Latest Articles and News - Jun 11, 2025

Multiorgan Failure Secondary to Intentional Acetaminophen Overdose-Induced Methemoglobinemia.

Although acetaminophen toxicity has been reported to cause methemoglobinemia, its recognition remains limited in the clinical literature. Methemoglobinemia often necessitates a high index of clinical suspicion, as it may contribute to lactic acidosis and multiorgan dysfunction due to impaired tissue oxygenation. A 21-year-old man presented to the emergency department (ED) via emergency medical services (EMS) with reports of an intentional overdose of an unknown amount of bupropion, two pill bottles of acetaminophen, and an unknown amount of bleach. The patient was emergently intubated. Despite reported bleach ingestion, esophagogastroduodenoscopy (EGD) revealed no evidence of caustic injury or esophagitis. The poison center was contacted, and the patient was started on N-acetylcysteine (NAC). The exact time of acetaminophen ingestion was unknown; however, liver function tests were normal at presentation. Transaminases became abnormal 48 hours later (well after NAC administration had begun). Persistent lactic acidosis in the context of normal initial transaminase levels raised clinical suspicion for methemoglobinemia, given the potential for tissue hypoxia. Methemoglobin levels were confirmed to be elevated, potentially explaining tissue ischemia. The patient received methylene blue as the antidote. The liver transplant team was consulted and agreed with the poison center's recommendation of excluding acetaminophen-induced liver injury. Due to unexplained elevated lactic acid and multisystem organ failure, the family elected for a Do Not Resuscitate (DNR) status. The patient expired four days later with multisystem organ failure.

https://pubmed.ncbi.nlm.nih.gov/40497192/

Fulminant Hepatitis Revealing Carob Intoxication: A Case Report.

A 34-year-old man with a history of obsessive-compulsive disorder was admitted with febrile altered consciousness and generalized mucocutaneous jaundice. His condition was attributed to excessive consumption of Ceratonia siliqua (also known as carob), which he believed had digestive benefits. On examination, he had an altered consciousness with a Glasgow Coma Scale evaluation at 8/15, was hemodynamically stable, and exhibited adequate respiratory function. Laboratory findings revealed severe hypoglycemia, hepatocellular failure with marked cytolysis, and a critically low prothrombin level, while viral serologies were negative and renal function remained normal. A cranial CT scan showed no abnormalities. In the absence of an identifiable cause for fulminant hepatitis, carob intoxication was suspected. The patient received mechanical ventilation, supportive care with 10% glucose infusion, vitamin K therapy, prophylactic ceftriaxone, laxatives, and plasmapheresis for five days. Despite intensive management, his condition deteriorated, and he succumbed to acute liver failure.

https://pubmed.ncbi.nlm.nih.gov/40497180/

Considering possible drivers of the recent decrease in drug overdose deaths in Canada.

https://pubmed.ncbi.nlm.nih.gov/40496343/

Gender-Based Clinical Differences in Hymenoptera Venom Poisoning: A Retrospective Study From Taiwan (April 2021 to March 2023).

Background: Hymenoptera stings are a common cause of emergency visits. Objective: This study aims to assess potential gender disparities in clinical presentation and outcomes of Hymenoptera stings. Methods: Medical records were collected from a single medical center in Northern Taiwan, covering the period from April 1, 2021, to March 31, 2023. A total of 87 patients with confirmed Hymenoptera sting incidents were identified. Data on gender, sting location, clinical presentation, diagnostic evaluation, complications, treatment, and clinical outcomes were analyzed. Results: Among the 87 patients, 47.1% were male and 52.9% were female, showing a nearly balanced distribution of cases. Females experienced a higher rate of stings during holidays. Males, however, were more likely to suffer from severe systemic reactions and had a higher average number of stings compared to females (1.3 vs. 1.0, p=0.049). Conclusion: Males are at higher risk for multiple stings and severe systemic reactions from Hymenoptera stings. Additionally, females tend to experience more stings during spring and autumn compared to males.

https://pubmed.ncbi.nlm.nih.gov/40495953/

Impact of meteorological conditions and air pollution on the incidence of carbon monoxide poisoning: a retrospective analysis in northern China.

Carbon monoxide (CO) poisoning remains a critical public health issue, particularly in residential settings during colder months when heating practices can lead to indoor CO accumulation. The relationship between meteorological conditions, air pollutants, and CO poisoning remains poorly understood. This study aims to investigate the impact of weather factors and air pollution on the incidence of CO poisoning, with a focus on identifying risk factors associated with severe outcomes such as coma. We conducted a retrospective study of CO poisoning cases in a northern Chinese urban area, categorizing patients into coma and non-coma groups. We analyzed clinical characteristics, including age, gender, comorbidities, time of hospital admission, and severity of poisoning. Meteorological data, including temperature, relative humidity, wind speed, and 24-hour temperature changes, as well as air quality indices (AQI), concentrations of CO, NO₂, SO₂, O₃, PM2.5, and PM10, were collected and analyzed for their correlation with CO poisoning incidence. The investigation revealed significant correlations between CO poisoning and patient characteristics and environmental factors. Notably, patients in the coma group were significantly older (P = 0.003) and predominantly presented at the hospital between 6:00 AM and 11:59 AM. Atmospheric CO concentration emerged as a critical risk factor, demonstrating nearly a twofold increase in poisoning risk per 1 mg/m³ increment (OR = 2.001, 95% CI: 1.105-3.622). Meteorological parameters exhibited complex interactions with poisoning susceptibility: mean temperature showed a pronounced protective effect (OR = 0.893, 95% CI: 0.873-0.914, P < 0.001), with each unit decrease corresponding to a 10.7% increase in risk. Temperature dynamics further amplified this risk, with 24-hour temperature fluctuations significantly increasing poisoning susceptibility by 25.7% per unit change (OR = 1.257, 95% CI: 1.174-1.344, P < 0.001), underscoring the multifaceted nature of environmental influences on CO poisoning occurrence. Older age and faster hospital admission are associated with more severe CO poisoning outcomes. Meteorological and environmental pollutant factors, including low temperatures, 24-hour temperature fluctuations and elevated CO concentrations, increase the risk of CO poisoning.Public health interventions, such as safety education, improved ventilation, install CO concentration alarm and early warnings during extreme weather, could significantly reduce the incidence of CO poisoning, particularly in colder months with adverse meteorological conditions.

https://pubmed.ncbi.nlm.nih.gov/40495131/