Dog bites snake

For the dog lovers in the world here  is a cute video about a women who was rescued by her Yorkie.  It seems the dog's owner was in her backyard when she was bitten on the heel by a snake.  When the little Yorkie sensed the danger it leaped to the owner's defense.  Multiple bites later, bites to both the dog and snake, the owner was safe and the snake was dead.  Unfortunately the little dog was ill. 

 

Snake bites to the face in dogs are not unusual.  The risk is the tremendous amount of swelling that can develop.  Swelling that may eventually close off the dog's airway.  Dogs can be readily treated with steroids or is severe cases, antivenin.  Outcomes, as in this case, are nearly always positive. 

 

One thing to remember.  When bitten by a snake it is NOT important to bring the snake to the ED.  Just tell the nurse you were bitten by a snake.  The ED staff will take care of the rest.  It is in attempting to corral or kill the snake that others get bitten.  Sometimes it is even a cute little Yorkie. 

 

 

       

Cyanide

Cyanide was originally discovery in the 18th century.  In the 20th century it became a means to commit suicide, murder and mass execution.  Cyanide is also a substance used in variety industries ranging from mining to electroplating and is a byproduct in oil refineries.  Exposures, both chronic and acute, do happen.  Thankfully there are antidotes available to treat cyanide poisoning.

Treatment initially starts with oxygen.  Refinery workers with low level cyanide exposure have done well with only oxygen as treatment.  The key is low level exposure.  Patient that are more symptomatic require more aggressive care.  For decades we have successfully used the Lily cyanide antidote kit as our source of life saving drugs.  Unfortunately the antidote kit, which consists of amyl nitrite, sodium nitrite and sodium thiosulfate, is no longer being manufactured.  Amyl nitrite can be purchased in bulk from a variety of distributors.  Sodium nitrite and sodium thiosulfate is available as an FDA approved combination product, Nithiodote, by Hope Pharmaceuticals.  There is a different antidote, hydroxocobalamine (Cyanokit) that is also available.  It is easier to use, works quickly and has a good adverse effect profile.  It can also be used in patients suffering from smoke inhalation.  Hydroxocobalamine has a long history of successful use in Europe.  Its downfall - cost.  Many hospitals simple do not carry it.

As health care providers and pharmacists it is incumbent on us to insure that we have the right tools to treat patients is the best way possible.  As the old kits expire hopefully hospitals will appropriately start stocking hydroxocobalamine. 

Yasser Arafat

Yasser Arafat is a fascinating historical figure.  Initially he gained fame as a military leader focused on denying statehood for Israel while championing statehood for Palestine.  Eventually he rose to become Chairman of the Palestine Liberation Organization.  In 1994 he received the Nobel Prise for the Middle East peace negotiations in Oslo.  Mention Yasser Arafat and many see a great man and hero fighting for Palestine.  Mention his name to others and he is vilified as a terrorist responsible for hundreds and thousands of deaths.     

Yasser Arafat died in 2004 from what was declared a massive brain hemorrhage. Almost immediately there were rumors surrounding his death.  Some claimed he died of AIDS or cancer.  Others claimed he was poisoned.  Over the last few years the debate has grown.  The focus has been on the theory that he was poisoned by Israel using everything from polonium to thallium.   Early this morning his body was exhumed and samples taken.   Here is an article from the BBC about the exhumation that gives some background.   

Time will give us a few more answers.  But the results of this process will likely only open more wounds and create more unanswered questions.  For toxicologists Yasser Arafat will remain a fascinating figure as we attempt to tie his clinical picture to what is discovered by these tests and then compare the data against more accusations.  To get your toxicologic juices flowing; does the clinical picture of polonium poisoning match his death?

Happy Poison Free Thanksgiving!

The Holiday Season is here.  Thanksgiving is tomorrow with its abundance of food, family and football.   For many this is a season of true joy as we celebrate together with friends and family. 

Today and tomorrow as you focus on preparing and consuming your feast there are a few pointers to keep in mind.  Remember to keep hands, utensils and countertops clean.  No spreading bacteria from one food or person to another. The American Association of Poison Centers blog has a nice poster  that should remind you of some important pointers on cooking your turkey.  The CDC Food Safety Program also has an excellent website that will answer many food preparation questions.  The last great resource for you is the Butterball Turkey Hotline.  Nutritionists and home economists are available for you to talk.  Turkey smells funny, give them a call.  Cat ate part of the turkey, give them a call.  Call 1-800-288-8372 (1-800-BUTTERBALL) for fast expert help.  And at all times, for any issue, remember the number to your local poison center:  1-800-222-1222.

