Table 32.
2015 fatalities reported in ToxIC Registry with known toxicological exposure (based on the response from a medical toxicologist “Did the patient have a toxicological exposure?” equals Yes with known agent(s)): single agent
| Age/gendera | Agents involved | Clinical findingsb | Life support withdrawn | Brain death confirmed | Treatmentc |
|---|---|---|---|---|---|
| 17F | Methanol | HT, TC, QRS, CNS, SZ, HGY, MA, AG | Yes | Yes | NaHCO3, vasopressors, glucose, intubation |
| 76F | Acetaminophen | HT, TC, AP, ALI, CNS, MA, CPT | No | Unknown | Calcium, fomepizole, NAC, NaHCO3, vasopressors, benzodiazepines, steroids, continuous renal replacement, intubation, IV fluids |
| 55F | Acetaminophen | HT, TC, QRS, ALI, RD, AGT, CNS, HGY, MA, HPT, CPT, AKI | Unknown | Unknown | NAC, intubation, IV fluids |
| 45M | Diphenhydramine | TC, VD, AGT, DLM, SZ, RBM | No | Unknown | Benzodiazepines, IV fluids |
| 50F | Acetaminophen | GIB | Yes | No | NAC |
| 89F | Digoxin | None listed | No | Unknown | None listed |
| 54F | Cocaine | VD, CNS | Yes | Unknown | None listed |
| 63M | Ethanol | None listed | No | Unknown | None listed |
| 43M | Acetaminophen | HT, VD, ALI, RD, CNS, MA, AG, HPT, AKI | Yes | Yes | NAC, vasopressors, antiarrhythmics, benzodiazepines, activated charcoal, hemodialysis, continuous renal replacement, CPR, ECMO, intubation, IV fluids |
| 28M | Methamphetamine | HT, TC, HYT, RD, CNS, RFX, HGY, MA, AG, HPT, GIB, INT, CPT, AKI, RBM | Yes | Yes | Vasopressors, benzodiazepines, hemodialysis, IV fluids |
| 70F | Morphine | TC, AP, CNS, MA | Yes | Unknown | Vasopressors |
| 16F | Acetaminophen | None listed | Unknown | Unknown | NAC |
| >89F | Amlodipine | HT, BC, QTC, QRS, CNS, MA, AKI | Yes | Unknown | Vasopressors, bronchodilators, intubation, IV fluids, pacemaker |
| 45M | Acetaminophen | HT, RD, CNS, SZ, MA, HPT, INT, PLT, AKI, RBM, OTH1 | Yes | Yes | Fomepizole, NAC, benzodiazepines, IV fluids |
| 54F | Verapamil | HT, BC, BP, QTc, RD, CNS, MA, AG, HPT, AKI | No | Unknown | Insulin-euglycemic therapy, vasopressors, whole bowel irrigation, CPR, intubation, IV fluids |
| 60F | Acetaminophen | HT, TC, VD, QRS, RD, CNS, HGY, MA, AG, HPT, CPT | No | Unknown | NAC, vasopressors, glucose, hemodialysis, CPR, cardioversion, intubation, IV fluids |
| 80M | Drain cleaner (caustic) | CRV | Yes | No | Steroids, IV fluids |
| 19M | Mannitol | RAD, CNS | No | Unknown | Vasopressors, bronchodilators, CPR, intubation |
| 58F | Amphetamine | TC, VD, CNS | Yes | Yes | Anithypertensives, neuromuscular blockers, intubation |
| 65F | Digoxin | None listed | Yes | Unknown | None listed |
| 12 mo M | Oxycodone | HT, VD, ALI, CNS, CPT | Yes | Yes | Naloxone, vasopressors, intubation |
| 42F | Acetaminophen | HT, CNS, RFX, MA, AG, HPT, CPT, WBC, AKI | Unknown | Unknown | Fomepizole, NAC, NaHCO3, vasopressors, continuous renal replacement, intubation, IV fluids |
| 17F | MDMA | HT, TC, HYT, RFX, MA, AG, HPT, HYS, CPT, PLT, AKI, RBM | Yes | Yes | Vitamin K, vasopressors, benzodiazepines, neuromuscular blockers, opioids, continuous renal replacement, intubation, IV fluids |
| 31F | Acetaminophen | CNS, HGY, HPT, CPT | Yes | Unknown | Glucagon, NAC, vitamin K, continuous renal replacement, intubation |
| 36F | Heroin | HT, ALI, RD, CNS, HPT | Yes | Yes | Insulin-euglycemic therapy, naloxone, NaHCO3, vasopressors, CPR, intubation |
| 33F | Acetaminophen | TC, QTc, AP, CNS, MA, AG, HPT, HYS, CPT | Yes | Yes | NAC, vasopressors, anticonvulsants, IV fluids |
| 49M | Sympathomimetic unspecified | TC, HYT, VD, QRS, RD,CNS, MA, CPT, WBC, AKI, RBM | No | Unknown | Vasopressors, antiarrhythmics, benzodiazepines, CPR, intubation, IV fluids |
| 19M | Acetaminophen | HT, QTc, ALI, SZ, MA, AG, HPT, HYS, CPT, PLT, AKI | Yes | No | NAC, vasopressors, benzodiazepines, neuromuscular blockers, opioids, steroids, continuous renal replacement, ECMO, intubation, IV fluids |
