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Journal of Veterinary Emergency and... Aug 2011To review the use of IV lipid emulsion (ILE) for the treatment of toxicities related to fat-soluble agents; evaluate current human and veterinary literature; and to... (Review)
Review
OBJECTIVE
To review the use of IV lipid emulsion (ILE) for the treatment of toxicities related to fat-soluble agents; evaluate current human and veterinary literature; and to provide proposed guidelines for the use of this emerging therapy in veterinary medicine and toxicology.
DATA SOURCES
Human and veterinary medical literature.
HUMAN DATA SYNTHESIS
Human data are composed mostly of case reports describing the response to treatment with ILE as variant from mild improvement to complete resolution of clinical signs, which is suspected to be due to the variability of lipid solubility of the drugs. The use of ILE therapy has been advocated as an antidote in cases of local anesthetic and other lipophilic drug toxicoses, particularly in the face of cardiopulmonary arrest and unsuccessful cardiopulmonary cerebral resuscitation.
VETERINARY DATA SYNTHESIS
The use of ILE therapy in veterinary medicine has recently been advocated by animal poison control centers for toxicoses associated with fat-soluble agents, but there are only few clinical reports documenting successful use of this therapy. Evidence for the use of ILE in both human and veterinary medicine is composed primarily from experimental animal data.
CONCLUSIONS
The use of ILE appears to be a safe therapy for the poisoned animal patient, but is warranted only with certain toxicoses. Adverse events associated with ILE in veterinary medicine are rare and anecdotal. Standard resuscitation protocols should be exhausted before considering this therapy and the potential side effects should be evaluated before administration of ILE as a potential antidote in cases of lipophilic drug toxicoses. Further research is waranted.
Topics: Animals; Antidotes; Fat Emulsions, Intravenous; Hazardous Substances; Humans; Poisoning
PubMed: 21827588
DOI: 10.1111/j.1476-4431.2011.00657.x -
British Journal of Pharmacology Oct 2010The use of biological agents has generally been confined to military-led conflicts. However, there has been an increase in non-state-based terrorism, including the use... (Review)
Review
The use of biological agents has generally been confined to military-led conflicts. However, there has been an increase in non-state-based terrorism, including the use of asymmetric warfare, such as biological agents in the past few decades. Thus, it is becoming increasingly important to consider strategies for preventing and preparing for attacks by insurgents, such as the development of pre- and post-exposure medical countermeasures. There are a wide range of prophylactics and treatments being investigated to combat the effects of biological agents. These include antibiotics (for both conventional and unconventional use), antibodies, anti-virals, immunomodulators, nucleic acids (analogues, antisense, ribozymes and DNAzymes), bacteriophage therapy and micro-encapsulation. While vaccines are commercially available for the prevention of anthrax, cholera, plague, Q fever and smallpox, there are no licensed vaccines available for use in the case of botulinum toxins, viral encephalitis, melioidosis or ricin. Antibiotics are still recommended as the mainstay treatment following exposure to anthrax, plague, Q fever and melioidosis. Anti-toxin therapy and anti-virals may be used in the case of botulinum toxins or smallpox respectively. However, supportive care is the only, or mainstay, post-exposure treatment for cholera, viral encephalitis and ricin - a recommendation that has not changed in decades. Indeed, with the difficulty that antibiotic resistance poses, the development and further evaluation of techniques and atypical pharmaceuticals are fundamental to the development of prophylaxis and post-exposure treatment options. The aim of this review is to present an update on prophylaxis and post-exposure treatment recommendations and research initiatives for biological agents in the open literature from 2007 to 2009.
Topics: Animals; Anti-Bacterial Agents; Antidotes; Antiviral Agents; Biological Warfare; Bioterrorism; Humans; Post-Exposure Prophylaxis; Time Factors; Vaccines
PubMed: 20860656
DOI: 10.1111/j.1476-5381.2010.00939.x -
The Netherlands Journal of Medicine Feb 2014Ethylene glycol (EG) and methanol poisoning can cause life-threatening complications. Toxicity of EG and methanol is related to the production of toxic metabolites by... (Review)
Review
Ethylene glycol (EG) and methanol poisoning can cause life-threatening complications. Toxicity of EG and methanol is related to the production of toxic metabolites by the enzyme alcohol dehydrogenase (ADH), which can lead to metabolic acidosis, renal failure (in EG poisoning), blindness (in methanol poisoning) and death. Therapy consists of general supportive care (e.g. intravenous fluids, correction of electrolytes and acidaemia), the use of antidotes and haemodialysis. Haemodialysis is considered a key element in the treatment of severe EG and methanol intoxication and is aimed at removing both the parent compound and its toxic metabolites, reducing the duration of antidotal treatment and shortening the hospital observation period. Currently, there are two antidotes used to block ADH-mediated metabolism of EG and methanol: ethanol and fomepizole. In this review, the advantages and disadvantages of both antidotes in terms of efficacy, safety and costs are discussed in order to help the physician to decide which antidote is appropriate in a specific clinical setting.
