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Clinical Toxicology of Iron
Published in Debasis Bagchi, Manashi Bagchi, Metal Toxicology Handbook, 2020
Shilia Jacob Kurian, Sonal Sekhar Miraj, Ahmed Alshrief, Sreedharan Nair, Mahadev Rao
Decontamination: Gastric lavage could be performed with the largest tube available in a patient presenting with symptoms or an alleged history of Fe overdose. An abdominal radiograph should be obtained after the lavage to confirm that the tablets have been cleared if not, lavage should be repeated. The suitable lavage solutions are tap water or 0.9% saline. However, the use of gastric lavage in these patients is still under discussion, due to lack of evidence for its clinical benefit. Although it can be done in patients presenting within minutes of toxic amounts of Fe ingestion, the risk of perforations and aspirations are associated with this procedure (Madiwale and Liebelt 2006; Chang and Rangan 2011; Baranwal and Singhi 2003).
Eosinophilic pneumonia induced by drugs
Published in Philippe Camus, Edward C Rosenow, Drug-induced and Iatrogenic Respiratory Disease, 2010
Bronchoalveolar lavage is often performed to exclude infection or other lung diseases. Although bacterial pneumonias are not associated with increases in either blood or BAL eosinophil counts, such increases can be seen in the setting of pneumonia if the patient has a coexistent drug allergy, for example to an antibiotic. In the intensive-care unit, the differentiation between drug-induced lung disease and nosocomial pneumonia can be particularly vexing since allergy to drugs prescribed in the unit can develop coincident with pulmonary infiltrates for a variety of other reasons, including pneumonia. BAL can also be useful to help exclude fungal or parasitic infection as a cause of pulmonary eosinophilia.
Pesticide exposure and poisoning in Brazil: Outcome severity, clinical manifestations and management of cases reported to a poison control center
Published in Archives of Environmental & Occupational Health, 2023
Josefa Cristina Pereira dos Santos, Joanina Bicalho Valli, Nixon Souza Sesse, Sarah Mackenzie Ross, Eliana Zandonade, Lorena Rocha Ayres, Karla Nívea Sampaio
The current study found gastric lavage was frequently performed in the initial treatment period. Yet, this measure was seldom recommended by the Poison center, which prioritized clinical observation, symptomatic treatment, and the use of activated charcoal. It was not possible to compare treatment measures adopted in the same patient because, for some cases, treatment history was not followed up, particularly in cases where exposure was nontoxic. It is clearly stated in best practices of clinical management of poisoned patients that gastric lavage should not be routinely employed because there are risks associated with this procedure that may complicate the patient’s condition.9,10,12,14,15 In fact, it has been well described that this procedure can significantly increase the hazard in pesticide poisoned patients.12 Additionally, gastric lavage is not recommended when the time from ingestion exceeds 60 min.9,10,12,14,15 Evidence shows that the time it takes for the patient to present to a treatment facility often exceeds this time window.18,51 Therefore, the high frequency of use of gastric lavage observed in the initial assistance offered to cases and the high frequency of nontoxic cases strongly suggests this procedure was unnecessary in many cases.
Hazardous dusts from the fabrication of countertop: a review
Published in Archives of Environmental & Occupational Health, 2023
W. Kyle Mandler, Chaolong Qi, Yong Qian
Our group has investigated the potential for toxicity of the emissions from sawing SSC.18,19 To characterize the acute toxicity and particle clearance, male mice were exposed to either phosphate buffer saline (PBS, negative control), 62.5, 125, 250, 500, or 1000 µg of SSC particles or 1000 µg crystalline silica (Min-U-Sil 5; US Silica Company, Berkeley Springs, West Virginia, positive control) via oropharyngeal aspiration. Body weights were measured for the duration of the study. Bronchoalveolar lavage fluid (BALF) and tissues were collected for analysis at 1- and 14-days post-exposure. Enhanced-darkfield and histopathologic analysis was performed to assess particle distribution and inflammatory responses. BALF cells and inflammatory cytokines were measured. The geometric mean diameter of the particles from sawing SSC following suspension in PBS was 1.25 µm. BALF analysis indicated that lactate dehydrogenase (LDH) activity, inflammatory cells, and pro-inflammatory cytokines were significantly elevated in the 500 and 1000 µg SSC particles exposure groups at days 1 and 14, suggesting that exposure to these concentrations of SSC particles induced inflammatory responses. Histopathology indicated the presence of acute alveolitis at all doses at day 1, which was largely resolved by day 14. Alveolar particle deposition and granulomatous mass formation were observed in all exposure groups at day 14. The SSC particles were poorly cleared, with 81% remaining at the end of the observation period.
Hypersensitivity pneumonitis in a slaughterhouse worker: A case report
Published in Archives of Environmental & Occupational Health, 2022
Elena Vasileiou, Paschalis Ntolios, Paschalis Steiropoulos, Theodoros Constantinidis, Evangelia Nena
Pulmonary Function Tests (PFTs) were performed according to the 2019 ATS/ERS statement on standardization of spirometry4 and revealed a restrictive respiratory disorder (Forced Vital Capacity – FVC: 60% predicted; Total Lung Capacity – TLC: 63% predicted; Diffusion Capacity for Carbon Monoxide – DLCO: 50% predicted). Six-minute walking test (6MWT) distance walked was 460 m (75.06% of predicted distance of 612.8 m). Chest High-Resolution Computed Tomography (HRCT) was typical for HP, demonstrating bilateral, sub-pleural reticular opacities, ground glass opacities and areas of decreased attenuation, representing air trapping. There was no zonal predominance of the distribution of these lesions.5 Honeycombing was absent. (Figure 1).6 All serologic tests were negative for auto-immune disorders. An extended panel for specific IgG antibody testing of most common antigens, including Aspergillus fumigatus, Micropolyspora faeni, Thermoactinomyces vulgaris was negative. A bronchoscopy with Bronchoalveolar Lavage (BAL) was performed and BAL fluid analysis demonstrated a lymphocyte predominance (60%).