Question of the Day – Tuesday, September 27, 2022
What is the proposed mechanism of action for activated charcoal in cyclopeptide mushroom poisoning? Prevention of absorption and interruption of a-Amanitin enterohepatic recirculation. Ye Y. Management of Amanita phalloides poisoning: A literature review and update. J Crit Care. 2018;46:17-22. doi: 10.1016/j.jcrc.2018.03.028.
Question of the Day – Monday, September 26, 2022
What is the reported lethal dose of a-Amanitin? 0.1 mg/kg. A single mushroom contains a potentially lethal amount of the toxin. 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….
Question of the Day – Friday, September 23, 2022
How does a-Amanitin enter hepatocytes? Sodium taurocholate cotransporter polypeptide (NTCP) and organic anion-transporter polypeptide 1B3 (OATP1B3). Both are bile acid transporters located in the sinusoidal membrane of hepatocytes. Goldfrank LR. Mushrooms. In: Nelson LS, Howland M, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS. eds….
Question of the Day – Thursday, September 22, 2022
What is the mechanism of toxicity of a-Amanitin? Prevents protein synthesis in hepatocytes via RNA polymerase II inhibition. 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,…
Question of the Day – Wednesday, September 21, 2022
What is the maximum safe dosage of lidocaine for tumescent lidocaine anesthesia for liposuction? Tumescent lidocaine anesthesia consists of subcutaneous injection of relatively large volumes (up to 4 L or more) of dilute lidocaine (≤1 g/L) and epinephrine (≤1 mg/L). Although some sources allow up…
Question of the Day – Tuesday, September 20, 2022
The current tumescent liposuction technique applies a subcutaneous injection of large volumes of diluted (0.05–0.10%) lidocaine as a wetting solution. Why is this technique often believed to rarely cause local anesthetic systemic toxicity (LAST)? According to the cited reference, practitioners often believe that the procedure…
Question of the Day – Monday, September 19, 2022
A patient is receiving this immune therapy to treat multiple myeloma. They present with a neurocognitive and hypokinetic movement disorder. What is the agent and what is the proposed mechanism? Ciltacabtagene autoleucel (cilta-cel). Ciltacabtagene autoleucel and idecabtagene vicleucel are B-cell maturation antigen (BCMA) targeted CAR-T…
Question of the Day – Friday, September 16, 2022
In a recent report of 30 patients with levamisol induced vasculitis, what laboratory abnormalities were noted on CBC? In a report of 30 patients with levamisole cocaine induced vasculitis, anemia was found in 73% of patients, lymphopenia in 70% and leukopenia in 28%. Munoz-Vahos CH…
Question of the Day – Thursday, September 15, 2022
What does Skin biopsy of patients with levamisole induced vasculitis show? In a report of 30 patients with levamisole cocaine induced vasculitis, skin biopsy was performed in 21 patients. Leukocytoclastic vasculitis was present in 24% followed by pseudovasculitis in 19% and thrombotic vasculopathy with leukocytclastic…
Question of the Day – Wednesday, September 14, 2022
Nitrous oxide irreversibly oxidizes the central cobalt moiety of B12 rendering it nonfunctional. What does this result in? Elevations in homocysteine and methylmalonic acid. Temple C et al. Nitrous oxide abuse induced subacute combined degeneration despite patient initiated B12 supplementation. Clin Tox. 2021; 872-875. doi/full/10.1080/15563650.2022.2046772