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Biomedical subjects

B H Rumack

Publications and source records attributed to B H Rumack.

At least 127 records · Page 7Linked to original sources

Drug information services for consumers and health professionals.

Provision of drug information services to both health professionals and consumers is described. The Rocky Mountain Drug Consultation Center (RMDCC) has been available to health professionals at Denver General Hospital since 1977. In April 1979, the RMDCC began promotion of combined health-professional- and consumer-oriented services. The service operates 8 a.m. to 6 p.m., Monday through Friday, with 24-hour on-call service. It is staffed by pharmacists who devote 70 man-hours per week to it. Training is primarily on the job. Most of the $80,500 budget is funded through a public health grant from the State of Colorado. a nine-member physician advisory board periodically reviews quality of responses. During a one-year period (April 1979-March 1980), 2264 calls were received from consumers and 1762 calls from health professionals--an increase of 197% over the previous year. Approximately 90% of consumer calls were not considered serious problems or were informational requests; 10% were considered potentially serious or serious drug-related problems. Less than 1% of consumers' questions required the use of anything more than basic drug information references. Of 76 follow-up calls made to consumers for serious or potentially serious problems, 73 were successfully recontacted, and 70 said they either followed RMDCC's recommendations or contacted their physician. The authors believe that combined consumer-oriented and health-professional-oriented drug information services help prevent misuse of medications by consumers.

Colorado↗

Methemoglobinemia resulting from absorption of nitrates.

Three cases of toxic methemoglobinemia resulted from absorption of nitrate salts through burned skin areas. In addition to the unusual route of intoxication, this report emphasizes the occupational hazard of methemoglobinemia in workers exposed to nitrogen salts and the importance of rapid diagnosis and treatment. The diagnosis of methemoglobinemia should be suspected in any case of cyanosis refractory to oxygen therapy. Appropriate treatment should include oxygen, methylene blue, and exchange transfusion in clinically severe cases.

Accidents, Occupational↗

Magical thinking and imipramine poisoning in two school-age children.

Two young school-aged boys took an overdose of imipramine hydrochloride to help their enuresis. One child died, and the other required resuscitation. An office survey found that one third of school-aged children did not realize the potentially hazadous consequences of taking extra amounts of prescription medications. Physicians might be able to prevent similar needless tragedies by warning both the child and the parents of the unusual lethality of imipramine and other dangerous prescription drugs.

Accidents, Home↗

Phenothiazine-induced ventricular tachycardia following acute overdose.

The chronic use of phenothiazine is known to result in ventricular arrhythmias in certain patients. The occurrence of cardiac abnormalities following acute phenothiazine overdose is less well documented. Phenothiazine-induced ventricular tachycardia, when it occurs in the overdose situation, may be refractory to conventional antiarrhythmic drugs. We present a case in which the usual therapy was unsuccessful. Only after a transvenous pacemaker was inserted was the patient's condition reversed.

Adult↗

Acute poisoning from over-the-counter sleep preparations.

All cases received by the Rocky Mountain Poison Center involving over-the-counter (OTC) sleep preparations were studied during an 18-month period to elucidate 1) the range of toxicity; 2) characteristic symptoms, and 3) the time of onset of symptoms. In 155 cases reviewed retrospectively, the three most commonly ingested agents were Sominex, Nytol and Sleepeze. Multiple ingestions were also involved. Symptomatology was equally divided among no symptoms, mild symptoms and possible life-threatening symptoms. The least amount taken to produce possible life-threatening symptoms was 16 Sominex, 18 Nytol and 15 Sleepeze, although the average amount producing the same symptoms was approximately twice that. These symptoms were seen within six hours in all but three of the 39 cases presenting with these symptoms. There were no deaths.

Adolescent↗

Fixed-bed uncoated charcoal hemoperfusion in the treatment of intoxications: animal and patient studies.

We examined the efficacy of a new, fixed-bed, uncoated charcoal device in experimentally intoxicated dogs and in drug-intoxicated as well as chemically poisoned patients. In the animal studies, 4 h of hemoperfusion resulted in a significant decrease in the blood level of phenobarbital, salicylate, pentobarbital and glutethimide. The drug clearances varied between 97 +/- 10 and 129 +/- 6 ml/min. However, the total amount of drug removed was higher for phenobarbital and salicylate which have a small apparent volume of distribution (AVD) than for pentobarbital and glutethimide which have an AVD greater than total body water. We next treated 14 patients suffering from a wide variety of intoxications. Patients intoxicated with phenobarbital, methsuximide, chlordane and Amanita muscaria all showed a significant improvement in their clinical status. Patients intoxicated with ethchlorvynol, glutethimide, methaqualone, podophyllin and fluoroacetamide did not improve. Charcoal hemoperfusion may be useful in patients poisoned with drugs characterized by an AVD smaller than total body water. No major complications were encountered during the hemoperfusions.

