• Toxicology


    A 35 year old man is brought to the ED by a friend after he attempted to commit suicide by ingesting a bottle of acetaminophen. What is the next best step in management? Presentation Day 1 (first 24h) nausea vomiting Day 2-3 (48-72h) hepatic failure Amount ingested 10 g is toxic 15 g is fatal amounts are lower if liver disease or alcohol abuse Diagnosis Acetaminophen level: get this if the amount ingested is not known and not sure if it was enough to cause toxicity. Remember, treatment is more important than knowing the acetaminophen level, so give N-acetylcysteine right away if suspected overdose, don’t wait on the acetaminophen level.…

  • Scombroid fish poisoning

    Scombroid fish poisoning

    Scombroid poisoning or scombroid fish poisoning occurs after consuming fish that contain high levels of histamine. This is often seen when eating fish that has not been properly stored or refrigerated. The amino acid histidine in the fish is converted to histamine by bacterial enzymes as the fish decomposes. High levels of histamine, even toxic levels, can be present in decomposing fish even before there is a noticeable smell or taste. The reaction is similar to an allergic reaction and occurs during , immediately after eating or a few hours later. Symptoms include vomiting, diarrhea and hives. Other symptoms include: flushing of the skin, itchiness, palpitations, rash, tingling, stomach pain,…