scholarly journals Dantrolene is not the answer to 2,4-dinitrophenol poisoning: more heated debate

2018 ◽  
Vol 11 (1) ◽  
pp. e225323 ◽  
Author(s):  
Jason Van Schoor ◽  
Esha Khanderia ◽  
Andrew Thorniley
Keyword(s):  
Weight Loss ◽  
Cardiac Arrest ◽  
Information Service ◽  
Online Retailer ◽  
Heated Debate ◽  
The Uk ◽  
Weight Loss Drug ◽  
Poisons Information

There has been a resurgence in the use of 2,4-dinitrophenol, C6H4N2O5 (DNP) recently as an illegal weight loss drug. We present a case of a healthy 25-year-old girl who took two tablets of DNP, purchased from an overseas online retailer. She was managed with aggressive, invasive cooling measures and 2.5 mg kg–1 dantrolene. Despite this, her temperature continued to rise exponentially to 41.5°C. Cardiac arrest occurred and resuscitation was unsuccessful. To our knowledge, this is the first reported case of the ineffective use of dantrolene in acute DNP poisoning. We review the pathophysiology of DNP toxicity and argue that the use of dantrolene therapy is biochemically implausible, based on poor evidence and likely to be futile. We have contacted the UK National Poisons Information Service (NPIS/TOXBASE) to propose changes to the management of acute DNP toxicity.

scholarly journals Management of poisoning with ethylene glycol and methanol in the UK: a prospective study conducted by the National Poisons Information Service (NPIS)

2015 ◽  
Vol 54 (2) ◽  
pp. 134-140 ◽  
Author(s):  
Ruben H. K. Thanacoody ◽  
Claire Gilfillan ◽  
Sally M. Bradberry ◽  
Jeremy Davies ◽  
Gill Jackson ◽  
...  
Keyword(s):  
Ethylene Glycol ◽  
Prospective Study ◽  
Information Service ◽  
The Uk ◽  
A Prospective Study ◽  
Poisons Information

scholarly journals Reductions in emergency department visits after primary healthcare use of the UK National Poisons Information Service

2017 ◽  
Vol 56 (5) ◽  
pp. 342-347 ◽  
Author(s):  
Muhammad E. M. O. Elamin ◽  
David A. James ◽  
Peter Holmes ◽  
Gillian Jackson ◽  
John P. Thompson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Primary Healthcare ◽  
Information Service ◽  
Emergency Department Visits ◽  
Healthcare Use ◽  
The Uk ◽  
Poisons Information

scholarly journals Snakebite enquiries to the UK National Poisons Information Service: 2004–2010

2012 ◽  
Vol 30 (11) ◽  
pp. 932-934 ◽  
Author(s):  
James Michael Coulson ◽  
Gillian Cooper ◽  
Channarayapatna Krishna ◽  
John Paul Thompson
Keyword(s):  
Information Service ◽  
The Uk ◽  
Poisons Information

Features reported after exposure to automatic dishwashing rinse aids

2020 ◽  
Vol 39 (6) ◽  
pp. 828-833
Author(s):  
R Day ◽  
SM Bradberry ◽  
EA Sandilands ◽  
SHL Thomas ◽  
JP Thompson ◽  
...  
Keyword(s):  
Information Service ◽  
Eye Pain ◽  
Central Nervous System Depression ◽  
Ethoxylated Alcohols ◽  
Other Substances ◽  
Automatic Dishwashing ◽  
Poisoning Severity Score ◽  
The Uk ◽  
Ocular Exposure ◽  
Poisons Information

