DOCSLIB.ORG

Extreme Methaemoglobinaemia Secondary to Recreational Use Of

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Extreme Methaemoglobinaemia Secondary to Recreational Use Of Journal of CASE REPORT Accident and Emergency J Accid Emerg Med: first published as 10.1136/emj.12.2.138 on 1 June 1995. Downloaded from Medicine 1995 Extreme methaemoglobinaemia secondary to 12,138-142 recreational use of amyl nitrite R.J. EDWARDS & J. UJMA Department of Emergency Medicine, Westmead Hospital, Westmead, New South Wales, Australia INTRODUCTION CASE REPORT Haemoglobin is continuously oxidized from the A 44-year-old man was brought by ambulance to ferrous (Fe2+) to the ferric (Fe3+) form and reduced St Vincent's Hospital Emergency Department at back again. The ferric (Fe3+) form, termed 23.37 hours. The patient had been found in the methaemoglobin (MetHb), is incapable of steam room of a bathhouse, unconscious, blue and transporting oxygen. In the normal physiological lying in a pool of vomitus. There was an empty state the concentration of methaemoglobin is less bottle of amyl (isobutyl) nitrite next to him, and than 1 %. Figure 1 illustrates the physiological workers at the establishment stated that he had reactions responsible for the reduction of MetHb 'consumed' large amounts of amyl nitrite. back to Hb. It is reported that MetHb levels of 10- On arrival of the paramedics, the patient was 25% produce cyanosis, 35-40% produce mild hypoventilating, hypotensive, unresponsive to pain symptoms (e.g. dyspnoea), levels of 60% produce and had poor skin colour. There was no response lethargy and coma and levels of 70% or more are to 2 mg of naloxone, administered intravenously. lethal.23 A case of extreme, life-threatening The patient was intubated endotracheally by the methaemoglobinaemia due to the recreational use paramedics, given 100% oxygen, ventilated of amyl (isobutyl) nitrite is presented. No case has manually and transported to hospital. been found in the literature where the MetHb level On arrival at the Emergency Department his skin was so high. was noted to be a deep charcoal grey colour, Key words: amyl nitrate, methaemoglobinaemia, despite the fact that he was receiving 100% oxygen http://emj.bmj.com/ methylene blue and having good air entry into both lungfields on Fig. 1. Mechanisms for reduction Major pathway (handles 95% of metHb. under physiological conditions) of methaemoglobin. MB, on September 28, 2021 by guest. Protected copyright. NADH MetHb. methylene blue; MW, methylene white; *Embden-Meyerhoff NADH* + MetHB. * NAD+ + Hb. reductase pathway is the major source of NADH in red blood cells; **hexose mono-phosphate shunt is the major source of NADPH. G6PD is required for its production. Pathway activated by methylene blue 20 Correspondence: Rob J. Edwards, NADPH MetHb. reductase Staff Specialist, Department of NADPH**. + MB MW + NADPH + Emergency Medicine, Westmead Hospital, CNR Hawkesbury Road & Darcy Street, Westmead, Hb MetHb NSW 2145, Australia © 1995 Blackwell Science Ltd R.J. Edwards et al. auscultation. His systolic blood pressure was 70 therapy unit to the ward. mmHg, and his pulse was 60 beats min-'. He was It was decided to keep the patient in hospital J Accid Emerg Med: first published as 10.1136/emj.12.2.138 on 1 June 1995. Downloaded from unresponsive to pain, and his pupils were and monitor him for haemolytic anaemia. However, constricted, equal and fixed. the patient discharged himself, against medical Arterial and venous samples were drawn for advice, on day 5. There was no evidence of arterial blood gas (ABG) analysis, MetHb, full blood anaemia at this time, and he showed no evidence count (FBC), and determination of electrolytes, of any residual neurological deficit on clinical urea and creatinine levels. testing. Total creatinine phosphokinase (CPK) However, 12 min after arrival