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PubMed1994

Oral rehydration solutions: increased water and sodium absorption by addition of a viscosity-enhancing agent in a rat model of chronic osmotic diarrhea.

Viscosity-enhancing agents such as carboxymethylcellulose (CMC) can alter absorption of solutes and fluid exchange in the small intestine. We investigated whether the standard World Health Organization oral rehydration solution (WHO-ORS) with the addition of CMC would improve net water and sodium absorption in rats using an in vivo intestinal perfusion technique. Four WHO-ORS, containing either 0, 2.5, 5.0, or 10.0 g/L of CMC, were perfused in rats with a well-tested model of cathartic-induced chronic osmotic diarrhea (D) and in normal controls (C). In D rats, the ORSs with CMC improved sodium absorption at the three concentrations used (p < 0.01). The same effect was shown in C rats. Net water absorption was also enhanced in D rats given ORSs with CMC, although the changes in C animals were less marked. The improvement in sodium and water absorption in both C and D rats positively correlated with the log of relative ORS viscosity. Ultrastructural examination of tissues perfused with 10 g/L of CMC showed an extended brush border glycocalyx. This study indicates that CMC added to WHO-ORS in the perfused rat jejunum improves the effectiveness of the solution by increasing sodium and water absorption.

Animals↗
PubMed1993

[Toad or toad cake intoxication in Taiwan: report of four cases].

The parotid glands and skin of the toad contain toxic substances. Ingestion of toad or toad cake may result in intoxication. Clinically, it may be predominantly manifested by a digitalis-like cardioactive effect. During the last six years, the National Poison Center of Taiwan has collected four cases of toad or toad cake intoxication: two cases were toad intoxication and two cases were toad cake intoxication. All four cases manifested with general weakness; three cases showed bradycardia, vomiting and diarrhea; two cases had numbness of the oral cavity; one case had excessive salivation; and two cases showed a consciousness change. In one case, an EKG showed bradycardia, and a first and second degree A-V block; this patient died of ventricular fibrillation. The prognosis in two cases was good. We lost contact with the last patient. The treatment principles in toad or toad cake intoxication is life support. If ingested, treatment is directed at prevention of absorption, including emesis, gastric lavage, activated charcoal and cathartics. Atropine, a pacemaker and other antiarrhythmic agents may be helpful in treating cardiovascular toxicity.

Adult↗
PubMed1994

Polarographic and absorptive stripping voltammetric determination of mitoxantrone, emodin and chrysarobin using mercury and glassy carbon electrodes.

Polarographic and voltammetric methods were used to study drugs of anthrone derivatives: mitoxandrone (antineoplastic), emodin (cathartic) and chrysarobin (antipsoriatic) on mercury and glassy carbon electrodes. The surface-active properties were exploited for developing a highly sensitive adsorptive stripping voltammetric method for determination of trace amounts of these compounds. Effective pre-concentration was obtained at glassy carbon electrode, with the surface species being measured via its reduction or oxidation, respectively. It was concluded that observed cathodic and anodic currents had the diffusive character. A simple, quick and accurate methods for the determination of all studied compounds in pure form and mitoxantrone in vials have been developed. The acetate buffer pH 4.6 containing 5 to 30% ethanol was used as a supporting electrolyte. The linear calibration range was 0.5 = 100 microg cm-3 on mercury and 25 - 250 ng cm-3 on glassy carbon electrode.

Anthracenes↗
PubMed1993

[Role of medicinal coal in primary management of poisoning].

Primary detoxication by ipecac-induced emesis or gastric lavage is incomplete. In mild to moderate childhood poisoning administration of activated charcoal alone without gastric emptying is often more effective, because it binds toxins promptly. In-vitro and in-vivo studies of many substances have shown good adsorption to activated charcoal (e.g. digitalis, beta-blocking agents, phenobarbitone, carbamazepine, theophylline). If in-vitro adsorption is moderate to poor, administration of activated charcoal might nevertheless prove clinically valuable by altering the severity of symptoms such as has been shown with acetaminophen, salicylates or organophosphate insecticide intoxications. Possible risks are shown and dosage regimens of activated charcoal are given alongside an evaluation of additional cathartics in the initial treatment of childhood poisonings. The role of repeated doses of activated charcoal as a method of secondary detoxication in comparison with hemoperfusion techniques and its significance in clinical routine is pointed out. General conclusion: In mild to moderate childhood poisoning early administration of activated charcoal alone after consultation of pediatrician and/or poison center specialists is an adequate therapy.

