Ingestion Of Toxic Substances Research Articles

Index of Suspicion * Case 1: Persistent Fever and Cough Following Episodes of Emesis in a 7-year-old Girl * Case 2: Blurry Vision and Unilateral Dilated Pupil in a 14-year-old Girl * Case 3: Swelling, Pain, and Erythema of the Thumb in a 10-year-old Girl With Habits of Nail Biting and Thumb Sucking

* CT: : computed tomography ESR: : erythrocyte sedimentation rate IV: : intravenous WBC: : white blood cell A 7-year-old girl presents to the emergency department with persistent fever and cough for 9 days. She was in her usual state of good health until she vomited twice 11 days earlier. She subsequently developed cough and fever, prompting three visits to an urgent care center in the preceding 9 days. She denies shortness of breath, chest pain, diarrhea, rash, urinary symptoms, or sore throat. A chest radiograph on the fourth day of fever was normal. Physical examination reveals a temperature of 102.9°F, heart rate of 115 beats per minute, respiratory rate of 28 breaths per minute, blood pressure of 110/65 mm Hg, and pulse oximetry reading of 98% in room air. Generally, she appears well, with occasional coughing during the visit. On respiratory examination, there is good air movement bilaterally, and no rales or wheezes are heard. The rest of the physical findings are normal. Her white blood cell count (WBC) is 25×103/μL with 88% neutrophils, 8% lymphocytes, and 4% monocytes; her C-reactive protein level is 16 mg/dL (normal <0.5); and an erythrocyte sedimentation rate (ESR) is 70 mm/hour. Results of her complete metabolic panel and urinalysis are normal. A blood culture and urine culture come back negative. An additional imaging study reveals the cause of her prolonged illness. A previously healthy 14-year-old girl presents with blurred vision in the right eye of a few hours’ duration. The blurring is worse while looking at close rather than at far objects. There is no history of trauma, ingestion of toxic substances, or recent illness, including headache, nausea, vomiting, weakness or tingling of the extremities, eye pain, ptosis, diplopia, or other symptoms referable to the cranial nerves. The past, social, and family histories are noncontributory, other than the presence of asthma and dry eyes in the mother. On physical …

Gustation.

Much has been discovered over the last few decades about the anatomy and physiology of the human taste system, most notably its receptor mechanisms and intermodal factors that influence its function. While the taste system works in concert with the olfactory, somatosensory, auditory, and visual sensory systems to establish the overall gestalt of flavor, its primary specialization is to ensure that the organism obtains energy, maintains proper electrolyte balance, and avoids ingestion of toxic substances. Despite its focus on inborn functions, taste-like its sister sense of smell-is remarkably malleable, reflecting the need to adapt to changing circumstances and general nutrient availability. It is now widely appreciated that taste dysfunction is common in many diseases and disorders, and is a frequent side effect of a number of medications. This interdisciplinary review examines salient aspects of the human gustatory system, including its anatomy, physiology, and pathophysiology. WIREs Cogn Sci 2012, 3:29-46. doi: 10.1002/wcs.156 For further resources related to this article, please visit the WIREs website.

Why on earth?: Evaluating hypotheses about the physiological functions of human geophagy.

Geophagy has been hypothesized to be an adaptive behavior, either as a means to allay nutrient deficiency or to protect against ingested pathogens and toxins. Others have proposed that geophagy is non-adaptive, occurring either to allay hunger or as an epiphenomenon of nutrient deficiencies. This paper evaluates these hypotheses using 482 published cultural-level accounts of human geophagy and 330 accounts of geophagy among 297 species of mammals, birds, and reptiles. Information was extracted from reports of human geophagy to permit statistical analysis; reports of non-human geophagy were tabulated. Human geophagy did not parallel changes in nutrient requirements, occurred most frequently among children and pregnant women and in tropical areas (where pathogen densities are highest), and was associated with ingestion of toxic substances and gastrointestinal distress. Earth ingested by humans was craved and carefully selected and prepared; it had high clay content, but few bioavailable mineral nutrients. In primates, geophagy was associated with both protection from toxins and obtaining nutrients, whereas in other vertebrates it was associated mainly with obtaining nutrients. Our results indicate that human geophagy is best explained as providing protection from dietary chemicals, parasites, and pathogens, whereas animal geophagy may involve both micronutrient acquisition and protection.

