Carolinas Poison Center

Charlotte, North Carolina, United States

Carolinas Poison Center

Charlotte, North Carolina, United States
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Murray B.L.,Carolinas Medical Center | Murphy C.M.,Carolinas Medical Center | Beuhler M.C.,Carolinas Poison Center
Journal of Medical Toxicology | Year: 2012

Introduction: 3,4-Methylenedioxypyrovalerone (MDPV) is a designer stimulant drug that has gained popularity in the USA. Although adverse effects of MDPV have been described, to our knowledge, this is the first reported death. Case Report: We report the case of a 40-year-old male who injected and snorted "bath salts" containing MDPV and subsequently became agitated, aggressive, and experienced a cardiac arrest. He was resuscitated after his initial arrest; however, he developed hyperthermia, rhabdomyolysis, coagulopathy, acidosis, anoxic brain injury, and subsequently died. Discussion: This is the first case in the medical literature to report death due to isolated confirmed MDPV intoxication. The manner of death is also consistent with excited delirium syndrome. © 2012 American College of Medical Toxicology.


Ford M.D.,Carolinas Poison Center
North Carolina medical journal | Year: 2010

Unintentional poisoning is a fast-growing public health problem that once evoked an image of a street denizen injecting heroin or snorting cocaine. Today's victim is white, male, and middle-aged--and the drugs are prescribed. In North Carolina, unintentional poisoning is the second-leading cause of death due to unintentional injury, and injuries due to any cause are the leading cause of potential years of life lost. Comprehensive prevention measures are needed now to stem this burgeoning problem.


Beuhler M.C.,Carolinas Poison Center | Spiller H.A.,Kosair Childrens Hospital | Sasser H.C.,Dickson Institute for Health Studies Research Planning and Evaluation
Journal of Medical Toxicology | Year: 2010

Unintentional bupropion pediatric exposures un-commonly report severe clinical effects such as seizures. We sought to determine the clinical effects and case outcomes for unintentional bupropion ingestions in children age ≤6 years. The National Poison Data System was queried for unintentional, acute, single substance bupropion ingestions in children age ≤6 years for the time period January 1, 2000 to February 27, 2007 for cases followed to a known outcome. If exposure amount was reported, a mg/kg dose was determined; when weight was absent, it was interpolated from the available data set. An adverse neurological effect (ANE) was defined as seizure (single, multi/discrete, and status) or coma. For analysis, the outcomes of no effect and mild outcome were grouped, and the outcomes of moderate outcome, major outcome, and death were grouped. A subset of case notes were reviewed for accuracy. Seven thousand one hundred eighteen cases met the inclusion criteria, with 1,154 cases excluded because of multiple substances and coding errors, resulting in 5,964 cases. A total of 4,557 cases (76.4%) were managed at or sent to a HCF. The most common clinical effects reported were nausea/vomiting (4.3%), tachycardia (3.9%), agitated/irritable (3.1%), drowsiness/lethargy (2.4%), and seizure (1.4%). There were no deaths. Overall, there was a 3.3% rate of moderate/major outcomes. A mg/kg dose was calculable in 76.1% of cases; the average amount for the no effect/minor cases and moderate/major effect was 13.8±18.8 and 38.8±44.0 mg/kg, respectively (p<0.0001). Average time until development of seizures was 4.2±3.2 h with a maximum of 14 h. Few children develop toxicity from unintentional reported bupropion ingestions, with about 1.5% of patients developing an ANE. © American College of Medical Toxicology 2010.


Daul A.M.,Carolinas Medical Center | Beuhler M.C.,Carolinas Poison Center | Beuhler M.C.,University of North Carolina at Chapel Hill
Journal of Emergency Medicine | Year: 2011

Background: Niacin, a well-established agent for treating dyslipidemia, has been promoted on the Internet as a method for passing urine drug screening, although there are no data to support its use for this purpose. In a handful of cases, this practice has resulted in serious niacin toxicity. Objectives: The aim of this article is to describe a unique clinical presentation of niacin toxicity. Case Report: A 23-year-old previously healthy man presented to an Emergency Department with altered mental status, fever, acute renal failure, microangiopathic hemolytic anemia, thrombocytopenia, and coagulopathy. It was revealed that he had taken approximately 22.5 g of sustained-release niacin over the preceding 48 h in an attempt to pass a pre-employment urine drug screen. After a complicated hospital course that included mechanical ventilation for respiratory failure and hemodialysis for acute renal failure, the patient made a full recovery and was discharged 10 days after his initial presentation. Conclusion: After a massive niacin overdose, the young man in this case presented with a complex clinical picture that mimicked concurrent thrombotic thrombocytopenic purpura and disseminated intravascular coagulation. Although this patient was fortunate to make a full recovery, the case highlights the potential for multi-system toxicity with niacin overdose, and the potential for harm posed by medical misinformation on the Internet. © 2011 Elsevier Inc.


