Skip to main content

Poisoning and Toxicity: The New Age

  • Chapter
  • First Online:
Adult Critical Care Medicine
  • 2126 Accesses

Abstract

This case serves to help navigate providers through the steps of managing the critically ill, hypotensive, bradycardic toxicologic patient.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Stanek EJ, Nelson CE, DeNofrio D. Amlodipine overdose. Ann Pharmacother. 1997;31(7–8):853–6. [PubMed].

    Article  CAS  Google Scholar 

  2. Craig CR, Stitzel RE. Modern pharmacology with clinical applications. 6th ed; Lippincott Williams & Wilkins, Philideplphia: 2004. p. 182–4.

    Google Scholar 

  3. Wang DW, Mistry AM, Kahlig KM, Kearney JA, Xiang J, George AL Jr. Propranolol blocks cardiac and neuronal voltage-gated sodium channels. Front Pharmacol. 2010;1:144.

    Article  CAS  Google Scholar 

  4. MacNeil DJ. The side effect profile of class III antiarrhythmic drugs; focus on d,l-sotalol. Am J Cardiol. 1997;80:90G–8G.

    Article  CAS  Google Scholar 

  5. Mani BK, Osborne-Lawrence S, Vijayaraghavan P, Hepler C, Zigman JM. β1-Adrenergic receptor deficiency in ghrelin-expressing cells causes hypoglycemia in susceptible individuals. J Clin Investig. 2016;126:3467–78. https://doi.org/10.1172/JCI86270.

    Article  PubMed  Google Scholar 

  6. Smith TW, Antman EM, Friedman PL, et al. Digitalis glycosides: mechanisms and manifestations of toxicity. Part I. Prog Cardiovasc Dis. 1984;26:413.

    Article  CAS  Google Scholar 

  7. Lawrenson JG, Kelly C, Lawrenson AL, Birch J. Acquired colour vision deficiency in patients receiving digoxin maintenance therapy. Br J Ophthalmol. 2002;86:1259–61.

    Article  CAS  Google Scholar 

  8. Manini AF, Nelson LS, Hoffman RS. Prognostic utility of serum potassium in chronic digoxin toxicity: a case-control study. Am J Cardiovasc Drugs. 2011;11:173–8.

    Article  CAS  Google Scholar 

  9. DigiFab [product monograph]. Ottawa: Canadian Pharmacists Association; Available: www.e-cps.ca.

  10. McMillin GA, Owen WE, Lambert TL, De BK, Frank EL, Bach PR, et al. Comparable effects of DIGIBIND and DigiFab in thirteen digoxin immunoassays. Clin Chem. 2002;48(9):1580–4. PubMed PMID: 12194938.

    CAS  PubMed  Google Scholar 

  11. Kearney TE. Digoxin-specific antibodies. In: Poisoning & drug overdose. 7th ed; BTG, a UK pharmaceutical company. 2017.

    Google Scholar 

  12. Bamshad MJ, Wasserman GS. Pediatric clonidine intoxications. Vet Hum Toxicol. 1990;32:220–3.

    CAS  PubMed  Google Scholar 

  13. Seger D. Clonidine toxicity revisited. Clin Toxicol. 2002;40:145–55.

    CAS  Google Scholar 

  14. Alinejad S, Kazemi T, Zamani N, Hoffman RS, Mehrpour O. A systematic review of the cardiotoxicity of methadone. EXCLI J. 2015;14:577–600.

    Google Scholar 

  15. Seyler DE, Borowitz JL, Maickel RP. Calcium channel blockade by certain opioids. Fundam Appl Toxicol. 1983;3:536–42.

    Article  CAS  Google Scholar 

  16. Mintzer MZ, Griffiths RR. Flumazenil-precipitated withdrawal in healthy volunteers following repeated diazepam exposure. Psychopharmacology. 2005;178:259–67.

    Article  CAS  Google Scholar 

  17. Roberts T, Thompson J. Illegal substances in anaesthetic and intensive care practices. Contin Educ Anaesth Crit Care Pain Adv Access. 2012;16(3):226–229.

    Google Scholar 

  18. Waseem M, Perry C, Bomann S. Cholinergic crisis after rodenticide poisoning. West J Emerg Med. 2010;11(5):524–7.

    PubMed  PubMed Central  Google Scholar 

  19. Vohra R. Organophosphorus and carbamate insecticides. In: Poisoning & drug overdose. 7th ed;Lange, New York: 2017.

    Google Scholar 

  20. Ito S, Nakazato Y, Ohga A. Further evidence for the involvement of Na+ channels in the release of adrenal catecholamine: the effect of scorpion venom and grayanotoxin I. Br J Pharmacol. 1981;72(1):61–7.

    Article  CAS  Google Scholar 

  21. Chan TYK. Aconite poisoning. Clin Toxicol. 2009;47:279–85. https://doi.org/10.1080/15563650902904407.

    Article  CAS  Google Scholar 

  22. Lung D. Venlafaxine pharmacobezoar causing intestinal ischemia requiring emergent hemicolectomy. J Med Toxicol. 2011;7:232–5.

