Road traffic accidents in Kathmandu—an hour of education yields a glimmer of hope

After the Metropolitan Traffic Police, Kathmandu initiated a “No Drinking and Driving” policy in 2011 in which a major intervention for intoxicated drivers was mandatory 1-hour class to modify drunk driving behaviors, reports show that the number of road traffic accidents in the year 2012 decreased by 23 percent from the year 2011. The injury to fatality ratio decreased by 21 percent in this period. We remain encouraged by these statistics which confirm that increased enforcement of road traffic rules, combined with behavioral change programs, can have positive changes in LMICs which suffer considerably from the global burden of trauma

The Poison Pen: Bedside Diagnosis of Urinary Diquat

Diquat is a bipyridyl herbicide with nephrotoxic effects. This in vitro study demonstrates a colorimetric test for detection of diquat in human urine. Urine specimens using ten concentrations of diquat herbicide solution and controls for urine and glyphosate were prepared. A two-step assay (addition of bicarbonate followed by sodium dithionite) was performed, with a resulting color change of the original solution for each specimen. Color change intensity was noted immediately and after 30 min, by gross visual inspection. A green color with concentration-dependent intensity was detected in all specimens, in which concentrations of diquat solution ranged from 0.73 to 730 mg/L. This colorimetric effect disappeared after 30 min. The sodium bicarbonate/dithionite test may be useful as a qualitative bedside technique for the detection of urinary diquat in the appropriate clinical setting

Road traffic accidents in Kathmandu¿an hour of education yields a glimmer of hope

Abstract After the Metropolitan Traffic Police, Kathmandu initiated a “No Drinking and Driving” policy in 2011 in which a major intervention for intoxicated drivers was mandatory 1-hour class to modify drunk driving behaviors, reports show that the number of road traffic accidents in the year 2012 decreased by 23 percent from the year 2011. The injury to fatality ratio decreased by 21 percent in this period. We remain encouraged by these statistics which confirm that increased enforcement of road traffic rules, combined with behavioral change programs, can have positive changes in LMICs which suffer considerably from the global burden of trauma

Methylene Blue Is Effective to Reverse Refractory Hemodynamic Instability due to Dimethoate Poisoning

Background:Organophosphates are commercially available agrochemicals for pest control, but may be abused for deliberate self-poisoning. We report a case of suicidal ingestion of dimethoate, a moderately toxic organophosphate insecticide, which can cause refractory hemodynamic instability, and the successful use of methylene blue (MB) for counteracting this complication. Case Presentation: An unconscious 47-year-old man was referred to emergency department with history of dimethoate ingestion. He rapidly developed hypotension that was refractory to antidotes, resuscitative hydration and multiple vasopressors including norepinephrine, epinephrine and vasopressin. Pulmonary artery catheterization revealed high cardiac output and low peripheral vascular resistance consistent with distributive shock, a complication previously reported in the setting of acute dimethoate toxicity. MB was initiated for the patient and improved hemodynamic status (increased MAP, systolic and diastolic blood pressures) and seized vasopressor requirement. Laboratory tests revealed that on-admission plasma cholinesterase level and dimethoate serum level were 2247 U and 56 μg/mL, respectively. The patient required 2 week ICU course with eventual tracheotomy for ventilation and later transferred to step down level of care. Discussion:Although MB therapy has been reported to be useful in managing sepsis-induced hypotension, there has been no similar report of its use in organophosphate poisoning. Our patient had no objective evidence for sepsis, and MB infusion improved hemodynamics within 6 hours and the effect was continued even after discontinuation of the therapy. The underlying mechanism of dimethoate-induced hypotension might be related to increase in nitric oxide (NO) formation. MB is effective to inhibit NO synthase. Conclusion:MB treatment was effective to reverse hypotension and restore hemodynamic instability caused by dimethoate poisoning. This index case may pave way to further investigation of MB therapy for OP-induced hemodynamic instabilities

Pediatric Exposures to Topical Benzocaine Preparations Reported to a Statewide Poison Control System

Introduction: Topical benzocaine is a local anesthetic commonly used to relieve pain caused byteething, periodontal irritation, burns, wounds, and insect bites. Oral preparations may containbenzocaine concentrations ranging from 7.5% to 20%. Pediatric exposure to such large concentrationsmay result in methemoglobinemia and secondarily cause anemia, cyanosis, and hypoxia.Methods: This is a retrospective study of exposures reported to a statewide poison controlsystem. The electronic health records were queried for pediatric exposures to topical benzocainetreated at a healthcare facility from 2004 to 2014. Cases of benzocaine exposure were reviewedfor demographic and clinical information, and descriptive statistical analysis was performed.Results: The query resulted in 157 cases; 58 were excluded due to co-ingestants, or miscodingof non-benzocaine exposures. Children four years of age and younger represented the majorityof cases (93%) with a median age of 1 year. There were 88 cases of accidental/ exploratoryexposure, while 6 cases resulted from therapeutic application or error, 4 cases from adversereactions, and 1 case from an unknown cause. Asymptomatic children accounted for 75.5%of cases, but major clinical effects were observed in 5 patients. Those with serious effectswere exposed to a range of benzocaine concentrations (7.5-20%), with 4 cases reportingmethemoglobin levels between 20.2%-55%. Methylene blue was administered in 4 of the casesexhibiting major effects.Conclusion: The majority of exposures were accidental ingestions by young children. Most exposuresresulted in minor to no effects. However, some patients required treatment with methylene blue andadmission to a critical care unit. Therapeutic application by parents or caregivers may lead to adverseeffects from these commonly available products. [West J Emerg Med.2017;18(5)923–927.

