Table 32.
ToxIC 2016 fatality cases with known toxicological exposure, single agent
| Age/sexa | Agents involved | Clinical findings | Life support withdrawn | Brain death confirmed | Treatmentb |
|---|---|---|---|---|---|
| 40M | Acetaminophen | HT, CNS, MA, AG, HPT, PNC, CPT, PLT, AKI, RBM | No | Unknown | NAC, vitamin K, vasopressors, anticonvulsants, neuromuscular blockers, opioids, continuous renal replacement, intubation, IV fluids |
| 41F | Acetaminophen | TC, RD, AGT, CNS, AG, HPT, PNC, HYS, AKI, RBM | Yes | Unknown | NAC, vitamin K, benzodiazepines, intubation, IV fluids |
| 21F | Heroin | HT, BC, BP, VD, RD, CNS, MA | Yes | Yes | Physostigmine, vasopressors, antiarrhythmics, CPR, intubation, IV fluids, therapeutic hypothermia |
| 41F | Acetaminophen | HT, RD, CNS, MA, AG, HPT, CPT, WBC, RBM | Yes | No | NAC, NaHCO3, vitamin K, vasopressors, anticonvulsants, benzodiazepines, opioids, continuous renal replacement, intubation, IV fluids |
| 43M | Methanol | HT, QRS, RD, CNS, MA, AG, OG, CPT, AKI, RBM | Yes | Yes | Folate, fomepizole, hemodialysis, intubation, IV fluids |
| 29F | Acetaminophen | HT, TC, CNS, HGY, HPT, CPT, AKI | Yes | No | NAC, NaHCO3, vitamin K, benzodiazepines, glucose, neuromuscular blockers, opioids, vasodilators, hemodialysis, continuous renal replacement, intubation, IV fluids, transfusion |
| 52M | Ethanol | HT, TC, MA, AG, HPT, PNC, PLT, AKI | Unknown | Unknown | NAC, vasopressors, continuous renal replacement, cardioversion, intubation, IV fluids |
| 35F | Amitriptyline | HT, TC, BP, VD, QRS, RD, CNS, MA, AG, HPT, AKI | Yes | Yes | Naloxone, NaHCO3, vasopressors, CPR, intubation, IV fluids |
| 54M | Ethanol | CNS | Yes | Yes | Fomepizole, NAC, hemodialysis, intubation, transfusion |
| 80M | Carbon monoxide | HT, AVB, RD, CNS, WKN, MA, OTH1 | Yes | No | Hydroxocobalamin, vasopressors, intubation, IV fluids |
| 77M | Metoprolol | HT, BC, AVB, RD, CNS | Yes | No | Insulin-euglycemic therapy, vasopressors, glucose, intubation, IV fluids |
| 51F | Acetaminophen | HT, TC, BC, BP, VD, ALI, RD, CNS, MA, AG, HPT, HYS, CPT, PLT, WBC, AKI | Yes | No | Lipid resuscitation, methylene blue, NAC, NaHCO3, vasopressors, intubation, transfusion |
| 51F | Heroin | HT, BP, RD, CNS, HPT, WBC, RBM | Yes | Yes | NaHCO3, vasopressors, benzodiazepines, intubation, IV fluids |
| 24F | Acetaminophen | HT, VD, CNS, HGY, MA, AG, HPT, PNC, PLT | Yes | No | NAC, vasopressors, benzodiazepines, glucose, continuous renal replacement, intubation, IV fluids, therapeutic hypothermia |
| 63F | Acetaminophen | HT, BC, BP, VD, ALI, RD, CNS, MA, AG, HPT, PNC, INT, CPT, PLT, WBC | No | No | NAC, vasopressors, CPR, intubation, IV fluids |
| 60M | Colchicine | HT, VD, MA, AG, CPT, PLT, PCT, WBC | No | No | Vasopressors, antiarrhythmics, continuous renal replacement, intubation, IV fluids |
| 51M | Metformin | HT, TC, ALI, MA, AG, RBM | Unknown | Unknown | Hemodialysis, intubation |
| 83F | Diltiazem | HT, BC, CNS, MA, AG, | Unknown | Unknown | Glucagon, insulin-euglycemic therapy, lipid resuscitation, vasopressors, intubation, IV fluids |
| 40F | Heroin | BP, CNS, MA | Yes | Yes | NAC, naloxone, |
