Laura M Tormoehlen

Indiana University-Purdue University School of Medicine, Indianapolis, Indiana, United States

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Publications (11)24 Total impact

  • Kristyn Tekulve · Andreia Alexander · Laura Tormoehlen
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    ABSTRACT: Background Synthetic cathinones or “bath salts” are an increasing problem in the United States. Their adverse effects are related to sympathomimetic toxicity and seizures have been listed among the side effects. This study details the seizures that occur following synthetic cathinone exposure in the adolescent population. Methods We used the American Association of Poison Control Centers database to capture all known synthetic cathinone exposures in children less than 20 years of age from January 1, 2010 through January 31, 2013. Demographic data along with symptoms of fever, acidosis, hallucinations/delusions, hypertension, tachycardia, electrolyte abnormalities, and co-ingested substances were collected for all synthetic cathinone users and compared to those users who experienced seizure activity. Results Over the specified time period, there were 1328 adolescent synthetic cathinone exposures. Seizures complicated 73 (5.5%) of the cases, with 37 (50.7%) of those cases experiencing a single seizure, 29 (39.7%) multiple seizures, and 7 (9.6%) status epilepticus. Fever and acidosis were associated with single seizures, multiple seizures, and status epilepticus. There was no correlation found between any seizure activity and electrolyte abnormalities, hallucinations/delusions, tachycardia, or hypertension. Co-ingestants were present in 33 (45%) of the seizure cases. The most commonly co-ingested substances were tetrahydrocannabinol, alcohol, and opioids. Conclusions Seizures complicated 5.5% of synthetic cathinone exposures in the adolescent population. Fever and acidosis were associated with seizure activity. The presence of fever following a synthetic cathinone exposure may warrant more aggressive monitoring and treatment.
    No preview · Article · Jul 2014 · Pediatric Neurology
  • L M Tormoehlen · K J Tekulve · K A Nañagas
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    ABSTRACT: Abstract Context. Clinical effects of hydrocarbon exposure have been reported since 1897. These substances are ubiquitous, and their exposures are common. The specific hydrocarbon and route of exposure will determine the clinical effect, and an understanding of this is helpful in the care of the hydrocarbon-exposed patient. Objective. To complete a comprehensive review of the literature on hydrocarbon toxicity and summarize the findings. Methods. Relevant literature was identified through searches of Medline (PubMed/OVID) and Cochrane Library databases (inclusive of years 1975-2013), as well as from multiple toxicology textbooks. Bibliographies of the identified articles were also reviewed. Search terms included combinations of the following: hydrocarbons, inhalants, encephalopathy, coma, cognitive deficits, inhalant abuse, huffing, sudden sniffing death, toluene, renal tubular acidosis, metabolic acidosis, arrhythmia, dermatitis, and aspiration pneumonitis. All pertinent clinical trials, observational studies, and case reports relevant to hydrocarbon exposure and published in English were reviewed. Chronic, occupational hydrocarbon toxicity was not included. Results. Exposure to hydrocarbons occurs through one of the following routes: inhalation, ingestion with or without aspiration, or dermal exposure. Inhalational abuse is associated with central nervous system depression, metabolic acidosis, and arrhythmia. The exact mechanism of the CNS depression is unknown, but experimental evidence suggests effects on NMDA, dopamine, and GABA receptors. Chronic toluene inhalation causes a non-anion gap metabolic acidosis associated with hypokalemia. Halogenated hydrocarbon abuse can cause a fatal malignant arrhythmia, termed "sudden sniffing death". Individuals who regularly abuse hydrocarbons are more likely to be polysubstance users, exhibit criminal or violent behavior, and develop memory and other cognitive deficits. Heavy, long-term use results in cerebellar dysfunction, encephalopathy, weakness, and dementia. Neuroimaging may demonstrate leukoencephalopathy in these cases. Acute exposures improve with cessation of exposure. Electrolyte and fluid replacement will improve metabolic acidosis. Arrhythmias are precipitated via catecholamine surge, and beta blockers are presumed protective. Aspiration of hydrocarbons causes a potentially fatal pneumonitis. Symptoms may include cough, wheezing respiratory distress, and hypoxia. Bilateral interstitial infiltrates may be delayed for several hours after the development of pneumonitis. Treatment consists of supportive care, supplemental oxygen, and may require intubation and admission to an intensive care unit in severe cases. Unfortunately, aspiration pneumonitis remains a leading cause of poisoning mortality in children. Dermal exposure can cause dermatitis, chemical burns, and defatting injury. Oral exposure can cause local irritation as well as vomiting, diarrhea, and abdominal pain. Conclusion. Acute hydrocarbon exposure can result in a wide array of pathology, such as encephalopathy, pneumonitis, arrhythmia, acidosis, and dermatitis. Intentional inhalational and accidental ingestion exposures with aspiration lead to the greatest morbidity and mortality.
    No preview · Article · Jun 2014 · Clinical Toxicology
  • L. M. Tormoehlen · N. Kumar
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    ABSTRACT: Neurotoxic disease can mimicmany common neurologic disease states, including parkinsonism, myelopathy, neuropathy, and encephalopathy. Accurate diagnosis and appropriate treatment may result in a favorable outcome. This review highlights 5 areas of neurotoxicology for which there is an emerging understanding of disease processes or patterns of exposure, including 3 specific metal toxicities (manganism, zinc-induced copper deficiency, and cobaltchromium neuropathy). Toxin-induced posterior reversible encephalopathy syndrome is more widely recognized and reported in association with an evergrowing list of drugs. Two new categories of street drugs, synthetic cathinones and cannabinoids, have been identified as public health threats due to their popularity, availability, and severity of toxicity.
    No preview · Article · Dec 2012 · Neurology: Clinical Practice (Print)
  • Rohit R Das · Kristyn J Tekulve · Atul Agarwal · Laura M Tormoehlen
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    ABSTRACT: Neurocysticercosis is one of the most common infections of the central nervous system in the developing world. Most often, neurocysticerci are found in the brain parenchyma, at the gray-white matter junction. A rare form of neurocysticercosis is the development of cysts at the basal subarachnoid region, termed racemose neurocysticercosis.
    No preview · Article · Nov 2012 · Seminars in Neurology
  • Joseph Turner · Laura Tormoehlen · Louise Kao

