Intentional Ingestion Research Articles

Glyphosate: Hepatotoxicity, Nephrotoxicity, Hemotoxicity, Carcinogenicity, and Clinical Cases of Endocrine, Reproductive, Cardiovascular, and Pulmonary System Intoxication.

Glyphosate (GLP) is an active agent of GLP-based herbicides (GBHs), i.e., broad-spectrum and postemergent weedkillers, commercialized by Monsanto as, e.g., Roundup and RangerPro formulants. The GBH crop spraying, dedicated to genetically engineered GLP-resistant crops, has revolutionized modern agriculture by increasing the production yield. However, abusively administered GBHs' ingredients, e.g., GLP, polyoxyethyleneamine, and heavy metals, have polluted environmental and industrial areas far beyond farmlands, causing global contamination and life-threatening risk, which has led to the recent local bans of GBH use. Moreover, preclinical and clinical reports have demonstrated harmful impacts of GLP and other GBH ingredients on the gut microbiome, gastrointestinal tract, liver, kidney, and endocrine, as well as reproductive, and cardiopulmonary systems, whereas carcinogenicity of these herbicides remains controversial. Occupational exposure to GBH dysregulates the hypothalamic-pituitary-adrenal axis, responsible for steroidogenesis and endocrinal secretion, thus affecting hormonal homeostasis, functions of reproductive organs, and fertility. On the other hand, acute intoxication with GBH, characterized by dehydration, oliguria, paralytic ileus, as well as hypovolemic and cardiogenic shock, pulmonary edema, hyperkalemia, and metabolic acidosis, may occur fatally. As no antidote has been developed for GBH poisoning so far, the detoxification is mainly symptomatic and supportive and requires intensive care based on gastric lavage, extracorporeal blood filtering, and intravenous lipid emulsion infusion. The current review comprehensively discusses the molecular and physiological basics of the GLP- and/or GBH-induced diseases of the endocrine and reproductive systems, and cardiopulmonary-, nephro-, and hepatotoxicities, presented in recent preclinical studies and case reports on the accidental or intentional ingestions with the most popular GBHs. Finally, they briefly describe modern and future healthcare methods and tools for GLP detection, determination, and detoxification. Future electronically powered, decision-making, and user-friendly devices targeting major GLP/GBH's modes of actions, i.e., dysbiosis and the inhibition of AChE, shall enable self-handled or point-of-care professional-assisted evaluation of the harm followed with rapid capturing GBH xenobiotics in the body and precise determining the GBH pathology-associated biomarkers levels.

Impact of social media “challenges” on poison center case volume for intentional ingestions among school-aged children: an observational study

Introduction Mental health problems among youth have escalated over the past decade, with increased rates of self-harm, including suicide attempts by ingestion. Social media use has been linked to youth mental health, including “challenges” urging youth to ingest substances for recreational and other purposes. We hypothesized that social media challenges for particular substances would temporally correspond with increased ingestions of these substances. Methods We identified peak Google Trends search times for social media ingestion challenges involving diphenhydramine, laundry pods, nutmeg, and cinnamon, and used data from America’s Poison Centers National Poison Data System to plot reported ingestions 3 months before and after peak searches in school-aged children. Results There were 2,169 individuals in the analysis. Diphenhydramine was the most frequently reported ingestion for misuse/abuse and suicidal purposes (n = 266 and 1,609, respectively). For all ingestions together, 45 percent (n = 979) had a moderate health effect, and 6.35 percent (n = 137) had a major health effect. Time of peak searches corresponded with increased ingestions for each substance. Discussion We found a temporal relationship between peak Google Trends searches for ingestion challenges and ingestions of that substance reported to United States poison centers. Compared to misuse/abuse ingestions, most suicidal ingestions peaked 1–2 months later, suggesting a public health opportunity for intervention. Limitations This retrospective observational study does not establish causal effect. All data are a result of self-reporting of the exposures, which may lead to a reporting bias. Google Trends is not the only search engine and likely underestimates the true incidence of social media posts. Conclusions Additional research is needed on the relationship between social media and youth mental health, particularly around “challenges” that place youths’ health at risk. There may be opportunities for intervention to decrease medical and mental health sequelae of these challenges.

