Table 35.
2019 fatalities reported in ToxIC Registry with known toxicological exposure: single agent.
| Age /gendera | Agents involved | Clinical findings | Life support withdrawn | Brain death confirmed | Treatmentb |
|---|---|---|---|---|---|
| 14F | Acetaminophen | HPT | Unknown | NAC | |
| 15F | Acetaminophen | None | No | NAC | |
| 32F | Acetaminophen | DLM, HGY, MA, HPT, CPT | Unknown | Vitamin K | |
| 36F | Acetaminophen | HT, CNS, DLM, HGY, MA, AG, HPT, GIB, PLT, AKI | Yes | No | Folate, NAC, thiamine, continuous renal replacement, intubation, IV fluids |
| 37F | Acetaminophen | HT, TC, HY, QTC, ALI, CNS, MA, HPT, AKI | Yes | No | NAC, NaHCO3, vasopressors (norepinephrine, vasopressin), glucose > 5%, intubation, IV fluids |
| 46F | Acetaminophen | TC, QTC, ALI, CNS, MA, AG, HPT, GII, CPT, PLT, WBC, AKI | No | NAC, NaHCO3, vitamin K, vasopressors (norepinephrine), beta-blockers, opioids, CPR, intubation, IV fluids | |
| 46F | Acetaminophen | HT, AP, RD, CNS, HPT | Unknown | NAC, vasopressors (norepinephrine, vasopressin), intubation, IV fluids | |
| 48M | Acetaminophen | HYT, RD, MA, AG, HPT, CPT, PLT, WBC, AKI | No | NAC, CPR, intubation, IV fluids | |
| 51M | Acetaminophen | RD, CNS, MA, AG, HPT, CPT, AKI | Yes | No | NAC, vasopressors (epinephrine, vasopressin), continuous renal replacement |
| 67F | Acetaminophen | PNC | No | NAC | |
| 72M | Acetaminophen | WBC | Unknown | NAC, opioids, IV fluids | |
| 77F | Acetaminophen | HT, CNS, MA, HPT, AKI | No | NAC, vasopressors (norepinephrine), continuous renal replacement, intubation, IV fluids | |
| > 89F | Acetaminophen | Sedative-hypnotic toxidrome, CNS, HPT | No | NAC | |
| 58F | Antimony | SZ | Yes | Yes | None |
| 4M | Baclofen | None | No | IV fluids | |
| 18F | Benzonatate | HT, HY, CNS, MA, AG | Yes | Yes | Naloxone/nalmefene, anticonvulsants, benzodiazepines, CPR, intubation |
| > 89F | Carpet cleaner | HT, MI, RD, MA, HYS, CPT | No | Intubation | |
| 14moF | Cocaine | Sympathomimetic syndrome, HT, TC, VD, QRS, QTC, RD, CNS, SZ, MA, AG, CPT | Yes | Yes | NaHCO3, vasopressors (epinephrine), anticonvulsants, CPR, intubation, IV fluids |
| 33M | Cocaine | HT, MI, ALI, CNS, SZ, MA, AKI | Yes | No | None |
| 15M | Diphenhydramine | TC, VD, QRS, CNS, DLM, SZ, MA, AG, WBC, RBM | No | NaHCO3, vasopressors (norepinephrine), benzodiazepines, opioids, CPR, intubation, IV fluids | |
| 15F | Diphenhydramine | Anticholinergic toxidrome, HTN, TC, QTC, CNS, MA, AG | Yes | Yes | Activated charcoal |
| 17F | Ethanol | Sedative-hypnotic toxidrome, HT, BP, AP, RD, CNS, MA, AG | Yes | Yes | CPR, intubation, IV fluids |
| 65M | Ethanol | DLM | Yes | No | Benzodiazepines, intubation, IV fluids |
| 20M | Fentanyl | Opioid toxidrome, HT, BP, VD, MI, ALI, RD, CNS, MA, AG, AKI | Unknown | NaHCO3, vasopressors (epinephrine, norepinephrine), continuous renal replacement, CPR, intubation, IV fluids | |
| 21M | Fentanyl | HT, VD, MI, AP, RD, CNS, MA, AG, HPT, GII, WBC, AKI | No | NAC, NaHCO3, vasopressors (epinephrine, norepinephrine, vasopressin), antiarrhythmics, benzodiazepines, neuromuscular blockers, CPR, cardioversion, intubation | |
| 34F | Fentanyl | Opioid toxidrome, HT, BP, MI, ALI, RD, CNS, MA, HPT, AKI | Yes | No | Flumazenil, naloxone/nalmefene, vasopressors (epinephrine, norepinephrine), CPR, intubation, IV fluids |
| 50M | Fentanyl | Opioid toxidrome, BP, RD, CNS, HPT, AKI, RBM | Yes | No | NAC, naloxone/nalmefene, vasopressors (phenylephrine), antihypertensives, benzodiazepines, beta blockers, opioids, hemodialysis, intubation, IV fluids |
| 18M | Flecainide | HT, BC, QRS, QTC, CNS | No | NaHCO3, vasopressors (epinephrine), antiarrhythmics, steroids, CPR, intubation, IV fluids | |
