Question of the Day – Monday, October 24, 2022
In the out-of-hospital setting, larger intramuscular doses of naloxone may be used because the IM route is more rapid and reliable. What is the frequency of severe agitation following administration of a single 1.6 mg IM naloxone dose in patients with opioid toxicity in the…
Question of the Day – Friday, October 21, 2022
In a recent multicenter prospective study of children who presented to the emergency department with opioid intoxication, what characteristics predicted severe outcome (ICU admission or in-hospital death)? Fentanyl exposure and age > 10 years. Cohen N, Mathew M, Davis A, et al. Predictors of severe…
Question of the Day – Thursday, October 20, 2022
What is the most common laboratory interference in patients with thiocyanate toxicity? Pseudohyperchloremia, especially as measured by ion selective electrodes. In the cited reference, chloride values were repeatedly elevated (113–148 mmol/L) or not reported due to instrument error flags, including “above measurement range” (reported in…
Question of the Day – Wednesday, October 19, 2022
At what time of year do gyromitrin containing mushrooms typically grow? Spring. Mushrooms are commonly found under conifer trees. Goldfrank LR. Mushrooms. In: Nelson LS, Howland M, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS. eds. Goldfrank’s Toxicologic Emergencies, 11e. McGraw Hill; 2019. Accessed August…
Question of the Day – Tuesday, October 18, 2022
What is the mechanism of toxicity of gyromitrin? Gyromitrin undergoes a series of hydrolysis reactions to form monomethylhydrazine which prevents the activation of pyridoxine to pyridoxal 5’ phosphate, a required cofactor for glutamic acid conversion to GABA. Symptoms typically consist of a variety of neurologic…
Question of the Day – Monday, October 17, 2022
Which Gyromitra species of mushrooms contain gyromitrin? Gyromitra esculenta, Gyromitra ambigua, and Gyromitra infula. Goldfrank LR. Mushrooms. In: Nelson LS, Howland M, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS. eds. Goldfrank’s Toxicologic Emergencies, 11e. McGraw Hill; 2019. Accessed August 29, 2022. https://accessemergencymedicine.mhmedical.com/content.aspx?bookid=2569§ionid=210276854
Question of the Day – Friday, October 14, 2022
What is the treatment for chronic toxicity from nitrous oxide abuse? High dose intramuscular vitamin B12 supplementation. A typical regimen is 1000 mcg IM daily for 14 days, followed by 1000 mcg IM weekly for four weeks, and then extended to monthly. Cyanocobalamin has generally…
Question of the Day – Thursday, October 13, 2022
Patients with subacute combined spinal cord degeneration (SCD) from chronic nitrous oxide abuse will often have elevated levels of methylmalonic acid and homocysteine. Which is more specific for B12 deficiency? MMA elevation is more specific for B12 deficiency because homocysteine may be elevated with folate…
Question of the Day – Wednesday, October 12, 2022
At what time of year do cyclopeptide containing mushrooms typically grow? June-November. Mushrooms can be found at the base of deciduous trees, such as oak trees. Moor-Smith M. The world’s most poisonous mushroom, Amanita phalloides, is growing in BC. BCMJ 2019;61(1): 20-24.
Question of the Day – Tuesday, October 11, 2022
What is the proposed mechanism of action for polymixin B in cyclopeptide mushroom poisoning? Binding to RNA polymerase II, preventing a-Amanitin binding and inhibition of protein synthesis. The suggested dose of 0.75 mg/kg (7,500 units/kg) is lower than typical doses used for antibiosis and is…