Pulmonary Radiological Manifestations of Paraquat Poisoning: A Pictorial Essay.

Paraquat (1,1'-dimethyl-4,4'-dipyridylium) is a liquid herbicide, linked to both accidental and intentional ingestion, which can result in severe and frequently lethal poisoning. It has been known to cause injury to the lungs, kidneys, and liver. We retrospectively reviewed five cases over the last 4 years with a history of paraquat ingestion. The time duration between ingestion and high-resolution computed tomography (HRCT) was assessed. HRCT chest scan was variable, ranging from 4 to 18 days postexposure. The follow-up of the patients was also reviewed.

Fueling for and recovering from resistance training: The periworkout nutrition practices of competitive powerlifters

PurposeNutrient timing is a concept that emphasizes the intentional ingestion of whole or fortified foods, and dietary supplements, to adequately fuel for, and recover from, acute and chronic exercise. The nutrition strategies used by powerlifters around training sessions have not, to our knowledge, been previously investigated. This study explored the self-reported periworkout (before, during, and after) nutrition practices of competitive powerlifters, including what, why, and information source that informed practice, with comparison to current sport nutrition guidelines. MethodsActively competing male (n = 240) and female (n = 65) powerlifters completed a cross-sectional online survey of self-reported periworkout nutrition practices in the pre-, intra-, and postexercise periods, fasted training, and supplementation. Data are presented as the number (n) and percentage (%) of all powerlifters practicing a given strategy followed by a % of responses reporting various practices or beliefs within this strategy. Categorical subgroups (sex, age, and weight class; and competitive caliber) were analyzed with a chi-square test or Fisher's exact test and denoted where significant (P ≤ 0.05). ResultsMost powerlifters reported paying specific attention to nutrition practices in the pre-exercise period (n = 261; 85.6%) by ingesting more carbohydrate (CHO) rich foods (n = 234; 89.6%) for the purpose of assisting in training performance (n = 222; 85.1%). Most powerlifters reported intraexercise nutrition strategies (n = 211; 69.2%), of which most included ingesting more CHO rich foods (n = 159; 74.5%) for the purpose of feeling less hungry and/or boosting energy levels during training (n = 129; 61.1%). Most powerlifters reported paying attention to postexercise nutrition (n = 244; 80%), by ingesting more protein rich foods (n = 182; 74.6%) for the purpose of recovering better for the whole day (n = 152; 62.3%) and enhancing the benefits of training (n = 149; 61.1%). Most powerlifters did not complete training sessions in the fasted state (n = 262; 85.9%). Most powerlifters reported paying attention to supplementation before training (n = 237; 77.7%), of which preworkout formulas (n = 137; 57.8%), energy drinks (n = 101; 42.6%), creatine (n = 88; 37.1%), and caffeine pills (n = 70; 29.5%) were most reported. Supplementation was used to assist in training performance (n = 197; 83.1%) and increase wakefulness/alertness (n = 183; 77.2%). Males reported more often than females that they informed multiple elements of their nutrition practices with the information they read or watched somewhere (P = 0.002–0.012). ConclusionThe periworkout nutrition practices used by competitive powerlifters followed current sport nutrition guidelines, by using CHO sources to fuel for training and ensuring the provision of protein postexercise. Competitive powerlifters may wish to exert caution with supplementation, as there is a risk of harm or inadvertent doping.

Endoscopist experience with pediatric recurrent and intentional foreign body ingestion (RIFBI): Management considerations and future directions.

