Kenneth Kulig's research while affiliated with Boston Medical Center and other places

Publications (91)

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Significant advances in diagnosis and management of tricyclic antidepressant overdose have occurred in recent years. This article reviews epidemiologic, pharmacologic, and therapeutic information to provide a systematic approach to these potentially life-threatening overdoses. The tricyclics are discussed as a group, with individual drugs specified...
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This study compares the clinical course of tricyclic antidepressant and fluoxetine overdose. The study was a prospective case series of 9 urban hospital systems. Consecutive sampling of overdose patients presenting to emergency departments provided the participants for the study. The therapy was determined by each institution. Clinical, laboratory,...
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Despite demonstrated differences in toxicity profiles between tricyclic antidepressants (TCAs) and selective serotonin (5-hydroxytryptamine; S-HT) reuptake inhibitors (SSRIs), no studies have examined hospital costs associated with acute antidepressant overdoses. Given the high incidence of such overdoses, it is important to examine treatment patte...
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Police departments, in conjunction with the National Highway Traffic Safety Administration, have developed a standardized evaluation aimed at identifying drivers impaired by drugs other than ethanol. These evaluations are performed by specially trained police officers known as Drug Recognition Experts. We retrospectively reviewed the evaluations of...
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The aim of this study was to determine if cimetidine in addition to N-acetylcysteine and standard supportive care provide additional hepatoprotection following acute acetaminophen poisoning. It was designed as a prospective study with alternate month treatment protocol, and the work was carried out at a regional certified poison information centre....
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To compare topical preparations of magnesium and calcium in the treatment of dermal hydrofluoric acid burns. A randomized, blinded, controlled animal model study. Animal care facility. New Zealand rabbits. Each rabbit was burned with hydrofluoric acid at four sites along the thoracolumbar spine. Equimolar amounts of calcium gluconate, magnesium glu...
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To study the effectiveness of activated charcoal in preventing toxicity after an enterally administered cocaine hydrochloride overdose in mice. A prospective, randomized, controlled animal laboratory investigation. Fasted mice were given aqueous cocaine hydrochloride (0.8% final concentration) 100 mg/kg body weight orally by gavage tube. One minute...
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To determine if sodium polystyrene sulfonate prevents absorption of lithium in human beings. Prospective, crossover study. Healthy volunteers age 22 to 34 years (three women and three men). After an eight-hour fast, subjects ingested 0.5 mEq/kg (18.5 mg/kg) lithium carbonate. One hour later, they ingested either 857 mg/kg sodium polystyrene sulfona...
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This article has no abstract; the first 100 words appear below. THE total number of patients who present at emergency departments because of drug overdose is difficult to ascertain, but in many facilities it is inordinately high. In one urban hospital, for example, overdoses and other drug-related emergencies are responsible for 38 percent of visit...
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Although activated charcoal (AC) is commonly used after ingestions of cocaine, the ability of AC to bind with this drug is unknown. We studied binding of cocaine to AC in vitro. Cocaine adsorption to charcoal for AC:drug ratios of 1:1, 2.5:1, and 5:1 at pH 1.2 was 40%, 92%, and 99%, respectively; at pH 8.0, it was 78%, 98%, and 99%, respectively. A...
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The inadvertent administration of a concentrated vancomycin solution to a 47 day-old premature male twin resulted in extremely high vancomycin levels and altered renal function. A 1.5 volume exchange transfusion did not change the measured vancomycin level. Multiple doses of oral activated charcoal, 1 g/kg, were administered beginning 5 h after the...
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We present two cases of severe headache associated with the use of bromocriptine for lactation suppression in otherwise healthy women. In each case, the additional use of a therapeutic sympathomimetic agent resulted in extreme worsening of symptoms with development of hypertension and life-threatening complications (ventricular tachycardia and card...
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To determine the safety and efficacy of a 48-hour IV N-acetylcysteine (IV NAC) treatment protocol for acute acetaminophen overdose. Nonrandomized trial open to all eligible patients. Multicenter; hospitals included moderate- and high-volume private, university, and municipal hospitals in urban and suburban settings. Two hundred twenty-three patient...
