Sample records for acute organophosphate poisoning

  1. Neurology of acute organophosphate poisoning

    Singh Gagandeep


    Full Text Available Acute organophosphate (OP poisoning is one of the most common poisonings in emergency medicine and toxicological practice in some of the less-developed nations in South Asia. Traditionally, OP poisoning comes under the domain of emergency physicians, internists, intensivists, and toxicologists. However, some of the complications following OP poisoning are neurological and involve neurologists. The pathophysiological basis for the clinical manifestations of OP poisoning is inactivation of the enzyme, acetylcholinesterase at the peripheral nicotinic and muscarinic and central nervous system (CNS nerve terminals and junctions. Nicotinic manifestations occur in severe cases and late in the course; these comprise of fasciculations and neuromuscular paralysis. There is a good correlation between the electrophysiological abnormalities and the severity of the clinical manifestations. Neurophysiological abnormalities characteristic of nicotinic junctions (mainly neuromuscular junction dysfunction include: (1 single, supramaximal electrical-stimulus-induced repetitive response/s, (2 decrement-increment response to high frequency (30 Hz repetitive nerve stimulation (RNS, and (3 decremental response to high frequency (30 Hz RNS. Atropine ameliorates muscarinic manifestations. Therapeutic agents that can ameliorate nicotinic manifestations, mainly neuromuscular, are oximes. However, the evidence for this effect is inconclusive. This may be due to the fact that there are several factors that determine the therapeutic effect of oximes. These factors include: The OP compound responsible for poisoning, duration of poisoning, severity of poisoning, and route of exposure. There is also a need to study the effect of oximes on the neurophysiological abnormalities.

  2. Neuropsychiatric manifestations following acute organophosphate poisoning

    Satyakam Mohapatra


    Full Text Available Acute muscarinic and nicotinic side effects of organophosphate (OP poisoning are well known and easily recognized, but neuropsychiatric changes are rarely reported. We are reporting a case of a 22-year-old male who developed psychotic features and motor neuropathy following acute OP poisoning.

  3. Pancreatic Pseudocyst after Acute Organophosphate Poisoning

    Kawabe, Ken; Ito, Tetsuhide; Arita, Yoshiyuki; Sadamoto, Yojiro; Harada, Naohiko; Yamaguchi, Koji; Tanaka, Masao; Nakano, Itsuro; Nawata, Hajime; Takayanagi, Ryoichi


    Acute organophosphate poisoning(OP) shows several severe clinical symptoms due to its strong blocking effect on cholinesterase. Acute pancreatitis is one of the complications associated with acute OP, but this association still may not be widely recognized. We report here the case of a 73-year-old man who had repeated abdominal pain during and after the treatment of acute OP. Hyperamylasemia and a 7-cm pseudocyst in the pancreatic tail were noted on investigations. We diagnosed pancreatic pse...

  4. Pancreatic pseudocyst after acute organophosphate poisoning.

    Kawabe, Ken; Ito, Tetsuhide; Arita, Yoshiyuki; Sadamoto, Yojiro; Harada, Naohiko; Yamaguchi, Koji; Tanaka, Masao; Nakano, Itsuro; Nawata, Hajime; Takayanagi, Ryoichi


    Acute organophosphate poisoning (OP) shows several severe clinical symptoms due to its strong blocking effect on cholinesterase. Acute pancreatitis is one of the complications associated with acute OP, but this association still may not be widely recognized. We report here the case of a 73-year-old man who had repeated abdominal pain during and after the treatment of acute OP. Hyperamylasemia and a 7-cm pseudocyst in the pancreatic tail were noted on investigations. We diagnosed pancreatic pseudocyst that likely was secondary to an episode of acute pancreatitis following acute OP. He was initially treated with a long-term intravenous hyperalimentation, protease inhibitors and octerotide, but eventually required surgical intervention, a cystgastrostomy. Acute pancreatitis and hyperamylasemia are known to be possible complications of acute OP. It is necessary to examine and assess pancreatic damage in patients with acute OP.

  5. Neuromuscular Effects of Acute Organophosphate Poisoning

    Taylan Pekoz


    Conclusion: There is no evoked potential studies performed in organophosphate poisoning althoung electroneurography repetitive and P300 studies exist in literature. More further studies are needed to evaluate the cardiac and neuromuscular effects of organophosphate poisoning. [Cukurova Med J 2014; 39(4.000: 795-800

  6. Mania following organophosphate poisoning

    Satyakam Mohapatra


    Full Text Available Organophosphate poisoning is the most common poisoning in developing countries. Although the acute muscarinic and nicotinic side-effects of organophosphate poisoning are well known and easily recognized, but neuropsychiatric changes are rarely reported. We are reporting a case of a 33-year-old female who developed manic episode following acute organophosphate poisoning.

  7. Mania following organophosphate poisoning

    Satyakam Mohapatra; Neelmadhav Rath


    Organophosphate poisoning is the most common poisoning in developing countries. Although the acute muscarinic and nicotinic side-effects of organophosphate poisoning are well known and easily recognized, but neuropsychiatric changes are rarely reported. We are reporting a case of a 33-year-old female who developed manic episode following acute organophosphate poisoning.

  8. Mania following organophosphate poisoning.

    Mohapatra, Satyakam; Rath, Neelmadhav


    Organophosphate poisoning is the most common poisoning in developing countries. Although the acute muscarinic and nicotinic side-effects of organophosphate poisoning are well known and easily recognized, but neuropsychiatric changes are rarely reported. We are reporting a case of a 33-year-old female who developed manic episode following acute organophosphate poisoning.

  9. Central respiratory failure during acute organophosphate poisoning.

    Carey, Jennifer L; Dunn, Courtney; Gaspari, Romolo J


    Organophosphate (OP) pesticide poisoning is a global health problem with over 250,000 deaths per year. OPs affect neuronal signaling through acetylcholine (Ach) neurotransmission via inhibition of acetylcholinesterase (AChE), leading to accumulation of Ach at the synaptic cleft and excessive stimulation at post-synaptic receptors. Mortality due to OP agents is attributed to respiratory dysfunction, including central apnea. Cholinergic circuits are integral to many aspects of the central control of respiration, however it is unclear which mechanisms predominate during acute OP intoxication. A more complete understanding of the cholinergic aspects of both respiratory control as well as neural modification of pulmonary function is needed to better understand OP-induced respiratory dysfunction. In this article, we review the physiologic mechanisms of acute OP exposure in the context of the known cholinergic contributions to the central control of respiration. We also discuss the potential central cholinergic contributions to the known peripheral physiologic effects of OP intoxication.

  10. Cardiovascular Effects of Acute Organophosphate Poisoning

    Shankar Laudari


    Conclusion:Cardiac effects of OP poisoning can be life-threatening. Prompt diagnosis, early supportive and definitive therapies with atropine and oximes along with vigilant monitoring of the patients for prominent cardiac effects such as QT prolongation, VT or VF during hospital stay can definitely save lives of the victims.

  11. Acute methaemoglobinaemia initially treated as organophosphate poisoning leading to atropine toxicity

    Srinivas Kakhandki


    Full Text Available A case of unknown compound poisoning is presented. It was initially treated as organophosphate poisoning with lack of response. A timely diagnosis of acute methaemoglobinaemia and iatrogenic atropine toxicity was made based on clinical evaluation. Treatment of methaemoglobinaemia using oral methylene blue and of atropine toxicity with supportive measures could save the patient.

  12. Is there a role for progesterone in the management of acute organophosphate poisoning during pregnancy?

    Jafarzadeh, Mostafa; Nasrabadi, Zeynab Nasri; Sheikhazadi, Ardeshir; Abbaspour, Abdollah; Vasigh, Shayesteh; Yousefinejad, Vahid; Marashi, Sayed Mahdi


    Organophosphates are commonly used pesticides and cause about one million unintentional and 2 million suicidal exposures with up to 300,000 fatalities every year around the world. Toxicity of organophosphates is due to inhibition cholinesterase activity and prolonging the effects of acetylcholine in the receptor site. Clinical features of organophosphate poisoning are defecation, urination, miosis, bronchorrhea, emesis, lacrimation and salivation. Spontaneous abortion reported some when in pregnant patients. Intravenous administration of benzodiazepines, atropine and pralidoxime is the formal treatment of this toxicity. Atropine and pralidoxime have been assigned to pregnancy class C by the FDA and should be recommended for use in pregnant women clinically suffer organophosphate poisoning. Benzodiazepines have been assigned to pregnancy class D and should be avoided during pregnancy. Clinical experiments suggest transplacental transfer of organophosphates is possible, and fetal sensitivity is probable, but a single acute overdose most likely don't make any physical deformities, therefore termination of pregnancy is not imperative. Nonetheless, no definite strategy focused on maintaining pregnancy. Here we propose an idea that in any female case of acute organophosphate poisoning in childbearing range of age, maternal serum Beta-HCG should be tested for pregnancy and prophylactic progesterone should be used in pregnant cases of organophosphate poisoning.

  13. Organophosphate poisoning : A review

    Parmod K. Sinha


    Full Text Available Organophosphate pesticides are used extensively worldwide, and poisoning by these agents, particularly in developing nations is a public health problem. Organophosphorous nerve agents are still considered as potential threat in both military or terrorism situations. The mechanism of toxicity is the inhibition of acetylcholinesterase, resulting in accumulation of the neurotransmitter acetylcholine and continued stimulation of acetylcholine receptors both in central and peripheral nervous systems. Beside acute cholinergic crisis, organophosphates are capable of producing several subacute or chronic neurological syndromes. The well described intermediate syndrome (IMS emerges 1-4 days after an apparently well treated cholinergic crisis. The standard treatment consists of reactivation of inhibited acetylcholinesterase with an oxime antidote (pralidoxime, obidoxime, HI-6 and Hlo7 and reversal of the biochemical effects of acetylcholine with atropine. The newer oximes HI-6 and Hlo& are much more suitable and efficacious acetylcholinesterase reactivator for severe acute nerve agent induced poisoning than currently used pralidoxime or obidoxime. Patients who receive treatment promptly usually recover from acute toxicity but may suffer from neurologic sequelae. (Med J Indones 2003; 12: 120-6 Keywords: poisoning, insecticide, organophosphate (OP, carbamates, acetylcholinesterase, oxime, pralidoxime, obidoxime, HI-6, HLo7

  14. Organophosphate Poisoning and Intermediate Syndrome

    Mustafa Yilmaz


    Full Text Available Toxic effects that occur after acute organophosphate poisoning (OP can manifest three phases, namely, acute cholinergic crisis, intermediate syndrome and delayed-type polyneuropathy. Clinical signs and symptoms of organophosphate poisoning depend on the accumulation of acetylcholine at the nerve junction. Organophosphate poisoning causes three main clinical findings; acute cholinergic crisis consisting of muscarinic, nicotinic and central nervous system symptoms, intermediate syndrome with recurrence of cholinergic symptoms or muscle weakness without fasciculation 24-96 hours after poisoning and delayed-type polyneuropathy that can usually occur several days or weeks after acute exposure to organic phosphorus compounds. In this article, intermediate syndrome, which is a late complication, has been reviewed. [Archives Medical Review Journal 2016; 25(1.000: 70-83

  15. Poisoning severity score, Glasgow coma scale, corrected QT interval in acute organophosphate poisoning.

    Akdur, Okhan; Durukan, Polat; Ozkan, Seda; Avsarogullari, Levent; Vardar, Alper; Kavalci, Cemil; Ikizceli, Ibrahim


    The aim of this study was to investigate effectiveness of the poisoning severity score (PSS), Glasgow coma scale (GCS), and corrected QT (QTc) interval in predicting outcomes in acute organophosphates (OP) poisoning. Over a period of 2 years, 62 patients with OP poisoning were admitted to emergency department (ED) of Erciyes University Medical School Hospital. The age, sex, cause of contact, compound involved, time elapsed between exposure and admission to the ED, duration of hospital stay, and cardiac manifestations at the time of presentation were recorded. GCS and poisoning severity score (PSS) was calculated for each patient. Electrocardiogram (ECG) analysis included the rate, rhythm, ST-T abnormalities, conduction defects, and measurement of PR and QT intervals. Sixty-two patients with OP poisoning presented to our ED from January 2007 to December 2008 from which 54 patients were included in the study. The mean age was 34.1 +/- 14.8 years. Of the cases, 53.7% were female. Twenty-six patients had a prolonged QTc interval. Mean PSS of men and women was 1.8 +/- 1.0. No statistically significant correlation was found between the PSS and QTc intervals of the cases. A significant correlation was determined between the GCS and PSS of grade 3 and grade 4 cases. GCS is a parameter that helps clinician to identify advanced grade OP poisoning patients in the initial assessment in the ED. However, ECG findings, such as prolonged QTc interval, are not effective in determination of short-term prognosis and show no relationship with PSS.

  16. The use of self-reported symptoms as a proxy for acute organophosphate poisoning after exposure to chlorpyrifos 50 % plus cypermethrin 5 % among Nepali farmers

    Kofod, Dea Haagensen; Jørs, Erik; Varma, Anshu


    cholinesterase (PchE) activity, in addition to the symptoms, when assessing occupational acute pesticide poisoning. This study evaluated self-reported symptoms as a proxy for acute organophosphate poisoning among Nepali farmers by examining self-reported acute organophosphate poisoning symptoms and PchE activity......%: moderately hazardous) spray session or a 2-h placebo spray session, and after 7 days' washout, the farmers were assigned to the other spray session. Before and after each spray session farmers were interviewed about acute organophosphate poisoning symptoms and PchE activity was measured. Analyses were...... symptoms among the farmers regardless of organophosphate exposure or poisoning. Thus, self-reported acute organophosphate symptoms seem to be a poor proxy for acute organophosphate poisoning as the occurrence of these symptoms is not necessarily associated with acute organophosphate poisoning. TRIAL...

  17. To identify morbidity and mortality predictors in acute organophosphate poisoning

    Arti Muley


    Full Text Available Background: Organophosphorus poisoning remains an important cause of morbidity and mortality, but no definite parameters have been identified as predictors of outcome. Prediction of morbidity at presentation might help in decision making in places of limited resources like rural settings in developing countries. Materials and Methods: A total of 76 cases were included in this retrospective cohort study. Logged relative risk of requirement of mechanical ventilation and hospital stay >7 days was measured in patients with serum acetylcholinesterase (s. acetylcholinesterase 1000, presenting in 12 and in patients with SpO 2 7 days. Conclusion: S. acetylcholinesterase, SpO 2 at room air, GCS, and duration of exposure at presentation can be used to identify the requirement of special care in acute organophosphorus poisoning. This can aid in decision making regarding admission to intensive care unit and referral in the places with limited resources.

  18. Time-Dependent Changes Of Hematological Parameters In Patients With Acute Organophosphate Poisoning

    Zerrin Defne Dündar


    Full Text Available Objective: To investigate the prognostic value of the time-dependent changes of hematological parameters in patients with acute organophosphate poisoning. Methods: All patients admitted to emergency departments from 2010 through 2013 due to organophosphate poisoning were enrolled in the study. Demographic data, route of exposure, serum cholinesterase levels, complete blood count results of 5 consecutive days, mechanical ventilation requirement, length of stay in hospital, and outcomes were recorded. Results: Mechanically ventilated patients had higher leukocyte and neutrophil counts than nonventilated patients during the whole follow-up period, and both of them had a trend of decrease in both patient groups. There was no difference between patient groups in terms of lymphocyte counts at day 1, but mechanically ventilated patients had lower lymphocyte counts than nonventilated patients after day 2. Hemoglobin levels had a trend of decrease during the whole follow-up period in both patient groups. Conclusion: The parameters obtained from complete blood count can be used as sensitive follow-up parameters in patients with acute organophosphate poisoning by serial measurement.

  19. Organophosphate Poisoning and Subsequent Acute Kidney Injury Risk: A Nationwide Population-Based Cohort Study.

    Lee, Feng-You; Chen, Wei-Kung; Lin, Cheng-Li; Lai, Ching-Yuan; Wu, Yung-Shun; Lin, I-Ching; Kao, Chia-Hung


    Small numbers of the papers have studied the association between organophosphate (OP) poisoning and the subsequent acute kidney injury (AKI). Therefore, we used the National Health Insurance Research Database (NHIRD) to study whether patients with OP poisoning are associated with a higher risk to have subsequent AKI.The retrospective cohort study comprised patients aged ≥20 years with OP poisoning and hospitalized diagnosis during 2000-2011 (N = 8924). Each OP poisoning patient was frequency-matched to 4 control patients based on age, sex, index year, and comorbidities of diabetes, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, coronary artery disease, and stroke (N = 35,696). We conducted Cox proportional hazard regression analysis to estimate the effects of OP poisoning on AKI risk.The overall incidence of AKI was higher in the patients with OP poisoning than in the controls (4.85 vs 3.47/1000 person-years). After adjustment for age, sex, comorbidity, and interaction terms, patients with OP poisoning were associated with a 6.17-fold higher risk of AKI compared with the comparison cohort. Patients with highly severe OP poisoning were associated with a substantially increased risk of AKI.The study found OP poisoning is associated with increased risk of subsequent AKI. Future studies are encouraged to evaluate whether long-term effects exist and the best guideline to prevent the continuously impaired renal function.

  20. Brain injury due to acute organophosphate poisoning Magnetic resonance imaging manifestation and pathological characteristics


    BACKGROUND: Acute organophosphate poisoning can cause injuries of multiple visceras; especially,central nervous system injury can increase risk factors of patients with severe acute organophosphate poisoning. An application of modem image may increase diagnostic rate of brain injury in an earlier period and provide evidences for clinical treatment.OBJECTIVE: To reveal imaging manifestations, pathological characteristics and multi-ways injured mechanism of brain injury due to acute organophosphate poisoning.DESIGN: Contrast observational study.SETTING: Department of Medical Image, the Second Hospital of Hebei Medical University.MATERIALS: The experiment was carried out in the Department of Nerve Molecule Imaging Medicine and Laboratory of Neurology, the Second Hospital of Hebei Medical University from August 2003 to February 2004. A total of 30 healthy cats weighing 2.8 - 3.5 g and of both genders were selected from Animal Experimental Center of Hebei Medical University.METHODS: Thirty healthy cats were randomly divided into control group (n =5) and intoxication group (n=25). Cats in the control group were subcutaneously injected with 0.3 mL/kg saline at four points; while, cats in the intoxication group were subcutaneously injected with 400 g/L 0.3 mL/kg O,O-dimethyl-S-(methoxycarbonylmethyl) thiophosphate at four points. Two minutes after intoxication, cats received muscular injection with 0.5 mg/kg atropine sulfate, and then, brain tissues were collected from parietal lobe, basal ganglia, hippocampus, cerebellum and brain stem were observed at 3, 6, 24 hours, 3 and 7 days after intoxication respectively under optic microscope and electron microscope and expressions of acetylcholinesterase (AChE), choline acetyltransferase (ChAT), glial fibrillary acidic protein (GFAP),glutamic acid (Glu) and γ-amino butyric acid after immunohistochemical staining.MAIN OUTCOME MEASURES: Results of MRI examinations; histological changes under optic microscope and electron

  1. Respiratory failure induced by acute organophosphate poisoning in rats: effects of vagotomy.

    Gaspari, Romolo J; Paydarfar, David


    Acute organophosphate (OP) poisoning causes respiratory failure through two mechanisms: central apnea and pulmonary dysfunction. The vagus nerve is involved in both the central control of respiratory rhythm as well as the control of pulmonary vasculature, airways and secretions. We used a rat model of acute OP poisoning with and without a surgical vagotomy to explore the role of the vagus in OP-induced respiratory failure. Dichlorvos (2,2-dichlorovinyl dimethyl phosphate) injection (100mg/kg subcutaneously, 3 x LD50) resulted in progressive hypoventilation and apnea in all animals, irrespective of whether or not the vagi were intact. However, vagotomized animals exhibited a more rapidly progressive decline in ventilation and oxygenation. Artificial mechanical ventilation initiated at onset of apnea resulted in improvement in oxygenation and arterial pressure in poisoned animals with no difference between vagus intact or vagotomized animals. Our observations suggest that vagal mechanisms have a beneficial effect during the poisoning process. We speculate that vagally mediated feedback signals from the lung to the brainstem serve as a modest protective mechanism against central respiratory depressive effects of the poison and that bulbar-generated efferent vagal signals do not cause sufficient pulmonary dysfunction to impair pulmonary gas exchange.

