Oregon Poison Center

Oregon City, OR, United States

Oregon Poison Center

Oregon City, OR, United States
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Hendrickson R.G.,Oregon Health And Science University | Hendrickson R.G.,Oregon Poison Center | McKeown N.J.,Oregon Health And Science University | McKeown N.J.,Oregon Poison Center | McKeown N.J.,Portland Veterans Affairs Medical Center
Clinical Toxicology | Year: 2012

Over the last few decades, the rate of breastfeeding has increased steadily in the developed countries of the world. During this time, opioid use in the general population has steadily increased as well. Despite this, clinicians remain unclear whether opioid use is safe during breastfeeding. While the vast majority of medications used during breastfeeding occur without incident, case reports and studies have reported possible opioid toxicity in breast-fed infants. Multiple enzymes are involved in the metabolism of opioids. CYP2D6 catabolizes O-demethylation of codeine, tramadol, oxycodone, and hydrocodone to more potent metabolites. CYP3A4 inactivates methadone, meperidine, and buprenorphine. Glucoronide conjugation by the UGT enzyme family inactivates morphine and hydromorphone. Genetic polymorphisms and interfering medications affect the maternal metabolism, which in turn determines the exposure and risk to the breast-fed neonate. We review the production of breast milk, the transfer of xenobiotics from blood to milk, the characteristics that alter xenobiotic breast-milk concentrations, and we review the evidence of specific common opioids and infant toxicity. The short-term maternal use of prescription opioids is usually safe and infrequently presents a hazard to the newborn. © 2012 Informa Healthcare USA, Inc.

French L.K.,Oregon Health And Science University | McKeown N.J.,Oregon Poison Center | Hendrickson R.G.,Oregon Health And Science University
Clinical Toxicology | Year: 2011

Context. Lamotrigine is used for both seizure and psychiatric disorders. Overdoses typically follow a benign course. Case details. A 19-year-old male with bipolar disorder ingested 4 g of lamotrigine. The patient suffered from multiple seizures, charcoal aspiration, respiratory arrest, prolongaton of the QRS interval on electrocardiogram, complete heart block, multiorgan failure and ultimately death. Discussion. We describe the emergency department (ED) and ICU course for this patient and briefly review the toxic effects of lamotrigine and the pharmacokinetics with and without hemodialysis. © 2011 Informa Healthcare USA, Inc.

Newgard C.D.,Oregon Health And Science University | Beeson M.S.,Oregon Health And Science University | Beeson M.S.,Akron General Medical Center | Kessler C.S.,Jesse Brown Veterans Administration Medical Center | And 8 more authors.
Academic Emergency Medicine | Year: 2012

This project was developed from the research network track at the 2012 Academic Emergency Medicine consensus conference on education research in emergency medicine (EM). Using a combination of consensus techniques, the modified Delphi method, and qualitative research methods, the authors describe multiple aspects of developing, implementing, managing, and growing an EM education research network. A total of 175 conference attendees and 24 small-group participants contributed to discussions regarding an education research network; participants were experts in research networks, education, and education research. This article summarizes relevant conference discussions and expert opinion for recommendations on the structure of an education research network, basic operational framework, site selection, leadership, subcommittees, guidelines for authorship, logistics, and measuring success while growing and maintaining the network. © 2012 by the Society for Academic Emergency Medicine.

Hendrickson R.G.,Oregon Poison Center | Cloutier R.L.,Doernbecher Childrens Hospital | Fu R.,Center for Policy Research in Emergency Medicine | Fu R.,Oregon Health And Science University
Academic Emergency Medicine | Year: 2010

Objectives: Methamphetamine is a drug of abuse that has been manufactured locally by chemical conversion from the decongestant pseudoephedrine. In July 2006, an Oregon state law was enacted to establish pseudoephedrine as a schedule III drug and make it available by prescription only. This study sought to determine if this legislation altered the number of emergency department (ED) visits that are related to methamphetamine use. Methods: This was a retrospective analysis of a database created during a prospective study aimed at determining the effect of methamphetamine on ED visits. That prospective study was 1 year in duration and required ED clinicians to determine whether a patient's visit was related to methamphetamine and if the patient had confirmed use of methamphetamine. The clinicians received initial and continued education and training on methamphetamine during the study period. The questions were asked at every ED visit during the study period and were electronically linked to the patient's disposition and could not be circumvented. The study period was divided into prelegislation (February 5, 2006, to June 30, 2006) and postlegislation periods (July 1, 2006, to February 5, 2007). Results: Over the 1-year study period, 37,625 patients were enrolled, 1.90% (n = 714) of patients had methamphetamine-related ED visits (MREDVs), and 1.65% (n = 620) had confirmed methamphetamine use. Patients with MREDVs were more likely than patients with non-MREDVs to be white and uninsured. The number and proportion of weekly MREDVs significantly decreased from the prelegislation period to the postlegislation period (mean number of weekly visits, 18.0 vs. 11.3, p = 0.001; mean proportion of weekly visits, 2.3% vs. 1.6%, p = 0.003). The number and proportion of weekly confirmed users of methamphetamine also significantly decreased during the study period (mean number of weekly users, 14.6 vs. 10.3, p = 0.004; mean proportion of weekly users, 1.9% vs. 1.4%, p = 0.017). There were no significant differences in the diagnoses of MREDVS between the pre- and postlegislation periods. Conclusions: This study found an association between the enactment of legislation that limits pseudoephedrine availability and a decrease in MREDVs and confirmed users of methamphetamine in the study ED. © 2010 by the Society for Academic Emergency Medicine.

