Table 33.
ToxIC 2016 fatality cases with known toxicological exposure, multiple agents
| Age/sexa | Agents involved | Clinical findings | Life support withdrawn | Brain death confirmed | Treatmentb |
|---|---|---|---|---|---|
| 45F | Carbon monoxide, cyanide | HT, TC, ALI, RD, CNS, MA, AG, | Yes | Yes | Hydroxocobalamin, intubation |
| 30M | Heroin, cocaine, diphenhydramine, dextromethorphan, citalopram | TC, AP, CNS, RFX, MA, HPT, CPT, WBC, AKI, RBM, OTH2 | Yes | No | NaHCO3, antihypertensives, benzodiazepines, neuromuscular blockers, opioids, hemodialysis, intubation, IV fluids |
| 59M | Acetaminophen, ethanol | HT, RD, CNS, HGY, GIB, CPT | Unknown | Unknown | NAC, intubation, IV fluids |
| 16M | Acetaminophen, ethanol | DLM | Unknown | Unknown | None listed |
| 52F | Nicotine, caffeine, dextromethorphan, venlafaxine | VD, QRS, AP, CNS, GIB | Yes | Yes | NAC, NaHCO3, vasopressors |
| 62M | Heroin, cocaine | HT, BC, QTc, ALI, CNS, MA, AG, HPT, AKI, RBM | Yes | Yes | NAC, naloxone, vasopressors, continuous renal replacement, intubation, IV fluids |
| 68F | Nortriptyline, duloxetine, zolpidem, oxycodone | HTN, HT, TC, AP, ALI, RD, AGT, DLM, RFX, MA, PNC, PLT, AKI, RBM | Yes | No | Naloxone, vasopressors, benzodiazepines, neuromuscular blockers, continuous renal replacement, intubation, IV fluids |
| Unknown F | Fentanyl, diazepam | HT, RD, CNS, MA | Yes | Yes | Vasopressors, intubation, IV fluids |
| 15F | Ibuprofen, quetiapine | HT, TC, VD, QRS, RAD, CNS, MA, AG, | Yes | Unknown | Insulin-euglycemic therapy, lipid resuscitation, NaHCO3, vasopressors, antiarrhythmics, activated charcoal, hemodialysis, ECMO |
| 32F | Fentanyl, heroin | BC, BP, RD, CNS, SZ, AKI | Yes | No | Naloxone, intubation, IV fluids, therapeutic hypothermia |
| 28M | Methadone, marijuana | CNS, SZ, MA | Unknown | Unknown | Benzodiazepines, neuromuscular blockers, intubation, IV fluids |
| 65F | Hydrocodone, alprazolam, diazepam | HT, RD, CNS | Yes | No | Calcium, glucagon, insulin-euglycemic therapy, NAC, naloxone, vasopressors, intubation, IV fluids |
| 35M | Olanzapine, valproic acid | HT, TC, AGT, DLM | No | No | NAC, NaHCO3, vasopressors, glucose, hemodialysis, intubation, IV fluids |
| 21F | Dextroamphetamine, lithium | AGT, RBM | Unknown | Unknown | IV fluids |
| 33M | Heroin, valproic acid | HT, BC, VD, AP, AP, ALI, RD, CNS | Yes | No | Carnitine, NaHCO3, intubation, IV fluids |
| 50M | Norepinephrine, argatroban | CPT, PLT, WBC, RBM, OTH2 | Yes | Unknown | Vasopressors, continuous renal replacement, intubation, IV fluids, transfusion |
| 70M | Warfarin, methadone, oxycodone, cocaine, heroin | HT, RD, CNS, CPT, AKI | Yes | Yes | Vitamin K, vasopressors, IV fluids |
| 57M | Acetaminophen, metformin | HT, BC, RD, CNS, SZ, MA, AG, HPT, PNC, PLT, AKI | No | No | NAC, vasopressors, anticonvulsants, steroids, continuous renal replacement, CPR, intubation |
| 38M | Methamphetamine, amphetamine, marijuana, benzodiazepine | HTN, TC | No | No | Antihypertensives, benzodiazepines, CPR, intubation |
| 54M | Ethanol, ibuprofen, acetaminophen | HT, CNS, MA, AG, HPT, PLT, AKI | No | No | Fomepizole, NAC, vitamin K, vasopressors, hemodialysis, continuous renal replacement, IV fluids |
| 47M | Oxycodone, alprazolam, diazepam | HT, TC, BC, BP, VD, MI, RD, CNS, MA, AKI | Unknown | Unknown | None listed |
| Unknown M | Cyanide, carbon monoxide | HT, VD, ALI, RD, CNS, AG | Yes | Yes | Hydroxocobalamin, vasopressors, hyperbaric oxygen, intubation, IV fluids |
| 66F | Fentanyl, hydromorphone | BP, RD, CNS, HGY, MA | No | No | Naloxone, glucose, opioids, intubation, IV fluids |
| 77M | Metoprolol, amlodipine | HT, BC, AVB, QRS, ALI, CNS, MA, HPT | Yes | No | Atropine, calcium, glucagon, insulin-euglycemic therapy, vasopressors, glucose, neuromuscular blockers, intubation, IV fluids |
| 53F | Insulin, zolpidem, venlafaxine | AP, CNS | Yes | Yes | Glucagon, naloxone, glucose, intubation, IV fluids |
| 56M | Cocaine, opioid unspecified | MI, AP, RD, CNS, AKI, RBM | Yes | No | Antihypertensives, benzodiazepines, glucose, opioids, intubation, IV fluids |
| 53F | Amlodipine, toluene, doxepin, carisoprodol, clonazepam | HT, BC, VD, QTc, QRS, RD, CNS, RFX, HGY | No | No | Calcium, methylene blue, naloxone, NaHCO3, methylene blue, naloxone, NaHCO3, thiamine, vasopressors, antiarrhythmics, benzodiazepines, glucose, steroids, intubation, IV fluids |
| 41F | Iron, diphenhydramine | HT, TC, BP, VD, ALI, CNS, MA, AG, HPT | No | No | NaHCO3, deferoxamine, vasopressors, hemodialysis, intubation, IV fluids |
| 21F | Hydroxyzine, fluoxetine, melatonin | HT, BP, QTc, RD, CNS, MA, AG, HPT, CPT, AKI, RBM | No | No | NAC, naloxone, vasopressors, CPR, cardioversion, intubation, IV fluids, therapeutic hypothermia |
| 43F | Heroin, cocaine | VD, RD, CNS | Yes | Yes | NaHCO3, vasopressors, intubation, IV fluids |
| 14M | Bupropion, fluoxetine, meclizine | HT, TC, BC, BP, VD, QTc, AP, AGT, CNS, SZ, RFX, MA, RBM | Yes | No | Lipid resuscitation, vasopressors, antiarrhythmics, anticonvulsants, benzodiazepines, neuromuscular blockers, opioids, CPR, ECMO, intubation |
| 57M | Acetaminophen, metformin | HT, CNS, SZ, HGY, MA, AG, HPT, CPT, WBC, AKI, RBM | No | No | NAC, vitamin K, vasopressors, benzodiazepines, steroids, continuous renal replacement, intubation, transfusion |
| 64M | Cyclobenzaprine, gabapentin, acetaminophen, codeine | CNS, AG | Yes | Yes | Naloxone, physostigmine |
| 53M | Metformin, atenolol | HTN, HT, QTc, QRS, MI, MA, AG, HPT, AKI, RBM | No | No | Calcium, lipid resuscitation, NaHCO3, vasopressors, activated charcoal, 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