Accidental foreign body ingestion (FBI) is a common pediatric referral concern. In contrast, recurrent and intentional FBI (RIFBI) is infrequent and associated with greater endoscopic and surgical intervention in adults. Although pediatric guidelines exist for FBI, the risk and therapeutic implications of RIFBI are not addressed. An anonymous international survey on pediatric gastroenterologist experience with RIFBI was distributed. A 33-item REDCap© survey was distributed via email to pediatric gastroenterologists identified through mailing and email lists obtained from pediatric gastroenterology professional organizations. During 9-12/2021 we accrued 202 completed surveys. Respondents were from 27 countries and across the career span. Eighty percent reported experience with RIFBI; 74% reported seeing ≤ 3 patients with RIFBI within the past 24 months and 4% reported seeing ≥ 6. Of those who treated RIFBI, 38% reported an average number of annual ingestions per patient was ≥5. Frequent morbidity but not mortality was reported. Half reported adherence to FBI guidelines. Later-career endoscopists treated RIFBI more aggressively than accidental ingestion. Ninety-six percent noted that patients with RIFBI had psychiatric comorbidities. Providers at academic medical centers reported referring to behavioral health more than those in other settings. Most gastroenterologists surveyed reported encountering RFBI several times a year and in patients with psychiatric comorbidities. Greater likelihood of adverse outcomes associated with endoscopy was reported. Most reported referral to behavioral health and few had RIFBI management protocols. A broader spectrum of psychologic comorbidities in the pediatric population with RIFBI, notably depression and autism spectrum disorder, were reported.

Can we predict the risk of esophageal stricture after caustic injury?

Nonoperative management of severe caustic injuries has demonstrated its feasibility, avoiding the need for emergency esogastric resection and resulting in low mortality rates. However, leaving superficial necrosis in place could increase the risk of esophageal stricture development. Data on the risk factors of esophageal stricture secondary to caustic ingestion are scarce. The aim of our study was to identify the risk factors for esophageal strictures after caustic ingestion at admission. From February 2015 to March 2021, all consecutive patients with esophageal or gastric caustic injury score ≥ II according to the Zargar classification were retrospectively analyzed. For each patient, we collected over 50 criteria at admission to the emergency room and then selected among them 20 criteria with the best clinical relevance and limited missing data for risk factor analyses. Among the 184 patients included in this study, 37 developed esophageal strictures (cumulative rate 29.4%). All esophageal strictures occurred within 3months. In multivariate analyses, the risk factors for esophageal strictures were voluntary ingestion (cause-specific hazard ratio 5.92; 95% confidence interval 1.76-19.95, P = 0.004), Zargar's esophageal score ≥ III (cause-specific hazard ratio 14.30; 95% confidence interval 6.07-33.67, P < 0.001), and severe ear, nose, and throat lesions (cause-specific hazard ratio 2.15; 95% confidence interval 1.09-4.22, P = 0.027). Intentional ingestion, severe endoscopic grade, and severe ENT lesions were identified as risk factors for esophageal stricture following caustic ingestion. Preventive measures for this population require further evaluation.

Acute Poisoning Emergencies at Gulu University Teaching Hospitals in Northern Uganda: Prevalence, Outcomes and Clinical Challenges

Acute poisonings, including envenomation as well as toxicological emergencies stemming from accidental or intentional ingestion of poisonous substances or drug overdose, are significant worldwide causes of morbidity and mortality. The study aimed to characterise acute poisoning emergencies admitted to two major hospitals in Northern Uganda. We conducted a retrospective review of charts of all patients admitted with acute poisoning emergencies between January and December 2021, as well as a structured interview of hospital staff working in these hospitals on challenges faced while managing these emergencies. Of the total 40,653 patient admissions, 416 (1%) were due to acute poisonings. The majority were admitted to SMHL (71.4%), 43.3% were between 20 and 40 years of age, and 59.9% were males. The average length of hospital stay was 1 (0-3). The most frequent diagnoses were acute alcohol intoxications (27.2%, n=113), snake bites (26.0%, n=108), and organophosphate poisonings (21.2%, n=88). Only 29.6% (n=123) of patients received antidotes. Peak admissions were observed in February, May, and July. The majority of poisonings were intentional (61.3%), resulting in a Case Fatality Rate of 6.3%. In the qualitative findings, participants highlighted key challenges in managing these conditions, including the lack of antidotes, patients presenting late at the hospital, economic barriers, staff shortages, and limited community awareness. Acute poisoning, especially acute alcoholic intoxication, snake bites and organophosphate poisoning, are common in northern Uganda, with significant numbers dying from it. The lack of antidotes remains a problem in these hospitals. Restriction of alcohol consumption use of agricultural organophosphates, and training of healthcare workers in managing these emergencies are recommended

Potassium Iodate Retinotoxicity after an Overdose of Anti-Radiation Pills: A Case of Apocalyptic Retinopathy.