| 27F | Heroin | Sedative-hypnotic toxidrome, AKI | No | Lipid therapy, NAC, naloxone/nalmefene, vasopressors, CPR, intubation, IV fluids | |
| 31M | Heroin | VD, RD, CNS | Yes | Yes | Naloxone/nalmefene, anticonvulsants, benzodiazepines, neuromuscular blockers, opioids, CPR, intubation, IV fluids |
| 39M | Heroin | HTN, QRS, QTC, RD, CNS, MA, PNC | Yes | Yes | Naloxone/nalmefene, vasopressors (epinephrine), benzodiazepines, opioids, intubation, IV fluids |
| 41F | Heroin | Opioid toxidrome, AP, CNS, RFX | Yes | Yes | None |
| 60F | Heroin | HTN, BP, VD, MI, RD, CNS, MA, AG, WBC | No | Naloxone/nalmefene, nitrites, NaHCO3, bronchodilators, antihypertensives, benzodiazepines, opioids, IV fluids | |
| 13M |
Loxosceles (recluse spider) |
RS | No | None | |
| 40M | Metformin | HT, RD, CNS, MA, AG | No | NaHCO3, vasopressors (epinephrine, norepinephrine, vasopressin), hemodialysis, CPR, intubation, IV fluids | |
| 48M | Metformin | HT, TC, AGT, MA, AG, GIB, WBC, AKI | No | Calcium, NaHCO3, vasopressors (norepinephrine), hemodialysis, continuous renal replacement, CPR, intubation, IV fluids | |
| 55M | Methanol | Sedative-hypnotic toxidrome, HGY, AG, OG, AKI | Yes | Yes | Fomepizole, vasopressors (epinephrine, norepinephrine), continuous renal replacement, CPR, IV fluids |
| 85F | Methotrexate | HT, CNS, PLT, PCT | Yes | No | Folate, benzodiazepines, steroids |
| > 89F | Methotrexate | DLM, HYS, CPT, PLT, RS, BL | No | Folate, vasopressors (norepinephrine), IV fluids | |
| 16F | Oxycodone | Opioid toxidrome, HT, VD, RD, CNS, MA, HPT, WBC | Yes | Yes | Naloxone/nalmefene, vasopressors (norepinephrine), intubation, IV fluids |
| 65F | Phenytoin | HYT, SZ, WBC | Yes | Yes | MDAC |
| 61F | Quetiapine | Sedative-hypnotic toxidrome, HT, VD, RD | Yes | No | Lipid therapy, vasopressors (epinephrine), intubation, IV fluids |
| 69F | Salicylic acid | TC | No | NaHCO3, IV fluids | |
| 43F | Smoke | RAD, CNS | Yes | Yes | Hydroxocobalamin, HBO, intubation, IV fluids |
| 21M | Tetrahydrocannabinol | ALI, CNS, AKI | No | Vasopressors (norepinephrine, vasopressin, dopamine), antiarrhythmics, opioids, steroids, continuous renal replacement, ECMO, intubation, IV fluids | |
| 33F | Verapamil | Sedative-hypnotic toxidrome, HT, BC, AVB, RAD, CNS, MA, AG, CPT, AKI | Yes | No | HIE, vasopressors (epinephrine, norepinephrine, vasopressin), activated charcoal, continuous renal replacement, intubation, IV fluids |
| 47F | Verapamil | HT, BC, VD, QRS, QTC, AVB, ALI, AP, RD, CNS, MA, AKI | No | Calcium, glucagon, HIE, lipid therapy, NaHCO3, vasopressors (epinephrine, norepinephrine, vasopressin, dopamine), glucose >5%, intubation, IV fluids, pacemaker |
Based on the response from the 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 pneumonitis, AVB AV block, BC bradycardia, BL blisters/bullae, BP bradypnea, CNS coma/CNS depression, CPT coagulopathy, CRV corrosive injury, DLM delirium, GIB GI bleeding, GII intestinal ischemia, HGY hypoglycemia, HPT hepatoxicity, HT hypotension, HTN hypertension, HYS hemolysis, HY hypothermia, HYT hyperthermia, MA metabolic acidosis, MI myocardial injury/ischemia, OG osmolar gap, PCT pancytopenia, PLT thrombocytopenia, PNC pancreatitis, QTC QTc prolongation, RAD asthma/reactive airway disease, RBM rhabdomyolysis, RD respiratory depression, RFX hyperreflexia/tremor, RS rash, SZ seizures, TC tachycardia, VD ventricular dysrhythmia, WBC leukocytosis, CPR cardiopulmonary resuscitation, ECMO extracorporeal membrane oxygenation, HBO hyperbaric oxygenation, HIE high-dose insulin euglycemic therapy, MDAC multiple-dose activated charcoal, NAC n-acetyl cysteine, NaHCO3 sodium bicarbonate
aAge in years unless otherwise stated
bPharmacological and non-pharmacological support as reported by medical toxicologist