Adolescent↗

Drug information--the problems and some solutions.

Several problems evident in the drug information delivery process and some solutions are presented. Major problems with current sources of drug information are accessibility of data, completeness of data, validity of information, appropriateness in the clinical setting, and currency. Better drug information sources are needed to provide rapid answers to patient-related questions routinely occurring in the clinical setting. Currently available mechanisms described to solve existing drug information problems are clinical pharmacologists and specialists, clinical pharmacists, drug information centers, and a computer-output microfiche drug information system (DRUGDEX).

Anticoagulants↗

Laetrile and pregnancy.

Pregnancy in a woman who took laetrile as daily intramuscular injections during the last trimester resulted in a live, term infant. No laboratory or clinical evidence of elevated cyanide or thiocyanate, a pricipal metabolite, could be detected. Neurological evidence of chronic cyanide exposure may not be recognizable in infancy, and long-term follow-up is indicated.

Adult↗

Toxicity of acetaminophen overdose.

Symptoms of toxicity following overdose of acetaminophen (APAP), now a common household medication, occur 24 to 48 hours following ingestion. Toxicity is mainly to the liver but, while data has implicated a minor metabolite, the precise mechanism is not known. Toxicity is likely to occur after a minimum ingestion of 140 mg/kg, but the toxic dose may vary as a function of individual glutathione levels. Since the early clinical picture is not diagnostic, APAP plasma levels must be measured. Supportive care alone has resulted in a 5% to 10% mortality with a high incidence of hepatic toxicity. Treatment within 10 to 12 hours following ingestion with any therapeutic agent reduced mortality to zero and diminished liver toxicity. N-acetylcysteine is an investigational new drug for treating APAP toxicity and can ethically be used if the patient is first enrolled in the current nationwide evaluation. Recommended treatment steps in a suspected APAP poisoning are 1) emesis or lavage; 2) plasma APAP determination; 3) obtain treatment protocol from the Rocky Mountain Poison Center; 4) history of use of other pharmacologic agents, and 5) diuresis, alkalinization or hemodialysis, as in aspirin poisoning, are contraindicated.

Acetaminophen↗

Regionalization of poison centers--a rational role model.

The Rocky Mountain Poison Center is a model system for regionalization. Minimal cost is achieved by concentrating expensive equipment and information materials in the main center. Access to information is rapid because each subregional center has a POISINDEX and thus the capacity to provide standardized initial therapy as soon as contact is made. Full integration of professional activities from training to education is accomplished within the framework of Emergency Medical Services. Public education is uniform throughout the region so that medical interaction is consistent and the public receives maximum reinforcement. Funding is found through many sources and includes a cost-sharing program in which 18 Colorado hospitals participate. Institutions with similar regionalized programs, integrated with Emergency Medical Services and drug consultation, will provide cost effective programs well-tailored to the unique characteristics of each region.

Drug Information Services↗

Pharmacokinetics of acetaminophen in children.

Acetaminophen absorption may occur at a somewhat greater rate in children if the syrup form is utilized. The overall plasma elimination of acetaminophen is somewhat slow in the neonate, but is comparable to that of adults in both children and adolescents, as judged by half-life determinations. This would suggest that the frequency of acetaminophen administration in children should be similar to the schedule recommended for adults and that a dosing interval of four hours should not result in drug accumulation. The question of a toxic quantity of acetaminophen for young children must remain open until adequate metabolic or retrospective toxicologic data become known. Since the volumes of distribution appear to be the same in both adults and children, the same dose should apply in both groups; currently, 10 mg/kg is considered to be both safe and effective for antipyresis.

Acetaminophen↗

Podophyllin poisoning. Systemic toxicity following cutaneous application.

The toxicity of topically applied podophyllin in a 16-year-old girl is presented. Coma requiring respiratory support and major neurologic complications as well as hematologic and hepatic toxicity was observed. Therapy with a new modality, charcoal hemoperfusion, resulted in resolution of the acute toxicity, leaving a peripheral neuropathy which had not completely resolved after 4 months. The pharmacology and suggested treatment measures for the toxicity of this rarely reported agent are reviewed.

Administration, Topical↗

Analysis for salicylic acid in serum by high-performance liquid chromatography.

We report a specific and sensitive quantitative assay for salicylate in serum or plasma. As little as 3 microliter of sample can be analyzed by an external standard procedure and larger volumes by diluting with the internal standard (o-methoxybenzoic acid). No extraction or derivatization is necessary and salicylic acid and the internal standard elute in 6 and 3.75 min, respectively. Peak-height ratios are linearly related to concentrations between 10 and 500 mg/liter. By comparison with an existing fluorometric method, our procedure is faster, more specific, and more sensitive.

Aspirin↗