    Article  Google Scholar 

  23. Erickson CP, Olson KR. Case files of the medical toxicology fellowship of the California poison control system-San Francisco: calcium plus digoxin-more taboo than toxic? J Med Toxicol. 2008;4(1):33–9.

    Article  CAS  Google Scholar 

  24. Bailey B. Glucagon in beta-blocker and calcium channel blocker overdoses: a systematic review. J Toxicol Clin Toxicol. 2003;41(5):595–602. Review. PubMed PMID: 14514004.

    Article  CAS  Google Scholar 

  25. Kerns W II. Management of beta-adrenergic blocker and calcium channel antagonist toxicity. Emerg Med Clin North Am. 2007;25(2):309–31.

    Article  Google Scholar 

  26. Kline JA, Raymond RM, Leonova ED, Williams TC, Watts JA. Insulin improves heart function and metabolism during non-ischemic cardiogenic shock in awake canines. Cardiovasc Res. 1997;34:289–98. https://doi.org/10.1016/S0008-6363(97)00022-9.

    Article  CAS  PubMed  Google Scholar 

  27. Das UN. Insulin: an endogenous cardioprotector. Curr Opin Crit Care. 2003;9(5):375–83.

    Article  Google Scholar 

  28. Yuan TH, Kerns WP, Tomaszewski CA, Ford MD, Kline JA. Insulin-glucose as adjunctive therapy of severe calcium channel antagonist poisoning. J Toxicol Clin Toxicol. 1999;37:463–74. https://doi.org/10.1081/CLT-100102437.

    Article  CAS  PubMed  Google Scholar 

  29. Jang DH, Nelson LS, Hoffman RS. Methylene blue for distributive shock: a potential new use of an old antidote. J Med Toxicol. 2013;9(3):242–9. https://doi.org/10.1007/s13181-013-0298-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Gourlaine H, Buneaux F, Borron W, Gouget B, Levillain P. Interference of methylene blue with CO-oximetry of hemoglobin derivatives. Clin Chem. 1997;43:1078–80.

    Google Scholar 

  31. Roderique JD, Van Dyck K, Holman B, Tang D, Chui B, Spiess BD. The use of high-dose hydroxocobalamin for vasoplegic syndrome. Ann Thorac Surg. 2014;97:1785–6.

    Article  Google Scholar 

  32. Fueyo L, Robles J, Aguilar I. Hemolysis index to detect degree of hydroxocobalamin interference with common laboratory tests. J Clin Lab Anal. 2017;31.

    Article  Google Scholar 

  33. Sutter M, Tereshchenko N, Rafii R, et al. Hemodialysis complications of hydroxocobalamin: a case report. J Med Toxicol. 2010;6:165–7.

    Article  Google Scholar 

  34. Ciechanowicz S, Patil V. Lipid emulsion for local anesthetic systemic toxicity. Anesthesiol Res Pract. 2012;2012:11. https://doi.org/10.1155/2012/131784.131784.

    Article  Google Scholar 

  35. Cave G, Harvey M. Intravenous lipid emulsion as antidote beyond local anesthetic toxicity: a systematic review. Acad Emerg Med. 2009;16:815–24.

    Article  Google Scholar 

  36. Armenian P, French D, Smollin C, Olson K, Wu AHB. Prolonged absorption from sustained-release verapamil preparation with documentation of serum levels and their response to intralipids. Clin Toxicol. 2010;48(6):646.

    Google Scholar 

  37. Mirtallo JM, et al. State of the art review: intravenous fat emulsions: current applications, safety profile, and clinical implications. Ann Pharmacother. 2010;44:688–700.

    Article  CAS  Google Scholar 

  38. Hayes BD, Gosselin S, Calello DP, et al. Systematic review of clinical adverse events reported after acute intravenous lipid emulsion administration. Clin Toxicol. 2016;54:365–404.

    Article  CAS  Google Scholar 

  39. Lee HM, Archer JR, Dargan PI, Wood DM. What are the adverse effects associated with the combined use of intravenous lipid emulsion and extracorporeal membrane oxygenation in the poisoned patient? Clin Toxicol (Phila). 2015;53:145–50.

    Article  CAS  Google Scholar 

  40. St-Onge M, Dubé PA, Gosselin S. Treatment for calcium channel blocker poisoning: a systematic review. Clin Toxicol. 2014;52:926–44.

    Article  CAS  Google Scholar 

  41. Weir MA, Dixon SN, Fleet JL, Roberts MA, Hackam DG, Oliver MJ, et al. b-Blocker dialyzability and mortality in older patients receiving hemodialysis. J Am Soc Nephrol. 2015;26:987–96.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kwai, K., Hinfey, P. (2019). Poisoning and Toxicity: The New Age. In: LaRosa, J. (eds) Adult Critical Care Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-94424-1_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-94424-1_19

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-94423-4

  • Online ISBN: 978-3-319-94424-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics