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Current Issues

Emergency Medicine Practice

Toxic Alcohol Ingestion: Prompt Recognition And Management In The Emergency Department (Critical Care Topic)

Abstract:
Emergency Medicine PracticeIdentifying patients with potential toxic alcohol exposure and initiating appropriate management is critical to avoid significant patient morbidity. Sources of toxic alcohol exposure include ethylene glycol, methanol, diethylene glycol, propylene glycol, and isopropanol. Treatment considerations include the antidotes fomepizole and ethanol, and hemodialysis for removal of the parent compound and its toxic metabolites. Additional interventions include adjunctive therapies that may improve acidosis and enhance clearance of the toxic alcohol or metabolites. This issue reviews common sources of alcohol exposure, basic mechanisms of toxicity, physical examination and laboratory findings that may guide rapid assessment and management, and indications for treatment.

Points & PearlsNEW!:

  • Testing for toxic alcohols is not readily available in hospital laboratories. While neither sensitive nor specific, an elevated osmol gap or unexplained elevated anion gap metabolic acidosis should prompt consideration of a toxic alcohol exposure.
  • In acute ethylene glycol or methanol ingestion, the relationship between the osmol gap and anion gap is reciprocal.

Pediatric Emergency Medicine Practice

Carbon Monoxide Poisoning In Children: Diagnosis And Management In The Emergency Department

Abstract:
Pediatric Emergency Medicine PracticeApproximately 5000 children present to the emergency department annually with unintentional carbon monoxide poisoning. Children may be more vulnerable to carbon monoxide poisoning because of their increased metabolic demand and their inability to vocalize symptoms or recognize a dangerous exposure, and newborn infants are more vulnerable to carbon monoxide poisoning because of the persistence of fetal hemoglobin. Mild carbon monoxide poisoning may present as viral symptoms in the absence of fever. While headache, nausea, and vomiting are the most common presenting symptoms in children, the most common symptom in infants is consciousness disturbance. This review discusses the limitations of routine pulse oximetry and carboxyhemoglobin measurement in determining carbon monoxide exposure, and notes effects of co-ingestions and comorbidities. Although the mainstay of treatment is 100% oxygen, the current evidence and controversies in the use of hyperbaric oxygen therapy in pediatric patients is reviewed, along with its possible benefit in preventing delayed neurologic sequelae.

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"Excellent reviews in both pediatric and adult EM situations. It provides an excellent update/review of the EM practice and provides significant CME hours without leaving home. I have retained every copy I have received for the past 5 or so years. The reviews are always up-to-date and accurate and readily applicable to my daily practice. The flow charts are used in my ED every day." -- Stephen Shy, DO, MBA, Huntington, WV

"I love your topics and your evidence-based medicine approach as well as how you cover controversial aspects of each topic. And very importantly, I perceive a very unbiased publication unlike some others. The algorithms are highly appreciated for those of us on the front lines." -- David Wagner, MD, Chino Hills, CA

 

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Last Modified: 09/25/2016
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