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"Toxicology" AND "Overdose" AND "Emergency"

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https://read.qxmd.com/read/30775936/new-synthetic-opioid-cyclopropylfentanyl-together-with-other-novel-synthetic-opioids-in-respiratory-insufficient-comatose-patients-detected-by-toxicological-analysis
#1
Dieter Müller, Hartmud Neurath, Merja A Neukamm, Maurice Wilde, Caroline Despicht, Sabine Blaschke, Marcel Grapp
INTRODUCTION: Fentanyl derivatives like cyclopropylfentanyl have recently appeared on the recreational drug market. Cyclopropylfentanyl is probably a highly potent opioid, but human toxicological data are not available so far. Similar to other fentanyl derivatives the most serious acute health risk due to the use of cyclopropylfentanyl is likely to be respiratory depression. In case of overdose, this may lead to apnoea, respiratory arrest and death. In this paper, we present three cases of severe intoxication with cyclopropylfentanyl...
February 18, 2019: Clinical Toxicology
https://read.qxmd.com/read/30658219/fentanyl-and-fentanyl-analog-involvement-in-drug-related-deaths
#2
Zheng Dai, Marie A Abate, Gordon S Smith, James C Kraner, Allen R Mock
BACKGROUND: To describe and analyze the involvement of fentanyl and fentanyl analogs (FAs) in drug-related deaths in West Virginia (WV), United States. METHODS: Retrospective analyses of all WV drug-related deaths from 2005 to 2017 were performed, including comparisons of demographic and toxicological characteristics among total deaths, deaths in which fentanyl/FAs were present, deaths in which they were absent, heroin-related deaths, and prescription opioid-related deaths...
March 1, 2019: Drug and Alcohol Dependence
https://read.qxmd.com/read/30653482/overdose-deaths-involving-fentanyl-and-fentanyl-analogs-new-york-city-2000-2017
#3
Cody Colon-Berezin, Michelle L Nolan, Jaclyn Blachman-Forshay, Denise Paone
Unintentional drug overdose deaths have climbed to record high levels, claiming approximately 70,000 lives in the United States in 2017 alone (1). The emergence of illicitly manufactured fentanyl* (a synthetic, short-acting opioid with 50-100 times the potency of morphine) mixed into heroin, cocaine, and counterfeit pills, with or without the users' knowledge, has increased the risk for fatal overdose (2,3). The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) conducts routine overdose mortality surveillance by linking death certificates with toxicology findings from the NYC Office of the Chief Medical Examiner (OCME)...
January 18, 2019: MMWR. Morbidity and Mortality Weekly Report
https://read.qxmd.com/read/30620247/legally-lethal-kratom-a-herbal-supplement-with-overdose-potential
#4
S Palasamudram Shekar, Edward Eurice Rojas, Christopher Charles D'Angelo, Samantha Rebecca Gillenwater, Nydia Patricia Martinez Galvis
This case report describes an overdose on kratom, and elicits the potential dangers of overdose on the regulated dietary supplement. A young male presented to the emergency department intubated after being found unresponsive. He was found by his family to be unarousable and agonal breathing with minimal response to naloxone administered by Emergency Medical Services (EMS). Urine toxicology and blood alcohol content were negative. Physical exam was significant for tachycardia, hypotension, and pinpoint pupils with sluggish reactivity to light...
January 8, 2019: Journal of Psychoactive Drugs
https://read.qxmd.com/read/30165647/the-opioid-epidemic-moving-toward-an-integrated-holistic-analytical-response
#5
Jayne B Morrow, Jeri D Ropero-Miller, Megan L Catlin, Agnes D Winokur, Amy B Cadwallader, Jessica L Staymates, Shannan R Williams, Jonathan G McGrath, Barry K Logan, Michael M McCormick, Kurt B Nolte, Thomas P Gilson, M J Menendez, Bruce A Goldberger
In many jurisdictions, public safety and public health entities are working together to enhance the timeliness and accuracy of the analytical characterization and toxicology testing of novel synthetic opioids. The improved sharing and early detection of these analytical data are intended to inform surveillance, interdiction efforts, patient intervention and treatment, all of which are critical to curbing the opioid epidemic. Forensic practitioners working to identify novel synthetic opioids struggle to provide timely results when encountering new or unknown substances, such as the fentanyl analogs...
