William Richard Smith

Ethchlorvynol (Placidyl⌖)-Induced Pulmonary Edema

Two patients experienced severe nonhemodynamic pulmonary edema following the intravenous injection of 25 and 40 mg/kg of body weight of ethchlorvynol (Placidyl). The pulmonary edema cleared rapidly. Injection of Placidyl (12 to 80 mg/kg of body weight) intravenously into dogs caused acute, severe, nonhemodynamic pulmonary edema (as evidenced by markedly elevated lung weights and microscopic evidence of intra-alveolar edema), hypotension with a relative bradycardia, and a decreased cardiac output. Injection of polyethylene glycol, the vehicle in which ethchlorvynol is diluted, did not reproduce the syndrome.

Paraquat poisoning: An analytical toxicologic study of three cases

Paraquat concentrations were measured in tissue, serum, urine and hemodialysate obtained from 3 patients who died 16.5 h, 22 days and 23 days after ingestion. In the patient who died 16.5 h post-ingestion, tissue paraquat levels were high. Kidney and liver had paraquat concentrations of 14 micrograms/g and 13.2 micrograms/g respectively, whereas lung tissue had a paraquat level of 3.8 micrograms/g. Low concentrations of paraquat were detectable in the tissues of the patients who died 22 and 23 days post-ingestion. Early in the poisoning, serum paraquat levels were high and large quantities of paraquat could be removed by both hemodialysis and forced diuresis. During an 8-h period, 713 mg of paraquat were removed by hemodialysis and 340 mg by forced diuresis. After the day of ingestion, little paraquat could be removed by hemodialysis or by forced diuresis; however, at all stages of the poisoning studied, hemodialysis was more effective than forced diuresis in removing paraquat from the blood.

Hemoglobinemia in heroin overdose patients.

Four heroin-overdosed patients presented with coma, elevated serum enzymes (creatine phosphokinase (CPK) and serum glutamic oxaloacetic transaminase (SGOT)), and increased levels of plasma free hemoglobin. In two patients marked myoglobinuria was also detected. The plasma free hemoglobin re-turned to normal levels by the 3rd hospital day. Since coma may eventuate in compression of muscles, we suggest that the disruption of erythrocytes occurs as they traverse these ischemic areas.