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To determine if and to what extent the total iron-binding capacity (TIBC) would increase following an iron overload, and to identify specific iron-binding proteins that might be responsible for the increased TIBC. A prospective laboratory investigation. A certified regional poison control center. Six healthy adult male volunteers. All volunteers in...
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The alcoholic patient, in an attempt to maintain an altered mental status, may ingest ethanol substitutes containing methanol, ethylene glycol, or isopropanol. The subsequent clinical presentation in the Emergency Department is highly variable and depends on the ethanol substitute ingested, the time since ingestion, and concomitant ethanol abuse. T...
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A 16-year-old boy ingested approximately 50 zinc sulfate tablets (ZnSO4; 500-mg tablets). After spontaneous emesis, ipecac-induced emesis, and orogastric lavage, an abdominal radiograph performed four hours after ingestion still demonstrated approximately 50 ZnSO4 tablets within the stomach and three pills within the colon. Whole-bowel irrigation w...
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Countermeasures to alcohol-related trauma are essential. The public perception that there is low risk of detection and punishment for alcohol-precipitated violence is being addressed.⁵⁷ Current legislation is aimed at decreasing the availability of alcohol (e.g., adjusting legal drinking age, decreasing the serum alcohol intoxication limit, restric...
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Isoniazid overdose is known to result in the rapid onset of seizures, metabolic acidosis, and prolonged obtundation. Pyridoxine has been reported to be effective in treating isoniazid-induced seizures. We report three cases of obtundation secondary to isoniazid overdose that was immediately reversed by intravenous pyridoxine. In two of these cases,...
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Although formalin ingestions have previously been reported in the literature, technology has only recently been developed to measure both formaldehyde and formate levels in plasma. Methanol, formaldehyde, and formate levels were followed in the case reported here until the patient's death approximately 13 h after the ingestion. The clinical course...
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The use of flumazenil, a benzodiazepine antagonist, was studied in two patients with coma of unknown etiology. One patient ingested 20.5 mg alprazolam before crashing his truck into parked automobiles. The patient was awakened by flumazenil administration, and the severity of his injuries was evaluated reliably. A second patient ingested 7.5 mg tri...
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This prospective study was undertaken to determine the incidence, severity, time of onset, and duration of coagulopathy in children following accidental ingestion of long-acting anticoagulant rodenticides, often called "superwarfarins." Of 110 children, who ingested superwarfarins and in whom one or more prothrombin time values were obtained, 8 had...
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During a nationwide acetaminophen overdose study conducted at the Rocky Mountain Poison and Drug Center from 1976-1985, 113 patients entered into the study were reported to be pregnant at the time of the overdose. Follow-up, including appropriate laboratory and pregnancy outcome data, was available in 60 cases. Of these, 19 women overdosed during t...
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A 78 year old man was found comatose, apneic, and asystolic after closed-space smoke inhalation. He was successfully resuscitated to pulse and blood pressure at the scene. A cyanide component to the poisoning was suspected and two 300 mg doses of sodium nitrite were administered, resulting in significant hypotension. Although high methemoglobin lev...
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During the investigational use of oral N-acetylcysteine as an antidote for poisoning with acetaminophen, 11,195 cases of suspected acetaminophen overdose were reported. We describe the outcomes of 2540 patients with acetaminophen ingestions treated with a loading dose of 140 mg of oral N-acetylcysteine per kilogram of body weight, followed four hou...
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In Reply. — We thank Drs Morgan and Jones for their comments. Lisinopril (Zestril) had not been approved by the Food and Drug Administration at the time of submission of our manuscript to JAMA and was therefore not included in the list of approved angiotensin converting enzyme inhibitors. Dr Jones is correct in that this case was unusual, and that...
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A 22-month-old, 10 kg child ingested 32 mg of chlorambucil and developed irritability, myoclonic-like muscle jerks, an exaggerated startle reflex, vomiting, and EEG changes within a few hours. The neurologic symptoms improved overnight, and the patient was discharged at about 28 hours postingestion. During the three weeks of follow-up, mild bone ma...