the patient suffered levels 12 and 36 h after admission were 385 and a bradycardic arrest, requiring cardio-pulmonary 681 U L-', respectively (<130 U L-'). The MB resuscitation and 2 mg adrenaline, administered fractions at these times were 24 and 25U L-1, intravenously. He regained a cardiac output after respectively (<15 U L-1). A repeat ECG before 30 s. The patient's MetHb level was 94% (n< 1.5%) discharge was normal. Clinically, the patient had and he was given 80 mg (c.1 mg kg-1) of made a complete, uncomplicated recovery. Further tetramethylthionine (methylene blue) intravenously follow-up was performed by the patient's local over a period of 10 min. Twenty minutes after medical officer. The patient refused counselling administration of the methylene blue, the patient's from the drug and alcohol service. colour had improved slightly and there was a return We note that the patient presented again to our of spontaneous respiration, but he remained Emergency Department 6 months later with chest unresponsive to pain. pain after injecting cocaine intravenously. ECG on Further physical examination revealed a core this occasion was normal, and he was discharged temperature of 32.5° C (per rectum). There were for follow-up with his local medical officer. no focal neurological signs, and the systolic blood pressure remained low (70 mmHg). The abdomen DISCUSSION was soft and not distended. There was no sign of trauma, and no other abnormality was found. Although rare, it is important to diagnose The results of initial investigations were as methaemoglobinaemia when it presents because follows (ranges in parenthesis): ABG (FiO2=1) pH it is potentially fatal and yet readily treated. A clue 7.17, (7.35-7.45); Po2, unable to be measured due to the diagnosis is the appearance of chocolate to technical problems; Pco2, 39 mmHg (32-45); brown blood upon venesection or arterial HCO3,14 mmol L-1 (24-31); and base excess (B.E.) sampling.14'14 The diagnosis can be confirmed by -14 (-3-+3). Chest radiograph was normal. A 12- spectrophotometric analysis of the patient's blood, http://emj.bmj.com/ lead electrocardiograph showed sinus rhythm, rate giving a MetHb level expressed as a percentage 98 beats min-1 with ST elevation (concave down) of the total Hb level. The blood should be analysed in leads V1-V6. Hb was 13.1 g dL-1 (13.0-18.0), very soon after being drawn, as the MetHb level in WCC was 9.7 x 109 L-1 (4.0-11.0), and platelet count the sample will decrease with time.36 was 211 x 109 (150-400). Blood alcohol level was 0.15%. Aetiology on September 28, 2021 by guest. Protected copyright. A repeat MetHb measurement gave a value of 26%. The patient was given another 100 mg of Table 1 lists the agents that most commonly cause methylene blue at this time. A further 50 mL of 8.4% acquired methaemoglobinaemia. It has been sodium bicarbonate were administered for a reported that ingestion of nitrites is not dangerous persisting metabolic acidosis (pH, 7.05; Pco2, 46; because they are degraded in the GIT.41 However, Po2, could not be measured; HCO3, 13; B.E., -19). there are many case reports of severe, sometimes By 06.00 hours, the patient's colour was pink. A fatal, methaemoglobinaemia resulting from repeat MetHb level was 1.6% at 09.30 hours. At ingestion of isobutyl nitrite.3'6'9'20 this time the patient was opening his eyes to of speech and obeying commands. He continued to Management acquired methaemoglobinaemia improve and was extubated at 18.00 hours. He was After ensuring and protecting the airway, providing confused initially, but his sensorium had cleared appropriate respiratory and cardiovascular support by the next morning. He remembered no details and decontamination (e.g., removing soiled from the night of his overdose. Thirty-six hours after clothing or decontaminating oxidants in the gut), 139 admission he was