McKeown N.,Oregon Health And Science University | McKeown N.,Oregon Poison Center | Vetter R.S.,University of California at Riverside | Vetter R.S.,ISCA Technologies, Inc. | And 2 more authors.
Toxicon | Year: 2014

This study compiled 33 verified spider bites from the state of Oregon (USA). The initial goal was to amass a series of bites by the hobo spider to assess whether it possesses toxic venom, a supposition which is currently in a contested state. None of the 33 bites from several spider species developed significant medical symptoms nor did dermonecrosis occur. The most common biters were the yellow sac spider, Cheiracanthium mildei (N = 10) and orb-weavers of the genus Araneus (N = 6). There were 10 bites from three genera of funnel web spiders of the family Agelenidae including one hobo spider bite and one from the congeneric giant house spider which is readily confused as a hobo spider. The hobo spider bite resulted in pain, redness, twitching in the calf muscle and resolved in 12 h. Also generated from this study were possibly the first records of bites from spiders of the genera Callobius (Amaurobiidae) and Antrodiaetus (Antrodiaetidae), both with minor manifestations.

Hendrickson R.G.,Oregon Poison Center | Hendrickson R.G.,Oregon Health And Science University | McKeown N.J.,Oregon Poison Center | McKeown N.J.,Oregon Health And Science University | And 5 more authors.
Journal of Medical Toxicology | Year: 2010

After acute ingestion, acetaminophen (APAP) is generally absorbed within 4 h and the APAP concentration ([APAP]) slowly decreases with a predictable half-life. Alterations in these pharmacokinetic principles have been rarely reported. We report here three cases of an unusual double hump, or Bactrian, pattern of [APAP]. We review the literature to describe the case characteristics of these rare cases. A 38-year-old woman ingested 2 g hydrocodone/65 g acetaminophen. Her [APAP] peaked at 289 mcg/mL (8 h), decreased to 167 mcg/mL (31 h), then increased to 240 mcg/mL (39 h). She developed liver injury (peak AST 1603 IU/L; INR1. 6). A 25-year-old man ingested 2 g diphenhydramine/26 g APAP. His [APAP] peaked at 211 mcg/mL (15 h), decreased to 185 mcg/mL (20 h), and increased again to 313 mcg/mL (37 h). He developed liver injury (peak AST 1153; INR 2.1). A 16-year-old boy ingested 5 g diphenhydramine and 100 g APAP. His [APAP] peaked at 470 mcg/mL (25 h), decreased to 313 mcg/mL (36 h), then increased to 354 mcg/mL (42 h). He developed liver injury (peak AST 8,686 IU/L; peak INR 5.9). We report three cases of Bactrian ("double hump") pharmacokinetics after massive APAP overdoses. Cases with double hump pharmacokinetics may be associated with large ingestions (26-100 g APAP) and are often coingested with antimuscarinics or opioids. Several factors may contribute to these altered kinetics including the insolubility of acetaminophen, APAP-induced delays in gastric emptying, opioid or antimuscarinic effects, or enterohepatic circulation. Patients with double hump APAP concentrations may be at risk for liver injury, with AST elevations and peaks occurring later than what is typical for acute APAP overdoses. © 2010 American College of Medical Toxicology.

Kusin S.,Oregon Poison Center | Tesar J.,Oregon Poison Center | Hatten B.,Oregon Poison Center | Horowitz B.Z.,Oregon Poison Center | And 3 more authors.
Morbidity and Mortality Weekly Report | Year: 2012

In August 2011, two men in Oregon drank a liquid they believed to be 2C-E (4-ethyl-2,5-dimethoxyphenethylamine), a psychoactive stimulant used as a recreational drug, after purchasing it on the Internet. Fifteen minutes after ingestion, the men became cyanotic and subsequently were treated for refractory methemoglobinemia and hemolytic anemia. The Oregon Poison Center, Oregon Public Health Division, Drug Enforcement Administration (DEA), and Food and Drug Administration (FDA) jointly investigated to determine the cause of the poisoning and identify other cases. The Oregon Poison Center and Oregon Public Health Division promptly alerted health-care providers and public health agencies and searched for additional cases. DEA confiscated all product remaining in the men's possession, and FDA identified the substance as aniline, an industrial solvent known to cause methemoglobinemia. One patient reported purchasing the substance from the Internet site of a Chinese chemical company. No additional cases were identified by investigators. Purchase of chemicals from unregulated Internet sources poses a serious risk to purchasers from product contamination and substitution.

