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Biomedical subjects

A S Manoguerra

Publications and source records attributed to A S Manoguerra.

At least 19 recordsLinked to original sources
PubMed2000

Prospective evaluation of mild to moderate pediatric acetaminophen exposures.

STUDY OBJECTIVE: To determine whether pediatric patients with acute, mild to moderate acetaminophen exposures, treated with home monitoring alone, develop systemic signs of hepatic injury. METHODS: A prospective, observational study of calls to a regional poison center over a 25-month period was performed. Patients were eligible for the study if they were younger than 7 years and had an acute maximum possible acetaminophen exposure of up to 200 mg/kg. Exclusion criteria included previous decontamination measures, possibility of ingestion of an extended-release preparation, health or medication issues that could increase susceptibility to hepatotoxicity, current symptoms of hepatotoxicity, and indeterminable ingestions. Study protocol included reviewing the signs and symptoms of early and late acetaminophen toxicity, a 4- to 6-hour follow-up call, and a 72-hour follow-up call. Outcome measures were defined as a verbal report by the patient's parent or guardian of the presence or absence of signs or symptoms of hepatotoxicity. RESULTS: A total of 1,039 patients were enrolled in the study, including 519 girls and 520 boys, with exposures ranging from 20 to 200 mg/kg. Eighteen patients were lost to follow-up; data were incomplete for 2 patients. At 72-hour follow-up, the remaining 1,019 patients were all doing well, without signs or symptoms of hepatotoxicity. CONCLUSION: On the basis of these data, pediatric patients with acute acetaminophen exposures of up to 200 mg/kg, treated with home monitoring alone, do not develop signs or symptoms of hepatic injury.

Acetaminophen↗
PubMed2000

Retrospective analysis of ingestions of iron containing products in the united states: are there differences between chewable vitamins and adult preparations?

Iron is the one of the leading causes of pediatric poisoning deaths in the United States. Most cases of serious iron overdose reported in the medical literature have resulted from adult formulations of iron. To begin evaluating the possibility that differences in toxicity exist between iron preparations, we performed a retrospective evaluation of all exposures to pediatric and adult iron products reported to the American Association of Poison Control Centers' (AAPCC) Toxic Exposure Surveillance System (TESS) from 1983 to 1998. We attempted to determine the incidence of fatal iron poisoning for each group. A total of 195,780 ingestions of children's vitamins containing iron were reported to the TESS between 1983 and 1998 with no resulting fatalities. During the same twelve-year study period, 147,079 exposures to adult forms of iron were reported with 60 fatalities (p < 0.0001). A prospective study is required to assess whether differences may exist in the toxicity of these two iron preparations.

Absorption↗
PubMed1999

Comparison of the toxicities of two iron formulations in a swine model.

OBJECTIVE: To describe the histopathologic and pharmacokinetic differences of acute iron poisoning between chewable multivitamins with iron and solid iron tablets in a swine model. METHODS: This was a prospective, randomized, unblinded toxicity study of iron poisoning of two iron formulations in male Yorkshire pigs. Eight swine were randomized to receive 60 mg/kg of iron in either solid iron tablets or chewable multivitamins with iron. Serum iron, arterial blood gases, and episodes of vomiting were recorded over a ten-hour period. Routine histologic evaluations of the esophagus, stomach, small intestine, large intestine, and liver were performed immediately after the study period. Pharmacokinetic analyses of area under the concentration-time curve (AUC), time to peak concentration, and peak serum iron concentration were performed. RESULTS: There was no significant difference between the serum iron levels except at three and four hours. There was a significant higher AUC in the chewable group compared with the solid group. Pathologic evaluation identified severe esophageal inflammation and focal erosion in the solid iron tablet group in two of the four animals, compared with no focal erosions and minimal esophageal inflammation in the chewable group. No significant change was identified in the liver, small intestine, or large intestine in either group. CONCLUSIONS: These results demonstrate increased local gastrointestinal toxicity following a large ingestion of solid iron tablets in a swine model, compared with chewable multivitamins with iron. Higher serum iron levels were identified in the animals that received chewable multivitamins with iron.

Administration, Oral↗
PubMed1999

Ethanol analysis following consumption of "alcohol-free" beer.

