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Hospital Medicine

Acetaminophen overdose

I. What every physician needs to know. Acetaminophen is a common toxic ingestion, resulting in over 400 deaths from fulminant hepatic failure in the United States each year. This ubiquitous over-the counter analgesic has been found to be safe in daily ingestions of less than 4gm daily. However, larger ingestions can be deadly, resulting in…
Hospital Medicine

Salicylate toxicity

I. What every physician needs to know. Salicylate toxicity, or salicylism, can occur from acute ingestion of a single large dose of salicylates, or it can occur from lower doses taken over a longer period of time. Salicylates are contained in many prescription and non-prescription products, from acetylsalicylic acid (aspirin), to methyl salicylate (oil of…
Hospital Medicine

Depression and Bipolar

I. What every physician needs to know. Depression and mania are serious disease states with significant morbidity and mortality. Patients with depressive symptoms should be screened for active suicidality, and if present, should be hospitalized if they are high risk. Mania is a medical emergency. Most patients with a manic episode should be hospitalized and…


Methemoglobinemia What every physician needs to know about methemoglobinemia: Methemoglobinemia is a condition in which the oxidation/reduction state of hemoglobin iron is pathologically altered, as described below. It can result from rare congenital abnormalities in the redox system of the red cell, or from toxic oxygen exposure. Those exposures, if of sufficient magnitude, can be…
Nephrology Hypertension

Pharmacology and Toxicology: Treatment of Poisons – Lithium Intoxication

Does this patient have lithium intoxication? Description of the problem Lithium has become one of the essential drugs of modern psychiatry. It is a first line medication for bipolar disorders and it also has efficacy in the treatment of major depression. It is the only medication that has been shown to decrease the suicide risk…
Hospital Medicine

Aspirin toxicity

Aspirin is a common over-the-counter medication valued for its anti-inflammatory, analgesic and antipyretic properties. However it can be highly toxic or even fatal with intentional or accidental overdose. Aspirin directly stimulates cerebral respiratory centers and inhibits the citric acid cycle, causing uncoupling of oxidative phosphorylation which ultimately leads to lactic acidosis. Patients who present with…
Hospital Medicine

Alcohol toxicity

Alcohol toxicity or poisoning is caused by drinking large quantities of alcohol in a short period of time. According to Centers for Disease Control (CDC) data released January 2015, an average of 6 people died of alcohol poisoning each day in the US from 2010-2012. Seventy-six percent of alcohol poisoning deaths are among adults ages…
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