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Fellows And Members Survey Of The Royal College Of Physicians Of Edinburgh, Alison Jones, S Lewis, D Doyle, R Agius, D Lawson
Fellows And Members Survey Of The Royal College Of Physicians Of Edinburgh, Alison Jones, S Lewis, D Doyle, R Agius, D Lawson
Alison L Jones
No abstract provided.
Mercury: Answering Some Of The Current Controversies About It, David M. Wood, Paul I. Dargan, Alison L. Jones
Mercury: Answering Some Of The Current Controversies About It, David M. Wood, Paul I. Dargan, Alison L. Jones
Alison L Jones
Recently there has been a lot of interest in the medical and lay press concerning exposure to mercury and its potential toxic effects. Mercury is a naturally occurring metallic element, which can be found as Hg or inorganic and organic salts. In this article we will review the risks of exposure and toxicity of each of the forms of mercury, including some of the current guidance concerning the risks of mercury toxicity from eating fish, dental amalgam and vaccinations containing mercury (thiomersal) preservatives.
Collapse, Reported Seizure-And An Unexpected Pill, David Wood, Paul Dargan, Jennifer Button, David Holt, Hanna Ovaska, John Ramsey, Alison Jones
Collapse, Reported Seizure-And An Unexpected Pill, David Wood, Paul Dargan, Jennifer Button, David Holt, Hanna Ovaska, John Ramsey, Alison Jones
Alison L Jones
In May, 2006, on a Bank Holiday weekend, an 18-year-old woman presented to an inner-city London emergency department. She had been at a nightclub with friends and purchased tablets, which she understood to be Ecstasy or amfetamines, from a dealer. After ingesting fi ve tablets, she collapsed in the nightclub and appeared to have a seizure lasting 10 min. On arrival in the emergency department, she was agitated and had dilated pupils (8 mm), sinus tachycardia (156 bpm), and a blood pressure of 150/51 mm Hg. Her score on the Glasgow coma scale was 15 and she was apyrexial (35·9°C). …
Severe Hypokalaemic Metabolic Alkalosis Following Ingestion Of Gaviscon, I Gawarammana, J Coburn, S Greene, Paul Dargan, Alison Jones
Severe Hypokalaemic Metabolic Alkalosis Following Ingestion Of Gaviscon, I Gawarammana, J Coburn, S Greene, Paul Dargan, Alison Jones
Alison L Jones
Uncommon metabolic abnormalities in the emergency department could be a result of drug overdose due to uncommon agents. Case report. A 35-year-old male presented to the emergency department with a Glasgow Coma Scale (GCS) of 3/15 and a normal pulse rate and blood pressure. Subsequent questioning after recovery revealed he had ingested 2 L of Gaviscon® over the preceding 48 hours. He had normal haematology, liver, and renal function during admission. The electrocardiogram showed T wave inversion in the inferior leads on admission. Arterial blood gas on air was: pH 7.54, HCO3 50 mmol/L (50 meq/L), Chloride 66 mmol/L, anion …
Should All Patients With Unexplained Anaemia Be Screened For Chronic Lead Poisoning?, I Gawarammana, Paul Dargan, S Woodcock, M Sculley, Ivan House, David Wood, Alison Jones
Should All Patients With Unexplained Anaemia Be Screened For Chronic Lead Poisoning?, I Gawarammana, Paul Dargan, S Woodcock, M Sculley, Ivan House, David Wood, Alison Jones
Alison L Jones
No abstract provided.