Breath alcohol devices are routinely employed by emergency department personnel to reflect blood ethanol levels. No data have been published using these devices following the ingestion of "alcohol-free" beer that are required to contain < 0.5% alcohol. We performed a prospective, randomized, unblinded study on 8 healthy male volunteers that abstained from alcohol for 48 h and fasted for 10 h. Each subject ingested a 6-pack of alcohol-free beer over 1 h; breath alcohol determinations were made at 30, 60 and 120 min. Elevated breath alcohol levels were obtained at 30 and 60 min and decreased in all but 1 subject by 120 min. The elevated breath alcohol levels at 30 and 60 min may represent the previously reported "mouthwash" effect.

Adult↗
PubMed1999

A review of selected seafood poisonings.

Seafood poisoning has been recognized as a problem in both coastal and inland populations for millennia. Many types of sea creatures from shellfish to the largest fish have been implicated. Severe cases of many different types of seafood poisonings can result in fatalities. While the pathophysiology of the toxins is well known in some cases, others, like ciguatera, remain somewhat confusing. As a result, the treatment of these conditions remains controversial, although supportive care continues to be the mainstay of therapy. In this manuscript, we review the pathophysiology, clinical presentation, and treatment of some of the most common and toxic varieties of seafood poisoning resulting from toxins.

Animals↗
PubMed1998

Clarithromycin induced digoxin toxicity.

A case of digoxin poisoning following the co-administration of digoxin and clarithromycin in a 28 year old male is described. Since the aetiology of chronic digoxin poisoning is often unclear, clinicians should be aware of the potential drug-drug interaction between digoxin and clarithromycin.

Adult↗
PubMed1997

Gastrointestinal decontamination after poisoning. Where is the science?

The approach to the use of gastrointestinal decontamination procedures in the treatment of ingested toxins has changed in recent years. Many toxicologists and physicians have taken strong positions either for or against the use of emesis, gastric lavage, activated charcoal, or other procedures. What is the scientific basis for these positions? This article reviews and comments on the published studies comparing the effectiveness of these widely used procedures.

Animals↗
PubMed1996

Disaster preparedness of poison control centers in the United States.

OBJECTIVE: To assess the state of disaster readiness of poison control centers, a survey questionnaire was sent to all 96 institutional poison control center members of the American Association of Poison Control Centers in the US, both certified and noncertified programs. DESIGN: The data reported are the results and responses from 76 of 96 (79.2%) poison control centers. RESULTS: Fifty-four percent of responding centers have written disaster plans, with 25% having drills to practice the plans. Of the centers that do not have a written plan, the majority have policies and procedures in place to address physical plant damage, increased phone traffic, loss of phone systems and malfunction of computers. Eighty-six percent of respondents have a back up generator, and 82% have an uninterruptable power supply in place. Fifty-four percent have a back up phone system and 33% have cellular phone capacity. Forty-six percent of responding centers have arrangements with other agencies in the event of a disaster. Only half of the managing directors of the responding centers believe their center can meet the public's needs in the event of a disaster.

Disaster Planning↗
PubMed1995

Raising the decontamination level for thyroid hormone ingestions.

Ninety-two pediatric cases (age < or = 6 years) of acute thyroid hormone ingestions that were reported over a 20-month period to one American Association of Poison Control Centers (AAPCC)-certified regional poison center were reviewed to determine whether significant toxicity in pediatric patients is associated with acute ingestions of < or = 5 mg levothyroxine (T4) equivalent of thyroid hormone and the highest-tolerated milligram-per-kilogram dose. Parameters evaluated included patient weight, amount ingested, drug preparation, treatment type, outcome, management site, and relevant comments. Eight patients had mild symptoms requiring no specific medical intervention and there was no correlation between the amount ingested and symptoms observed. The maximum T4 dose ingested without gastrointestinal decontamination was 0.13 mg/kg (2 mg). A literature review was also conducted. Only one case of moderate toxicity with a dose of less than 5 mg T4 equivalent was found in the literature review. Significant toxicity is not expected with ingestions of less than or equal to 5 mg T4 equivalent of thyroid hormone.

Child, Preschool↗
PubMed1995

Iron overdose and detection of gastrointestinal bleeding with the hemoccult and gastroccult assays.