Part 12: Cardiac Arrest in Special Situations

This section of the 2010 AHA Guidelines for CPR and ECC addresses cardiac arrest in situations that require special treatments or procedures beyond those provided during basic life support (BLS) and advanced cardiovascular life support (ACLS). We have included 15 specific cardiac arrest situations. The first several sections discuss cardiac arrest associated with internal physiological or metabolic conditions, such as asthma (12.1), anaphylaxis (12.2), pregnancy (12.3), morbid obesity (12.4), pulmonary embolism (PE) (12.5), and electrolyte imbalance (12.6). The next several sections relate to resuscitation and treatment of cardiac arrest associated with external or environmentally related circumstances, such as ingestion of toxic substances (12.7), trauma (12.8), accidental hypothermia (12.9), avalanche (12.10), drowning (12.11), and electric shock/lightning strikes (12.12). The last 3 sections review management of cardiac arrest that may occur during special situations affecting the heart, including percutaneous coronary intervention (PCI) (12.13), cardiac tamponade (12.14), and cardiac surgery (12.15). Asthma is responsible for more than 2 million visits to the emergency department (ED) in the United States each year, with 1 in 4 patients requiring admission to a hospital.1 Annually there are 5,000 to 6,000 asthma-related deaths in the United States, many occurring in the prehospital setting.2 Severe asthma accounts for approximately 2% to 20% of admissions to intensive care units, with up to one third of these patients requiring intubation and mechanical ventilation.3 This section focuses on the evaluation and treatment of patients with near-fatal asthma. Several consensus groups have developed excellent guidelines for the management of asthma that are available on the World Wide Web: ### Pathophysiology The pathophysiology of asthma consists of 3 key abnormalities: Complications of severe asthma, such as tension pneumothorax, lobar atelectasis, pneumonia, and pulmonary edema, can contribute to fatalities. Severe asthma exacerbations are commonly associated with …

Suicide research and prevention in developing countries in Asia and the Pacific

Suicide research and prevention in developing countries in Asia and the Pacific

Adsorption of Peanut (Arachis hypogaea, Leguminosae) Proteins by Activated Charcoal

The binding of peanut protein allergens to activated charcoal (AC), used medically for gastric decontamination following the ingestion of toxic substances, was investigated for potential clinical application. Crude peanut extract (CPE) or purified peanut protein allergens Ara h 1 and 2 were co-incubated with AC under a variety of conditions followed by centrifugation to remove the AC and adsorbed protein. The resulting supernatant solution was analyzed for unadsorbed protein by gel electrophoresis and quantitative protein assay. The extent of protein adsorption by a known amount of AC was determined. Protein binding to AC was rapid and irreversible. The extent of adsorption was unaffected by pH, but was optimal near physiological salt concentrations. Denatured proteins, or those of larger molecular weight, required more AC than smaller or native proteins. The extent of protein binding increased with temperature, supporting the concept that protein molecules diffuse into vacant pores of appropriate size on the charcoal surface.

Competing Effects of Toxin-Producing Phytoplankton on Overall Plankton Populations in the Bay of Bengal

The coexistence of a large number of phytoplankton species on a seemingly limited variety of resources is a classical problem in ecology, known as 'the paradox of the plankton'. Strong fluctuations in species abundance due to the external factors or competitive interactions leading to oscillations, chaos and short-term equilibria have been cited so far to explain multi-species coexistence and biodiversity of phytoplankton. However, none of the explanations has been universally accepted. The qualitative view and statistical analysis of our field data establish two distinct roles of toxin-producing phytoplankton (TPP): toxin allelopathy weakens the interspecific competition among phytoplankton groups and the inhibition due to ingestion of toxic substances reduces the abundance of the grazer zooplankton. Structuring the overall plankton population as a combination of nontoxic phytoplankton (NTP), toxic phytoplankton, and zooplankton, here we offer a novel solution to the plankton paradox governed by the activity of TPP. We demonstrate our findings through qualitative analysis of our sample data followed by analysis of a mathematical model.

