In the second part of our interview with new CTEH Senior Medical Toxicologist Dr. Michael G. Holland, we ask about recent breakthroughs in his field and he expands on some of his recent journal articles.

Dr. Holland, in your opinion, what is the most important discovery, breakthrough, or research finding of the last decade or so? 

We regularly use two novel discoveries that have changed our historical treatment methods:

1) High-dose insulin-euglycemia therapy, or HIET, is a miracle drug that has been a mainstay in hypotension treatment for 10 to 12 years and is very inexpensive. The treatment is just what the name suggests: insulin, but in high doses. If someone is experiencing low blood pressure, or hypotension, and overdosed on beta-blocker agents or calcium channel blockers, this treatment can save the person’s life. This treatment halts the process and helps the heart utilize glucose for its energy needs (rather than the free fatty acids it normally relies on,  to better pump blood and raise blood pressure. To treat hypotension, we would administer a continuous infusion of high dose of insulin every hour. This treatment saves thousands of lives every year and has been a revolutionary breakthrough in the last decade or so.

2) (Intralipid) Fatty Acid Emulsion Therapy – Administered intravenously, this therapy is the same as the treatment given to people who can’t eat, but need intravenous nutrition. It is a soybean and egg yolk emulsion that is made water-soluble and that delivers necessary fats and calories for IV feedings. In the last five to six years, anesthesia researchers discovered this therapy’s effectiveness in saving the lives of patients who have been given an overdose of local anesthetics that are used to block nerves in certain areas. The lipid therapy acts like a sponge that can absorb dangerous drugs form the circulation and halts the overdose, saving the patient’s life.

You wrote an article titled “Severe Central Nervous System and Cardiovascular Toxicity in a Pediatric Patient after Ingestion of an Over-the-Counter Local Anesthetic.” Can you tell us a little about that particular incident and what types of over-the-counter drugs parents should be very cautious about in their homes? 

Regarding the article, the parents should be cautious of any drug that treats tooth pain and numbs gums.  If ingested, this particular drug has the same toxicity as a local anesthetic and is formulated in a 1% (one-percent) solution, which sounds low, but can quickly get to a toxic dose, since that means there is 1,000mg (1gram) of drug in only 100mL of the formulation . Benzocaine is one of the more harmful topical pain relieving drugs, as it causes cardiac toxicity and blocks sodium channels in the nervous system. Treatment is an intravenous sodium bicarbonate and fatty acid emulsion (like I mentioned above). Raising the pH a little changes alkalinity and the drug’s ability to bind to cardiac cells.

Another very dangerous product – harmful to a toddler in just one sip – is methanol, which is found in windshield cleaner/de-icer. Just a capful can be deadly to a toddler and is the same color as juice.

Even more dangerous is  ethylene glycol, which is found in antifreeze for car radiators.  You may have heard horror stories of a spouse poisoning their significant other with antifreeze.  This popular poisoning agent tastes sweet, so it can be pleasing to drink and is lethal in small doses. A person who has ingested  ethylene glycol may appear drunk as well.

You may be surprised to learn that the number one overdose agent is Tylenol –acetaminophen- worldwide. First-world overdoses are over-the-counter and prescription based medicines.

In third worlds, pesticides and herbicides are the most common  agents. Agrochemical overdoses may not be on the top of your cautionary list, but you should be aware of the potential dangers- people overdose on what things are readily available to them.

Lastly, toilet bowl and drain cleaners are extremely dangerous because they are caustic and destroy tissues. If ingested they destroy the esophagus and stomach. A person can die from these ingestions, and if they survive may lose their ability to swallow properly and may need tube feedings.