  2. Neurological syndromes following organophosphate poisoning.

    Singh S


    Full Text Available Organophosphorous compounds, the anticholinesterases, produce significant morbidity and mortality in India. Although exact estimates are not available, hospital based statistics suggest that nearly half of the admissions to emergency with acute poisoning are due to organophosphates. Following accidental or suicidal exposure, these anticholinesterases lead to three well defined neurological syndromes i.e. initial life threatening acute cholinergic crisis which often requires management in intensive care unit, intermediate syndrome in which cranial nerve palsies, proximal muscle weakness and respiratory muscle weakness are common and patients often require respiratory support and delayed organophosphate induced polyneuropathy. In addition to these three classical neurological syndromes following acute exposure and in some following low dose chronic exposure, several neurobehavioural changes have been observed and these have been termed together as ′chronic organophosphate induced neuropsychiatric disorders′ (COPIND. Organo-phosphate compounds produce significant pesticide related illness in developing countries. There is, thus, a need to determine exact extent of the problem and to develop appropriate strategies to manage these cases with available resources in these countries.

  3. Fresh frozen plasma as a successful antidotal supplement in acute organophosphate poisoning.

    Vučinić, Slavica; Zlatković, Milica; Antonijević, Biljana; Ćurčić, Marijana; Bošković, Bogdan


    Despite improvements to intensive care management and specific pharmacological treatments (atropine, oxime, diazepam), the mortality associated with organophosphate (OP) poisoning has not substantially decreased. The objective of this examination was to describe the role of fresh frozen plasma (FFP) in acute OP poisoning. After a deliberate ingestion of malathion, a 55-year-old male suffering from miosis, somnolence, bradycardia, muscular fasciculations, rales on auscultation, respiratory insufficiency, as well as from an inhibition of red blood cell acetylcholinesterase (AChE) and plasma butyrylcholinesterase (BuChE), was admitted to hospital. Malathion was confirmed in a concentration of 18.01 mg L(-1). Apart from supportive measures (including mechanical ventilation for four days), antidotal treatment with atropine, oxime-pralidoxime methylsulphate (Contrathion(R)), and diazepam was administered, along with FFP. The potentially beneficial effects of FFP therapy included a prompt increase of BuChE activity (from 926 IU L(-1) to 3277 IU L(-1); reference range from 7000 IU L(-1) to 19000 IU L(-1)) and a reduction in the malathion concentration, followed by clinical recovery. Due to BuChE replacement, albumin content, and volume restitution, FFP treatment may be used as an alternative approach in patients with acute OP poisoning, especially when oximes are not available.

  4. Acute severe organophosphate poisoning in a child who was successfully treated with therapeutic plasma exchange, high-volume hemodiafiltration, and lipid infusion.

    Yesilbas, Osman; Kihtir, Hasan S; Altiti, Mohammad; Petmezci, Mey Talip; Balkaya, Seda; Bursal Duramaz, Burcu; Ersoy, Melike; Sevketoglu, Esra


    Acute severe organophosphate poisoning is a serious complication seen in developing and agricultural countries. Pralidoxime and high dose atropine are the standard treatments. There is no consensus about acute severe organophosphate poisonings that are unresponsive to pralidoxime, atropine, and supportive therapies. We report a case of acute severe organophosphate poisoning that was unresponsive to standard treatments and successfully treated with high-volume continuous venovenous hemodiafiltration and therapeutic plasma exchange combined with lipid infusion. J. Clin. Apheresis 31:467-469, 2016. © 2015 Wiley Periodicals, Inc.

  5. Oxime and atropine failure to prevent intermediate syndrome development in acute organophosphate poisoning

    Vučinić Slavica


    Full Text Available Introduction. Intermediate syndrome (IMS was described a few decades ago, however, there is still a controversy regarding its exact etiology, risk factors, diagnostic parameters and required therapy. Considering that acute poisonings are treated in different types of medical institutions this serious complication of organophosphate insecticide (OPI poisoning is frequently overlooked. The aim of this paper was to present a case of IMS in organophosphate poisoning, which, we believe, provides additional data on the use of oxime or atropine. Case report. After a well-resolved cholinergic crisis, the patient developed clinical presentation of IMS within the first 72 h from deliberate malathion ingestion. The signs of IMS were weakness of proximal limb muscles and muscles innervated by motor cranial nerves, followed by the weakness of respiratory muscles and serious respiratory insufficiency. Malathion and its active metabolite were confirmed by analytical procedure (liquid chromatography-mass spectrometry. Pralidoxime methylsulphate, adiministered as a continuous infusion until day 8 (total dose 38.4 g, and atropine until the day 10 (total dose 922 mg did not prevent the development of IMS, hence the mechanical ventilation that was stopped after 27 h had to be continued until the day 10. Conclusion. Continuous pralidoxime methylsulphate infusion with atropine did not prevent the development of IMS, most likely due to the delayed treatment and insufficient oxime dose but also because of chemical structure and lipophilicity of ingested OPI. A prolonged intensive care monitoring and respiratory care are the key management for the intermediate syndrome. [Projekat Ministarstva nauke Republike Srbije, br. OI 176018, No. 46009

  6. The spectrum of intermediate syndrome following acute organophosphate poisoning: a prospective cohort study from Sri Lanka.

    Pradeepa Jayawardane


    Full Text Available Intermediate syndrome (IMS is a major cause of death from respiratory failure following acute organophosphate poisoning. The objective of this study was to determine repetitive nerve stimulation (RNS predictors of IMS that would assist in patient management and clinical research.Seventy-eight consenting symptomatic patients with organophosphate poisoning were assessed prospectively with daily physical examination and RNS. RNS was done on the right and left median and ulnar nerves at 1, 3, 10, 15, 20, and 30 Hz. The study was conducted as a prospective observational cohort study in the Central Province, Sri Lanka. IMS was diagnosed in ten out of 78 patients using a priori clinical diagnostic criteria, and five of them developed respiratory failure. All ten patients showed progressive RNS changes correlating with the severity of IMS. A decrement-increment was observed at intermediate and high frequencies preceding the onset of clinical signs of IMS. As the patient developed clinical signs of IMS, decrement-increment was progressively noted at low and intermediate frequencies and a combination of decrement-increment and repetitive fade or severe decrement was noted at high frequencies. Severe decrement preceded respiratory failure in four patients. Thirty patients developed forme fruste IMS with less severe weakness not progressing to respiratory failure whose RNS was characterized by decrement-increment or a combination of decrement-increment and repetitive fade but never severe decrements.Characteristic changes in RNS, preceding the development of IMS, help to identify a subgroup of patients at high risk of developing respiratory failure. The forme fruste IMS with the characteristic early changes on RNS indicates that IMS is a spectrum disorder. RNS changes are objective and precede the diagnosis and complications of IMS. Thus they may be useful in clinical management and research.

  7. Alcohol Withdrawal Mimicking Organophosphate Poisoning

    Nezihat Rana Disel


    Full Text Available Organophosphates, which can cause occupational poisoning due to inappropriate personal protective measures, are widely used insecticides in agricultural regions of southern Turkey. Therefore, the classical clinical findings of this cholinergic poisoning are myosis, excessive secretions, bradicardia and fasciculations are easy to be recognized by local medical stuff. Diseases and conditions related to alcoholism such as mental and social impairments, coma, toxicity, withdrawal, and delirium are frequent causes of emergency visits of chronic alcoholic patients. Here we present a case diagnosed and treated as organophosphate poisoning although it was an alcohol withdrawal in the beginning and became delirium tremens, due to similar symptoms.

  8. Is there a relationship between the blood cholinesterase and QTc interval in the patients with acute organophosphate poisoning?

    Baydin, A; Aygun, D; Yazici, M; Karatas, A; Deniz, T; Yardan, T


    Organophosphates cause poisoning as a result of the excessive accumulation of acetylcholine at the cholinergic synapses due to inhibition of acetylcholinesterase (ChE). In the literature, it has been reported that there have been electrocardiographic abnormalities, including QT-interval prolongation in most patients with acute organophosphate poisoning (OPP), and a relation between blood ChE level and clinical severity in acute OPP. The aim of this study is to assess the relationship between blood ChE level and QTc interval in the patients with acute OPP. This retrospective study consists of 20 patients admitted to the emergency intensive care unit. A total of 93 QTc interval and blood ChE measures obtained on the same day from 20 cases were compared for their correlation. There were prolonged QTc intervals in 35.4% of the ECGs. There was a negative correlation between QTc interval and blood ChE measures. In following up the patients with acute OPP, QTc interval may be useful when blood ChE levels are low and may provide complementary information concerning the severity of poisoning. However, further prospective studies, supporting the present results, are needed.

  9. Increased Risk of Dementia in Patients With Acute Organophosphate and Carbamate Poisoning: A Nationwide Population-Based Cohort Study.

    Lin, Jiun-Nong; Lin, Cheng-Li; Lin, Ming-Chia; Lai, Chung-Hsu; Lin, Hsi-Hsun; Yang, Chih-Hui; Kao, Chia-Hung


    Organophosphate (OP) and carbamate (CM) are the most commonly used pesticides against insects. Little is known regarding the relationship between dementia and acute OP and CM poisoning. A nationwide population-based cohort study was conducted from the National Health Insurance Research Database in Taiwan. The incidence and relative risk of dementia were assessed in patients hospitalized for acute OP and CM poisoning from 2000 to 2011. The comparison cohort was matched with the poisoned cohort at a 4:1 ratio based on age, sex, and the year of hospitalization. During the follow-up period, the incidence of dementia was 29.4 per 10,000 person-years in the poisoned group, and represented a 1.98-fold increased risk of dementia compared with the control cohort (95% confidence interval, 1.59-2.47). This study provides evidence on the association between dementia and acute OP and CM poisoning. Regular follow-up of poisoned patients for dementia is suggested.

  10. Effects of acute organophosphate poisoning on pituitary target gland hormones at admission, discharge and three months after poisoning: A hospital based pilot study

    Pinaki Dutta


    Full Text Available Background: Organophosphate compound (OPC poisoning is common in the developing countries such as India. The acute and later effects of OPC poisoning on pituitary and target gland hormones is largely unknown. Materials and Methods: This prospective study was conducted at Postgraduate Institute of Medical Education and Research between January 2012 and March 2013. Fourteen patients (8 males, age 18-50 years with acute OPC poisoning were included in the study based on the history and clinical features, documented decreased in plasma cholinesterase activity or presence of the OPC in gastric lavage/blood samples. The hormonal parameters were done at baseline, at the time of discharge and at three months of follow-up. Results: A total of 14 patients out of 46 with the mean age of 30.1 ± 10.3 years were finally eligible for the study. Hormonal alterations at admission were similar to sick euhormonal syndrome. Overall 7 of them had nine hormonal deficits at three months of follow up, 4 having sub normal basal cortisol level and two each had low testosterone and growth hormone and only one had thyroxine deficiency. Conclusion: Acute organophosphate poisoning results in endocrine dysfunction akin to sick euhormonal syndrome. However, in a small subset of patients, varying level of hormonal insufficiency may occur either at admission or later. These observations need re-validation in a larger group of patients with specific OPC.

  11. Organophosphate and carbamate poisoning.

    King, Andrew M; Aaron, Cynthia K


    Organophosphates (OPs) and carbamates have a wide variety of applications, most commonly as pesticides used to eradicate agricultural pests or control populations of disease-carrying vectors. Some OP and carbamates have therapeutic indications such as physostigmine. Certain organophosphorus compounds, known as nerve agents, have been employed in chemical warfare and terrorism incidents. Both classes inhibit acetylcholinesterase (AChE) enzymes, leading to excess acetylcholine accumulation at nerve terminals. In the setting of toxicity from either agent class, clinical syndromes result from excessive nicotinic and muscarinic neurostimulation. The toxic effects from OPs and carbamates differ with respect to reversibility, subacute, and chronic effects. Decontamination, meticulous supportive care, aggressive antimuscarinic therapy, seizure control, and administration of oximes are cornerstones of management. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Detoxification of Organophosphate Poisoning Using Nanoparticle Bioscavengers.

    Pang, Zhiqing; Hu, Che-Ming J; Fang, Ronnie H; Luk, Brian T; Gao, Weiwei; Wang, Fei; Chuluun, Erdembileg; Angsantikul, Pavimol; Thamphiwatana, Soracha; Lu, Weiyue; Jiang, Xinguo; Zhang, Liangfang


    Organophosphate poisoning is highly lethal as organophosphates, which are commonly found in insecticides and nerve agents, cause irreversible phosphorylation and inactivation of acetylcholinesterase (AChE), leading to neuromuscular disorders via accumulation of acetylcholine in the body. Direct interception of organophosphates in the systemic circulation thus provides a desirable strategy in treatment of the condition. Inspired by the presence of AChE on red blood cell (RBC) membranes, we explored a biomimetic nanoparticle consisting of a polymeric core surrounded by RBC membranes to serve as an anti-organophosphate agent. Through in vitro studies, we demonstrated that the biomimetic nanoparticles retain the enzymatic activity of membrane-bound AChE and are able to bind to a model organophosphate, dichlorvos, precluding its inhibitory effect on other enzymatic substrates. In a mouse model of organophosphate poisoning, the nanoparticles were shown to improve the AChE activity in the blood and markedly improved the survival of dichlorvos-challenged mice.

  13. Therapeutic effectiveness of sustained low-efficiency hemodialysis plus hemoperfusion and continuous hemofiltration plus hemoperfusion for acute severe organophosphate poisoning.

    Hu, Shou-liang; Wang, Dan; Jiang, Hong; Lei, Qing-feng; Zhu, Xiao-hua; Cheng, Jun-zhang


    There is no report on the effects of sustained low-efficiency dialysis (SLED) plus hemoperfusion (HP) (SLED + HP) in patients with acute severe organophosphate (OP) poisoning (ASOPP). This study was designed to compare the therapeutic effectiveness between SLED + HP and continuous hemofiltration (CHF) plus HP (CHF + HP) in patients with ASOPP. In order to assess the two treatment methods, 56 patients with ASOPP were divided into CHF + HP group and SLED + HP group. The biochemical indicators, in-hospital duration, hemodynamic parameters, Acute Physiology, and Chronic Health Evaluation (APACHE II) score, and survival and mortality rates were compared. In both groups after treatment, the levels of serum creatine kinase isozyme MB, creatine kinase, creatinine, glutamic-oxalacetic transaminease, and glutamate-pyruvate transaminase, and the APACHE II scores on the first, second, and seventh day decreased (P  0.05). In conclusion, SLED has similar hemodynamic stability to CHF and the two treatment methods have similar effects on ASOPP patients. More importantly, SLED plus HP is relatively economical and convenient for patients with ASOPP in clinical practice.




    Full Text Available BACKGROUND To study the efficacy of intravenous magnesium sulphate in the treatment of OPC poisoning and its outcome. To assess merits and demerits of use of MgSO4 with conventional therapy. METHOD This is a case control study of patients admitted with severe OPC poisoning in intensive care medical unit of tertiary care hospital. RESULTS Total of 69 cases and 64 control patients were compared. Among both cases and controls incidence of poisoning was more common among male sex and common among patients belonging to third decade of age. When compared to control arm, there is statistically significant reduction in mortality when intravenous MgSO4 was given to patients in addition to standard treatment protocol for severe OPC poisoning. CONCLUSION In our study, addition of MgSO4 has shown significant clinical improvement of severe OPC poisoning with no adverse outcome. Long term and large studies are needed to determine the efficacy of MgSO4 in treatment of OPC poisoning

  15. Amitraz: a mimicker of organophosphate poisoning.

    Dhooria, Sahajal; Behera, Digambar; Agarwal, Ritesh


    Amitraz is used as an ectoparasiticide for dogs and cattle. Human poisoning due to amitraz may be misdiagnosed as organophosphate/carbamate (OPC) toxicity, since amitraz poisoning shares several clinical features (miosis, bradycardia and hypotension) encountered with OPC poisoning. A 19-year-old man with an alleged history of suicidal ingestion of a pesticide presented with drowsiness and was found to have constricted pupils, hypotension and bradycardia. He was diagnosed as a case of OPC poisoning and was treated with atropine and pralidoxime prior to presentation to our centre. Absence of a hypersecretory state, and the presence of hyperglycaemia and hypothermia along with a normal serum cholinesterase level suggested an alternate possibility. Retrieval of the poison container confirmed the diagnosis of amitraz poisoning. The patient made a rapid recovery with supportive management. Clinician awareness is key to successful management of this poisoning, which carries a good prognosis.

  16. Coronary artery bypass grafting in a patient with organophosphate poisoning.

    Pieris, Rajeeva R; Fernando, Ravindra


    A 43-year-old male, with no previous history of mental illness, was diagnosed with coronary heart disease, after which he became acutely depressed and attempted suicide by ingesting an organophosphate pesticide. He was admitted to an intensive care unit and treated with pralidoxime, atropine, and oxygen. His coronary occlusion pattern required early coronary artery bypass grafting (CABG) surgery. His family, apprehensive of a repeat suicidal attempt, requested surgery be performed as soon as possible. He recovered well from the OP poisoning and was mentally fit to express informed consent 2 weeks after admission. Seventeen days after poisoning, he underwent coronary artery bypass grafting and recovered uneventfully. Six years later, he remains in excellent health. We report this case because to the best of our knowledge there is no literature regarding CABG performed soon after organophosphate poisoning.

  17. Does organophosphate poisoning cause cardiac injury?

    Aghabiklooei, Abbas; Mostafazadeh, Babak; Farzaneh, Esmaeil; Morteza, Afsaneh


    Organophosphates are insecticides which are widely used as a suicidal agent in Iran. They are associated with different types of cardiac complications including cardiac arrest and arrhythmia, however their role in cardiac injury is not known yet. The aim of this study was to investigate the presence of myocardial damage in patients with cholinesterase poisoning.It was a prospective study conducted from January 2008 to March 2010. Cohorts of patients with cholinesterase poisoning due to suicidal attempt who have been referred to Loghman hospital were selected. Patients who have taken more than one poison or were used concomitant drugs were excluded. Physical examination was performed on admission to discover warning sign. Peripheral arterial blood gases, creatine kinase, creatine kinase-myocardial band, troponin-T measurements were performed in all cases. There were 24 patients, 7 of them women, with the mean age of 41.2±15.05 who were included in this study. Non-survivors had significantly higher levels of systolic blood pressure, partial pressure of oxygen in arterial blood, partial pressure of carbon dioxide, bicarbonate Glasgow Coma Scale scoring and longer duration of mechanical ventilation. Our findings showed that cardiac injury is an important cause of death in organophosphate poisoning. It could be hypothesized that cardiac injury is a strong predictor of death in patients with organophosphate poisoning.

  18. Organophosphate Insecticide Poisoning and Parkinsonism

    J Gordon Millichap


    Full Text Available Extrapyramidal parkinsonism in a 14 year-old boy developed 5 days after the accidental ingestion of a raw eggplant sprayed with the organophosphate dimethoate (Rogor, in a report from Meyer Children Hospital, Rappaport School of Medicine, Haifa, Israel.

  19. Clinical rescue experience of 42 cases of acute organophosphate poisoning%42例急性有机磷中毒抢救的临床体会



    Objective To summarize the rescue method of acute organophosphate poisoning. Methods Forty- two cases of patients with organophosphate poisoning were pumped into at ropine by the micro- pump continually. Strict observation was done before atropinization was com pleted in order to prevent excessive Atropine intake and atropine poisoning. Results Five out of 42 cases were reported dead and the remaining cases were improved and discharged after treatment. The total cure rate was 88.10%. The average atropinization time was (138.5 ± 38.2) min, and at ropinization process required (78.3 ± 6.8) mg. Two cases (4.76%) had Atropine overdose and poi soning, 3 cases (7. 14%) condition rebounding, and 2 cases (4. 76%) intermediate syndrome. Conclusion Using continuous micro - pump into the Atropine in acute organophosphate poisoning rescue can reduce the required dose of atropinization and reduce the risk of overdose and poisoning.%目的 总结急性有机磷中毒抢救的方法.方法 对42例有机磷中毒患者进行持续微量泵泵入阿托品,严格观察使之阿托品化,防止出现阿托品过量以及阿托品中毒.结果 42例病例除5例死亡外,其余病例均经治疗后好转出院,治愈率88.10%.患者达到阿托品化的平均时间为(138.5±38.2) min,阿托品化需药量(78.3±6.8) mg.出现阿托品过量及中毒2例(4.76%),出现病情反跳3例(7.14%),出现中间综合征者2例(4.76%).结论 在急性有机磷中毒的抢救中使用持续微量泵入阿托品,可以降低达到阿托品化的需药量,并且可以降低出现阿托品过量及中毒的风险.