Murphy C.M.,Carolinas Medical Center | Dulaney A.R.,Carolinas Poison Center | Beuhler M.C.,Carolinas Poison Center | Kacinko S.,NMS Laboratories
Journal of Medical Toxicology | Year: 2013

Abuse of psychogenic substances sold as "bath salts" and "plant food" has escalated in recent years in the United States (USA). Previous reports suggest regional differences in the primary active β-keto phenylalkylamines found in these products and the corresponding signs and symptoms reported after exposure. Currently, there are only limited studies describing the clinical effects associated with reported "bath salts" exposure in the USA. This study describes the clinical effects associated with "bath salt" and "plant food" exposures as reported to the poison center serving the state of North Carolina (Carolinas Poison Center). We performed a retrospective review of the Carolinas Poison Center database for all cases of reported human exposure to "bath salt" and "plant food" products from 2010 to 2011 with specific attention to clinical effects and routes of exposure. Additionally, we reviewed therapies used, trended the volume of exposure cases reported over the study period, and evaluated the distribution of calls within state counties using descriptive statistics. Carolinas Poison Center received 485 total calls and 409 reported exposure calls regarding "bath salt" or "plant food" products between January of 2010 and December of 2011. The peak of reported exposures occurred in May of 2011. Clinical effects commonly reported in the exposure cases generated from these calls included tachycardia (53. 3 %, n = 218), agitated/irritable (50. 4 %, n = 206), hallucination/delusions (26. 7 %, n = 109), and hypertension (25. 2 %, n = 103). In addition to intravenous fluids, common therapies included benzodiazepines (46. 0 %, n = 188), sedation (13. 4 %, n = 55), alkalinization (3. 90 %, n = 16), antihistamine (4. 16 %, n = 17), and intubation (3. 67 %, n = 15). Haloperidol was the antipsychotic agent used most often to treat agitation (n = 40). Serious complications associated with reported exposure to "bath salt" and "plant food" products included rhabdomyolysis, renal failure, excited delirium syndrome, and death. While treatments have not been empirically determined, sedation with benzodiazepines, aggressive cooling for hyperthermic patients, and use of small doses of antipsychotics for choreoathetoid movements not controlled with benzodiazepines are not likely to be harmful. © 2012 American College of Medical Toxicology.


Beuhler M.C.,Carolinas Poison Center | Gala P.K.,Children's Hospital of Philadelphia | Wolfe H.A.,Children's Hospital of Philadelphia | Meaney P.A.,Children's Hospital of Philadelphia | And 3 more authors.
Pediatric Emergency Care | Year: 2013

OBJECTIVES: The objectives of this study were to present and explore the clinical presentation of the increasingly common pediatric exposure to the widely available single-use laundry packets or "laundry pods." METHODS: This is a case report of 4 pediatric patients with significant toxicity due to laundry pod detergent exposure and a review of the available literature including abstract-only publications. RESULTS: An unexpectedly severe clinical pattern was noted; 3 of the 4 children required intubation for management, airway injury was noted in 1 of them, and 2 of them had hospital courses of at least 1 week. The literature suggests that laundry pod exposures are associated with increased morbidity compared to traditional laundry detergent exposures. To date, no specific contaminant or component has been identified as being responsible for the injury, although some evidence points to the surfactant component. CONCLUSIONS: A different approach to the triage and management of pediatric exposures to laundry detergent pod ingestions is required compared with nonpod ingestions. Although the exact cause is not known, practitioners should be vigilant for rapid onset of neurological impairment and inability to protect the airway in addition to its caustic effects. Copyright © 2013 Lippincott Williams & Wilkins.


Spiller H.A.,Central Ohio Poison Center | Beuhler M.C.,Carolinas Poison Center | Beuhler M.C.,University of North Carolina at Chapel Hill | Ryan M.L.,Louisiana Poison Center | And 5 more authors.
Pediatric Emergency Care | Year: 2013

OBJECTIVE: The nature of pediatric poisonings is dynamic, with changes occurring over time. We evaluated poisoning in children younger than 6 years for trends during an 11-year period regarding the substances involved in the poisoning, medical outcomes, and health care use. METHODS: This was retrospective study of poisoning in children younger than 6 years reported to 12 poison centers in 5 US states for the years 2000 through 2010. Data abstracted included substance category involved in the exposure, age of patient, year of occurrence, location of patient management, and medical outcome. RESULTS: There were 2,577,036 poison exposures in children younger than 6 years, with a 12.4% increase from 210,270 poison exposures in 2000 to 236,425 poison exposures in 2010. There was a 33% increase (P < 0.05) in pharmaceutical related exposures in children younger than 6 years and a 2.8% decline in the number of nonpharmaceutical related exposures. Among those substance categories representing more than 1% of exposures, the only pharmaceutical showing decline was cough/cold preparations. There was a 53% increase in serious medical outcomes, including 119 deaths and a significant increase in health care facility use, primarily owing to pharmaceutical exposures. CONCLUSIONS: Poisoning in young children increasingly involves pharmaceuticals and is associated with an increased number of serious outcomes and children treated in a health care facility. We believe that these changes are related to increased availability of medications in the home and poison prevention education efforts should include a focus on the availability of these products to small children. Copyright © 2013 by Lippincott Williams & Wilkins.


