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  1. Article ; Online: Multi-Organ System Injury from Inhalant Abuse.

    Dingle, H Evan / Williams, Saralyn R

    Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors

    2018  Volume 23, Issue 4, Page(s) 580–583

    Abstract: We present an illustrative case of a 24-year old male who developed cardiovascular and multi-organ system toxicity after inhaling a keyboard dust cleaner containing a halogenated hydrocarbon. In the field, the patient demonstrated neurotoxic effects in ... ...

    Abstract We present an illustrative case of a 24-year old male who developed cardiovascular and multi-organ system toxicity after inhaling a keyboard dust cleaner containing a halogenated hydrocarbon. In the field, the patient demonstrated neurotoxic effects in addition to electrocardiographic changes concerning for toxic myocarditis. We discuss the types of hydrocarbons, methods of abuse, and toxic effects of their inhalation including "sudden sniffing death" from myocardial sensitization.
    MeSH term(s) Administration, Inhalation ; Emergency Medical Services ; Humans ; Inhalant Abuse/complications ; Inhalant Abuse/diagnosis ; Inhalant Abuse/therapy ; Male ; Multiple Organ Failure/diagnosis ; Multiple Organ Failure/etiology ; Young Adult
    Language English
    Publishing date 2018-12-03
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 1461751-1
    ISSN 1545-0066 ; 1090-3127
    ISSN (online) 1545-0066
    ISSN 1090-3127
    DOI 10.1080/10903127.2018.1536771
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  2. Article: Case Report: Phenazopyridine-Induced Sulfhemoglobinemia in an 83-Year-Old Presenting with Dyspnea.

    Morales, Andre / Walsh, Ryan / Brown, Wade / Checinski, Patricia / Williams, Saralyn R

    The Journal of emergency medicine

    2021  Volume 61, Issue 2, Page(s) 147–150

    Abstract: Background: Sulfhemoglobinemia is a rare dyshemoglobinemia that presents similarly to methemoglobinemia.: Case report: An 83-year-old woman with stage IV ovarian cancer presented to the Emergency Department after a near syncopal spell and was found ... ...

    Abstract Background: Sulfhemoglobinemia is a rare dyshemoglobinemia that presents similarly to methemoglobinemia.
    Case report: An 83-year-old woman with stage IV ovarian cancer presented to the Emergency Department after a near syncopal spell and was found to be cyanotic with a pulse oximetry reading of 71%. Pulse oximetry improved to only the mid-80s range with administration of high-flow oxygen. Her arterial blood gas on supplemental high-flow oxygen demonstrated a PaO
    MeSH term(s) Aged, 80 and over ; Cyanosis ; Dyspnea ; Female ; Humans ; Methemoglobinemia/diagnosis ; Methylene Blue ; Oximetry ; Phenazopyridine ; Sulfhemoglobinemia
    Chemical Substances Phenazopyridine (K2J09EMJ52) ; Methylene Blue (T42P99266K)
    Language English
    Publishing date 2021-05-24
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 605559-x
    ISSN 0736-4679
    ISSN 0736-4679
    DOI 10.1016/j.jemermed.2021.03.002
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  3. Article ; Online: Annals of Emergency Medicine Journal Club. Treatment of calcium channel blocker poisoning: should we reprioritize our potpourri of treatment options?: answers to the September 2013 Journal Club questions.

    Pfeffer, Andrew N / Williams, Saralyn R

    Annals of emergency medicine

    2014  Volume 63, Issue 2, Page(s) 259–265

    MeSH term(s) Calcium Channel Blockers/poisoning ; Critical Care/methods ; Diltiazem/poisoning ; Drug Overdose/drug therapy ; Female ; Humans ; Male ; Vasoconstrictor Agents/therapeutic use ; Verapamil/poisoning
    Chemical Substances Calcium Channel Blockers ; Vasoconstrictor Agents ; Verapamil (CJ0O37KU29) ; Diltiazem (EE92BBP03H)
    Language English
    Publishing date 2014-02
    Publishing country United States
    Document type Comment ; Journal Article
    ZDB-ID 603080-4
    ISSN 1097-6760 ; 0196-0644
    ISSN (online) 1097-6760
    ISSN 0196-0644
    DOI 10.1016/j.annemergmed.2013.10.028
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  4. Article ; Online: Annals of Emergency Medicine Journal Club. Treatment of calcium channel blocker poisoning: should we re-prioritize our potpourri of treatment options?

