Papers by Barry H Rumack, MD
Nephron, 1979
We examined the efficacy of a new, fixed-bed, uncoated charcoal device in experimentally intoxica... more We examined the efficacy of a new, fixed-bed, uncoated charcoal device in experimentally intoxicated dogs and in drug-intoxicated as well as chemically poisoned patients. In the animal studies, 4 h of hemoperfusion resulted in a significant decrease in the blood level of phenobarbital, salicylate, pentobarbital and glutethimide. The drug clearances varied between 97 +/- 10 and 129 +/- 6 ml/min. However, the total amount of drug removed was higher for phenobarbital and salicylate which have a small apparent volume of distribution (AVD) than for pentobarbital and glutethimide which have an AVD greater than total body water. We next treated 14 patients suffering from a wide variety of intoxications. Patients intoxicated with phenobarbital, methsuximide, chlordane and Amanita muscaria all showed a significant improvement in their clinical status. Patients intoxicated with ethchlorvynol, glutethimide, methaqualone, podophyllin and fluoroacetamide did not improve. Charcoal hemoperfusion may be useful in patients poisoned with drugs characterized by an AVD smaller than total body water. No major complications were encountered during the hemoperfusions.
Clinical Chemistry, Apr 1, 1977
We describe a capillary-sampling method for serum or plasma acetaminophen by cation-exchange chro... more We describe a capillary-sampling method for serum or plasma acetaminophen by cation-exchange chromatography. As little as 1.5 mul of plasma or serum and an equal volume of the internal standard (N-butyryl-p-aminophenol) were run, with a precision of +/- 5% between duplicates. Acetaminophen and the internal standard chromatographed in 32 and 50 min, respectively, distinct from intrinsic plasma peaks and peaks caused by other medications.
Heart, Apr 1, 1974
A I7-year-old patient attempted suicide with a massive digoxin overdose. Peak serum digoxin level... more A I7-year-old patient attempted suicide with a massive digoxin overdose. Peak serum digoxin level was 35 ng/ml. Half-life of digoxin was I3 hours which is in contrast to the usual therapeutic half-life of approximately 36 hours. Pronounced hyperkalaemia, peaking at 8-2 mEqll., was noted I4 hours after ingestion. Control of toxic symptoms was achieved with small doses of diphenylhydantoin. It is suggested that the usual initial treatment of this overdose with potassium as suggested in many sources is inappropriate.
Seminars in Dialysis, Oct 1, 2007
Annals of Emergency Medicine, Jul 1, 1986
Annals of Emergency Medicine, Sep 1, 1987
Annals of Emergency Medicine, Jun 1, 1990
From these limited data it appears that sodium nitrite infusion resulted in lower than expected M... more From these limited data it appears that sodium nitrite infusion resulted in lower than expected METHB levels, which occurred 35 to 70 minutes following the nitrite infusion. The slow fall in METHB levels did not appear to be affected by HBO. Concerns about CAKinduced METHB adding to the toxicity of COHB may be unfounded.
Pediatrics in Review, Nov 1, 1983
Jimsonweed (Datura stramonium) is a plant found commonly throughout the United States. It is a me... more Jimsonweed (Datura stramonium) is a plant found commonly throughout the United States. It is a member of the Solanum family to which other common plants, such as the potato, also belong. The genus Datura is found throughout the world under a variety of common names. All have similar pharmacologic activity. The botanical and common names for some of the Datura genus are shown in Table 1. Also listed are some examples of the Solanaceae family and others that have similar anticholinergic pharmacology and presentation. Datura stramonium is a plant which grows to the height of three to six feet. Other members of the genus may be tree-like and grow to heights of more than 20 feet, especially in South America. D stramonium is an annual herb which grows from midspring to the first hard freeze; it reproduces primarily from seeds. It has dark green leaves similar to but larger than those seen on common tomato plants. It blooms approximately two months after it begins growth and develops long white flowers, lending the name "angel's trumpet" to members of this species. If the temperature condition at night does not fall below approximately 58°F, the fruit will set at the base of these flowers. A round fruit with spines will develop, thus the name "thron apple" (Figs 1 and 2).
Journal of toxicology, Oct 1, 1988
Various Thermopsis species are found in the foothills and plains of the Rocky Mountains. There ar... more Various Thermopsis species are found in the foothills and plains of the Rocky Mountains. There are no reported cases of human ingestion to Thermopsis reported in the literature. We report 5 cases of ingestion of seeds or flowers where the primary symptoms were nausea, vomiting and headache of several hours duration. As few as 6 seeds produced symptoms. The common names used by parents when calling the poison center could have easily lead to misidentification and a careful history and subsequent professional identification were required to ascertain the actual plant involved.
