Chemical burns are common injuries seen in the ED, but some potentially caustic agents are not obvious. The ash residue which remains after wood is burned contains variable amounts of potassium hydroxide and potassium carbonate. The solution of lye that results from wood ash soaked or boiled in water is …
Read MoreWhat is Kratom? Which of Your Patients Might Be Using It?
Two million Americans have Opioid Use Disorder (DSM-V), showing a pattern of opioid use leading to problems or distress. One distinguishing characteristic is experiencing withdrawal and taking opioids (or a closely related substance) to relieve or avoid withdrawal symptoms. Another is craving – the intense desire for repeated opioid use. …
Read MoreLoperamide – An Unexpected Drug of Abuse
Does anything surprise us anymore?– Yes, even the over-the-counter antidiarrheal drug, loperamide (Imodium), can be abused. It is a legal, inexpensive, and accessible alternative for someone with opioid use disorder, or merely curious about the pleasurable effects of opioids. It is also used for self-treatment of opioid withdrawal symptoms, giving …
Read MoreGastric Perforation After Baking Soda Ingestion to Beat a Drug Test
QUICK FACTS Sodium bicarbonate has been touted as a home-remedy detox to pass a drug test. A quick internet search of “baking soda to pass drug test” yields >1 million search results. Sodium bicarbonate plus gastric acid releases carbon dioxide. Doses suggested on the internet for detox are not safe. …
Read MoreBaclofen Overdose or Brain Death?
QUICK FACTS Baclofen reduces muscle tone and spasticity. It has a delayed peak and prolonged half-life in overdose. Deep coma with absent brain stem reflexes may mimic brain death in overdose. Treatment is symptomatic and supportive, there is no antidote. Baclofen controls muscle spasticity in conditions such as multiple sclerosis …
Read MoreVenlafaxine & Desvenlafaxine Overdose
QUICK FACTS Venlafaxine and desvenlafaxine can cause delayed onset seizures. There is also a risk of serotonin toxicity in overdose. There are active metabolites, so symptoms can be prolonged. Benzodiazepines are the first line treatment to manage seizures. Venlafaxine (Effexor®) is a popular medication used to treat numerous conditions such …
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Super-Absorbent Polymers (SAP) Ingestion
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.
Read More Inhalant Abuse
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.
Read MoreThe QT Nomogram: Assessing Risk of Torsades de Pointes when the QT Interval is Prolonged
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 …
Read MoreIV NAC Protocol
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
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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Benadryl Overdose Treatment
Diphenhydramine is a ubiquitous OTC medicine found in almost everyone’s medicine cabinet. It is commonly known as Benadryl® or Banophen®. It treats allergies, itching, hives, URI symptoms, motion sickness, and insomnia. The drug comes in capsules, cough and cold preparations, and topicals. It almost meets the old-fashioned definition of a …
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