Toxicology in the ICU

Levine, M.D. Norman; Ruha, Anne‐Michelle; Graeme, K. A.; Brooks, Daniel E.; Canning, Joshua; Curry, Steven C.

doi:10.1378/chest.11-0295

Cited by 18 publications

(8 citation statements)

References 121 publications

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“…Twenty percent of habu bites are dry. This incidence is higher than that of bites by other snakes, such as the saw-scaled viper ( Echis carinatus ) with 8% dry bites and the rattlesnake in Central California with 10.9% dry bites [ 30 - 32 ]. While most dry bite cases do not require admission, Levine recommends repeating laboratory test within 6 h [ 4 ].…”

Section: Reviewmentioning

confidence: 99%

Venomous snake bites: clinical diagnosis and treatment

et al. 2015

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Snake bites are life-threatening injuries that can require intensive care. The diagnosis and treatment of venomous snake bites is sometimes difficult for clinicians because sufficient information has not been provided in clinical practice. Here we review the literature to present the proper management of bites by mamushi, habu, and yamakagashi snakes, which widely inhabit Japan and other Asian countries. No definite diagnostic markers or kits are available for clinical practice; therefore, definitive diagnosis of snake-venom poisoning requires positive identification of the snake and observation of the clinical manifestations of envenomation. Mamushi (Gloydius blomhoffii) bites cause swelling and pain that spreads gradually from the bite site. The platelet count gradually decreases due to the platelet aggregation activity of the venom and can decrease to <100,000/mm3. If the venom gets directly injected into the blood vessel, the platelet count rapidly decreases to <10,000/mm3 within 1 h after the bite. Habu (Protobothrops flavoviridis) bites result in swelling within 30 min. Severe cases manifest not only local signs but also general symptoms such as vomiting, cyanosis, loss of consciousness, and hypotension. Yamakagashi (Rhabdophis tigrinus) bites induce life-threatening hemorrhagic symptoms and severe disseminated intravascular coagulation with a fibrinolytic phenotype, resulting in hypofibrinogenemia and increased levels of fibrinogen degradation products. Previously recommended first-aid measures such as tourniquets, incision, and suction are strongly discouraged. Once airway, breathing, and circulation have been established, a rapid, detailed history should be obtained. If a snake bite is suspected, hospital admission should be considered for further follow-up. All venomous snake bites can be effectively treated with antivenom. Side effects of antivenom should be prevented by sufficient preparation. Approved antivenoms for mamushi and habu are available. Yamakagashi antivenom is used as an off-label drug in Japan, requiring clinicians to join a clinical research group for its use in clinical practice.

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Section: Reviewmentioning

confidence: 99%

Venomous snake bites: clinical diagnosis and treatment

et al. 2015

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“…Mushroom poisoning, termed mycetism or mycetismus, most commonly ensues after mushrooms are foraged, misidentified and then consumed [1,7,[9][10][11][12][13][14][15][16][17][18][19][20]. The incidence of ingesting wild, toxic mushrooms is increasingly reported [8,21,22].…”

Section: Overview Of Exposurementioning

confidence: 99%

“…Worldwide, hundreds of mushroom poisonings are fatal each year [6,8,23,24]. Most fatalities are secondary to Amanita phalloides ingestions [8,9,12,23].…”

Section: Overview Of Exposurementioning

confidence: 99%

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Mycetism: A Review of the Recent Literature

Graeme

2014

J. Med. Toxicol.

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Approximately 100 of the known species of mushrooms are poisonous to humans. New toxic mushroom species continue to be identified. Some species initially classified as edible are later reclassified as toxic. This results in a continually expanding list of toxic mushrooms. As new toxic species are identified, some classic teachings about mycetism no longer hold true. As more toxic mushrooms are identified and more toxic syndromes are reported, older classification systems fail to effectively accommodate mycetism. This review provides an update of myscetism and classifies mushroom poisonings by the primary organ system affected, permitting expansion, as new, toxic mushroom species are discovered.

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“…Serum metabolic profile (creatine phosphokinase, electrolytes, glucose, renal and hepatic function tests), complete blood count, prothrombin time (PT), and activated partial thromboplastin time (aPTT) usually suffice in most cases [17,18]. The most common laboratory abnormalities are abnormalities in hematological parameters and transaminase elevations [4,5].…”

Section: Discussionmentioning

confidence: 99%