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Biomedical subjects

P M Wax

Publications and source records attributed to P M Wax.

At least 19 recordsLinked to original sources
PubMed2000

Fellowship training in medical toxicology: characteristics, perceptions, and career impact.

STUDY OBJECTIVE: To determine the number of physicians who have received fellowship training in medical toxicology and to describe fellowship-trained medical toxicologists' perceptions of fellowship training and its career impact. METHODS: All current medical toxicology fellowship directors were contacted by mail for information on who had trained at their program. Subsequently, a written survey was mailed to all current American College of Medical Toxicology members regarding work force and educational issues pertaining to medical toxicology. Fellowship-trained toxicologists were asked about their clinical and research experiences during fellowship, and career impact of toxicology fellowship training. RESULTS: Fellowship directors from 21 programs reported that 147 physicians had completed a toxicology fellowship since 1970. Of the 236 current American College of Medical Toxicology members surveyed, 160 (68%) responded. Ninety-four of the 160 (59%) are fellowship trained. Sixty-four of the 94 (68%) fellowship-trained toxicologists are emergency medicine board certified. About half the respondents believed they did not have enough inpatient and outpatient experiences during fellowship, but poison center time was more than adequate. After fellowship, 91% remain in medical toxicology although 78% spend less than 3/4 time in toxicology-related activities. More than 50% of respondents believed that fellowship training impacted their career by choosing an academic career, developing a toxicology clinical program, and altering clinical responsibilities. CONCLUSIONS: Most fellowship-trained toxicologists only work part-time in medical toxicology, but fellowship training has significant impact on choice of academic career and altering clinical responsibilities. Training concerns include limited bedside experiences, particularly outpatient, and uncertain job prospects.

Career Mobility↗
PubMed2000

Recovery from severe arsenic-induced peripheral neuropathy with 2,3-dimercapto-1-propanesulphonic acid.

CASE REPORT: A 33-year-old female with a 1.5-year history of multisystem illness was diagnosed with arsenic poisoning. Twenty-four-hour urine arsenic was 1030 microg/dL (normal 0-99) and root hair arsenic was 130 microg/g (normal 0-3). Despite treatment with succimer meso-2,3-dimercaptosuccinic acid, her neuropathy progressed to ventilator dependence and quadriplegia. Subsequent intravenous treatment with 2,3-dimercapto-1-propanesulfonic acid sodium salt was associated with arsenic diuresis, marked neuropathic improvement, and extubation. At 1-year follow-up, neuropathy was limited to mild distal lower extremity weakness and sensory loss. The use of 2,3-dimercapto-1-propanesulphonic acid in the treatment of severe arsenic neuropathy was associated with increased urinary elimination of arsenic and dramatic clinical recovery.

Adult↗
PubMed2000

Mercury contamination of heavy metal collection containers.

We investigated discordant urinary mercury testing results from 2 patients with potential mercury exposures. Two patients had mercury levels of 634 and > 1,000 micrograms/L respectively. Although repeat 24 h urine mercury levels were elevated, spot urines were negative. Investigation revealed that technical HCl with high mercury content had been added to the 24 h urine collection containers. Subsequently, 20 hospitals were contacted to determine their heavy metals testing procedure and to analyze the acid used for mercury. Most hospitals contacted used acid in the preparation of their urine heavy metal collection containers. Of 13 HCl samples tested, 5 had low levels of mercury and 1 had heavy mercury content. Acid added to heavy metal collection containers should be of high purity grade to avoid mercury contamination of samples.

Adult↗
PubMed2000

Treatment of atenolol overdose in a patient with renal failure using serial hemodialysis and hemoperfusion and associated echocardiographic findings.

A 28-y-old male with end stage renal failure (ESRF) received an overdose of atenolol. Subsequent cardiac arrest and prolonged cardiogenic shock required aggressive pharmacologic support, intraaortic balloon pump insertion, and mechanical ventilation. Four hemodialyses with charcoal hemoperfusion were performed over 72 h. Plasma atenolol levels decreased from 7.4 mg/L to 2.1 mg/L although significant rebound occurred between dialyses. Transthoracic echocardiogram showed global hypokinesis with an ejection fraction (EF) of 5-10% prior to cardiac arrest, compared to baseline and following EF's of approximately 35%. Our experience supports hemodialysis for ESRF patients with atenolol toxicity.

Adrenergic beta-Antagonists↗
PubMed1999

Toxicology training of paramedic students in the United States.

