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Intentional Ethylene Glycol Poisoning Increase after Media Coverage of Antifreeze Murders  [cached]
Morgan, Brent,Geller, Robert,Kazzi, Ziad
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2011,
Abstract: Background: The media can have a profound impact on human behavior. A sensational murder by ethylene glycol (EG) poisoning occurred in our state. The regional media provided extensive coverage of the murder. We undertook this investigation to evaluate our incidence of EG poisoning during the timeframe of before the first report linking a death to ethylene glycol to shortly after the first murder trial.Methods: Descriptive statistics and linear regression were used to describe and analyze the number of EG cases over time. A search of the leading regional newspaper’s archives established the media coverage timeline.Result: Between 2000 and 2004, our poison center (PC) handled a steady volume of unintentional exposures to EG [range: 105–123 per year, standard deviation (SD)=7.22]. EG exposures thought to be suicidal in intent increased from 12 cases in 2000 to 121 cases in 2004. In the 19 months prior to the first media report of this story, our PC handled a mean of 1 EG case with suicidal intent per month [range: 0–2, SD=.69]. In the month after the first media report, our PC handled 5 EG cases with suicidal intent. When media coverage was most intense (2004), our PC received a mean of 10 EG suicidal-intent calls per month [range: 5–17, SD=3.55]. Although uncommon, reports of malicious EG poisonings also increased during this same period from 2 in 2000 to 14 in 2004.Conclusion: Media coverage of stories involving poisonings may result in copycat events, applicable to both self-poisonings and concern for malicious poisonings. Poison centers should be aware of this phenomenon, pay attention to local media and plan accordingly if a poisoning event receives significant media coverage. The media should be more sensitive to the content of their coverage and avoid providing “how to” poisoning information. [West J Emerg Med. 2011;12(3):296-299.]
Treatment of patients with ethylene glycol or methanol poisoning: focus on fomepizole
Bruno Mégarbane
Open Access Emergency Medicine , 2010, DOI: http://dx.doi.org/10.2147/OAEM.S5346
Abstract: eatment of patients with ethylene glycol or methanol poisoning: focus on fomepizole Review (3892) Total Article Views Authors: Bruno Mégarbane Published Date August 2010 Volume 2010:2 Pages 67 - 75 DOI: http://dx.doi.org/10.2147/OAEM.S5346 Bruno Mégarbane Réanimation Médicale et Toxicologique, H pital Lariboisière and Université Paris-Diderot, Paris, France Abstract: Ethylene glycol (EG) and methanol are responsible for life-threatening poisonings. Fomepizole, a potent alcohol dehydrogenase (ADH) inhibitor, is an efficient and safe antidote that prevents or reduces toxic EG and methanol metabolism. Although no study has compared its efficacy with ethanol, fomepizole is recommended as a first-line antidote. Treatment should be started as soon as possible, based on history and initial findings including anion gap metabolic acidosis, while awaiting measurement of alcohol concentration. Administration is easy (15 mg/kg-loading dose, either intravenously or orally, independent of alcohol concentration, followed by intermittent 10 mg/kg-doses every 12 hours until alcohol concentrations are <30 mg/dl). There is no need to monitor fomepizole concentrations. Administered early, fomepizole prevents EG-related renal failure and methanol-related visual and neurological injuries. When administered prior to the onset of significant acidosis or organ injury, fomepizole may obviate the need for hemodialysis. When dialysis is indicated, 1 mg/kg/h-continuous infusion should be provided to compensate for its elimination. Side-effects are rarely serious and with a lower occurrence than ethanol. Fomepizole is contraindicated in case of allergy to pyrazoles. It is both efficacious and safe in the pediatric population, but is not recommended during pregnancy. In conclusion, fomepizole is an effective and safe first-line antidote for EG and methanol intoxications.