Adsorption↗
PubMed1993

Colonic toxicity of administered medications and chemicals.

Although medication-induced colonotoxicity is uncommon, it is important that it be recognized, because the initial therapy for this condition is medication discontinuation. This review categorizes the association between the listed medications and colonotoxicity as "well-established" or "probable," according to the following criteria: number of clinical studies by independent clinical investigators, total number of reported cases, plausibility of an association based on experimental and pharmacologic studies, and validity of an association in each reported case. Medications associated with colonic ischemia include cocaine, ergotamine, estrogen, amphetamines, digitalis, methysergide, and vasopressin. Medications associated with colonic pseudoobstruction include narcotics, phenothiazines, vincristine, atropine or other anticholinergics, ganglionic blocking agents, and tricyclic antidepressants. Medications promoting infectious or necrotizing enterocolitis include numerous antibiotics associated with pseudomembranous colitis, deferoxamine associated with Yersinia enterocolitis, chemotherapy associated with neutropenic colitis, and hyperosmolar medications or formulas in infants. Medications associated with an allergic, inflammatory, or cytotoxic colitis include gold compounds, nonsteroidal antiinflammatory drugs, alpha-methyldopa, flucytosine, methotrexate, salicylates, and sulfasalazine. Potassium chloride, administered in slow-release wax matrices, can cause intestinal ulcers. Chronic cathartic use leads to colonic hypomotility and abdominal distention. Methysergide can cause a colonic stricture due to retroperitoneal fibrosis. Intrarectally administered compounds that have produced a toxic colitis include powerful acids, bases, and other corrosives. Enemas using hypertonic radiographic contrast agents have been associated with colitis in patients with colonic obstruction.

Colonic Diseases↗
PubMed1993

Prevalence of encysted Toxoplasma gondii in raptors from Alabama.

Little is known about the prevalence of encysted Toxoplasma gondii in wild birds. We examined the hearts and breast muscles from 101 raptors for encysted T. gondii. All of the raptors had been submitted for necropsy to the State Veterinary Diagnostic Laboratory, Auburn, Alabama. Tissues were digested in acid-pepsin solution and inoculated into groups of 3-5 laboratory mice. Toxoplasma gondii was isolated from 27 of 101 (26.7%) raptors: 8 of 12 (66.7%) red-shouldered hawks (Buteo lineatus), 13 of 27 (41.1%) red-tailed hawks (Buteo jamaicensis), 1 of 4 (25%) Cooper's hawks (Accipiter cooperi), 1 of 5 (20%) great horned owls (Bubo virginianus), 4 of 15 (26.7%) barred owls (Strix varia), and 1 of 3 (33.3%) kestrels (Falco sparverius). Toxoplasma gondii was not isolated from 3 broad-winged hawks (Buteo platypterus), 3 sharp-shinned hawks (Accipiter striatus), 6 barn owls (Tyto alba), 9 screech owls (Asio otus), a Mississippi kite (Ictinia misisippiensis), 2 golden eagles (Aquila chrysaetos), a bald eagle (Haliaeetus leucocephalus), 4 ospreys (Pandion haliaetus), 4 turkey vultures (Cathartes aura), or 2 black vultures (Coragyps atratus). No significant difference (P > 0.05) in prevalence was detected based on sex using chi-square analysis. Chi-square analysis of the data demonstrated that adult raptors had encysted stages of T. gondii significantly (P < 0.05) more often than did immature raptors.

Age Factors↗
PubMed1993

[Lactulose and its derivatives--treatment of hepatic encephalopathy and other possible indications for its use].

Lactulose and lactitol, the synthetic compounds of lactose, are poorly absorbed from the small intestine, and both are almost exclusively metabolized by the bacterial flora of the colon. These disaccharides shorten the small bowel transit time mechanically and lower the pH of the bowel, both by their osmotic effects and by the acidic pH of their metabolites. Lactulose and lactitol diminish the absorption of ammonia and metabolites of other toxic proteins by two distinct mechanisms; by exerting a cathartic effect and by suppressing the dissociation of ammonia. Lactulose and lactitol are the classical therapy of choice for the treatment of hepatic encephalopathy since 1964 and since 1982, respectively. Another indication is, the treatment of constipation. Because lactulose decreases the concentration of cholic acid and may prevent its absorption, the drug was recently suggested to be successful for the prevention of recurrence of cholesterol stone formation, and to be useful as an anticarcinogenic agent.