A 16-item survey was mailed to the directors of 618 paramedic training programs in the United States to determine (1) the number of lecture hours devoted to toxicology topics and (2) how often paramedic training includes a rotation in a poison control center. The response rate was 82%. Toxicology accounts for approximately 2% of paramedic students' total training. Cardiovascular drug toxicity and hazardous materials are discussed for over 60 minutes by more than 50% of paramedic training programs. Four paramedic programs have no lecture time on cyclic antidepressant overdoses and one program has no lecture time on carbon monoxide poisoning. Eighty-one percent (377 of 467) have access to a regional poison control center; 11% (42 of 377) use the poison control center as a paramedic training site. Some US paramedic training programs spend insufficient time covering topics that have significant out-of-hospital morbidity. Although poison control centers are often available, they are underutilized for paramedic training.

Allied Health Personnel↗
PubMed1999

Prehospital epinephrine overdose in a child resulting in ventricular dysrhythmias and myocardial ischemia.

INTRODUCTION: Epinephrine overdoses in children have been associated with supraventricular tachycardia. Myocardial ischemia subsequent to epinephrine overdose has not been reported in pediatric patients. CASE REPORT: We report a case of ventricular dysrhythmias and myocardial ischemia in a 5-year-old boy who received 10 times the recommended dose of subcutaneous epinephrine. Prehospital providers administered the epinephrine, believing it was part of a "high-dose" epinephrine protocol. DISCUSSION: There is no role for high-dose epinephrine in the treatment of allergic reactions or asthma. Careful epinephrine dosing, using mg/kg and verifying the volume, dilution, and route of administration is essential to prevent epinephrine toxicity.

Adolescent↗
PubMed1999

Should home ipecac-induced emesis be routinely recommended in the management of toxic berry ingestions?

Poison center (PC) management of toxic berry ingestions may include recommendations to administer syrup of ipecac (SI) regardless of the number of berries ingested. We investigated whether the routine use of SI in the home management of asymptomatic single or few (< 6) berry ingestions may be unnecessary. A prospective, randomized clinical trial compared SI + home observation (HO) to HO alone for management of pediatric toxic berry ingestions. Subjects were children 9 mo to 5 y who ingested a small number (< 6) of Taxus sp (yew), Solanum americanus (nightshade), Ilex sp (holly) or unknown potentially toxic berries. Exclusions were symptomatic subjects, ingestion of more than 1 type of berry or other plant part, or contraindication to SI. Outcome variables consisting of symptom assessment and disposition were assessed 24 h following the ingestion. Over a 27-mo period 103 subjects were entered into the study; 45 received SI/HO and 51 received only HO. While 100% of the SI/HO group experienced vomiting, none of the HO group vomited. Diarrhea and sedation were more common in the SI/HO group. Use of SI in the home management of young children who ingest fewer than 6 toxic berries (yew, nightshade, holly or unknown) and who are asymptomatic when the PC is contacted may be responsible for the majority of symptoms. Ingestion of small amounts of berries may require no intervention beyond observation. Methodological limitations of this study included the lack of confirmed identification of the berries and the inability to confirm ingestion and absorption.

Child, Preschool↗
PubMed1998

Prehospital gastrointestinal decontamination of toxic ingestions: a missed opportunity.

The purpose of this study was to determine if emergency medical services (EMS) providers routinely initiate field gastrointestinal decontamination of adult drug overdose patients transported to the emergency department (ED). A retrospective prehospital chart review was performed on adult patients identified as drug overdose who were transported by EMS. ED charts on patients transported to a university hospital were reviewed for follow-up data. Prehospital care records showed that gastrointestinal decontamination was initiated in only 6 of 361 (2%) patients, all of whom received ipecac. No patient received activated charcoal. The median transport time was 25 minutes (range, 5 to 66 minutes). Follow-up data on patients transported to the university hospital revealed that 30 of 43 (70%) patients who might have been suitable candidates for prehospital activated charcoal actually received activated charcoal in the ED. Median time to activated charcoal in the ED was 82 minutes (range, 32 to 329 min). Use of activated charcoal in the field appears to be deferred despite its known loss of efficacy over time. The failure to start activated charcoal in the field contributes to the delay in initiating activated charcoal therapy.

Administration, Oral↗
PubMed1997

Analeptic use in clinical toxicology: a historical appraisal.

