Daniel L. Savitt

Delayed diagnosis of coin ingestion in children

Diagnosis of coin ingestion with esophageal impaction may be delayed if appropriate history is lacking. This delay may lead to mistreatment and complicate management. A series of illustrative cases are reported and relevant literature is reviewed. Guidelines for radiographic evaluation of potential ingestions are provided.

Use of Sodium Polystyrene Sulfonate for Reduction of Plasma Lithium Concentrations After Chronic Lithium Dosing in Mice

OBJECTIVES Previous studies have shown that oral sodium polystyrene sulfonate lowers plasma lithium concentrations after acutely administered oral doses of lithium chloride. However, a significant proportion of lithium overdose cases resulting in morbidity and mortality are those in which exposure to lithium is chronic. This study was designed to determine whether multiple oral doses of sodium polystyrene sulfonate are effective in reducing plasma lithium concentrations after chronic dosing. DESIGN Placebo-controlled animal study. INTERVENTIONS One hundred thirty mice were given 75 mM lithium chloride in their drinking water for a period of 14 days. At the end of that period, half of the animals were given orogastric sodium polystyrene sulfonate at 5 g/kg/dose 0, 60, 120, 180, and 360 minutes after the cessation of lithium chloride; the remaining half received orogastric water at equivalent times. Subgroups of each group were sacrificed at 90, 150, 330, 480, 1440, and 2880 minutes after lithium chloride cessation and plasma analyzed for lithium content. Lithium concentrations were compared by analysis of variance and single degree of freedom contrasts. Significance was set at an alpha level of 0.05. RESULTS Lithium concentration was lower overall in the animals treated with sodium polystyrene sulfonate (p < .0001) and specifically at 150, 330, and 480 minutes after lithium chloride cessation (p < .05). CONCLUSIONS Repetitive oral doses of sodium polystyrene sulfonate effectively lowered plasma lithium concentrations. Further study may ultimately define a role for the use of sodium polystyrene sulfonate in the treatment of patients with chronic lithium toxicity.

Traumatic aortic rupture: Delayed presentation with a normal chest radiograph

Traumatic aortic injury is a potentially fatal complication of blunt trauma. Patients with this entity may have a constellation of signs and symptoms and frequently have other significant injuries. The diagnosis is often suspected through abnormalities on the presenting chest radiograph. Delay in diagnosis results in increased morbidity and mortality. This report details the delayed presentation of an ambulatory patient with traumatic aortic rupture and a normal chest radiograph.

Direct effects of lithium chloride (LiCl) on cardiac function in the isolated, spontaneously beating rat heart. ♦ 353

Direct effects of lithium chloride (LiCl) on cardiac function in the isolated, spontaneously beating rat heart. ♦ 353

POTASSIUM (K + ) REPLETION FAILS TO INTERFERE WITH REDUCTION OF SERUM LITHIUM (Li) CONCENTRATIONS BY SODIUM POLYSTYRENE SULFONATE (SPS) IN MICE. • 287

POTASSIUM (K + ) REPLETION FAILS TO INTERFERE WITH REDUCTION OF SERUM LITHIUM (Li) CONCENTRATIONS BY SODIUM POLYSTYRENE SULFONATE (SPS) IN MICE. • 287