Biomedical subjects
B Zane Horowitz
Publications and source records attributed to B Zane Horowitz.
"Parachuting" meth: a novel delivery method for methamphetamine and delayed-onset toxicity from "body stuffing".
BACKGROUND: Methamphetamine is an illicit stimulant that is typically smoked, insufflated, or injected. We report an unusual method of ingesting methamphetamine called "parachuting" and its implications for the treatment of "body stuffers." CASE REPORT: A 25-year-old man wrapped methamphetamine into a plastic baggie and ingested it in an attempt to "parachute." He presented to an Emergency Department 10 hours after his ingestion because he realized that he forgot to puncture the baggie. He had no complaints and had a transient tachycardia. He was treated with activated charcoal and whole bowel irrigation, observed for 24 hours, and discharged. He returned 42 hours after his ingestion with tachycardia (220 bpm), agitation, hypertension (179/74 mmHg), and rhabdomyolysis (CPK 7771 U/L), requiring mechanical ventilation and a midazolam drip (10 mg/hr). CONCLUSION: "Parachuting" is a novel method of ingesting methamphetamine. We report a case of a single-packet "body stuffer" with severe symptom onset that was delayed over 36 hours. Treatment protocols for "body stuffers" using this technique may require more prolonged observation and/or imaging studies to determine the absence of gastrointestinal packets.
Botulinum toxin.
Botulinum toxin is regarded as the most lethal substance known. It is estimated that the human LD50 for inhalation botulism is 1 to 3 nanograms of toxin/kilogram body mass. Although only three cases of inhalational botulism have been described, an understanding of the pathophysiology of food-borne outbreaks, wound botulism, and infant botulism, and their therapies, enables the medical community to plan treatment in the event of an aerosol release of botulinum toxin. Antitoxin, vaccine, and F(ab')2 immune fragment therapies are discussed as adjuncts to supportive therapy.
Fosphenytoin farewell?
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Massive hepatic gas embolism from a health food additive.
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Lead poisoning from a toy necklace.
A 4-year-old, previously healthy boy experienced intermittent abdominal pain for several weeks. He was diagnosed with probable gastroenteritis, but his symptoms worsened. Laboratory tests revealed normocytic anemia, and an abdominal radiograph showed a metallic foreign body in the stomach, without evidence of obstruction. Endoscopy resulted in the retrieval of a quarter and a medallion pendant from the stomach. A venous blood lead level measurement was extremely elevated, at 123 microg/dL (level of concern: > or =10 microg/dL). The medallion was tested by the state environmental quality laboratory and was found to contain 38.8% lead (388,000 mg/kg), 3.6% antimony, and 0.5% tin. Similar medallions purchased from toy vending machines were analyzed and were found to contain similarly high levels of lead. State health officials notified the US Consumer Product Safety Commission, which resulted in a national voluntary recall of >1.4 million metal toy necklaces.
Was it necessary to add Bitrex (denatonium benzoate) to automotive products?
Oregon was the first state to mandate the addition of a bitter aversive agent to consumer automotive products containing > or = 10% ethylene glycol (EG) or > or = 4% methanol (MeOH). The 1995 Toxic Household Products statute required the addition of denatonium benzoate at a concentration of 30-50 ppm with the intent to reduce the frequency of serious pediatric exposures to these products. Retrospective review included Oregon Poison Center (OPC) records of all reported pediatric (< 6 y) exposures to automotive antifreeze (EG) and windshield washer fluid (MeOH) from 1987 through 2003, OPC charts of children treated with ethanol, fomepizole, or hemodialysis for EG or MeOH poisoning from 1987 through 2002, and coroner reports of poisoning deaths for 1994-1997 to identify EG or MeOH deaths not reported to the OPC. OPC recorded 332 EG and 117 MeOH exposures among preschool children from 1987-2003 with no change in annual frequency after 1995. No child died or suffered "major" effects before or after 1995. Ten children received ethanol infusions until laboratory results were available; 9 had no detectable concentration of the suspected agent, and 1 had a sub-toxic concentration. Two children received fomepizole but had no detectable EG. No child underwent hemodialysis. Coroner reports detected no missed pediatric deaths from toxic alcohols in 1994-1997. The mandatory addition of denatonium benzoate was unnecessary as unintentional ethylene glycol or methanol exposures in pre-school age children did not cause measurable toxicity.
Polar poisons: did Botulism doom the Franklin expedition?
In 1845 the Franklin expedition left London with 2 ships and 134 men on board in an attempt to find the route through the Northwest Passage. The ships were built with state-of-the-art technology for their day, but provisioned with supplies from the lowest bidder. After taking on fresh provisions in the Whalefish Islands, off the coast of Greenland, the entire crew was never heard from again. Graves found on remote Beechey Island indicate that three able-bodied seamen died during the first winter. A note written on a ship's log, later found in a cairn, indicate that the expedition's leader, Sir John Franklin, died during the second winter entrapped on the ice, by which time 24 men had also perished. The remaining crew failed in their attempt to walk out of the Arctic by an overland route. In 1981 Owen Beattie, from the University of Alberta, exhumed the remains of the sailors from the three graves on Beechey Island. Elevated lead levels were found in all three sailors. While lead poisoning has been a leading theory of the cause of the crew's deaths, blamed on the crudely tinned provisions the ships carried with them from England, chronic lead exposure may only have weakened the crew, not necessarily killed them. One of three exhumed sailors also had in his intestine the spores of an unspecified Clostridium species. The theory put forth by this article is that Botulism, type E, which is endemic in the Arctic, may have been responsible for their deaths.
Droperidol--behind the black box warning.
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Pesticide-related illness: are poison centers reporting to the state health department?
Pesticide-related illness should be reported by physicians to state health departments. Since poison centers (PC) are involved in the management of many of these cases, it may be assumed that they should report these cases. A 5-y audit of pesticide related illness reported to a centralized state pesticide oversight agency (PARC) was conducted. During the 5-y period the PC received 5,828 calls involving exposures to reportable pesticides; 1,011 of these were for organophosphates. Eight organophosphates cases were treated with antidotes, but ony 2 were reported as a pesticide-related illness. During this same time PARC reviewed 540 cases of persons suspected of being exposed to pesticides. The largest percent of referrals (19.6%) came from the PC, however only 1% of all PC pesticide exposure cases were reported as pesticide-related illnesses.