American Journal of Emergency Medicine, 1989
TOXIC SMOKE INHALATION To rhe Edifor:-Jones et al' are to be commended for their review of combin... more TOXIC SMOKE INHALATION To rhe Edifor:-Jones et al' are to be commended for their review of combined carbon monoxide/cyanide poisoning in closed-space fiie smoke inhalation fatalities. This important clinical entity deserves attention from providers of emergency care. Several comments may be made about the evaluation and treatment of combined carbon monoxide/cyanide-poisoned patients. The concept of a "lethal blood cyanide level" as used by the authors is probably erroneous in treated patients, as treatment with both supportive measures and antidotes has resulted in survival with levels as high as 4ObLg/mL.' This is similar to the mean postmortem level of 49.2 + I-20.7 pg/mL noted in seven untreated cyanide poisoning victims, and considerably higher than the levels of 6.8 to 18.3 pg/mL found in four of the 1982 Chicago cyanideacetaminophen tampering incident victims.' We would argue against the use of sodium nitrite in combined carbon monoxide/cyanide smoke inhalation poisoning if administered in any setting other than in a hyperbaric oxygen chamber at pressure to a patient with a carboxyhemoglobin level >30% to 40%. Sodium nitrite can be administered after the patient is receiving hyperbaric oxygen, as enough oxygen can then be dissolved directly in the plasma to maintain normal tissue respiration.4 Sodium thiosulfate alone may be sufficient treatment for less severe cyanide poisoning,' and in selected smoke inhalation cases it is most likely preferable to administer it first. We are concerned about the lack of importance given to hyperbaric oxygen therapy in the article by Jones et al. In cases of smoke inhalation with coma and elevated carboxyhemoglobin levels, treatment with hyperbaric oxygen is preferable to treatment with 100% normobaric oxygen.4*6 Although animal and human data are currently conflicting on whether hyperbaric oxygen is antidotal for cyanide poisoning,'-" it is clearly antidotal for the carbon monoxide component of a mixed intoxication. In previously reported cases of mixed poisoning from smoke inhalation, treatment with both antidotes and hyperbaric oxygen has usually resulted in a good outcome, although the contribution of each therapy individually cannot be ascertained.4 The goal of nitrite therapy is improvement in the patient's clinical status (cessation of seizures if present, improvement in respirations, vital signs, and level of consciousness, resolving metabolic acidosis), and not attainment of a "therapeutic methemoglobin level" of 25%. Only enough sodium nitrite should be administered to achieve a satisfactory clinical response, because of the dangers of excessive methemoglobin induction (particularly problematic in a patient with elevated carboxyhemoglobin levels) and severe hypotension with rapid administration (which may develop even at frequently recommended infusion rates). The usual dose for the average child is 0.33 mL/kg, not 0.2 mL/kg as stated in the article. As stressed by Jones et al, a cyanide poisoning component may be a significant part of the toxicological picture in vic
Archives of internal medicine, Feb 23, 1981
Dr Winchester : One of the controversial issues that came out in the article of Dr Meredith and h... more Dr Winchester : One of the controversial issues that came out in the article of Dr Meredith and his colleagues is the delay of vomiting and symptoms in the cases reported to the National Poison Information Service (NPIS) of Great Britain. I would like to ask Dr Meredith and the panel, in general, first, whether there has been any defect in the reporting by physicians in your survey and, second, whether there is any evidence that the combination tablets have an antiemetic effect? More than half of your patients who reported had taken a combination tablet. Dr Meredith : I think the reporting is reliable. Nevertheless, it is possible that some of the more subtle symptoms are missing. For this reason, we attempted to corroborate the more indirect findings of the NPIS by including figures from the Analgesic Overdose Survey in which patients were admitted to hospitals that had a special interest
Annals of Emergency Medicine, 1986
Annals of Emergency Medicine, Volume 15, Issue 1, Pages 93-94, January 1986, Authors:Alan H Hall,... more Annals of Emergency Medicine, Volume 15, Issue 1, Pages 93-94, January 1986, Authors:Alan H Hall, MD; Barry H Rumack, MD; Michael I Schaffer, MD; Christopher H Linden, MD.
Archives of pediatrics & adolescent medicine, Jun 1, 1993
Annals of Emergency Medicine, Nov 1, 1980
Annals of Emergency Medicine, Oct 1, 1991
The Journal of emergency medicine, 1985
Pediatric Annals, Nov 1, 1987
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Papers by Barry H Rumack, MD