Alexander B. Baer

Massive Caffeine Overdose Requiring Vasopressin Infusion and Hemodialysis

Abstract Introduction. Massive caffeine overdose is associated with life‐threatening hemodynamic complications that present challenges for clinicians. We describe the highest‐reported serum concentration of caffeine in a patient who survived and discuss the first‐reported use of vasopressin and hemodialysis in a caffeine‐poisoned patient. Case Report. A 41‐yr‐old woman presented 3 h after ingesting approximately 50 g of caffeine. She subsequently underwent cardiopulmonary resuscitation and received multiple medications in an attempt to raise her blood pressure and control her heart rate without success. Vasopressin infusion increased her blood pressure to the point where hemodialysis could be performed. Despite ensuing multisystem organ failure, she survived and has made a complete recovery. Conclusion. Hemodialysis and vasopressin infusions may be of benefit in the management of caffeine‐intoxicated patients who fail to respond to standard therapies.

Analysis of Moonshine for Contaminants

Objectives: In the past, some moonshine products contained potentially toxic contaminants. Although moonshine production continues in the United States, no studies have analyzed the content of moonshine since the early 1960s. We hypothesize that moonshine continues to contain potentially toxic concentrations of contaminants. Methods: Forty‐eight samples of illicitly distilled moonshine were obtained from law enforcement agencies. An independent laboratory, blinded to both the moonshine source and a control sample of ethanol, conducted the analysis. Lead content was determined using atomic absorption spectrophotometry with a graphite tube atomizer. Alcohol content, including ethanol, acetone, isopropanol, methanol, and ethylene glycol, was determined using gas liquid chromatography with flame ionization detection. Results: Ethanol content ranged from 10.5% to 66.0% with a mean value of 41.2%. Lead was found in measurable quantities in 43 of 48 samples with values ranging from 5 to 599 parts per billion (ppb) with a mean value of 80.7 ppb. A total of 29 of 48 (60%) of samples contained lead concentrations above or equal to the EPA water guideline of 15 ppb. Methanol was found in only one sample at a concentration of 0.11%. No samples contained detectable concentrations of acetone, isopropanol, or ethylene glycol. Conclusions: Many moonshine samples contain detectable concentrations of lead. Extrapolations based on the described moonshine lead content suggest that chronic consumers of moonshine may develop elevated lead concentrations. Physicians should consider lead toxicity in the differential diagnosis when evaluating patients consuming moonshine.

Visual Diagnosis in Emergency and Critical Care Medicine: Holstege/Visual Diagnosis in Emergency and Critical Care Medicine

Visual diagnosis in emergency and critical care medicine / , Visual diagnosis in emergency and critical care medicine / , کتابخانه دیجیتال جندی شاپور اهواز

Visual Diagnosis in Emergency and Critical Care Medicine: Holstege/Visual

IT IS said that a picture is worth a thousand words and the proverb is endorsed by this lavishly produced book. It presents illustrations of 101 cases, ranging from a neonate with fever and rash to an older woman with groin swelling, to represent the range of patients who may present at an emergency department (ED).