Tight, targeted stepwise regulation was exhibited in all trials. Overall, tight glycemic regulation is achieved in a broad critical care cohort with optimized insulin and nutrition delivery, effectively managing glycemia even with high effective insulin resistance.

No abstract

We report an 89-year-old retired farmer with prolonged bradycardia and hypotension after pyrethroid insecticides ingestion in a suicidal attempt. This patient also had a clinical manifestation mimicking organophosphate poisoning, included confusion, lacrimation and salivation. He required intensive care support, atropine and inotrope infusions treatments. Only metabolites of synthetic pyrethroid insecticides (3-phenoxybenzoic acid and 3-phenoxybenzaldehyde) were detected in the urine sample. In the serum toxicology screening, specific analysis for organophosphate pesticides was negative. He eventually recovered without major sequela. (Hong Kong j.emerg.med. 2016;23:47-51)

Paraquat is highly toxic to human and is widely used in agriculture as a contact herbicide. However, it is easily accessible in agricultural product shops. Seven cases of paraquat poisoning were treated in Tuen Mun Hospital from 1998-2005. The mortality (4 out of 7) was very high. One patient died after oral exposure to paraquat despite immunosuppressive and antioxidant therapies. The mechanism of toxicity and potential new therapies of paraquat poisoning are discussed in the article.

A 28-year-old woman ingested 20 g of hydroxychloroquine sulphate for suicidal attempt. She developed hypotension, cardiac conduction disturbance, hypokalemia and hypoglycemia. Despite treatment with mechanical ventilation, epinephrine, sodium bicarbonate, diazepam and potassium replacement, she succumbed 10 hours post-overdose. Previous case reports of hydroxychloroquine overdose are summarised and the therapeutic choices are discussed. (Hong Kong j.emerg.med. 2007;14:53-57) (Figure 1). Twenty grams of dextrose given intravenously brought her GCS to 15/15 and blood glucose to 13.4 mmol/L. The BP was improved to 80/50 mmHg after infusion of 1 L of normal saline. Gastrointestinal decontamination was performed with 50 g of oral activated charcoal but gastric lavage was not done.She was later transferred to the Intensive Care Unit. She remained conscious but the BP and central venous pressure were 57/35 mmHg and 26 cmH 2 O respectively. She was intubated and put on synchronised intermittent mandatory ventilation mode of mechanical ventilation. The medications given included intravenous diazepam 60 mg followed by infusion of 2 mg/h, epinephrine 20 µg/min and sodium bicarbonate 100 mmol. The serum potassium three hours after the overdose was 1.5 mmol/L. Potassium chloride of 20 mmol was given over one hour followed by a maintenance infusion of 1.6 mmol/h.Her BP was sustained well above systolic 100 and diastolic 60 mmHg one hour after starting the epinephrine drip. At six hours post-overdose, the QRS