Second Edition Atlas of HUMAN POISONING and ENVENOMING Second Edition Atlas of HUMAN POISONING and ENVENOMING James H. Diaz LSUHSC School of Public Health New Orleans, Louisiana, USA Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2015 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20140903 International Standard Book Number-13: 978-1-4665-0541-4 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. 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Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Section i General Medical toxicology Chapter 1 The Pharmacology of Human Poisoning and Envenoming . . . . . . . . . . . . . . . . . . 3 Chapter 2 General Poisoning Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Chapter 3 Diagnostic Work-Up of the Poisoned Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Chapter 4 Poison Antidotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53 Chapter 5 Toxicity of Antiseptics and Drug Additives . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81 Chapter 6 Poisonings with Over-the-Counter and Opioid Analgesics . . . . . . . . . . . . . . . . . 89 Chapter 7 Household Product Poisonings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105 Chapter 8 Drug and Illicit Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Chapter 9 Anticonvulsants and Sedative-Hypnotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 v vi Atlas of Human Poisoning and Envenoming Chapter 10 Reproductive and Perinatal Toxicology and Teratogenesis . . . . . . . . . . . . . . . 217 Chapter 11 Hypoglycemic and Other Endocrine Agent Toxicity . . . . . . . . . . . . . . . . . . . . 233 Chapter 12 Cardiovascular Drug Toxicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 Chapter 13 Antibiotic Toxicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 Chapter 14 Anticancer Drug Toxicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269 Chapter 15 Environmental and Occupational Nephrotoxicology . . . . . . . . . . . . . . . . . . . .281 Chapter 16 Neurotoxicology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309 Section ii environmental toxicology Chapter 17 Food Poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .359 Chapter 18 Seafood Poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379 Chapter 19 Mushroom Poisonings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395 Chapter 20 Herbal Poisonings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413 Chapter 21 Common Poisonous Household and Garden Plants . . . . . . . . . . . . . . . . . . . . . 443 Chapter 22 Bites and Stings: Terrestrial Envenomings . . . . . . . . . . . . . . . . . . . . . . . . . . . .477 Chapter 23 Common Arthropod Vectors of Infectious Diseases . . . . . . . . . . . . . . . . . . . .525 Chapter 24 Tick Paralysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .557 Contents vii Chapter 25 Bites and Stings: Marine Envenomings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 569 Chapter 26 Voodoo, Hoodoo, and Cajun Traditions and Poisonings . . . . . . . . . . . . . . . . . 583 Section iii industrial and occupational toxicology Chapter 27 Volatile Organic Chemicals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 613 Chapter 28 Petrochemical Toxicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .629 Chapter 29 Industrial Gas Exposures and Occupational Lung Diseases . . . . . . . . . . . . . . 645 Chapter 30 Metal and Metalloid Poisonings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .673 Chapter 31 Pesticide Poisonings: Insecticides, Rodenticides, and Herbicides . . . . . . . . . . 707 Chapter 32 Radiation Toxicology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 727 Chapter 33 Chemical, Biological, and Radiological Weapons and Warfare . . . . . . . . . . . . 747 Chapter 34 Workplace Substance Abuse Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . .769 Chapter 35 Miscellaneous Toxicants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 813 Section iV epidemiology and Statistics for toxicology Chapter 36 Epidemiology and Statistics for Toxicology . . . . . . . . . . . . . . . . . . . . . . . . . . .843 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 855 Preface Since the first edition of this atlas was published in 2006, there have been many changes in the manner in which clinicians are examined for clinical competencies during their residencies, certified in their primary and secondary fields after completing training, and peri- odically recertified in all areas of their expertise . Some significant changes include annual com- puter-based examinations with passing scores required for residents to progress to advanced levels; computer-based national board certification examinations administered near the end of residency training and later after fellowships or periods of active practice; and computer-based national recertification examinations every 10 years . Today, most provider organizations, hos- pital staffs, and health insurance companies require proof of recertification by examination for their medical providers to maintain hospital practice privileges and to qualify for reimburse- ments of services . All these required examinations share similarly structured test questions that are now rede- signed to assess clinical acumen and judgment rather than rote recall . Frequently, the test ques- tions will begin with an image of a patient, a radiograph or electrocardiogram, a lesion or wound, or a venomous animal or plant . Following a short vignette of the clinical encounter, typically a mini-history and physical examination, the examinee will face a series of multiple- choice questions based on the image and its vignette . Since the images are rarely analyzed or interpreted, examinees must quickly identify the images and any potential adverse outcomes and proceed to answer a series of questions that follow . Initial mistakes in analyzing and inter- preting images and any associations with their accompanying vignettes will result in not one, but several, incorrect answers, in a required test–subject category . The second edition of the Atlas of Human Poisoning and Envenoming will continue to serve as a visual and written reminder of the ubiquitous sources of toxins and toxoids in the environ- ment and the outcomes of accidental and intentional toxic exposures in humans . The atlas has been redesigned as a ready resource with bulleted text, tables, and figure legends that resemble the vignettes that accompany national examination images to better prepare practitioners from several fields for image-intense, computer-based examinations in their respective fields . The atlas will be a useful study guide for emergency physicians, emergency medical service first responders, poison control center professionals, military physicians, family practitioners, physi- cian assistants, preventive medicine and veterinary medicine practitioners, public health offi- cers, occupational medicine specialists, pediatricians, and health science and medical students preparing for a professional lifetime of image-intense national examinations . ix x Atlas of Human Poisoning and Envenoming Several new chapters have been added to the second edition, including chapters on the prescription and illicit drug abuse epidemics, environmental and occupational nephrotoxicol- ogy and neurotoxicology, tick paralysis, and petrochemical toxicants . The atlas will conclude chapters on biological, chemical, and radiological warfare agents; workplace substance abuse screening and monitoring; and epidemiological design and statistical analysis of toxicological investigations .