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Papers by Randall Browning

0 Abstract-We report the historical, chnicaf, and laboratory ff in 5 patients after crack cocaine... more 0 Abstract-We report the historical, chnicaf, and laboratory ff in 5 patients after crack cocaine ingestion. All patknb e&Mted adrenergic crisis as a result of their ingestion. Analysis of their history revealed a latency period before signs and symptoms occurred as well as a wide vzriatioa in the number of crack cocaine nuggets ingested. Signs of intozkation were hypertension, tacbycardia, hyperthermia, agitation, and generabzed seizure activity. Treatment Muded &erapentfc sedation with lorazepam and adret& with esmolol infusion. The majority of patients showed c evidence of cardiac ischemia, bnt not elevations in serum ereatinine phosphokina3e enzymes-MB fraction. One patient died of eomplkations associated w%t subeK&al status epilepticus. The toxicities of crack cocaine ingestion are seldom appreciated. Prompt reversal of both cardiovascular and neurological signs and symptoms with appropriate pharmacologic agents is indicated.

Advanced Emergency Nursing Journal, Aug 31, 1993

The Journal of Emergency Medicine, 1994

We report the historical, clinical, and laboratory findings in 5 patients after crack cocaine ing... more We report the historical, clinical, and laboratory findings in 5 patients after crack cocaine ingestion. All patients exhibited adrenergic crisis as a result of their ingestion. Analysis of their history revealed a latency period before signs and symptoms occurred as well as a wide variation in the number of crack cocaine nuggets ingested. Signs of intoxication were hypertension, tachycardia, hyperthermia, agitation, and generalized seizure activity. Treatment included therapeutic sedation with lorazepam and adrenolysis with esmolol infusion. The majority of patients showed electrocardiographic evidence of cardiac ischemia, but not elevations in serum creatinine phosphokinase enzymes--MB fraction. One patient died of complications associated with subclinical status epilepticus. The toxicities of crack cocaine ingestion are seldom appreciated. Prompt reversal of both cardiovascular and neurological signs and symptoms with appropriate pharmacologic agents is indicated.

Human & Experimental Toxicology, 1992

1 Glycol ethers and their alkoxyacetic acid metabolites produce a linear increase in plasma osmol... more 1 Glycol ethers and their alkoxyacetic acid metabolites produce a linear increase in plasma osmolality with increasing plasma concentration. 2 This change in osmolality may be too small to be clinically useful at concentrations expected in cases of acute human glycol ether poisoning.

Human & Experimental Toxicology, 1994

The glycol ethers constitute a family of organic solvents commonly found in industrial and househ... more The glycol ethers constitute a family of organic solvents commonly found in industrial and household products. Because of their widespread availability and potential for serious toxicity, physicians should be aware of the clinical toxicology of these compounds. Until recently, knowledge of the toxic effects of glycol ethers has been derived from animal studies and a limited number of case reports and small case series. A growing body of data from epidemiological studies, controlled human studies, and studies using human tissue now allows for advancement in the understanding of the acute and chronic toxicity of these compounds. This review summarizes and evaluates human and pertinent animal literature on the clinical toxicology of glycol ethers, with a focus on the commonly encountered monoalkyl ethers of ethylene glycol. Management options for acute poisoning, as well as measures for the control of workplace exposures, are discussed.

Annals of Emergency Medicine, 1990

Annals of Emergency Medicine, 1993

$Research paper thumbnail of Successful Treatment of Amoxapine‐induced Refractory Status Epilepticus with Propofol (Diprivan)$

Academic Emergency Medicine, 1995

ABSTRACTTonic‐clonic seizure activity is a recognized complication of amoxapine overdose. Refract... more ABSTRACTTonic‐clonic seizure activity is a recognized complication of amoxapine overdose. Refractory drug‐induced status epilepticus is associated with significant morbidity and mortality. Standard regimens for controlling status epilepticus may be ineffective for aborting drug‐induced seizures. The authors report the case of a 30‐year‐old woman who presented with an amoxapine overdose that deteriorated into status epilepticus refractory to conventional therapy. Propofol given by intravenous bolus and maintenance infusion successfully halted the patient's seizure activity. This case suggests that propofol may be effective as an anticonvulsant in refractory drug‐induced status epilepticus.