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Pesticide poisoning

Chapter by: Chiang, William K; Wang, RY
in: Intensive care medicine by Rippe, James M (Ed)
Boston : Little, Brown, 1995
pp. 1663-1685
ISBN: 9780316747288
CID: 3146152

Validation of a Plant Identification Application Using Digital Images of Toxic Plants [Letter]

Mahonski, Sarah; Furlano, Emma; Chiang, William
PMID: 35084709
ISSN: 1937-6995
CID: 5154682

Antibiotics versus Appendectomy for Acute Appendicitis - Longer-Term Outcomes [Letter]

Davidson, Giana H; Flum, David R; Monsell, Sarah E; Kao, Lillian S; Voldal, Emily C; Heagerty, Patrick J; Fannon, Erin; Lavallee, Danielle C; Bizzell, Bonnie; Lawrence, Sarah O; Comstock, Bryan A; Krishnadasan, Anusha; Winchell, Robert J; Self, Wesley H; Thompson, Callie M; Farjah, Farhood; Park, Pauline K; Alam, Hasan B; Saltzman, Darin; Moran, Gregory J; Kaji, Amy H; DeUgarte, Daniel A; Salzberg, Matthew; Ferrigno, Lisa; Mandell, Katherine A; Price, Thea P; Siparsky, Nicole; Glaser, Jacob; Ayoung-Chee, Patricia; Chiang, William; Victory, Jesse; Chung, Bruce; Carter, Damien W; Kutcher, Matthew E; Jones, Alan; Holihan, Julie; Liang, Mike K; Faine, Brett A; Cuschieri, Joseph; Evans, Heather L; Johnson, Jeffrey; Patton, Joe H; Coleman, Natasha; Fischkoff, Katherine; Drake, F Thurston; Sanchez, Sabrina E; Parsons, Charles; Odom, Stephen R; Kessler, Larry G; Talan, David A
PMID: 34694761
ISSN: 1533-4406
CID: 5042232

Intravenous Acetaminophen Overdose in an Infant With Toxicokinetic Data

Trebach, Joshua; Mahonski, Sarah G; Melchert, Kristina; Howland, Mary Ann; Chiang, William K
CASE REPORT/UNASSIGNED:A 12-month-old (former 24 week gestational age), 8.7 kg male was hospitalized after an uneventful colostomy reversal. In the postoperative unit, the patient unintentionally received 1000 mg IV (114.9 mg/kg) acetaminophen instead of the intended 100 mg IV. Serial acetaminophen concentrations were drawn. The patient received IV Nacetylcysteine and ultimately had no adverse outcomes. DISCUSSION/UNASSIGNED:This case report adds to the existing literature regarding toxicokinetics of IV APAP in infants. Our patient had a calculated ke of 0.263 h-1, correlating with a half-life of 2.63 hours. Based on current available data, the half-life of IV APAP in infants varies (2.6 to 4.9 hours). The reason for this variation is unknown and further research is needed in this area.
PMID: 34080465
ISSN: 1531-1937
CID: 4891722

Comment on "The Incidence of QT Prolongation and Torsades des Pointes in Patients Receiving Droperidol in an Urban Emergency Department"

DiSalvo, Philip C; Backus, Timothy C; Chiang, William K
PMID: 33856328
ISSN: 1936-9018
CID: 4841792

Emergence of Extended-Spectrum β-Lactamase Urinary Tract Infections Among Hospitalized Emergency Department Patients in the United States

Talan, David A; Takhar, Sukhjit S; Krishnadasan, Anusha; Mower, William R; Pallin, Daniel J; Garg, Manish; Femling, Jon; Rothman, Richard E; Moore, Johanna C; Jones, Alan E; Lovecchio, Frank; Jui, Jonathan; Steele, Mark T; Stubbs, Amy M; Chiang, William K; Moran, Gregory J
STUDY OBJECTIVE/OBJECTIVE:Enterobacteriaceae resistant to ceftriaxone, mediated through extended-spectrum β-lactamases (ESBLs), commonly cause urinary tract infections worldwide, but have been less prevalent in North America. Current US rates are unknown. We determine Enterobacteriaceae antimicrobial resistance rates among US emergency department (ED) patients hospitalized for urinary tract infection. METHODS:We prospectively enrolled adults hospitalized for urinary tract infection from 11 geographically diverse university-affiliated hospital EDs during 2018 to 2019. Among participants with culture-confirmed infection, we evaluated prevalence of antimicrobial resistance, including that caused by ESBL-producing Enterobacteriaceae, resistance risk factors, and time to in vitro-active antibiotics. RESULTS:Of 527 total participants, 444 (84%) had cultures that grew Enterobacteriaceae; 89 of 435 participants (20.5%; 95% confidence interval 16.9% to 24.5%; 4.6% to 45.4% by site) whose isolates had confirmatory testing had bacteria that were ESBL producing. The overall prevalence of ESBL-producing Enterobacteriaceae infection among all participants with urinary tract infection was 17.2% (95% confidence interval 14.0% to 20.7%). ESBL-producing Enterobacteriaceae infection risk factors were hospital, long-term care, antibiotic exposure within 90 days, and a fluoroquinolone- or ceftriaxone-resistant isolate within 1 year. Enterobacteriaceae resistance rates for other antimicrobials were fluoroquinolone 32.3%, gentamicin 13.7%, amikacin 1.3%, and meropenem 0.3%. Ceftriaxone was the most common empirical antibiotic. In vitro-active antibiotics were not administered within 12 hours of presentation to 48 participants (53.9%) with ESBL-producing Enterobacteriaceae infection, including 17 (58.6%) with sepsis. Compared with other Enterobacteriaceae infections, ESBL infections were associated with longer time to in vitro-active treatment (17.3 versus 3.5 hours). CONCLUSION/CONCLUSIONS:Among adults hospitalized for urinary tract infection in many US locations, ESBL-producing Enterobacteriaceae have emerged as a common cause of infection that is often not initially treated with an in vitro-active antibiotic.
PMID: 33131912
ISSN: 1097-6760
CID: 4660402