August 27, 2018: Journal of Analytical Toxicology
https://read.qxmd.com/read/29992157/metabolic-profiles-of-propofol-and-fospropofol-clinical-and-forensic-interpretative-aspects
#6
REVIEW
Ricardo Jorge Dinis-Oliveira
Propofol is an intravenous short-acting anesthetic widely used to induce and maintain general anesthesia and to provide procedural sedation. The potential for propofol dependency and abuse has been recognized, and several cases of accidental overdose and suicide have emerged, mostly among the health professionals. Different studies have demonstrated an unpredictable interindividual variability of propofol pharmacokinetics and pharmacodynamics with forensic and clinical adverse relevant outcomes (e.g., pronounced respiratory and cardiac depression), namely, due to polymorphisms in the UDP-glucuronosyltransferase and cytochrome P450 isoforms and drugs administered concurrently...
2018: BioMed Research International
https://read.qxmd.com/read/29915095/prospective-countywide-surveillance-and-autopsy-characterization-of-sudden-cardiac-death-post-scd-study
#7
Zian H Tseng, Jeffrey E Olgin, Eric Vittinghoff, Philip C Ursell, Anthony S Kim, Karl Sporer, Clement Yeh, Benjamin Colburn, Nina M Clark, Rana Khan, Amy P Hart, Ellen Moffatt
BACKGROUND: Studies of out-of-hospital cardiac arrest and sudden cardiac death (SCD) use emergency medical services records, death certificates, or definitions that infer cause of death; thus, the true incidence of SCD is unknown. Over 90% of SCDs occur out-of-hospital; nonforensic autopsies are rarely performed, and therefore causes of death are presumed. We conducted a medical examiner-based investigation to determine the precise incidence and autopsy-defined causes of all SCDs in an entire metropolitan area...
June 19, 2018: Circulation
https://read.qxmd.com/read/29902699/abuse-of-fentanyl-an-emerging-problem-to-face
#8
REVIEW
Katarzyna Kuczyńska, Piotr Grzonkowski, Łukasz Kacprzak, Jolanta B Zawilska
Fentanyl is a potent synthetic opioid used as a narcotic analgesic supplement in general and regional anesthesia as well as in management of persistent, severe chronic pain. Alarming epidemiological and forensic medicine reports, accumulated mainly during the last two decades, point to a growing increase in illicit use of fentanyl, mainly in North America and Europe. Toxicological data indicates that fentanyl use is inextricably linked with polydrug use. There are two main sources of fentanyl on the "recreational" drug market...
August 2018: Forensic Science International
https://read.qxmd.com/read/29772071/to-test-or-not-to-test-the-value-of-toxicology-in-a-delayed-overdose-death
#9
Erin E Walsh, Elisa N Shoff, Mary Elizabeth Zaney, George W Hime, Fintan Garavan, Diane M Boland
A case demonstrating the necessity of thorough death investigation processes where toxicology plays an active role is presented. A 33-year-old white man presented to the emergency room in respiratory distress after an overdose episode where he was revived on the scene by fire rescue. His condition continued to deteriorate and he expired 6 days after the initial incident. No admission specimens were available for testing; however, there were specimens drawn 4 and 5 days after the incident. Drug paraphernalia from the scene was obtained by the laboratory through collaboration with local law enforcement...
May 17, 2018: Journal of Forensic Sciences
https://read.qxmd.com/read/29760852/altered-mental-status-current-evidence-based-recommendations-for-prehospital-care
#10
REVIEW
Ashley Sanello, Marianne Gausche-Hill, William Mulkerin, Karl A Sporer, John F Brown, Kristi L Koenig, Eric M Rudnick, Angelo A Salvucci, Gregory H Gilbert
Introduction: In the United States emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California. Methods: We performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS) and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations...
