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Biomedical subjects

K W Kulig

Publications and source records attributed to K W Kulig.

At least 37 records · Page 2Linked to original sources
PubMed1988

Ethyl alcohol (ethanol)-containing cologne, perfume, and after-shave ingestions in children.

Colognes, perfumes, and after-shaves containing ethyl alcohol (ethanol) are frequently ingested by children. These products may contain from 50% to 99% ethanol. To determine if ingestion of colognes, perfumes, or after-shaves by children results in serious ethanol toxic reactions, this retrospective study was performed. One hundred twenty-three cases of children younger than 6 years old who ingested these products were reviewed. The cases were arbitrarily divided into three groups based on the amount ingested by history. Group 1 included children in whom less than 30 mL was ingested; group 2, 30 to 60 mL was ingested; and group 3, more than 60 to 105 mL was ingested. Of the 102 patients in group 1, no children experienced symptoms or signs. One of 17 children in group 2 was described by parents as sleepy but was asymptomatic one hour later. Two of four children in group 3 behaved as if intoxicated, yet blood ethanol levels were undetectable within 2 1/2 hours after ingestion. Based on our study, asymptomatic children who ingested by history less than 105 mL of a cologne, perfume, or after-shave and remain asymptomatic can be safely watched at home. All children with symptoms of intoxication need health care facility referral.

Alcoholic Intoxication↗
PubMed1988

Magnesium levels after magnesium-containing cathartics.

To determine the effect on serum Mg++ levels of oral Magnesium-containing cathartics (MgCC) used in the treatment of suspected drug overdose, a prospective, non-randomized study of 24 cases of suspected drug overdose was conducted. Ten cases admitted to the observation unit were assigned to the single dose MgCC group. Fourteen cases admitted to either the ICU or the observation unit were assigned to the multiple dose MgCC group. Single dose cases received 30 gm of magnesium sulfate (MgSO4) at 0 hours. Multiple dose cases received 3 30 gm doses of MgSO4 at 0, 4, and 8 hours. Mg++ levels were measured prior to each MgSO4 dose and 1 and 4 hours after the final dose in both groups. In the single dose group, there was no difference between baseline Mg++ levels and post MgSO4 levels, and only 2/10 developed slightly elevated levels (2.2, 2.3 mEq/L). In the multiple dose group, levels increased and remained significantly higher than baseline after the second MgSO4 dose, and 9/14 developed elevated levels (2.2 to 5.0 mEq/L). All patients who developed elevated Mg++ levels had normal BUN and creatinine values. When the single and multiple dose groups were compared, baseline Mg++ levels were no different (1.68 +/- 0.21 vs 1.69 +/- 0.24, p = 0.952), but peak Mg++ levels were significantly higher in the multiple dose group (1.80 +/- 0.31 vs 2.61 +/- 0.86, p = 0.004). Cases that developed hypermagnesemia had slightly higher baseline Mg++ levels (1.78 +/- 0.22 vs 1.60 +/- 0.19 mEq/L, p = 0.041). In the multiple dose group, higher peak Mg++ levels were noted in cases involving ingestions of anticholinergic or opioid drugs (2.83 vs 1.98, p = 0.025). Hypermagnesemia developed in some cases with normal renal function, blood pressure, and urine output. We conclude that significant hypermagnesemia can occur rapidly after use of multiple dose Mg++ cathartics in standard doses in patients with normal renal function.

Administration, Oral↗
PubMed1988

Ibuprofen overdose--a prospective study.

Of 61 cases of ibuprofen overdosage reported consecutively to the Rocky Mountain Poison and Drug Center from September 1985 through April 1986, 16 were excluded because of incomplete follow-up or concurrent medication ingestion. A toxic reaction developed in 7 (16%) of the remaining 45 patients. Nausea, vomiting, abdominal cramps, mild central nervous system depression, coma, tachycardia, apnea, metabolic acidosis with or without respiratory alkalosis, hematemesis, and oliguric renal failure were noted. Two of six adults had a toxic reaction, and one died. Among pediatric patients, 5/39 (13%) had a toxic reaction. Of patients whose ibuprofen ingestion was less than 104 mg per kg, none became ill. All patients in whom the time of ingestion was known (six of seven) and who had a toxic reaction did so within four hours of ingestion. An ibuprofen overdose, although usually benign, can occasionally produce serious toxicity.

Adolescent↗
PubMed1987

Clinical effects of accidental levothyroxine ingestion in children.

Forty-one children, aged 1 to 5 years, who accidentally ingested levothyroxine sodium were studied. Symptoms possibly associated with the ingestion occurred in 11 patients (27%). These symptoms (tachycardia, hyperactive behavior, fever, vomiting, diarrhea, diaphoresis, and flushing) were categorized as minor and all resolved without treatment. Because observed effects were generally mild and often unrelated to either estimated amounts of hormone consumed or serum thyroxine levels, a conservative approach to patient treatment is recommended in cases of levothyroxine ingestion in children.

Administration, Oral↗
PubMed1987

Intravenous epinephrine abuse.

A 19-year-old man with a history of intravenous cocaine and amphetamine abuse injected 1.1 mg of epinephrine intravenously from an over-the-counter bronchodilator inhaler. Within seconds, headache, nausea, numbness of hands and feet, precordial chest discomfort, and palpitations developed. The patient was given a sublingual nitroglycerin tablet by a bystander and promptly had a syncopal episode. Hypotension was observed in the emergency department 10 minutes later. Administration of 2 L of Ringer's lactate maintained blood pressure at 80-90 mm Hg systolic. An electrocardiogram showed ischemic changes in the precordial leads. Cardiac enzymes remained normal. Mild hypokalemia and hyperglycemia were observed. This case illustrates an unusual route of abuse of an over-the-counter epinephrine bronchodilator.

Adult↗
PubMed1987

Acute toxic blindness: unrecognized quinine poisoning.

Two cases of acute blindness due to quinine poisoning are presented. In both cases, the diagnosis was initially unsuspected. In addition, tinnitus, decreased hearing, vomiting, abdominal pain, and confusion were noted in one patient, and the other experienced decreased hearing, headache, confusion, tachycardia, later bradycardia, and first-degree atrioventricular block. The onset of blindness was delayed more than 12 hours after ingestion in both cases. Quinine levels of 13.6 micrograms/mL and 18.6 micrograms/mL were demonstrated (therapeutic = 1 to 3 micrograms/mL). One patient developed marked constriction of visual fields and some residual decreased acuity, while the other regained normal visual acuity.

Acute Disease↗
PubMed1987

TCA cardiac toxicity.

Explore the source record for details and available documents.

Antidepressive Agents, Tricyclic↗
PubMed1987

Intravenous theophylline poisoning and multiple-dose charcoal in an animal model.

Large overdoses of IV theophylline (50 to 100 mg/kg) were administered to five canines on two separate occasions. On day one, with no charcoal administered, theophylline levels were serially obtained between ten minutes and 12 hours after infusion and the animals were recovered from anesthesia. Three days later the same dose of theophylline was administered, but then 50 g activated charcoal was placed through a nasogastric tube into the duodenum every hour for eight doses. In all five animals tested, activated charcoal significantly decreased the area under the serum concentration-time curve, decreased the half-life of elimination, and increased the clearance of theophylline. This effect on pharmacokinetics was not seen when the nasogastric tube was put into the stomach instead of the small bowel because the charcoal administered did not pass beyond the pylorus. In a separate experiment in which bile theophylline concentrations were measured, it was demonstrated that enhanced elimination was not from interruption of enterohepatic circulation of theophylline. This suggests that the demonstrated physiologic mechanism is that of gastrointestinal dialysis.

Animals↗
PubMed1987

Nitrite/thiosulfate treated acute cyanide poisoning: estimated kinetics after antidote.

