Zane Horowitz

Zane Horowitz
Oregon Health and Science University | OHSU · Department of Emergency Medicine

MD

About

117
Publications
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Introduction
Skills and Expertise

Publications

Publications (117)
Article
Objective: The aim of this study was to assess national trends in recreational and suicidal ingestions of over-the-counter cough preparations that contain Coricidin. Methods: Using the American Association of Poison Control Center's National Poison Data System, we obtained data from 2004 to 2017 on patients aged 13 to 19 years with an ingestion...
Article
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Tear gas agents are divided into “C” agents, and “pepper spray” and are currently being used by law enforcement. CN (1-chloroacetophenone) is more toxic, sometimes causing skin blistering in addition to eye lacrimation. It was replaced by CS (o-chlorobenzylidene malonitrile). CR (dibenzy-1,4,oxazepane) was developed in 1962 as a more potent and les...
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Introduction: Endotracheal intubation (ETI) is an essential component of the supportive care provided to the critically ill patient with pharmaceutical poisoning; however, specific nuances surrounding intubation including techniques and complications in the context of pharmaceutical poisoning have not been well elucidated. Discussion: A search o...
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Introduction: The jequirity bean (Abrus precatorius) seed contains abrin, a toxalbumin, that irreversibly binds the 60-s ribosomal subunit inhibiting protein synthesis. Neurologic manifestations of ingestions are rare. Case details: We present a case of a 20-year-old man with 24 h of vomiting, diarrhea and 2 h of hematemesis and hematochezia. He ad...
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Introduction: We described calls to U.S. poison centers (PCs) related to potential exposure to substances through breast milk. Materials and Methods: We analyzed National Poison Data System calls between 2001 and 2017 with "Exposure through breast milk" or "Drug use during breastfeeding" as the coded scenario. Data handling and descriptive statist...
Article
Objective: Bupropion is often categorized as a newer generation antidepressant and assessed with serotonin reuptake inhibitors as a lower risk than older tricyclic antidepressants (TCAs). The objective of this study was to compare outcomes in adolescent suicide from ingestions between bupropion and TCA medications. Study design: An analysis of the...
Article
Adolescent ingestions are common reasons for calls to poison centers in United States. As opposed to younger children who mostly have unintentional exposures, adolescent ingestions often result from intentional use. This manuscript reviews recent reports on adolescent ingestions related to intentional abuse, self-harm and use of opioid medications.
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Study objective: In cases of high-concentration peroxide ingestion reported to US poison centers, we describe medical outcomes, examine the role of hyperbaric oxygen, and review the use of endoscopy. Methods: The study was a retrospective analysis of a structured database, the National Poison Data System. The chart for each poison center case of...
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Purpose: Suicide attempts by adolescents most commonly involve the overdose of medications. To date, there has been little information on the over-the-counter or prescription medicines that adolescents ingest for self-harm. Identification of medications chosen in suicide attempts may help guide anticipatory guidance to parents by primary care prov...
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Background: Opioid abuse is a public health epidemic in the United States. Much literature has focused on the prescribing practices of physicians and opioid misuse by adults. However, there are limited data on the effect of opioid prescriptions on adolescent recreational ingestion of these medications. Objectives: The objective of this study was...
Article
Cardiovascular toxicity, including sudden hypertension, tachycardia, coronary arterial vasoconstriction, and/or dysrhythmia, may arise from cocaine or methamphetamine use. Treatment options should be considered carefully based upon the unique pharmacology of these different stimulants. We report a rare case of acute cardiovascular toxicity from con...
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Introduction Anhydrous caffeine, often sold on the Internet as a powdered caffeine product, is sold as “pure caffeine” to be used as an additive to beverages and has also been used as an ingredient in energy supplement products. Methods This is a retrospective multiple-poison center chart review of calls regarding powdered caffeine to poison center...
Chapter
Jellyfish belong to the phylum Cnidaria (Greek derived from ‘nettle’) and are mostly free-swimming marine animals that may have an umbrella-shaped bell with varying length tentacles. The pulsations of the bell are relied on as their mode of locomotion, while the tentacles are typically used for capturing prey. Jellyfish have a worldwide distributio...
Chapter
Jellyfish belong to the phylum Cnidaria (Greek derived from ‘nettle’) and are mostly free-swimming marine animals that may have an umbrella-shaped bell with varying length tentacles. The pulsations of the bell are relied on as their mode of locomotion, while the tentacles are typically used for capturing prey. Jellyfish have a worldwide distributio...
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Full-text available
Patients may be intubated after exposure to a variety of substances because of respiratory failure, CNS sedation, pulmonary pathology, or cardiovascular instability. However, there is little data describing the types of substances that are associated with endotracheal intubation or the rates of intubation after these exposures. Evaluation of this a...