Portal And Systemic Haemodynamic Response To Acute And Chronic Administration Of Low And High Dose Isosorbide-5-Mononitrate In Patients With Cirrhosis, Alison Jones, I Bangash, James Walker, K Simpson, N Finlayson, P Hayes
Portal And Systemic Haemodynamic Response To Acute And Chronic Administration Of Low And High Dose Isosorbide-5-Mononitrate In Patients With Cirrhosis, Alison Jones, I Bangash, James Walker, K Simpson, N Finlayson, P Hayes
Alison L Jones
Oral isosorbide-5-mononitrate (Is-5-Mn) was given in doses of 10 and 40 mg acutely and chronically (twice daily for four weeks), allowing a nitrate free interval to 25 patients with cirrhosis. Both 10 mg and 40 mg Is-S-Mn reduced the hepatic venous pressure gradient acutely and chronically, without evidence of tolerance. This was achieved by a reduction in the wedged hepatic venous pressure. The effect on mean azygos blood flow was variable with no significant mean change seen acutely or after chronic use with either dose. The variability was dependent not on the dose used but on the initial azygos flow; …
Dimercaprol, Alison Jones, Robert Flanagan
Atypical Antipsychotics Not Recommended For Control Of Agitation In The Emergency Department [10], K Whelan, Paul Dargan, Alison Jones
Atypical Antipsychotics Not Recommended For Control Of Agitation In The Emergency Department [10], K Whelan, Paul Dargan, Alison Jones
Alison L Jones
We read with concern the article by Yildiz et al, regarding the recommended use of atypical antipsychotics for the control of agitated patients in the emergency department.1 Our concern rests mainly with the control of agitation secondary to drug ingestion, particularly sympathomimetic drugs of misuse (cocaine, MDMA ‘‘ecstasy’’, and amphetamines), and antidepressants (SSRIs, tricyclic antidepressants, MAOIs).
The Authors Reply, N.T.C Athuraliya, T.D.J Abeysekera, P Amerasinghe, R.P.V Kumarasiri, P Bandara, U Karunaratne, A Milton, Alison Jones
The Authors Reply, N.T.C Athuraliya, T.D.J Abeysekera, P Amerasinghe, R.P.V Kumarasiri, P Bandara, U Karunaratne, A Milton, Alison Jones
Alison L Jones
No abstract provided.
Methionine Risks Not Established, Alison Jones
Insufficient Evidence That Agitation Is Common In Y-Hydroxybutyrate Toxicity, David Wood, Indika Gawarammana, Shaun Greene, Paul Dargan, Alison Jones
Insufficient Evidence That Agitation Is Common In Y-Hydroxybutyrate Toxicity, David Wood, Indika Gawarammana, Shaun Greene, Paul Dargan, Alison Jones
Alison L Jones
Zvosec and Smith have reported that agitation is common in patients who present with c-hydroxybutyrate (GHB) toxicity. Previously, many clinicians would be aware that people withGHBtoxicity typically present with sedation, respiratory depression, and, potentially, coma if severely intoxicated. The authors’ finding that agitation is common in patients with GHB toxicity should alert physicians to other previously unreported potential clinical manifestations of GHB intoxication or to consider intoxication with other agents that cause agitation, such as amphetamine derivatives. However, the data the authors have presented from their observational study do not support their conclusion that agitation is common in people with …
Paracetamol: Balancing Risk Against Benefit, Paul Dargan, Alison Jones
Paracetamol: Balancing Risk Against Benefit, Paul Dargan, Alison Jones
Alison L Jones
No abstract provided.
Comparison Of Assays For Measuring Plasma Paracetamol. Possibility Of Calibration Error Needs Evaluation, Alison L. Jones, D R. Jarvie, D Simpson, L F. Prescott
Comparison Of Assays For Measuring Plasma Paracetamol. Possibility Of Calibration Error Needs Evaluation, Alison L. Jones, D R. Jarvie, D Simpson, L F. Prescott
Alison L Jones
Egleston et al report a significant difference in plasma paracetamol concen trations assayed with the AcetaSite bench assay and a standard laboratory assay. Rapid and accurate determinations of plasma paracetamol concentrations are crucial in the expeditious and appropriate administration of antidotal treatment, which prevents severe liver damage if given sufficiently early in the course of poisoning.