A 34 year old, 73 kg man ingested a 1 gram potassium cyanide pellet in a suicide attempt. Within one hour, coma, apnea, metabolic acidosis, and seizures developed. Sodium nitrite and sodium thiosulfate were administered. Dramatic improvement in the clinical condition occurred by the completion of antidote infusion. Methemoglobin level was 2% immediately after nitrite administration. Serial whole blood cyanide levels were obtained, documenting a highest measured level of 15.68 mcg/mL. Estimations of toxicokinetic parameters including terminal half-life (t 1/2) (19 hours), clearance (163 mL/minute), and volume of distribution (Vd) (0.41 L/kg) were calculated. The nitrite/thiosulfate combination was clinically efficacious in this case and resulted in complete recovery.

Adult↗
PubMed1986

Ibuprofen overdose: 126 cases.

In this study of ibuprofen overdose, symptoms developed in 19% of patients (24 of 126)--in 7% of children (6 of 88) and in 47% of adults (18 of 38). Central nervous system depression, seizures, gastrointestinal disturbances, bradycardia, hypotension, apnea, abnormal renal functions, hematuria, nystagmus, and blurred vision were observed. No patients became symptomatic more than four hours after ingestion. There was no significant difference (P greater than .05) between symptomatic and asymptomatic adult groups in either total milligrams or milligram-per-kilogram amounts ingested by history. Pediatric patients who became symptomatic had a mean ingestion by history of 440 mg/kg; those who remained asymptomatic had a mean ingestion by history of 114 mg/kg (P less than .001). No patients ingesting less than 99 mg/kg by history developed any symptoms. Two children had seizures or apnea and one died. Ibuprofen occasionally may cause serious toxicity in overdose.

Adolescent↗
PubMed1986

Acute ingestions of boric acid.

Four patients with elevated serum boric acid levels after single, acute ingestions of 10 to 297 grams were reported to the Rocky Mountain Poison and Drug Center (RMPDC) between January 1983 and August 1985. Systemic effects were absent. In 1983-4, 364 cases of boric acid exposure were reported to the RMPDC with only one fatality from a probable chronic ingestion. Vomiting, nausea, diarrhea, and abdominal cramps were rather common. Systemic effects were notably absent in acute ingestions. Five of three hundred sixty-four patients had measured serum levels and were the only ones hospitalized. These observations suggest that significant poisoning is unlikely to result from a single, acute ingestion of boric acid. Serum boric acid levels appear to correlate poorly with clinical toxicity following acute ingestion.

Acute Disease↗
PubMed1986

Cyanide poisoning from laetrile ingestion: role of nitrite therapy.

A 4-year-old child ingested laetrile and almost died of cyanide poisoning. Treatment with the Lilly cyanide antidote kit resulted in rapid, complete recovery. Extremely high whole blood cyanide levels were documented. The necessity for use of the antidote kit in serious cyanide poisoning has recently been questioned. This case demonstrates benefit from antidotal treatment.

Acute Disease↗
PubMed1986

Hemorrhagic pancreatitis associated with acetaminophen overdose.

A 19-yr-old man ingested 25 g of acetaminophen in a suicide attempt. Twenty-one hours after the ingestion the plasma acetaminophen level was potentially hepatoxic at 62 micrograms/ml. The toxicology screen was negative for all other drugs. Thirty-six hours after admission the patient developed an acute abdomen with a serum amylase of 1500 IU. Peritoneal lavage revealed a grossly hemorrhagic fluid. Exploratory laparotomy revealed necrotic pancreatitis. Hepatoxicity with the peak SGOT greater than 2000 IU and a mild renal toxicity with the creatinine of 1.9 mg/dl occurred despite late initiation of treatment with n-acetylcysteine. No other etiology for the pancreatitis was found. Peritoneal irrigation was continuously performed through a surgically placed dialysis catheter. Pancreatitis associated with acetaminophen overdose has been reported twice in the past. Although the pathophysiology of the pancreatic injury is obscure, the lack of other etiological factors and temporal association of the pancreatitis with acetaminophen-induced hepatic and renal toxicity suggest a causal relationship.

Abdomen, Acute↗
PubMed1985

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↗