Delayed ethylene glycol poisoning presenting with abdominal pain and multiple cranial and peripheral neuropathies: a case report
Fiona Baldwin, Hersharan Sran
Journal of Medical Case Reports , 2010, DOI: 10.1186/1752-1947-4-220
Abstract: A 53-year-old Afro-Caribbean man presented with vomiting, abdominal pain and oliguria, and was found to have acute renal failure requiring emergency hemofiltration, and raised inflammatory markers. Computed tomography imaging of the abdomen revealed the appearance of bilateral pyelonephritis, however he failed to improve with broad-spectrum antibiotics, and subsequently developed multiple cranial neuropathies and increasing obtundation, necessitating intubation and ventilation. Computed tomography of the brain showed no focal lesions, and a lumbar puncture revealed a raised cerebrospinal fluid opening pressure and cyto-albuminological dissociation. Nerve conduction studies revealed a sensorimotor radiculoneuropathy mimicking a Guillain-Barre type lesion with an atypical distribution. It was only about two weeks after presentation that the history of ethylene glycol ingestion one week before presentation was confirmed. He had a slow recovery on the intensive care unit, requiring renal replacement therapy for eight weeks, and complicated by acute respiratory distress syndrome, neuropathic pain and a slow neurological recovery requiring prolonged rehabilitation.Although neuropathy as a result of ethylene glycol poisoning has been described in a few case reports, all of these were in the context of a known history of ingestion. As the diagnosis may well be obscured if the history of ingestion is not elucidated, it is important to be aware of this possibility especially if presentation is delayed.Ethylene glycol (EG) is a common constituent of anti-freeze, coolants and other solvents and is responsible for both inadvertent and intentional poisoning with a reported incidence of exposure in the USA of almost 5000 episodes annually [1]. The diagnosis of EG poisoning is relatively obvious in an individual presenting with a history of ingestion, and a clinical presentation consistent with poisoning, associated with a high anion-gap metabolic acidosis and elevated osmolar gap.
Treatment of patients with ethylene glycol or methanol poisoning: focus on fomepizole
Bruno Mégarbane
Open Access Emergency Medicine , 2010,
Abstract: Bruno MégarbaneRéanimation Médicale et Toxicologique, H pital Lariboisière and Université Paris-Diderot, Paris, FranceAbstract: Ethylene glycol (EG) and methanol are responsible for life-threatening poisonings. Fomepizole, a potent alcohol dehydrogenase (ADH) inhibitor, is an efficient and safe antidote that prevents or reduces toxic EG and methanol metabolism. Although no study has compared its efficacy with ethanol, fomepizole is recommended as a first-line antidote. Treatment should be started as soon as possible, based on history and initial findings including anion gap metabolic acidosis, while awaiting measurement of alcohol concentration. Administration is easy (15 mg/kg-loading dose, either intravenously or orally, independent of alcohol concentration, followed by intermittent 10 mg/kg-doses every 12 hours until alcohol concentrations are <30 mg/dl). There is no need to monitor fomepizole concentrations. Administered early, fomepizole prevents EG-related renal failure and methanol-related visual and neurological injuries. When administered prior to the onset of significant acidosis or organ injury, fomepizole may obviate the need for hemodialysis. When dialysis is indicated, 1 mg/kg/h-continuous infusion should be provided to compensate for its elimination. Side-effects are rarely serious and with a lower occurrence than ethanol. Fomepizole is contraindicated in case of allergy to pyrazoles. It is both efficacious and safe in the pediatric population, but is not recommended during pregnancy. In conclusion, fomepizole is an effective and safe first-line antidote for EG and methanol intoxications.Keywords: ethanol, hemodialysis, metabolic acidosis
First report of suspected ethylene glycol poisoning in 2 dogs in South Africa : clinical communication  [cached]
N. Keller,A. Goddard
Journal of the South African Veterinary Association , 2012, DOI: 10.4102/jsava.v76i2.409
Abstract: Ethylene glycol (anti-freeze) toxicity is a serious emergency in both veterinary and human medicine. Ethylene glycol (E/G) is the active anti-freeze principle in radiator water additives. It is odourless, colourless and has a sweet taste. As little as 5 m or 20 m is sufficient to kill a cat or a dog, respectively. Ethylene glycol is rapidly absorbed and metabolised in the liver to oxalate, which is deposited as calcium oxalate in the kidneys causing irreversible damage. This report describes 2 dogs that were suspected to have ingested ethylene glycol. The report contains a description of the 3 stages of ethylene glycol toxicity as well as a short discussion of the treatment. Public awareness about the dangers of anti-freeze will help in limiting exposure of pets and humans to this potentially fatal toxin. Veterinarians need to be aware of anti-freeze toxicity as delayed recognition and treatment will lead to the death of the patient.