Introduction: Automatic dishwashing rinse aids are drying aids which contain non-ionic surfactants, usually ethoxylated alcohols, typically at concentrations of ≤30%. Objective: To assess the reported toxicity of rinse aids. Methods: Telephone enquiries to the UK National Poisons Information Service were analysed from January 2008 to June 2019. Results: Ingestion: Ingestion was involved in 976 cases and produced gastrointestinal features, coughing and central nervous system depression, particularly in young children. In those in whom the amount ingested was known, the majority (56%) of children <18 years and of adults (57%) ingested <50 mL of rinse aid. Although moderate or severe exposures (Poisoning Severity Score (PSS) ≥ 2) were uncommon, they occurred significantly ( p < 0.0008) more often in adults (9.0%) than in children (1.8%); however, three of the four adults with PSS ≥ 2 co-ingested other substances. Eye exposure: Ocular exposure was reported in 35 cases, of whom 29 developed features. Eye irritation ( n = 10, 28.6%) and eye pain ( n = 10, 28.6%) were reported most commonly, and three patients (8.6%) developed corneal abrasions (PSS 2). Dermal exposure: Thirty-four patients were exposed dermally, and six (17.6%) reported features, including rash, numbness, pruritus and burns (PSS 1). Conclusions: Overall, clinical features developed in 47% of patients exposed to rinse aids, but more severe features (PSS ≥ 2) were rare (<3%) following exposure by any route.

Methylene blue toxicity following infusion to localize parathyroid adenoma

2005 ◽  
Vol 120 (2) ◽  
pp. 138-140 ◽  
Author(s):  
A Majithia ◽  
M P Stearns
Keyword(s):  
Methylene Blue ◽  
Parathyroid Adenoma ◽  
Intravenous Infusion ◽  
Information Service ◽  
Complete Recovery ◽  
Parathyroid Glands ◽  
Rare Occurrence ◽  
Mechanism Of Toxicity ◽  
The Uk ◽  
Poisons Information

The parathyroid glands are small, inconspicuous, and variable in number, colour and position. Their identification is vital for excision of hyper-functioning glands and for preservation of normally functioning ones in patients undergoing thyroidectomy.Intravenous infusion of methylene blue at a dose of 7.5 mg/kg is commonly used to aid visualization of the parathyroid glands intra-operatively. Methylene blue is generally considered benign, and there are only two cases published in the literature reporting toxicity following intravenous infusion – such toxicity is a diagnosis of exclusion.We report a case of methylene blue toxicity resulting in expressive aphasia, confusion and disinhibition following infusion for parathyroid adenoma localization. The patient made a complete recovery over 48 hours. Methaemoglobinaemia was excluded as a cause. We suggest that the mechanism of toxicity was a direct effect of methylene blue, although an adverse interaction with serotonin re-uptake inhibitors could not be excluded.In keeping with the UK National Poisons Information Service recommendations, we have altered our practice and now use methylene blue at a dose not exceeding 4 mg/kg. This has not affected our success rate for identification of parathyroid glands. We report this case to highlight the rare occurrence of methylene blue toxicity when used at a dose of 7.5 mg/kg.

Clinical Toxicology - Past, Present and Future

1988 ◽  
Vol 7 (5) ◽  
pp. 481-487 ◽  
Author(s):  
A.T. Proudfoot
Keyword(s):  
Information Service ◽  
Acute Poisoning ◽  
Clinical Toxicology ◽  
Repeat Dose ◽  
Analytical Toxicology ◽  
Dose Oral ◽  
Life Threatening ◽  
The 1960S ◽  
The Uk ◽  
Poisons Information

1 The alarming increase in the incidence of self-poisoning in Western countries in the 1950s prompted the establishment of the National Poisons Information Service in the UK and the designation of certain Regional Poisoning Treatment Centres. 2 The substances taken in acute poisoning episodes largely reflect the poisons available in the community and, in the UK at least, have changed with fashions in prescribing although psychotropic drugs and analgesics always predominate. 3 Intensive supportive care with repeat-dose oral activated charcoal and even haemoperfusion has been proved effective in acute poisoning with central nervous depressant drugs such as barbiturates even though these latter drugs are now rarely encountered in overdose. 4 Other advances in clinical toxicology include the introduction of the opiate antagonist naloxone, Fab antibody fragments for life-threatening digoxin overdosage and proven treatment for paracetamol poisoning. Analytical toxicology has also made a major contribution. 5 On the debit side, formal psychiatric assessment of patients after acute poisoning remains contentious, tricyclic antidepressants are still a major problem and there is no effective treatment for poisoning with paraquat or for paracetamol when presentation is delayed. 6 As to the future, although the 'epidemic' of serious acute poisoning of the 1960s and 70s appears to be past its peak, there will always be unusual and serious problems and the UK poisons information services must develop to make the best use of computer-based technology.

Sign in / Sign up

Export Citation Format

Share Document