  20. Body mass index as a prognostic factor in organophosphate-poisoned patients.

    Lee, Duk Hee; Jung, Koo Young; Choi, Yoon Hee; Cheon, Young Jin


    Organophosphate poisoning is a serious clinical entity and considerable morbidity and mortality. Several factors have been identified to predict outcomes of organophosphate poisoning. Organophosphates are lipophilic and therefore predicted to have a large volume of distribution and to rapidly distribute into tissue and fat. Thus, toxic effects of organophosphate would be expected to last longer in obese patients. We investigated the relationship between obesity and clinical course in 112 acute organophosphate-poisoned patients from an initial medical record review of 234 patients. One hundred twenty-two patients were excluded: 6 were children, 14 had an uncertain history of exposure and of uncertain agent, 10 were transferred to another hospital, 67 were discharged from the emergency department because their toxicity was mild, 21 had carbamate poisoning, and 4 did not have height or weight checked. Clinical features, body mass index, Glasgow Coma Scale, laboratory findings, serum cholinesterase activity, electrocardiogram finding, management, and outcomes were examined. The lipid solubility of the implicated organophosphate was characterized by its octanol/water coefficient. Forty of 112 patients were obese. Obese patients who were poisoned by high lipophilicity organophosphate compounds had a need for longer use of mechanical ventilation, intensive care unit care, and total length of admission. Body mass index can provide a guide to physicians in predicting clinical course and management in organophosphate-poisoned patients.

  1. Case report: an unusual heart rhythm associated with organophosphate poisoning.

    Gul, Enes Elvin; Can, Ilknur; Kusumoto, Fred M


    Organophosphate pesticides have emerged as a common cause of poisoning, particularly in developing countries. The most common electrocardiographic abnormalities observed in organophosphate poisoning are sinus tachycardia, QT interval prolongation, and, very rarely, ventricular arrhythmias. We report a case of organophosphate poisoning associated with atrial fibrillation, right bundle branch block, QT interval prolongation, and intermittent narrow QRS complexes that were most likely due to automaticity from the region of the left posterior fascicle.

  2. Optimization of Therapeutic Strategies for Organophosphate Poisoning


    exposed person survives the initial effects of organophosphate poisoning, other symptoms may persist for weeks and include “irritability, anxiety anticonvulsant, and diazepam is the preferred medicine (Cannard, 2006:92). Diazepam reduces the severity of seizures and epilepsy, which are...addition, medical doctors may administer 5 mg of diazepam intravenously for patients with convulsions (CDC, 2008:19). The New York Department of Health

  3. 急性有机磷中毒洗胃的护理体会%The experience of nursing for gastric lavage for acute organophosphate poisoning



      目的探讨并分析对急性有机磷中毒患者进行洗胃的方法及临床效果。方法对于2005年9月至2010年12月间在我院就诊的30例急性有机磷中毒患者的临床资料进行回顾性分析。通过随机的方式将30例患者分为试验组和对照组两组,其中试验组患者15例,对照组患者15例。对试验组的患者通过对胃管进行留置进而反复进行洗胃的方法进行洗胃护理,对照组的患者则接受传统方法进行洗胃护理。比较两组护理临床效果。结果试验组患者的护理总有效率高于对照组,且不良反应少于对照组。结论对急性有机磷中毒患者通过留置反复洗胃的方法可以起到良好的临床效果,值得在临床是进一步的研究和应用。%  Objective: To discuss the different methods and clinical effect of nursing for gastric lavage for acute organophosphate poisoning. Methods: Choosed 60 cases of acute organophosphate poisoning from Sep. 2005 to Dec. 2010 to analyze retrospectly. Divided these 30 patients into study group and controled group for 15 in each other. The study group were treated with gastric tuber detaining for repeating gastric lavage, while controled group were treated with routine methods. Compared the clinical effect of these two groups. Results:The total rate of nursing of study group was higher than controled group with less adverse effect. Conclusion: The clinical effect of using repeating organophosphate poisoning is good to extend in clinical.

  4. Temperature changes among organophosphate poisoned patients, Tehran- Iran

    Talaie Haleh


    Full Text Available Abstract Background Acute poisoning with organophosphorus compounds (OPs is a major global clinical problem in the developing countries. There have been many animal studies and few human surveys on the effects of organophosphorus pesticide (OP poisoning on thermoregulation. The aim of this prospective study was to document the pattern of tympanic temperature changes among OP poisoned patients throughout the length of their hospital stay. Methods 60 patients with diagnose of organophosphate poisoning were included in this study. Questioner was filled out by trained nurses including demographic, clinical and paraclinical data. Tympanic temperature and Pulse rate data of the cases were collected on five- occasions after admission. Results There were 41 (68.3% male and 19 (31.7% female, with a mean age of 34.4 ±19.4 years (range 13–89 years. Forty five patients had intentional poisoning for suicidal attempt. At the time of entry, the mean tympanic temperature, pulse rate, respiratory rate and blood pressure (systolic and diastolic of the OP poisoned patients were respectively 37.1+/−0.6°C (36.0- 39.5, 91+/−18 (55–145, 18+/−5.6 (8–44, 116+/−20 mm Hg (70–170 and 75+/−11.6 mm Hg (40–110. 41.7% of the cases had serum butyryl cholinesterase activities (BChE ≥ 50% normal (≥1600 mU/ml. Our patients had normal temperature at the time entry (mean = 37.1. Tympanic temperature decreasing below 36°C was not detected among the patients during the study period. A rise in mean tympanic temperature was found after atropine administration. Conclusion Our study showed hypothermia was not considerable factor among organophosphate poisoned patients, although more studies with similar situations in tropical countries are needed.

  5. Much caution does no harm! Organophosphate poisoning often causes pancreatitis.

    Yoshida, Shozo; Okada, Hideshi; Nakano, Shiho; Shirai, Kunihiro; Yuhara, Toshiyuki; Kojima, Hiromasa; Doi, Tomoaki; Kato, Hisaaki; Suzuki, Kodai; Morishita, Kentaro; Murakami, Eiji; Ushikoshi, Hiroaki; Toyoda, Izumi; Ogura, Shinji


    Organophosphate poisoning (OP) results in various poisoning symptoms due to its strong inhibitory effect on cholinesterase. One of the occasional complications of OP is pancreatitis. A 62-year-old woman drank alcohol and went home at midnight. After she quarreled with her husband and drank 100 ml of malathion, a parasympathomimetic organophosphate that binds irreversibly to cholinesterase, she was transported to our hospital in an ambulance. On admission, activated charcoal, magnesium citrate, and pralidoxime methiodide (PAM) were used for decontamination after gastric lavage. Abdominal computed tomography detected edema of the small intestine and colon with doubtful bowel ischemia, and acute pancreatitis was suspected. Arterial blood gas analysis revealed severe lactic acidosis. The Ranson score was 6 and the APACHE II (Acute Physiology and Chronic Health Evaluation) score was 14. Based on these findings, severe acute pancreatitis was diagnosed. One day after admission, hemodiafiltration (HDF) was started for the treatment of acute pancreatitis. On the third hospital day, OP symptoms were exacerbated, with muscarinic manifestations including bradycardia and hypersalivation and decreased plasma cholinesterase activity. Atropine was given and the symptoms improved. The patient's general condition including hemodynamic status improved. Pancreatitis was attenuated by 5 days of HDF. Ultimately, it took 14 days for acute pancreatitis to improve, and the patient discharged on hospital day 32. Generally, acute pancreatitis associated with OP is mild. In fact, one previous report showed that the influence of organophosphates on the pancreas disappears in approximately 72 hours, and complicated acute pancreatitis often improves in 4-5 days. However, it was necessary to treat pancreatitis for more than 2 weeks in this case. Therefore, organophosphate-associated pancreatitis due to malathion is more severe. Although OP sometime causes severe necrotic pancreatitis or

  6. New generic approach to the treatment of organophosphate poisoning : Adenosine receptor mediated inhibition of ACh-release

    van Helden, HPM; Moor, E; Westerink, BHC; Bruijnzeel, PLB


    Current treatment of acute organophosphate (OP) poisoning includes a combined administration of a cholinesterase reactivator (oxime), a muscarinic receptor antagonist (atropine) and an anticonvulsant (diazepam). This treatment is not adequate since it does not prevent neuronal brain damage and incap

  7. New generic approach to the treatment of organophosphate poisoning : Adenosine receptor mediated inhibition of ACh-release

    van Helden, HPM; Moor, E; Westerink, BHC; Bruijnzeel, PLB


    Current treatment of acute organophosphate (OP) poisoning includes a combined administration of a cholinesterase reactivator (oxime), a muscarinic receptor antagonist (atropine) and an anticonvulsant (diazepam). This treatment is not adequate since it does not prevent neuronal brain damage and incap

  8. Efficacy of fresh packed red blood transfusion in organophosphate poisoning

    Bao, Hang-xing; Tong, Pei-jian; Li, Cai-xia; Du, Jing; Chen, Bing-yu; Huang, Zhi-hui; Wang, Ying


    Abstract The mortality rate caused by organophosphate (OP) poisoning is still high, even the standard treatment such as atropine and oxime improves a lot. To search for alternative therapies, this study was aimed to investigate the effects of packed red blood cell (RBC) transfusion in acute OP poisoning, and compare the therapeutic effects of RBCs at different storage times. Patients diagnosed with OP poisoning were included in this prospective study. Fresh RBCs (packed RBCs stored less than 10 days) and longer-storage RBCs (stored more than 10 days but less than 35 days) were randomly transfused or not into OP poisoning patients. Cholinesterase (ChE) levels in blood, atropine usage and durations, pralidoxime durations were measured. We found that both fresh and longer-storage RBCs (200–400 mL) significantly increased blood ChE levels 6 hours after transfusion, shortened the duration for ChE recovery and length of hospital stay, and reduced the usage of atropine and pralidoxime. In addition, fresh RBCs demonstrated stronger therapeutic effects than longer-storage RBCs. Packed RBCs might be an alternative approach in patients with OP poisoning, especially during early stages. PMID:28296779

  9. Abnormal Spontaneous Eye Movements as Initial Presentation of Organophosphate Poisoning

    De Lima Teixeira, Igor; Bazan, Silméia Garcia Zanati; Schelp, Arthur Oscar; Luvizutto, Gustavo José; De Lima, Fabrício Diniz; Bazan, Rodrigo


    Background Atypical ocular bobbing may result from an intentional poisoning from an organophosphate compound. Phenomenology Shown The patient exhibited conjugated, slow, arrhythmic, unpredictable eye movements in all directions, diagnosed as atypical ocular bobbing. Educational Value This is a rare, well‐documented, clinically relevant case for medical students for correct diagnosis and appropriate treatment of organophosphate intoxication. PMID:28243486

  10. severe organophosphate poisoning with delayed cholinergic crisis ...



    Nov 3, 2011 ... effect on neuromuscular junction and Autonomic Synapses is clinically important. After exposure ... was 80% with 6L/min flow of oxygen through nasal prongs but .... Abula T, Wondmikun Y. The pattern of acute poisoning in a ...

  11. Organophosphate poisoning: Diagnosis of intermediate syndrome

    Poojara L


    Full Text Available Organophosphate compound (OPC poisoning with suicidal intent is common in Indian ICUs. The effect of OPCs is to produce a persistent depolarization of the neuromuscular junction leading to muscle weakness. After initial recovery from cholinergic crisis, some patients have resurgence of respiratory muscle paralysis requiring continued ventilatory support. This is termed intermediate syndrome (IMS. This could be due to a change in the type of neuromuscular block to a non depolarisation block characterized by a fade on tetanic stimulation. However peripheral nerve stimulation using train-of-four ratio (TOF and/tetanus have failed to consistently show such a change. We elected to study whether electro physiological monitoring using repetitive nerve stimulation might show a decremental response during IMS. Material & Methods: This was a prospective blinded study done from April 2002 to March 2003 in our ICU. 45 consecutive patients of OPC poisoning admitted during this period were included in this study. Repetitive nerve stimulation (RNS using a train of ten at 3Hz 10Hz and 30Hz (slow , intermediate and fast speeds respectively at the median nerve was done on all patients on day 1, 4, 7 and every 4th day thereafter until discharge. Patients were ventilated until ready to wean as per our usual protocol. The results of the RNS study were not revealed to the intensivist. Results: 9 out of 45 patients required ventilation for more than 6 days and showed overt signs of intermediate syndrome - proximal muscle weakness, twitching and respiratory weakness. Only 2 patients out of the 9 had a decremental response on RNS at 3Hz indicating a post-junctional dysfunction at the motor end-plate, Both patients had consumed a very large quantity of OPC and were deeply comatose for >4 days and required ventilation for >12 days. All other patients with IMS showed no changes on RNS. The exact type of poison consumed varied with each individual patient. Conclusion: RNS

  12. 急性有机磷农药中毒30例临床分析%Clinical analysis of acute organophosphate poisoning in 30 cases

    董磊; 李晶晶


      目的探讨急性有机磷农药中毒(AOPP)的临床表现及治疗方案。方法观察30例 AOPP 患者的临床表现,给予相应的治疗措施,分析其转归及预后。结果本组共治愈出院27例,平均住院7 d;3例心搏、呼吸停止,经胸外按压、呼吸机辅助通气后心搏恢复,但终因脑复苏不成功死亡。结论有机磷农药中毒病势凶险,发展快,彻底、反复洗胃,及早应用抗胆碱能药阿托品的同时早期应用胆碱酯酶复能剂是抢救成功的关键。%  Objective To investigate the clinical features and treatment of acute organophosphate poisoning. Methods The clinical manifestations in 30 patients with AOPP were observed. Giving the expectant treatment, and then prognosis of the patients were analyzed. Results 27patients were healing well, the average days in hospital were 7days. 3 cases suffered from cardiorespiratory arrest, after cardiopulmonary resuscitation their hearts beaten. But the 3 patients died because of brain death. Conclusion AOPP is dangerous. Patients underwent Gastric lavage again and again, and treatment of cholinesterase reactivator and atropine as early as possible are key points of successful rescuing.

  13. Reprint of 'Evaluating organophosphate poisoning in human serum with paper'.

    Yen, Tzung-Hai; Chen, Kuan-Hung; Hsu, Min-Yen; Fan, Shu-Ting; Huang, Yu-Fen; Chang, Chia-Ling; Wang, Yu-Ping; Cheng, Chao-Min


    This manuscript describes the development and clinical testing of a paper-based, metabolic assay designed for rapid, semi-quantitative measurement of organophosphate poisoning. Paper-based platforms, including point-of-care devices and 96-well plates, provided semi-quantitative information regarding the concentration of AchE (a biomarker for organophosphate poisoning). The paper-based 96-well-plate developed and implemented in this study was used to measure the level of organophosphate poisoning in three different clinical patients. Results were comparable to those obtained using conventional hospital methods currently considered the "gold standard". This diagnostic device offers several advantages over conventional methods, including short operating time (twice as fast as conventional methods), procedure simplicity, and reduced fabrication cost. With further commercialization efforts, the methods described in this manuscript could be applied to a wide range of potential diagnostic applications in the field.

  14. Evaluating organophosphate poisoning in human serum with paper.

    Yen, Tzung-Hai; Chen, Kuan-Hung; Hsu, Min-Yen; Fan, Shu-Ting; Huang, Yu-Fen; Chang, Chia-Ling; Wang, Yu-Ping; Cheng, Chao-Min


    This manuscript describes the development and clinical testing of a paper-based, metabolic assay designed for rapid, semi-quantitative measurement of organophosphate poisoning. Paper-based platforms, including point-of-care devices and 96-well plates, provided semi-quantitative information regarding the concentration of AchE (a biomarker for organophosphate poisoning). The paper-based 96-well-plate developed and implemented in this study was used to measure the level of organophosphate poisoning in three different clinical patients. Results were comparable to those obtained using conventional hospital methods currently considered the "gold standard". This diagnostic device offers several advantages over conventional methods, including short operating time (twice as fast as conventional methods), procedure simplicity, and reduced fabrication cost. With further commercialization efforts, the methods described in this manuscript could be applied to a wide range of potential diagnostic applications in the field.

  15. Antidotes to organophosphate poisoning. 2. Thiadiazole-5-carboxaldoximes

    Benschop, H.P.; Berg, G.R. van den; Hooidonk, C. van; Jong, L.P.A. de; Kientz, C.E.; Berends, F.; Kepner, L.A.; Meeter, E.; Visser, R.P.L.S.


    Three new nonquaternary oximes have been evaluated with respect to their antidotal activities against organophosphate poisoning. The oximes 1,2,3-thiadiazole-5-carboxaldoxime (1, pKa = 7.6), 2-methyl-1,3,4-thiadiazole-5-carboxaldoxime (2, pKa = 8.4), and 3-methyl-1,2,4-thiadiazole-5-carboxaldoxime

  16. 21例急性有机磷农药中毒患者皮肤灼伤处理%21 cases of acute organophosphate pesticide poisoning patients with skin burns

    丁娴; 张文军; 周彬


    目的探讨急性有机磷农药中毒患者皮肤灼伤处理.方法回顾性分析我院的21例急性有机磷农药中毒患者皮肤灼伤的临床资料.结果创面浅Ⅱ度6-10天治愈,创面深Ⅱ度10-18天治愈.讨论反复进行灼伤创面清洗以及保持灼伤创面的干燥及涂抹典类制剂是灼伤创面扩大和后期感粢的重要措施.%objective to explore the acute organophosphate pesticide poisoning patients with skin burns. Methods retrospective analysis of 21 cases of acute organophosphate pesticide poisoning were burned skin clinical data. Results the wound H degrees 6-shallow 10 days. II deep wounds heal degrees 10-18 days cured. Discuss the repeated bum wounds and keep the wound clean burns dry and daub Canon agents is wound infection and later expanded burns the important measures.

  17. Analysis of acute organophosphate poisoning complicated with plmonary edema: 52 cases%52例有机磷农药急性中毒并发急性肺水肿分析



    Objective To discuss the clinical features and treatment of pulmonary edema caused by acute organophosphate poisoning. Methods The symptoms and therapeutic results of 52 cases (1994.1~ 1998.12) of organophosphate poisoning complicated with pulmonary edema were summrized. Results The clinical features of pulmonary edema caused by acute organophosphate poisoning were atypical during early stage. 8 of 52 patients died (15.4% ), and among this eight patients, 3 died of respiratory failure caused by pulmonary edema(5.8% ). Conclusion The physician should pay more attention to pulmonary edema and diagnose it early in acute organophosphate paisoning.%目的探讨有机磷农药急性中毒并发急性肺水肿的机理、临床特点、影像学特征及治疗方法。方法分析 1994年 1月~ 1998年 12月间,经抢救和治疗的 52例有机磷农药急性中毒并发急性肺水肿患者的症状、胸部 X线摄片、诊断及治疗结果的临床资料。结果 52例患者中 44例( 84.6%)治愈好转出院,死亡 8例( 15.4%)。其中死于肺水肿致呼吸衰竭 3例 (5.8% ).结论急性有机磷农药中毒并发急性肺水肿临床特点和 X线表现早期表现不明显,易被中毒的其它全身表现所掩盖。在治疗措施上 ,既要针对肺水肿的临床表现 ,又要考虑到原发疾病的病因治疗。

  18. The role of serum cholinesterase activity and S100B protein in the evaluation of organophosphate poisoning.

    Yardan, T; Baydin, A; Acar, E; Ulger, F; Aygun, D; Duzgun, A; Nar, R


    The aim of this study was to investigate the role of serum cholinesterase (SChE) activity and S100B protein in the evaluation of patients with acute organophosphate (OP) poisoning. Patients with acute OP poisoning admitted to the emergency department were included in this cross-sectional study. Twenty healthy volunteers served as controls. The SChE activity and serum S100B were determined on admission. Patients were divided into two groups (low severity and high severity). Thirty-six patients diagnosed with acute OP poisoning were enrolled. Serum S100B concentrations were higher in patients than in the control group (p poisoning.