May 2018: Western Journal of Emergency Medicine
https://read.qxmd.com/read/29652682/kratom-an-emerging-drug-of-abuse-a-case-report-of-overdose-and-management-of-withdrawal
#11
Jack Diep, David Tian Chin, Somdatta Gupta, Faraz Syed, Ming Xiong, Jianguo Cheng
Kratom is an herb indigenous to Southeast Asia with psychoactive opioid compounds, often used as a treatment for chronic pain or opiate withdrawal symptoms. It is legally and readily available via Internet sales and has been identified as an emerging drug of abuse in the United States. Kratom use has been associated with psychosis, seizures, and even death. At lower doses, kratom acts as a stimulant, while at higher doses, it produces analgesia and euphoria. Here, we describe the successful management of kratom overdose and withdrawal in a young man with negative toxicology screens...
April 15, 2018: A&A practice
https://read.qxmd.com/read/29385414/newly-emerging-drugs-of-abuse-and-their-detection-methods-an-aclps-critical-review
#12
REVIEW
Li Liu, Sarah E Wheeler, Raman Venkataramanan, Jacqueline A Rymer, Anthony F Pizon, Michael J Lynch, Kenichi Tamama
Objectives: Illicit drug abuse has reached an epidemic level in the United States. Drug overdose has become the leading cause of injury-related deaths since 2008 due to the recent surge of opioid overdose by heroin, controlled prescription drugs, and nonmethadone synthetic opioids. Synthetic designer drugs such as synthetic cathinones ("bath salts") and synthetic cannabinoids ("Spice" and "K2") continue to emerge and attract recreational users. Methods: The emergence of new drugs of abuse poses a steep challenge for clinical toxicology laboratories...
January 29, 2018: American Journal of Clinical Pathology
https://read.qxmd.com/read/29290509/ambient-mass-spectrometry-for-rapid-diagnosis-of-psychoactive-drugs-overdose-in-an-unstable-patient
#13
Chi-Wei Lee, Yu-Ying Chao, Jentaie Shiea, Jheng-Heng Shen, Hei-Hwa Lee, Bai-Hsiun Chen
A 25-year-old man suffered from consciousness change was sent to our emergency department by friends who reported that they were not sure what had happened to him. Physical examination revealed bilateral pupils dilatation, lethargy, slurred speech, and ataxia. Computer-aided tomographic scan of the brain revealed no definite evidence of intracranial lesions. Routine laboratory tests revealed total physiological turmoil. Despite immediate commencement of aggressive treatment, the patient's condition deteriorated long before the traditional drug screen provided an answer for the identities of the multiple drugs overdose...
March 2018: American Journal of Emergency Medicine
https://read.qxmd.com/read/29183241/alcohol-involvement-in-suicide-and-self-harm
#14
Celine Larkin, Eve Griffin, Paul Corcoran, Carmel McAuliffe, Ivan J Perry, Ella Arensman
BACKGROUND: Alcohol misuse and alcohol consumption are significant risk factors for suicidal behavior. AIMS: This study sought to identify factors associated with alcohol consumption in cases of suicide and nonfatal self-harm presentations. METHOD: Suicide cases in Cork, Ireland, from September 2008 to June 2012 were identified through the Suicide Support and Information System. Emergency department presentations of self-harm in the years 2007-2013 were obtained from the National Self-Harm Registry Ireland...
November 2017: Crisis
https://read.qxmd.com/read/29150198/comparative-effectiveness-of-extended-release-naltrexone-versus-buprenorphine-naloxone-for-opioid-relapse-prevention-x-bot-a-multicentre-open-label-randomised-controlled-trial
#15
RANDOMIZED CONTROLLED TRIAL
Joshua D Lee, Edward V Nunes, Patricia Novo, Ken Bachrach, Genie L Bailey, Snehal Bhatt, Sarah Farkas, Marc Fishman, Phoebe Gauthier, Candace C Hodgkins, Jacquie King, Robert Lindblad, David Liu, Abigail G Matthews, Jeanine May, K Michelle Peavy, Stephen Ross, Dagmar Salazar, Paul Schkolnik, Dikla Shmueli-Blumberg, Don Stablein, Geetha Subramaniam, John Rotrosen
BACKGROUND: Extended-release naltrexone (XR-NTX), an opioid antagonist, and sublingual buprenorphine-naloxone (BUP-NX), a partial opioid agonist, are pharmacologically and conceptually distinct interventions to prevent opioid relapse. We aimed to estimate the difference in opioid relapse-free survival between XR-NTX and BUP-NX. METHODS: We initiated this 24 week, open-label, randomised controlled, comparative effectiveness trial at eight US community-based inpatient services and followed up participants as outpatients...
