Episode 3 kaboom v2Episode 3: Kaboom! – Exploding Tox

Written by Theresa Kim

 

Outline

1)     “Wax†or “dabâ€

2)     Meth lab explosions

3)     Smoking stool syndrome

4)     Ingestion of fireworks

5)     Nitropatch

6)     Bonus topic related to the prior discussion of Hunan hand and food related tox

Wax or Dab

• 
  
• A nearly pure form of THC called “wax†or “dab†can be extracted from marijuana using a volatile hydrocarbon solvent (usually butane)
  
• Name derived from the wax-like quality of the final product
  
• Numerous reports of explosions at home “wax†labs
  
• Legal in Colorado
  

Meth Lab Explosions

• 
  
• Several methods of manufacturing methamphetamines exist, but all ultimately reduce pseudoephedrine or ephedrine to methamphetamine
  
  • 
    
  • Hydroiodic acid
    
    • 
      
    • Manufactured from Iodine + red phosphorus
      
    • Problems with the production process:
      
      • 
        
      • Fumes produced during this process can cause chemical pneumonitis and respiratory distress
        
      • Red phosphorus when heated turns into white (or yellow) phosphorus, which is highly combustible
        
      • Hydroiodic acid plus red phosphorus can form phosphine, which can cause delayed pulmonary toxicity with onset 18 hours or longer after exposure, as well as cellular damage
        
      
      
      
    
    
    
  
  
  
• Australian method
  
  • 
    
  • Hydrophosphoric acid is substituted for red phosphorus
    
  • Also involves risks of explosions and the production of phosphine
    
  
  
  
• “Nazi†method
  
  • 
    
  • Purportedly used in WWII in Germany
    
  • Anhydrous ammonia + lithium + sodium
    
  • Anhydrous ammonia is caustic and can cause respiratory distress
    
  
  
  

Smoking Stool Syndrome

• 
  
• Phosphorus occurs in 2 forms: red & yellow (white)
  
  • 
    
  • Red phosphorus is relatively nontoxic because it is nonvolatile, nonabsorbable, and insoluble> It is found in safety matches
    
  • Yellow (aka white) phosphorus can cause severe systemic toxicity
    
    • 
      
    • Used to be readily available and was used in the manufacturing of matches, fireworks, rodenticides, and home remedies
      
    
    
    
  
  
  
• Case reports:
  
  • 
    
  • 3 year old female presents after spreading a piece of bread with rat paste which contained 2.5% of inorganic phosphorus
    
  • 2 year old male presents after ingesting rat poisoning he found in a trash can
    
  • 7 year old male presents after ingesting rat paste
    
  
  
  
• Syndrome: Smoking stool & garlic odor
  
• 3 stages of acute phosphorus poisoning
  
  • 
    
  • 1^st stage: Painful second and third degree burns within minutes to hours after exposure, can also see cardiopulmonary arrest during this stage due to the effects of phosphorus on the myocardium and hypovolemia from fluid loss
    
  • 2^nd stage: relatively symptom free period that can last for 1-3 days
    
  • 3^rd stage: Symptoms as a result of direct effects on the liver, heart, kidneys, CNS
    
  
  
  

Correction: On the audio, it was erroneously stated  that the quiescent period (2nd Stage) can last for weeks. This is not correct — stage 2, when seen, usually lasts 1-3 days. However, in the majority of severe cases this stage will not occur and stage 1 will blend directly into stage 3 without an asymptomatic period.

Fireworks Ingestion

• 
  
• 13 year old male presents to the hospital after ingesting 16 snake fireworks
  
• Profoundly hypokalemic initially with a potassium of 2.1, and a wide complex tachycardia
  
• Work up revealed high concentrations of barium
  
• Components of fireworks:
  
  • 
    
  • Oxidizer, reducer, fuel, binder of starch, metals
    
  • Main poisons seen with firework ingestion are barium, arsenic, and phosphorus
    
  • Barium blocks the efflux of potassium out of the cells
    
  • Salts responsible for the colors seen in fireworks:
    
    • 
      
    • Red: strontium or lithium
      
    • Orange: calcium
      
    • Yellow: sodium
      
    • Green: barium
      
    • Blue: copper
      
    • Clinical points regarding barium ingestion:
      
      • 
        
      • May be exception to the rule that poison-induced wide complex tachycardia should be treated with boluses of sodium bicarbonate — this may further lower the serum potassium
        
      • Oral magnesium sulfate may decrease absorption by forming insoluble .barium sulfate
        
      • IV magnesium sulfate is contraindicated, since it may cause renal failure from precipitation of bariums sulfate in kidney tubules
        
      
      
      
    
    
    
  
  
  

 

Nitropatch Explosion

• 
  
• 58 year old male with a past medical history of myocardial infarction and chronic stable angina presents with chest pain, hypotension, and SVT on the monitor
  
• The patient was cardioverted using 200 J
  
• There was a spark and explosion when one of the paddles was placed over his nitropatch
  
• Arcing of current through the aluminum backing of nitropatches can result in small explosions
  
  • 
    
  • Also seen with nitropaste
    
  • Electrical resistance from the patch can alter the amount of current delivered making cardioversion unsuccessful
    
  • Clinical points:
    
    • 
      
    • Remove  nitropatch or ointment prior to cardioversion & defibrillation
      
    
    
    
  
  
  

Jalaproctitis

• 
  
• 3 women and 2 women ingested between 3 and 13 jalapeno peppers in an eating contest
  
• Symptoms: Dysuria, burning discomfort on defecation within 24 hrs
  

Quizzler Answer from Episode 2

Q: Which Chinese emperor died of heavy metal toxicity in attempt to try to gain immortality

A: Qin Shi Huang

Winner: Congratulations Natalie Thurtle!

Quizzler Episode 3

Posed at the end of the podcast

Submit responses as well as any feedback to toxtrivia@gmail.com

The first correct response wins a $10 Amazon gift card

 

BIBLIOGRAPHY

“Wax†or “Dabâ€

Black, B. (2012). To dab or not to dab? High Times  (accessed 3/23/14)

Meth lab explosions

Bloom, G.R., Suhail, F., Hopkins-Price, P., & Sood, A. (2008). Acute anhydrous ammonia injury from accidents during illicit methamphetamine production. Burns, 34(5), 713-718.

O’Neill, T.B., Rawlins, J.M., & Wood, F.M. (2011). Methamphetamine laboratory-related burns in western Australia—why the explosion?. Burns, 37(6), 1044-1048.

Santos, A.P., Wilson, A.K., Hornung, C.A., Rodriguez, J.L., & Franklin, G.A. (2005). Methamphetamine lab explosions: a new and emerging burn injury. Journal of Burn Care and Rehabilitation, 26(3), 228-232

Fireworks ingestion

 Christian, M., Erickson, T. (2011). Don’t eat the fireworks, Emergency Physician Monthly (accessed 3/23/14)

Simon, F.A., & Pickering, L.K. (1976). Acute yellow phosphorus poisoning: “smoking stool syndrome.†JAMA, 235(13), 1343-1344

Jalaproctitis

Diehl, A.K., & Bauer, A.L. (1978). Jalaproctitis. The New England Journal of medicine, 299(20), 1137-1138.

Nitropatch  hazards

http://www.thepoisonreview.com/wp-content/uploads/Episode-3-kaboom-v3.mp3Wrenn, K. (1990). The hazards of diffibrilation through nitroglycerin patches. Annals of Emergency Medicine, 19(11), 1327-1328