transferred from the intensive tetramethylthionine (methylene blue, MB) should © 1995 Blackwell Science Ltd, Journal of Accident and Emergency Medicine 12, 138-142 Extreme Table 1. Agents most commonly implicated in acquired methaemoglobinaemia methaemoglo- J Accid Emerg Med: first published as 10.1136/emj.12.2.138 on 1 June 1995. Downloaded from Nitrates, nitrites binaemia Isobutyl (amyl) nitrite 3.5.6.16.19.20 secondary to Glyceryl trinitrate (sublingual, i.v.)21-24 recreational use of Food/water contaminants2830 amyl nitrite Local anaesthetics Topical 7.17.18.25.27.29 Intravenous8 Benzocaine, prilocaine and lignocaine most commonly Aniline dyes Industrial411 Domestic products Antimicrobial agents Sulfonamides Dapsone (high dose)31.32 Quinones33 be used early on if it is indicated. Figure 1 shows above enzymes, or there is failure of an adequate its mechanism of action. dose of MB (up to 7 mg kg-1) to reduce the MetHb Accepted indications for MB are a MetHb level level and produce a clinical improvement, 3436 then of >30-40%, or a situation where the patient is alternative or additional treatment with an symptomatic or anaemic, regardless of the MetHb exchange transfusion should be considered. Apart level.24 The clinician must be careful to treat each from the above situations, MB should not be case individually according to the clinical indicators withheld if the indications for its use and reuse are of severity (e.g., level of consciousness, dyspnoea, present. This is because the methaemoglobin- myocardial ischaemia), as some patients have producing effects of MB in vivo are small,10'11 and died1'16 or have been severely symptomatic17 with are dominated by the methaemoglobin-reducing MetHb levels under 35%, while other patients have effects. Table 2 lists the reasons why acquired recovered with levels above 80%.1418 The initial methaemoglobinaemia may fail to respond to MB. http://emj.bmj.com/ dose is 1- 2 mg kgh-1 body weight, administered Methylene blue, especially at doses of 7 mg kg-', intravenously over 5 min.249 Significant clinical may cause a sensation of dyspnoea, pressure on improvement and a substantial reduction in the the chest, restlessness, excitation, apprehension, MetHb level usually occur within 30-60 min.
Load more

Recommended publications
  • Aldrich Raman
    Aldrich Raman Library Listing – 14,033 spectra This library represents the most comprehensive collection of FT-Raman spectral references available. It contains many common chemicals found in the Aldrich Handbook of Fine Chemicals. To create the Aldrich Raman Condensed Phase Library, 14,033 compounds found in the Aldrich Collection of FT-IR Spectra Edition II Library were excited with an Nd:YVO4 laser (1064 nm) using laser powers between 400 - 600 mW, measured at the sample. A Thermo FT-Raman spectrometer (with a Ge detector) was used to collect the Raman spectra. The spectra were saved in Raman Shift format. Aldrich Raman Index Compound Name Index Compound Name 4803 ((1R)-(ENDO,ANTI))-(+)-3- 4246 (+)-3-ISOPROPYL-7A- BROMOCAMPHOR-8- SULFONIC METHYLTETRAHYDRO- ACID, AMMONIUM SALT PYRROLO(2,1-B)OXAZOL-5(6H)- 2207 ((1R)-ENDO)-(+)-3- ONE, BROMOCAMPHOR, 98% 12568 (+)-4-CHOLESTEN-3-ONE, 98% 4804 ((1S)-(ENDO,ANTI))-(-)-3- 3774 (+)-5,6-O-CYCLOHEXYLIDENE-L- BROMOCAMPHOR-8- SULFONIC ASCORBIC ACID, 98% ACID, AMMONIUM SALT 11632 (+)-5-BROMO-2'-DEOXYURIDINE, 2208 ((1S)-ENDO)-(-)-3- 97% BROMOCAMPHOR, 98% 11634 (+)-5-FLUORODEOXYURIDINE, 769 ((1S)-ENDO)-(-)-BORNEOL, 99% 98+% 13454 ((2S,3S)-(+)- 11633 (+)-5-IODO-2'-DEOXYURIDINE, 98% BIS(DIPHENYLPHOSPHINO)- 4228 (+)-6-AMINOPENICILLANIC ACID, BUTANE)(N3-ALLYL)PD(II) CL04, 96% 97 8167 (+)-6-METHOXY-ALPHA-METHYL- 10297 ((3- 2- NAPHTHALENEACETIC ACID, DIMETHYLAMINO)PROPYL)TRIPH 98% ENYL- PHOSPHONIUM BROMIDE, 12586 (+)-ANDROSTA-1,4-DIENE-3,17- 99% DIONE, 98% 13458 ((R)-(+)-2,2'- 963 (+)-ARABINOGALACTAN BIS(DIPHENYLPHOSPHINO)-1,1'-
