GO-EM: An Approach

Sunday, September 11, 2016

Clinical manifestations of severe synthetic cannabinoid toxicity: An Update

Clinical manifestations of severe synthetic cannabinoid toxicity

Synthetic cannabinoids consist of a heterogeneous group of chemical compounds that act as agonists at cannabinoid receptors with 2 to 800 times the potency of delta-9 tetrahydrocannabinol (THC), the active component of cannabis (marijuana). They have emerged as a popular recreational drug in the United States and Europe. In an observational study of a multicenter, hospital-based registry of medical toxicology consultations, over two-thirds of 277 patients with single-agent exposure to synthetic cannabinoids had altered mental status including severe agitation, toxic psychosis, hallucinations, seizures, and coma [1]. Rhabdomyolysis and acute kidney injury were present in approximately 5 percent of these patients. There were three deaths, including a 17-year-old adolescent with sudden death after first-time inhalational use. Thus, unlike cannabis, synthetic cannabinoids have significant potential to cause serious and life-threatening toxicity among recreational users.

Uptodate Sep 08, 2016

Monday, September 5, 2016

Salicylate Poisoning Mechanism: Learning Toxicology

Salicylates act directly on the respiratory center in the brainstem, causing hyperventilation and respiratory alkalosis.
In addition, salicylates interfere with the citric acid cycle limiting adenosine triphosphate (ATP) production and generating lactate. Due to increased catecholamines and an increased utilization of glucose, fatty acid metabolism increases leading to ketoacidosis.
Finally, salicylates are weak acids and contribute to the acidosis through direct proton donation. These factors contribute to increased ventilation through compensation but would not be expected to cause alkalemia (overcompensation).
Although the metabolic acidosis begins in the earliest stages of salicylate toxicity, the respiratory alkalosis predominates initially, leaving the patient with a respiratory alkalosis, metabolic acidosis, and alkalemia.

Adolescents or adults presenting with respiratory acidosis early after a salicylate overdose likely have a coingested CNS depressants, experience salicylate-induced acute lung injury, or have underlying respiratory disease.

The combination of acute respiratory alkalosis, metabolic acidosis, and acidemia is an ominous finding, indicating a life-threatening salicylate overdose.

Reference: Tintinalli

Lithium Toxicity: Learning Toxicology

A 45ym known with MDP
, on Lithium ,
He took an unknown amount of Lithium to commit suicide .

The following is/are true or false regarding Lithium toxicity :

1-Both hypothyroidism and hyperthyroidism, as well as calcium disturbances secondary to hyperparathyroidism, have been reported with lithium poisoning.

True

2-Flattened T waves, prolonged QTc intervals, and bradycardia are common.

False,
Are rare

3-Phenobarbitone is the first line therapy for seizures.

False.
Benzodiazepine

4-Patients with acute lithium toxicity are at risk for developing nephrogenic diabetes insipidus (NDI)

False
with chronic toxicity

5-Whole bowel irrigation with polyethylene glycol (PEG) solution are not effective in patients with large acute ingestions .

False
Effective

6-Serum lithium concentrations correlate more closely with clinical signs in patients with chronic toxicity

True
For chronic toxicity

7-The syndrome of irreversible lithium effectuated neurotoxicity (SILENT) consists of prolonged neurologic and neuropsychiatric symptoms following lithium toxicity.

True,
Fact

8-Lithium poisoning is associated with elevations in cardiac biomarkers and left ventricular dysfunction.

False
Is not

9-Severe lithium intoxication can cause nonconvulsive status epilepticus, and encephalopathy.

True

Wednesday, August 31, 2016

Commonly injured structures in Wrist: Orthopedics

Commonly injured structures in Wrist: Orthopedics

The scapholunate ligament is the most commonly injured ligament in the wrist, usually the result of a fall on an outstretched hand. The scapholunate ligament is an intrinsic ligament binding the scaphoid and lunate together between the proximal and distal rows of carpal bones. Scapholunate dissociation is diagnosed radiographically with a widening of the scapholunate space greater than 3 mm. This is also known as the Terry Thomas sign.

Injuries to the triquetrolunate ligament are less common, and usually result from a fall onto an outstretched and dorsiflexed hand. This injury may produce pain on the ulnar aspect of the wrist and can be confused with injury to the triangular fibrocartilage complex.

The Space of Poirier refers to the area between the two palmar arches at the junction of the capitate and lunate, and is vulnerable to ligamentous disruption.

Laceration of Tendons: Orthopedics

Laceration of Tendons

Mallet finger is the injury resulting from laceration or rupture of the extensor tendon over Zone I, the distal phalanx, or distal interphalangeal joint. This injury causes the distal interphalangeal joint to be flexed at 40 degrees. It is the most common tendon injury in athletes.

Swan neck deformity may result from chronic untreated Mallet finger.

Boutonniere deformity results from an injury in Zone III over the proximal interphalangeal joint. Injury of the central tendon and disruption of the lateral bands allow flexion as well as the flexor digitorum profundus to function unopposed. There is retraction of the extensor hood and resultant extension of the metacarpophalangeal and distal interphalangeal joints. Gamekeeper’s thumb is the rupture of the ulnar collateral ligament. This occurs as the result of radial deviation of the metacarpophalangeal joint.