Cholic Acid↗
PubMed1993

A comparison of the effectiveness and patient tolerance of oral sodium phosphate, castor oil, and standard electrolyte lavage for colonoscopy or sigmoidoscopy preparation.

One hundred thirteen patients were randomized to receive either oral sodium phosphate (Fleet Phospho-Soda), lemon-flavored castor oil (Purge), or standard polyethylene glycol-based lavage solution (GoLYTELY) before elective colonoscopy. The study purpose was to confirm the efficacy of oral sodium phosphate and extend observations to include castor oil. Overall, patients reported that sodium phosphate and castor oil were easier to complete (p < 0.05). Scores for cleansing the entire colon as determined by endoscopists who were blinded to the cathartic agent were highest in patients receiving sodium phosphate (p < 0.02). Scores of left-colon cleansing for flexible sigmoidoscopy were equally high for the three methods. Scores for taste and symptom side effects were similar for each preparation. There were no recognized signs or symptoms of hypocalcemia in the sodium phosphate group. Because of the low cost of oral sodium phosphate combined with the lowest repeat endoscopy rate for inadequate cleansing, patient savings were projected to be $5000 per 100 patients at this center. Oral sodium phosphate is a cost-effective colonoscopy preparation that is better tolerated and more effective than the polyethylene glycol-electrolyte lavage solution or castor oil.

Administration, Oral↗
PubMed1993

Fatal hyperphosphatemia following Fleet Phospo-Soda in a patient with colonic ileus.

A fatal case of hyperphosphatemia secondary to enteral administration of Fleet Phospo-Soda is presented. A 64-yr-old male admitted for theophylline toxicity was treated with activated charcoal and sorbitol, but subsequently developed colonic ileus. Two sequential doses of Phospo-Soda were administered to facilitate clearance of the charcoal; however, this resulted in marked hyperphosphatemia, hypocalcemia, acidemia, and other electrolyte abnormalities, followed by the patient's demise. This case is added to several other reports about the risks of injudicious use of sodium phosphate cathartics.

Charcoal↗
PubMedDate not supplied

[Angiodysplasia of the right colon].

Ascending colon angiodysplasia is a frequent cause of colorrhagia or chronic blood loss in old patients, but also possible under the age of 55. Angiodysplasia diagnosis is often underestimated. For a long time colorrhagia or lower intestinal bleeding were generally diagnosed like diverticular bleeding. This conclusion was the result of several conditions: the conservative management of distal gastrointestinal bleeding is in most cases successful; the double dye clysma was the first and the main diagnostic procedure for many years and the result was a not correct diagnosis of diverticular bleeding since large bowel diverticulosis is always present in the elderly. The authors report on three cases of low intestinal bleeding where the diagnosis of angiodysplasia in the first patient was performed by upper mesenteric artery arteriography, in the second by preoperative colonoscopy and after confirmed by the histology of the specimen and in the last one by colonoscopy performed in emergency and after intestinal irrigation. The first patients refused the operation; the second had right hemicolectomy and the third one had a spontaneous stop of bleeding. According to their clinical experience the authors suggest that colonoscopy performed in emergency or intraoperative is the first choice diagnostic procedure: it can detect the source of bleeding between right or left colon. Arteriography often shows vascular images characteristic for angiodysplasia or other vascular malformations but, in our experience, it may be absolutely not diagnostic. Colonoscopy performed in emergency during bleeding or per-operative is the best procedure in order to diagnose the source of bleeding. Emergency colonoscopy can distinguish if the blood is coming from the right or left colon and in our experience, colonoscopy during bleeding is always possible because blood has a cathartic effect. In case of emergency operation pre-operative colonoscopy can usually detect the source of bleeding. A double dye clysma, whether barium or hydrosoluble doesn't give a diagnostic support in low intestinal bleeding; on the contrary it can prevent a correct arteriographic and endoscopic evaluation. At last histopathological findings on the specimen are conclusive for the diagnosis.

Aged↗
PubMedDate not supplied

[Treatment of acute poisoning caused by carbamazepine, digoxin, and acetylsalicylic acid, with repeated doses of activated charcoal].

