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2833 Flumazenil usage within the ED
Aims and ObjectivesBenzodiazepine overdose causes significant morbidity and mortality amongst the UK population. Flumazenil is an effective antidote but concerns regarding side effects have limited its use in the UK. This project aims to review flumazenil use within NHS Lothian.Method and DesignA search was conducted on the electronic note system for ‘flumazenil’ over the last 2 years. These notes were reviewed by two toxicologists who stated yes/no/insufficient information as to whether flumazenil was indicated. Additionally, the two toxicologists reviewed intubations within the ED caused by toxins/overdose. Each case was given a yes/no/unsure for whether flumazenil was indicated.Results and ConclusionWith duplicates removed there were 39 mentions of ‘flumazenil’. It was considered but not given in 14 cases and it was given in the remaining 25. Of the cases where flumazenil was given both reviewers agreed with its administration in 9 cases and both disagreed with its administration in 3 cases. The two reviewers directly disagreed on 3 occasions with the remaining 10 at least one reviewer ‘unsure/insufficient information’.Of the 14 where it was considered but not given the reviewers agreed that it was not indicated in 10 of the cases. They both agreed in two of the cases that it was indicated and the remaining two at least one reviewer was ‘unsure/insufficient information’.Of the 15 intubations, in 4 cases both reviewers thought flumazenil was indicated, 4 cases at least one reviewer thought it was indicated and the other was ‘unsure/insufficient information’.From reviewing flumazenil use it is obvious that there is significant variation in its use as well as disagreement amongst expert reviewers as to when it is indicated/contraindicated. We have also identified at least 4 occasions where flumazenil could have potentially avoided an ICU admission. This project demonstrates a need for a comprehensive guideline for flumazenil use in the ED.
Journal Article
No more dirty looks : the truth about your beauty products-- and the ultimate guide to safe and clean cosmetics
Most of us don't realize that the products we use every day can expose us to thousands of chemicals that are readily absorbed through our skin. The impact on your health? It's not pretty.
Book
Reasons, Form of Ingestion and Side Effects Associated with Consumption of IAmanita muscaria/I
In recent months, there has been a new trend involving the consumption of Amanita muscaria. The aim of this article was to investigate the reasons for consumption, the form taken and the adverse symptoms that were indicated by those consuming Amanita muscaria. After analysing 5600 comments, 684 people were included in the study, who, in social media groups such as Facebook, stated the purpose of consuming the mushroom (n = 250), the form of mushroom they were taking (n = 198) or the adverse symptoms they experienced (n = 236). The gender of the subjects differentiated the parameters analysed. In the study group of women, the main purpose of consuming Amanita muscaria was to reduce pain, as well as to reduce skin problems, while in men it was mainly to relieve stress, reduce the severity of depressive symptoms and reduce insomnia (p < 0.001). With regard to the form of mushroom ingested, tincture was predominant in the women’s study group, while dried was predominant in the men (p < 0.001). In terms of side effects, women reported primarily headaches, while men reported nausea, vomiting, abdominal pain and drowsiness (p < 0.001). Advanced research on Amanita muscaria should be carried out to make the community aware of the toxicity of this fungus.
Journal Article
The exposome and nutritional pharmacology and toxicology: a new application for metabolomics
Abstract
The exposome refers to all of the internal and external life-long exposures that an individual experiences. These exposures, either acute or chronic, are associated with changes in metabolism that will positively or negatively influence the health and well-being of individuals. Nutrients and other dietary compounds modulate similar biochemical processes and have the potential in some cases to counteract the negative effects of exposures or enhance their beneficial effects. We present herein the concept of Nutritional Pharmacology/Toxicology which uses high-information metabolomics workflows to identify metabolic targets associated with exposures. Using this information, nutritional interventions can be designed toward those targets to mitigate adverse effects or enhance positive effects. We also discuss the potential for this approach in precision nutrition where nutrients/diet can be used to target gene-environment interactions and other subpopulation characteristics. Deriving these “nutrient cocktails” presents an opportunity to modify the effects of exposures for more beneficial outcomes in public health.
Journal Article