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NACCT 2010 Abstracts Clinical Toxicology (2010) 48, 604–667 Copyright © Informa UK, Ltd. ISSN: 1556-3650 print / 1556-9519 online DOI: 10.3109/15563650.2010.493290 ABSTRACTSLCLT NACCT 2010 Abstracts Abstracts 1. Aluminum Testing in Children: What Do Table 1. Results and Reference Ranges Mean? 1 1 2 Zeager MA, Woolf AD, Goldman RH. Cases 1Children’s Hospital Boston, Boston, MA, USA; 2 Cambridge Health Alliance, Cambridge, MA, USA First assessment Second assessment Controls Background: Some parents of children with develop- mental issues are raising concerns about their child’s SCV (m/s) Median 53.7 (8.1) 52.8 (8.3)$ 56.0 (5.9) aluminum exposure and requesting biological testing $ from health care providers. Aluminum can be measured Ulnar 55.2 (7.0)* 55.9 (6.7) 59.6 (5.2) in plasma, serum, or urine, but there is scant scientific MCV (m/s) information about the normal range of aluminum con- Median 55.2 (4.3)* 55.5 (4.5) 56.6 (3.6) centrations in the general population, let alone age- Ulnar 53.9 (4.8)* 54.4 (5.1)$ 56.2 (4.4) related norms. Yet commercial laboratories offering Common peroneal 46.6 (4.9)* 48.2 (4.7)@ 49.4 (5.1) aluminum testing provide reference ranges when report- Amplitude of distal motor nerve conduction complex (mV) ing results. In this study, we sought to determine what Median 13.4 (3.6) 14.2 (4.6) 14.3 (4.2) scientific literature has been used to support the reference Ulnar 9.4 (2.5)* 10.0 (2.4) 10.4 (2.1) ranges provided, whether such literature sources specif- Common peroneal 7.7 (3.4) 7.2 (2.7)$ 8.6 (3.4) ically studied aluminum levels in otherwise normal infants and children, and how to interpret results of Area of distal motor nerve conduction complex (mVms) such testing. Methods: We obtained the names of 11 Median 32.2 (10.4) 30.9 (9.8) 33.6 (10.0) commercial laboratories in the United States that per- Ulnar 18.6 (6.5) 17.1 (5.3)$ 19.4 (4.3) form aluminum testing from texts, published lists, and Common peroneal 15.3 (6.8) 13.1 (4.9)$,@ 16.1 (6.7) Internet sources. Either telephone or emailed surveys F wave occurrence (%) were conducted with laboratory personnel or Internet Median 81.9 (17.2)# 78.4 (22.3)& 90.3 (10.5) searches were performed seeking current information Ulnar 82.8 (20.5)# 83.4 (16.6)& 92.6 (8.8) regarding reference ranges and methods of testing for Tibial 89.1 (16.3) 91.5 (11.7) 92.8 (11.9) aluminum in biological samples. For a subset of seven laboratories the published scientific reports cited in *p < 0.05; controls vs. first assessment, $p < 0.05; controls vs. second assessment (unpaired determining the reference ranges were reviewed for T-test). @p < 0.05; first vs. second assessment (paired T-test). #p < 0.05; controls vs. first details regarding the ages and health of the population assessment, &p < 0.05; controls vs. second assessment (Mann–Whitney test). sampled. Results: For laboratories using the AAS For personal use only. method, serum aluminum references ranged from <5.41 to <20 mcg/L, plasma from <7 to 0–10 mcg/L out of seventy attended the 6 week assessment. 26 products were ordered each month and 129 (82.7%) and urine 5–30 mcg/L; for those using ICP-MS, serum Results: All patients received atropine, 54 patients products were received in total. One hundred and ranged from 0–6 to <42 mcg/L, plasma from 0–10 to received pralidoxime. The mean (SD) of neurophysio- twenty-six (97.7%) contained an active compound, most 0–15 mcg/L, and urine from 0–7 to 5–30 mcg/L. logical findings in Table 1 show evidence of statistically commonly the Piperazines (55, 43%) and cathinones (43, Laboratories relied upon studies of small populations significant reductions of SCV, MCV, amplitude, area of 33%). Common active combinations were 4-methyl- of healthy adults, adult dialysis patients, sick children motor complexes and F waves. Conclusion: Function methcathinone (Mephedrone), Ethcathinone and caf- on aluminum-containing parenteral therapy, hospital- of sensory and motor nerve fibers were affected by the feine (20, 16%); 3-Fluoromethcathinone and caffeine ized patients, or analogous studies of other single episode of acute exposure to OP. Slowing of (20, 16%); and 1-benzylpiperazine (BZP), 3-Trifluo- metals. Conclusions: Commercial laboratories provide nerve conduction velocity may reflect demyelinisation. romethylphenylpiperazine (TFMPP) and Chlorophe- normal reference ranges for tissue aluminum assay The reduction of amplitude in motor complexes and nylpiperazine (13, 10%). Seventeen (85%) of the 20 results that show large variability. These reference F waves suggests axonal damage. products that were supplied in more than 1 month con- ranges are based upon studies that may not be appropriate sistently contained the same compounds, but there was for either the general population or children. Conse- variation