What's New In Toxicology?, Alison Jones, Paul Dargan
What's New In Toxicology?, Alison Jones, Paul Dargan
Alison L Jones
Poisoning in children under 5 years of age is common, the majority of cases are accidental ingestions. Children may ingest pharmaceutical products, household substances, chemicals, plants or street drugs. Most children develop no clinical features or only mild effects and the challenge in managing these children is to identify the 1% who may go on to develop severe clinical effects and require specific management. The latest guidelines on gastric decontamination are reviewed together with developments in the management of poisoning with paracetamol, tricyclic antidepressants, iron, lead and ethylene glycol and methanol. Prevention of childhood poisoning is important and the use …
Reduced Packet Sizes May Decrease Paracetamol And Salicylate Self-Poisoning, Paul Dargan, Alison Jones
Reduced Packet Sizes May Decrease Paracetamol And Salicylate Self-Poisoning, Paul Dargan, Alison Jones
Alison L Jones
BACKGROUND Paracetamol is commonly used in cases of deliberate self-poisoning. Overdoses are a major cause of liver failure in the United Kingdom. Legislation introduced in September 1998 aimed to reduce such incidents by restricting the size of over-the-counter paracetamol packaging and including specific health warnings. OBJECTIVE To evaluate the effect of legislative changes restricting ‘over the counter’ paracetamol and salicylate package sizes on self-poisoning rates. SETTING Five liver units and seven general hospitals, United Kingdom; September 1996-September 1999. METHOD Before and after observational study.
How Feasible Is It To Conform To The European Guidelines On Administration Of Activated Charcoal Within One Hour Of An Overdose?, A Karim, S Ivatts, Paul Dargan, Alison Jones
How Feasible Is It To Conform To The European Guidelines On Administration Of Activated Charcoal Within One Hour Of An Overdose?, A Karim, S Ivatts, Paul Dargan, Alison Jones
Alison L Jones
Objectives—The European and American position statement on the use of activated charcoal recommends its administration within an hour of ingestion of a charcoal binding poison. But in reality, this time limit is difficult to follow for the majority of poisoned patients. This study aimed to examine the treatment of acutely poisoned patients with activated charcoal in an accident and emergency (A&E) department. Methods—63 patients who had taken potentially serious overdoses and required hospital admission from a London teaching hospital A&E department were identified over a six month period. The patients’ case notes were analysed for age, sex, substances taken, and …
Over-The-Counter Analgesics: A Toxicology Perspective., Alison Jones
Over-The-Counter Analgesics: A Toxicology Perspective., Alison Jones
Alison L Jones
The decision to use any analgesic is a balance of benefit and risk. In the case of analgesics, it is important to balance the therapeutic benefit against both the risk in therapeutic use and the risk (and ease of treatment) in overdose. Paracetamol in therapeutic dose carries little risk of adverse events. Less than 0.1% of the estimated 30 million paracetamol users in the United Kingdom attend hospital with a paracetamol overdose each year, and approximately 200 people die, most of whom presented late or did not receive the antidote, N-acetylcysteine, within 12 hours. Nonsteroidal anti-inflammatory drugs (NSAIDs) have greater …
Doctors' Knowledge Of The Appropriate Use And Route Of Administration Of Antidotes In The Management Of Recreational Drug Toxicity, S Lidder, Hanna Ovaska, J.R.H Archer, S Greene, Alison Jones, Paul Dargan, David Wood
Doctors' Knowledge Of The Appropriate Use And Route Of Administration Of Antidotes In The Management Of Recreational Drug Toxicity, S Lidder, Hanna Ovaska, J.R.H Archer, S Greene, Alison Jones, Paul Dargan, David Wood
Alison L Jones
Background: Specific antidotes (eg, naloxone, flumazenil, cyproheptadine and benzodiazepines) are available for the management of certain recreational drug-induced toxicities. Some controversies surround the use of some of these antidotes, especially flumazenil in benzodiazepine toxicity. There are no previously published data on doctors’ knowledge of the use of these specific antidotes. Methods: A questionnaire survey was designed to determine internal/emergency medicine doctors’ knowledge of the appropriate use of antidotes in the management of clinical scenarios of acutely poisoned patients. For nine simulated clinical scenarios of acute toxicity from recreational drugs (benzodiazepines, cocaine, N-methyl-L-(3, 4-methylene-dioxyphenyl)-2-aminopropane (MDMA)-induced serotonin toxicity and opioids), they were …
Naloxone In Opioid Poisoning: Walking The Tightrope, Simon Clarke, Paul Dargan, Alison Jones
Naloxone In Opioid Poisoning: Walking The Tightrope, Simon Clarke, Paul Dargan, Alison Jones
Alison L Jones
Acute opioid intoxication and overdose are common causes of presentation to emergency departments. Although naloxone, a pure opioid antagonist, has been available for many years, there is still confusion over the appropriate dose and route of administration. This article looks at the reasons for this uncertainty and undertakes a literature review from which a treatment algorithm is presented.