    No preview · Article · Aug 2012 · Clinical Toxicology
  • Kristine A Nañagas · Laura M Tormoehlen
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    ABSTRACT: Urine testing for heavy metal concentrations is increasingly performed in the outpatient setting as a part of laboratory evaluation for neuropathy. Abnormal urine arsenic levels due to dietary intake of organic arsenic can lead to unnecessary chelation therapy. A 54-year-old man underwent a 24-hour urine collection for heavy metal concentrations in evaluation of paresthesia of the right foot. The total arsenic level was 8880 μg/d with concentrations of 4749 μg/L and 3769 μg/g creatinine. He was urgently referred to the toxicology clinic for consideration of chelation therapy. History revealed consumption of 2 lobster tails 5 days before the testing. Speciation was then performed on the original urine specimen and revealed an organic arsenic concentration of 4332 μg/L. No inorganic or methylated arsenic was detected. Repeat testing after abstaining from seafood demonstrated a total arsenic level of 50 μg/d with concentrations of 30 μg/L and 21 μg/g creatinine. Our patient demonstrates the highest level of arsenobetaine reported in the literature, and this level is higher than expected for a person who had not consumed seafood for 5 days before testing. The high levels may be due to consumption of food that he did not recognize as containing arsenobetaine or that his clearance of arsenobetaine from the ingested lobster is slower than published ranges. This case demonstrates the importance of speciation when measuring urine arsenic levels to avoid unnecessary chelation therapy.
    No preview · Article · Mar 2012 · American journal of therapeutics
  • Ross Sullivan · Michael J Hodgman · Louise Kao · Laura M Tormoehlen
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    ABSTRACT: Brain death guidelines should be used with caution in patients with drug intoxication. It is often suggested that physicians use five half-lives of a drug when observing a patient with an overdose. We report two cases of baclofen intoxication where brain death was entertained as an explanation for prolonged coma, with arousal seen days later, suggesting that routine use of a 5-half-life observation period is insufficient with baclofen intoxication. A 40-year-old woman was found unresponsive by her family. Baclofen was found to be the responsible overdose. The patient had absent brain stem reflexes and was intubated and in the ICU for several days. Although EEG and Apnea test were inconclusive, the patient was thought to be brain dead and organ procurement was arranged. On hospital day 5, the patient started having purposeful movements. The patient had progressive arousal and was eventually transferred without neurologic sequelae to psychiatry. The second patient also had a massive baclofen overdose, had absence of almost all brain stem reflexes and was also intubated and in the ICU. Brain death was felt to be imminent, but the patient began to awake on hospital day 7. Our two cases suggest that baclofen intoxication may result in very prolonged and profound coma and may, in fact, mimic brain death. Conclusion. The determination of brain death in the comatose overdose patient must proceed with caution. An adequate period of time to allow drug clearance must be allowed.
    No preview · Article · Feb 2012 · Clinical Toxicology
  • Josh Mugele · Kristine A Nañagas · Laura M Tormoehlen
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    ABSTRACT: Serotonin syndrome is associated with use of certain street drugs, including methamphetamine, cocaine, and ecstasy. We describe a case of a woman who developed clinical findings consistent with serotonin syndrome after insufflation of 3,4-methylenedioxypyrovalerone (MDPV), a synthetic amphetamine. MDPV belongs to a group of substances called phenylethylamines, which are β-ketone analogs of other drugs of abuse, such as amphetamines and 3,4-methylenedioxymethamphetamine. She also received fentanyl initially during her hospitalization, which has also been associated with serotonin syndrome. In addition to benzodiazepines and supportive care, she was treated with cyproheptadine for 8 days, with slow resolution of her symptoms.
    No preview · Article · Jan 2012 · Annals of emergency medicine
  • Laura M. Tormoehlen