STUDY OBJECTIVE: To determine the ability of the Hemoccult and Gastroccult tests (SmithKline Diagnostics) to detect blood in vitro in whole-bowel irrigation (WBI) solution. INTERVENTIONS: One tablet of ferrous gluconate 324 mg, ferrous sulfate 325 mg, or ascorbic acid 500 mg; or one Materna prenatal vitamin tablet (Lederle Laboratories) was dissolved in 30 mL of Colyte. Colyte alone and each test solution were tested with Hemoccult and Gastroccult slides, then retested at pH values of 3 and 8. Fresh solutions were then spiked with blood and tested with Gastroccult slides. Materna and ascorbic acid solutions were spiked with blood, then tested with Hemoccult slides. RESULTS: Positive results were difficult to detect on Gastroccult slides. Hemoccult slides were falsely positive for solutions containing only iron and falsely negative for blood-spiked samples containing ascorbic acid. CONCLUSION: Both the Hemoccult and Gastroccult tests may be unreliable in detecting GI bleeding in cases of iron overdose treated with WBI.

Ascorbic Acid↗
PubMed1994

Sunlight and the plant: a toxic combination: severe phytophotodermatitis from Cneoridium dumosum.

A severe case of phytophotodermatitis occurred in a patient who had spent several hours walking through an area densely populated with Cneoridium dumosum. This patient's co-worker experienced a similar reaction after undergoing patch testing of an area of skin and exposing it to sunlight. Voluntary patch testing by one of the authors produced a reaction consistent with the other two cases. Approximately twenty other cases were described by a U.S. Fish and Wildlife Service ranger in students who came into contact with the plant during a field trip with him to Baja California, Mexico. Cneoridium dumosum is a common native bush that grows in the chaparral vegetation zone of southern California and Baja California, Mexico. In a search of Poisindex, Medline, Agris International, and Agricola databases, no previous reports of toxic exposures were found.

Arm↗
PubMed1992

Interaction of tricyclic antidepressants with cholestyramine in vitro.

The adsorption of amitriptyline, desipramine, doxepin, imipramine, and nortriptyline onto cholestyramine was demonstrated in vitro with use of 1.2 mol/L HCl at 37 degrees C to simulate gastric fluid. Binding to cholestyramine was approximately 80% for each of the tricyclic antidepressants, and this was about the same degree of binding noted with a nonpharmaceutical, non-ionic resin widely used in the diagnostic toxicology laboratory (Amberlite XAD-2). In contrast, five other non-antidepressants (acetaminophen, chlordiazepoxide, procainamide, quinidine, and theophylline) showed only minimal binding to cholestyramine under these conditions. Activated charcoal completely bound all drugs studied. These findings suggest that cholestyramine should be used with caution in patients receiving tricyclic antidepressants. They also suggest that cholestyramine may be a potentially useful adjunctive therapy in treatment of overdose with the tricyclic antidepressants.

Adsorption↗
PubMed1991

Severe cyanide poisoning from the ingestion of an acetonitrile-containing cosmetic.

A 39-year-old woman ingested 59 mL of Super Nail Nail Off (American International Industries, Hollywood, CA) (containing 99% acetonitrile) in a suicide attempt. Following a latent period of approximately 12 hours, the patient developed cyanide poisoning with severe metabolic acidosis, seizures, and shallow respirations. She responded to the administration of sodium nitrite and sodium thiosulfate, although the administration of nitrite produced bradycardia and hypotension. She developed several relapses over the course of her hospitalization and each time responded to sodium thiosulfate administration. The patient developed hypernatremia from the sodium load given to her; hemodialysis and charcoal hemoperfusion were initiated to correct the hypernatremia and to attempt to remove cyanide, thiocyanate, and acetonitrile. On the fifth hospital day, the patient was fully recovered and was discharged.

Acetonitriles↗
PubMed1990

Full thickness skin burns secondary to an unusual exposure to diquat dibromide.

Diquat dibromide is a commonly used herbicide. The product label cautions against allowing the material to contact the skin as severe skin irritation is possible as well as absorption of the material into the systemic circulation. Waterproof footwear and clothing should be worn to minimize skin contact. A case of full thickness burns of the feet requiring skin grafting occurred following prolonged exposure of the soles of the feet to diquat dibromide.

Burns, Chemical↗