| 31F | Acetaminophen | TC, CNS, SZ, MA, AG, OG, PNC, HYS, CPT, AKI | Yes | Yes | NAC, NaHCO3, vitamin K, anticonvulsants, continuous renal replacement, intubation, transfusion |
| 45F | Cocaine | RD, CNS, AG, HYS, CPT | Unknown | Unknown | Calcium, flumazenil, NaHCO3, thiamine, vasopressors, benzodiazepines, vasopressors, intubation, IV fluids |
| 72M | Ethanol | AGT, RFX, CPT, PLT | Yes | No | Benzodiazepines, beta blockers, intubation |
| 4M | Smoke | HT, MA | Yes | Yes | Hydroxocobalamin, vasopressors, CPR, intubation, IV fluids |
| 40F | Acetaminophen | HT, BC, AVB | Yes | Unknown | NAC, intubation |
| 67M | Digoxin | HT, BC, AVB | Yes | Unknown | Digoxin Fab, vasopressors |
| 55M | Cocaine | HT, BP, RD, CNS, MA, AG, RBM | Yes | Yes | Naloxone, vasopressors, opioids, IV fluids |
| 32M | Methadone | HT, AP, ALI, RD, CNS, MA, AG, HPT, CPT, PLT, AKI, RBM, OTH2 | Yes | Yes | Naloxone, vasopressors, CPR, intubation, IV fluids, therapeutic hypothermia |
| 17F | Diltiazem | None listed | Yes | No | Continuous renal replacement, IV fluids |
| Unknown F | Acetaminophen | HT, TC, RD, CNS, HGY, MA, AG, HPT, CPT, AKI | No | Unknown | NAC, vitamin K, vasopressors, glucose, continuous renal replacement, intubation, IV fluids, transfusion |
| 19 mo F | Oxycodone | HT, TC, AP, ALI, CNS | Yes | Yes | Naloxone, vasopressors, intubation, IV fluids |
| 55F | Acetaminophen | HT, HGY, AG, HPT, CPT, PLT, AKI | No | Unknown | NAC, vasopressors, glucose, continuous renal replacement, intubation, IV fluids, therapeutic hypothermia, transfusion |
| 35F | Acetaminophen | HT, ALI, RD, CNS, DLM, MA, AG, HPT, CPT, PLT, WBC, AKI | Yes | Yes | NAC, NaHCO3, vasopressors, continuous renal replacement, intubation, IV fluids |
| 34M | Cocaine | HT, TC, VD, QRS, ALI, RD, CNS, MA, AG, AKI, RBM | Yes | Unknown | Calcium, NaHCO3, vasopressors, CPR, intubation, IV fluids, therapeutic hypothermia |
| 29F | Laundry detergent pod | HT, AP, ALI, RD, CNS | No | Unknown | Vasopressors, CPR, intubation, IV fluids |
| 26M | Diesel fuel | HT, TC, BP, VD, AP, ALI, CNS, MA, AG, HYS, CPT, PLT, RBM | No | Unknown | None listed |
| 30M | Heroin | HT, BC, ALI, CNS, MA, AG, PLT, AKI, RBM | Yes | Yes | Calcium, vasopressors, continuous renal replacement, CPR, ECMO, intubation, IV fluids, transfusion |
| 2M | Amphotericin | None listed | Yes | Yes | IV fluids, peritoneal dialysis |
| 65M | Vitamin A | PLT, PCT | No | Unknown | None listed |
| 17F | Metoprolol | HT, BC, RD, CNS | No | Unknown | Lipid resuscitation therapy |
| 22F | Amphetamine | CNS, RFX, WKN | Yes | Unknown | Dantrolene, intubation, IV fluids |
aAge in years unless otherwise stated. wk weeks, mo months
b AG anion gap, AGT agitation, AKI acute kidney injury, ALI acute lung injury/ARDS, AP aspiration pneumonia, AVB AV block, BC bradycardia, BP bradypnea, CNS coma/CNS depression, CPT coagulopathy, CRV corrosive injury, DLM delirium, EPS dystonia, GIB GI bleeding, HCN hallucinations, HGY hypoglycemia, HPT hepatoxicity, HT hypotension, HTN hypertension, HYS hemolysis, HYT hyperthermia, INT intestinal ischemia, MA metabolic acidosis, MET methemoglobinemia, NP neuropathy, OG osmole gap, OTH1 rash, OTH2 skin blisters, necrosis, PCT pancytopenia, PLT thrombocytopenia, PNC pancreatitis, PST paresthesia, QRS QRS prolongation, QTc QTc prolongation, RAD asthma/reactive airway disease, RBM rhabdomyolysis, RD respiratory depression, RFX hyperreflexia/tremor, SZ seizures, TC tachycardia, VD ventricular dysrhythmia, WBC leukocytosis, WKN weakness/paralysis
cPharmcological and nonpharmacological support as reported by a medical toxicologist; BAL dimercaprol, CPR cardiopulmonary resuscitation, ECMO extracorporeal membrane oxygenation, NAC N-acetyl cysteine, NaHCO 3 sodium bicarbonate