Question Of The Day

What is Tyrolean Infantile Cirrhosis? Tyrolean Infantile Cirrhosis is a non-Wilsons hepatic copper toxicosis. According to the cited reference 138 infants and young children died between 1900 and 1974 from this combination of genetic predisposition and high dietary copper intake from cooking utensiles. Muller T,…

What were the “T’s and Blues”? “T’s and Blues” described the IV use of pentazocine (a mu and kappa opioid receptor agonist; “T” came from the tradename Talwin) and tripelennamine (an antihistamine with a light blue color). Users crushed the two oral medications in order…

In a retrospective study from two databases in Australia, the authors described oral potassium overdoses greater than or equal to six grams, over twelve year period. All 12 ingestions were 600 mg sustained-release tablets of potassium chloride. What percentage of patients had severe hyperkalemia with…

Clove oil results in toxicity in children in very small doses. What is the toxin and what is the proposed antidote? Less than 5 mL of clove oil can result in toxicity in pediatric patients. The mechanism of toxicity is incompletely understood but animal models…

A recent study analyzed the currently accepted dosing scheme of fomepizole in CRRT. What is the newly proposed dosing interval? This small study showed that dosing fomepizole every 8 hours during CRRT was sufficient in maintaining the minimum required plasma concentration. Lao YE, Vartdal T,…

In a meta-analysis examining the risk of adverse events associated with the use of flumazenil in patients with impaired consciousness due to a known or suspected benzodiazepine overdose, what was the most common adverse event? Aggressiveness defined as agitation, screaming or restlessness Penninga EI, Graudal…

According to a recent study, what characteristics are associated with diphenhydramine toxicity that result is more severe outcomes? Acidemia, prolonged QRS and elevated anion gap. Hughes AR, Lin A, Hendrickson RG; Toxicology Investigator’s Consortium (ToxIC). Clinical and patient characteristics associated with severe outcome in diphenhydramine…

Abacavir hypersensitivity is life threatening and occurs in 5-8% of patients. What gene is implicated? HLA-B*57:01. It is believed that short peptide fragments of abacavir form a peptide HLA-complex with HLA-B*57:01 which activates CD8+ T cells which then induce a hypersenstivity response. The CPIC &…

What is the clinical significance of the drug interaction between valproate and carbapenem antibiotics? Carbapenem antibiotics decrease serum valproate concentrations within 1-3 days after treatment initiation of the carbapenem. In a recent meta analysis, the mean reduction of valproate concentrations was 43.98 mg/L. Seizure frequency…

What was the relative decrease of Torsades de Pointes with a single dose of activated charcoal given within 1 hour of greater than 600 mg of citalopram overdose? In this in-vivo study, modeling predicted that charcoal given within 60 minutes resulted in a relative decrease…