Botulism Presenting with Unilateral Paralysis: First Case Report  [cached]
Hasan Karsen,Ali ?rfan Baran,Selami Ekin,Faruk ?mer Odaba?
Klimik Journal , 2011,
Abstract: Food-borne botulism is an acute form of food poisoning that results from ingestion of the toxin produced by Clostridium botulinum. Intoxication classically presents as an acute, symmetrical paralysis. In this study, we report a case of botulism with unilateral paralysis that was confirmed by the mouse inoculation and neutralization method.
Case Report: Ethylene glycol poisoning
M Borkum, A Kropman
Continuing Medical Education , 2012,
Abstract: No
Unilateral Vocal Cord Paralysis
Sumit S,Sharat, M,Kat Y
Calicut Medical Journal , 2005,
Abstract: Introduction : Unilateral vocal cord paralysis is a result of dysfunction of the recurrent laryngeal or vagus nerve. This produces a characteristically breathy voice. Another associated problem is aspiration which may be aggravated by additional superior laryngeal nerve involvement. Operations on the thyroid, cervical spine by an anterior approach, carotid body tumours and the chest carry a risk of iatrogenic vocal cord paralysis. Malignant tumours of the skull base, thyroid, oesophagus, lung and mediastinal metastases could involve recurrent laryngeal or vagus nerves. Idiopathic vocal cord paralysis is a diagnosis of exclusion when no identifiable cause is found. This is usually attributed to viral or inflammatory process. In this paper we take a look at the aetiology, presentation and evaluation of unilateral vocal cord paralysis and also review its management, complications and outcome of treatment. A retrospective outcome audit was carried out on the results of type I Thyroplasty in our department.Purpose : The purpose of this audit was to evaluate the effectiveness of type I Thyroplasty in treating patients with symptomatic unilateral vocal cord paralysis.Methods : Thirty two consecutive cases of unilateral vocal cord paralysis who were operated on between 1998 and 2002 by the same surgeon were included in this audit. Voice quality was assessed subjectively by double-blinded evaluation by experienced speech therapists using a modified Jennifer Oates scale (comparable to the well-researched GRBAS assessment) and by calculating the scores on patient satisfaction questionnaire. Objective evaluation involved videostroboscopy and measurement of Maximum Phonation Time.Results : All patients had subjective improvement in voice quality (100%). 30 patients had improvement in Maximum Phonation Time (93.75%). Three patients had aphonia pre-operatively and none postoperatively (100%).Conclusion : Thyroplasty type 1 improves voice quality and Maximum Phonation Time in patients with unilateral vocal cord paralysis.