Pediatric Exposures to Topical Benzocaine Preparations Reported to a Statewide Poison Control System

Introduction: Topical benzocaine is a local anesthetic commonly used to relieve pain caused by teething, periodontal irritation, burns, wounds, and insect bites. Oral preparations may contain benzocaine concentrations ranging from 7.5% to 20%. Pediatric exposure to such large concentrations may result in methemoglobinemia and secondarily cause anemia, cyanosis, and hypoxia. Methods: This is a retrospective study of exposures reported to a statewide poison control system. The electronic health records were queried for pediatric exposures to topical benzocaine treated at a healthcare facility from 2004 to 2014. Cases of benzocaine exposure were reviewed for demographic and clinical information, and descriptive statistical analysis was performed. Results: The query resulted in 157 cases; 58 were excluded due to co-ingestants, or miscoding of non-benzocaine exposures. Children four years of age and younger represented the majority of cases (93%) with a median age of 1 year. There were 88 cases of accidental/ exploratory exposure, while 6 cases resulted from therapeutic application or error, 4 cases from adverse reactions, and 1 case from an unknown cause. Asymptomatic children accounted for 75.5% of cases, but major clinical effects were observed in 5 patients. Those with serious effects were exposed to a range of benzocaine concentrations (7.5–20%), with 4 cases reporting methemoglobin levels between 20.2%–55%. Methylene blue was administered in 4 of the cases exhibiting major effects. Conclusion: The majority of exposures were accidental ingestions by young children. Most exposures resulted in minor to no effects. However, some patients required treatment with methylene blue and admission to a critical care unit. Therapeutic application by parents or caregivers may lead to adverse effects from these commonly available products

Pediatric Exposures to Topical Benzocaine Preparations Reported to a Statewide Poison Control System

Introduction: Topical benzocaine is a local anesthetic commonly used to relieve pain caused by teething, periodontal irritation, burns, wounds, and insect bites. Oral preparations may contain benzocaine concentrations ranging from 7.5% to 20%. Pediatric exposure to such large concentrations may result in methemoglobinemia and secondarily cause anemia, cyanosis, and hypoxia. Methods: This is a retrospective study of exposures reported to a statewide poison control system. The electronic health records were queried for pediatric exposures to topical benzocaine treated at a healthcare facility from 2004 to 2014. Cases of benzocaine exposure were reviewed for demographic and clinical information, and descriptive statistical analysis was performed. Results: The query resulted in 157 cases; 58 were excluded due to co-ingestants, or miscoding of non-benzocaine exposures. Children four years of age and younger represented the majority of cases (93%) with a median age of 1 year. There were 88 cases of accidental/ exploratory exposure, while 6 cases resulted from therapeutic application or error, 4 cases from adverse reactions, and 1 case from an unknown cause. Asymptomatic children accounted for 75.5% of cases, but major clinical effects were observed in 5 patients. Those with serious effects were exposed to a range of benzocaine concentrations (7.5–20%), with 4 cases reporting methemoglobin levels between 20.2%–55%. Methylene blue was administered in 4 of the cases exhibiting major effects. Conclusion: The majority of exposures were accidental ingestions by young children. Most exposures resulted in minor to no effects. However, some patients required treatment with methylene blue and admission to a critical care unit. Therapeutic application by parents or caregivers may lead to adverse effects from these commonly available products

Parenteral organophosphorus poisoning in a rural emergency department: a case report

BACKGROUND: Poisoning is a common presentation in the emergency department. Oral exposures to organophosphorus compounds are especially frequent in rural and agricultural regions of South Asia and throughout the developing world. CASE PRESENTATION: Here we report a case of deliberate self-harm with an organophosphorus pesticide via the relatively uncommon parenteral route. A young woman injected herself with chlorpyriphos. Although the cholinergic effects were mild, cellulitis and abscess development were noted as a result. CONCLUSION: Resource limited agricultural countries like Nepal present health care workers with numerous challenges in poisoning management. This case represents a rare but potentially morbid method of agrochemical poison exposure