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Objective: Adolescent intentional ingestions remain a significant public health problem in the United States with little research to date on the over-the-counter or prescription medicines that adolescents abuse. These data are important for anticipatory guidance by primary care providers, preventive health, and poison center outreach. Methods: T...
Article
Overdose of amphetamine, related derivatives, and analogues (ARDA) continues to be a serious worldwide health problem. Patients frequently present to the hospital and require treatment for agitation, psychosis, and hyperadrenegic symptoms leading to pathologic sequelae and mortality. To review the pharmacologic treatment of agitation, psychosis, an...
Chapter
Botulinum toxin is the ultimate example of the core principle in toxicology that all substances are poisons, and it is only the dose that determines if a substance is therapeutic or toxic. Two forms of pharmaceutical products, onabotulinum toxin A (Botox) and rimabotulinum toxin B (Myobloc), are used as injectable therapeutic agents to induce local...
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Context and objectives: Synthetic cannabinoids are illegal drugs of abuse known to cause adverse neurologic and sympathomimetic effects. They are an emerging health risk: 11% of high school seniors reported smoking them during the previous 12 months. We describe the epidemiology of a toxicologic syndrome of acute kidney injury associated with synt...
Conference Paper
BACKGROUND: Synthetic cannabinoids are illegal drugs that cause adverse neurologic and sympathomimetic effects. During 2010, synthetic cannabinoids resulted in >11,000 US emergency department visits. Synthetic cannabinoids are increasingly popular; nationally, 11.4% of high school seniors reported smoking them during the previous 12 months. In Augu...
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Context: Lead toxicity from the ingestion of a lead foreign body has been described in several case reports. Management of ingested live ammunition presents its own challenges due to the risk of accidental discharge. A safe and effective method of retrieving a live cartridge must be considered. Case details: We present two cases of lead toxicity...
Article
A 54-year-old man treated with dabigatran experienced new onset of a stroke with a score of 9 on the National Institutes of Health Stroke Scale. Administration of recombinant tissue plasminogen activator (rtPA) was not recommended because of the dabigatran therapy. Angiography showed occlusion of the left middle cerebral artery by an embolic thromb...
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In March 2012, the Wyoming Department of Health was notified by Natrona County public health officials regarding three patients hospitalized for unexplained acute kidney injury (AKI), all of whom reported recent use of synthetic cannabinoids (SCs), sometimes referred to as "synthetic marijuana." SCs are designer drugs of abuse typically dissolved i...
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Introduction: We present a case of envenomation by a Great Lakes Bush Viper, Atheris nitschei. Atheris species are a group of snakes that are indigenous to the forested areas of Central Africa. Prior reports of envenomation by Great Lakes Bush Vipers were not found in a Medline search. However, reports of other Atheris species envenomations descri...
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A 13-month-old male who ingested 20 diphenhydramine (25 mg) tablets presented with seizures and ultimately progressed to status epilepticus and wide-complex tachycardia. Due to worsening clinical course, hemodialysis was performed with temporal resolution of his symptoms. Hemodialysis may be considered in critically ill diphenhydramine overdoses no...
Article
Botulism was believed to be a rare disease in both the US and UK in the 1920's, until two deadly outbreaks altered that view and launched public health measures to control it. In the United States, the ripe olive scare of 1920 found glass-packaged olives linked to multiple deaths. In the United Kingdom, eight deaths from glass-potted duck paste, in...
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A Vietnamese family living in the Pacific Northwest harvested several wild mushrooms grown in their front lawn. All three in the family suffered from delayed GI symptoms starting approximately 12 h after ingestion. One patient died and two developed hepatic injury. We provide photography and describe common characteristics of Amanita phalloides mus...
Article
There are seven known serotypes of botulism, designated A through G; almost all human cases of botulism are caused by types A, B, and E. Botulism type E is the predominant serotype causing disease associated with native Arctic foods. In the circumpolar regions of the world, the coastal soils are rich in botulism type E, and consumption of fish and...
Article
Ingestion of concentrated hydrogen peroxide (H(2)O(2)) has been associated with venous and arterial gas embolic events, hemorrhagic gastritis, gastrointestinal bleeding, shock, and death. Although H(2)O(2) is generally considered a benign ingestion in low concentrations, case reports have described serious toxicity following high concentration expo...
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Salicylates are common exposures. We report an unusual case of salicylate ingestion, as salsalate, with resolution of symptoms and return of salicylate levels to non-toxic values, with a subsequent, unexpected recrudescence to toxic levels requiring reinstitution of therapy. A 31-year-old man ingested unknown amounts of salsalate, hydroxyzine, and...