Ingestion of Toxic Substances by Infants and Children

Ingestion of Toxic Substances by Infants and Children

Activated Charcoal Revisited

Activated charcoal (AC) is used in clinical toxicology to prevent the systemic absorption of toxic agents from the gastrointestinal tract and to enhance the elimination of toxic agents already absorbed. Single oral doses of AC decrease the absorption of most drugs as well as organic and inorganic materials with the exception of ethanol, strong acids and alkalis, iron, and lithium. The efficacy of AC is inversely related to the time elapsed after the ingestion of toxic substances. Activated charcoal should probably be given soon after most significant ingestions because of the low frequency of serious complications and the absence of effective techniques to enhance the elimination of most toxins once absorbed. The administration of multiple doses of activated charcoal has been shown to enhance the elimination of a variety of drugs. Although shortening the half-life of a drug in overdose should logically benefit a patient clinically, the proof of this is still lacking. Therefore, administration of multiple doses of activated charcoal should mainly be considered when confronted with possible life-threatening intoxications with carbamazepine, dapsone, phenobarbital, quinine, or theophylline.

Muerte súbita en epilepsia: la experiencia del clínico

The disconcerting experience of sudden unexpected death in epilepsy (SUDEP) obliges the clinician to consider the differential diagnosis and study the mechanisms by which it may be prevented.A 13 year old patient with idiopathic generalized epilepsy and a history of febrile convulsions, both also described in the family history, who suddenly died at his home from no apparent cause. The legal autopsy findings were normal. The serum levels of valproic acid, previously normal, were non existent at death. In this case the differential diagnosis included intentional causes, ingestion of toxic substances, feeding disorders, long QT syndrome and SUDEP.After considering the available evidence we suggest that this was a case of SUDEP. Epidemiological studies specifically designed to seek risk factors may suggest preventive measures even when the causes and pathogenic mechanisms of the disorder are not known. The creation of a national SUDEP register would be a great step in this direction.

Ingestion of toxic substances by children.

Ingestion of a harmful substance is among the most common causes of injury to children less than six years of age. Fortunately, in most cases, the ingested agent has minimal or no clinically important toxic effect. Occasionally, however, such ingestion can be life-threatening or can even result in death. Although preventive measures have been remarkably successful in reducing the frequency and severity of poisoning in children, poisoning continues to occur and requires strategies for treatment and prevention that are safe and effective. In this review, I discuss the management of poisoning in children, with an emphasis on current guidelines for . . .

Evaluation of high-risk smoking practices used by the homeless

The purpose of this study was to evaluate the prevalence of high-risk smoking practices in a homeless population. High-risk cigarette smoking practices include misuse of tobacco products or alternative methods of cigarette smoking that increase the likelihood of ingestion of toxic substances and infectious agents that can potentiate the hazards associated with cigarette smoking. An 84-item questionnaire was developed by the researcher to measure these practices. Fifty-six male and three female homeless people were interviewed in downtown Los Angeles. The most common high-risk smoking practices were cigarette sharing (86%); smoking cigarettes remade from discarded cigarette butts and filters (71%); smoking cigarettes remade by others (63%); smoking discarded cigarette butts (63%); blocking filter vents (24%); using things other than tobacco, such as discarded cigarette filters and drugs, in remaking cigarettes (22%); and smoking discarded cigarette filters (19%). These high-risk smoking practices pose a greater risk of exposure to toxins trapped in filters and tobacco remains and increase the threat of infectious disease transmission. The long-term effects of high-risk smoking practices among the homeless have potential economic implications for society.

