Resolution after radiotherapy of severe pulmonary damage due to paraquat poisoning.

A 29 year old man was admitted 36 hours after ingesting about 5 g paraquat. His arterial oxygen pressure fell progressively to 3.4 kPa (34 mm Hg), and pulmonary damage induced by paraquat was diagnosed. His condition did not improve after treatment with prednisolone and cyclophosphamide, but after irradiation both lungs cleared and arterial oxygen pressure started to improve. Irradiation of the lungs should be considered in patients who, after surviving the acute phase of poisoning with paraquat, show progressive deterioration of respiratory function.     

Acute poisoning: an update.

Treatment of the patient who has taken an overdose of a harmful substance includes support of vital functions and toxicologic analysis. Early recognition of signs and symptoms indicating poisoning by a specific agent or group of related chemicals is essential since specific antidotes may be lifesaving. Activated charcoal is an effective gastrointestinal decontaminant that adsorbs many common drugs. Administration of weak acids as an antidote to alkali ingestion is to be condemned; the only treatment should be dilution with water. The use of physostigmine as a specific antidote for the anticholinergic syndrome has been very successful; the incidence of this syndrome as a result of poisoning by tricyclic antidepressants is increasing. Effective therapy for acetaminophen overdose is still being investigated, but activated charcoal and methionine, if given early enough, seem to be effective.     

Death due to salicylate poisoning in Ontario.

Acute salicylate poisoning may result in death. A review of seven fatal cases of salicylate poisoning in Ontario in 1984 showed that the average duration of hospitalization before death was 18.1 hours. Factors that contributed to death included failure to administer activated charcoal and sodium bicarbonate, to appreciate the need for hemodialysis and to consult with experts in toxicology.     

Subclavian-axillary vein thrombosis: successful treatment with streptokinase.

Proximal vein thrombosis has been associated with residual disability from the postphlebetic syndrome in patients receiving symptomatic therapy or heparin and sodium warfarin. This paper describes a man with painless swelling of the right arm secondary to subclavian-axillary vein thrombosis that was successfully treated with streptokinase and conventional anticoagulant therapy.     

Lipid storage myopathy: successful treatment with propranolol.

Lipid storage myopathies are a rare but serious cause of muscle weakness characterised by the accumulation of abnormal amounts of neutral fat in type 1 fibres. A case is reported in which the patient presented with weakness of the proximal limb muscles and greatly increased activities of creatine kinase and lactate dehydrogenase. After two years lipid myopathy was diagnosed when electron microscopy confirmed the presence of large numbers of lipid particles within muscle fibres. Twelve years after the initial presentation propranolol (40 mg thrice daily) was started. Strength gradually improved and enzyme activities returned to normal. The improvement in the patient''s condition was almost certainly due to the propranolol, although the mode of action of the drug remains unknown.