Topics: Animals; Antidotes; Ethanol; Ethylene Glycol; Fomepizole; Humans; Methanol; Poisoning; Pyrazoles; Renal Dialysis; Solvents
PubMed: 24659589
DOI: No ID Found -
Current Pharmaceutical Biotechnology Aug 2012More than 90% of all fatal mushroom poisonings worldwide are due to amatoxin containing species that grow abundantly in Europe, South Asia, and the Indian subcontinent.... (Review)
Review
More than 90% of all fatal mushroom poisonings worldwide are due to amatoxin containing species that grow abundantly in Europe, South Asia, and the Indian subcontinent. Many cases have also been reported in North America. Initial symptoms of abdominal cramps, vomiting, and a severe cholera-like diarrhea generally do not manifest until at least six to eight hours following ingestion and can be followed by renal and hepatic failure. Outcomes range from complete recovery to fulminant organ failure and death which can sometimes be averted by liver transplant. There are no controlled clinical studies available due to ethical reasons, but uncontrolled trials and case reports describe successful treatment with intravenous silibinin (Legalon® SIL). In nearly 1,500 documented cases, the overall mortality in patients treated with Legalon® SIL is less than 10% in comparison to more than 20% when using penicillin or a combination of silibinin and penicillin. Silibinin, a proven antioxidative and anti-inflammatory acting flavonolignan isolated from milk thistle extracts, has been shown to interact with specific hepatic transport proteins blocking cellular amatoxin re-uptake and thus interrupting enterohepatic circulation of the toxin. The addition of intravenous silibinin to aggressive intravenous fluid management serves to arrest and allow reversal of the manifestation of fulminant hepatic failure, even in severely poisoned patients. These findings together with the available clinical experience justify the use of silibinin as Legalon® SIL in Amanita poisoning cases.
Topics: Amanitins; Animals; Antidotes; Chemical and Drug Induced Liver Injury; Humans; Molecular Structure; Mushroom Poisoning; Silymarin; Tissue Distribution; Treatment Outcome
PubMed: 22352731
DOI: 10.2174/138920112802273353 -
Journal of Photochemistry and... Dec 2015The sun rays brings along the ultraviolet radiations (UVRs) which prove deleterious for living organisms. The UVR is a known mutagen and is the prime cause of skin... (Review)
Review
The sun rays brings along the ultraviolet radiations (UVRs) which prove deleterious for living organisms. The UVR is a known mutagen and is the prime cause of skin carcinomas. UVR causes acute oxidative stress and this in turn deteriorates other physiological functions. Inflammatory conditions and elevation of pro-inflammatory molecules are also associated with UVR mediated cellular damages. The inflammatory conditions can secondarily trigger the generation of free radicals and this act cumulatively in further deterioration of tissue homeostasis. Photoimmunologists have also related UVR to the suppression of not only cutaneous but also systemic immunity by different mechanisms. Some researchers have proposed the use of various plant products as antioxidants against UVR induced oxidative imbalances but Melatonin is gaining rapid interest as a product that can be utilized to delineate the pathological effects of UVR since it is an established antioxidant. Besides the antioxidative nature, the capacity of melatonin to attenuate apoptosis and more importantly the efficacy of its metabolites to further aid in the detoxification of free radicals have made it a key player to be utilized against UVR mediated aggravated conditions. However, there is need for further extensive investigation to speculate melatonin as an antidote to UVR. Although too early to prescribe melatonin as a clinical remedy, the hormone can be integrated into dermal formulations or oral supplements to prevent the ever increasing incidences of skin cancers due to the prevalence of the UVR on the surface of the earth. The present review focuses and substantiates the work by different photo-biologists demonstrating the protective effects of melatonin and its metabolites against solar UVR - Melatonin as a possible antidote to UV radiation induced cutaneous damages and immune-suppression: an overview. J Photochem Photobiol B.
Topics: Animals; Antidotes; Antioxidants; Apoptosis; Humans; Melatonin; Skin; Skin Neoplasms; Ultraviolet Rays
PubMed: 26496791
DOI: 10.1016/j.jphotobiol.2015.10.006 -
Current Opinion in Pediatrics Apr 2007For decades, activated charcoal has been used as a 'universal antidote' for the majority of poisons because of its ability to prevent the absorption of most toxic agents... (Review)
Review
PURPOSE OF REVIEW
For decades, activated charcoal has been used as a 'universal antidote' for the majority of poisons because of its ability to prevent the absorption of most toxic agents from the gastrointestinal tract and enhance the elimination of some agents already absorbed. This manuscript will review the history of activated charcoal, its indications, contraindications, and the complications associated with its use as reported in the literature.