Murphy C.M.,Carolinas Medical Center | Hong J.J.,University of North Carolina at Chapel Hill | Beuhler M.C.,Carolinas Poison Center
Journal of Medical Toxicology | Year: 2011

Latrodectus mactans antivenin is a safe and effective therapy for severe black widow spider envenomations when given to most patients. We report a case of a 37-year-old male with a history of asthma that was given L. mactans antivenin for symptoms related to a black widow envenomation and developed a severe anaphylactic reaction resulting in cardiac arrest. When traditional therapies failed, the patient was given methylene blue for anaphylactic shock resulting in a 30-h period of hemodynamic stability. Despite initial resuscitation, the patient ultimately died 40 h after presentation. Under the right circumstances, L. mactans antivenin remains a safe and effective therapy for severe black widow envenomations. However, anaphylaxis is a risk for those receiving this therapy, even when the antivenin is diluted and given as an infusion. We report the first death related to diluted L. mactans antivenin given as an infusion. © 2011 American College of Medical Toxicology.


PubMed | Carolinas Poison Center, Duke University and University of North Carolina at Chapel Hill
Type: Journal Article | Journal: PloS one | Year: 2015

Ethylene glycol is highly toxic and represents an important cause of poisonings worldwide. Toxicity can result in central nervous system dysfunction, cardiovascular compromise, elevated anion gap metabolic acidosis and acute kidney injury. Many states have passed laws requiring addition of the bittering agent, denatonium benzoate, to ethylene glycol solutions to reduce severity of exposures. The objectives of this study were to identify differences between unintentional and intentional exposures and to evaluate the utility of denatonium benzoate as a deterrent.Using the National Poison Data System, we performed a retrospective analysis of reported cases of ethylene glycol exposures from January 2006 to December 2013. Outcome classification was summed for intentionality and used as a basis for comparison of effect groups. There were 45,097 cases of ethylene glycol exposures resulting in 154 deaths. Individuals more likely to experience major effects or death were older, male, and presented with more severe symptoms requiring higher levels of care. Latitude and season did not correlate with increased exposures; however, there were more exposures in rural areas. Denatonium benzoate use appeared to have no effect on exposure severity or number.Deaths due to ethylene glycol exposure were uncommon; however, there were major clinical effects and more exposures in rural areas. Addition of denatonium benzoate was not associated with a reduction in exposures. Alternative means to deter ingestion are needed. These findings suggest the need to consider replacing ethylene glycol with alternative and less toxic agents.


PubMed | U.S. Army, Carolinas Poison Center and Carolinas Medical Center
Type: Journal Article | Journal: Journal of medical toxicology : official journal of the American College of Medical Toxicology | Year: 2016

Animal studies and human case reports show promise in using lipid rescue to treat refractory calcium channel antagonist toxicity. However, the majority of research and clinical experience has focused on non-dihydropyridine agents. Thus, we sought to investigate the value of lipid emulsion (ILE) therapy for dihydropyridine-induced shock. This IACUC-approved study utilized seven swine that were sedated with alpha-chloralose, mechanically ventilated, and instrumented for drug delivery and hemodynamic measures. After stabilization and basal measures, nifedipine (0.01875 mg/kg/min) was infused until imminent cardiac arrest (seizure, end tidal CO2 < 10 mmHg, bradydysrhythmia, or pulseless electrical activity). Animals then received a 7mL/kg bolus of 20% lipid emulsion via central catheter. Lipid circulation was visually confirmed by the presence of fat in peripheral arterial blood. Hemodynamics were continuously monitored until 10 min after lipid bolus. Surviving animals were euthanized. Pre- and post-lipid treatment parameters were analyzed using the Wilxocon signed rank test (p <0.05 significant). Nifedipine toxicity was characterized by vasodilatory hypotension, impaired vascular contractility, and tachycardia with terminal bradycardia. The median time to imminent cardiac arrest from start of nifedipine infusion was 218 min. Lipid treatment did not improve hemodynamics or restore circulation in any animal. There was no benefit from lipid rescue in this model of nifedipine toxicity. Further study of ILE for dihydropyridine toxicity is warranted but initial animal model results are not promising.

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