| 57M | Bupropion | VD, AP, ALI, CNS, SZ, AKI | No | No | Lipid resuscitation, NaHCO3, vasopressors, benzodiazepines, CPR, intubation, IV fluids |
| 19M | Fentanyl | RD, CNS | Yes | Yes | Naloxone, CPR, intubation |
| 14F | Diphenhydramine | HT, VD, QTc, QRS, CNS, SZ, MA, AG | Yes | No | Vasopressors, antiarrhythmics, anticonvulsants, benzodiazepines, intubation, IV fluids |
| 63F | Doxepin | RD, CNS, AKI | Yes | No | Glucagon, NaHCO3, intubation, IV fluids |
| 22F | Acetaminophen | HT, TC, RD, CNS, SZ, MA, AG, HPT, CPT | Yes | Yes | NAC, vasopressors, anticonvulsants, benzodiazepines, intubation, IV fluids, |
| 14F | Bupropion | HT, QRS, ALI, RD, CNS, SZ, MA, AKI, RBM | Yes | Unknown | Insulin-euglycemic therapy, lipid resuscitation, NaHCO3, vasopressors, urinary alkalinization, CPR, intubation, IV fluids, therapeutic hypothermia |
| 60F | Quinidine | MET | No | No | Calcium, methylene blue, NaHCO3, vitamin K, vasopressors, hypoglycemia, exchange transfusion, IV fluids, transfusion |
| 52M | Sevoflurane | HTN, TC, HYT, VD, QTc, QRS, EPS | Yes | No | Dantrolene, NaHCO3, intubation, IV fluids |
| 32M | Cyanide | HT, TC, CNS, MA | No | No | Hydroxocobalamin, intubation, IV fluids |
| 19F | Acetaminophen | None listed | No | No | NAC, IV fluids |
| 47M | Hydromorphone | AP | No | No | NAC, IV fluids |
| 65F | Digoxin | HT, BC, WKN | Yes | No | Digoxin Fab, vasopressors, IV fluids |
| 60F | Amitriptyline | HT, TC, VD, QRS, RAD, ALI, RD, | Yes | No | NaHCO3, vasopressors, intubation, intubation, IV fluids |
| 17F | Cocaine | TC, RD, AGT, CNS, DLM, SZ, MA, AG, HPT, HYS, CPT, PLT, WBC, AKI | Yes | No | Vasopressors, anticonvulsants, benzodiazepines, glucose, opioids, hemodialysis, CPR, intubation, IV fluids, transfusion |
| 32M | Cyanide | HT, VD, RAD, AGT, CNS, MA | No | No | Hydroxocobalamin, thiosulfate, vasopressors, CPR, intubation, IV fluids |
| 51M | Warfarin | CNS, CPT, WBC | Yes | Yes | Anticoagulant reversal, anticonvulsants, neuromuscular blockers, intubation |
| 33M | Hydrogen sulfide | HT, TC, VD, ALI, RD, CNS, MA | Yes | Unknown | Vasopressors, antiarrhythmics, benzodiazepines, CPR, cardioversion, intubation, IV fluids |
| 61M | Ethanol | HT, DLM, HCN, HPT, PNC, HYS, PLT | Yes | Unknown | Calcium, folate, octreotide, thiamine, benzodiazepines, IV fluids, transfusion |
| 21F | Acetaminophen | HT, BC, VD, ALI, RD, CNS, MA, AG, HPT, CPT, AKI | No | No | NAC, NaHCO3, vasopressors, antiarrhythmics, benzodiazepines, CPR, cardioversion, intubation, IV fluids |
| 45M | Codeine | HT, BC, VD, RD, CNS, MA, AG, | Yes | Yes | NAC, NaHCO3, vasopressors, antiarrhythmics, anticonvulsants, beta blockers, opioids, CPR, cardioversion, intubation, IV fluids, therapeutic hypothermia |
| >89M | Carbon monoxide | HT, VD, RD, CNS, AG | No | No | Thiosulfate, vasopressors, intubation, IV fluids |
| 68M | Digoxin | HT, QRS, RD, AGT, CNS | Yes | Unknown | Digoxin Fab, pacemaker |
| 39F | Gabapentin | HT, VD, QTc, MI, RD, CNS, MA, AG, HPT, MI, WBC, AKI, RBM | Yes | No | Vasopressors, antiarrhythmics, CPR, intubation, therapeutic hypothermia |