    [Show full text]
  • WEST VIRGINIA LEGISLATURE House Bill 2526
    WEST VIRGINIA LEGISLATURE 2017 REGULAR SESSION ENROLLED Committee Substitute for House Bill 2526 BY DELEGATES ELLINGTON, SUMMERS, SOBONYA AND ROHRBACH [Passed April 8, 2017; in effect ninety days from passage.] Enr. CS for HB 2526 1 AN ACT to amend and reenact §60A-2-201, §60A-2-204, §60A-2-206, §60A-2-210 and §60A-2- 2 212 of the Code of West Virginia, 1931, as amended, all relating to classifying additional 3 drugs to Schedules I, II, IV and V of controlled substances; and adding a provision relating 4 to the scheduling of a cannabidiol in a product approved by the Food and Drug 5 Administration. Be it enacted by the Legislature of West Virginia: 1 That §60A-2-201, §60A-2-204, §60A-2-206, §60A-2-210 and §60A-2-212 of the Code of 2 West Virginia, 1931, as amended, be amended and reenacted, all to read as follows: ARTICLE 2. STANDARDS AND SCHEDULES. §60A-2-201. Authority of state Board of Pharmacy; recommendations to Legislature. 1 (a) The state Board of Pharmacy shall administer the provisions of this chapter. It shall 2 also, on the first day of each regular legislative session, recommend to the Legislature which 3 substances should be added to or deleted from the schedules of controlled substances contained 4 in this article or reschedule therein. The state Board of Pharmacy shall also have the authority 5 between regular legislative sessions, on an emergency basis, to add to or delete from the 6 schedules of controlled substances contained in this article or reschedule such substances based 7 upon the recommendations and approval of the federal food, drug and cosmetic agency, and shall 8 report such actions on the first day of the regular legislative session immediately following said 9 actions.
    [Show full text]
  • Effects of Nitric Oxide Synthase Inhibitors on Equine and Bovine Follicular Dynamics and Steroidogenesis
    Louisiana State University LSU Digital Commons LSU Historical Dissertations and Theses Graduate School 2001 Effects of Nitric Oxide Synthase Inhibitors on Equine and Bovine Follicular Dynamics and Steroidogenesis. Carlos Roberto fontes Pinto Louisiana State University and Agricultural & Mechanical College Follow this and additional works at: https://digitalcommons.lsu.edu/gradschool_disstheses Recommended Citation Pinto, Carlos Roberto fontes, "Effects of Nitric Oxide Synthase Inhibitors on Equine and Bovine Follicular Dynamics and Steroidogenesis." (2001). LSU Historical Dissertations and Theses. 430. https://digitalcommons.lsu.edu/gradschool_disstheses/430 This Dissertation is brought to you for free and open access by the Graduate School at LSU Digital Commons. It has been accepted for inclusion in LSU Historical Dissertations and Theses by an authorized administrator of LSU Digital Commons. For more information, please contact [email protected]. INFORMATION TO USERS This manuscript has been reproduced from the microfilm master. UMI films the text directly from the original or copy submitted. Thus, some thesis and dissertation copies are in typewriter face, while others may be from any type of computer printer. The quality of this reproduction is dependent upon the quality of the copy submitted. Broken or indistinct print, colored or poor quality illustrations and photographs, print bleedthrough, substandard margins, and improper alignment can adversely affect reproduction. In the unlikely event that the author did not send UMI a complete manuscript and there are missing pages, these will be noted. Also, if unauthorized copyright material had to be removed, a note will indicate the deletion. Oversize materials (e.g., maps, drawings, charts) are reproduced by sectioning the original, beginning at the upper left-hand comer and continuing from left to right in equal sections with small overlaps.