    Pfeffer, Andrew N / Williams, Saralyn R

    Annals of emergency medicine

    2013  Volume 62, Issue 3, Page(s) 273–274

    MeSH term(s) Calcium Channel Blockers/poisoning ; Critical Care/methods ; Diltiazem/poisoning ; Drug Overdose/drug therapy ; Female ; Humans ; Male ; Vasoconstrictor Agents/therapeutic use ; Verapamil/poisoning
    Chemical Substances Calcium Channel Blockers ; Vasoconstrictor Agents ; Verapamil (CJ0O37KU29) ; Diltiazem (EE92BBP03H)
    Language English
    Publishing date 2013-09
    Publishing country United States
    Document type Comment ; Journal Article
    ZDB-ID 603080-4
    ISSN 1097-6760 ; 0196-0644
    ISSN (online) 1097-6760
    ISSN 0196-0644
    DOI 10.1016/j.annemergmed.2013.07.005
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  5. Article ; Online: A 3-Year-Old With Sudden-Onset Anisocoria After Playing Outside.

    Garcia, Kelly L / Breazzano, Mark P / Bond, John B / Williams, Saralyn R / Smith, Austin T

    Pediatric emergency care

    2018  Volume 34, Issue 6, Page(s) e111–e114

    MeSH term(s) Anisocoria/etiology ; Belladonna Alkaloids/poisoning ; Child, Preschool ; Diagnosis, Differential ; Female ; Humans ; Solanaceae/poisoning
    Chemical Substances Belladonna Alkaloids
    Language English
    Publishing date 2018-06-11
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 632588-9
    ISSN 1535-1815 ; 0749-5161
    ISSN (online) 1535-1815
    ISSN 0749-5161
    DOI 10.1097/PEC.0000000000001513
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  6. Article: Overdose of aripiprazole, a new type of antipsychotic.

    Carstairs, Shaun D / Williams, Saralyn R

    The Journal of emergency medicine

    2005  Volume 28, Issue 3, Page(s) 311–313

    Abstract: Aripiprazole is the first member of a new class of antipsychotic medications. Unlike other antipsychotics, it acts as a partial agonist at dopamine D(2) and 5-HT(1A) receptors, thereby mitigating most of the adverse reactions such as extrapyramidal side ... ...

    Abstract Aripiprazole is the first member of a new class of antipsychotic medications. Unlike other antipsychotics, it acts as a partial agonist at dopamine D(2) and 5-HT(1A) receptors, thereby mitigating most of the adverse reactions such as extrapyramidal side effects and hyperprolactinemia. Additionally, most research to date has suggested a low incidence of QTc prolongation and orthostatic hypotension at therapeutic doses. Experience in the setting of intentional overdose, however, is limited. We present a case of a 27-year-old woman who intentionally ingested 330 mg of aripiprazole in a suicide attempt. Clinical effects were limited to mild sedation. Serum levels performed by the drug's manufacturer confirmed a total level (parent drug and active metabolite) of 716 ng/mL, nearly six times the upper limit of accepted therapeutic levels. This suggests that aripiprazole's therapeutic index is quite high and reinforces the drug's known safety profile.
    MeSH term(s) Adult ; Antipsychotic Agents/poisoning ; Aripiprazole ; Drug Overdose ; Emergency Medical Services ; Female ; Humans ; Piperazines/poisoning ; Quinolones/poisoning ; Suicide, Attempted
    Chemical Substances Antipsychotic Agents ; Piperazines ; Quinolones ; Aripiprazole (82VFR53I78)
    Language English
    Publishing date 2005-04
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 605559-x
    ISSN 0736-4679
    ISSN 0736-4679
    DOI 10.1016/j.jemermed.2004.09.013
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  7. Article: Fatal unintentional overdose of diltiazem with antemortem and postmortem values.

    Cantrell, F Lee / Williams, Saralyn R

    Clinical toxicology (Philadelphia, Pa.)

    2005  Volume 43, Issue 6, Page(s) 587–588

    Abstract: Background: Therapeutic errors involving calcium channel antagonists (CCA) resulting in death rarely have been reported in detail. We report a fatality from an unintentional overdose of sustained-release (SR) diltiazem including antemortem and ... ...

    Abstract Background: Therapeutic errors involving calcium channel antagonists (CCA) resulting in death rarely have been reported in detail. We report a fatality from an unintentional overdose of sustained-release (SR) diltiazem including antemortem and postmortem blood concentrations.
    Case report: A 65-year-old man with aortic stenosis mistakenly took six tablets of diltiazem 360 mg SR. He developed symptoms of toxicity by 7 hours after ingestion. By 10 hours, he went to the emergency department. Despite a prolonged resuscitative attempt, the patient died 17 hours postingestion. An antemortem blood sample drawn 11.5 hours after ingestion was 2.9 mcg/mL. Postmortem gas chromatography of central blood revealed a diltiazem level of 6 mcg/mL and the peripheral blood sample measured 5 mcg/ mL.
    Conclusion: This case suggests that an unintentional overdose with a CCA may be lethal if the patient's cardiovascular ability to compensate for the toxic effects is compromised.
    MeSH term(s) Aged ; Diltiazem/blood ; Diltiazem/poisoning ; Drug Overdose ; Fatal Outcome ; Humans ; Male
    Chemical Substances Diltiazem (EE92BBP03H)
    Language English
    Publishing date 2005-09-09
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 204476-6
    ISSN 1556-9519 ; 1556-3650 ; 0009-9309 ; 0731-3810
    ISSN (online) 1556-9519
    ISSN 1556-3650 ; 0009-9309 ; 0731-3810
    DOI 10.1081/clt-200068860
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  8. Article: Phenytoin-potentiated hepatotoxicity following acetaminophen overdose? A closer look.