To report a case of severe retinal toxicity after an attempted suicidal overdose of anti-radiation pills containing a well-known retinal pigment epithelial toxin, potassium iodate. Clinical examination and multimodal imaging are provided from a clinic visit eleven years after the suicide attempt. The 42-year-old patient had widespread retinal atrophy in both eyes with near complete absence of the retinal pigment epithelium and severe retinal thinning. A few remaining areas of preserved photoreceptors provided her with 20/60 and 20/200 vision in her right and left eyes, respectively, with very constricted visual fields. Despite being first described over 100 years ago, few cases of iodate retinotoxicity have been reported in the published literature, and most are related to accidental or intentional ingestion of iodate salts used to iodize table salt. This unique case of iodate retinotoxicity secondary to anti-radiation tablets highlights the risks of unregulated sale of these agents marketed in the United States as essential components of nuclear apocalypse "go bags" because they have a poor margin-of-safety and no specific warnings of the risk of permanent blindness with overdosage.

Repeated foreign body ingestion as a dynamic game: A case report

In this case report, we correct the analysis of mitigating intentional foreign body ingestion offered by Sarah J. Diamond and Amnon Sonnenberg. Patients who notoriously swallow foreign objects generate significant economic costs to hospitals. In previous publications, it has been argued that hospitals might reduce the need for endoscopy by offering such patients a paid position to discourage foreign body ingestions. However, the game-theoretical analysis offered in the literature was based on a static game which did not justify the relevant equilibrium. To obtain the actual goal of keeping the patient away from foreign body ingestion, we consider a repeated game with an infinite horizon. We show that there exists a combination of strategies applied by the hospital and the patient that leads to a steady state in which the patient will be discouraged from foreign body ingestion.

Role of Sapindus emarginatus Pericarp Extract in Gut Serotonin Level and its Emetic Activity in Animal Models

Background: Emesis is a complex and distressing protective mechanism that helps to remove toxic substances from the stomach and prevent further ingestion. The emetics and cathartics are predominantly used for accidental and intentional ingestion of poisons or toxins. The availability and usage of emetics in humans are limited because of their side effects. Therefore, to treat poisoned people, we need effective medications. Sapindus emarginatus Vahl., often called soapnut, is a member of the Sapindaceae family. They have historically been used as emetic, antipruritic, laxative, antifertility, and anti-inflammatory medicines. Objective: This study aims to assess the gut serotonin level and emetic effect of Sapindus emarginatus hydroethanolic pericarp extract (HESE) by using animal models. Methods: Gravimetric analysis was used to determine the HESE's saponin content. The emetic effect of the HESE at a dose of 250, 500, 1000, and 2000 mg/kg was evaluated by copper sulfateinduced emesis in the chick model and cisplatin-induced emesis in the rat-pica model. The serotonin level in rat intestinal mucosa was measured by spectrofluorimetry. Results: HESE was estimated to contain 11.92% saponin. The extract at high doses of 1000 and 2000 mg/kg showed emetic activity evidenced by increased frequency of retching in chick, increased kaolin intake, and anorexia in the rat-pica model. The extract showed a significant increase in serotonin levels in the proximal part of the small intestine in comparison with normal animals. Conclusion: According to the results of the current investigation, which employed various animal models, the HESE demonstrated appreciable emetic activity. The extract at a high dose showed a significant emetic effect due to increased serotonin levels in the gut. The HESE was discovered to be a strong contender for the treatment of poisoned patients. More research are required to validate their adverse effects of frequent usage.

Poisoning with e-cigarette liquid (VPG Power Smoke Baze) - case report

Introduction and purpose: E-cigarettes have emerged as an alternative to traditional tobacco smoking. Toxicological studies have investigated the composition and potential toxicity of e-cigarette liquid components. While they are generally considered less harmful than combustible cigarettes, cases of poisoning associated with e-cigarette liquid ingestion or exposure have been reported.&#x0D; Brief description of the state of knowledge: Nicotine intoxication resulting from e-cigarette liquid ingestion can lead to a range of symptoms and complications, including cardiovascular effects, neurological symptoms, gastrointestinal disturbances, respiratory issues, and even death. This report presents a case of a 58-year-old woman hospitalized in the Toxicology and Cardiology Department due to poisoning with e-cigarette liquid.&#x0D; Conclusions: Accidental or intentional ingestion and/or injection of e-liquid is becoming a new emerging challenge for Emergency Medicine, mainly because of the easy accessibility of advertisements and the sales of e-cigarettes online, and the high nicotine concentration in e-liquids. It is important to report instances of e-liquid-related nicotine intoxication in order to improve the legal restrictions on the sale of e-liquid.