RECENT FINDINGS
Recent randomized prospective studies, although with small numbers, have shown no difference in length of hospital stay, morbidity, and mortality between groups who received and did not receive activated charcoal. No study has had sufficient numbers to satisfactorily address clinical outcome in patients who received activated charcoal less than 1 h following ingestion.
SUMMARY
If used appropriately, activated charcoal has relatively low morbidity. Due to the lack of definitive studies showing a benefit in clinical outcome, it should not be used routinely in ingestions. AC could be considered for patients with an intact airway who present soon after ingestion of a toxic or life-threatening dose of an adsorbable toxin. The appropriate use of activated charcoal should be determined by the analysis of the relative risks and benefits of its use in each specific clinical scenario.
Topics: Antidotes; Charcoal; Child; Contraindications; Humans; Poisoning
PubMed: 17496769
DOI: 10.1097/MOP.0b013e32801da2a9 -
Academic Emergency Medicine : Official... Sep 2009The objective was to asses the efficacy of lipid emulsion as antidotal therapy outside the accepted setting of local anesthetic toxicity. (Review)
Review
OBJECTIVES
The objective was to asses the efficacy of lipid emulsion as antidotal therapy outside the accepted setting of local anesthetic toxicity.
METHODS
Literature was accessed through PubMed, OVID (1966-February 2009), and EMBASE (1947-February 2009) using the search terms "intravenous" AND ["fat emulsion" OR "lipid emulsion" OR "Intralipid"] AND ["toxicity" OR "resuscitation" OR "rescue" OR "arrest" OR "antidote"]. Additional author and conference publication searches were undertaken. Publications describing the use of lipid emulsion as antidotal treatment in animals or humans were included.
RESULTS
Fourteen animal studies, one human study, and four case reports were identified. In animal models, intravenous lipid emulsion (ILE) has resulted in amelioration of toxicity associated with cyclic antidepressants, verapamil, propranolol, and thiopentone. Administration in human cases has resulted in successful resuscitation from combined bupropion/lamotrigine-induced cardiac arrest, reversal of sertraline/quetiapine-induced coma, and amelioration of verapamil- and beta blocker-induced shock.
CONCLUSIONS
Management of overdose with highly lipophilic cardiotoxic medications should proceed in accord with established antidotal guidelines and early poisons center consultation. Data from animal experiments and human cases are limited, but suggestive that ILE may be helpful in potentially lethal cardiotoxicity or developed cardiac arrest attributable to such agents. Use of lipid emulsion as antidote remains a nascent field warranting further preclinical study and systematic reporting of human cases of use.
Topics: Adrenergic beta-Antagonists; Animals; Antidepressive Agents; Antidotes; Cardiotoxins; Drug Overdose; Fat Emulsions, Intravenous; Heart Arrest; Humans
PubMed: 19845549
DOI: 10.1111/j.1553-2712.2009.00499.x -
Emergency Medicine Clinics of North... Feb 2015Asphyxiants deprive the body of oxygen. Simple asphyxiants displace oxygen from the lungs, whereas systemic asphyxiants interfere with transport of oxygen by hemoglobin... (Review)
Review
Asphyxiants deprive the body of oxygen. Simple asphyxiants displace oxygen from the lungs, whereas systemic asphyxiants interfere with transport of oxygen by hemoglobin or with mitochondrial oxidative phosphorylation. Asphyxiants may be gases, liquids, or solids, or their metabolites. The typical clinical picture of asphyxiant poisoning is one of progressive mental status changes, alteration of breathing, progressively abnormal vital signs, coma, seizures, and eventually cardiovascular collapse and death. Treatment of asphyxiant poisoning is aggressive supportive care, with control of the airway and ventilation and maintenance of cardiac output. Supportive care is often enhanced by the administration of specific antidotes.
Topics: Antidotes; Asphyxia; Diagnosis, Differential; Disease Management; Emergency Medical Services; Humans; Oxygen Inhalation Therapy; Poisoning
PubMed: 25455664
DOI: 10.1016/j.emc.2014.09.014 -
American Journal of Therapeutics 2006
Review
Topics: Antidotes; Chemical Warfare Agents; Cyanides; Humans; Hydroxocobalamin; Poisoning; United States
PubMed: 16645433
DOI: 10.1097/01.mjt.0000174349.89671.8c -
Journal of Medical Toxicology :... Mar 2015
Topics: Antidotes; Antivenins; Chemistry, Pharmaceutical; Drug Industry; Drug Stability; Drug Storage; Guidelines as Topic; Health Systems Plans; Humans; Legislation, Drug; Orphan Drug Production; Societies, Medical; Toxicology; United States; United States Food and Drug Administration; Workforce
PubMed: 25711999
DOI: 10.1007/s13181-013-0372-1