Clinical Policy for the Initial Approach to Patients Presenting With Acute Toxic Ingestion or Dermal or Inhalation Exposure

Syrup of ipecac is an important component in the treatment of acute toxic ingestion. The American Academy of Pediatrics1 recommends that syrup of ipecac be kept in the household to be used for the conscious patient in the treatment of toxic ingestion when advised by a physician. Syrup of ipecac is not without toxicity, however, and this increased availability opens the door to poisoning by ipecac itself. Toxicity has been observed in adults ranging from direct noxious effects on the gastrointestinal system2-4 to cardiomyopathy,2,5 generalized myopathy,6,7 and fatalities secondary to dehydration or electrolytic distubrances.8 Little is known about the signs and symptoms of ipecac toxicity in infants and children.

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Clinical and Pathologic Aspects of Cardiomyopathy From Ipecac Administration in Munchausen's Syndrome by Proxy

PEDIATRICS ◽

10.1542/peds.97.6.902 ◽

1996 ◽

Vol 97 (6) ◽

pp. 902-906

Author(s):

Douglas J. Schneider ◽

Angel Perez ◽

Timothy E. Knilans ◽

Stephen R. Daniels ◽

Kevin E. Bove ◽

...

Keyword(s):

Emergency Management ◽

First Aid ◽

Toxic Effects ◽

Toxic Ingestion ◽

Munchausen's Syndrome ◽

Toxic Manifestation ◽

Munchausen’S Syndrome ◽

Acute Toxic

Syrup of ipecac is an important component of the emergency management of acute toxic ingestion in children. It is generally safe for acute emergency use, and is recommended for first aid kits in homes with children. However, there are important toxic effects of excessive or long-term ingestion of syrup of ipecac. Cardiomyopathy is a potentially fatal, but often reversible, toxic manifestation of ipecac abuse, most commonly occurring in patients with bulimia. Another setting in which ipecac abuse occurs is Munchausen's syndrome by proxy. We report two cases, one fatal, of cardiomyopathy from ipecac toxicity secondary to Munchausen's syndrome by proxy.

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Toxic effects of inhaled DMMP on the kidneys of Fischer-344 rats

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100128687 ◽

1987 ◽

Vol 45 ◽

pp. 880-881

Author(s):

D.R. Mattie ◽

C.J. Hixson

Keyword(s):

Left Kidney ◽

Inhalation Exposure ◽

Electron Microscopic Examination ◽

Exposure Period ◽

Male Rats ◽

Continuous Exposure ◽

Fischer 344 Rats ◽

Electron Microscopic ◽

Thin Sections ◽

Fischer 344

Dimethylmethylphosphonate (DMMP) is a simple organophosphate used industrially as a flame retardant and to lower viscosity in polyester and epoxy resins. The military considered the use of DMMP as a nerve gas simulant. Since military use of DMMP involved exposure by inhalation, there was a need for a subchronic inhalation exposure to DMMP to fully investigate its toxic potential.Male Fischer-344 rats were exposed to 25 ppm or 250 ppm DMMP vapor on a continuous basis for 90 days. An equal number of control rats were sham-exposed. Following the 90-day continuous exposure period, 15 male rats were sacrificed from each group. Two rats from each group had the left kidney perfused for electron microscopic examination. The kidneys were perfused from a height of 150 cm water with 1% glutaraldehyde in Sorensen's 0.1M phosphate buffer pH 7.2. An additional kidney was taken from a rat in each group and fixed by immersion in 2.5% glutaraldehyde and 2% paraformaldehyde in 0.1M cacodylate buffer pH 7.4. A portion of the 9 kidneys collected for electron microscopy were processed into Epon 812. Thin sections, stained with uranyl acetate and lead citrate, were examined with a JEOL 100B Transmission Electron Microscope. Microvilli height was measured on photographs of the cells of proximal tubules. This data, along with morphologic features of the cells, allows the proximal convoluted tubules (PCT) to be identified as being S1, S2, or S3 segment PCT.

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Evaluation of hippocampus in rhesus monkeys after chronic (1-year) inhalation exposure to marijuana: I. Electron microscopy

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100159539 ◽

1990 ◽

Vol 48 (3) ◽

pp. 398-399

Author(s):

A.M. Andrews ◽

S.W. Wilson ◽

A.C. Scallet ◽

S.F. Ali ◽

J. Bailey ◽

...

Keyword(s):

Synaptic Vesicles ◽

Rhesus Monkeys ◽

Low Dose ◽

Inhalation Exposure ◽

Synaptic Cleft ◽

High Dose ◽

Withdrawal Time ◽

Treatment Groups ◽

Ultrastructural Evidence ◽

Male Rhesus

Exposure of rhesus monkeys (Macaca mulatta) to marijuana via inhalation or to intravenous delta-9-tetrahydrocannabinol (THC), reportedly caused ultrastructural evidence of increased synaptic width. Chronic marijuana smoke in a single rhesus monkey examined after a six month withdrawal time caused ultrastructure changes in the septal, hippocampal and amygdala regions; the synaptic cleft was widened, electron opaque material was found in the cleft and in the pre- and postsynaptic regions, with some clumping of the synaptic vesicles. The objective of our study was to assess neuropathological alterations produced by chronic inhalation of marijuana smoke.Nineteen male rhesus monkeys, 3-5 years of age and weighing 3-8 kg, were divided into four treatment groups: a) sham control, b) placebo smoke (7 days/ week) c) low dose marijuana (2 times/week with 5 days/week sham) and d) high dose marijuana (7 times/week). A smoke exposure consisted of smoke from one cigarette (2.6% THC) burned down to 10 mm butt length. Smoke was administered via smoke generator (ADL II, Arthur D. Little, Inc. Cambridge, MA) and nose-mouth only masks (local production) equipped with one-way valves.

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