The use of CytoSorb in acute oral mercuric chloride poisoning at a potentially lethal dose.

The study aims to present a case of acute mercuric chloride poisoning treated successfully with continuous renal replacement therapy using the CytoSorb filter. A 21-year-old female patient after a suicide attempt by intentional ingestion of mercuric chloride, was admitted to the hospital with features of multiple organ damage for specific treatment. The performed laboratory tests confirmed high levels of mercury in the blood (1051 μg/L) and urine (22,960 μg/L). Due to acute renal failure, continuous renal replacement therapy (CRRT) CVVHD Ci-Ca was initiated; the procedure was then converted to CVVHDF Ci-Ca with ultrafiltration to optimise therapy, and CytoSorb was added to the artificial kidney system on day 3. Specific antidote therapy (DMPS) was administered concurrently. The ongoing treatment resulted in a reduction in subjective complaints, a decrease in blood mercury levels to 580 μg/L, and an improvement in parenchymal organ function. In the event of poisoning with inorganic mercury compounds (mercuric chloride), continuous renal replacement therapy using the CytoSorb filter as an extracorporeal blood purification method may be considered.

Epidemiologic features and outcomes associated with caustic ingestion among adults admitted in intensive care unit from 2013 to 2019: a French national observational study.

Caustic ingestion is a potential life-threatening condition associated with high morbidity and mortality. Data on patients admitted to Intensive Care Unit (ICU) for severe caustic ingestion are lacking. We aimed to describing epidemiological features and outcomes of patients admitted to ICU for caustic ingestion in France. In a retrospective, observational, and multicenter study, data from the national French Programme de Médicalisation des Systèmes d'Informations (PMSI) database were analysed from 2013 to 2019. In-hospital mortality rate (primary outcome) and in-ICU complications (secondary outcomes) were reported and analysed. 569 patients (289 males (50.8%), with median age of 49years [interquartile (26-62)] were admitted in 65 French ICU for severe caustic ingestion. Five hundred and thirteen patients (90%) were admitted for intentional caustic ingestion. The median length of stay in ICU was 14.0 [4.0-31.0] days. In-hospital mortality occurred in 56 patients (9.8%). In multivariate analysis, age and simplified acute physiology score II were associated with in-hospital mortality age of 40-59years [OR = 15.3 (2.0-115.3)], age of 60-79years [OR = 23.6 (3.1-182.5)], and age > 80years [OR = 37.0 (4.2-328.6)] and SAPS 2 score [OR = 1.0018 (1.003-1.033), p < 0.001]. During ICU stay, 423 complications (74%) were reported in 505 patients (89%). Infectious (244 (42.9%)), respiratory (207 (36.4%)), surgical 62 (10.9%), haemorrhagic (64 (11.2%)) and thrombo-embolic and (35 (6.2%)) complications were the most frequently reported during ICU stay. ICU admission for severe caustic ingestion is associated with 9.8% mortality and 74% complications. Age > 40years and SAPS 2 score were independently associated with mortality.

Management of foreign body ingestion in adults: Time to STOP and rethink endoscopy