  19. 急性有机磷中毒中间型综合征的危险因素分析及护理对策%The risk factors analysis of acute organophosphate poisoning intermediate syndrome and nursing countermeasures



    Objective To analyze the risk factors of acute organophosphate pesticide poisoning intermediate syndrome(IMS ),and discuss the corresponding nursing countermeasures. Methods From January 2007 to January 2011,50 cases of patients with acute organophosphate pesticide poisoning were collected as the research object.And we analyzed the risk factors of related intermediate syndrome. Results The incidence rate of acute organophosphate poisoning intermediate syndrome was 10.0%.IMS mainly occurred at age of 20~50 years old,rarely occurred at age of <20 and >50 years old.The incidence of IMS with oral intake was higher than respiratory poisoning and skin poisoning.The incidence of IMS caused by drugs of moderate toxicity was higher than drugs with high or low toxicity.The incidence of IMS patients who got atropinization within 2 hours was less than those without it.The incidence of IMS patients using aminoglycoside drugs was higher than those not using them. Conclusions Poisoning way,toxicity of toxicant,timely treatment,basic diseases,atropinization within 2 hours,and using aminoglycoside drugs can influence the condition and prognosis of intermediate syndrome caused by organophosphate pesticide poisoning.%目的 分析急性有机磷农药中毒中间型综合征(IMS)的危险因素,并探讨相应的护理对策.方法 选取2007年1月至2011年1月我院收治的50例急性有机磷农药中毒患者为研究对象.调查与中间型综合征病情相关的危险因素.结果 所有急性有机磷中毒患者中间型综合征的发生率为10.0%.就年龄来看,IMS主要发生于20~50岁,<20岁和>50岁无病例,但20~30岁,31~40岁,41~50岁3个年龄组IMS发生率无明显差异.就中毒途径来看,经口中毒IMS发生率,依次高于经呼吸道中毒、经皮肤中毒;毒物的毒性程度方面:中等毒性药物IMS发生率依次高于高毒性药物、低毒性药物;延缓救治患者IMS发生率高于及时救治患者

  20. Multivariate Analysis of Prognosis after Acute Organophosphate Poisoning%影响急性有机磷农药中毒患者预后的多因素分析

    瞿海龙; 麻晓静; 张冰; 梁璐; 彭广军


    [Objective]To explore the prognostic factors and the mortality of different organophosphates following acute organophos phate poisoning.[Methods]This retrospective study included 96 patients with acute organophosphate poisoning.The patients were investigated according to initial parameters, including the initial acute physiology and chronic health evaluation ( APACHE ) Ⅱ score.Serum cholinesterase level, haemodialysis, blood gas analysis were analyzed statistically, meanwhile the mortality was evaluated according to organophosphate types.[Results]Twenty of the 96 patients died, The agents responsible for mortality were different.The APACHE Ⅱ score related to respiratory failure and mortality (OR values was 1.194, 1.273 respectively; P < 0.01).The mortality was 0% for malathion, Phoxim, Dimethoate, Dipterex; that for phenthoate was 15.4%, 21.1% of acephatemet, 40.0% of omethoate, and 50% of Phorate.The usefulness of hemoperfusion on prognosis appeared to be limited.[Conclusion]The APACHE Ⅱ score is a useful prognostic indicator for acute organophosphate poisoning, and different organophosphates have different poisoning mortality.%目的 探讨影响急性有机磷农药中毒患者预后的因素以及不同种类有机磷农药致死率的差异.方法 回顾性分析急性有机磷农药中毒患者96例,对所有患者进行急性生理和慢性健康状况(APACHEⅡ)评分,统计血清胆碱酯酶活力、血液透析、血气分析等情况,对多种因素对患者预后的影响进行统计学分析,并评估不同有机磷农药中毒死亡率的差异.结果 96例患者中20例死亡,不同有机磷农药死亡率不同.APACHEⅡ评分与呼吸衰竭、患者死亡有关(OR值分别为1.194,1.273,P均<0.01).马拉硫磷、辛硫磷、乐果、敌百虫死亡率为零,稻丰散为15.4%,甲胺磷为21.1%,氧化乐果为40.0%,甲拌磷为50%.血液透析对有机磷农药中毒预后无明显作用.结论 APACHEⅡ评分是判断急性有机

  1. The Study of Electrocardiographic Findings in Patients with Organophosphate Poisoning

    Morteza Rahbar Taromsari


    Full Text Available Background: Cardiac manifestations that occur in a majority of patients with organophosphate (OP poisoning may range from innocuous electrocardiographic manifestations, such as sinus tachycardia, to life-threatening complications, including cardiogenic pulmonary edema and myocardial necrosis. In this study, we evaluated the various electrocardiographic manifestations in patients with OP poisoning. Methods: This retrospective-descriptive study was performed by reviewing the medical records from all patients poisoned with organophosphate admitted to Razi Educational Hospital, Rasht, Iran, from April 2008 to March 2011. Patients with incomplete records were excluded from the study. Histories of all patients were collected and ECG analysis was conducted including the rate, rhythm, ST-T abnormalities, conduction defects, and measurement of PR and QT intervals by a cardiologist. Descriptive statistical analysis was conducted by SPSS software version18. Results: Of the total 100 patients (75 were male with OP poisoning that referred to the Emergency Ward of Razi Hospital, 63 patients presented ECG abnormalities. The mean age of the patients was 35.78 ± 12.91 years. The causes of poisoning were occupational in 71 patients, suicidal in 26 patients, and accidental in 3 patients. Sinus tachycardia (31% was the most common ECG abnormality, followed by non-specific ST-T changes (24%. Overall, mortality rate was 5% and all of the deceased patients presented changes in ECG. Conclusion: OP poisoning is associated with significant ECG abnormalities, especially tachycardia and non-specific ST-T changes.

  2. Is there a relationship between the WHO hazard classification of organophosphate pesticide and outcomes in suicidal human poisoning with commercial organophosphate formulations?

    Peter, John Victor; Jerobin, Jayakumar; Nair, Anupama; Bennett, Anjana


    The WHO classification of pesticides by hazard is based primarily on the acute oral and dermal toxicity to rats. In several Asian countries there is no legislation against the sale of Class I insecticides. We evaluated if there was an association between the WHO hazard Class I, II or III organophosphate compound and outcomes in human poisoning. Two-hundred and fifty-one patients with mean (SD) age of 30.4 (11.8) years, admitted with symptomatic poisoning and treated with atropine and supportive care, were followed up until death or hospital discharge. The admission pseudocholinesterase level of 818.8 (1368) IU/L indicated significant suppression of cholinesterase activity. Class I compounds were ingested by 126, Class II by 113 and Class III by 12 patients. The hospital mortality rate was 16.7%, 5.3% and 0% with Class I, II and III organophosphate compounds, respectively (P=0.01). Ventilatory requirements were higher with Class I compared with Class II poisoning (77.0% vs. 54.9%, Ppoisoning needed mechanical ventilation for a longer period (10.55 (7.4) vs. 7.0 (5.2) days, P=0.002). The linear relationship between the WHO hazard class and mortality in acute organophosphate poisoning mandates the restriction of the sale of organophosphate compounds associated with higher lethality amongst humans.

  3. Comparative study of conventional nursing and cluster nursing in acute organophosphate poisoning%集束化护理与常规护理在急性有机磷中毒中的比较研究



    目的:探讨集束化护理与常规护理在急性有机磷中毒中的临床效果。方法83例急性有机磷中毒患者随机分成观察组42例与对照组41例,对照组实施常规护理,观察组在常规护理的基础上实施集束化护理,比较两组患者治疗情况。结果观察组阿托品化所需时间(10.77±3.15)min、胆碱酯酶(CHE)恢复正常所需时间(4.01±1.46)d、机械通气时间(72.87±62.40)h、并发症发生率及院内感染率、病死率(16.67%、11.90%、23.19%)均明显少于对照组(P<0.05、0.01)。结论集束化护理可有效缩短急性有机磷中毒患者阿托品化时间、CHE恢复正常所需时间及机械通气时间,降低并发症发生率、院内感染率及病死率。%ObjectiveTo investigate the clinical effects of conventional nursing and cluster nursing in acute organophosphate poisoning.Methods83 patients with acute organophosphate poisoning were randomly divided into observation group(42 cases) and control group(41 cases), patients in the control group were received conventional nursing, patients in the observation group were received the cluster nursing on the basis of conventional nursing, treatment were compared.ResultsThe required time of atropinization (10.77±3.15) min, the time for cholinesterase (CHE) to resume normal (4.01±1.46) d, the duration of mechanical ventilation (72.87±62.40) h, and the incidence of complications and nosocomial infection rate,mortality rate (16.67%, 11.90%, 23.19%) were significantly less than control group (P<0.05, 0.01).ConclusionCluster nursing can effectively shorten atropinization time in patients with acute organophosphate poisoning, CHE to normal time and duration of mechanical ventilation, reduce the incidence of complications and nosocomial infection rate, mortality rate.

  4. Organophosphate poisoning in Ongole cattle in Sukamandi

    Yulvian Sani


    Full Text Available An integrated farming system between rice and beef cattle was initiated in 2000 in Sukamandi, West Java. However, since 2002 some cattle were suffering from neurological and ophthamological signs, and some of them were found dead after consuming rice straws. Field studies showed that 6 out of 12 cattle were suffered from eye disorders such as blindness, corneal opacity and sereous lacrimation. Two of 6 cattle were severely affected. But, neurological signs were not found during field observation. Pesticide analysis in rice straws shows that both groups of pesticide, organochlorines (OP and organophosphates (OP were detected. Residues of OC were higher than OP as shown as 14.41 vs 2.84 ppm (before processing for OC and 1.80 vs 0.0003 ppm (processed for OP consisting aldrin, lindane, dieldrin, endosulfan and chlorpyrifos methyl. There was only OC detected in sera consisting lindane (0.6–37.6 ppb; heptachlor (0.03–4.4 ppb; and aldrin (0.8–20.4 ppb with an average total of 21,4 ppb. The neurological and ophthalmological signs were suspected to be due to organophosphates (OPs contaminated-rice straws and any other factors such as insufficient vitamin A, magnesium and calcium. Feed replacement with fresh grasses for two cattle reduced corneal changes. Similar symptoms were also reproduced in Wistar rats dosed intraperitoneally with chlorpyriphos methyl. Clinical signs included incoordination, cachexia, eye disorder and corneal opacity. Necropsy showed hepatic injury (hepatic necrosis, mottling of hepatic surface and pale; pale kidneys; swollen of spleen and hyperaemic brain. Microscopic changes were found in brain, liver and eyes. Hepatic changes included haemorrhages, centrolobular hepatic necrosis and focal coagulative necrosis. Brains were showing focal necrosis, haemorrhages, vacuolisation, neuronal necrosis, chromatolysis and nucleolysis. Eyes appeared to have necrosis of tunica muscularis, haemorrhages and eosinophilic infiltration. The

  5. Organophosphate acetylcholine esterase inhibitor poisoning from a home-made shampoo.

    Sadaka, Yair; Broides, Arnon; Tzion, Raffi Lev; Lifshitz, Matitiahu


    Organophosphate acetylcholine esterase inhibitor poisoning is a major health problem in children. We report an unusual cause of organophosphate acetylcholine esterase inhibitor poisoning. Two children were admitted to the pediatric intensive care unit due to organophosphate acetylcholine esterase inhibitor poisoning after exposure from a home-made shampoo that was used for the treatment of head lice. Owing to no obvious source of poisoning, the diagnosis of organophosphate acetylcholine esterase inhibitor poisoning in one of these patients was delayed. Both patients had an uneventful recovery. Organophosphate acetylcholine esterase inhibitor poisoning from home-made shampoo is possible. In cases where the mode of poisoning is unclear, direct questioning about the use of home-made shampoo is warranted, in these cases the skin and particularly the scalp should be rinsed thoroughly as soon as possible.

  6. Research progress on the middle syndrome emergency treatment and nursing of acute organophosphate poisoning%急性有机磷中毒中间综合征的急救与护理的研究进展



    为提高急性有机磷中毒中间综合征的急救与护理,探讨我国急性有机磷中毒中间综合征的的临床特征、发病机制及急救与护理的研究进展,为今后护理人员对急性有机磷中毒中间综合征急救与护理的研究提供依据.%To improve emergency treatment and nursing of acute organophosphate poisoning, explore the research progress on the clinical characteristics, pathogenesis, emergency treatment and nursing.

  7. Nursing on acute organophosphate poisoning patients' early mechanical ventilation rescue%早期机械通气抢救重度有机磷中毒的护理体会



    Objecttive To discuss the experience of nursing on acute organophosphate poisoning patients' early mechanical ventilation rescue. Method Timely and thoroughly gastric lavage, early and full dosage use specific antidote and quickly achieved atropinization, early put to use mechanical ventilation, and strengthen observation and nursing. Result The data of blood gas analysis were obviously different in 32 patients before and after mechanical ventilation (P<0.05). Twenty-six patients were rescue successfully, and 6 patients were died. Success rate reached 81%. Conclusion Beside the systemic rescue, putting to use mechanical ventilation early and strengthening obser-vation and nursing is the key to the success of acute organophosphate poisoning patients' rescue.%目的 探讨早期机械通气抢救重度有机磷农药中毒(AOPP)患者的护理措施.方法 在及时彻底洗胃,早期足量使用特效解毒药,尽快达到阿托品化的同时,早期机械通气,加强病情观察及护理.结果 32例重度有机磷中毒患者,经机械通气抢救成功26例,死亡6例,成功率81%,机械通气前后血气分析比较有显著性差异(P<0.05).结论 重度有机磷农药中毒患者在系统的急诊治疗时,早期应用机械通气,加强病情观察及良好护理是抢救成功的关键.

  8. Clinical features of organophosphate poisoning: A review of different classification systems and approaches

    John Victor Peter


    Full Text Available Purpose: The typical toxidrome in organophosphate (OP poisoning comprises of the Salivation, Lacrimation, Urination, Defecation, Gastric cramps, Emesis (SLUDGE symptoms. However, several other manifestations are described. We review the spectrum of symptoms and signs in OP poisoning as well as the different approaches to clinical features in these patients. Materials and Methods: Articles were obtained by electronic search of PubMed® between 1966 and April 2014 using the search terms organophosphorus compounds or phosphoric acid esters AND poison or poisoning AND manifestations. Results: Of the 5026 articles on OP poisoning, 2584 articles pertained to human poisoning; 452 articles focusing on clinical manifestations in human OP poisoning were retrieved for detailed evaluation. In addition to the traditional approach of symptoms and signs of OP poisoning as peripheral (muscarinic, nicotinic and central nervous system receptor stimulation, symptoms were alternatively approached using a time-based classification. In this, symptom onset was categorized as acute (within 24-h, delayed (24-h to 2-week or late (beyond 2-week. Although most symptoms occur with minutes or hours following acute exposure, delayed onset symptoms occurring after a period of minimal or mild symptoms, may impact treatment and timing of the discharge following acute exposure. Symptoms and signs were also viewed as an organ specific as cardiovascular, respiratory or neurological manifestations. An organ specific approach enables focused management of individual organ dysfunction that may vary with different OP compounds. Conclusions: Different approaches to the symptoms and signs in OP poisoning may better our understanding of the underlying mechanism that in turn may assist with the management of acutely poisoned patients.

  9. Clinical features of organophosphate poisoning: A review of different classification systems and approaches.

    Peter, John Victor; Sudarsan, Thomas Isiah; Moran, John L


    The typical toxidrome in organophosphate (OP) poisoning comprises of the Salivation, Lacrimation, Urination, Defecation, Gastric cramps, Emesis (SLUDGE) symptoms. However, several other manifestations are described. We review the spectrum of symptoms and signs in OP poisoning as well as the different approaches to clinical features in these patients. Articles were obtained by electronic search of PubMed(®) between 1966 and April 2014 using the search terms organophosphorus compounds or phosphoric acid esters AND poison or poisoning AND manifestations. Of the 5026 articles on OP poisoning, 2584 articles pertained to human poisoning; 452 articles focusing on clinical manifestations in human OP poisoning were retrieved for detailed evaluation. In addition to the traditional approach of symptoms and signs of OP poisoning as peripheral (muscarinic, nicotinic) and central nervous system receptor stimulation, symptoms were alternatively approached using a time-based classification. In this, symptom onset was categorized as acute (within 24-h), delayed (24-h to 2-week) or late (beyond 2-week). Although most symptoms occur with minutes or hours following acute exposure, delayed onset symptoms occurring after a period of minimal or mild symptoms, may impact treatment and timing of the discharge following acute exposure. Symptoms and signs were also viewed as an organ specific as cardiovascular, respiratory or neurological manifestations. An organ specific approach enables focused management of individual organ dysfunction that may vary with different OP compounds. Different approaches to the symptoms and signs in OP poisoning may better our understanding of the underlying mechanism that in turn may assist with the management of acutely poisoned patients.

  10. Effectiveness of High Dose Pralidoxime for Treatment of Organophosphate Poisoning

    Pham Due


    Full Text Available Background: For effective treatment of organophosphate (OP poisoning, development of a standardized protocol with flexible dose regimen for atropine and pralidoxime is an essential step. In this study, we aimed to assess the protocol devised in our setting; Bach Mai Hospital Poison Treatment Center, for treatment of OP poisoning that included a higher dose regimen of pralidoxime (2PAM. Methods: A protocol for treatment of OP poisoning was developed during 1995 to 1996, which included an atropinization scoring scale and a modification of 2PAM dose regimen. In this study, OP poisoned patients who were treated during 1997 to 2002 with the new protocol (study group or cases were compared with historical control group which included OP poisoned patients treated between 1993 and 1994 prior to establishment of the new protocol. Results: One-hundred and eight cases and 54 controls were included. The cases and controls were not significantly different according to age, gender and plasma cholinesterase activity on admission from each other. There was no significant difference of mean duration of 2PAM therapy between the two groups. The controls received mean total 2PAM dose of 7.2±4.1 g, while the patients in the study group received 20.0±12.7 g which was 2.77 times higher than the dose for control group (P

  11. Organophosphate poisoning in a 12-day-old infant: case report.

    O'Reilly, D A; Heikens, G T


    A 12-day-old infant girl was admitted with increasing lethargy and respiratory distress. Initial treatment was for pneumonia but deterioration despite appropriate treatment prompted review of her diagnosis and consideration of organophosphate poisoning. There was a brisk response to atropine. To our knowledge, this is the youngest infant reported to have been exposed to poisoning by organophosphates.

  12. Clinical analysis of acute organophosphate poisoning using atropine and penehyclidine hydrochloride atropine about 80 cases%急性有机磷中毒使用长托宁和阿托品临床80例分析

    刘丽; 王正康; 牟丽琴


    目的 探讨在急性有机磷中毒时使用长托宁(盐酸戊乙奎醚)对阿托品剂量、时间使用的影响.方法 将我院自2003~2009年共收治80例急性有机磷中毒患者分为对照组和治疗组.治疗组为阿托品、碘解磷定加长托宁,对照组为常规使用使用阿托品、碘解磷定组,分析两组患者阿托品用量、维持时间及病死率.结果 长托宁可以使轻、中、重急性有机磷中毒患者减少阿托品用药总量,治疗组分别为15、76、101mg,对照组分别为43、83、840mg减少阿托品用药次数,治疗组分别为:15、23、30次,对照组分别为:20、35、94次,缩短阿托品化时间,治疗组分别为:1.5、3、5h,对照组分别为:3、5、8h,缩短治愈时间:治疗组分别为:3、4、5d,对照组分别为:4、5、6d,两组比较差异有统计学意义.结论 急性有机磷中毒配合使用长托宁,减少阿托品使用总量及维持时间,并且不易发生反跳,病死率降低,长托宁是一种比阿托品效果好、不良反应少的新型抗胆碱能药.%To explore in acute organophosphate poisoning "to use long temple, use of atropine doses. Methods From 2003 -2009 1995,23 cases of acute organophosphate poisoning 80 cases of patients in the control group and divided into treatment group, the treatment group for atropine and recent iodine, torre for extended for routine use of atropine in recent, iodine, analyzes two groups for group patients maintain time and atropine, mortality. Results Torre would make long mild, moderate, and severe acute organophosphale poisoning patients reduce total drug treatment group and atropine 15mg respectively, 76mg, l0lmg, respectively, in 43mg83mg, 840mg reduce atropine, drug treatment group is respectively: 15 times, 23 times, 30 times, respectively is; 20 times, 35, 94, shorten the time of atropine, the treatment group is respectively: 1.5h 5h and control, 3h, respectively, the 5h and 8h: 3h, shorten the time: treatment group cure

  13. Neuropathology of organophosphate poisoning in dairy cattle

    Yulvian Sani


    Full Text Available The purpose of this study is to investigate pathological changes in brain tissues of Frisien Holstein dairy cattle affected by organophosphate (OP. The study was directed to anticipate spongiform encephalopathy. Samples consisted of animal feeds, sera and brain tissues were collected from Lembang, West Java. Animal feeds (fodders and commercial feed were collected directly from the dairy farms around Lembang. Sera (31 samples were from dairy cattle owned by the local farmers and brain tissues were from the local animal slaughter house. Pesticide residues were analysed following a standard procedure using gas chromatography (GC. There was an interaction between pesticide residues in animal feeds, residue level of pesticides in sera and brain tissues to cause encephalopathy in dairy cattle. Pesticide contamination in animal feeds was regarded as the source of encephalopathy in dairy cattle. The total average of OP residues (16.8 ppb were lower than organochlorines/OC (18.7 ppb in fodder, showing that pesticides were originated from the contaminated soils. On the other hand, the total average of OP residues in commercial feeds (12.0 ppb, sera (85.6 ppb and brain tissues (22.7 ppb were higher than OC (1.8; 16.7; and 5.1 ppb. The OP appears more frequently used for dairy farm activity as insecticides. Histopathological examination for brain tissues of dairy cattle showed that most cattle were diagnosed as encephalopathy with microscopic changes of vacuolation, neuronal necrosis, chromatolysis of neurons and nucleolysis of neurons. The encephalopathy was confirmed in rats intoxicated with chlorpyrifos methyl as severe brain damage with spongiform-like lesions.