Lesson Of The Week: Alcohol Hand Rubs - Hygiene And Hazard, J.R.H Archer, David M. Wood, Zoe Tizzard, Alison L. Jones, Paul I. Dargan
Lesson Of The Week: Alcohol Hand Rubs - Hygiene And Hazard, J.R.H Archer, David M. Wood, Zoe Tizzard, Alison L. Jones, Paul I. Dargan
Alison L Jones
Hospital acquired infections are common and increase morbidity, mortality, and length of stay. The benefit of hand washing has been highlighted, and studies have shown that alcohol hand rub is significantly better than soap in reducing hand contamination. In 2004, NHS trusts were advised to introduce “near patient” alcohol based hand rubs (for example, attached beds and at entrances to wards) by April 2005. With the widespread introduction of these hand rubs, risk assessments were made for the possibility of fire and ingestion. Although alcohol hand rub is flammable, no incidents involving fire have occurred. The risk of ingestion was …
Gut Decontamination Of Acutely Poisoned Patients: What Do Doctors Really Know About It?, David Wood, S Greene, Alison Jones, Paul Dargan
Gut Decontamination Of Acutely Poisoned Patients: What Do Doctors Really Know About It?, David Wood, S Greene, Alison Jones, Paul Dargan
Alison L Jones
There are consensus guidelines on the appropriate use of gut decontamination in the management of poisoned patients. This study demonstrates that few doctors have read these guidelines and that they have poor knowledge of the use of gut decontamination, which can be improved with specific clinical toxicology teaching. Future guidelines should be published in journals more widely read by those doctors treating poisoned patients.
Neuroleptic Malignant Syndrome Or A Statin Drug Reaction? A Case Report, Joyce Cooper, Alison Jones
Neuroleptic Malignant Syndrome Or A Statin Drug Reaction? A Case Report, Joyce Cooper, Alison Jones
Alison L Jones
A 60-year-old woman with a long psychiatric history presented with delirium and mutism. She was febrile, with marked limb rigidity and elevated creatinine kinase (CK) level. Current medications included pericyazine. Current or recent use of dopamine-blocking agents, such as pericyazine, together with a disturbance in conscious state, autonomic dysfunction, and an elevated CK level may be suggestive of neuroleptic malignant syndrome (NMS). The diagnosis was confirmed as NMS, and she was successfully treated with bromocriptine. Eight years later, she represents with symptoms suggesting recurrence of NMS including elevated CK level and myalgia, however, without limb rigidity. Current medications include quetiapine, …
Eye Drops - The Hidden Poison, Alison Jones, J Keighley, W Gold, A Good
Eye Drops - The Hidden Poison, Alison Jones, J Keighley, W Gold, A Good
Alison L Jones
Eye drops are very commonly prescribed bur their potential for systemic absorption and serious toxicity may be forgotten. This paper examines patterns of prescription of eye drops in Scotland by general practitioners. A review of the serious systemic features and toxicity and their management, of commonly used eye drops is undertaken. Practical recommendations for the monitoring of such effects in clinical practice are made.
