Question Of The Day

What is the most common cause of idiosyncratic drug induced liver injury in the US Drug Induced Liver Injury Network registry?   Amoxicillin-Clavulanate deLemos AS, Ghabril M, Rockey DC, et al. Amoxicillin-Clavulanate-Induced Liver Injury. Dig Dis Sci. 2016;61(8):2406-2416. doi:10.1007/s10620-016-4121-6

Available as an over-the-counter diuretic, what product can result in the following urine discoloration?   Magnesium salicylate, available as “diurex” Viswanathan, Stalin. “Urine Bag as a Modern Day Matula.” ISRN Nephrology, vol. 2013, 2013, pp. 1–8., doi:10.5402/2013/215690.

Name 3 xenobiotics associated with black urine.   According to the cited referecene, the following xenobiotics have been associated with black urine: Alpha-methyldopa, cresol, iron, cascara, senna, L-dopa, methocarbamol, metronidazole, nitrofurantoin, sorbitol. Aycock RD, Kass DA. Abnormal urine color. South Med J. 2012;105(1):43-47. doi:10.1097/SMJ.0b013e31823c413e

What factors were associated with repeated emergency department encounters for opioid usage?   A retrospective study of four Indiana hospital systems from 2012-2017 evaluated patients with opioid-related ED visits. Factors associated with higher odds of repeat opioid-related encounters included number of previous opioid-related ED encounters,…

What abnormalities were identified on thromboelastography (TEG) for patients with copperhead (Agkistrodon contortrix) envenomation?   None. A retrospective study of 16 patients with copperhead envenomation reported no abnormalities in coagulation parameters identified on laboratory evaluation. There were four patients that also received TEG, all with…

What was the most common clinical outcome for pediatric exploratory ingestions of lithium reported to US poison centers?   No effect was reported in 88% of 1863 single-substance exposures in children < 6 years of age. Moderate or major effects were reported in approximately 2%…

What was the primary symptom reported in patients with tianeptine intoxication?   Lethargy. A recent retrospective study of tianeptine exposures reported to a statewide poison center identified 17 cases of intoxication over a 2.5-year period. Lethargy was most commonly reported in 65% of patients. No…

What thromboelastogram (TEG) value improved approximately 2-5 hours prior to recovery of fibrinogen concentrations after antivenom administration in a case report of severe Crotalus adamanteus (Eastern Diamondback) envenomation?   Alpha angle which measures speed of fibrin build-up and cross-linking. The authors suggested potential benefit in…

What enzyme is used in the production of Crotalidae Immune Fab’2 (Equine) antivenom?   Pepsin removes the Fc portion of the antibody leaving two fragment antigen-binding (Fab) portions connected by disulfide bonds. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a16596a5-e87e-40c2-8e34-cea5839849c3

What enzyme is used in the production of Crotalidae Polyvalent Immune Fab (Ovine) antivenom?   Papain cleaves antibodies leaving solely the fragment antigen-binding (Fab) segment. Caution is advised in patients with documented allergies to papain, chymopapain, or bromelain (from pineapple) due to the risk of…