    [Show full text]
  • ATSDR Case Studies in Environmental Medicine Nitrate/Nitrite Toxicity
    ATSDR Case Studies in Environmental Medicine Nitrate/Nitrite Toxicity Agency for Toxic Substances and Disease Registry Case Studies in Environmental Medicine (CSEM) Nitrate/Nitrite Toxicity Course: WB2342 CE Original Date: December 5, 2013 CE Renewal Date: December 5, 2015 CE Expiration Date: December 5, 2017 Key • Nitrate toxicity is a preventable cause of Concepts methemoglobinemia. • Infants younger than 4 months of age are at particular risk of nitrate toxicity from contaminated well water. • The widespread use of nitrate fertilizers increases the risk of well-water contamination in rural areas. About This and This educational case study document is one in a series of Other Case self-instructional modules designed to increase the Studies in primary care provider’s knowledge of hazardous Environmental substances in the environment and to promote the Medicine adoption of medical practices that aid in the evaluation and care of potentially exposed patients. The complete series of Case Studies in Environmental Medicine is located on the ATSDR Web site at URL: http://www.atsdr.cdc.gov/csem/csem.html In addition, the downloadable PDF version of this educational series and other environmental medicine materials provides content in an electronic, printable format. Acknowledgements We gratefully acknowledge the work of the medical writers, editors, and reviewers in producing this educational resource. Contributors to this version of the Case Study in Environmental Medicine are listed below. Please Note: Each content expert for this case study has indicated that there is no conflict of interest that would bias the case study content. CDC/ATSDR Author(s): Kim Gehle MD, MPH CDC/ATSDR Planners: Charlton Coles, Ph.D.; Kimberly Gehle, MD; Sharon L.
    [Show full text]
  • Continuous-Flow Production of Alkyl Nitrites, Originally Designed by BIOS Chemicals
    FLOW CHEMISTRY Industry Perspective ● Peer reviewed Jean-Christophe M. Continuous-flow production Monbaliu of alkyl nitrites JEAN-CHRISTOPHE M. MONBALIU1*, JEREMY JORDA2, BÉRENGÈRE CHEVALIER2, CHRISTIAN V. STEVENS1, BERNARD MORVAN3 *Corresponding author 1. Ghent University, SynBioC Research Group, Department of Sustainable Organic Chemistry and Technology, Faculty of Bioscience Engineering, Coupure links 653, Gent, B-9000, Belgium 2. CORNING S.A.S, Corning European Technology Center, Avenue de Valvins 7 bis, Avon, F-77210, France 3. BIOS Chemicals, Plateforme technologique DELTA Sud, Verniolle, F- 09340, France the oxidation of olefins (6f, 7c). Recent publications reported ABSTRACT their use for the production of diazonium intermediates in the Alkyl nitrites are important building blocks for the chemical continuous production of synthesis of azo dyes (6c). and pharmaceutical industries. In this article, we report a case study for the continuous-flow production of alkyl nitrites, originally designed by BIOS Chemicals. The PREPARATION OF ALKYL NITRITES intrinsic advantages of a Corning® Advanced-Flow™ reactor system, including high versatility, high mixing, and Numerous methods have been developed at the lab scale heat-exchange efficiency under corrosive conditions, for preparing alkyl nitrites from alcohols: esterification with allowed the development of an economically viable and nitrous acid; transesterification from tert-butyl nitrite (8a) or from user-friendly process in a short period of time, leading to N-nitrosoamines (8b); and nitrosation with various nitrosating a throughput of 10t/year of processed material with high agents such as nitrosyl chloride (8c). Thiols and trimethylsilyl ethers purity (93-98 percent). can also be transformed in the corresponding nitrites (8d). Industrial processes can be divided into two categories: (a) 50 liquid phase processes and (b) vapour phase processes.