Drug Abusers And Poisoned Patients: A Potential Source Of Organs For Transplantation?, Alison Jones, K Simpson
Drug Abusers And Poisoned Patients: A Potential Source Of Organs For Transplantation?, Alison Jones, K Simpson
Alison L Jones
One of the major constraints to transplantation of solid organs is lack of availability of grafts and any attempt to use all available donors is to be welcomed. We address the possibility of expanding the transplant donor pool by inclusion of more patients who have suffered intoxication with drugs premortem. Particularly important in this context is the exclusion of organ-specific damage, and also infective risk to the potential recipient due to viral causes in the donor.
Lessons Learned On Lead Poisoning In Children: One-Hundred Years On From Turner's Declaration, Mark Taylor, Carolyn Schniering, Bruce Lanphear, Alison Jones
Lessons Learned On Lead Poisoning In Children: One-Hundred Years On From Turner's Declaration, Mark Taylor, Carolyn Schniering, Bruce Lanphear, Alison Jones
Alison L Jones
There is significant emerging evidence showing life-long negative health, intellectual and socio-behavioural impacts as a result of childhood blood lead concentrations well below the widely used intervention level of 10 mg/dL. This issue raises serious health concerns for children in several Australian smelting and mining towns. Routine educational and home cleanliness advice to wet mop floors rather than to use a brush and pan to reduce lead exposure risks have been shown to have limited efficacy. This paper argues, as advocated 100 years ago by Queensland doctor Alfred Jefferis Turner, that childhood lead poisoning can only be mitigated via primary …
Drug Misuse Should Always Be Considered In Young People With Impaired Consciousness, K R. Whelan, Alison L. Jones, Paul I. Dargan
Drug Misuse Should Always Be Considered In Young People With Impaired Consciousness, K R. Whelan, Alison L. Jones, Paul I. Dargan
Alison L Jones
We agree with Ikeda et al that the absence of systolic hypertension may provide some discriminatory power towards exclusion of brain lesions, be they ischaemic, haemorrhagic, or space occupying in nature.1 However, we disagree with them that neurological examination of patients with impaired consciousness is often a waste of time and resources and can delay diagnosis.
Toxicologie D'Urgence, Alison Jones, Paul Dargan
Antidotes To Cyanide, Robert Flanagan, Alison Jones
Antidotes To Cyanide, Robert Flanagan, Alison Jones
Alison L Jones
No abstract provided.
Analysis Of Serial Serum Alpha-Fetoprotein Concentrations In Patients With Cirrhosis, Alison Jones, J Plevris, C Shearing, I.A.D Bouchier, P Hayes
Analysis Of Serial Serum Alpha-Fetoprotein Concentrations In Patients With Cirrhosis, Alison Jones, J Plevris, C Shearing, I.A.D Bouchier, P Hayes
Alison L Jones
No abstract provided.
Deconstructing Cancer: What Makes A Good-Quality News Story?, Amanda Wilson, Billie Bonevski, Alison Jones, David Henry
Deconstructing Cancer: What Makes A Good-Quality News Story?, Amanda Wilson, Billie Bonevski, Alison Jones, David Henry
Alison L Jones
Objective: To describe an in-depth analysis of the content and quality of stories about new cancer interventions in Australian media. Design and setting: Search of the Media Doctor Australia media-monitoring website for stories about newly reported cancer interventions, including drugs, diagnostic tests, surgery and complementary therapies, that had been collected from June 2004 to June 2009 and rated for quality using a validated rating instrument. A mixed-methods approach was used to analyse data and story content. Data from the website on stories about other new health interventions and procedures were compared. Main outcome measures: Differences in quality scores between cancer-related …