  14. Pharmacokinetic Studies on Oximes in Organophosphate Poisoning: A Mini Review

    Girish Thunga


    Full Text Available Organophosphate (OP poisoning is one of the most common causes of poisoning in developing countries especially in Southeastern Asia. Poisoning with phosphorus-containing organic chemicals or OP compounds can be managed with antidotes like oximes which are potential reactivators of acetylcholinesterase (AChE. The efficacy of oxime therapy in OP poisoned patients mainly depends upon various factors such as different dose plans, infusion rate of oximes, genetic differences of patients, type of oxime used and chemical nature of the OP compound ingested. Studies on pralidoxime kinetics in OP poisoned patients have shown that reactivation of AChE depends on the plasma concentration of oximes as well as OP compounds. The plasma concentration of oximes mainly depends on the dose plan from intermittent injection to continuous infusion after a loading dose. The incontrovertible fact is that the intermittent dosing of oximes results in deep troughs in blood pralidoxime/oxime levels (BPL whereas continuous infusion of oximes maintains steady state plasma concentrations. Many published literature also highlighted pralidoxime via continuous infusion results in better outcomes with minimum fluctuation in BPL compared to intermittent dosing. At therapeutic doses, adverse effects of oximes are reported to be minimal. But high BPL is associated with some common adverse effects including dizziness, blurred vision and diastolic hypertension. Considering all the facts, it is important to note that kinetic studies of oximes are useful not only in deciding the dose regimen, but also in predicting the possible side-effects.

  15. Developments in alternative treatments for organophosphate poisoning.

    Iyer, Rupa; Iken, Brian; Leon, Alex


    Organophosphosphates (OPs) are highly effective acetylcholinesterase (AChE) inhibitors that are used worldwide as cheap, multi-purpose insecticides. OPs are also used as chemical weapons forming the active core of G-series and V-series chemical agents including tabun, sarin, soman, cyclosarin, VX, and their chemical analogs. Human exposure to any of these compounds leads to neurotoxic accumulation of the neurotransmitter acetylcholine, resulting in abnormal nerve function and multiple secondary health complications. Suicide from deliberate exposure to OPs is particularly prevalent in developing countries across the world and constitutes a major global health crisis. The prevalence and accessible nature of OP compounds within modern agricultural spheres and concern over their potential use in biochemical weapon attacks have incentivized both government agencies and medical researchers to enact stricter regulatory policies over their usage and to begin developing more proactive medical treatments in cases of OP poisoning. This review will discuss the research undertaken in recent years that has investigated new supplementary drug options for OP treatment and support therapy, including progress in the development of enzymatic prophylaxis.

  16. 长托宁对急性有机磷农药中毒患者的疗效分析%Clinical analysis of Penehyclidine Hydrochloride treatment for acute organophosphate pesticide poisoning



    Objective To observe the clinical effect on acute organophosphate pesticide poisoning treated by Penehyclidine Hydrochloride. Methods 76 cases with acucte organophosphate peticide poisoning were randomly divided into Penehyclidine Hydrochloride group and Atropine group, with 38 cases in each group. The two groups were given Penehyclidine Hydrochloride and Atropine at the base of conventional treatment, the efficacy was compared. Results The total effective rate of Penehyclidine Hydrochloride group was 97.4%, significantly higher than 78.9% of Atropine group (P < 0.05). The disappear time of poisoning symptoms and cholinesterase energy recovery in Penehyclidine Hydrochloride group was shorter than the Atropine group (P < 0.05). The drug dose and the average number of drugs were significantly different between the two groups (P < 0.05). The incidence rate of adverse reaction of Penehyclidine Hydrochloride group was 7.9%, significantly lower than Atropine group (26.3%) (P < 0.05). Conclusion The clinical effect on acute organophosphate pesticide poisoning treated by Penehyclidine Hydrochloride is satisfactory, recovery faster and less adverse reactions, which is worthy of clinical application.%目的 观察长托宁治疗急性有机磷农药中毒的临床疗效.方法 将76例急性有机磷中毒患者随机分为长托宁组和阿托品组,各38例,两组在常规治疗的基础上分别给予长托宁和阿托品肌注联合氯解磷定治疗,比较两组的临床疗效.结果 长托宁组和阿托品组的有效率分别为97.4%和78.9%,两组比较差异有统计学意义(P < 0.05);长托宁组的中毒症状消失时间和胆碱酯酶活力恢复时间均明显短于阿托品组,住院时间也明显缩短(P < 0.05).长托宁组的用量和给药次数均明显少于阿托品组(P < 0.05).治疗过程中长托宁组的不良反应发生率为7.9%,显著低于阿托品组的26.3%(P < 0.05).结论 长托宁用于急性有机磷中毒的抢救疗效显

  17. Role of Magnetic Resonance Imaging in Diagnosing Neurological Complications in Intermediate Syndrome of Organophosphate Poisoning

    Ravikanth, Reddy


    Organophosphate poisoning (OP) is a very common mode of suicide in rural and urban areas due to the wide availability of pesticides. The identification of OP and timely referral for appropriate supportive care can be lifesaving. Injury to the central nervous system is a serious entity in acute OP. Application of modern imaging techniques like diffusion weighted imaging increases the diagnostic rate of brain injury in the early period and can provide evidence for medical treatment. We present the imaging features in the intermediate syndrome of OP. PMID:28250609

  18. Role of magnetic resonance imaging in diagnosing neurological complications in intermediate syndrome of organophosphate poisoning

    Reddy Ravikanth


    Full Text Available Organophosphate poisoning (OP is a very common mode of suicide in rural and urban areas due to the wide availability of pesticides. The identification of OP and timely referral for appropriate supportive care can be lifesaving. Injury to the central nervous system is a serious entity in acute OP. Application of modern imaging techniques like diffusion weighted imaging increases the diagnostic rate of brain injury in the early period and can provide evidence for medical treatment. We present the imaging features in the intermediate syndrome of OP.

  19. 头孢哌酮预防急性有机磷中毒患者医院感染的临床研究%Clinical study of Cefoperazone for prevention of nosocomial infection in patients with acute organophosphate poisoning

    王庭学; 莫翠毅; 颜洪顺


    OBJECTIVE To investigate clinical outcomes of cefoperazone for prevention of nosocomial infection in patients with acute organophosphate poisoning ,in order to improve the level of clinical treatment .METHODS To‐tally 150 patients with acute organophosphate poisoning during Jan .2011 to Apr .2013 were enrolled in this study and were divided into two groups ,the control group of 75 cases and the observation group of 75 cases .The control group only received symptomatic treatment such as conventional gastric lavage ,while the observation group addi‐tionally received cefoperazone for prevention of nosocomial infection .The changes in infection status after treat‐ment were observed for the two groups .RESULTS The number of cases of nosocomial infection was 14 in the con‐trol group (the infection rate 18 .67% ) and 9 in the observation group (12% ) .The infection related indicators leu‐kocytes ,neutrophils ,C‐reactive protein at 1 day after admission showed no difference between the two groups , while there was significant difference at 3 and 5 days dafter admission (P< 0 .05) .CONCLUSION Cefoperazone can prevent the occurrence and development of nosocomial infection in patients with acute organophosphate poison‐ing .%目的:探讨头孢哌酮预防急性有机磷中毒患者医院感染临床效果,以期提高临床治疗水平。方法选取2011年1月-2013年4月150例急性有机磷中毒患者为研究对象,分为对照组75例,仅常规的洗胃等对症治疗,观察组75例,在对照组基础上加用头孢哌酮预防医院感染治疗,观察两组治疗后在医院感染上的变化情况。结果对照组医院感染例数为14例,感染率为18.67%,观察组医院感染例数为9例,感染率为12.00%;白细胞、中性粒细胞、C‐反应蛋白两组入院后第1天比较差异无统计学意义,而入院后第3、5天比较则差异有统计学意义(P<0.05)。结论头孢哌酮可

  20. Organophosphate insecticide poisoning of Canada geese in the Texas panhandle

    White, D.H.; Mitchell, C.A.; Wynn, L.D.; Flickinger, Edward L.; Kolbe, E.J.


    Sixteen hundred waterfowl, mostly Canada Geese, died near Etter, Texas, in late January 1981 from anticholinesterase poisoning. Winter wheat in the area of the die-off had been treated with organophosphate insecticides to control greenbugs. Cholinesterase (ChE) levels in brains of a sample of geese found dead were 75% below normal, enough to account for death (Ludke et al. 1975). The gastrointestinal (G I) tracts of geese found dead were packed with winter wheat; gas chromatography techniques identified parathion and methyl parathion in the GI tract contents. Residues of both chemicals were confirmed by mass spectrometry. We recommend that less toxic materials, such as malathion, be used on grain crops when waterfowl are in the vicinity of treatment.

  1. [Acute arsenic poisoning].

    Montelescaut, Etienne; Vermeersch, Véronique; Commandeur, Diane; Huynh, Sophie; Danguy des Deserts, Marc; Sapin, Jeanne; Ould-Ahmed, Mehdi; Drouillard, Isabelle


    Acute arsenic poisoning is a rare cause of suicide attempt. It causes a multiple organs failure caused by cardiogenic shock. We report the case of a patient admitted twelve hours after an ingestion of trioxide arsenic having survived thanks to a premature treatment.

  2. Caramiphen edisylate: an optimal antidote against organophosphate poisoning.

    Raveh, Lily; Eisenkraft, Arik; Weissman, Ben Avi


    Potent cholinesterase inhibitors such as sarin, induce an array of harmful effects including hypersecretion, convulsions and ultimately death. Surviving subjects demonstrate damage in specific brain regions that lead to cognitive and neurological dysfunctions. An early accumulation of acetylcholine in the synaptic clefts was suggested as the trigger of a sequence of neurochemical events such as an excessive outpour of glutamate and activation of its receptors. Indeed, alterations in NMDA and AMPA central receptors' densities were detected in brains of poisoned animals. Attempts to improve the current cholinergic-based treatment by adding potent anticonvulsants or antiglutamatergic drugs produced unsatisfactory results. In light of recent events in Syria and the probability of various scenarios of military or terrorist attacks involving organophosphate (OP) nerve agent, research should focus on finding markedly improved countermeasures. Caramiphen, an antimuscarinic drug with antiglutamatergic and GABAergic facilitating properties, was evaluated in a wide range of animals and experimental protocols against OP poisoning. Its remarkable efficacy against OP exposure was established both in prophylactic and post-exposure therapies in both small and large animals. The present review will highlight the outstanding neuroprotective effect of caramiphen as the optimal candidate for the treatment of OP-exposed subjects.

  3. Cases of poisoning with organophosphates treated at the University Clinical Centre of Kosova.

    Gashi, Musli; Gashi, Sanije; Berisha, Merita; Mekaj, Agon; Gashi, Goneta


    Everywhere today, poisonings present a significant and continuous increase of incidence in illness. Poisonings with organophosphates are more and more often. We do not have accurate statistics for this problem. The aim of this work was to present the clinical characteristics of poisoning with organophosphates, treated in University Clinical Centre in Prishtina. With the retrospective method, 23 patients were analyzed, 18 female and 5 male. Out of these, to (43.5%) have had tentative suicide, while 13 (56%) were accidentally exposed to poison. Poisoning with organophosphates was present in 3.8% of the overall number of poisonings. Organophosphate that was found in the analyzed poisoned patients was malathion (known here as Etiol). Average hospitalization time was 8.8 days (1 - 50 days range), average age of the patients was 27.1 years. Mortality scale was 52.1%. All these patients were treated with atropine. Atropine was given in intravenous way during 4.2 +/- 3.5 days and the average total dose was 82 +/- 61.5 mg. Pralidoxime antidote was not given to any of the patients. In adults, the poisoning was done mainly with the aim of suicide. Poisoned children with Etiol are in larger numbers from rural areas.

  4. Economic evaluation for early hemoperfusion in the treatment of acute organophosphate poisoning%早期血液灌流在急性有机磷农药中毒患者治疗中的经济学评价



    目的 从经济学方面对急性有机磷农药中毒治疗中的早期血液灌流技术进行评价.方法 40例急性有机磷农药中毒患者根据是否行早期血液灌流分为早期灌流组(20例)和对照组(20例).观察两组患者在基础情况、治疗和预后情况以及治疗费用方面的差别.结果 两组在性别构成、年龄、初始胆碱酯酶(ChE)水平、中毒程度方面比较差异无统计学意义(P>0.05).两组患者在病程中均接受了至少1次血液灌流治疗.早期灌流组和对照组开始血液灌流时间分别为(1.6±0.9)h和(6.4±3.6)h,两组比较差异有统计学意义(P<0.05).早期灌流组ChE恢复正常时间和住院时间短于对照组[(8.5±2.1)d比(10.0±1.8)d、(10.5±4.2)比(12.3±5.4)d],差异有统计学意义(P<0.05).早期灌流组再次血液灌流5例,机械通气4例,对照组分别为8、5例,早期灌流组无院内死亡及28 d死亡,对照组院内死亡1例,28 d死亡1例.早期灌流组总住院费用、每天治疗费用、监护费用及药品费用均低于对照组[(17 231.75±5 411.45)元比(21 394.52±6 049.81)元、(1 412.25±169.33)元比(1 579.41±307.19)元、(4 309.22±1 490.12)元比(5 581.71±1 681.00)元、(8 223.41±1 426.10)元比(9 790.02±1 909.24)元],差异有统计学意义(P<0.05).结论 对于急性有机磷农药中毒患者,在病程早期实施血液灌流对其预后有益,缩短了血ChE恢复正常时间和住院时间,且降低了总住院费用.%Objective To evaluate early hemopeffusion in the patients of acute organophosphate poisoning from economic.Methods Forty patients with acute organophosphate poisoning were divided into early hemoperfusion group (20 cases) and control group (20 cases) according to the condition of early hemoperfusion in three hours after the diagnosis.The date of basal clinical conditions,treatment,prognosis and cost in the 2 groups were observed.Results There were no statistical differences in sex,age,the level of


    李志强; 张印刚; 程爱斌; 邱方


    [目的]评价解磷定对急性中重度有机磷中毒患者病死率、中问综合症发病率、需机械通气患者比例和机械通气时间的影响.[方法]计算机检索PubMed(1966~2009.10)、Cochrane Database(2009年第3期)、CBM(1978~2009.10)和CNKI(1979~2009),收集国内外关于解磷定对急性中重度有机磷中毒患者影响的随机对照试验,并进行系统评价.[结果]共6篇文献入选,1篇A级文猷,其余为B级文献.分析显示长期高剂量应用解磷定可以降低病死率、中间综合征发病率、需机械通气患者比例和缩短机械通气时问(P<0.05),而短期高剂量应用对患者有害.[结论]长期高剂量应用解磷定可能对急性中熏度有机磷患者有益.由于纳入文献的总体质量不高,尚需进行更多大样本、高质量随机对照试验来进一步证实解磷定的疗效.%[Objective] To compare the effects of pralidoxime therapy on mortality rate, incidence of intermediate syndrome, need for mechanical ventilation and the duration of mechanical ventilation. [Methods] Randomized controlled trials (RCTs) were identified from PubMed (1966-2009.10), Cochrane Database (Issue 3, 2009), CBM (1978-2009.10) and CNKI (1979-2009). All RCTs of pralidoxime in acute moderate and severe organophosphorus pesticide poisoning were included, and a systematic review was performed. [Results] Six literatures were enrolled in the systematic review. The clinical benefit, including mortality, the incidence of intermediate syndrome, ventilatory requirements and duration of ventilation could be produced in long-term and high-dose application of pralidoxime subgroup, meanwhile, a detrimental effect was observed in short-term and low-dose application subgroup. [Conclusion] Based on the current available data, long-term and high-dose application of pralidoxime may be benefit in human organophosphate poisoning. The lack of high quality literatures, it needs large sample and high quality randomized

  6. Observation on curative effects of hemoperfusion of 124 cases with acute organophosphate poisoning%血液灌流治疗急性有机磷中毒患者124例疗效观察

    王二宁; 王永升


    Objective :To explore the curative effect of hemoperfusion in adjuvant treatment on patients with acute organophosphate poisoning .Methods :124 cases ASOPP patients from January 2014 to April 2015 admit‐ted to the emergency department of the hospital were divided into conventional treatment group (n = 58) and combi‐nation therapy group (n = 66) according to whether the use of hemoperfusion ,value of acetylcholinesterase after treatment 1 ,3 ,5d ,the total course of ChE and atropine agents ,Intermediate syndrome incidence ,survival ,hospital‐ization time and other indicators of the two groups were compared .Results :After treatment 1d ,3d ,5d ,value of acetylcholinesterase in combination group was increased significantly higher than the control group over the same pe‐riod ,the difference was statistically significant (P < 0 .05) ;the combined group ChE re - agent total volume ,atro‐pine total amount was less than the conventional treatment group ,the difference was statistically significant (P< 0 . 05) ;intermediate joint syndrome group was lower than the conventional group ,the cure rate was higher ,a shorter hospital stay than the control group ,the differences were there was statistically significant (P < 0 .05) .Conclusion :Hemoperfusion in adjuvant treatment of acute organophosphate poisoning can significantly enhance the survival rate and reduce the incidence of complications ,reduce the amount of conventional drugs ,and thus accelerate the rehabili‐tation of patients .%目的:探究血液灌流辅助治疗急性有机磷中毒患者(ASOPP)的疗效。方法:选择本院急诊科收治的124例 ASOPP 患者,根据是否采用血液灌流治疗,分为常规治疗组(n=58)和联合治疗组(n=66),比较两组患者治疗后第1、3、5d 的乙酰胆碱酯酶值、总疗程的胆碱酯酶(ChE)复能剂及阿托品总用量、中间综合征发生率、成活率、患者住院时间等指标。结果:联合组治疗第1d




    Full Text Available BACKGROUND AND OBJECTIVE: Acute poisoning is an important medical emergency. Studies of this nature will be useful tool in planning, early diagnosis and management of acute poisoning cases. The objective of the study are to study the clinical features, diagnosis and management, morbidity and mortality of various acute poisoning. METHODOLOGY: This study comprises of 350 patients of acute poisoning admitted to Chigateri General Hospital and Bapuji Hospital attached to J. J. M. Medical College, Davangere, between 1st March 2011 to 31st October 2011. REUSLTS: Out of 350 cases of acute poisoning studied, there were 268 males and 82 females. Males comprised 76.57%and females 23.42% of the total, in this series, Organophosphorous compounds were the commonest (30%, majority of the patients hailed from rural area 70%. Mortality is 10.57%.

  8. An intravenous organophosphate poisoning with intermediate syndrome: An unusual way of intoxication

    Badhe Ashok


    Full Text Available Organophosphate (OP poisoning is very common form of poisoning in Indian population because of its availability and easy access. Intoxication occurs following the absorption of OP agents through gastrointestinal tract, skin and respiratory tract and rarely by intramuscular or intravenous route. The clinical features depend on the amount of the poison consumed, it′s concentration, the route of administration and the time of instituting therapy. We are reporting a case of an intravenous monochrotophos poisoning, an unusual way of intoxication, which was managed in our ICU.