    Cook, Matthew D / Williams, Saralyn R / Clark, Richard F

    Digestive diseases and sciences

    2007  Volume 52, Issue 1, Page(s) 208–209

    MeSH term(s) Acetaminophen/poisoning ; Analgesics, Non-Narcotic/poisoning ; Anticonvulsants/pharmacology ; Drug Overdose ; Drug Synergism ; Humans ; Liver Failure, Acute/chemically induced ; Phenytoin/pharmacology
    Chemical Substances Analgesics, Non-Narcotic ; Anticonvulsants ; Acetaminophen (362O9ITL9D) ; Phenytoin (6158TKW0C5)
    Language English
    Publishing date 2007-01
    Publishing country United States
    Document type Comment ; Letter
    ZDB-ID 304250-9
    ISSN 1573-2568 ; 0163-2116
    ISSN (online) 1573-2568
    ISSN 0163-2116
    DOI 10.1007/s10620-006-9153-x
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  9. Article: Vasopressin treatment for cyclic antidepressant overdose.

    Barry, James David / Durkovich, David W / Williams, Saralyn R

    The Journal of emergency medicine

    2006  Volume 31, Issue 1, Page(s) 65–68

    Abstract: Due to neurotransmitter reuptake inhibition, peripheral alpha receptor blocking effects, and sodium channel blockade, severe cyclic antidepressant poisoning may lead to intractable hypotension. We report a case of severe amitriptyline toxicity, with ... ...

    Abstract Due to neurotransmitter reuptake inhibition, peripheral alpha receptor blocking effects, and sodium channel blockade, severe cyclic antidepressant poisoning may lead to intractable hypotension. We report a case of severe amitriptyline toxicity, with hypotension unresponsive to direct alpha receptor agonists after pH manipulation, but improved with intravenous vasopressin. Vasopressin use in the setting of cyclic antidepressant toxicity has not been previously reported. Vasopressin may be a beneficial agent in the treatment of recalcitrant hypotension associated with poisoning or overdose. The anecdotal nature of this report must be emphasized and the use of vasopressin requires further research to define efficacy, dose, and potential side effects.
    MeSH term(s) Amitriptyline/poisoning ; Antidepressive Agents, Tricyclic/poisoning ; Drug Overdose/drug therapy ; Humans ; Hypotension/chemically induced ; Hypotension/drug therapy ; Male ; Middle Aged ; Vasoconstrictor Agents/therapeutic use ; Vasopressins/therapeutic use
    Chemical Substances Antidepressive Agents, Tricyclic ; Vasoconstrictor Agents ; Vasopressins (11000-17-2) ; Amitriptyline (1806D8D52K)
    Language English
    Publishing date 2006-07
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 605559-x
    ISSN 0736-4679
    ISSN 0736-4679
    DOI 10.1016/j.jemermed.2005.08.012
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  10. Article ; Online: Arrhythmogenic Munchausen syndrome culminating in caffeine-induced ventricular tachycardia.

    Vaglio, Joseph C / Schoenhard, John A / Saavedra, Pablo J / Williams, Saralyn R / Raj, Satish R

    Journal of electrocardiology

    2011  Volume 44, Issue 2, Page(s) 229–231

    Abstract: We report a patient with numerous abnormal electrocardiograms (ECGs) in both inpatient and outpatient settings. Our patient both simulated and stimulated her arrhythmias with an ECG rhythm generator and intentional caffeine intoxication. To our knowledge, ...

    Abstract We report a patient with numerous abnormal electrocardiograms (ECGs) in both inpatient and outpatient settings. Our patient both simulated and stimulated her arrhythmias with an ECG rhythm generator and intentional caffeine intoxication. To our knowledge, this is the first report of caffeine overdose for arrhythmogenesis.
    MeSH term(s) Adult ; Caffeine/toxicity ; Central Nervous System Stimulants/toxicity ; Female ; Humans ; Munchausen Syndrome/chemically induced ; Munchausen Syndrome/diagnosis ; Tachycardia, Ventricular/chemically induced ; Tachycardia, Ventricular/diagnosis
    Chemical Substances Central Nervous System Stimulants ; Caffeine (3G6A5W338E)
    Language English
    Publishing date 2011-03
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 410286-1
    ISSN 1532-8430 ; 0022-0736
    ISSN (online) 1532-8430
    ISSN 0022-0736
    DOI 10.1016/j.jelectrocard.2010.08.006
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