Stay safe and enjoy a wonderful poison-free Thanksgiving!    

      

Holiday Guests

The Holidays are here.  Starting this afternoon traffic will pick-up, airports will start to clog and homes will get that last cleaning.  Part of getting ready for the holidays is to make sure your home is ready for all your holiday guests.  Food is properly prepared for the variety of dietary needs you will encounter.  The beer frig and liquor cabinet and adequately stocked.  And the house is safe for everyone. 

But no matter how well we poison proof our homes some guests bring their own poisons.  Cyanide as stuffing seasoning?  Strychnine for the soup?  or is it arsenic for the candied yams.  No, none of those.  It is big brother or crazy uncle that chews and spits into his diet coke can.  So far this year the Illinois Poison Center has reported 24 exposures to chewing tobacco spit.  The Missouri center another 32.  The adults all know that is his spit can.  But to a curious two year old it looks like diet coke.   Nicotine that is contained in tobacco gets concentrated in what gets spit into the can.  Nicotine frequently causes nausea and vomiting.  More serious effects like an increase in heart rate, drowsiness and seizures have all happened to unsuspecting children

This holiday season keep your medications and cleaning products put away, your carbon monoxide detector working, cooking utensils clean and keep an eye out for a wayward spittoon.

Help needed!

Winter is coming.  With the first blast of cold furnaces kick in and heating bills go up.  With furnaces turning on the number of people poisoned by carbon monoxide jumps dramatically.  Today the Milwaukee Journal-Sentinel posted an alert warning us about risks of carbon monoxide poisoning.  So get your furnace checked, get a detector and be smart. 

Sadly, accidents and carbon monoxide poisoning still happen.  What could be sadder than a home full of small children and puppies being evacuated into the cold due to carbon monoxide?  It is WHEN MY FAVORITE BREWER HAS TO EVACUATE DUE TO CARBON MONOXIDE.  The Journal-Sentinel was again all over the story.    Thankfully it appears that no one was injured due to the high levels of CO.  Randy Sprecher, if you need a clinical toxicologist to help you determine if your beer is still good I would be happy to help.  If you need an additional 55 or so young college aged aspiring pharmacists/toxicologists to assist, I know where they are too!    

Please help yourself and your family by purchasing a carbon monoxide detector.  It may save a life, and it could be yours. 

Please help my favorite brewery by toasting with a Sprecher Oktoberfest tonight.  I know I will.

Angel of Death

Richard Angelo graduate with honors from nursing school.  He was a volunteer fireman and an eagle scout.  Richard had a reputation for heroism arriving when patients were arresting and reviving them.  Unfortunately for his patients he desire to be a hero went a little far.  

 

Richard was hired to work the graveyard shift at Good Samaritan Hospital in Long Island.  For some odd reason there was a large number of codes during the graveyard shift when Richard was there.  As one patient was slowly deteriorating he pressed his call button.  An alert nurse responded and recognised something was amiss.  A urine sample was obtained and it contained panucuronium and succinylcholine, but neither was prescribed.  The patient survived and described a large bearded nurse with glasses who was in his room.  The police took over from there and found bottle of Pavulon and Anectine in nurse Angelo's home. 

 

Pancuronium and succinylcholine are neuromuscular blocking agents commonly used in surgery and for emergency intubations.  They both prevent muscle contraction by effecting conduction at the neuromuscular junction.  Your muscles can not work (no waving for help, no breathing, nothing), yet you are wide awake. 

 

On this day in 1987 Richard Angelo, nicknamed the "Angel of Death", was arrested for murder.  It is estimated that in the seven months he worked at the hospital nurse Angelo poisoned 35 patients, or which 10 died.   

McAfee murder

Dear Fellow Toxicology Enthusiasts,

A story broke yesterday about a murder Sunday night in Belize allegedly perpetrated by the McAfee Antivirus mogul, John McAfee. As the story goes, a builder colleague, Gregory Faull, filed a formal complaint with police against Mr. McAfee for his “roguish behavior” and erratic use of firearms. He has, over the past several months, been posting in drug forums about his pursuit to obtain a certain purified substance that authorities suspect they will find in his system when he is caught.

