Question Of The Day

In a recent retrospective analysis of seizures due to venlafaxine overdose, how common did patients with venlafaxine overdose have a seizure? The California Poison Center System (CPCS) retrospectively reviewed 10 years of venlafaxine exposures. During the time frame of the study, 953 patients who ingested…

In a recent porcine model of carbon monoxide poisoning, the lactate to pyruvate ratio was elevated compared to the control group. What do the authors hypothesize this is due to? The lactate/pyruvate ratio (LPR) is often an indication of dysfunction within the electron transport chain…

This laboratory test appears to be prognostic of mortality in calcium channel blocker poisoning. Serum lactate. In a recent retrospective review of 177 patients, presented at EAPCCT 2020, initial blood lactate concentration accurately predicted CCB-poisoning related mortality. In this study, initial blood glucose concentrations was…

What agents may be helpful in the treatment of methotrexate mediated neurotoxicity. Dextromethorphan and methylxanthines. 1. Fernandez-Fernandex FJ et al. Dextromethorphan and methylxanthines might be useful in the treatment of methotrexate induced neurotoxicity. Pediatric Emerg Care 2017; 33(5): 380. 2. Drachtman RA et al. Dextromethorphan…

What are the proposed mechanisms for methotrexate mediated neurotoxicity? Chronic folate depletion; homocysteine excess through folate dependent methylation and alterations of biopterin and adenosine metabolism resulting in decreased neurotransmitter synthesis. 1. Subrahmanian KN et al. Evaluation and Management of Acute Onset Hemiparesis in an Adolescent…

The street term “tranq” refers to what? In a recent report, there is increasing presence of xylazine in heroin and/or fentanyl deaths in Philadelphia, Pennsylvania. In Philadelphia, xylazine is referred to as “tranq” on the street and “tranq dope” refers to heroin and fentanyl cut…

During a chemotherapy treatment, a patient inadvertently received a 10 fold dosing error of IV methotrexate. Glucarpidase was given shortly after the dosing error was identified. 48 hours later, the serum methotrexate concentration was still markedly elevated. What is the likely culprit? False elevation of…

A patient presents with nausea, vomiting, flushing and altered mental status after participating in a cleanse the day prior. You note this on her ankle. What is the exposure? Kambo. Kambo or sapo is the dried skin scrapings from the giant leaf frog (Phyllomedusa bicolor)….

What can be used as a predictor for mortality in patients poisoned by cardiotoxic drugs? ECG and Troponin while CK-MB was not predictive. Hilal, M. A., Mahmoud, S. E., Shokry, M. M., & Said, A. M. (2020). Predictive Role of Cardiac Troponin I, Creatine Kinase-Mb…

What preceding signs or symptoms are strongly associated with hemolysis in patients’ envenomated by Loxosceles reclusa? One study found that the odds ratio for hemolysis was highest for malaise (OR 40.7) and myalgia (OR 10.2). Others included exanthema (OR 9.0), fever/ chills (OR 8.5), nausea…