in content of 3 (15%) products. All five post- quently aluminum testing results are difficult to inter- 3. A Study Assessing the Content of Legal Highs legislation samples contained an active compound with Clinical Toxicology Downloaded from informahealthcare.com by 67.186.110.124 on 07/10/11 pret clinically. Further study of blood and urine Purchased from the Internet β-keto-N-methylbenzodioxolylpropylamine (Butylone), aluminum concentrations in healthy populations, which Dargan PI,1 Davies S,2 Smith G,2 Button J,2 Ramsey J,2 Methylenedioxypyrovalerone (MDPV) and caffeine include children, is warranted. Holt DW,2 Wood DM.1 detected in four products; one product contained BZP, 1Guy’s and St Thomas’ NHS Foundation Trust, London, TFMPP and caffeine. Conclusions: Most legal highs UK; 2St George’s, University of London, London, UK sold over the Internet in the UK contain active com- 2. Subclinical Nerve Fiber Dysfunction Following pounds that have the potential for significant acute Acute Organophosphate (OP) Poisoning Background: There has been a significant increase in toxicity with recreational use. The actual drug content the use of “legal highs” and an associated increase in Jayasinghe SS, Pathirana KD. cannot be predicted from the name of the product and Emergency Department presentations with acute toxic- 1Faculty of Medicine, University of Ruhuna, Galle, there is variation in content of the products over time. ity related to their use. These products are commonly Sri Lanka There was a change towards the sale of legal com- supplied over the Internet and there is often limited pounds post-legislation, but one product still contained Background: Following acute OP poisoning patients information available on the web-sites and the packaging controlled compounds. complain of numbness without objective sensory or of the products to inform users of their content. The aim features of OP induced delayed polyneuropathy. While of this study was to determine the drug content of prod- animal studies have shown demyelination and axonal ucts sold from Internet sites and whether this remained 4. Clinical Course of Bark Scorpion Envenomation degeneration there have been no clinical correlates of stable over time. Methods: We purchased legal high When Antivenom is Unavailable this characterized in humans. The aim of this study was products from five Internet sites over 6 months in 2009 O’Connor AD,1 Ruha A-M.2 to measure nerve conduction after acute exposure to OP. and in 1 month in 2010; the same products were ordered 1Banner Good Samaritan Medical Center, Phoenix, AZ, Methods: A prospective case-control study was con- each month. The products were analysed using gas- USA; 2Phoenix Children’s Hospital, Phoenix, AZ, USA ducted to assess motor nerve conduction velocity chromatography mass-spectrometry (GC-MS). The (MCV), amplitude and area of motor complexes, sen- main study was conducted before the December 2009 Background: Bark scorpion envenomation is a poten- sory nerve conduction velocity (SCV) and F waves control of Piperazines in the UK. The follow up study tially life-threatening condition in children, traditionally following OP poisoning. Assessment was performed was performed after this Piperazine legislation, but treated with antivenom (AV) in Arizona. In 2004 AV around 1 and 6 weeks after the exposure in 70 cases and before Mephedrone and related cathinones were became unavailable. Due to the historic widespread use age, sex and occupation matched controls. Fifty-three controlled. Results: In the initial 6 month study, of AV, there are few reports describing severe scorpion Clinical Toxicology vol. 48 no. 6 2010 Abstracts 605 envenomation without AV treatment. We sought to UK government restricted pack size of APAP in 1998 describe the clinical course, management, complica- and withdrew APAP-propoxyphene (co-proxamol) in Matched Unmatched tions and outcome of children with severe scorpion 2005 as harm reduction strategies. We report patterns (n = 1,769) (n = 5,789) envenomation treated with supportive care alone. of self-harm overdose (OD) 2000–2008 for APAP, (95% CI) (95% CI) Methods: A retrospective chart review was performed APAP-opioid combinations and ibuprofen (IBU), for after obtaining IRB approval. All children presenting to a large UK hospital with a stable catchment of Mean LOS 2.54 (2.39, 2.69) 3.48 (3.35, 3.62) a metropolitan tertiary care children’s hospital between 500,000, a single ED and a consistent admissions (days) September 1, 2004 and July 31, 2006 with severe scor- policy. Methods: Presentations were analysed retro- Median LOS 2 (1, 2) 2 (1, 2) pion envenomation, who did not receive AV, were spectively for APAP – containing and IBU ODs (days) included in the study. Two reviewers performed a chart between 2000 and 2008.
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