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    ABSTRACT: Exposure to pharmaceutical, occupational, or environmental toxins may cause or increase the risk of certain neurological emergencies. Early identification of the exposure and the toxin can be instrumental in the diagnosis and management of toxin-induced neurological emergencies. This chapter reviews the toxins associated with hyperthermic syndromes, ischemic and hemorrhagic stroke, seizures and status epilepticus, weakness, and acute encephalopathy.
    No preview · Chapter · Jan 2012
  • Laura M Tormoehlen
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    ABSTRACT: Leukoencephalopathy is a syndrome of neurologic deficits, including alteration of mental status, caused by pathologic changes in the cerebral white matter. The term, toxic leukoencephalopathy, encompasses a wide variety of exposures and clinical presentations. The diagnosis in these syndromes is made by careful attention to the history, clinical features, and radiologic findings. This article details three of the best-defined toxic leukoencephalopathies: delayed posthypoxic leukoencephalopathy, including delayed neurologic sequelae after carbon monoxide poisoning; heroin inhalation leukoencephalopathy; and posterior reversible encephalopathy syndrome.
    No preview · Article · Aug 2011 · Neurologic Clinics
  • Laura M Tormoehlen · James B Mowry · Jeffrey D Bodle · Daniel E Rusyniak
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    ABSTRACT: Adolescents are at risk to abuse opioid analgesics for many reasons, including inaccurate perception of risk and increased drug availability. In 2000, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) released pain management standards that emphasized pain control as a patient rights issue. This focus on analgesia may have increased both the prescribing and use of opioid analgesics, thereby increasing availability. Using data from a US poison center, this study aims to compare the number of adolescent opioid cases and their outcome severity before and after the 2000 JCAHO pain initiative. Retrospective case series of opioid exposures involving persons 12-18 years of age reported to a US poison center from 1994 to 2007. The main outcome measure was the number of adolescent opioid cases reported for 1994-2000 compared to 2001-2007. Secondary outcomes included outcome severity, number of cases involving specific opioids, and correlation between the number of cases and the amount of opioids distributed to the state. There were 1634 adolescent opioid-related cases with 187 cases developing medical complications. Compared with 1994-2000, the rate ratio of cases involving adolescents and opioid analgesics for the years 2001-2007 was 1.69 (95% CI: 1.53, 1.86), and these cases were 2.84 (95% CI: 2.06, 3.91) times more likely to have had medical complications. Medical complications involving methadone (p =0.001) increased after the JCAHO initiative, while complications related to codeine (p =0.001) and propoxyphene (p =0.030) decreased. There were 15 deaths in 2001-2007 and none in 1994-2000 (p =0.012). Lastly, there was a correlation between the rate of adolescent opioid cases and the amount of opioids distributed to the state (r(2) =0.90; p < 0.001). In the 7 years following the JCAHO pain standards, there was an increase in the number and severity of adolescent opioid-related poison center cases. The increase correlates with statewide availability of opioids. These data may prove useful in drug education and prevention programs targeting adolescents.
    No preview · Article · Jul 2011 · Clinical Toxicology
  • Laura M Tormoehlen · Robert M Pascuzzi
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    ABSTRACT: The relationship between myasthenia gravis and thymic pathology, including thymoma, is well known. Approximately 10% to 15% of patients who have myasthenia gravis are observed to have a thymoma. Myasthenia gravis may be considered as the most common of the paraneoplastic syndromes in patients who have thymoma. This article summarizes the clinical aspects of myasthenia gravis, followed by a review of the less often recognized paraneoplastic disorders noted to occur in patients who have thymoma.
    No preview · Article · Jul 2008 · Hematology/Oncology Clinics of North America

Publication Stats

166 Citations
24.00 Total Impact Points


  • 2012-2014
    • Indiana University-Purdue University School of Medicine
      • Emergency Medicine
      Indianapolis, Indiana, United States
  • 2008-2014
    • Indiana University-Purdue University Indianapolis
      • • Department of Medicine
      • • Department of Emergency Medicine
      • • Department of Neurology
      Indianapolis, Indiana, United States