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Biomedical subjects

D G Spoerke

Publications and source records attributed to D G Spoerke.

At least 19 recordsLinked to original sources

Granuloma formation induced by spines of the cactus, Opuntia acanthocarpa.

Embedded cactus spines may cause immediate pain due to mechanical damage, be a source of infection, or result in foreign body granulomas. The cholla cacti are particularly tenacious in the manner in which the spines stay embedded in the skin. Pulling away from the cactus may result in a portion breaking away from the main plant and embedding other spines. Granuloma formation has been seen with plant material embedded in the dermis. Onset is generally within a few days, and duration may be as long as 9 mo. Treatment is generally best accomplished with a topical corticosteroid. We present a case of granuloma caused by the cactus Opuntia acanthocarpa which persisted for 8 w despite topical treatment with 0.05% fluocinonide.

Adult

Fluoride ingestion in children: a review of 87 cases.

All cases of fluoride ingestion in children younger than 12 years old reported to the Rocky Mountain Poison Center between January 1 and December 31, 1986, were retrospectively reviewed. Eighty-seven cases were identified. Eighty-four cases involved accidental ingestion of dental fluoride products in the home (tablets, drops, rinses) in children 8 months to 6 years old. Two older children (8 and 9 years old) became symptomatic after fluoride treatment by a dentist. A 13-month-old child died after ingesting an unknown amount of sodium fluoride insecticide, the only insecticide exposure in our series. Postmortem total serum calcium value was 4.8 mg/dL (normal 8.8 to 10.3). No other patients had serious symptoms or sequelae. Twenty-six (30%) of 87 became symptomatic, with gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain) in 25 patients and drowsiness in 1. Only 3 patients became symptomatic later than 1 hour after ingestion. Analysis of data from 70 cases with sufficient information revealed that as the amount of fluoride ingested increased, the percentage of patients with symptoms increased. Not including the fatal case, 6 patients had serum calcium levels measured, and all were normal. Children who ingested up to 8.4 mg/kg of elemental fluoride in dental products had mild and self-limited symptoms, mostly gastrointestinal.

Accidents

Plants and mushrooms of abuse.

The plants described earlier are only a few of those that can be misused. Most have effects similar to those of more popular synthetic drugs but can cause unpleasant side effects and unpredictable results. Identification of the offending botanic agent can be problematic. These plants are still used because most are legal to possess, and they do produce desired hallucinogenic and stimulant effects. Because the active ingredients are similar pharmacologically to agents such as LSD and amphetamine, required treatment is often similar. The challenge for the Emergency Department physician is to recognize the potential for abuse of these botanic agents, their probable side effects, and the need for appropriate, usually supportive, treatment. There are many more plants with abuse potential than can be discussed in detail in an article of this size. Table 1 lists a number of other agents that might be misused. Phenylamine hallucinogens occur in several species and include N,N-dimethyltryptamine (DMT), N-monomethyltryptamine (MMT), 5-methoxy-N-N-dimethyltryptamine (5-MeO-DMT), 5-methoxy-N-monomethyltryptamine (5-MeO-DMT), 5-methoxy-N-monomethyltryptamine (5-MeO-MMT), 5-hydroxy-N-N-dimethyltryptamine (bufotenine or 5-H-DMT), and N,N-dimethyltryptamine-N-oxide (DMT-N-oxide).

Ambulatory Care

Toxicity of homeopathic products.

Homeopathy is an alternative form of medicine that employs infinitesimal doses, individualized treatments and the concept of "like cures like". Practitioners are attempting to gain credibility with standard medical practice by making their drug testing (provings) conform more closely to the placebo and double-blind crossover studies done by standard medicine. Overdoses of homeopathic remedies are seldom serious (although all should be evaluated) because of the very small doses employed.

Drug-Related Side Effects and Adverse Reactions

Five cases of Thermopsis poisoning.