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To the Editor.— The current (11th) edition of the Harriet Lane Handbook contains several serious errors we wish to bring to your attention. These are (1) an incorrect and inadequate 24-hour oral dosage regimen for which there is no scientific basis, (2) a dangerous recommendation for administering oral Mucomyst intravenously, (3) a suboptimal intra...
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We present a case in which a patient took an overdose of captopril (Capoten) and alprazolam (Xanax) in a suicide attempt. The patient presented with hypotension (systolic blood pressure of 80 mm Hg) and drowsiness. The hypotension initially responded to administration of intravenous fluids and dopamine; however, it recurred twice at 18.5 and 24.5 h...
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Of 61 cases of ibuprofen overdosage reported consecutively to the Rocky Mountain Poison and Drug Center from September 1985 through April 1986, 16 were excluded because of incomplete follow-up or concurrent medication ingestion. A toxic reaction developed in 7 (16%) of the remaining 45 patients. Nausea, vomiting, abdominal cramps, mild central nerv...
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Colognes, perfumes, and after-shaves containing ethyl alcohol (ethanol) are frequently ingested by children. These products may contain from 50% to 99% ethanol. To determine if ingestion of colognes, perfumes, or after-shaves by children results in serious ethanol toxic reactions, this retrospective study was performed. One hundred twenty-three cas...
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Despite debate over their efficacy, magnesium-containing cathartics are widely used in the care of poisoned and over-dosed patients. Until recently, such patients generally received only a single dose of cathartic early in the course of their management. There have been no reported cases of hypermagnesemia in patients with normal renal function aft...
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To determine the effect on serum Mg++ levels of oral Magnesium-containing cathartics (MgCC) used in the treatment of suspected drug overdose, a prospective, non-randomized study of 24 cases of suspected drug overdose was conducted. Ten cases admitted to the observation unit were assigned to the single dose MgCC group. Fourteen cases admitted to eit...
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A prospective review of 51 cases of tobacco ingestion and 5 cases of nicotine resin chewing gum exposure was conducted to evaluate the incidence and degree of toxicity caused by these products in children. A dose-response relationship was observed for cigarette exposures. Nine of 10 children ingesting more than one cigarette or three cigarette butt...
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Forty-one children, aged 1 to 5 years, who accidentally ingested levothyroxine sodium were studied. Symptoms possibly associated with the ingestion occurred in 11 patients (27%). These symptoms (tachycardia, hyperactive behavior, fever, vomiting, diarrhea, diaphoresis, and flushing) were categorized as minor and all resolved without treatment. Beca...
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Large overdoses of IV theophylline (50 to 100 mg/kg) were administered to five canines on two separate occasions. On day one, with no charcoal administered, theophylline levels were serially obtained between ten minutes and 12 hours after infusion and the animals were recovered from anesthesia. Three days later the same dose of theophylline was adm...
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A 19-year-old man with a history of intravenous cocaine and amphetamine abuse injected 1.1 mg of epinephrine intravenously from an over-the-counter bronchodilator inhaler. Within seconds, headache, nausea, numbness of hands and feet, precordial chest discomfort, and palpitations developed. The patient was given a sublingual nitroglycerin tablet by...
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A 34 year old, 73 kg man ingested a 1 gram potassium cyanide pellet in a suicide attempt. Within one hour, coma, apnea, metabolic acidosis, and seizures developed. Sodium nitrite and sodium thiosulfate were administered. Dramatic improvement in the clinical condition occurred by the completion of antidote infusion. Methemoglobin level was 2% immedi...
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Two cases of acute blindness due to quinine poisoning are presented. In both cases, the diagnosis was initially unsuspected. In addition, tinnitus, decreased hearing, vomiting, abdominal pain, and confusion were noted in one patient, and the other experienced decreased hearing, headache, confusion, tachycardia, later bradycardia, and first-degree a...
