Blog | Thursday, September 26, 2013

AAFP: Everything can kill you.

A guy who waterproofs boats for a living suddenly comes down with flu-like symptoms.
A retired man who likes to strip furniture in his basement has multiple myocardial infarctions, the last fatal.
An Alzheimer's patient has toxic levels of heavy metals in her blood after pottery class at a day program.

Finding toxic causes for illness can require a physician to use his detective skills, Peter Ziemkowski, MD, an associate professor of family medicine at Western Michigan University, explained this morning. (I'm at the American Academy of Family Physicians annual meeting in San Diego today and tomorrow.)

He offered those three anecdotes (and others, including a hiker who got too close for his health to a beaver dam and the infamous Colorado popcorn-sniffer) to emphasize the importance of getting a thorough history from patients who may be presenting with a toxic exposure.

In the first case, the patient had smoked a cigarette, which heated up the waterproofing material on his hands and released dangerous fumes. In the second case, the patient could potentially have saved by his physicians' recognition that paint thinner in a confined environment can cause ischemia. And the third patient had drunk down a Dixie cup of ceramic glaze, which wouldn't be harmful at the time of manufacture, but changes chemical structure when it's left on the shelf.

So pay attention, and don't be afraid to look up potential exposures you don't know about, Dr. Ziemkowski advised.

He also provided some reassurance about a couple exposures you and your patients might have been fearing. First, don't worry about that popcorn chemical (diacetyl)—most of the microwave popcorn companies have taken it out of their recipes. Second, there is a scary black mold (stachybotrys) that can cause serious respiratory problems, but there are lots of other common molds (which won't hurt immunocompetent people) that are also black. Inconveniently, the only way to distinguish them is to have a lab run a culture.