Various Thermopsis species are found in the foothills and plains of the Rocky Mountains. There are no reported cases of human ingestion to Thermopsis reported in the literature. We report 5 cases of ingestion of seeds or flowers where the primary symptoms were nausea, vomiting and headache of several hours duration. As few as 6 seeds produced symptoms. The common names used by parents when calling the poison center could have easily lead to misidentification and a careful history and subsequent professional identification were required to ascertain the actual plant involved.

Child

Cigarette and nicotine chewing gum toxicity in children.

A prospective review of 51 cases of tobacco ingestion and 5 cases of nicotine resin chewing gum exposure was conducted to evaluate the incidence and degree of toxicity caused by these products in children. A dose-response relationship was observed for cigarette exposures. Nine of 10 children ingesting more than one cigarette or three cigarette butts developed signs or symptoms, while 12 of 24 ingesting lesser amounts became symptomatic (P less than 0.01). Severe symptoms (e.g. limb jerking and unresponsiveness) were only seen with the larger amounts. Nicotine resin gum produced toxicity in 4 of 5 children who chewed 1/2 to 4 pieces. Agitation, lethargy, tachycardia, hypotension, abdominal pain, and vomiting were seen within 30 min of exposure to the gum.

Chewing Gum

Toxicity of Cyclamen persium (Mill).

Cyclamen spp contain toxic saponins, although the number of serious exposures is very low. The plant was investigated for toxic and pharmacologic properties in the 1950's and 1960's, but there is little current investigation. Cyclamens have been found both as woodland plants and houseplants in Europe for years, and the plant is becoming increasingly popular in the US. Poison centers should be aware of the potential toxicity of this plant, especially that of the rhizomatous tubers. Additional data on exposures reported to poison centers may be helpful in further defining the toxicity of this plant.

Humans

Human overdose with the veterinary tranquilizer xylazine.

Three patients self-injected the veterinary tranquilizing agent xylazine (Rompun). The first patient developed mild bradycardia and hypotension, miosis, and a feeling of disorientation. The other two patients became apneic and required intubation and mechanical ventilation. Initial mild hypertension followed by mild hypotension and a mildly elevated blood glucose was seen in the second patient, whereas both the second and third patients developed mild bradycardia. Xylazine has structural similarity to the phenothiazines and pharmacological activity similar to clonidine. With increasing veterinary use, the availability and potential for human exposures may also increase.

Adult

Assessing mistletoe toxicity.

To assess the potential toxicity of mistletoe ingestion, data were collected on 14 cases of ingestion of one to three berries or one or two leaves of American mistletoe (Phoradendron sp) from 1982 to 1985. Eleven patients ingested berries and three ingested leaves; none became symptomatic. Nine patients were observed at home without intervention except poison center telephone follow-up. Five had induced emesis, including two who were referred to emergency departments for evaluation, where no findings other than ipecac-induced vomiting were noted. Also reviewed were data on a total of 318 cases of mistletoe ingestion reported to the Food and Drug Administration Poison Control case reporting system between 1978 and 1983 (n = 177) and the American Association of Poison Control Centers national data collection system (n = 141) in 1984. The majority remained asymptomatic and no deaths were recorded. These data allow the conclusion that ingestion of one to three mistletoe berries or one or two leaves is unlikely to produce serious toxicity.

Adolescent

Human ivermectin exposure.

Ivermectin is a veterinary antiparasitic medication for domestic animals. Two cases of human exposure to veterinary preparations of ivermectin are reported. Patient number one accidentally self-injected ivermectin and developed nausea, pallor, and transient pain and numbness in the affected extremity. Patient number two, a 4-year-old child, ingested an unknown amount of the paste preparation and remained asymptomatic. As ivermectin is being used with increasing frequency in veterinary medicine, more human exposures may be anticipated.

Adult

Blue-green algae poisoning.

Poisoning by blue-green algae occurs after an algal "bloom" caused by warm weather and algal concentration. On death or disintegration, the algae release liver toxins and neurotoxins (fast death factor). Although deaths are common in animal exposures, human exposures have been limited to various allergic reactions, mild liver enzyme elevation, and gastroenteritis. A case of animal deaths and its relationship to human exposures is discussed.

Animals