January 27, 2018: Lancet
https://read.qxmd.com/read/29123931/rapid-ascending-sensorimotor-paralysis-hearing-loss-and-fatal-arrhythmia-in-a-multimorbid-patient-due-to-an-accidental-overdose-of-fluoxetine
#16
Matthew Herrmann, Prissilla Xu, Antonio Liu
Background: Common side effects of selective serotonin reuptake inhibitors (SSRIs) include tachycardia, drowsiness, tremor, nausea, and vomiting. Although SSRIs have less toxic side effects compared to more traditional antidepressants, serious and life threatening cases of SSRI overdose have been reported. We describe a 24-year-old multimorbid female who presented to the emergency department with rapid onset ascending sensorimotor paralysis, complicated by respiratory and cardiac arrest, found to have fatal levels of fluoxetine by toxicological analysis, not taken in a suicidal act...
2017: Case Reports in Neurological Medicine
https://read.qxmd.com/read/29077662/kratom-an-emerging-drug-of-abuse-a-case-report-of-overdose-and-management-of-withdrawal
#17
Jack Diep, David Tian Chin, Somdatta Gupta, Faraz Syed, Ming Xiong, Jianguo Cheng
Kratom is an herb indigenous to Southeast Asia with psychoactive opioid compounds, often used as a treatment for chronic pain or opiate withdrawal symptoms. It is legally and readily available via Internet sales and has been identified as an emerging drug of abuse in the United States. Kratom use has been associated with psychosis, seizures, and even death. At lower doses, kratom acts as a stimulant, while at higher doses, it produces analgesia and euphoria. Here, we describe the successful management of kratom overdose and withdrawal in a young man with negative toxicology screens...
October 26, 2017: A & A Case Reports
https://read.qxmd.com/read/29046744/clinical-and-epidemiological-characteristics-of-patients-with-acute-drug-intoxication-admitted-to-icu
#18
Jose Orsini, Nanda Din, Ershad Elahi, Anthony Gomez, Salil Rajayer, Ryan Malik, Elie Jean
Background : Drug overdose continues to be the most common cause of acute poisoning worldwide. There has been a substantial increase in drug overdose incidence and prevalence over the past decade, probably as a result of the emergence of new synthetic designer drugs. The purpose of this study is to describe the clinical and epidemiological characteristics of patients with acute drug intoxication admitted to the Intensive Care Unit (ICU). Methods : A single center, prospective, observational study was conducted among all adult patients with clinical signs suggestive of acute drug intoxication admitted from the Emergency Department (ED) to ICU during a 6-month period (September to March)...
October 2017: Journal of Community Hospital Internal Medicine Perspectives
https://read.qxmd.com/read/29040568/u-47700-a-not-so-new-opioid
#19
Timothy P Rohrig, Samuel A Miller, Tyson R Baird
U-47700 was developed by the Upjohn Co. in the 1970s as part of their search for a selective μ-opioid agonist with similar potency as morphine. U-47700 has re-emerged recently in the illicit drug market and is easily and cheaply obtained via the internet as well as on the street, many times falsely sold as another drug. Several fatalities from U-47700 have been reported in scientific literature, often in combination with other intoxicants. This case report describes the first death in south-central Kansas resulting solely from U-47700 intoxication: a 26-year-old white male found dead in his bedroom with apparent drug paraphernalia...
January 1, 2018: Journal of Analytical Toxicology
https://read.qxmd.com/read/29016517/pediatric-poisonings-in-a-rural-ugandan-emergency-department
#20
Katherine L Boyle, Usha Periyanayagam, Kavita M Babu, Brian T Rice, Mark Bisanzo
OBJECTIVE: This study aims to describe pediatric poisonings presenting to a rural Ugandan emergency department (ED), identifying demographic factors and causative agents. METHODS: This retrospective study was conducted in the ED of a rural hospital in the Rukungiri District of Uganda. A prospectively collected quality assurance database of ED visits was queried for poisonings in patients under the age of 5 who were admitted to the hospital. Cases were included if the chief complaint or final diagnosis included anything referable to poisoning, ingestion, or intoxication, or if a toxicologic antidote was administered...
October 9, 2017: Pediatric Emergency Care
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