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Methaemoglobin is haemoglobin with the iron oxidised to the ferric (Fe ) state from the normal (or reduced) ferrous (Fe++) state. Methaemoglobinaemia refers to the presence of greater than the normal physiological concentration of 1 to 2% methaemoglobin in erythrocytes. Methaemoglobin is incapable of transporting oxygen. It has an intense dark blue...
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In this study of ibuprofen overdose, symptoms developed in 19% of patients (24 of 126)--in 7% of children (6 of 88) and in 47% of adults (18 of 38). Central nervous system depression, seizures, gastrointestinal disturbances, bradycardia, hypotension, apnea, abnormal renal functions, hematuria, nystagmus, and blurred vision were observed. No patient...
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A 4-year-old child ingested laetrile and almost died of cyanide poisoning. Treatment with the Lilly cyanide antidote kit resulted in rapid, complete recovery. Extremely high whole blood cyanide levels were documented. The necessity for use of the antidote kit in serious cyanide poisoning has recently been questioned. This case demonstrates benefit...
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Hydrogen sulfide poisoning from inhalation of roofing asphalt fumes is a rare but devastating injury. Two cases of toxic inhalation involving exposure to several gases, including hydrogen sulfide, evolved from cooling asphalt, are presented. Both victims were treated with supportive measures, including 100% normobaric oxygen, and one also received...
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Methaemoglobin is haemoglobin with the iron oxidised to the ferric (Fe+++) state from the normal (or reduced) ferrous (Fe++) state. Methaemoglobinaemia refers to the presence of greater than the normal physiological concentration of 1 to 2% methaemoglobin in erythrocytes. Methaemoglobin is incapable of transporting oxygen. It has an intense dark bl...
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A 19-yr-old man ingested 25 g of acetaminophen in a suicide attempt. Twenty-one hours after the ingestion the plasma acetaminophen level was potentially hepatoxic at 62 micrograms/ml. The toxicology screen was negative for all other drugs. Thirty-six hours after admission the patient developed an acute abdomen with a serum amylase of 1500 IU. Perit...
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Four patients with elevated serum boric acid levels after single, acute ingestions of 10 to 297 grams were reported to the Rocky Mountain Poison and Drug Center (RMPDC) between January 1983 and August 1985. Systemic effects were absent. In 1983-4, 364 cases of boric acid exposure were reported to the RMPDC with only one fatality from a probable chr...
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To the Editor.— In reviewing recent publications on hyperosmolality in infants due to the excipient propylene glycol, we detected a major discrepancy between formulas for estimating the propylene glycol plasma level from the osmol gap as presented by Glasgow et al1 and by Fligner et al.2 Both detail similar propylene glycol apparent half-lives (Gla...
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During an 18-month period, 592 acute oral drug overdose patients were studied prospectively in a controlled, randomized fashion to determine the efficacy of gastric emptying procedures in altering clinical outcome. Patients presenting on even-numbered days had no gastric emptying procedures performed, and they were compared to patients presenting o...
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We describe the cases of two patients with guanabenz overdose who developed lethargy, bradycardia, and hypotension. The first patient described here recovered after only fluid administration. The second responded to therapy with small doses of atropine and dopamine. Naloxone had little effect in either patient but should be administered to any pati...
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In order to develop a rapid, simple test to differentiate toxic naphthalene from the less toxic mothball ingredient paradichlorobenzene, both types of mothballs were dissolved in isopropyl alcohol, ethanol, methanol, and turpentine. Twenty-five naphthalene and 25 paradichlorobenzene mothballs were weighed, randomly grouped, and then dissolved in th...
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Ivermectin is a veterinary antiparasitic medication for domestic animals. Two cases of human exposure to veterinary preparations of ivermectin are reported. Patient number one accidentally self-injected ivermectin and developed nausea, pallor, and transient pain and numbness in the affected extremity. Patient number two, a 4-year-old child, ingeste...
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Intentional overdosage of copper salts is seen infrequently in the U.S., but is fairly common in other countries (1). Toxic blood levels can be seen after oral ingestion of as little as one gram of copper sulfate in an adult (2). We report a case of a patient who ingested 250 grams of copper sulfate, developed transient hepatic dysfunction, and rec...