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Inhalant Abuse

Twistadmin Poison Alerts

While not particularly in vogue as abused substances, use of inhalants for euphoriant effects caused several dozen toxic cases in Missouri in the last 2 years, including 2 fatalities.

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The QT Nomogram: Assessing Risk of Torsades de Pointes when the QT Interval is Prolonged

Twistadmin Poison Alerts

QUICK FACTS The QT interval predominately represents ventricular repolarization, as well as the much-shorter depolarization (QRS wave.) The primary concern regarding a prolonged QT interval is the potential risk for the rare life-threatening arrhythmia, Torsades de Pointes. The QT nomogram assesses the actual QT interval versus the heart rate from …

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Administration Protocols for IV NAC

Twistadmin Poison Alerts

Acetaminophen (APAP) is an OTC analgesic/antipyretic found in most medicine cabinets. It is available as a single ingredient or formulated with other OTC or prescription medications. Overdose with APAP is one of the most common poisonings in the US. The FDA-approved 21-hour, three-bag protocol for IV NAC administration is effective; however, there is substantial risk for dosing and administration errors.

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Loperamide Abuse

Twistadmin Poison Alerts

It may be surprising, but it’s not a myth – yes, even the over-the-counter antidiarrheal drug, loperamide (Imodium), can be abused. For someone addicted to opioids, it may appear to be a legal, inexpensive, and accessible alternative, but the effects can be dangerous, potentially causing life-threatening arrhythmia.

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Diphenhydramine Toxicity

Twistadmin Poison Alerts

It’s a ubiquitous OTC medicine found in almost everyone’s medicine cabinet in some form as capsules, cough and cold preparations, and topicals.  It treats allergies, itching, hives, URI symptoms, motion sickness, and insomnia.  It almost meets the old-fashioned definition of a cure-all. Unfortunately, diphenhydramine (DPH) is also abused recreationally for …

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Mushroom Poisoning

Twistadmin Poison Alerts

There are bold mushroom hunters and there are old mushroom hunters, but there are no old bold mushroom hunters. — A wise person As spring approaches, one thing we can count on: mushrooms in the yard, woods, roadsides, etc.  We can also count on children’s curiosity getting the best of …

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Gastric Decontamination

Twistadmin Poison Alerts

“First do no harm.” Can GI Decontamination (GID) do harm? Sometimes: A child who was seen ingesting several tablets of clonidine is brought to an ED 30 minutes post ingestion. Upon arrival, the alert child is lavaged and given AC by orogastric (OG) tube. As often happens rapidly with clonidine, …

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Toxic Hazards in the All American Garage Part 2

Twistadmin Poison Alerts

We hope you found a new tox tidbit in Part 1 of “Toxic Hazards in the All-American Garage” about toxic alcohols and hydrocarbons, but there are still more hazards in the garage to discuss. Refresh your knowledge about lawn/garden products and caustics in this second issue. Lawn and Garden Products …

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Foreign Body & Battery Ingestion

Twistadmin Poison Alerts

“Kids Swallow the Darndest Things” News headlines earlier this year sounded the alarm,  “Toddler Dies After Ingesting Button Battery,” and “Child Nearly Dies After Swallowing Magnets.”  Oral exploration of small objects is a typical behavior of young children. Occasionally the object being mouthed is swallowed, and parental anxiety goes off …

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Synthetic Cannabinoids

Twistadmin Poison Alerts

Be on alert there are reports in both the media and to poison centers, of what appears to be an emerging drug of abuse. Often patients are calling the substance “synthetic marijuana.”. No one, however, positively has identified the actual chemical involved in these exposures. Calls to some of the …

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The FLACK about FLAKKA

Twistadmin Poison Alerts

New recreational drugs are hitting the international scene at a rapid-fire pace – by some estimates one novel substance a week.  In 2015, one of these made the news in Florida and was also reported in other states across the country.  This drug goes by the name of  “flakka,” derived …

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