https://ogma.newcastle.edu.au/vital/access/ /manager/Index en-au 5 https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:47721 1000 U/L). Method: Retrospective review of paracetamol RSTI presentations to two toxicology services over a four-year period. Patients were included if they ingested >4 g per 24 h of paracetamol for a period >8 h, regardless of intent. Data collected included demographics, ingestion history, pathology results, treatments and outcomes. Results: 266 patients were identified with median ingested dose of 9 g per 24 h (IQR: 6–12 g) over a median of 2 days (IQR: 1–5 days). On presentation, paracetamol was detected in 192 (72%), with median concentration of 14 mg/L (IQR: 7–27 mg/L). Median ALT on admission in those developing hepatotoxicity was significantly higher, 1182 U/L (IQR: 598–4251 U/L), compared to 30 U/L (IQR: 18–59 U/L; p < .0001) in those who did not. All 17 who developed hepatotoxicity had an ALT ≥50 U/L on presentation. Five patients presenting with an ALT <50 U/L developed a peak ALT between 50 and 1000 U/L, of which three had a paracetamol concentration <20 mg/L. 139 (52%) received acetylcysteine, of which 64 received an abbreviated course (<20 h), with a median length of infusion of 11 h (IQR: 7–14 h). 127 (48%) patients were not treated with acetylcysteine, none of these patients returned to hospital. Conclusions: Our results confirm that those developing hepatotoxicity from RSTI of paracetamol have an elevated ALT on presentation. Presenting ALT <50 U/L appears to be a safe threshold not to administer acetylcysteine, provided the paracetamol concentration is low.]]> Wed 25 Jan 2023 13:37:11 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:43163 Wed 24 May 2023 08:55:31 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:46919 Wed 07 Dec 2022 10:33:29 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:43173 Tue 13 Sep 2022 16:03:41 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:45457 Thu 17 Aug 2023 11:09:33 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:44786 2.6 nmol/L (2 µg/L). There were no deaths from acute digoxin toxicity. Conclusions: The new practice of using small, titrated doses of Digoxin-Fab led to a considerable reduction in total usage and major savings. The clinical response to titrated doses was safe and acceptable in acute digoxin poisoning.]]> Mon 24 Oct 2022 09:17:30 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:44536 2 (PLA₂), and L-amino acid oxidase (LAAO) – in the venom of 39 species of Australian elapids (40% of terrestrial species diversity) and used linear parsimony and BayesTraits to investigate any correlation between enzyme activity and phylogeny or diet. Results: PLA₂ activity ranged from 0 to 481 nmol/min/mg of venom, and LAAO activity ranged from 0 to 351 nmol/min/mg. Phylogenetic comparative methods, implemented in BayesTraits showed that enzyme activity was strongly correlated with phylogeny, more so for LAAO activity. For example, LAAO activity was absent in both the Vermicella and Pseudonaja/Oxyuranus clade, supporting previously proposed relationships among these disparate taxa. There was no association between broad dietary categories and either enzyme activity. There was strong evidence for faster initial rates of change over evolutionary time for LAAO (delta parameter mean 0.2), but no such pattern in PLA₂ (delta parameter mean 0.64). There were some exceptions to the phylogenetic patterns of enzyme activity: different PLA₂ activity in the ecologically similar sister-species Denisonia devisi and D. maculata; large interspecific differences in PLA₂ activity in Hoplocephalus and Austrelaps. Conclusions: We have shown that phylogeny is a stronger influence on venom enzyme activity than diet for two of the four major enzyme families present in snake venoms. PLA₂ and LAAO activities had contrasting evolutionary dynamics with the higher delta value for PLA₂ Some species/individuals lacked activity in one protein family suggesting that the loss of single protein family may not incur a significant fitness cost.]]> Mon 17 Oct 2022 09:03:36 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:53531 Mon 04 Dec 2023 15:38:31 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:47198 Fri 30 Jun 2023 10:59:49 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:45740  3000 mg were identified in each unit’s database. Excluded were cases of chronic exposure, hospital presentation > 24 hours after ingestion, and cases without a salicylate concentration. Included in our analysis was demographic data, clinical effects, investigations, complications, and treatment. Results: There were 132 presentations in 108 patients (79 females (73%)). The median age was 28 years (range: 13–93 years). The median dose ingested was 7750 mg (IQR: 6000–14,400 mg). There were 44 aspirin-only ingestions. Mild toxicity (nausea, vomiting, tinnitus or hyperventilation) occurred in 22 with a median dose of 160 mg/kg. Moderate toxicity (acid–base disturbance, confusion) occurred in 16 with a median ingested dose of 297 mg/kg. There were no cases of severe toxicity (coma or seizures) due to aspirin alone. The median peak salicylate concentration was 276 mg/L (IQR: 175–400 mg/L, range: 14–814 mg/L). There was a moderate association between dose ingested and peak concentration (Pearson r = 0.58; 95% CI 0.45–0.68). Activated charcoal was administered in 36 (27%) cases, which decreased the median peak salicylate concentration (34.2 to 24.8 mg/L/g (difference: 9.4, 95% CI: 1.0–13.1)). Bicarbonate was administered in 34 (26%) presentations, decreasing the median apparent elimination half-life from 13.4 to 9.3 h (difference: 4.2 h, 95% CI: 1.0–6.5 h). Conclusions: Acute aspirin overdose caused only mild to moderate effects in this series. Early administration of activated charcoal decreased absorption and use of bicarbonate enhanced elimination.]]> Fri 19 Apr 2024 12:58:48 AEST ]]>