Name that drug!

For those who want to cheat: http://gizmodo.com/5959812/john-mcafee-wanted-for-murder

 

Kidneys and acetaminophen

Acetaminophen poisoning.  The epidemic of liver injury seen in hospitals today is thought to be due to high use of acetaminophen by all of us.  Changes in liver function has been documented following just a therapeutic dose in some people.  Liver transplants and death have also been widely reported following both acute and chronic ingestion of acetaminophen.   

But that is not the whole story.  There is a group of patients that also suffer kidney damage secondary to acetaminophen poison.  It is known that the kidney contains some of the same enzymes that in the liver change a small portion of acetaminophen into a toxic metabolite.  And when following a large acute overdose renal toxicity is something that needs to be monitored.  But how frequent is renal toxicity noted in patients with acetaminophen poisoning?  In a study published last year (Nephro Dialysis Transplantation 2011; 26(11):3501-08) only 21 % of patients that were inpatients in an intensive care unit with liver toxicity due to acetaminophen did NOT develop renal toxicity.  The over whelming majority had some level of kidney impairment.  Most of those patients did recover kidney function.  But a small percentage of patients develop chronic kidney failure. 

Being aware of acetaminophen induced hepatic damage is very important for all of us.  But don't forget the kidney, it is another organ that we should worry about.

Quinoa?

Yesterday I was asked an interesting question.  Can I eat the quinoa I prepared before the power went out nine days ago?  Two thoughts came to mind.  First, What is quinoa?  and second, food poisoning.  After a little research (ask and you shall be told) I now know what quinoa is.  Food poisoning is something that we should all be familiar with.  Food poisoning covers a variety of illnesses.  There is the standard bacterial food poisoning caused by E. coli or salmonella.  We have all gotten sick with diarrhea, vomiting and cramps because of something we ate.  Then there are parasites secondary to eating bad or poorly prepared food.  Yuck.  Food allergies are also a problem.  Everyone with a peanut allergy knows that peanuts are the number one cause of death due to food related anaphylaxis. 

So food poisoning is nothing to be ignored.  Rather we should all be taking precautions to avoid it.  Yet every year many, many people suffer from food poisoning.  Many due to their own decisions.  This is the time of the year when food poisoning ramps up.  We have treats left over from Halloween to consume.  Soon we will have thanksgiving leftovers.  Then day old trays from Christmas parties.  There are many websites to help you with your food related questions.  But this one is the best.   Use it frequently this holiday season, I know I will. 

Nine day old quinoa prepared with fresh fruit and a little milk that has been sitting at room temp.  According to Food Safety.gov, throw it away.  The question for you to answer; Is the risk of getting sick worth the deliciousness of the food?       

Drugs and pregnancy

Today I saw an interesting question...  How many women use illicit drugs in pregnancy? 

We all know that different drugs cause different birth defects.  Prescription, over-the-counter and illicit drugs can all cause birth defects.  Some effects are truly horrific, like those due to thalidomide, and avoidable.  Others far more subtle.  In a perfect world no pregnant women would ever take a drug, legal or illegal.  But this is not a perfect world.  We still get headaches and we still get colds.  Chronic diseases do not go away when you become pregnant, nor do addictions.  So we keep taking drugs. 

So how many women take illicit drugs when pregnant? 4.7 %  Interestingly, more than 6 % of pregnant women reported the use of multiple drugs.  Drugs that include tobacco, alcohol, prescription and illicit.  The 4.7 % admit using at least one illicit drug sometime during pregnancy. 

Thank AACT question of the day.

Formication

Words.  Every discipline has its own words.  There are strange words in chemistry and equally strange words in poetry.  But medicine and toxicology may top them all. 

Today's word is "formication".  I know what you are thinking. "I saw one of those growing in a cave!"  Close, but incorrect.  Formication is an odd delusion that is associated with methamphetamine abuse.  The abuser thinks that their skin is being infested and bitten by bugs.  What do you do when bugs on your skin?  You pick them off.  So formication is the act of picking your skin when nothing is there.  As a result your skin doesn't look to good. 

Its true, sometime a picture is better than words.