    [Show full text]
  • Synthesis of Novel Nitric Oxide Donors and Prodrugs of 5- Fluorouracil
    SYNTHESIS OF NOVEL NITRIC OXIDE DONORS AND PRODRUGS OF 5- FLUOROURACIL DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University By Tingwei Cai, M.S. ***** The Ohio State University 2005 Dissertation Committee: Approved by Professor Peng George Wang, Advisor Professor Robert S. Coleman _________________________________ Professor Matthew S. Platz Advisor Graduate Program in Chemistry ABSTRACT This dissertation describes my Ph.D. work that focused on the synthesis and evaluation of novel nitric oxide donors, and the synthesis of derivatives of 5-fluorouracil. In chapter 1, a series of alkyl and aryl N-hydroxyguanidines were synthesized and demonstrated to act as substrates of nitric oxide synthases (NOS). The discovery of these non-amino acid hydroxyguanidines as novel substrates also led to the discovery of a novel-binding mode of NOS. In chapter 2, in order to achieve site specific delivery of nitric oxide (NO), a new class of glycosidase activated NO donors has been developed. Glucose and galactose were covalently coupled to 3-morphorlinosydnonimine (SIN-1), a mesoionic heterocyclic NO donor, via a carbamate linkage at the anomeric position. The β-glycosides were successfully prepared for these conjugates, while the α glycosidic compounds were very unstable. The new stable sugar-NO conjugates could release NO in the presence of glycosidases. Such NO prodrugs may be used as enzyme activated NO donors in biomedical research. In chapter 3, a new sialated diazeniumdiolate has been synthesized and the glycosylation product was exclusively an α anomer. This new nitric oxide donor exhibited significantly improved stability as compared to its parent diazeniumdiolate salts and it ii could be efficiently hydrolyzed by neuraminidase to release nitric oxide with a Km of 0.14 mM.
    [Show full text]
  • Poppers Maculopathy to 000015) Were Inserted Regarding the Presence of Visual Date
    Original article BMJ Open Ophth: first published as 10.1136/bmjophth-2016-000015 on 25 January 2017. Downloaded from The prevalence of visual symptoms in poppers users: a global survey Andrew J Davies,1 Rohan Borschmann,2,3 Simon P Kelly,4 John Ramsey,5 Jason Ferris,6 Adam R Winstock7 To cite: Davies AJ, ABSTRACT Key messages Borschmann R, Kelly SP, Introduction and aims: The use of ‘poppers’ et al. The prevalence of (volatile alkyl nitrites) has been associated with the visual symptoms in poppers What is already known about this subject? development of visual symptoms secondary to the users: a global survey. BMJ " Specific macular features associated with Open Ophth 2016;1:1–6. development of maculopathy. There are currently no poppers abuse have been reported and are doi:10.1136/bmjophth-2016- data regarding the prevalence of this condition among increasingly recognised by retinal specialists on 000015 poppers users. The aim of this study was to quantify clinical imaging. " Prepublication history and the presence of visual symptoms among poppers What are the new findings? additional material is users from a global cohort. " This global study provides descriptive data on available. To view please visit Design and methods: The Global Drug Survey the visual symptoms that poppers users may the journal (http://dx.doi.org/ (GDS) conducts annual anonymous online surveys of experience. We also provide a review of all 10.1136/bmjophth-2016- drug and alcohol use. Within the 2012 GDS, questions published cases of poppers maculopathy to 000015) were inserted regarding the presence of visual date.
    [Show full text]
  • Amyl Nitrate Is Also Referred to As
    Amyl Nitrate Is Also Referred To As Vitreum Jared browsed her hoovers so downright that Shane disguisings very astringently. Treeless soand septennially ascitic Christof or misteach always recreate any unrestraints much and meteorologically. hogties his ranches. Exarate Micheal never overpeopled Initial epidemiologic studies indicated that gentle use of inhalant drugs such as amyl nitrite isobutyl nitrite IBN and butyl nitrite may raise a risk factor for acquired. Using amyl nitrate from. Users often also referred to amyl nitrite. What are Poppers Where they even Be Purchased and Dangers. Can nitrates be added to a sign schedule or allow scripting from sexual health practitioners? Clinical and nitrates. Using too much amyl nitrite may prefer a dangerous overdose If regular medicine does science seem fine be plenty as old after money have used it require a while check been your doctor to not pocket the dose on my own. The patient was maintained in the method is common are swallowed, that pushed underground into the fumes for example, dizziness and severity of aids in. Alkyl nitrates also refers to amyl is our patient had thrombocytopenia, with reference entry into phosgene and levels can potentially deadly substance choice for. Amyl nitrite Rx Medscape Reference. Burroughs wellcome and to as literature, but notthat of the manufacturing nitroglycerin or vitals and sometimes serious lung metabolism. Nitrite are two very similar to psychological withdrawal is not result in these products to dilate the rat by particular sections of subjects. The nitrate is to nitrates are referred to browse this? Diseases and contaminants: nitrate and drinking water or private wells.
