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ABSTRACT: Lead, the 82nd element in our periodic table, has accompanied humankind throughout the millennia of our history and development. As a ubiquitous heavy metal, lead is used in multiple applications and nine billion tons continue to be extracted globally every year. Although the United States has succeeded in limiting lead exposure among its own citizens by banning the use of lead in gasoline and household paint, while instituting improved working conditions for those who are exposed to lead in the workplace, the battle against lead is not won. In addition, it continues to plague the rest of the world today; the United States has played an increasing role in the world's exposure to lead and plans to stop are currently stalled. The year 2011 marked the centennial celebration of the life's work of Dr. Alice Hamilton in exposing lead poisoning among industrial workers in Chicago, Illinois. Her legacy provides us with the opportunity to look back and reevaluate our leaded history in the US. It also reminds us that there is more to be done to mitigate lead poisoning both domestically and in the developing world.
Clinical Toxicology 07/2012; 50(6):528-31. · 2.22 Impact Factor
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Clinical Toxicology 02/2011; 49(2):130. · 2.22 Impact Factor
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The American journal of emergency medicine 05/2010; 28(4):530-2. · 1.54 Impact Factor
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ABSTRACT: Toxic overdose can present with various clinical signs and symptoms. These may be the only clues to diagnosis when the cause of toxicity is unknown at the time of initial assessment. The prognosis and clinical course of recovery of a patient poisoned by a specific agent depends largely on the quality of care delivered within the first few hours in the emergency setting. Usually the drug or toxin can be quickly identified by a careful history, a directed physical examination, and commonly available laboratory tests. Once the patient has been stabilized, the physician must consider how to minimize the bioavailability of toxin not yet absorbed, which antidotes (if any) to administer, and if other measures to enhance elimination are necessary.
Emergency Medicine Clinics of North America 06/2007; 25(2):249-81; abstract vii. · 0.86 Impact Factor
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Yaron Finkelstein,
Michael S Wahl,
Yedidia Bentur,
Tal Schechter,
Ben Zion Garty, Timothy B Erickson,
Gabby Chodick,
Alfred Cahana,
Bill J Mounstephen,
Gideon Koren,
Steven E Aks
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ABSTRACT: Iron continues to be a common cause of poisoning in young children, in part due to its widespread use and easy accessibility.
To determine differences in the epidemiology and outcome of unintentional iron ingestion by young children in populations practicing selective (eg, US) versus universal (eg, Israel) iron supplementation to infants.
All cases of unintentional iron ingestion in children younger than 7 years in a one year period were identified through the poison control center databases of 2 sites (Illinois and Israel). Parameters compared include patient sex and age; type, form, and dose of iron preparation; circumstances and clinical manifestations; management; and outcome.
A total of 602 children were identified: 459 in Illinois and 143 in Israel. The majority of Illinois children ingested multivitamin preparations (94%), whereas Israeli children ingested single-ingredient iron preparations (78%) (p < 0.001). Iron doses ingested were higher in Israel (median 14.5 vs 6.6 mg/kg; p < 0.001) but remained within the nontoxic range for most children. No deaths or severe poisonings were reported, and 93% of children in both groups were asymptomatic. The majority of ingestions in both locations were due to unintentional self-ingestion. However, parental miscalculation occurred more frequently in Israel (16%) than in Illinois (1%).
Universal iron supplementation to infants was not associated with a negative impact on the outcome of pediatric unintentional ingestions. Low-dose exposures were safely managed by on-site observation.
Annals of Pharmacotherapy 03/2007; 41(3):414-9. · 2.13 Impact Factor
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ABSTRACT: Dieffenbachia is a common domestic plant. Oral contact with the plant usually is associated with minimal consequences. However, chewing on the stem or the leaf of the Dieffenbachia can result in painful oropharyngeal edema and the inability to speak or handle secretions. Airway compromise has been reported only in a pediatric ingestion. We report a case of an adult who bit into the stem of the plant thinking it was sugar cane. He instantly spit out the remaining stem and despite this brief exposure, oropharyngeal edema developed refractory to medicinal therapy, requiring surgical airway management. The exact mechanism of edema is not known; therefore, methods of treatment are variable. We recommend caution when presented with a patient exposed to Dieffenbachia. Even the patient who initially seems stable may have an airway that will quickly deteriorate.
Journal of Emergency Medicine 12/2003; 25(4):391-7. · 1.31 Impact Factor
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ABSTRACT: One of the most enduring symbols of the Olympics is the torch or flame, an icon of peace and sportsmanship that has its roots in Ancient Greece. According to the Creed of the Olympics: "The important thing in the Games is not winning, but taking part. The essential thing is not conquering. but fighting well." The modern Olympic Games (1896-2000) have been heavy laden with controversy, as athletes have abused performance enhancing drugs to thrust themselves into the limelight in search of gold. It was not until 1967 that the International Olympic Medical Commission began banning drugs. Full-scale drug testing was instituted in 1972.: Retrospective review of modern summer and winter Olympics Game sources (1896-2002) was done for documentation of drug abuse, drug-related overdoses, and positive drug screens. Data were collected for the type of drug documented. the athlete's name, their country of origin, and Olympic event. Seventy cases were identified. The most common class of agents were steroids (29), followed by stimulants (22), diuretics (7), beta-2 agonists (2), and beta blockers (1). Alcohol and marijuana, while not historically prohibited, have been outlawed by several individual sport federations. Toxicities of these 2 agents were most likely under-reported. Countries of origin of individual athletes included Bulgaria (7), USA (7), Sweden (4), Spain (4), Japan (2), Poland (2), Greece (2), Canada (2), Hungary (2), Russia (2), Austria (2), and Great Britain, Norway, Romania, Armenian, and Latvian, each with 1. The most common Olympic events in which drug abuse was documented were weightlifting (25), trackand field (12), skiing (5), wrestling (5), volleyball (3), modern pentathlon (3), cycling (2), swimming (2), gymnastics (1), and rowing (1). As athletic pressures and financial gains of the Olympic Games heighten, more toxicities are likely to occur despite attempts at restricting performance-enhancing drugs.
Veterinary and human toxicology 04/2003; 45(2):97-102.