  9. 急性有机磷中毒合并呼吸衰竭患者医院感染的相关因素分析%Analysis of related factors of nosocomial infections in acute organophosphate poisoning with respiratory failure

    许红艳; 严震行; 陈园园


    OBJECTIVE To analyze the related factors of nosocomial infections in acute organophosphate poisoning complicated with respiratory failure , and propose appropriate nursing measures to reduce infection rates . METHODS Clinical data of patients with acute organophosphate poisoning complicated with respiratory failure from Jun .2011-Jun .2013 were retrospectively analyzed ,including 26 cases of nosocomial infections .The infected patients were analyzed and compared for relevant factors ,and the corresponding nursing measures were proposed . RESULTS The main site of infections in acute organophosphate poisoning with respiratory failure was respiratory tract ,accounting for 57 .69% ,followed by gastrointestinal and urinary tract ,each accounting for 15 .38% ,other sites accounting for 11 .55% .The univariate analysis showed age over 60 years ,length of hospital stay longer than 14 d ,endotracheal intubation ,endotracheal excision ,coma ,combination use of multiple antibiotics and invasive procedures were risk factors for nosocomial infections in acute organophosphate poisoning complicated with respir-atory failure (P<0 .05) .The multivariate logistic regression analysis showed advanced age ,long hospital stay , endotracheal intubation , invasive procedures and coma were high risk factors for infections ( P < 0 .05 ) . CONCLUSION Factors for acute organophosphate poisoning with respiratory failure are various .Therefore ,in the nursing process clinicians should strengthen environmental sterile control ,strictly implement aseptic operation , accomplish basic care ,reduce invasive procedures ,and rationally use antimicrobial drugs to control and reduce nosocomial infection rates .%目的:分析急性有机磷中毒合并呼吸衰竭患者发生医院感染的相关因素,提出相应的护理对策,以降低感染率。方法回顾性分析2011年6月-2013年6月81例急性有机磷中毒合并呼吸衰竭患者的临床资料,对其中26例发生医院感染患

  10. Organophosphate poisoning in the developed world - a single centre experience from here to the millennium.

    Hrabetz, Heidi; Thiermann, Horst; Felgenhauer, Norbert; Zilker, Thomas; Haller, Bernhard; Nährig, Jörg; Saugel, Bernd; Eyer, Florian


    Organophosphate (OP) poisoning is still associated with high morbidity and mortality rates, both in resource-poor settings and in well-developed countries. Despite numerous publications dealing with this particular poison, detailed clinical data on more severe overdoses with these agents are relatively sparsely reported. A retrospective study was consequently conducted on 33 patients with OP poisoning admitted to our intensive care unit (ICU) to provide additional data on clinical features. We included moderate to severe poisonings between 2000 and 2012 who required admission to ICU. Patients ingested dimethyl-OPs in 19 cases, diethyl-OPs in 8 cases and otherwise classified OPs in 6 cases. Death (5/33) occurred rather late and only one of these fatalities died during on-going cholinergic crisis. Of the survivors (28/33), 71% recovered fully while 29% showed predominantly neurological disabilities before being transferred to neurologic rehabilitation. Aspiration pneumonia predominated in 27/33 patients and one patient died in refractory acute respiratory distress syndrome (ARDS). The intermediate syndrome occurred twice and cardiopulmonary resuscitation had to be performed in 6/33 patients. Fatalities showed a higher Poison-severity-score, APACHE-II-score and SOFA-score on admission compared with survivors and they showed significantly longer QTc-time in the ECG, lower systolic blood pressure and heart rate, a lower pH and a lower base excess on admission. Patients with diethyl-OPs required intubation significantly earlier and showed lower and more sustained inhibited activity of the plasma-cholinesterase on admission compared with patients ingesting dimethyl-OPs. Treatment with atropine and obidoxime was comparable between these groups and severity of poisoning, outcome, hemodynamics on admission, duration of mechanical ventilation and length of stay in the ICU did not significantly differ between the involved group of dimethyl- and diethyl-OPs. We conclude that

  11. Predicting outcomes in organophosphate poisoning based on APACHE II and modified APACHE II scores.

    Eizadi-Mood, N; Saghaei, M; Jabalameli, M


    The aim of this study was to evaluate the scores of the Acute Physiology and Chronic Health Evaluation (APACHE) II and a modified APACHE II system (MAS), without parameters of biochemical tests; and to find prognostic value of individual elements of the APACHE II and MAS in predicting outcomes in organophosphate (OP) poisoning. Data were collected from 131 patients. The median (25th-75th percentiles) of APACHE II score for survivors without intubation were found to be lower than those of non survivors or survivors with intubation and ventilation, [4 (1-7); versus 17.5 (7.8-29), and 13.5 (7.8-16.3)]. Logistic regression analysis identified white blood cell (WBC), potassium, Glasgow coma scale (GCS), age and sodium in APACHE II; GCS and mean arterial pressure in MAS system as prognostically valuable. There was no statistically significance difference between APACHE II and MAS scores in terms of area under Receiver Operating Characteristic Curve [(0.902, 95% confidence interval: (0.837-0.947) for APACHE II), and (0.892, 95% confidence interval: (0.826-0.940) for MAS); P=0.74) to predict need for intubation. It is concluded usage of MAS facilitates the prognostication of the OP poisoned patients due to simplicity, less time-consuming and effectiveness in an emergency situation.

  12. Ambiguous Phorate Granules for Sesame Seeds Linked to Accidental Organophosphate Fatal Poisoning

    S Khatiwada


    Full Text Available Ingestion of organophosphate compound for suicidal attempt is a major health problem in developing countries. However, unintentional ingestion by an adult is rare. An 80-year-old lady and her 30-year-old granddaughter consumed phorate (organophosphate granules thinking it to be the seeds of sesame. After grinding the granules and mixing with pickle, they consumed the preparation with rice. The granddaughter was brought dead at emergency department and the older lady after resuscitation shifted to intensive care unit. She was extubated on 17th day and discharged on 23rd day. Pesticide formulation resembling any edible items must be withdrawn from the market at the earliest. Stringent regulation on vendors, apparent formulation or packaging and education about the hazards of these compounds can prevent this type of unintentional poisoning. Keywords: Ambiguous, organophosphate, phorate, sesame seeds, unintentional poisoning.

  13. Performance assessment of the SOFA, APACHE II scoring system, and SAPS II in intensive care unit organophosphate poisoned patients.

    Kim, Yong Hwan; Yeo, Jung Hoon; Kang, Mun Ju; Lee, Jun Ho; Cho, Kwang Won; Hwang, SeongYoun; Hong, Chong Kun; Lee, Young Hwan; Kim, Yang Weon


    This study assessed the ability of the Sequential Organ Failure Assessment (SOFA) and Acute Physiology, Chronic Health Evaluation (APACHE) II scoring systems, as well as the Simplified Acute Physiology Score (SAPS) II method to predict group mortality in intensive care unit (ICU) patients who were poisoned with organophosphate. The medical records of 149 organophosphate poisoned patients admitted to the ICU from September 2006 to December 2012 were retrospectively examined. The SOFA, APACHE II, and SAPS II were calculated based on initial laboratory data in the Emergency Department, and during the first 24 hr of ICU admission. The probability of death was calculated for each patient based on the SOFA score, APACHE II score, and SAPS II equations. The ability to predict group mortality by the SOFA score, APACHE II score, and SAPS II method was assessed using two by two decision matrices and receiver operating characteristic (ROC) curve analysis. A total of 131 patients (mean age, 61 yr) were enrolled. The sensitivities, specificities, and accuracies were 86.2%, 82.4%, and 83.2% for the SOFA score, respectively; 65.5%, 68.6%, and 67.9% for the APACHE II scoring system, respectively; and 86.2%, 77.5%, and 79.4% for the SAPS II, respectively. The areas under the curve in the ROC curve analysis for the SOFA score, APACHE II scoring system, and SAPS II were 0.896, 0.716, and 0.852, respectively. In conclusion, the SOFA, APACHE II, and SAPS II have different capability to discriminate and estimate early in-hospital mortality of organophosphate poisoned patients. The SOFA score is more useful in predicting mortality, and easier and simpler than the APACHE II and SAPS II.

  14. Influence of organophosphate poisoning on human dendritic cells.

    Schäfer, Marina; Koppe, Franziska; Stenger, Bernhard; Brochhausen, Christoph; Schmidt, Annette; Steinritz, Dirk; Thiermann, Horst; Kirkpatrick, Charles James; Pohl, Christine


    Organophosphourus compounds (OPC, including nerve agents and pesticides) exhibit acute toxicity by inhibition of acetylcholinesterase. Lung affections are frequent complications and a risk factor for death. In addition, epidemiological studies reported immunological alterations after OPC exposure. In our experiments we investigated the effects of organophosphourus pesticides dimethoate and chlorpyrifos on dendritic cells (DC) that are essential for the initial immune response, especially in the pulmonary system. DC, differentiated from the monocyte cell line THP-1 by using various cytokines (IL-4, GM-CSF, TNF-α, Ionomycin), were exposed to organophosphourus compounds at different concentrations for a 24h time period. DC were characterized by flow cytometry and immunofluorescence using typical dendritic cell markers (e.g., CD11c, CD209 and CD83). After OPC exposure we investigated cell death, the secretion profile of inflammatory mediators, changes of DC morphology, and the effect on protein kinase signalling pathways. Our results revealed a successful differentiation of THP-1 into DC. OPC exposure caused a significant concentration-dependent influence on DC: Dendrites of the DC were shortened and damaged, DC-specific cell surface markers (i.e., CD83and CD209) decreased dramatically after chlorpyrifos exposure. Interestingly, the effects caused by dimethoate were in general less pronounced. The organophosphourus compounds affected the release of inflammatory cytokines, such as IL-1ß and IL-8. The anti-inflammatory cytokine IL-10 was significantly down regulated. Protein kinases like the Akt family or ERK, which are essential for cell survival and proliferation, were inhibited by both OPC. These findings indicate that the tested organophosphourus compounds induced significant changes in cell morphology, inhibited anti-inflammatory cytokines and influenced important protein signalling pathways which are involved in regulation of apoptosis. Thus our results highlight

  15. Value of β2-MG in the Diagnosis of Acute Kidney Injury Induced by Acute Organophosphate Pesticide Poisoning%β2-MG诊断急性有机磷农药中毒急性肾损伤的价值

    刘春晓; 唐开奖; 黄向阳


    目的 了解血清β2-微球蛋白(β2-MG)诊断急性有机磷农药中毒(AOPP)急性肾损伤(AKI)的价值.方法 81例AOPP患者根据其乙酰胆碱酯酶水平分为轻度组(31例)、中度组(29例)、重度组(21例).同期门诊体检健康者30例为对照组.分别检测各组血清肌酐(Scr)、β2-MG含量;分析β2-MG诊断AKI的特异度、灵敏度.结果 AOPP时AKI的总发生率为76.5%(62/81),轻、中、重度组AKI发生率分别为45.2%(14/31)、93.1%(27/29)、100.0%(21/21).β2-MG诊断AOPP致AKI的总体灵敏度、特异度分别为46.8%(29/62)、100.0%.各中毒组的β2-MG阳性率依次为0%(0/31)、34.5%(10/29)、90.5%(19/21),重度组>中度组>轻度组(P<0.01).β2-MG含量及阳性率与中毒程度均呈负相关关系(P<0.05).结论 β2-MG诊断AOPP致AKI的灵敏度、阳性率低,不是早期诊断AKI的敏感指标.%Objective To explore the value of β2-microglobulin( β2-MG ) in the diagnodid of acute kidney injury( AKI ) induced by acute organophosphate pesticide poisoning( AOPP ). Methods Eighty one patients with AOPP were divided into three groups( mild poisoning group, moderate poisoning group and severe poisoning group ) according to acetylcholinesterase( AchE ) level. Thirty healthy controls in out-patient clinic were also recruited. Creatinine ( Scr),β2-MG were detected in each group,and β2-MG was analyzed to diagnose the specificity and sensitivity of AKI. Results The total incidence of AKI induced by AOPP was 76. 5%( 62/81 ),the incidences of mild poisoning group, moderate poisoning group and severe poisoning group were 45. 2%( 14/31 ),93. 1%( 27/29 ) and 100. 0%( 21/21 ), respectively. The total specificity and sensitivity of β2-MG in the diagnosis of AKI induced by AOPP were 46.8%( 29/62 ), 100.0% respectively. The positive rates of β2-MG in each poisoning group were 0%( 0/31 ),34. 5%( 10/29 ) and 90.5%( 19/21 ),which was the highest in the severe poisoning group but the lowest in the mild poisoning

  16. Clinical Effect Compare of Patients with Acute Organophosphate Poisoning Treated by Pralidoxime Chloride Using Intravenous Injection and Micro Pump%微量泵输注与静脉注射氯解磷定抢救急性有机磷农药中毒的疗效观察

    张小青; 卢绍禹


    目的:比较微量泵输注与静脉注射氯解磷定抢救有机磷农药中毒患者的临床效果。方法回顾性分析84例急性有机磷农药中毒病例,按照随机对照原则分为A、B两组。 A组患者采用常规间断静脉注射氯解磷定;B组在首次静脉注射氯解磷定后给予持续微量泵静脉维持给药。观察比较两组患者的胆碱酯酶恢复情况、住院时间、不良反应发生率、及死亡率。结果 B组患者的胆碱酯酶恢复时间(P<0.001)、住院时间(P<0.01)、不良反应发生率及死亡率(P<0.005)均低于A组。结论微量泵输注氯解磷定抢救有机磷中毒死亡率及不良反应发生率低,并且操作简便,值得临床推广。%Objettive To compare The clinical ef ect of patients with acute Organophosphate poisoning treated by pralidoxime Chloride using intravenous injection and micro pump. Methods 84 patients with acute Organophosphate poisoning were retrospectively analyzed. The patients were divided into group A and group B. Each group has 42 cases. patients in group A were treated with intermit ent intravenous injection of Pralidoxime Chloride. patients in group B were treated with continuous intravenous injection of Pralidoxime Chloride by micro pump. The recovery of cholinesterase, average length of stay in hospital ,the incidence of adverse reactions, mortality rate were compared between the two groups. Rusults The recovery time of cholinesterase ( P<0.001), average length of stay ( P<0.01), incidence of adverse reactions and mortality rate ( P<0.005).in group B were significantly less than those in group A. Conclusion Mortality rate and incidence of adverse reactions of patients with acute Organophosphate poisoning treated by cholinesterase Chloride using micro pump is less, and it is easy to control, it is worthy of clinical application.

  17. Intravenous lipid emulsions combine extracorporeal blood purification: a novel therapeutic strategy for severe organophosphate poisoning.

    Zhou, Yaguang; Zhan, Chengye; Li, Yongsheng; Zhong, Qiang; Pan, Hao; Yang, Guangtian


    Organophosphorus (OP) pesticide self-poisoning is a major clinical problem in rural Asia and it results in the death of 200,000 people every year. At present, it is lack of effective methods to treat severe organophosphate poisoning. The high mortality rate lies on the amount of toxic absorption. Intravenous lipid emulsions can be used as an antidote in fat-soluble drug poisoning. The detoxification mechanism of intravenous lipid emulsions is "lipid sink", which lipid emulsions can dissolve the fat-soluble drugs and separate poison away from the sites of toxicity. Most of organophosphorus pesticides are highly fat-soluble. So, intravenous lipid emulsions have the potentially clinical applications in treatment of OP poisoning. Extracorporeal blood purification especially charcoal hemoperfusion is an efficient way to eliminate the poison contents from the blood. We hypothesize that the combination of intravenous lipid emulsions and charcoal hemoperfusion can be used to cure severe organophosphate poisoning. This novel protocol of therapy comprises two steps: one is obtained intravenous access to infuse lipid emulsions as soon as possible; another is that charcoal hemoperfusion will be used to clear the OP substances before the distribution of OP compounds in tissue is not complete. The advantages of this strategy lie in three points. Firstly, it will alleviate the toxic effect of OP pesticide in the patients by isolation and removal the toxic contents. Secondly, the dosage of antidotes can be reduced and its side-effects will be eased. Thirdly, a large bolus of fatty acids provide energy substrate for the patients who are nil by mouth. We consider that it would become a feasible, safe and efficient detoxification intervention in the alleviation of severe organophosphate poisoning, which would also improve the outcome of the patients.

  18. Glyphosate Poisoning with Acute Pulmonary Edema

    Thakur, Darshana Sudip; Khot, Rajashree; Joshi, P. P.; Pandharipande, Madhuri; Nagpure, Keshav


    GlySH-surfactant herbicide (GlySH), one of the most commonly used herbicides worldwide, has been considered as minimally toxic to humans. However, clinical toxicologists occasionally encounter cases of severe systemic toxicity. The US Environmental Protection Agency (EPA) states that ‘GlySH’ is of relatively low oral and acute dermal toxicity. It does not have anticholinesterase effect and no organophosphate-like central nervous system (CNS) effects. The clinical features range from skin and throat irritation to hypotension and death. Severe GlySH-surfactant poisoning is manifested by gastroenteritis, respiratory disturbances, altered mental status, hypotension refractory to the treatment, renal failure, and shock.[1] GlySH intoxication has a case fatality rate 3.2–29.3%. Pulmonary toxicity and renal toxicity seem to be responsible for mortality. Metabolic acidosis, abnormal chest X-ray, arrhythmias, and elevated serum creatinine levels are useful prognostic factors for predicting GlySH mortality.[2] There is no antidote and the mainstay of treatment for systemic toxicity is decontamination and aggressive supportive therapy. We report a case of acute pulmonary edema, which is a rare but severe manifestation of oral GlySH poisoning, where patient survived with aggressive supportive therapy. PMID:25948977

  19. Intranasal delivery of obidoxime to the brain prevents mortality and CNS damage from organophosphate poisoning.

    Krishnan, Jishnu K S; Arun, Peethambaran; Appu, Abhilash P; Vijayakumar, Nivetha; Figueiredo, Taíza H; Braga, Maria F M; Baskota, Sudikshya; Olsen, Cara H; Farkas, Natalia; Dagata, John; Frey, William H; Moffett, John R; Namboodiri, Aryan M A


    Intranasal delivery is an emerging method for bypassing the blood brain barrier (BBB) and targeting therapeutics to the CNS. Oximes are used to counteract the effects of organophosphate poisoning, but they do not readily cross the BBB. Therefore, they cannot effectively counteract the central neuropathologies caused by cholinergic over-activation when administered peripherally. For these reasons we examined intranasal administration of oximes in an animal model of severe organophosphate poisoning to determine their effectiveness in reducing mortality and seizure-induced neuronal degeneration. Using the paraoxon model of organophosphate poisoning, we administered the standard treatment (intramuscular pralidoxime plus atropine sulphate) to all animals and then compared the effectiveness of intranasal application of obidoxime (OBD) to saline in the control groups. Intranasally administered OBD was effective in partially reducing paraoxon-induced acetylcholinesterase inhibition in the brain and substantially reduced seizure severity and duration. Further, intranasal OBD completely prevented mortality, which was 41% in the animals given standard treatment plus intranasal saline. Fluoro-Jade-B staining revealed extensive neuronal degeneration in the surviving saline-treated animals 24h after paraoxon administration, whereas no detectable degenerating neurons were observed in any of the animals given intranasal OBD 30min before or 5min after paraoxon administration. These findings demonstrate that intranasally administered oximes bypass the BBB more effectively than those administered peripherally and provide an effective method for protecting the brain from organophosphates. The addition of intranasally administered oximes to the current treatment regimen for organophosphate poisoning would improve efficacy, reducing both brain damage and mortality.

  20. Prognostic Factors of Organophosphate Poisoning Between the Death and Survival Groups

    Tzeng-Jih Lin


    Full Text Available In this prospective case series study, we consider the different factors between death and survival groups of organophosphate poisoning. Patients in tertiary-care medical center who had been exposed to organophosphate were included in the study. Pralidoxime (PAM was discontinued after atropine had controlled the clinical situation. We recorded the demographic data, amount of organophosphate consumption, duration of coma, duration of ventilator use, duration of hospitalization, findings of chest X-ray, white blood cell count, acetylcholinesterase concentration, plasma cholinesterase concentration, total atropine amount, duration of atropine use, total PAM amount, duration of PAM use, urine organophosphate peak concentration, duration of urine organophosphate and mortality rate. Urine was collected every 8 hours and was analyzed by gas chromatography equipped with a flame photometric detector and gas chromatography with mass spectrometer detector for organophosphate determination. The urine organophosphate peak concentration was recorded. Wilcoxon rank sum test was used to compare the factors between death and survival groups. Fisher's exact test was used to compare the different findings of chest X-ray between the death and survival groups. Evidently, the death group had a higher amount of organophosphate consumption, duration of coma, and higher white blood cell count than those in the survival group. Also, the death group had lower duration of hospitalization, and decreased concentrations of acetylcholinesterase and plasma cholinesterase. Total PAM amount use and duration of PAM use were lower. However, the duration of ventilator use, findings of chest X-ray, total atropine amount, duration of atropine, urine organophosphate peak concentration and duration of urine organophosphate were similar in both groups. The mortality rate of our 50 cases was 20%. As stated earlier, the cases of the death group had insufficient PAM therapy. The maximum

  1. Acute arsenic poisoning diagnosed late.

    Shumy, Farzana; Anam, Ahmad Mursel; Kamruzzaman, A K M; Amin, Md Robed; Chowdhury, M A Jalil


    Acute arsenicosis, although having a 'historical' background, is not common in our times. This report describes a case of acute arsenic poisoning, missed initially due to its gastroenteritis-like presentation, but suspected and confirmed much later, when the patient sought medical help for delayed complications after about 2 months. © The Author(s) 2015.

