Cases of nonfatal (51) and fatal (38) ingestions involving ethchlorvynol over a 14-year period (1975 through 1988) were reviewed in order to evaluate the current status of ingestion of this drug. In both series of cases men and women were involved approximately equally. Sixty-three percent of cases in both series occurred during the period 1975 through 1980. Most (78% of nonfatal and 89% of fatal) ingestions involved other drugs in addition to ethchlorvynol. Physical findings for nonfatal ingestions and causes of death for fatal ingestions are presented. Blood ethchlorvynol concentrations are discussed, and a composite of the average patient for each series is presented. Although ethchlorvynol abuse appears to be decreasing with time, it still occurs, and a search for this sedative-hypnotic agent should be included in the so-called "toxicology screen."

Adolescent↗

PubMedDate not supplied

Interpretation of blood and tissue concentrations in fatal self-ingested overdose involving amitriptyline: an update (1978-1979).

Thirty-two cases of fatal self-ingested overdose involving amitriptyline were studied over the two-year period 1978 to 1979. The average decedent was a 44-year-old woman who ingested amitriptyline and at least one other drug (usually ethanol, diazepam, propoxyphene, or codeine). The mean concentrations of amitriptyline and nortriptyline were significantly higher in liver than in myocardium, and they were significantly higher in myocardium than in blood. In addition, concentrations in these tissues showed significant correlation with each other. The mean tissue concentrations of amitriptyline and nortriptyline in this series of overdoses were significantly greater than those in fourteen other decedents whose deaths were not due to drug overdose but involved amitriptyline as an incidental finding. The mean ratio of amitriptyline to nortriptyline in each tissue was also significantly higher in overdose than those in the corresponding tissues of the non-overdose group, suggesting that the former ingestions were more acute. The estimated survival times showed no significant correlation with tissue concentrations of either amitriptyline or nortriptyline.

Adult↗

PubMedDate not supplied

A study of salicylate and caffeine excretion in the breast milk of two nursing mothers.

Salicylate excretion was studied in the breast milk of a nursing mother (Patient A) taking chronic therapeutic doses of aspirin, and caffeine excretion was monitored in the breast milk of a nursing mother (Patient B) who was a heavy coffee drinker. Salicylate concentrations were maximal in serum at 2.25 hours (10.8 mg/dL) and in milk at 3.00 hours (1.0 mg/dL) following 975 mg of aspirin in Patient A. Caffeine concentrations peaked at 5.50 hours in serum (2.14 micrograms/mL) and at 2.00 hours in milk (1.15 micrograms/mL) during a period of steady coffee drinking by Patient B. Milk:serum concentration ratios ranged up to 0.08 for patient A and up to 0.63 for Patient B, demonstrating that relatively more caffeine than salicylate was excreted into milk. Sodium, potassium, pH, and percent solute remained essentially unchanged in milk samples from both patients throughout the study periods so that changes in the state of hydration of pH of the milk could not be implicated for the observed excretion patterns. More than 25 liters of milk at its peak drug concentration would have to be consumed by the infants of Patients A and B respectively to provide the salicylate content of one aspirin tablet or the caffeine content of an average cup of coffee.

Adult↗

PubMedDate not supplied

The question of natural selection against mutable-to-terminator codons.

Codons that differ from a terminator triplet by only a single base are sometimes thought, because of their greater risk of undergoing a harmful mutation, to be kept at a reduced frequency by natural selection. The present study on human genes shows that these codons are infrequent, but their low frequency is not directly related to their risk of mutation to terminator. Rather, it is a consequence of their ending in A or G; comparable A-ending and G-ending codons that are not mutable to terminator are also infrequent. Natural selection does not appear to have depressed the frequency of mutable-to-terminator codons by directly eliminating some of them individually. It may have depressed their frequency indirectly by adjusting mutation rates in the population so that most of the purine-ending codons--and consequently most of the mutable-to-terminator ones as well--are infrequent.

Adenosine↗

PubMedDate not supplied

Blood concentrations and clinical findings in nonfatal and fatal intoxications involving glutethimide and codeine.

Blood concentrations and clinical findings were evaluated in twenty-six nonfatal and twelve fatal intoxications involving the combination of glutethimide and codeine ("loads"). The mean glutethimide concentration was 10 +/- 5 mg/L for nonfatal cases (range 2-18 mg/L) and 13.9 +/- 6.6 mg/L for fatal cases (range 4.6-26.4 mg/L). The mean codeine concentration for fatal intoxications was 1.21 +/- 1.17 mg/L (range 0.13-4.32 mg/L). Codeine concentrations were not measured in cases of nonfatal intoxication. Nine nonfatal cases required hospitalization on a medical ward (mean length of stay 3 +/- 3 days). Depressed level of consciousness was the most common abnormal physical finding (24 cases); 18 patients were lethargic but arousable with nonpainful stimulation and 6 patients with serum glutethimide concentrations of 10 mg/L or greater were comatose. The level of consciousness showed statistically significant correlation with the glutethimide concentration (P less than 0.01). Twenty-four nonfatal intoxications involved at least one other drug in addition to glutethimide and codeine (salicylates in 12 and acetaminophen in 4), while only 7 fatal cases involved at least one additional drug (acetaminophen and diazepam in 3 each). The finding of glutethimide should prompt a search for codeine and vice versa, especially when the presence of either does not in and of itself explain the clinical condition of the patient.

Adult↗