone interviews are compared with a similar survey conducted 6 years earlier by the Maryland Poison Center. When faced with a harmful exposure, the most common response in the 1981 survey (32.9 percent) was to call the poison center. That response was only the fourth most frequent answer (14.5 percent) in the 1975 survey. Calling a physician or taking the person to a physician was the most frequent response in 1975 (29.5 percent) but only the fourth most frequent in 1981 (15.0 percent). Of the respondents who would call a poison center, 55.7 percent in the 1981 survey knew the center's telephone number or had ready access to it. Public awareness of Mr. Yuk remained at approximately 60 percent in both surveys. Persons familiar with the warning symbol in the latest survey were three times as likely to call the poison center as those who were not aware of it.

Attitude to Health↗