Abstract Background and study aims Foreign body ingestion is a common cause for Emergency Department presentation. In adults, foreign body ingestion is more common in patients with underlying psychiatric comorbidity, the elderly, alcohol intoxication, and in prisoners. This study reviewed the management of patients presenting to a tertiary hospital with foreign body ingestion. Patients and methods A retrospective review of patients presenting with foreign body ingestion to a tertiary hospital in Melbourne, Victoria, was undertaken from January 2017 to December 2021. Data collected included patient demographics, type of foreign body, length of stay, imaging modalities, management strategies, and complications. High-risk ingestion was defined as sharp objects, length &gt;5 cm, diameter &gt;2.5 cm, button battery and/or magnet ingestion or esophageal as per international guidelines. Results A total of 157 presentations by 63 patients with foreign body ingestion occurred between 2017 and 2021 (50% male; median age 30 years). Of the patients, 56% had underlying psychiatric comorbidities. The majority of presentations occurred in prisoners (65%). The most commonly ingested objects were batteries (23%), alleged drug-containing balloons (17%), razor blades (16%), and miscellaneous (40%). High-risk ingestion occurred in approximately two-thirds of presentations. Conservative management was the most common approach in 55% of patients. Complications, defined as perforation, bowel obstruction or fistula formation, did not occur in this cohort despite more than half presenting with high-risk ingestions. Thirty-day re-presentation rates were high (31%) and that was most common in patients with intentional ingestion, underlying mental health disorders, and a documented history of self-harm. Conclusions Conservative management for patients presenting with recurrent high-risk foreign body ingestion was safe in appropriately selected cases. Re-presentation is common and poses significant challenges for health care providers.

Unusual Cause of Acute Abdomen by Foreign Body: Intentional Spoon Ingestion

Introduction There is a wide variety of uncommon and unusual gastrointestinal causes of acute abdominal pain in which foreign bodies are included. Case report 30-year-old patient with severe chest and epigastric pain, previous vomiting and loss of consciousness. A thoracic X-ray study revealed a 15-cm-long metallic object located in the esophagus and two more apparently located in the stomach. The patient underwent an emergent laparotomy, a transverse incision was made to the stomach (gastrotomy) at the perforation site, removing 4 metallic soup spoons; then, it was closed primarily. Conclusions Intentional ingestion of foreign large metallic bodies is infrequent but not uncommon. Diagnosis should be suspected primarily in patients with history of psychiatric disorders or substance use. Clinical manifestations may vary according to the site of the gastrointestinal tract perforation. A surgical approach may be the best option due to a large size of the objects, time of clinical presentation and risk of subsequent complications.

Sanitary inspection and microbial health risks associated with enteric bacteria in groundwater sources in Ilara-Mokin and Ibule-Soro, Nigeria.

This study set out to determine the sanitary risk scores and microbial health risks associated with wells and boreholes in Ilara-Mokin and Ibule-Soro, Nigeria. Water samples (n = 96) were collected over a period of five months to determine the levels of enteric bacteria and to perform a Quantitative Microbial Risk Assessment (QMRA) of drinking water quality. Sanitary risk scores revealed `medium' and `low' overall risks for the wells and boreholes, respectively. Three risk factors (faulty fence; small apron; pollution sources) exhibited high significant (p < 0.01) association with the presence of E. coli and thermotolerant coliforms in water samples from the wells. E. coli and Salmonella ranged from 1.82 to 2.28 and 2.15 to 2.63 log10 CFU/100 ml respectively in water from the wells, but were below detection limit in water from the boreholes. Shigella and Campylobacter were detected in all water samples. Estimated risks of infection associated with Shigella (2.1 × 10-2 to 2.3 × 10-1) were higher than those of Campylobacter (6.7 × 10-2 to 1.9 × 10-1) and Salmonella (1.9×10-3 to 5.6×10-3). Adaption of water safety plans may be advantageous in these settings, since intentional ingestion of water from the wells and boreholes may pose potential risks of diarrheal illness to humans.

Abstract 18979: Calm Before the Storm: Exploring the Risk of Torsades De Pointes With Dexmedetomidine Administration