BACKGROUND: The introduction and increasing popularity of the barbiturates during the first two decades of the 20th century was associated with a new life threatening toxicological problem: the barbiturate overdose. METHODS: This paper reviews the four major phases of analeptic use. As interest in the principles of physiologic antagonism between stimulants and depressants grew, analeptic agents were increasingly used to treat the obtundation and respiratory depression of barbiturate overdose. At first, naturally occurring stimulants such as camphor, strychnine, picrotoxin, and caffeine were used in desperate attempts to awaken patients. During the 1930s, and continuing at some centers into the 1960s, an increasing number of synthetic analeptics agents such as nikethamide, pentylenetetrazol, bemegride, amphetamine, and methylphenidate were enthusiastically recommended as barbiturate antidotes, often at very high doses. Unfortunately, utilizing generous amounts of multiple convulsants was not without its share of complications. Using this analeptic strategy the mortality rate after moderate to severe barbiturate overdose remained as high as 45%. Beginning in the mid-1940s a group of Scandinavian physicians pioneered a revolutionary approach to sedativehypnotic overdose that rejected the use of analeptics and relied on respiratory ventilation and supportive care. CONCLUSIONS: Although barbiturate overdose mortality decreased to less than 1% using this strategy, it would take another 20 years before this technique was universally adapted. While analeptic therapies for the treatment of drug overdose have now been abandoned, one of these analeptics, methylphenidate, currently enjoys wide use in the treatment of attention deficit hyperactivity disorder.

Barbiturates↗
PubMed1996

Five days of whole-bowel irrigation in a case of pediatric iron ingestion.

The maximum duration and volume of polyethylene glycol electrolyte solution (PEG-ELS) that can be safely administered during whole-bowel irrigation of the poisoned patient are poorly defined. We present a case of a 33-month-old boy who ingested at least 160 mg/kg elemental iron and received 44.3 L of PEG-ELS (2,953 ml/kg) over 5 days because of the persistence of iron tablets in teh gastrointestinal tract. The child remained clinically well after initiation of PEG-ELS therapy, and further significant iron absorption did not appear to occur. The rectal effluent cleared within 2 days of the start of PEG-ELS therapy despite the persistence of iron in the gastrointestinal tract as shown on radiography. No adverse effects resulted from teh large volume or duration of the PEG-ELS therapy. This is the greatest reported volume of PEG-ELS to be used for whole-bowel irrigation in the treatment of a toxic ingestion.

Child, Preschool↗
PubMed1996

It's happening again--another diethylene glycol mass poisoning.

What lessons have we learned? Certainly, the similarities among these DEG poisoning tragedies are striking. Their raison d'êrre, especially in the last few poisoning epidemics, appears to be financially driven. DEG, an inexpensive solvent, is more profitable to use than the more expensive propylene glycol or glycerin. Despite the world wide proliferation of chemicals, pharmaceutical regulation is carried out at a national level. Certainly this sort of poisoning is bound to occur again unless much stricter pharmaceutical manufacturing oversight is employed and enforced throughout the world. Developing countries with fewer resources to implement such quality control monitoring will continue to be at higher risk for such poisoning epidemics. For now, we need to remain vigilant or such history will continue to repeat itself.

Bangladesh↗
PubMed1995

Elixirs, diluents, and the passage of the 1938 Federal Food, Drug and Cosmetic Act.

The Elixir Sulfanilamide disaster of 1937 was one of the most consequential mass poisonings of the 20th century. This tragedy occurred shortly after the introduction of sulfanilamide, the first sulfa antimicrobial drug, when diethylene glycol was used as the diluent in the formulation of a liquid preparation of sulfanilamide known as Elixir Sulfanilamide. One hundred five patients died from its therapeutic use. Under the existing drug regulations, premarketing toxicity testing was not required. In reaction to this calamity, the U.S. Congress passed the 1938 Federal Food, Drug and Cosmetic Act, which required proof of safety before the release of a new drug. The 1938 law changed the drug focus of the Food and Drug Administration from that of a policing agency primarily concerned with the confiscation of adulterated drugs to a regulatory agency increasingly involved with overseeing the evaluation of new drugs. The Elixir Sulfanilamide tragedy, its effect on drug regulations, and the history of other diethylene glycol and diluent mass poisonings are discussed.

Drug Approval↗
PubMed1995

Intestinal infarction due to nifedipine overdose.

The first case of intestinal infarction associated with nifedipine overdose is presented. This is also the first reported case of an overdose with an extended release nifedipine preparation. The formation of a large gastric concretion of nifedipine tablets may have enhanced its local vasodilatory effects thereby producing mesenteric hypoperfusion, ischemia, and infarction.

Abdomen, Acute↗
PubMed1995

Tributyltin use in interior paints: a continuing health hazard.

We report on five patients who developed mucous membrane irritation after inhalational exposure to an interior use latex paint containing the organotin compound bis(tributyltin) oxide. Stricter regulations regarding the use of bis(tributyltin) oxide with interior paint would most likely have prevented these cases of tributyltin toxicity. Bis(tributyltin) oxide should not be used with paint intended for interior use.

Adult↗