  2. Development of Optimized Guidelines for Therapeutic Strategies for Organophosphate Poisoning


    Hoang, 1995). Metabolism is a complex mechanism, but is implemented into PBPK models in the form of zero order, first order, or Michaelis - Menten ...kinetics. The Vmax and Km required in the Michaelis - Menten equation are derived from in vitro and in vivo 22 measurements. Most PBPK models...metabolism occurs in the liver and follows Michaelis - Menten kinetics (Hoang, 1995). PBPK modeling of organophosphates The consideration of developing a

  3. Study on the weaning method of mechanical ventilation in the treatment of 51 patients with acute severe respiratory failure caused by organophosphate poisoning%机械通气治疗急性重度有机磷中毒致呼吸衰竭患者撤机方法探讨



    Objective To explore the weaning method of mechanical ventilation in the treatment of acute severe respiratory failure caused by organophosphate poisoning.Methods The clinical features and weaning situation of 51 patients with acute severe respiratory failure caused by organophosphate poisoning by the treatment of mechanical ventilation were retrospectively analyzed.Results In 51 cases,45 cases were cured,the survival rate was 88.2% and 6 cases died,the fatality rate 11.8%.Conclusion Early ventilator to rescue and choose opportunity for weaning could directly impact on the qualitv of life of patients,and improve outcomes,and reduce mortality.%目的 探讨机械通气治疗急性重度有机磷农药中毒致急性呼吸衰竭中毒患者的撤机方法.方法 回顾性分析51例使用机械通气抢救急性重度有机磷农药中毒致呼吸衰竭患者的临床资料和撤机情况.结果 51例患者治愈45例,抢救成功率88.2%,死亡6例,病死率11.8%.结论 尽早使用呼吸机抢救并择机撤机直接影响到患者的生活质量和改善预后、降低病死率.

  4. A comprehensive review on experimental and clinical findings in intermediate syndrome caused by organophosphate poisoning

    Abdollahi, Mohammad, E-mail:; Karami-Mohajeri, Somayyeh


    Acute organophosphate (OP) intoxication is important because of its high morbidity and mortality and occurrence of muscular paralysis associated by inhibition of acetylcholinesterase (AChE) activity at the neuromuscular junction. Cholinergic crisis, intermediate syndrome (IMS), and OP-induced delayed neuropathy (OPIDN) are the evidences that can be observed in OP intoxication. The main cause of morbidity due to OP poisoning is IMS that occurs 24–96 h after poisoning. Mechanisms underlying the IMS are not fully known. Although the electrophysiological aspects of delayed neuropathy are best characterized, the IMS remain very little studied. The aim of this study was to revisit current knowledge related to OP and the IMS. For this purpose, a systematic review without date limitation was performed. A total of 599 relevant articles were found and reviewed. Data were categorized according to experimental and clinical studies. Occurrences of persistent AChE inhibition, electromyography changes, muscle cell injury, and oxidative stress are the most important pieces of evidence for involvement of IMS in OP toxicity. Delayed AChE inhibition, muscle necrosis, down regulation or desensitization of postsynaptic ACh receptors, failure of postsynaptic ACh release, and oxidative stress-related myopathy are involved in IMS. Toxicokinetic factors, such as a high lipid-solubility, duration of AChE inhibition and metabolite excretion, evolution of alterations on repetitive nerve stimulation (RNS), type and frequency of muscle lesions can estimate the probability of the IMS. Plasma AChE of less than 200 units is a predictor and the 30 Hz RNS decremental response could be a useful marker for the IMS.


    Basavaraj G.


    Full Text Available BACKGROUND: Organophosphorus compound poisoning is a global problem and is most common medico toxic emergency in India and is associated with high rate of mortality, if not diagnosed early and treated adequately. We studied clinical profile, electrocardiographic changes and electrolyte derangements in patients with organophophorus compound poisoning. METHODOLOGY: We studied randomly selected 100 patients of organophosphorus compound poisoning admitted within 12 hours of consumption. Clinical profile, electrocardiographic changes and serum electrolytes derangements were analyzed on outcome basis. RESULT: In this study, most vulnerable age group was between 12-30 years (46%, male to female ratio is 3.17:1. Majority of patient belongs to rural areas (54% and 66% patient belongs to low socioeconomic status. In all the patients mode of exposure was suicidal and route of intake oral, commonest symptom found was vomiting (46% and commonest sign was smell of poison (96%. Type of organophosphate was identified in 60% and unidentified in 40% patient. Monocrotophos (30% was most common compound among identified group. Majority of patients (52% were hospitalized within 2-4 hrs of organophosphate compound consumption and total hospital stay was 6-10 days in 61% patient. Electrocardiographic changes were detected in 54% patient; most common electrocardiographic change was sinus tachycardia (29%, QTc prolongation (28%, ST-T wave changes (22% sinus bradycardia (21%, conduction defects (4% and Arrhythmia (VT (3%. Mortality rate in present study is 16%, mortality rate among patient with prolonged QTc interval was 50%, and was statistically significant when compared with mortality of 2.78% in those with normal QTc interval (x2=33.41, P < 0.001. Serum electrolyte derangements (Na+, K+, Ca++ were found statistically insignificant in present study. CONCLUSION: Estimation of electrocardiographic changes will be useful parameter in assessing prognosis of

  6. Can anisodamine be a potential substitute for high-dose atropine in cases of organophosphate poisoning?

    Wang, W; Chen, Q-F; Ruan, H-L; Chen, K; Chen, B; Wen, J-M


    A case of organophosphate (OP) poisoning was admitted to the emergency room. The patient accepted treatment with pralidoxime (PAM), atropine, and supporting therapy. It was observed that even after 22 h after treatment, 960 mg of atropine was not enough for the patient to be atropinized. However, a 160-mg follow-up treatment of anisodamine was quite enough for atropinization after 4 h. As a case report, more studies are required before any definite conclusion can be reached regarding the use of anisodamine as a potential substitute for high-dose atropine in cases of OP poisoning.

  7. New Onset Refractory Status Epilepticus as an Unusual Presentation of a Suspected Organophosphate Poisoning

    Shahan Waheed


    Full Text Available New onset refractory status epilepticus (NORSE is a new entity in medical literature. It has different infectious and noninfectious etiologies showing a devastating impact onto the clinical outcome of patients. Therapy with anaesthetic and antiepileptic agents often fails to improve the condition, unless the primary cause is rectified. Here is presented the case of a young female with a history of depression who after a recent bereavement came to the Emergency Department of Aga Khan University Hospital with complaints of drowsiness that lasted for few hours. Though she had no history of organophosphate poisoning, her physical examination and further investigations were suggestive of the diagnosis. During her hospital stay, she developed refractory status epilepticus. Her seizures did not respond to standard antiepileptic and intravenous anesthetic agents and subsided only after intravenous infusion of atropine for a few days. Organophosphate poisoning is a very common presentation in the developing world and the associated status epilepticus poses a devastating problem for emergency physicians. In patients with suspected organophosphate poisoning with favoring clinical exam findings, the continuation of atropine intravenous infusion can be a safe option to abate seizures.

  8. Comparative study of penehyclidime hydrochloride and atropine in treatment of acute organophosphate pesticide poisoning%盐酸戊乙奎醚与阿托品治疗急性有机磷农药中毒疗效比较研究

    朱艳霞; 杨贤义; 肖敏


    Objective To compare the clinical efficacy of penehyclidime hydrochloride and atropine in treatment of a-cute organophosphate pesticide poisoning. Methods Totally 76 patients within six hours of organophosphorus pesticide poisoning were randomly divided into penehyclidime hydrochloride group (re = 38) and atropine group ( n = 38 ),they were all combined with pralidoxime chloride,different doses of penehyclidime hydrochloride and atropine were given according to difference degrees of severity which was ranged in terms of cholinesterase value. The clinical efficacy of two groups was compared. Results The penehyclidime hydrochloride group,the poisoning symptoms time,cuative time and CHE recovery time were compared with that of the atropine group,the difference was statistically significant (P < 0. 01) ; The incidence rate of adverse reactions significantly less than that of the atropine group ( P < 0. 01). Conclusion Penehyclidime hydrochloride in treatment of acute organophosphate pesticide poisoning is safer and more effective than atropine.%目的 比较盐酸戊乙奎醚与阿托品治疗急性有机磷农药中毒的临床疗效.方法 76例6h内有机磷农药中毒者随机分成盐酸戊乙奎醚组(38例)和阿托品组(38例),均配伍用氯解磷定,分别按照胆碱酯酶数值划分的轻中重度程度,给予不同剂量的盐酸戊乙奎醚及阿托品,比较两组患者的临床疗效.结果 盐酸戊乙奎醚组的中毒症状消失时间、治愈时间、CHE恢复时间与阿托品组比较,差异均有统计学意义(P<0.01);并且不良反应的发生率明显比阿托品组低(P<0.01).结论 盐酸戊乙奎醚治疗急性有机磷农药中毒疗效确切,不良反应少,优于阿托品.

  9. Spectrum of Acute Pharmaceutical and Chemical Poisoning in Northern Bangladesh

    Devendranath Sarkar


    Full Text Available Background: Acute poisoning is a major public health problem in Bangladesh. It is a common method for suicide. A clear picture regarding clinical presentation, most commonly used toxic agents, background factors and outcome of poisoned patients is necessary in every region. The aim of this study was to investigate frequency and outcome of acute pharmaceutical and chemical poisoning cases in Northern Bangladesh. Methods: This was a retrospective descriptive study on poisoned patients with 18 years of age and above who were admitted to Rangpur Medical College Hospital during 1st December 2011 to 30th November 2012. Results: During the study period, a total of 956 patients were investigated. Males slightly outnumbered females (51.6%. The majority of patients (92% were in the 18-40 year age-group. Regarding occupation, housewives were the most frequent (33.6% followed by farmers (31.7% and students (20.9%. Organophosphate compounds (OPC were the most commonly used toxic agents (73.5%. Most of poisoning cases occurred following suicidal attempts (88%. Familial disharmony was the main cause of suicidal attempts (92.3%. Univariate Analysis showed that age less than 40 years, being married, living in rural areas and educational attainment below secondary level were significantly associated with an increased risk of poisoning (P

  10. Oximes in organophosphate poisoning: 60 years of hope and despair.

    Worek, Franz; Thiermann, Horst; Wille, Timo


    The high number of annual fatalities following suicidal poisoning by organophosphorus (OP) pesticides and the recent homicidal use of the chemical warfare nerve agent sarin against civilian population in Syria underlines the continuous threat by these highly toxic agents. The need for an effective treatment of OP poisoning resulted in the implementation of a combination therapy with the muscarinic receptor antagonist atropine and an oxime for the reactivation of OP-inhibited acetylcholinesterase (AChE). Since the invention of the first clinically used oxime pralidoxime (2-PAM) in the 1950s ongoing research attempted to identify more effective oximes. In fact, several thousand oximes were synthesized in the past six decades. These include charged and non-charged compounds, mono- and bispyridinium oximes, asymmetric oximes, oximes with different substitutes and more recently non-oxime reactivators. Multiple in vitro and in vivo studies investigated the potential of oximes to reactivate OP-inhibited AChE and to reverse OP-induced cholinergic signs. Depending on the experimental model, the investigated species and the tested OP largely variable results were obtained by different laboratories. These findings and the inconsistent effectiveness of oximes in the treatment of OP-pesticide poisoned patients led to a continuous discussion on the value of oximes. In order to provide a forward-looking evaluation of the significance of oximes in OP poisoning multiple aspects, including intrinsic toxicity, in vitro reactivation potency, efficacy and pharmacokinetics, as well as the impact of the causative OP have to be considered. The different influencing factors in order to define the benefit and limitations of oximes in OP poisoning will be discussed.

  11. Pulmonary edema in acute carbon monoxide poisoning

    Kim, Kun Sang; Chang, Kee Hyun; Lee, Myung Uk [Seoul National University College of Medicine, Seoul (Korea, Republic of)


    Acute carbon monoxide poisoning has frequently occurred in Korean, because of the coal briquette being widely used as fuel in Korean residences. Carbon monoxide poisoning has been extensively studied, but it has been sparsely reported that pulmonary edema may develop in acute CO poisoning. We have noticed nine cases of pulmonary edema in acute CO poisoning last year. Other possible causes of pulmonary edema could be exclude in all cases but one. The purpose of this paper is to describe nine cases of pulmonary edema complicated in acute CO poisoning and discuss the pathogenesis and the prognosis.

  12. 微泵注入与肌注氯解磷定对急性有机磷中毒的疗效比较%The Effect Compare of Patients with Acute Organophosphate Poisoning Treated by Pralidoxime Chloride Using Intramuscularly and Micro-pump


      目的:比较氯解磷定微泵与肌注二种不同的给药方式在救治急性有机磷中毒中的治疗效果。方法:将42例急性有机磷农药中毒患者在常规对抗毒蕈碱样症状治疗基础上按就诊顺序单号和双号分为观察组和对照组各21例,观察组采用微泵注入氯解磷定的方式,对照组应用肌注氯解磷定的方式,比较两组患者的治疗效果和胆碱酯酶(ChE)的恢复情况。结果:观察组中胆碱酯酶的恢复时间、氯解磷定的总量、从昏迷到清醒时间和住院的平均时间均明显小于对照组(P <0.05)。结论:微泵注入氯解磷定治疗急性有机磷中毒的效果明显优于肌注氯解磷定。%Objective: To compare the clinical effect of patient with acute organophosphate treated poisoning by pralidoxime chloride using intramuscularly and micro-pump. Method: 42 patients with acute organophosphate poisoning in conventional treatment against muscarinic symptoms based on the sequence by a single number and two-doctor Number were divided into observation group and control group, and each group was 21 cases. The observation group was accepted pralidoxime chloride by micro-pump, while the control group was accepted pralidoxime chloride by intramuscular. The clinical effect and the recovery of cholinesterase were compared between the two groups. Results:The recovery time and the amount of pralidoxime chloride,from coma to awake and the average hospitalization time in the observation group were significantly less than those in the control group (P < 0.05). Conclusion:The clinical effect of patients with organophosphorus poisoning treated by pralidoxime chloride using micro-pump is better than using intramuscular.

  13. [Interest of the cholinesterase assay during organophosphate poisonings].

    Jalady, A-M; Dorandeu, F


    Cholinesterases are the main targets of organophosphorus compounds. The two enzymes present in the blood (butyrylcholinesterase, BChE; acetylcholinesterase, AChE) are biomarkers of their systemic toxicity. Activity of the plasma BChE is very often determined as it allows a rapid diagnostic of poisoning and is a marker of the persistence of the toxicant in the blood. The activity of the red blood cell AChE gives a better picture of the synaptic inhibition in the nervous system but the assay is less commonly available in routine laboratories. Better biomarker of the exposure, it allows a diagnosis of the severity of the poisoning and helps to assess the efficacy of oxime therapy. Besides the practical aspects of blood collection and sample processing, and the interpretation of the assays, this review stresses the complementarity of both enzyme assays and recalls their crucial interest for the confirmation of poisoning with an organophosphorus in a situation of war or terrorist attack and for the monitoring of occupational exposures.

  14. [Resuscitation in acute poisonings based on 2005 and 2010 Resuscitation Guideline].

    Macheta, Alicja; Pach, Janusz; Andres, Janusz


    Acute poisonings in USA are a leading cause of cardiac arrest, especially in youngsters. Primary survey and cardiopulmonary resuscitation for poisoning is based on ABCDE procedure. One of the most common manifestation of acute poisoning is coma. An open airway should be ensured. Endotracheal intubation should be performed by an experienced person. The mouth-to mouth method of artificial respiration can be applied ultimately. In case of cyanide, hydrogen sulfide, organophosphates and corrosives poisonings a special caution is needed and pocket mask or self-inflating bag with a face mask should be rather used. A quick poison identification and a contact with regional poison information centre regarding patient management are crucial. Different procedures include prolonged cardiopulmonary resuscitation.

  15. Posterior reversible encephalopathy syndrome in a patient of organophosphate poisoning

    Rajesh Phatake


    Full Text Available A 32-year-old male presented with a history of consuming some organophosphorous compound with suicidal intention.He was treated with atropine, pralidoxime, ventilator support. During stay patient had persistent irritability, tachycardiaand hypertension despite sedation and labetalol infusion. He developed headache, visual blurring hemiparesis and focal seizures. Magnetic resonance imaging of the brain revealed multifocal hyperintensities mainly in subcortical areas of parietal and occipital regions in T2-weighted images, with increased values of Apparent Diffusion Coefficient, suggesting posterior reversible encephalopathy syndrome (PRES. The possibilities of PRES caused by organophosphorous poisoning either due to hypertension caused by autonomic deregulation or direct neurological toxicity has been discussed.

  16. Organophosphorus pesticide poisoning : cases and developments

    Aardema, H.; Ligtenberg, J. J. M.; Peters-Polman, O. M.; Tulleken, J. E.; Zijlstra, J. G.; Meertens, John H. J. M.


    Self-poisoning with organophosphate pesticides is a major health problem world-wide. Through the inhibition of acetylcholinesterase, organophosphorus poisoning is characterised by the clinical picture of acute cholinergic crisis. Other manifestations are the intermediate neurotoxic syndrome and dela

  17. 急性有机磷农药中毒"中间期肌无力综合征"的研究进展%The recent advances in research of "intermediate myasthenia syndrome"in acute organophosphates poisoning

    肖诚; 何凤生


    @@ 有机磷农药(organophosphorus pesticides,OPs)中毒是我国农村重要的公共卫生问题[1].OPs中毒除可产生急性胆碱能危象(acute cholinergic crisis,ACC)和迟发性多发性神经病(organophosphate induced delayed polyneuropathy,OPIDP)外,还可使某些患者于急性OPs中毒后第1~4天发生颅神经支配的肌肉、屈颈肌、四肢近端肌肉和呼吸肌无力等表现,临床上称为中间期肌无力综合征(intermediate myasthenia syndrome,IMS)[2,3].徐海滨[4]、黄金祥等[5]曾综述既往对IMS的研究结果.近年来因IMS引起的呼吸肌麻痹为急性OPs中毒常见的死因,其早期诊断、治疗与发病机制皆受到研究者的关注,有关进展现综述如下.

  18. Organophosphate ester flame retardant-induced acute intoxications in dogs.

    Lehner, Andreas F; Samsing, Francisca; Rumbeiha, Wilson K


    Flame retardants have wide industrial applications and are incorporated into articles found in automobiles and home environments, including seat cushions. These compounds differ widely chemically and in their toxic potential. We report here two cases involving dogs following ingestion of car seat cushions impregnated with organophosphate ester fire retardants. Two case reports are presented. Two adult American Pit Bull dogs were presented at an emergency clinic with acute signs of central nervous system excitation including seizures. The most severely affected dog died 15 min after presentation, while the less affected dog fully recovered following treatment. In the second case, both a German Shepherd and a Rottweiler were found dead in the morning after they were left in a car overnight. A comprehensive toxicological analysis of samples from both cases revealed the presence of significant amounts (>2 ppm) of tris(2-chloroethyl)phosphate (TCEP) in stomach contents. This compound is a known inducer of epileptic seizures. Some other structurally related organophosphate ester compounds were found, and their role in the acute intoxications reported here is not known and remains to be determined. This is the first report linking acute deaths in dogs to the ingestion of car seat cushions found to contain large amounts of TCEP, an organophosphate ester compound. It is highly likely that this compound caused death through its known seizure-inducing activity.