| 38F | Acetaminophen | HT, TC, MI, ALI, CNS, MA, AG, HPT, GIB, HYS, CPT, PLT, PCT, AKI, RBM | Yes | Unknown | NAC, NaHCO3, vitamin K, vasopressors, glucose, continuous renal replacement, intubation, IV fluids |
| 68M | Chlorine | HT, QTc, MI, ALI, RD, CNS | No | No | Vasopressors, neuromuscular blockers, intubation, IV fluids |
| 68M | Copper | HT, CRV, GIB, MET, WBC, AKI | No | No | BAL, penicillamine, vasopressors, hemodialysis, continuous renal replacement, CPR, intubation, IV fluids, transfusion |
| 46M | Amlodipine | HT, RAD, CNS, MA, AKI | Yes | No | Lipid resuscitation, methylene blue, NaHCO3, thiamine, vitamin K, vasopressors, bronchodilators, antiarrhythmics, benzodiazepines, neuromuscular blockers, opioids, steroids, intubation, IV fluids |
| 24M | Opioid unspecified | VD, QTc, QRS, MI, AP, RD, CNS, MA, | Yes | Yes | None listed |
| 74M | Ciguatera | PST, WKN | Yes | No | None listed |
| 27M | Morphine | HT, BP, MI, RAD, ALI, RD, CNS, MA, AG. CPT, AKI, RBM | Yes | Yes | Naloxone, vasopressors, CPR, intubation, IV fluids, therapeutic hypothermia |
| 38M | Heroin | HT, TC, MI, ALI, CNS, NP, MA, WBC | Unknown | Unknown | Folate, naloxone, vasopressors, intubation, IV fluids |
| 31M | Heroin | HT, VD, QRS, MI, RAD, RD, CNS, MA, AG, AKI | Yes | Yes | None listed |
| 58M | Amphetamine | QRS, QTc, AGT, MA, AG, OG, INT, PLT, AKI | Yes | Unknown | Fomepizole, vasopressors, hemodialysis, continuous renal replacement, intubation |
| 44F | Heroin | HT, BP, VD, RD, CNS, MA, AG, | No | No | Naloxone, vasopressors, CPR, intubation, IV fluids |
| 34M | Heroin | RD, CNS | Unknown | Unknown | Naloxone, CPR |
| 26M | Heroin | CNS | Yes | Yes | Naloxone, intubation |
| 70M | Diltiazem | HT, CNS | Yes | Yes | Calcium, insulin-euglycemic therapy, vasopressors, IVF |
| 65M | Opioid unspecified | None listed | No | No | Antihypertensives, opioids, |
| 62F | Ethanol | HT, BC, MI, RD, CNS, MA,AG, OG, GIB, WBC, RBM | No | No | Fomepizole, vasopressors, continuous renal replacement, CPR, intubation, IV fluids |
| 60M | Acetaminophen | None listed | No | No | NAC |
| 32F | Aspirin | HT, BC, VD, RD, CNS, | No | No | NaHCO3, vasopressors, CPR, intubation, IV fluids |
| 32M | Cyanide | RD, CNS, AG, MET | Yes | Yes | Hydroxocobalamin, methylene blue, NaHCO3, vasopressors, intubation, IV fluids |
| 44M | Acetaminophen | AP, HPT, MET, MYS, CPT, AKI, RBM | Yes | No | NAC, hemodialysis, continuous renal replacement, intubation, IV fluids, transfusion |
| 43M | Methanol | TC, RD, CNS, SZ, MA, AG, OG | Yes | Yes | Folate, fomepizole, thiamine, vasopressors, anticonvulsants, benzodiazepines, hemodialysis, intubation, IV fluids |
Based on response from medical toxicologist “Did the patient have a toxicological exposure?” equals yes, with known agent(s)
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/rigidity, 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, MI myocardial injury/ischemia, 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, BAL dimercaprol, CPR cardiopulmonary resuscitation, ECMO extra-corporeal membrane oxygenation, NAC n-acetyl cysteine, NaHCO 3 sodium bicarbonate
aAge in years unless otherwise stated
bPharmcological and non-pharmacological support as reported by medical toxicologist