West P.L.,Oregon Health And Science University | West P.L.,Oregon Poison Center | McKeown N.J.,Oregon Health And Science University | McKeown N.J.,Oregon Poison Center | And 3 more authors.
Annals of Emergency Medicine | Year: 2010

Study objective: We describe the demographics, characteristics, treatment, and clinical course of methamphetamine body stuffers. We also determine the clinical characteristics of methamphetamine body stuffers who have severe outcomes. Methods: A 6.5-year descriptive nonconcurrent observational case series evaluated methamphetamine body stuffers about whom the Oregon Poison Center was consulted by their primary physicians. Poison center charts were supplemented by completed hospital charts (for 95% of patients). Results: Six hundred forty-eight patients with methamphetamine exposure were identified and reviewed, and 55 charts met the criteria for "methamphetamine body stuffer." We found the following characteristics of methamphetamine body stuffers: mean age 29 years (range 16 to 57 years), men in 44 of 55 cases (80%), mean time to arrival 2.7 hours after ingestion, with a median of 1 hour after ingestion. Ninety-seven percent (53/55) stuffed methamphetamine orally (2/55 rectally). Methamphetamine was most frequently swallowed in baggies, but 25% were unpackaged. The median dose ingested was 3.5 g of methamphetamine in 1 package. Outcome-based analysis revealed 29% (16/55) of patients had severe outcomes, as defined by end-organ toxicity, with agitation requiring intubation the most common severe outcome. There was 1 death reported. Toxicity did not appear to be related to the amount of methamphetamine or number of packets. Patients with severe outcomes had higher mean initial pulse rates and temperatures. Eighty-eight percent (14/16) of patients with severe outcomes had a presenting pulse rate greater than 120 beats/min or a temperature greater than 38°C versus 18% (7/39) patients with a benign outcome. Twenty-four radiographic studies were obtained; none detected packets. Conclusion: Methamphetamine body stuffers have similar demographics to those of body stuffers of other stimulants, but tended to ingest fewer baggies with larger masses, and had a higher percentage of severe outcomes (29%) than previously reported with other stimulants. Increases in presenting pulse rate and temperature (pulse rate >120 beats/min or >38.0°C) are common in patients who will develop end-organ damage. © 2009 American College of Emergency Physicians.

West P.L.,Oregon Health And Science University | West P.L.,Oregon Poison Center | Horowitz B.Z.,Oregon Health And Science University | Horowitz B.Z.,Oregon Poison Center
Journal of Medical Toxicology | Year: 2010

Salicylates are common exposures. We report an unusual case of salicylate ingestion, as salsalate, with resolution of symptoms and return of salicylate levels to non-toxic values, with a subsequent, unexpected recrudescence to toxic levels requiring reinstitution of therapy. A 31-year-old man ingested unknown amounts of salsalate, hydroxyzine, and a benzodiazepine. He was intubated and treated with IV sodium bicarbonate and two doses of oral activated charcoal. Eight hours after presentation, his serum salicylate concentration peaked at 55 mg/dL, and then decreased to a nadir of 5.6 mg/dL 38 h after presentation, coinciding with return of GI motility. Several hours later salicylate concentrations began to rise, peaking 67 h after presentation at 61.7 mg/dL. He was treated with sodium bicarbonate and charcoal, which resulted in decreased serum salicylate to therapeutic levels. Salicylate ingestions are known to exhibit unusual toxicokinetics and absorption in overdose; however, this is the first case we are aware of that shows a return to toxic concentrations after apparent resolution of toxicity. Recrudescence of salicylate concentrations to a degree that would dictate reinstitution of therapy for overdose is unusual and may warrant prolonged monitoring of serum salicylate concentrations in salsalate ingestions. © 2010 American College of Medical Toxicology.

Lopez A.M.,Oregon Health And Science University | Hendrickson R.G.,Oregon Health And Science University | Hendrickson R.G.,Oregon Poison Center
Emergency Medicine Clinics of North America | Year: 2014

Toxins such as pharmaceuticals, herbals, foods, and supplements may lead to hepatic damage. This damage may range from nonspecific symptoms in the setting of liver test abnormalities to acute hepatic failure. The majority of severe cases of toxin-induced hepatic injury are caused by acetaminophen and ethanol. The most important step in the patient evaluation is to gather an extensive history that includes toxin exposure and exclude common causes of liver dysfunction. Patients whose hepatic dysfunction progresses to acute liver failure may benefit from transfer to a transplant service for further management. Currently, the mainstay in management for most exposures is discontinuing the offending agent. This manuscript will review the incidence, pathophysiology, diagnosis and management of the different forms of toxin-induced hepatic injury and exam in-depth the most common hepatic toxins. © 2014 Elsevier Inc.

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