A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis

Flum, David R; Davidson, Giana H; Monsell, Sarah E; Shapiro, Nathan I; Odom, Stephen R; Sanchez, Sabrina E; Drake, F Thurston; Fischkoff, Katherine; Johnson, Jeffrey; Patton, Joe H; Evans, Heather; Cuschieri, Joseph; Sabbatini, Amber K; Faine, Brett A; Skeete, Dionne A; Liang, Mike K; Sohn, Vance; McGrane, Karen; Kutcher, Matthew E; Chung, Bruce; Carter, Damien W; Ayoung-Chee, Patricia; Chiang, William; Rushing, Amy; Steinberg, Steven; Foster, Careen S; Schaetzel, Shaina M; Price, Thea P; Mandell, Katherine A; Ferrigno, Lisa; Salzberg, Matthew; DeUgarte, Daniel A; Kaji, Amy H; Moran, Gregory J; Saltzman, Darin; Alam, Hasan B; Park, Pauline K; Kao, Lillian S; Thompson, Callie M; Self, Wesley H; Yu, Julianna T; Wiebusch, Abigail; Winchell, Robert J; Clark, Sunday; Krishnadasan, Anusha; Fannon, Erin; Lavallee, Danielle C; Comstock, Bryan A; Bizzell, Bonnie; Heagerty, Patrick J; Kessler, Larry G; Talan, David A
BACKGROUND:Antibiotic therapy has been proposed as an alternative to surgery for the treatment of appendicitis. METHODS:We conducted a pragmatic, nonblinded, noninferiority, randomized trial comparing antibiotic therapy (10-day course) with appendectomy in patients with appendicitis at 25 U.S. centers. The primary outcome was 30-day health status, as assessed with the European Quality of Life-5 Dimensions (EQ-5D) questionnaire (scores range from 0 to 1, with higher scores indicating better health status; noninferiority margin, 0.05 points). Secondary outcomes included appendectomy in the antibiotics group and complications through 90 days; analyses were prespecified in subgroups defined according to the presence or absence of an appendicolith. RESULTS:In total, 1552 adults (414 with an appendicolith) underwent randomization; 776 were assigned to receive antibiotics (47% of whom were not hospitalized for the index treatment) and 776 to undergo appendectomy (96% of whom underwent a laparoscopic procedure). Antibiotics were noninferior to appendectomy on the basis of 30-day EQ-5D scores (mean difference, 0.01 points; 95% confidence interval [CI], -0.001 to 0.03). In the antibiotics group, 29% had undergone appendectomy by 90 days, including 41% of those with an appendicolith and 25% of those without an appendicolith. Complications were more common in the antibiotics group than in the appendectomy group (8.1 vs. 3.5 per 100 participants; rate ratio, 2.28; 95% CI, 1.30 to 3.98); the higher rate in the antibiotics group could be attributed to those with an appendicolith (20.2 vs. 3.6 per 100 participants; rate ratio, 5.69; 95% CI, 2.11 to 15.38) and not to those without an appendicolith (3.7 vs. 3.5 per 100 participants; rate ratio, 1.05; 95% CI, 0.45 to 2.43). The rate of serious adverse events was 4.0 per 100 participants in the antibiotics group and 3.0 per 100 participants in the appendectomy group (rate ratio, 1.29; 95% CI, 0.67 to 2.50). CONCLUSIONS:For the treatment of appendicitis, antibiotics were noninferior to appendectomy on the basis of results of a standard health-status measure. In the antibiotics group, nearly 3 in 10 participants had undergone appendectomy by 90 days. Participants with an appendicolith were at a higher risk for appendectomy and for complications than those without an appendicolith. (Funded by the Patient-Centered Outcomes Research Institute; CODA number, NCT02800785.).
PMID: 33017106
ISSN: 1533-4406
CID: 4669442

Acetaminophen poisoning: reclaiming the definition of recovery [Letter]

DiSalvo, Philip C; Chiang, William K; Wang, Josh J
PMID: 32400217
ISSN: 1556-9519
CID: 4438102

Laboratory variability in reporting salicylate levels may limit high-quality poison center recommendations [Meeting Abstract]

Backus, Timothy C.; Disalvo, Philip C.; Furlano, Emma R.; Ali, Khameinei; Chiang, William K.; Wang, Josh J.
ISSN: 1556-3650
CID: 4491752

Valproic acid reporting cutoffs impact poison control recommendations [Meeting Abstract]

Furlano, Emma R.; Disalvo, Philip C.; Backus, Timothy C.; Ali, Khameinei; Chiang, William K.; Wang, Josh J.
ISSN: 1556-3650
CID: 4491762