From resource to rescues
Toxicologist puts expertise to
By Caroline Sheen
year, Chechen rebels seized a Moscow theater and took the playgoers
as hostages, leading to a standoff of several days. Eventually,
Russian authorities released an unknown chemical inside the building
to quickly incapacitate the occupants, then stormed the theater.
chemical, which Russian law-enforcement authorities refused to
identify, caused illness among many of the hostages, some of whom
died. Analysts initially suspected the chemical to be 3-quinuclidinyl
benzilate, also known as QNB or BZ, a chemical warfare agent used
as a hallucinogen.
sought confirmation from U.Va. medical toxicologist Dr. Christopher
Holstege, the only person in the world who had written a chapter
solely on the chemical.
reviewed photos from the event, analyzed the patients symptoms
and determined that QNB was not the released toxin. We knew
it wasnt QNB, because people fell down immediately. QNBs
effects are slow, said Holstege, an assistant professor
of emergency medicine and medical director of the Blue Ridge Poison
and Mark Kirk, director of the medical toxicology fellowship program
and associate medical director of the Blue
Ridge Poison Center, are the only full-time, practicing medical
toxicologists in Virginia. Last summer, the U.Va. Health System
took advantage of their talents by opening the states only
Center for Clinical Toxicology, housing clinical, research and
educational programs related to toxicological emergencies and
surprisingly, Holstege has played a major part in the development
of local homeland security plans. Since the Sept. 11, 2001, attacks,
Holstege has worked to educate the public, increase communication
between the 50 hospitals across the region which he regularly
consults, and become more knowledgeable of the inventory of antidotes
available regionally to combat chemical warfare agents.
Most of Holsteges day-to-day work, however, does not involve
international consulting or national security.
takes the shine off moonshine
word conjures up images of country folk sneaking off into
the back woods or downstairs to their basements to engage
in an illicit Southern tradition moonshine.
to recent news reports, it continues to thrive in Virginia
and according to a physician at the U.Va. Health System,
it can cause serious health problems in those who abuse
Christopher Holstege, assistant professor of emergency medicine
and director of the Division of Medical Toxicology at U.Va.
Health System, conducted research and found that more than
half of the illicitly distilled alcohol samples he studied
contained lead levels that were above Environmental Protection
Agency water guidelines of 15 parts per billion (ppb). This
lead content, Holstege suggests, can lead to toxic levels
in those who abuse moonshine. His research results were
presented at the Society for Academic Emergency Medicine
annual meeting on May 31 in Boston.
moonshine is considered a tradition of the past, toxicity
from moonshine consumption is likely to be overlooked,
Holstege said. With hundreds of thousands of gallons
of moonshine produced around the nation annually, physicians
need to be aware of this problem when evaluating moonshine
studied 48 different still samples of illicitly distilled
moonshine obtained from law enforcement officials. An independent
laboratory, blinded to the samples of moonshine and a control
sample of ethanol, conducted the analysis. Lead content
was determined using atomic absorption spectrophotometry.
The results showed that 43 of the 48 samples had lead levels
ranging from five to 599 ppb.
significant studies have been done to analyze Virginia moonshine
for impurities since the 1960s, Holstege said. Hopefully
this research will make the public aware that there are
still hazards associated with drinking moonshine.
was called in this winter when an overworked boiler at the U.Va.
heating plant belched large quantities of soot that soon settled
on the Venable neighborhood. Holstege considered the settled soot
medically harmless. The only concern, he said, was
the aesthetic damage.
gratifying, he said, is his work with individual patients. When
a 16-year-old girl overdosed on her mothers hypertension
medicine, leaving her near death, Holstege led a team focused
intensely on salvaging what seemed a grim situation. He remained
bedside, fighting for the girls survival, for eight hours.
She was finally able to stabilize, he said. That
was the most rewarding experience. Its pases like that that
make a difference.
to describe a typical day in his life, Holstege laughed at the
impossibility. He is on call to respond to poisoning cases from
62 neighboring counties with a population of 2.8 million people,
in addition to his teaching duties and his role as a husband and
father of six young children.
is not the norm.
not complaining. Holstege finds his position as head of the Blue
Ridge Poison Center thrilling, diverse and unparalleled. I
love my job because it is a unique specialty. I get the opportunity
to teach, and its my job to ensure that all the patients
are taken care of.
Blue Ridge Poison Center has four focused areas, including the
center of clinical toxicology comprising the clinical service,
the educational service, research and the Blue Ridge Poison Center.
emphasizes the educational side of toxicology and has implemented
a rotation for residents in training and medical/pharmacy students.
he says, is the most rewarding role in his career. As a
medical toxicologist, if we are able to impact young clinicians
early in their career in reference to their knowledge of drugs,
then we, as teachers, are doing our jobs, he said. Health
care providers should know what the medications do.