By Joshua Nogar, MD
Introduction
Hydrofluoric acid (HF) is a corrosive agent with unique chemical properties that set it apart from other caustic agents. Elemental fluorine is the most electronegative of all elements, a property that lends to the many industrial applications of HF and other fluoride-containing compounds as well as to its unique toxicity. Not only does HF behave like other acids and is capable of causing caustic injuries - the severity of which is proportional to the acid-strength and duration of exposure - but it can cause systemic toxicity as well. Severe toxicity and death have been described after dermal exposures as small as 2.5% total body surface area with anhydrous (100%) HF. Other agents containing fluoride include sodium fluoride (NaF), ammonium biflouride, and sulfuryl fluoride.
Case presentation
A 23 year old male graduate student working in a materials science laboratory was etching silicon wafers with 10% HF when he noticed his left forearm began to sting. This sensation progressed to a burning feeling over the course of about one hour, after which he noticed that the affected area had become erythematous with an area of central pallor. Being trained in the hazards of HF use, he immediately decontaminated the affected…
By Sean P. Nordt, MD
Spring 2009
Introduction
Hydrocarbons (HC) are organic compounds containing primarily hydrogen and carbon atoms, although they may contain other molecules such as halogens or alcohols. Generally speaking there are two types of HC, aliphatic or straight chained and cyclic, aromatic, or other ringed structures. Hydrocarbons are derived from many different sources including: plant materials, animal fat, natural gas, and coal. Hydrocarbons are widely used in daily life and industrial applications as fuel, lubricants, solvents, degreasers, etc. Some HC are used medicinally such as chloral hydrate, chlorobutanol, and alcohols. Three general “methods” of inhaled HC abuse are employed:
- “sniffing,” whereby the HC is directly smelled from a container e.g., glue, correction fluid
- “huffing,” where HC is applied to cloth and held to the face
- “bagging,” where HC is placed in a plastic bag and inhaled.
Case presentation
A 16 year old male was being chased by a police officer when he suddenly collapsed and was found to be pulseless and unresponsive. The police officer had found the child behind a school with a spray paint can and a rag in his hand. When the police officer told the child to drop…
By Alicia Minns, MD
Introduction
Most plants with anticholinergic properties are from the family Solanaceae, and can be identified from their characteristic flowers. The Solanaceae family is extensively utilized by humans for food and medicine but is often rich in alkaloids that can cause life-threatening toxicity in humans. Plant chemistry is complex and most plants contain multiple chemicals and chemical classes that work independently or additively. Plants causing human toxicity include Atropa belladonna (deadly nightshade), Mandragora officinarum (mandrake), Hyoscyamus niger (henbane), Datura and Brugmansia. Atropa belladonna contains sweet-tasting berries that may be particularly dangerous for children. In addition to poisonous plants, a number of food staples, such as potato, tomato, eggplant and chili pepper belong to the Solanaceae family. Although atropine can be isolated in small quantities from the unripe skin of these “edible” plants, symptoms of toxicity are rare. Alkaloids are nitrogen-containing organic compounds that act as bases and form salts with acids. Alkaloids are generally distributed throughout the plant; therefore all ingested parts may be toxic. However, alkaloid concentrations vary within and among each plant, and victims are unaware of the…
By Jonathan D. Auten, DO, and Michael J. Matteucci, MD
Introduction
Methamphetamine, closely related to amphetamine, is a fat-soluble sympathomimetic agent that in users can produce symptoms as mild as restlessness, tachycardia, and headache to severe side effects such as agitation, delirium, cardiac ischemia, seizures, strokes, rhabdomyolysis and renal failure. Methamphetamine abuse has been rising over the past decade due to the relative ease of availability and low cost.
In the United States, methamphetamine abuse rose through the 1960’s despite prohibition of its unregistered possession, manufacture, or sale by the US Drug Abuse Control Amendment (USDCA) in 1965. This ban unfortunately promoted occult methamphetamine laboratories along the coast of California in the 1960s, and its recreational use spread up and down the Pacific Coast. In the 1980s, crystal methamphetamine, a smokable and more potent form was developed spurring a new epidemic of abuse. In 1996, the US Congress passed the Comprehensive Methamphetamine Control Act, enacting new controls over key ingredients such as iodine, red phosphorous, hydrochloric acid, and pseudoephedrine, while further restricting the sale, possession and manufacture of methamphetamine. Despite these measures…
By Jeffrey R. Suchard, MD
Introduction
Loxosceles reclusa, or the brown recluse spider is one of the most feared and at the same time misunderstood arthropods in the United States. Although their venom contains several enzymes and other agents capable of causing skin necrosis, these spiders are shy and rarely ever bite except when threatened. Our common human fear of spiders has helped propagate the undeserved reputation of this spider.
Case 1 presentation
A 38-year-old man presents to an Emergency Department in Orange County, California for evaluation of a brown recluse spider bite. He reports seeing a "violin" spider crawling on his arm about an hour earlier. He thinks that the spider bit him, although he cannot be certain because he immediately crushed the spider and then cut a 0.5 cm incision into his arm and proceeded to "suck out the poison." He is tachycardic and very anxious, but has a normal physical examination other than some mild erythema surrounding the non-bleeding, superficial incision. He is wondering whether he requires antitoxin, antibiotics, or possibly amputation, since his friends have told him that brown recluse spider bites are often fatal. The spider was described as less than 1 cm in size, dark-colored (brown…