Sunday, November 29, 2015

Toxic or Not?

December is a much-decorated month and the season comes with warnings of the toxicity of the greenery. Of the plants used, poinsettia plant has the largest numbers of calls to the poison control centers. Despite a long-standing belief in the legend of poinsettia toxicity, there is little data to support this. The toxic reputation stems from a single unconfirmed death of a 2-year-old in Hawaii in 1919. Poinsettia is in the same plant family as natural rubber latex and shares 2 common allergen proteins. Forty percent of individuals with a latex allergy develop cross-sensitivity with the poinsettia plant. A vast majority of exposures, however, result in either no effect or minor gastrointestinal upset and nausea with occasional vomiting. Contact dermatitis is very rare.

Holly is the third most common reported plant exposure. The berries containing the toxin saponin are poisonous; the leaves are not. The primary clinical effects observed, which occur exclusively with large ingestions, include nausea, vomiting, abdominal cramping, and occasionally dermatitis. In adults, one must eat 20-30 berries before becoming symptomatic, whereas children only have to consume five.

All sections of mistletoe are potentially harmful as they contain the toxin phoratoxin. Most ingestions result in little physical reaction, although some patients may experience gastrointestinal symptoms. The only cases involving deaths likely related to mistletoe are cases in which there were ‘teas’ infused with the fruits and other parts of the plants. The only two reported deaths from ingestion of mistletoe in the past 25 years were patients who ingested beverages made from mistletoe parts steeped in hot water; 11% of ingestions were suicide attempts.

An article from the NIH can help make wise decorating choices.

Monday, November 16, 2015

Renal Threshold

The classic presentation of uncontrolled diabetes is the “polys” – polyphagia (eating too much), polydipsia (drinking too much) and polyuria (urinating too much) accompanied by weight loss. The underlying cause is that the blood sugar level is too high for the kidneys and sugar leaks out into the urine.

The body tries hard to hold onto sugar since in earlier days it was hard to get enough food for survival and the kidneys would reclaim glucose as they filtered blood so as not to waste calories. However, once the blood sugar level is greater than about 180 the system gets overwhelmed and sugar leaks out. The sugar molecules attract water leading to increased urine volume. The body needs to replace the water lost via urination leading to increased thirst. Weight loss can be dramatic and the thirst relentless.

The whole idea of losing weight by peeing it out is enticing but creates metabolic havoc. The high blood sugar is toxic to small blood vessels, especially in the eyes and the kidneys. The liver attempts to compensate by storing excess blood damage; this creates another set of problems.

A new class of diabetes medications “tricks” the kidneys into allowing glucose into the urine without setting off a bad cascade of events. While useful these medications can have significant side effects.

The National Diabetes Education Initiative has many excellent PDF downloads that discuss many of the newer medications as well as advice on diabetes management. 

Monday, November 2, 2015

Am I being lazy?

One of my mentors once said, “If you are thinking about doing something, you should be doing it.” The context then was about checking a blood count, looking up drug interactions or getting a second opinion on a chest X-ray. In other words: don’t be lazy.

Making a point not to be lazy improves life in general. Go take that walk. Put the dishes in the dishwasher – and then empty it after the cycle. Write the thank-you note right away. Peel the orange instead of grabbing chips.

After a while, these conscious decisions will become habit. If it’s a habit to pack lunch then you won’t spend time and money scrounging for something to eat. That makes it easier to spend a few minutes exercising (even if it means climbing stairs or circling the parking lot). A less cluttered environment is associated with improved health outcomes. If you don’t want to purge, at least put things away.

At least once a day I’ll ask myself if I am being lazy – if the answer is yes I will go ahead with the task. I don’t bother with a to-do list since at the end of the day I would rather just have things done.