    [Show full text]
  • Health Hazards of Nitrite Inhalants, 83
    Health Hazards of Nitrite Inhalants U.S. DEPARMENT OF HEALTH AND HUMAN SERVICES • Public Health Service • Alcohol, Drug Abuse, and Mental Health Administration Health Hazards of Nitrite Inhalants Editors: Harry W. Haverkos, M.D. Divlsion of Clinical Research National Institute on Drug Abuse John A. Dougherty, Ph.D. Veterans Administration Medical Center Lexington, KY NIDA Research Monograph 83 1988 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Alcohol, Drug Abuse, and Mental Health Administration National Institute on Drug Abuse 5500 Fishers Lane Rockville, MD 20857 For Sale by the Superitendent of Documents, U.S. Government Printing Office Washington, DC 20402 NIDA Research Monographs are prepared by the research divisions of the National Institute on Drug Abuse and published by its Office of Science. The primary objective of the series is to provide critical reviews of research problem areas and techniques, the content of state-of-the-art conferences, and integrative research reviews. Its dual publication emphasis is rapid and targeted dissemination to the scientific and professional community. Editorial Advisors MARTIN W. ADLER, Ph.D. MARY L. JACOBSON Temple Universlty School of Medicine National Federation of Parents for Philadelphia, Pennsylvania Drug-Free Youth Omaha, Nebraska SYDNEY ARCHER, Ph.D. Rensselaer Polytechnic Institute Troy, New York REESE T. JONES, M.D. Langley Porter Neuropsychiatric lnstitute RICHARD E. BELLEVILLE, Ph.D. San Francisco, California NB Associates, Health Sciences RockviIle, Maryland DENISE KANDEL, Ph.D. KARST J. BESTEMAN College of Physicians and Surgeons of Alcohol and Drug Problems Association Columbia University of North America New York, New York Washington, D.C GILBERT J.
    [Show full text]
  • Formation of New Bioactive Organic Nitrites and Their Identification with Gas Chromatography-Mass Spectrometry and Liquid Chromatography Coupled to Nitrite Reduction
    Formation of new bioactive organic nitrites and their identification with gas chromatography-mass spectrometry and liquid chromatography coupled to nitrite reduction. Kristofer F. Nilsson, Michael Lundgren, Per Agvald, L. Christofer Adding, Dag Linnarsson, Lars E. Gustafsson To cite this version: Kristofer F. Nilsson, Michael Lundgren, Per Agvald, L. Christofer Adding, Dag Linnarsson, et al.. Formation of new bioactive organic nitrites and their identification with gas chromatography-mass spectrometry and liquid chromatography coupled to nitrite reduction.. Biochemical Pharmacology, Elsevier, 2011, 82 (3), pp.248. 10.1016/j.bcp.2011.04.005. hal-00711297 HAL Id: hal-00711297 https://hal.archives-ouvertes.fr/hal-00711297 Submitted on 23 Jun 2012 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Accepted Manuscript Title: Formation of new bioactive organic nitrites and their identification with gas chromatography-mass spectrometry and liquid chromatography coupled to nitrite reduction. Authors: Kristofer F. Nilsson, Michael Lundgren, Per Agvald, L. Christofer
    [Show full text]
  • Proposed Occupational Exposure Limits for Non-Carcinogenic Hanford Waste Tank Vapor Chemicals