Explorations of Unilateral Diaphragmatic Paralysis  [PDF]
Alexandre Quesnel,Fran?oise Beuret Blanquart,Jean Paul Marie,Eric Verin
Journal of Respiratory Medicine , 2014, DOI: 10.1155/2014/683852
Abstract: Objective. The aim of the present study was to evaluate sniff test, maximal inspiratory pressure, and presence of paradoxical inspiratory diaphragmatic movements and their diagnostic value in patients referred for suspicion of diaphragmatic dysfunction. Methods. Twenty-two patients (8 men and 14 women, years) with suspected diaphragmatic dysfunction were included. Pulmonary function test was evaluated by spirometry. Diaphragm dysfunction was diagnosed with unilateral phrenic nerve stimulation. Esophageal pressure was recorded during sniff test and maximal static inspiratory movements. Detection of paradoxical diaphragmatic movement was performed with anteroposterior projection of chest X-ray fluoroscopic video. Results. Phrenic nerve stimulation enabled diagnosis of diaphragmatic paralysis in 15 of the 22 patients. The remaining 7 patients had normal explorations. Lung volumes were significantly lower in patients with diaphragmatic paralysis than in control subjects, as maximal inspiratory pressure. No patient with normal diaphragmatic exploration had paradoxical inspiratory movement. The combined diagnostic value of reduced esophageal pressure during sniff test, reduced esophageal pressure during maximal static inspiratory movements, and presence of paradoxical inspiratory movement had a sensitivity of 87% and a specificity of 71%. Conclusion. Our results suggest that, in most cases, a combination of sniff test, maximal inspiratory pressure, and paradoxical inspiratory movement could help to diagnose diaphragmatic dysfunction. Nevertheless, phrenic nerve stimulation remains the best test for assessing diaphragmatic dysfunction. 1. Introduction Diaphragmatic paralysis is common and may be due to infectious, iatrogenic, or malignant causes, although the most common is frigore paralysis. Damage to the diaphragm or the phrenic nerve decreases inspiratory pressure, leading to diaphragmatic weakness and reduction in inspiratory muscle capacity [1] and lung volume, which in turn impair respiratory muscle endurance [2] and produce dyspnea [3]. Diaphragmatic dysfunction should thus be considered as a differential diagnosis of unexplained dyspnea, but its definitive diagnosis is difficult to assert. Definitive diagnosis can be obtained by phrenic nerve stimulation combined with measurement of twitch transdiaphragmatic pressure [4, 5], but the technique may be difficult in some patients. In clinical practice, suspicion of diaphragmatic paralysis is usually based on diaphragmatic curse during diaphragmatic fluoroscopic examination [6], inspiratory muscle strength
Unilateral laryngeal paralysis  [PDF]
Mitrovi? Slobodan,Mumovi? Gordana,Jovi? Rajko M.,Kljaji? Vladimir
Medicinski Pregled , 2003, DOI: 10.2298/mpns0302059m
Abstract: Introduction Phoniatric rehabilitation is mainly aimed at restoring satisfactory phonation. Voice quality depends on the capacity of intact vocal cords to compensate the deficiency involved, as well as on automatism of phonation. Material and methods The study included 50 patients. All subjects underwent history taking, reported symptoms that urged them to visit a phoniatrician; they were submitted to a clinical otorhinolaryngologic and phoniatric examinations, voice assessment by subjective acoustic analysis spectral analysis by digital sonography and laryngostroboscopy. All patients underwent Seeman's method of laryngeal compression. Results The examined group of 50 subjects included 17 males (34%) and 33 females (66%). Vocal cord palsy was most often due to neck surgery (strumectomy) in 19 patients (38%) followed by an idiopathic palsy involved in 12 patients (24%). Disocclusion of 1-2 mm and 3-3 mm was registered in 54 % and 24% patients, respectively After treatment total occlusion was established in 20 % of patients, while disocclusion of up to 1mm, 1-2 mm or 2-3 mm persisted in 36 %, 20% and 2% of patients, respectively. T-test revealed a statistically significant difference in glottic incompetence prior to and after treatment (p<0.01). After treatment, using Seeman's method of digital compression of the larynx 48 % of patients regained satisfactory speech and voice clarity and 50% of them still presented mild dysphonia. Moderate dysphonia was registered in 2% but none of the patients had severe dysphonia. Discussion Central laryngeal palsies made 4% of our examined group, while according to the literature they make 1.2-8.7% of all laryngeal palsies. In majority of cases, paralysis of the recurrent laryngeal nerve was due to neck surgery (38%), but literature reports indicate that iatrogenic palsies are mostly due to operation of the thyroid. The well known fact that the left recurrent nerve is more frequently paralyzed, has been confirmed in our study as well. Conclusion Accurate and efficient treatment of unilateral laryngeal palsies requires team work Phoniatric rehabilitation of the disorder using Seeman's method has proved efficient in diminishing the glottic incompetence and dysphonia. Patients who fail to respond to phoniatric rehabilitation should be treated using other therapeutic modalities.
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