Twelve pediatric patients with acute poisonings caused by carbamazepine, digoxin and acetylsalicylic acid were treated with multiple doses of activated charcoal combined with a saline cathartic (adsorption surface of activated charcoal nearly 950 m2/g). This procedure was effective to shorten the plasmatic levels of the drugs, besides the clinical improvement of the poisoned patients. The average initial and final levels of the drugs were: carbamazepine 21.64 and 0.9 micrograms/ml (lowering 95.81%, p < 0.05), digoxin 5.14 and 1.1 ng/ml (lowering 78.6%, P < 0.05) and acetylsalicylic acid 418.5 and 57.5 micrograms/ml, respectively, (lowering 86.3%, p < 0.05). These results suggest the usefulness of activated charcoal in the clearance of the four overdosed drugs.

Acute Disease↗
PubMed1977

Lomotil poisoning in children: two case reports.

Lomotil is a proprietary antidiarrhoeal agent in common use. Two cases of Lomotil poisoning, one of them fatal, are described. Symptoms are those of central nervous system depression and atropinism. Treatment consists of gastric emptying, administration of specific narcotic antagonists, cathartics and activated charcoal.

Atropine↗
PubMed1977

Acetaminophen toxity.

A case report of an acetaminophen overdose is described, and the toxicity, clinical course and treatment of acetaminophen overdose are discussed. Treatment modalities include removal of the acetaminophen by emesis or gastric lavage, the use of activated charcoal and a saline cathartic. Several antidotes have been proposed, most notably cysteamine and acetylcysteine.

Acetaminophen↗
PubMed1996

[Suicidal process and suicidal motives. Suicide illustrated by the art, life and illness of Vincent van Gogh].

A suicide will naturally be a shock to the surroundings, unexpected and brutal as it is. Suicide survivors will often emphasize the unexpected. Nevertheless a suicide must be regarded as the end result of a long process. In this paper the extremely well-documented case of Vincent van Gogh is used to study suicidal processes and suicidal motives. In van Gogh's case, an early childhood trauma initiated a life-long suicidal process. His difficulties as regards attachment to and separation from his parents continued throughout his life and his emotional instability, intensity and lowered tolerance to frustration seem to portray a borderline personality. Vincent van Gogh's chronic suicidal ideation and behaviour led to a series of crises throughout his life, escalating during the last 18 months before his suicide in 1890. It is possible to identify at least three prominent suicidal motives in van Gogh's case. The first is unbearable emotional pain related to personal experience of loss which reactivated the childhood trauma. The second is introverted murderous rage arising from conflicts with other persons. The third motive described is the need for a cathartic release of energy and emotion.

France↗
PubMed1996

Intestinal pseudo-obstruction (Ogilvie's syndrome) in theophylline overdose.

Intestinal pseudo-obstruction (Ogilvie's syndrome) has previously been reported in 2 patients with theophylline toxicity treated with activated charcoal (AC), mechanical ventilation and opioid induced sedation. We report a case of Ogilvie's syndrome in a theophylline toxic patient treated with AC. A 45-y-old male with severe chronic obstructive pulmonary disease presented with vomiting and multifocal atrial tachycardia after an intentional theophylline overdose. His initial potassium concentration was 2.7 mEq/L and his theophylline was 191 mg/L (1060 mumol/L). The patient was hemodialyzed and given a total of 1,000 g of AC without cathartics during the first hospital day. He also received iv potassium replacement. On the second hospital day he required mechanical ventilation for respiratory acidosis. Clindamycin was given for purulent sputum and fever. Haloperidol was given to treat agitation. No other anticholinergic agents or opioids were given. The patient's potassium rose to 6.5 mEq/L and he was given kayexalate. During the third hospital day the patient developed abdominal distention, tenderness and leukocytosis. Abdominal radiographs revealed a distended cecum. In the operating room the cecum was found dilated to 16 cm with no distal obstruction. A cecostomy tube drained AC and pill fragments. A 6 cm charcoal bezoar was found in the stomach. The patient recovered uneventfully.

Administration, Oral↗
PubMed1996

Carbamazepine poisoning in adolescent suicide attempters. Effectiveness of multiple-dose activated charcoal in enhancing carbamazepine elimination.