    PNNL-15736 Proposed Occupational Exposure Limits for Non-Carcinogenic Hanford Waste Tank Vapor Chemicals TS Poet C Timchalk March 2006 Prepared for the U.S. Department of Energy under Contract DE-AC05-76RL01830 DISCLAIMER This report was prepared as an account of work sponsored by an agency of the United States Government. Neither the United States Government nor any agency thereof, nor Battelle Memorial Institute, nor any of their employees, makes any warranty, express or implied, or assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of any information, apparatus, product, or process disclosed, or represents that its use would not infringe privately owned rights . Reference herein to any specific commercial product, process, or service by trade name, trademark, manufacturer, or otherwise does not necessarily constitute or imply its endorsement, recommendation, or favoring by the United States Government or any agency thereof, or Battelle Memorial Institute. The views and opinions of authors expressed herein do not necessarily state or reflect those of the United States Government or any agency thereof. PACIFIC NORTHWEST NATIONAL LABORATORY operated by BATTELLE for the UNITED STATES DEPARTMENT OF ENERGY under Contract DE-AC05-76RL01830 Printed in the United States of America Available to DOE and DOE contractors from the Office of Scientific and Technical Information, P.O. Box 62, Oak Ridge, TN 37831-0062; ph: (865) 576-8401 fax: (865) 576-5728 email: [email protected] Available to the public from the National Technical Information Service, U.S. Department of Commerce, 5285 Port Royal Rd., Springfield, VA 22161 ph: (800) 553-6847 fax: (703) 605-6900 email: [email protected] online ordering: http://www.ntis.gov/ordering.htm This document was printed on recycled paper.
    [Show full text]
  • WEST VIRGINIA LEGISLATURE House Bill 2526
    INTRODUCED H.B. 2017R2413 WEST VIRGINIA LEGISLATURE 2017 REGULAR SESSION Introduced FISCAL House Bill 2526 NOTE BY DELEGATES ELLINGTON, SUMMERS, SOBONYA AND ROHRBACH [Introduced February 16, 2017; Referred to the Committee on Health and Human Resources then the Judiciary.] INTRODUCED H.B. 2017R2413 1 A BILL to amend and reenact §60A-2-204, §60A-2-206, §60A-2-210 and §60A-2-212 of the Code 2 of West Virginia, 1931, as amended, all relating to classifying additional drugs to 3 Schedules I, II, IV and V of controlled substances. Be it enacted by the Legislature of West Virginia: 1 That §60A-2-204, §60A-2-206, §60A-2-210 and §60A-2-212 of the Code of West Virginia, 2 1931, as amended, be amended and reenacted, all to read as follows. ARTICLE 2. STANDARDS AND SCHEDULES. §60A-2-204. Schedule I. 1 (a) Schedule I shall consist of the drugs and other substances, by whatever official name, 2 common or usual name, chemical name, or brand name designated, listed in this section. 3 (b) Opiates. Unless specifically excepted or unless listed in another schedule, any of the 4 following opiates, including their isomers, esters, ethers, salts and salts of isomers, esters and 5 ethers, whenever the existence of such isomers, esters, ethers and salts is possible within the 6 specific chemical designation (for purposes of subdivision (34) of this subsection only, the term 7 isomer includes the optical and geometric isomers): 8 (1) Acetyl-alpha-methylfentanyl (N-[1-(1-methyl-2-phenethyl) -4-piperidinyl]-- 9 phenylacetamide); 10 (2) Acetylmethadol; 11 (3) Allylprodine; 12 (4) Alphacetylmethadol (except levoalphacetylmethadol also known as levo-alpha-acetylmethadol, 13 levomethadyl acetate, or LAAM); 14 (5) Alphameprodine; 15 (6) Alphamethadol; 16 (7)Alpha-methylfentanyl (N-[1-(alpha-methyl-beta-phenyl) ethyl-4-piperidyl] 17 propionanilide; 1-(1-methyl-2-phenylethyl)-4-(– propanilido) piperidine); 18 (8) Alpha-methylthiofentanyl (N-[1-methyl-2-(2-thienyl) ethyl- 4-piperidinyl]--phenylpropanamide); 1 INTRODUCED H.B.
    [Show full text]