Introduction: The use of electronic cigarette devices is increasing with a growing concern about possible adverse effects from these currently unregulated ...
2013 Annual Meeting of the NACCT
237. Steroids, growth hormone, and the poison center Michael E. Nelson1, Jordan Nugent2, Sean M. Bryant1
Clinical Toxicology Downloaded from informahealthcare.com by Univ of Kansas Med Center on 08/17/14 For personal use only.
1Cook County Hospital (Stroger), The Toxikon Consortium, Chicago IL USA; 2The Chicago Medical School, North Chicago IL USA
Background: Anabolic Androgenic Steroids (AAS) and human Growth Hormone (GH) have received extensive media coverage over the past decade for their reported abuse in professional athletics. Additional reports have placed steroid use in the general population, including high school students, between 2–6%. The purpose of this study is to characterize calls to the Illinois Poison Control Center (IPC) regarding AAS and GH over a period of ten years. Methods: All calls to the IPC related to anabolic steroids or hormones were evaluated from January 1, 2002 to December 31, 2011. A total of 456 cases were identified. Each case was then carefully evaluated and determined if the concern for AAS or GH prompted the call to the IPC and narrowed to 122 cases. Each of these was characterized by patient age, gender, reason for use, route of exposure, clinical effects, recommendations by poison specialists (i.e. decontamination, treatment, etc.), and any additional unique characteristics of each case. Results: Of the 122 cases thoroughly evaluated, 112 cases (91.8%) were related to AAS, 9 cases (7.4%) related to GH alone, and 1 case (0.8%) was a combined AAS and GH issue. 50 (40.9%) of these calls occurred in the pediatric age range (0–18) with 32 (26.2%) in the 0–5 year-old age demographic. 80 (65.6%) were male and 43 (38.4%) were female. 61 cases (50%) were accidental exposures, 53 (43%) were intentional use, and the remaining cases were unclear based on the documented information. 9 cases involved accidental ocular exposure from injectable AAS for which all were treated with eye irrigation. Additional reported effects with AAS included acne (2), weight gain (2), psychosis (5), aggression (5), skin irritation (3), GI upset (4), hypoglycemia (1), jaundice (1), and insomnia (1). 64 cases (52.4%) had no reported effects. 13 cases (10.6%) involved suicide attempts. 19 cases (16.8%) were using AAS for bodybuilding. 8 (88.8%) of GH alone cases were accidental overdose due to auto-injector malfunction or misreading dosing instructions with no clinical effects observed. The one case with combined GH and AAS involved a 28 year-old male bodybuilder that developed acute psychosis and agitation and required psychiatric admission. Conclusion: Poison center consultation for AAS and GH use is a relatively rare event averaging roughly 1 case per month over ten years despite the large amount of media coverage on this topic. A large amount of calls to the IPC however did involve accidental exposures with minimal to no clinical effects. Interestingly, 10.6% of calls involving AAS and GH were in suicide attempts. Despite the unique occurrence, the poison center provides a valuable source of information for AAS and GH education and guidance. Keywords: Poison center, Steroids, Growth hormone
238. Fatal intravenous injection of electronic cigarette “eLiquid” solution Stephen Thornton, Lisa Oller, Tama Sawyer University of Kansas Hospital Poison Control Center, Kansas City KS USA Copyright © Informa Healthcare USA, Inc. 2013
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Introduction: The use of electronic cigarette devices is increasing with a growing concern about possible adverse effects from these currently unregulated devices. We report a fatality associated with the intentional injection of “eLiquid”, a nicotine containing solution used to refill certain types of electronic cigarettes. Case report: A 29 year old man was found by emergency medical services in cardiopulmonary arrest with a suicide note indicating that he had intravenously injected himself with “eLiquid.” In the emergency department (ED) he developed seizures resistant to lorazepam, phenobarbital, phenytoin, and leviteracetam. Labs were notable for a leukocystosis of 21.8 K/mm3, a potassium of 2.4 mmol/L, blood sugar of 401 mg/dL, creatinine of 2.0 mg/dL, creatine kinase of 977 unit/L, and a troponin of 0.34 ng/mL. A urine drug immunoassay was positive for amphetamines. A head CT was unremarkable. He was transferred to a tertiary care hospital where the seizures were controlled with the addition of propofol. Therapeutic hypothermia was initiated but he never regained consciousness. He was diagnosed with anoxic encephalopathy and declared brain dead on hospital days 5. An autopsy was not performed as he was an organ donor. Comprehensive serum drug testing on specimens obtained on arrival to the ED detected only lidocaine, which he received during his resuscitation, nicotine, and nicotine’s primary metabolite, cotinine. No amphetamines were detected. His serum nicotine and cotinine was 2000 ng/ml and 2100 ng/ml, respectively. These levels are consistent with other fatalities attributed to nicotine. Discussion: Electronic cigarettes are currently unregulated and many are refillable with nicotine containing solutions such as the “eLiquid” solution in this case. A recent study found some of these solutions to contain as much as 25 mg/ml of nicotine. Even higher concentrations are purported on internet websites. Thus, a 10 ml bottle of “eLiquid” may contain enough nicotine to be fatal to an average sized adult. Children would be at even more risk. Health care providers should be aware that as the use of electronic cigarettes increase, toxicity from both intentional and unintentional exposure to these nicotine containing liquids may become more prevalent. Keywords: Intoxication, Cardiac toxicity, Seizure
239. Nicotine poisoning following ingestion of e-Liquid Matthew Valento University of Washington Division of Emergency Medicine Background: Electronic cigarettes (e-cigarettes), initially marketed as smoking cessation aids, are increasingly popular among tobacco users. These devices utilize a cartridge filled with ‘e-Liquid’, a solution of dissolved nicotine concentrate, connected to an atomizer. The user can purchase bottles of replacement e-Liquid for future use. We present a case of nicotine poisoning following intentional ingestion of e-Liquid. Case report: A 22 year-old male presented to the emergency department (ED) shortly after intentional ingestion of approximately 30 ml of e-Liquid (nicotine content: 24 mg/ml). 20 minutes after ingestion, he developed nausea and vomiting. He then rubbed an additional 30 ml over his skin. His family contacted emergency medical services (EMS), who performed skin decontamination prior to arrival in the ED. In the ED, the patient complained of