Chronic hepatitis with fatty change

Ten patients with clinical features of chronic hepatitis showed on liver biopsy histologic evidence of chronic hepatitis plus predominantly moderate to severe fatty change. No patient had a history of excess alcohol intake, or prolonged intake of hepatotoxic drugs and steroids, and were not obese or malnourished. These cases differ from the reported cases of non-alcoholic steatohepatitis resembling alcoholic hepatitis as they occurred in relatively young health adults, predominantly males, who were not diabetic or obese. Mallory's hyalin in liver was absent in all cases. Ingestion of toxic substances was possible but no history was obtained to account for it. While these could be unusual cases of chronic non-A, non-B hepatitis, this can be only speculation until a serologic test for non-A, non-B hepatitis becomes available. Follow-up of eight patients for 1-3 years with liver biopsy showed that they had a relatively benign course with no evidence of progression to cirrhosis.

Use of cathartics in toxic ingestions

Cathartics are commonly recommended for treatment of ingestion of toxic substances. Literature review shows little evidence of efficacy of this practice. Published reports of morbidity are limited to pediatric patients experiencing electrolyte imbalance. Our survey of the members of the American Board of Toxicology, as well as our literature review, form the basis for suggesting catharsis of most patients when treating toxic ingestions. However, caution must be used in very old or very young patients, in those with preexisting renal disease or ingestion of nephrotoxic substances, in corrosive ingestions, in patients with recent bowel surgery or absent bowel sounds, and in patients with hypertension or congestive heart failure. Oil catharsis is not recommended.

Maternal mortality in south Iran: a seven-year survey.

To evaluate the effect of recent improvements in health care in Iran in reducing the number of maternal deaths results of the present study are compared with previous data. Autopsies were conducted for 96 maternal deaths which occured from January 1970-December 1976 at the Pahlani University teaching hospitals. Deaths were classified as direct obstetric indirect obstetric and unrelated to obstetric events. During the 7 years of the study there was an incidence of 248.7 deaths/100000 live births. Leading causes for 58 deaths due to direct obstetric causes were infection (25) hemorrhage (11) pulmonary embolism (8) toxemia (6) and choriocarcinoma. Deaths due to indirect obstetric causes declined substantially from the previous study; Causes were chronic glomerulonephritis generalized miliary tuberculosis hepatic failure viral hepatitis cardiac disease and peritonitis. 25 maternal deaths (26%) resulted from unrelated causes including communicable and infectious diseases. 4 deaths due to ingestion of toxic substances were classified as suicides. Other causes were acute myeloblastic leukemia ependymoma of the cerebellum and amyloidosis of the kidney. Pregnancy wastage occured in 68% of the 96 pregnancies (79%) with maternal mortality. Although results indicate a significant reduction in the maternal death rate the pattern of diseases leading to maternal mortality has remained unchanged. Recommendations for prevention include improvement in sanitation prevention of communicable diseases upgrading the health care system and expansion of the new midwifery program.

Tryptophan determination in cataract due to deficiency or delayed supplementation of tryptophan.

IN SEVERAL recent papers it has clearly been shown that in dietary deficiencies not connected with ingestion of toxic substances, such as dinitrophenol, naphthalene, thallium and ergot, or with consumption of galactose, lactose or xylose, or with vitamin deficiencies, corneal vascularization, and often cataract formation as well, can be induced in experimental animals by inadequate diets in which the missing component is protein or one of its building stones, an essential amino acid. With protein deprivation (Hall and associates¹) and with deficiencies of lysine and tryptophane (Totter and Day,²) of methionine (Berg and associates³), of phenylalanine, leucine and histidine (Maun, Cahill and Davis⁴) and of phenylalanine, isoleucine, threonine, valine and arginine (Sydenstricker, Hall, Bowles and co-workers⁵), corneal vascularization was commonly observed. Cataract formation was less common. One of the earliest reports of cataract formation associated with dietary inadequacies in which protein or its components were