Question Of The Day

What was the incidence of hepatotoxicity in patients with “massive” acetaminophen overdose treated with standard dose IV N-acetylcysteine? 24%. A retrospective study of acetaminophen exposures reported to a regional poison center identified 104 cases of massive overdose (4-hour level > 300 mcg/mL). Only 4% of…

What common household cooking product can lead to significant ethanol intoxication which may require hospitalization when ingested? Pure vanilla extract. According to the FDA standard, natural vanilla extract must contain a minimum of 35% ethanol by volume. Ingestion of 1.3mL/kg of pure vanilla extract in…

A 7-year-old boy presented to the hematology–oncology clinic for treatment of severe aplastic anemia. What drug lead to gum hypertrophy shown in this photo? Cyclosporine. Several months after cyclosporine was started gum hypertrophy developed. When cyclosporine was weaned off, the adverse effect resolved. Two years…

This drug recently was shown to cause a mean weight loss of 14.9% from baseline over a 68 week time period. Semaglutide 2.4 mg once weekly resulted in a mean weight loss of 14.9% from baseline with lifestyle interventions in a recent study over a…

In a retrospective study comparing those treated with cyproheptadine and without for serotonin syndrome in California over eleven years, patients who were intubated and sedated were more likely to receive cyproheptadine, but was there a difference in serious outcome or hospitalization? No. The odds ratio…

This antibiotic is a potent inhibitor of organic anion transporting polypeptide B3 (OAPTB3) transporter of amatoxin into human hepatocytes. Rifampicin. Both rifampicin and high dose penicillin G have been shown in in vitro studies to be inhibitors of OAPTB3 transporter and in one study, rifampicin…

Which prescription medication is metabolized to diethyldithiocarbamate (DDC) and is used off-label as a nickel chelator? Disulfiram. Disulfiram is a prescription drug that is metabolized by cleaving the disulfide bond to yield two molecules of DDC (a nickel chelator used outside of the USA). Disulfiram…

What weight loss supplement, labelled as extremely dangerous and not fit for human consumption in 1938, continues to be used today and has similar toxicological mechanism to salicylate toxicity? Dinitrophenol (DNP) Dinitrophenol, like aspirin, decouples oxidative phosphorylation. The energy that no longer can be made…

A 38 yo female with large B cell lymphoma who received a CAR-T cell infusion 7 days ago presenting with a temperature of 39°C, RR 26 rpm, BP 70/40, SaO2 84% on room air, that did not respond to 6 L of supplemental oxygen by…

What structural property of alprazolam has been cited in discussion of its differntial pharmacological effects when compared with other benzodiazepines? Alprazolam is a triazolobenzodiazepine with a benzodiazepine receptor affinity roughly 4 times that of diazepam.  It is an intermediate acting benzodiazepine with an elimination half life of 12…