Introduction: Corrected QT interval (QTc) prolongation is the known side effect of multiple medications especially in antipsychotic and antiarrhythmic family. Patients with either inherited or secondary prolonged QTc should be monitored closely as they can develop life threatening complications like Torsades de-pointes and ventricular fibrillation. Here we present a case of cardiac arrest secondary to dexmedetomidine. Case: A 49-year-old female with history of bipolar disorder was admitted to intensive unit for seizure after intentional ingestion of uncounted amount of diphenhydramine pills. Patient was intubated for airway protection and started on propofol. Her vitals at the time of admission included the pulse rate of 76, blood pressure of 102/49 mmHg. Her urine drug screen was positive for TCA and cannabinoids. Her ECG at the time of admission was significant for prolonged QTC of 600msec that improved to 460msec in the consecutive ECGs after administration of total of 4mg intravenous magnesium. Continuous EEG was negative for seizure and she was weaned off sedation. After awakening, she became agitated, after pushes of benzodiazepines, was eventually started on dexmedetomidine. Twenty minutes after starting low dose dexmedetomidine, patient was noted to be in cardiac arrest. Reviewing telemetry prior to event, revealed the R on T phenomenon and Torsades de pointes that lasted for few seconds with progression into ventricular fibrillation. Discussion: Currently dexmedetomidine is labeled with a low to possible risk of Torsade de pointes and QTC prolongation. Dexmedetomidine induced Torsade de pointes might be explained by bradycardia in patients which causes further prolongation of QT interval. Studies have shown that continuous IV infusion of dexmedetomidine at rate of 0.3 mcg/kg/hour can worsen QTC prolongation. Conclusions: In this case we present a case of VFib arrest secondary to Torsade after twenty minutes of infusion of dexmedetomidine without any sign of bradycardia prior to the event. This carries a significant importance as it shows this drug carries a potential risk of QTc prolongation similar to previous studies. Whether this side effect is dose dependent or not requires further investigation.

An adolescent female with intentional ingestion of a large amount of metformin requiring extracorporeal membrane oxygenation and continuous renal replacement therapy

Acute overdose of metformin can show potentially fatal lactic acidosis. Management should be directed towards close monitoring of renal function and hemodynamics. Patients may require dialysis or extracorporeal membrane oxygenation in cases of hemodynamic instability. This case presents an adolescent with massive metformin ingestion estimated at 100 g leading to metformin-associated lactic acidosis and subsequent respiratory failure, cardiovascular collapse, and acute kidney injury. The complications were successfully managed with venoarterial extracorporeal membrane oxygenation, continuous renal replacement therapy, and mechanical ventilation.

Caustic Ingestions: Feel the burn

A 56-year-old male with a past medical history of depression presented with intentional caustic ingestion. This resulted in lactic acidosis, intubation for impending airway compromise, and ultimately to gastrectomy due to the extent of the gastric injury. Caustic ingestions cause either coagulative (acidic substance) or liquefactive (alkaline substance) necrosis. Management and treatment include observation, labs, imaging, endoscopy, and may require more urgent interventions such as intubation and vasopressors. Consider consulting the local poison control center early and GI, ENT or surgery depending on severity and types of injuries. Endoscopy is useful for prognosis, but early CT imaging may also be useful and more readily available.

DELIBERATE INGESTION OF FOREIGN BODIES: A SYSTEMATIC REVIEW

ABSTRACT: Introduction and objective: Accidents with foreign bodies of all types have been described in most parts of the body. The most common places are the natural head and neck cavities. The objective of this study is to know the situation of deliberate ingestion of foreign bodies. Method: We conducted a search in PubMed, Cochrane, Scopus, Wos and Scielo, selecting those articles in which the existence of intentional ingestion of foreign bodies was mentioned. Two ways of research were used using the terms “deliberate” and “intentional” AND “foreign body” in the maximum time suggested by the PubMed platform. Results: With the word “deliberate”, 14 articles were found from 1990 to 2021 and with the word “intentional”, 25 articles were found in the period from 1984 to 2021. All other research sources had zero articles. The sum of these articles was 39. A screening was performed and only clinical cases were selected and we obtained 12 articles using the word “deliberate” and 9 using the word “intentional”. Of these, 1 article was excluded because it is not in the selected language (English, Portuguese or Spanish), leaving a sample of 11 articles. Of these, 2 were excluded because they did not have an abstract, leaving 9 articles and all of them were excluded because they did not comply with the inclusion criteria (in non-prisoner individuals and without mental disorders). Conclusions: Accidents with foreign bodies are common in ENT clinical practice, however, deliberated ingestion is less frequent. The deliberate ingestion of foreign bodies appears in groups at risk, such as prisoners and the mentally ill with the aim of drawing attention or getting out of prisons in an attempt to escape.