Yesterday in class a point was made that to properly assess a poisoned patient no detail can be overlooked. From vital signs to history and physical exam, all are important. Yellow phosphorus is a case in point. Yellow phosphorus is one of the ingredients used to make fireworks. As noted in, "Ates M et al. Living donor liver transplantation
for acute liver failure in pediatric patients caused by the ingestion of
fireworks containing yellow phosphorus. 2011 Liver Transplantation 17:1286-1291", blood levels are not helpful and there are no diagnostic tests to run. The authors of this paper point out that, “if the history is
unclear, a garlicky odor and luminescence of vomitus or stool may be helpful.
Faint fumes emanating from the stool are called smoking stool syndrome”. You have got to love toxicology!
Thank you to the American Academy of Clinical Toxicology, Tox Question of the Day.
Thursday, August 30, 2012
Wednesday, August 29, 2012
August 29
Today is the
anniversary of the death of Louis Gdalman, a pioneer is pharmacy.
In the 1930s, Louis Gdalman established a
poison information service at St. Luke's Hospital in Chicago. Hospital pharmacists provided poison
information to the physicians and nurses working in the emergency room. By the early 1950s, Gdalman had established an
extensive library of information on the management of poisoning and had
developed a standard data collection form.
He personally provided a 24-hour poison information service and often
took calls at home. In 1953, the
American Academy of Pediatrics and Dr. Edward Press together with Louis Gdalman
established the Chicago Area Poisoning Control Program expanding the service to
include treatment and referral centers at 11 local hospitals. Louis Gdalman was the only pharmacist
involved in the program.
Today that center is the Illinois Poison
Center. In 2011, the Illinois poison
Center handled 86,680
calls.
As Director of Pharmacy Louis Gdalman continued working at
Presbyterian-St. Luke’s Hospital until his retirement in 1975. In 1967, Gdalman was named Hospital
Pharmacist of the Year by the Illinois Council of Hospital Pharmacists. He was
a charter member of the American Society of Hospital Pharmacists, the first
hospital pharmacist to chair the State Pharmacy Board, and the only pharmacist
elected a Fellow of the Institute of Medicine of Chicago. He was named emeritus
professor of internal medicine and pharmacology at Rush University and as
emeritus senior scientist at Presbyterian-St. Luke’s Hospital. During his
career, he lectured at various other institutions, including Northwestern
University and Illinois Masonic Hospital.
Thank you to the Chicago Tribune, Rush University and the
American Journal of Hospital Pharmacy for information that contributed to this
posting.
August 29
Today in 2005 Hurricane Katrina hit New Orleans. Katrina and the subsequent flooding claimed 1,836 lives and made countless homeless.
Damage was estimated at $81 billion. Poison Center data from the time of the
hurricane and the following weeks showed a spike in carbon monoxide poisoning
from generator use. In addition there
was an increase in exposures to gasoline as people siphoned gas into generators
and power tools. Poison centers in Texas
answered many drug identification calls as refugees looking for health care
came only with bags of pills.
Tuesday, August 28, 2012
August 28
Today in 1976 actress Anissa Jones ("Buffy"
on Family Affair) was found dead. While partying with friends Anissa took a
variety of drugs including seconal, quaaludes cocaine and phencyclidine.
August 27
On this date in 1967 Beatles
manager Brian Epstein was found dead.
Death was due to an overdose of sleeping pills and alcohol. There is speculation that his death was
suicide, although the coroner ruled the death as accidental. Carbitral® was a bromide containing
sleep aid widely available and used in Europe at the time. Brian Epstein suffered from insomnia and was a
chronic user of Carbitral®.
Bromide persists in the body. One theory is that Brian Epstein took his
Carbitral®
the evening of his death. He was
drinking (adding an additional sedative) and forget he took his dose. He then took more Carbitral®. It is also said that Epstein left a suicide
note.
Welcome!
Welcome to the Clinical Toxicology blog. It seems that there is something exciting
happening in toxicology every day. It
may be historical (see August 27) or it may be medicinal (FDA release). Some days I may have some tox trivia to share
or an interesting patient. Of course all
posts will be tremendously educational. In addition any questions regarding
class will be answered here for all to see.
Welcome and enjoy!
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