The aim of the study was to evaluate continuous administration of multiple-dose activated charcoal (MDAC) in enhancing elimination of carbamazepine (CBZ) in eight consecutive adolescent suicide attempters. Diluted charcoal was administered through a nasogastric tube at a dose of 1 g/kg every 4 h, and a saline cathartic at the same dosage was administered every 12 h. Plasma CBZ concentrations were measured at 0.0, 12, 24 and 36 h by means of a modified EMIT technique. As a measure of CBZ disappearance, half life of elimination (t1/2 beta) and exogenous total body clearance (CLB) were calculated. Clinical improvement occurred after 12 to 24 h, except in one patient who was the most severely intoxicated and who required advanced life-support therapy. Pharmacokinetic data reported a mean t1/2 beta of 9.5 h, shorter than the reference value of 18-54 h (p < 0.05), and a mean CLB of 103.13 ml/ min/kg, higher than the reference of 75.01 ml/min/ kg (p < 0.05). Initial mean CBZ levels of 27.9 decreased to 0.82 microgram/ml (97% of elimination, p < 0.05). MDAC was free from adverse side effects. In conclusion, MDAC is an effective procedure in enhancing CBZ elimination in overdosed patients as well as being relatively free from serious side effects, widely available, inexpensive and non-invasive.

Adolescent↗
PubMed1996

A study of deliberate self-poisoning in patients with adjustment disorders.

A sample of 140 patients (34 men and 106 women), hospitalized for deliberate self-poisoning in a toxicological clinic, was evaluated clinically and by Pöldinger's risk list for assessment of suicidality. All subjects met the criteria of DSM-IV adjustment disorder with no additional Axis I and Axis II comorbidity. 18% of the patients had a chronic adjustment disorder. The most common problems on Axis IV were those with the primary support group (especially in women). Occupational and economic problems were more frequent in men than in women. Most of the studied subjects undertook the suicidal attempt impulsively. Suicidal thoughts after deliberate self-poisoning persist in only 11% of the patients. The suicidal risk measured by Pöldinger's risk list for assessment of suicidality was negligible in 4/5 of the cases. The suicidal risk was higher in patients with chronic adjustment disorder and in patients with previous suicide attempts. The most represented age group - from 15 to 19 years old showed the highest suicidal risk. In women the suicidal risk increased with age. Women with impulsive suicide attempt showed a lower suicidal risk than women with a non-impulsive suicide attempt. A cathartic and abreactive effect of the suicide attempt was detected, but this effect only partially accounts for the relatively low percentage of suicidal thoughts after the suicidal act and the insignificant suicidal risk in 4/5 of the studied subjects.

Adjustment Disorders↗
PubMed1997

Antihistamine-containing cough/cold medications present a low hazard in pediatric accidental exposure incidents: analysis of Poison Control Center data.

We studied accidental exposure to pediatric cough/cold medications in children under 6-y-of-age to determine whether the presence of an antihistamine (chlorpheniramine) in the product increased the likelihood for adverse outcomes. General accidental exposure cases reported to the American Association of Poison Control Centers (AAPCC) during 1988-1992 were analyzed for specific over-the-counter cough/cold pediatric products containing identical concentrations of active ingredients except for the presence or absence of chlorpheniramine. These case reports were evaluated for differences in medical outcome, symptom assessment, management site and therapy, as coded by poison control centers participating in the AAPCC Toxic Exposure Surveillance System. A total of 10,289 cases of accidental exposures were evaluated for the specific products included in this analysis. While these cases represented a small percentage of total exposures to these products (approximately 3% of total cases in children under 6-y-of-age reported to the AAPCC for all cough/cold medications during 1988-1992), they provided a unique opportunity to evaluate the impact of the antihistamine component of the formulation. This study demonstrated that the presence of chlorpheniramine did not affect the medical outcome or the extent to which symptoms were reported. Additionally, similar percentages of exposures for these 2 products were managed at the site of the incident, and required either no therapy or only required fluids and observation. There were no notable differences in the percentage of cases which involved more aggressive treatment procedures (activated charcoal, cathartic, lavage). This analysis demonstrates that over-the-counter cough/cold medications containing chlorpheniramine present low potential for hazard in cases of accidental ingestions in young children and do not show an increased likelihood for adverse outcomes of accidental exposures compared to cough/cold medications not containing this antihistamine.

Child↗