Table 36.
2019 fatalities reported in ToxIC Registry with known toxicological exposure: multiple agents.
| Age/gendera | Agents involved | Clinical findings | Life support withdrawn | Brain death confirmed | Treatmentb |
|---|---|---|---|---|---|
| 15F | Acetaminophen, caffeine | V | Unknown | NAC | |
| 16F | Acetaminophen, aspirin, caffeine | None | No | None | |
| 17M | Acetaminophen, anticholinergic unspecified | Anticholinergic toxidrome, AGT, V | No | NAC, IV fluids | |
| 61M | Acetaminophen, opioid unspecified | HT, MI, RD, CNS, MA, AG, GIB, AKI | No | NAC, vasopressors (norepinephrine), intubation, IV fluids | |
| 75M | Acetaminophen, donepezil, levothyroxine, lisinopril, tamsulosin | HT, BC, RD | No | Glucagon, methylene blue, NAC, vasopressors (epinephrine, norepinephrine, vasopressin, phenylephrine), continuous renal replacement therapy, intubation | |
| 79F | Acetaminophen, codeine | RD, CNS, MA, HPT, PNC | Yes | Yes | NAC, vasopressors (dobutamine) |
| 60F | Acetylsalicylic acid, ethanol | HT, TC, BC, QRS, RD, CNS, SZ, MA, AG, HPT, CPT, RBM | No | Calcium, Fab for digoxin, methylene blue, naloxone/nalmefene, NaHCO3, vitamin K, vasopressors, antiarrhythmics, benzodiazepines, glucose > 5%, steroids, activated charcoal, hemodialysis, intubation | |
| 49M | Amlodipine, nortriptyline, duloxetine, meloxicam | HT, RD, CNS, MA, AKI | Yes | Unknown | Calcium, glucagon, HIE, lipid therapy, methylene blue, vasopressors (epinephrine, norepinephrine, vasopressin, phenylephrine, dopamine, dobutamine), benzodiazepines, neuromuscular blockers, opioids, intubation, IV fluids |
| 67M | Amlodipine, lorazepam | BC, QRS, RD, CNS, MA, AG, CPT, AKI, RBM | Yes | Yes | Atropine, calcium, glucagon, HIE, NaHCO3, vasopressors (epinephrine, norepinephrine), benzodiazepines, glucose > 5%, neuromuscular blockers, intubation, IV fluids |
| 70M | Amlodipine, aspirin, fluoxetine | HT, ALI, CNS, DLM, AKI | No | Calcium, glucagon, hydroxocobalamin, HIE, lipid therapy, methylene blue, NaHCO3, hemodialysis, continuous renal replacement therapy, IV fluids | |
| 68M | Baclofen, clonidine, hydromorphone, bupivacaine | Sedative-hypnotic toxidrome, CNS, WBC, AKI | Yes | Yes | IV fluids, opioids |
| 31M | Cocaine, ethanol | AGT, DLM | Unknown | IV fluids | |
| 37M | Cocaine, opioid unspecified | HTN, HT, BP, QTC, AP, RD, CNS, MA, AG, HPT, WBC, RBM | Yes | Yes | Vasopressors (norepinephrine, vasopressin), intubation, IV fluids |
| 83F | Digoxin, diltiazem, metoprolol | HT, BC, CNS | Yes | Unknown | Fab for digoxin, glucagon, vasopressors (dopamine), IV fluids |
| 58F | Ethanol, valacyclovir | HTN, HT, QTC, CNS, SZ, MA, AKI | Yes | Yes | Thiamine, vasopressors (norepinephrine), antihypertensives, benzodiazepines, opioids, vasodilators, intubation, IV fluids |
| 67F | Ethanol, alprazolam, | Serotonin syndrome, BC, ALI, AGT, HCN, RFX, HYS | Yes | Yes | Antipsychotics, benzodiazepines |
| 34F | Fentanyl, norfentanyl | Opioid toxidrome, RD, CNS, SZ, AG, WBC | Yes | Yes | Naloxone/nalmefene, benzodiazepines |
| 66F | Glimepiride, tramadol | AGT, HGY | No | Octreotide, glucose > 5%, IV fluids | |
| 87F | Haloperidol, thiothixene, aripiprazole | EPS | No | IV fluids | |
| 63F | Hydrocodone, tramadol, ibuprofen | Sedative-hypnotic toxidrome, HT, ALI, CNS, HPT, RBM | Yes | Yes | NAC, naloxone/nalmefene, intubation, IV fluids |
| 21F | Oxycodone, ibuprofen, aripiprazole, fluoxetine, propranolol | HT, QRS, MI, ALI, AP, RD, CNS, HGY, MA, PNC, CRV, GIB, CPT, PLT, AKI | No | Calcium, glucagon, vasopressors (isoproterenol), glucose > 5%, intubation, IV fluids | |
| 65M | Tamsulosin, emtricitabine, darunavir, elvitegravir | HT | Unknown | Vasopressors (norepinephrine) | |
| 60M | Ziprasidone, alprazolam | Sedative-hypnotic toxidrome, HT, BP, QRS, QTC, RD, CNS, MA | Yes | Yes | Lipid therapy, vasopressors (dopamine), CPR, intubation |
Based on response from Medical Toxicologist “Did the patient have a toxicological exposure?” equals yes with known agent(s)
AG anion gap, AGT agitation, ALI acute lung injury/ARDS, AKI acute kidney injury, AP aspiration pneumonitis, BC bradycardia, BP bradypnea, CNS coma/CNS depression, CPT coagulopathy, CRV corrosive injury, DLM delirium, EPS dystonia, GIB GI bleeding, HCN hallucinations, HGY hypoglycemia, HLS hemolysis, HPT hepatoxicity, HT hypotension, HTN hypertension, HYS hemolysis, MA metabolic acidosis, MI myocardial infarction, PLT thrombocytopenia, PNC pancreatitis, QRS QRS prolongation, QTC QTc prolongation, RBM rhabdomyolysis, RD respiratory depression, RFX hyperreflexia/tremor, SZ seizures, TC tachycardia, V vomiting, WBC leukocytosis, CPR cardiopulmonary resuscitation, HIE high-dose insulin euglycemic therapy, NAC n-acetyl cysteine, NaHCO3 sodium bicarbonate
aAge listed in years unless otherwise stated
bPharmacological and non-pharmacological support as reported by medical toxicologist