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We present a case of catatonia, which occurred shortly after starting a new antipsychotic, paliperidone, an active metabolite of risperidone. Catatonia may be caused by a variety of conditions, including metabolic, neurologic, psychiatric and toxic processes. Interestingly, risperidone, which has been thought to cause several cases of catatonia, ha...
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Zigadenus (commonly known as "death camas" or "mountain camas") is a common plant in the lily family found throughout the United States. Its onion-like roots can be mistaken for an edible plant. Ingestion may cause hemodynamic instability which has successfully been treated with atropine. It has been suggested that vasopressors may be an effective...
Article
The ingestion of poison hemlock, or Conium maculatum, is described in a 2-year-old boy. He had the onset of abdominal pain and weakness after being fed C. maculatum picked by his sister from the roadside 2 hours earlier. He had a rapidly progressive muscular weakness and was intubated for respiratory failure. His symptoms completely resolved within...
Article
Legislation requiring bittering of antifreeze enables assessment of the impact on frequency, volume, and severity of pediatric antifreeze ingestions. US poison control data for antifreeze ingestions in children younger than 5 years were analyzed comparing 232 ingestions occurring in states after enactment of bittering requirements with 6218 cases o...
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In the Pacific Northwest a new pattern of mushroom ingestion has emerged, attributed to Amanita smithiana, in which renal failure has been the predominant manifestation. A 55-year-old male ate 3 raw wild mushrooms in a salad and had onset of severe nausea and vomiting within 6 hours. His vital signs were unremarkable. His labs were significant for...
Article
Arsenic trioxide is available for home use in ant baits. Potential arsenic toxicity from unintentional pediatric ingestion is not well studied. The goal of this study is to describe the clinical course and urinary arsenic concentrations of children who ingested ant bait containing arsenic trioxide (0.46%). This is a case series of pre-school childr...
Article
Legislation requiring the addition of bittering agents to antifreeze enables assessment of the impact on frequency, volume and severity of suicidal antifreeze ingestions. U.S. poison control data were analyzed comparing 130 suicidal antifreeze ingestions occurring in two states after enactment of bittering requirements with 3,493 cases occurring in...
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Methamphetamine is an illicit stimulant that is typically smoked, insufflated, or injected. We report an unusual method of ingesting methamphetamine called "parachuting" and its implications for the treatment of "body stuffers." A 25-year-old man wrapped methamphetamine into a plastic baggie and ingested it in an attempt to "parachute." He presente...
Article
Botulinum toxin is regarded as the most lethal substance known. It is estimated that the human LD50 for inhalation botulism is 1 to 3 nanograms of toxin/kilogram body mass. Although only three cases of inhalational botulism have been described, an understanding of the pathophysiology of food-borne outbreaks, wound botulism, and infant botulism, and...
Article
A 4-year-old, previously healthy boy experienced intermittent abdominal pain for several weeks. He was diagnosed with probable gastroenteritis, but his symptoms worsened. Laboratory tests revealed normocytic anemia, and an abdominal radiograph showed a metallic foreign body in the stomach, without evidence of obstruction. Endoscopy resulted in the...
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Oregon was the first state to mandate the addition of a bitter aversive agent to consumer automotive products containing > or = 10% ethylene glycol (EG) or > or = 4% methanol (MeOH). The 1995 Toxic Household Products statute required the addition of denatonium benzoate at a concentration of 30-50 ppm with the intent to reduce the frequency of serio...
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In 1845 the Franklin expedition left London with 2 ships and 134 men on board in an attempt to find the route through the Northwest Passage. The ships were built with state-of-the-art technology for their day, but provisioned with supplies from the lowest bidder. After taking on fresh provisions in the Whalefish Islands, off the coast of Greenland,...
Article
Pesticide-related illness should be reported by physicians to state health departments. Since poison centers (PC) are involved in the management of many of these cases, it may be assumed that they should report these cases. A 5-y audit of pesticide related illness reported to a centralized state pesticide oversight agency (PARC) was conducted. Duri...
Article
To evaluate the epidemiology of symptomatic human pesticide exposures using poison control center data and geographic information systems. All symptomatic human pesticide exposures reported to the poison center during the period from January 1 to December 31, 2000 were included for analysis using geographic information systems. A space-time scan st...
Article
The objective of this study was to evaluate pre-hospital triage of patients with an isolated brief loss of consciousness (LOC) to a regional trauma center (RTC). Data from a 6-month period were retrospectively reviewed from an existing pre-hospital data collection set. Patients were included if either they or a witness claimed a LOC, but they had r...
Article
We report the case of a pregnant woman with chronic lead toxicity and a blood lead of 57 microg/dL (2.7 micromol/L) who gave birth to a healthy-appearing neonate with a cord blood lead of 126 microg/dL (6.08 micromol/L). The mother was prescribed a single course of oral succimer late in the third trimester of pregnancy, without any appreciable chan...