Abnormal vital signs in patient's following toxic exposures can suggest underlying toxidromes. Differential diagnosis of abnormal signs
The differential diagnosis of toxicological causes of cardiac arrest are many and varied. It is useful to consider the causes in terms of mechanism.
Malignant Hyperthermia = pharmacogenetic disease of skeletal muscle induced by exposure to certain anaesthetic agents; incidence 1:5,000 -> 1:65,000 anaesthetics (suspected); mutation in the gene coding for the ryanodine receptor
Much of what we do in toxicology is because we think it works, not because we know it works. Clinical toxicology has traditionally been based on animal studies, case reports and case series based on clinical observation rather than clinical trials
Iron overdose can have local gastrointestinal effects as well as characteristic systemic toxicity (metabolic acidosis, liver failure, shock and multi-organ failure). Risk assessment is based on the amount of elemental iron ingested
Severe toxicity from plants is rare in humans; risk assessment is often difficult - plant identification may be difficult; - toxin quantification may be impossible
Lithium: acute overdose is usually benign if adequate hydration is maintained and renal function is normal; chronic toxicity can be difficult to manage and result in devastating neurotoxicity
Alcohol Withdrawal: common and can be fatal; manifests within 48 hours of stopping drinking
Toxidromes associated with hyperthermia may be difficult to distinguish: serotonin syndrome; anticholingeric syndrome; sympathomimetic syndrome; neuroleptic malignant syndrome; malignant hyperthermia
Mephedrone is a new stimulant drug being abused on the street, and has recently been discovered in Australia. The following review provides emergency clinicians with assessing managing patients under the influence of mephedrone.
Muttered shadows pervade the lugubrious intermission chamber with a festive rainbow of illicit degustations. Red tablets, green pills, yellow capsules, white poppers, purple hum-dingers and now…pure bath salts.