Question Of The Day

What percentage of patients develop symptoms of serotonin toxicity within 1 and 6 hours of a precipitating event? In a review of 41 case reports of serotonin toxicity, 30% of patients developed symptoms of serotonin toxicity within 1 hour and 60% developed symptoms within 6…

In Europe, silibinin is the drug of choice for amatoxin mushroom poisoning, but pharmaceutical grade silibinin is unavailable in North America. What widely available immunosuppressive drug (used to prevent organ transplant rejection) may treat or prevent hepatotoxicity caused by amatoxins?   Cyclosporine. Cyclosporine is a…

Ingestion of naphthalene mothballs can cause what effects? Methemoglobinemia and hemolytic anemia. Clinical effects can include headache, altered mental status, vomiting, diarrhea, abdominal pain, fever, tachycardia, and hypotension. The acute intravascular hemolysis can lead to hematuria, leukocytosis with neutrophil predominance, jaundice, hepatic and renal dysfunction….

Acute ingestion of mothballs containing what toxicant can cause the abrupt onset of generalized seizures? Camphor. Seizures are a known complication of camphor toxicity and are reported after ingestion, inhalation, and dermal exposure Khine H, et al. A cluster of children with seizures caused by…

Chronic isoniazid toxicity can cause peripheral neuropathy that is preventable with concurrent administration of pyridoxine. What manifestation of chronic toxicity is not prevented by concurrent pyridoxine administration? Hepatotoxicity. Some studies have shown a mortality benefit in using corticosteroids and N-acetylcysteine early in the course of…

What part of the cell contains the majority of enzymes performing phase I and phase II reactions? Drug metabolism occurs primarily in the endoplasmic reticula of cells through these two general classes of enzymatic processes. Sandritter TL, et al. Nelson Textbook of Pediatrics. 2020. Chapter…

What compound, found in licorice, can cause electrolyte abnormalities, edema and elevated blood pressure after excessive intake? Glycyrrhetic acid is hydrolyzed in the intestine to the pharmacologically active compound glycyrrhetic acid, which inhibits the enzyme 11-ß-hydroxysteroid dehydrogenase enzyme type 2 with a resultant cortisol-induced mineralocorticoid…

What licorice substitute has been manufactured  avoid the potential side effects of excess licorice intake? De-glycyrrhizinated licorice (DGL) is manufactured by removing the active compound glycyrrhizin. It is available in capsules, lozenges, wafers and liquid. Omar HR, Komarova I, El-Ghonemi M, et al. Licorice abuse:…

Licorice, due to its aldosterone-like action, can cause what clinical effects when taken in excess? Hypokalemia with subsequent hypokalemic myopathy manifesting as flaccid paralysis and QT prolongation with possible torsade de pointes. Other clinical findings can include edema and increased blood pressure. Table 3 in…

In 1981, in Spain, the ingestion of an oil fraudulently sold as olive oil caused an outbreak of a previously unrecorded condition, later known as toxic oil syndrome (TOS). Among survivors, there is a high prevalence what chronic conditions? Scleroderma (9-13%) and neuromuscular changes. Neuromuscular…