  19. 1 cases of acute organophosphate poisoning combined experience from the nursing of alcohol withdrawal syndrome%1例急性有机磷中毒合并酒精戒断综合征的护理体会

    姚松楠; 徐娟


    The nursing experience of one case of acute organic phosphorus poisoning combined with alcohol withdrawal syndrome was reported. Close observation of the patient's condition changes; observe the effect and adverse reaction of drugs such as atropine, and to observe the mental symptoms of patients with alcohol withdrawal reaction, strengthen safety management, and pay attention to the patient's psychological nursing.%报道1例急性有机磷中毒合并酒精戒断综合征的护理体会。密切观察该患者病情变化,以及应用阿托品等药物的疗效和不良反应;关注患者酒精戒断反应的精神症状的观察;加强安全管理;重视患者的心理护理。

  20. Pharmacokinetic Potentiation of Mixed Organophosphate and Pyrethroid Poison Leading to Prolonged Delayed Neuropathy

    Srinivasan, Meenakshi; Amin, Ruhul; Nagiri, Shivashankar Kaniyoor; Kudru, Chandrashekar Udyavara


    Organophosphate (OP) and mixed pesticide poisoning remains an important cause of hospital admission. Therefore, physician must be aware of atypical presentations of delayed neurological complications of poisoning by taking proper patient history. We report a case of a 23-year-old female who presented with high stepping gait and muscle wasting in hands. Patient history revealed consumption of approximately 4ml of mixed pesticide, consisting of 50% chlorpyrifos with synthetic pyrethroid, 5% cypermethrin. The prolonged and severe nature of delayed peripheral neuropathy, persisting at two years of follow-up, suggests that even small quantities of OP taken in combination with a pyrethroid can result in significant morbidity and is irreversible. PMID:28050396

  1. Morphological analysis of the vestibular system of guinea pigs poisoned by organophosphate

    Lícia Assunção Cogo


    Full Text Available ABSTRACT INTRODUCTION: The vestibular system is responsible for body balance. There are substances that damage it, causing dizziness; these are termed vestibulotoxic substances. Agrochemicals have been investigated for ototoxicity because of studies that identified dizziness as a recurrent symptom among rural workers' complaints. OBJECTIVE: To histopathologically evaluate the vestibular system in guinea pigs exposed to an organophosphate, and to identify the drug's effects on this system. METHODS: Experimental clinical study. Eighteen guinea pigs were used; six of them poisoned with the organophosphate chlorpyrifos at doses of 0.5 mg/kg/day and seven of them at 1 mg/kg/day; and a control group of five guinea pigs was exposed to distilled water, all for 10 consecutive days. Later, ciliary tufts of saccule and utricle maculae were counted by scanning electron microscopy. RESULTS: Comparing the groups, a one-way ANOVA test for the variable "saccule" ( p = 0.0569 and a Kruskal-Wallis test for the variable "utricle" ( p = 0.8958 were performed, revealing no difference among groups in both variables. CONCLUSION: The histopathologic analysis of the vestibular system of guinea pigs exposed to an organophosphate showed no difference in the amount of ciliary tufts of saccule and utricle maculae at the doses tested, although the result for the variable "saccule" was considered borderline, showing a trend for significance.

  2. Multifunctional drugs as novel antidotes for organophosphates' poisoning.

    Weissman, Ben Avi; Raveh, Lily


    Some organophosphorus compounds (OPs) are nerve agents that continue to concern military personnel and civilians as potential battlefield and terrorist threats. Additionally, OPs are used in agriculture where they are associated with numerous cases of intentional and accidental misuse. These toxicants induce an array of deleterious effects including respiratory distress, convulsions and ultimately death. A mechanism involving a rapid and potent inhibition of peripheral and central cholinesterases leading to a massive buildup of acetylcholine in synaptic clefts was suggested as the underlying trigger of the toxic events. Indeed, therapy comprised of an acetylcholinesterase reactivator (i.e., oxime) and a cholinergic antagonist (e.g., atropine) is the accepted major paradigm for protection. This approach yields a remarkable survival rate but fails to prevent neurological and behavioral deficits. Extensive research revealed a complex picture consisting of an early activation of several neurotransmitter systems, in which the glutamatergic plays a pivotal role., Data accumulated in recent years support the concept that multi-targeting of pathways including glutamatergic and cholinergic circuits is required for an effective treatment. Drugs that demonstrate the ability to interact with several systems (e.g., caramiphen) were found to afford a superior protection against OPs as compared to specific antimuscarinic ligands (e.g., scopolamine). Compounds that potently block muscarinic receptors, interact with the NMDA ion channel and in addition are able to modulate σ(1) sites and/or GABAergic transmission seem to represent the emerging backbone for novel antidotes against OP poisoning. Several multifunctional drugs are already used for complex diseases e.g., cancer and depression.

  3. Respiratory recovery following organophosphate poisoning in a rat model is suppressed by isolated hypoxia at the point of apnea.

    Gaspari, Romolo J; Paydarfar, David


    Normal respiratory activity (eupnea) and gasping represent different types of respiratory activity, one of which is supported by oxygen (eupnea) and the other suppressed by oxygen (gasping). There is a loss of respiratory activity post-organophosphate (OP) poisoning that returns following treatment. It is not clear if post-OP respiratory activity represents eupnea or gasping. Depending on the type of respiratory activity, oxygenation during recovery from OP poisoning may have the potential to either support or suppress respiratory activity. We hypothesize that respiratory recovery following OP-induced central apnea represents a resumption of eupnea and is supported by oxygenation. We used an animal model of acute OP poisoning with detailed physiologic recordings. Animals were poisoned with dichlorvos and allowed to recover during a period of mechanical ventilation. Two experimental models were analyzed: (1) animals supported with 100% oxygen and (2) animals supported with a normoxic gas mixture titrated to a PaO(2) of 115 mmHg. Rats in this study demonstrated breathing that resumes spontaneously following OP-induced apnea with characteristics of both eupnea and gasping. The post-OP respiratory activity was suppressed by hypoxia, a characteristic of eupneic respiration and not gasping respiration. However, the respiratory rate during post-apneic breathing corresponded more closely to gasping. Analysis of phrenic nerve discharge activity was distinct from both eupnea and gasping, with peak inspiratory and post-inspiratory discharge activities significantly reduced compared to both eupnea and gasping. In summary, in this animal model post-apneic breathing distinct from eupnea and gasping that emerges following prolonged OP-induced central apnea is suppressed by hypoxia.

  4. Heart rate-corrected QT interval helps predict mortality after intentional organophosphate poisoning.

    Shou-Hsuan Liu

    Full Text Available INTRODUCTION: In this study, we investigated the outcomes for patients with intentional organophosphate poisoning. Previous reports indicate that in contrast to normal heart rate-corrected QT intervals (QTc, QTc prolongation might be indicative of a poor prognosis for patients exposed to organophosphates. METHODS: We analyzed the records of 118 patients who were referred to Chang Gung Memorial Hospital for management of organophosphate poisoning between 2000 and 2011. Patients were grouped according to their initial QTc interval, i.e., normal (0.44 s. Demographic, clinical, laboratory, and mortality data were obtained for analysis. RESULTS: The incidence of hypotension in patients with prolonged QTc intervals was higher than that in the patients with normal QTc intervals (P = 0.019. By the end of the study, 18 of 118 (15.2% patients had died, including 3 of 75 (4.0% patients with normal QTc intervals and 15 of 43 (34.9% patients with prolonged QTc intervals. Using multivariate-Cox-regression analysis, we found that hypotension (OR = 10.930, 95% CI = 2.961-40.345, P = 0.000, respiratory failure (OR = 4.867, 95% CI = 1.062-22.301, P = 0.042, coma (OR = 3.482, 95% CI = 1.184-10.238, P = 0.023, and QTc prolongation (OR = 7.459, 95% CI = 2.053-27.099, P = 0.002 were significant risk factors for mortality. Furthermore, it was revealed that non-survivors not only had longer QTc interval (503.00±41.56 versus 432.71±51.21 ms, P = 0.002, but also suffered higher incidences of hypotension (83.3 versus 12.0%, P = 0.000, shortness of breath (64 versus 94.4%, P = 0.010, bronchorrhea (55 versus 94.4%, P = 0.002, bronchospasm (50.0 versus 94.4%, P = 0.000, respiratory failure (94.4 versus 43.0%, P = 0.000 and coma (66.7 versus 11.0%, P = 0.000 than survivors. Finally, Kaplan-Meier analysis demonstrated that cumulative mortality was higher among patients with prolonged QTc

  5. 脑钠肽前体及肌钙蛋白I在老年急性有机磷中毒心肌损伤中的价值%Clinical significance of N-terminal pro-brain natriuretic peptide and cardiac troponin I in myocardium damage of elderly acute organophosphate poisoning patients

    胡鹏; 朱庆祝; 林涛; 程庆荣


    目的:探讨脑钠肽前体(NT-proBNP)及肌钙蛋白I(cTnI)在老年急性有机磷农药中毒(AOPP)心肌损伤中的变化及病情判断、评估中的临床价值。方法102例老年患者按入院时中毒的程度分为轻度中毒24例(轻度组),中度中毒38例(中度组),重度中毒40例(重度组)。于患者入院后4 h、3 d、7 d抽取静脉血4 ml,同步测定NT-proBNP、cTnI、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)值,与同期40例健康查体者(对照组)比较;合并发生中间型综合征(IMS)33例(IMS组),未发生IMS 69例(非IMS组),比较对照组、IMS组和非IMS组血清各项指标水平及心电监护情况。结果中、重度组老年AOPP患者的血清NT-proBNP、cTnI、CK、CK-MB较对照组显著升高(P<0.05),且随中毒程度和病情加重而升高,各组间两两比较差异均有统计学意义(P<0.05),血清NT-proBNP的敏感性和特异性均高于cTnI、心肌酶谱。IMS组入院后4 h内检测值显著高于非IMS组,差异均有统计学意义(P<0.05);IMS组较非IMS组出现心电图异常的比例更高。结论老年 AOPP 患者中毒越重,血清 cTnI、NT-proBNP 升高越显著,血清 NT-proBNP检测可以更详细地反映心肌的损害程度,早期联合检测可以更好地协助老年AOPP临床分级、病情判断、指导救治和预后评估。%Objective To investigate the changes significance of N-terminal pro-brain natriuretic peptide and cardiac troponin I simultaneously in the myocardium damage of elderly acute organophosphate poisoning patients and the clinical value in disease condition judgment.Methods 102 older acute organophosphate poisoning patients were divided into three groups according to the degree of poisoning on admission: mild poisoning 24 cases (mild), moderate poisoning 38 cases (moderate) and severe poisoning 40 cases(severe). All patients were extracted 4 ml of venous

  6. Refolded Recombinant Human Paraoxonase 1 Variant Exhibits Prophylactic Activity Against Organophosphate Poisoning.

    Bajaj, Priyanka; Tripathy, Rajan K; Aggarwal, Geetika; Datusalia, Ashok K; Sharma, Shyam S; Pande, Abhay H


    Organophosphate (OP) compounds are neurotoxic chemicals, and current treatments available for OP-poisoning are considered as unsatisfactory and inadequate. There is an urgent need for the development of more effective treatment(s) for OP-poisoning. Human paraoxonase 1 (h-PON1) is known to hydrolyze a variety of OP-compounds and is a leading candidate for the development of prophylactic and therapeutic agent against OP-poisoning in humans. Non-availability of effective system(s) for the production of recombinant h-PON1 (rh-PON1) makes it hard to produce improved variant(s) of this enzyme and analyze their in vivo efficacy in animal models. Production of recombinant h-PON1 (rh-PON1) using an Escherichia coli expression system is a key to develop variant(s) of h-PON1. Recently, we have developed a procedure to produce active rh-PON1 enzymes by using E. coli expression system. In this study, we have characterized the OP-hydrolyzing properties of refolded rh-PON1(wt) and rh-PON1(H115W;R192K) variant. Our results show that refolded rh-PON1(H115W;R192K) variant exhibit enhanced OP-hydrolyzing activity in in vitro and ex vivo assays and exhibited prophylactic activity in mouse model of OP-poisoning, suggesting that refolded rh-PON1 can be developed as a therapeutic candidate.

  7. The effect of hyperbaric oxygen on the expression of hypoxia inducible factor-1alpha in brain tissue after acute organophosphate poisoning%高压氧干预对急性有机磷中毒大鼠脑组织中缺氧诱导因子-1α表达的影响

    杨勇; 杨金连; 谢智慧


    疗组,其作用机制与抗氧化损伤和抑制HIF-1α的表达有关.%Objective To study the expression of hypoxia-inducible factor-1 (HIF-1) in the brain tissue after the brain injury caused by acute organophosphate poisoning,and the interventional effect and mechanism of hyperbaric oxygen (HBO) therapy.Methods Sixty healthy male Sprague-Dawley rats randomly divided into a control group (n=6),a poisoning group (n=18),a routine group (n=18) and an HBO group (n=18) according to a random number table.Acute organophosphate poisoning was induced into all rats except those in the control group.The routine group was given penehyclidine hydrochloride and pralidoxime chloride for once,while the HBO group was provided with HBO therapy immediately on the basis of routine treatment.At 1,3 and 7 hours after acute organophosphate poisoning was induced,six rats were sacrificed at each time point and the blood samples were taken from inferior caval vein to measure the content of Malondialdehyde (MDA).The expression of HIF-1α mRNA in the brain tissue was detected by the quantitative real-time PCR,and that of HIF-1 protein was evaluated by immunohistochemical method.Meanwhile,pathologic changes of the brain tissues were observed using hematoxylin-eosin (HE) staining.Results Compared with the poisoning group,the pathological damage to cerebral tissues lessened in the HBO group.The expression of HIF-1 protein and HIF-1 mRNA of the poisoning and the HBO groups was significantly higher than the control group at 3 different time points.After the HBO treatment,the protein expression of HIF-1 lowered from 226.57 ± 57.49,to 205.91 ± 30.36 and further to 187.67 ± 29.25,while the MDA content decreased from 7.74 ± 0.14,to 7.40 ± 0.13 and later to 6.10 ±0.08,both were significantly lower than those of the poisoning group at all time points,with HIF-1 being 1305.67 ± 167.17,2667.83 ± 367.79 and 1709.24 ± 199.07,along with MDA content being 9.48 ± 0.05,11.56 ± 0.13 and 12.26 ± 0

  8. Organophosphate-pyrethroid combination pesticides may be associated with increased toxicity in human poisoning compared to either pesticide alone.

    Iyyadurai, R; Peter, J V; Immanuel, S; Begum, A; Zachariah, A; Jasmine, S; Abhilash, K P P


    Organophosphate (OP) poisoning results in significant toxicity while pyrethroid poisoning is associated with extremely low fatality. OPs can inhibit the detoxification of pyrethroid and increase the toxicity of the combination. We assessed whether mixed OP-pyrethroid poisoning impacted outcome in human poisoning. Patients were identified from a prospectively collected institutional poisoning database that incorporates demographic and outcome data of patients presenting with poisoning. Of the 1177 poisoned patients admitted over 2 years, 32 presented with OP-pyrethroid (50% chlorpyrifos-5% cypermethrin mixture) poisoning (Group 1), 26 consumed 20% chlorpyrifos (Group 2), and 32 took 15% cypermethrin (Group 3). Seizures occurred in 15.6% (n = 5) with chlorpyrifos-cypermethrin poisoning, 18.8% (n = 6) with cypermethrin poisoning, and 3.9% (n = 1) with chlorpyrifos poisoning. Ventilatory requirements were 53.5% (17/32), 42.3% (11/26), and 15.7% (5/32) in Groups 1-3, respectively. Ventilator-free days (Mean ± SD) was significantly lower (p pesticides alone. Further studies are required comparing patients poisoned by formulations with similar quantities of OP and pyrethroid or with analysis of blood pesticide concentration on admission.

  9. Pesticide use and self-reported symptoms of acute pesticide poisoning among aquatic farmers in Phnom Penh, Cambodia

    Jensen, Hanne Klith; Konradsen, Flemming; Jørs, Erik


    Organophosphates and carbamates (OPs/CMs) are known for their acetylcholinesterase inhibiting character. A cross-sectional study of pesticide handling practices and self-perceived symptoms of acute pesticide poisoning was conducted using questionnaire-based interviews with 89 pesticide sprayers...

  10. A phase II clinical trial to assess the safety of clonidine in acute organophosphorus pesticide poisoning

    Karunatilake Harindra


    Full Text Available Abstract Background An estimated 2–3 million people are acutely poisoned by organophosphorus pesticides each year, mostly in the developing world. There is a pressing need for new affordable antidotes and clonidine has been shown to be effective in animal studies. Our aim was to determine the safety of clonidine given as an antidote in adult patients presenting with signs or symptoms of acute organophosphate ingestion. Methods This study was a dose finding, open-label, multicentre, phase II trial. Forty eight patients with acute organophosphate poisoning were randomized to receive either clonidine or placebo: Four to receive placebo and twelve to receive clonidine at each dose level. The first dose level was an initial loading dose of 0.15 mg followed by an infusion of 0.5 mg of clonidine over 24 hours. The initial loading dose was increased to 0.3 mg, 0.45 and 0.6 mg. at all dosing levels however the subsequent infusion remained at 0.5 mg of clonidine over 24 hours. Results The baseline characteristics of both groups were similar. The trial was stopped after completion of the 3rd dosing level. At the 1st and 2nd dosing level there were no reported adverse drug reactions. At the 3rd dosing level 5 patients (42% developed significant hypotension during clonidine treatment that responded to intravenous fluids. There were no statistical differences in ventilation rate, pre and post GCS, and mortality rates over all levels. Conclusion Our findings suggest use of moderate doses of clonidine in acute organophosphate poisoning can be used without causing frequent clinical problems but that higher doses are associated with a high incidence of hypotension requiring intervention. Further studies are needed to study the efficacy of clonidine as an antidote in organophosphate poisoning. Trial registration Current Controlled Trial ISRCTN89917816.

  11. Cholinesterase reactivators: the fate and effects in the organism poisoned with organophosphates/nerve agents.

    Bajgar, J; Kuca, K; Jun, D; Bartosova, L; Fusek, J


    Understanding the mechanism of action of organophosphates (OP)/nerve agents -- irreversible acetylcholinesterase (AChE, EC inhibition at the cholinergic synapses followed by metabolic dysbalance of the organism -- two therapeutic principles for antidotal treatment are derived. The main drugs are anticholinergics that antagonize the effects of accumulated acetylcholine at the cholinergic synapses and cholinesterase reactivators (oximes) reactivating inhibited AChE. Anticonvulsants such as diazepam are also used to treat convulsions. Though there are experimental data on a good therapeutic effects of reactivators, some attempts to underestimate the role of reactivators as effective antidotes against OP poisoning have been made. Some arguments on the necessity of their administration following OP poisoning are discussed. Their distribution patterns and some metabolic and pharmacological effects are described with the aim to resolve the question on their effective use, possible repeated administration in the treatment of OP poisoning, their peripheral and central effects including questions on their penetration through the blood brain barrier as well as a possibility to achieve their effective concentration for AChE reactivation in the brain. Reactivation of cholinesterases in the peripheral and central nervous system is described and it is underlined its importance for the survival or death of the organism poisoned with OP. Metabolization and some other effects of oximes (not connected with AChE reactivation) are discussed (e.g. forming of the phosphonylated oxime, parasympatholytic action, hepatotoxicity, behavioral changes etc.). An universality of oximes able to reactivate AChE inhibited by all OP is questioned and therefore, needs of development of new oximes is underlined.

  12. 国内延长胃管插入长度抢救急性有机磷农药中毒效果的Meta分析%A Meta-analysis for the rescue effects of sever acute organophosphate pesticide poisoning by different of length of gastric lavage tube in China

    毛仁丹吉; 伏旭; 马晓红; 贺莉


    Objective To evaluate the rescue effects for sever acute organophosphate pesticide poison (AOPP) by different length of gastric lavage tube .Method The Cochrane library(1994 to March ,2014) ,VIP (1994 to March , 2014) ,CBM (1994 to March ,2014) and Wanfang (1994 to March ,2014) was searched to identify randomized con‐trolled trials (RCTs) related to length of gastric lavage tube for sever AOPP .The quality of included studies as as‐sessed and data analyses were performed by RevMan 5 .0 .Result 9 RCTs involving 1440 patients were included .The results showed that prolong the length of gastric lavage tube for sever AOPP are better than traditional gastric lav‐age in the first gastric lavage time[OR= -0 .38 ,95% CI(-0 .40 , -0 .35)] ,total gastric lavage time[OR=-7 .22 ,95% CI(-7 .67 ,-6 .77)] ,blood gastric juice[OR=0 .16 ,95% CI(0 .09 ,0 .30)] ,abdominal pain[OR=0 .22 ,95% CI(0 .14 ,0 .34)]Conclusion Prolong length of gastric lavage tube for sever AOPP can increase the rescue effect in patients .%目的:评价延长胃管插入长度抢救急性有机磷农药中毒(Acute organophosphate pesticide poisoning , AOPP)患者的效果。方法计算机检索CNKI数据库(1994~2014.3)、VIP数据库(1989~2014.3)、CBMdisc数据库(1980~2014.3)、万方数据库(1998~2014.3),收集延长胃管插入长度后抢救AOPP患者的所有随机对照实验(RCT),按照Cochrane系统评价的方法,纳入符合标准的 RCT ,评价纳入研究的质量,采用RevMan5.0软件进行M eta分析。结果共纳入9个RC T ,共计1440例患者。M eta分析显示:延长胃管插入长度在首次洗出液时间[OR=-0.38,95% CI(-0.40,-0.35)]、总洗胃时间[OR=-7.22,95% CI(-7.67,-6.77)]、发生血性洗出液[OR=0.16,95% CI(0.09,0.30)]、发生上腹不适[OR=0.22,95% CI(0.14,0.34)]均优于传统洗胃胃管插入长度。结论延长

  13. Is hair analysis for dialkyl phosphate metabolites a suitable biomarker for assessing past acute exposure to organophosphate pesticides?

    Tsatsakis, A M; Tutudaki, M; Tzatzarakis, M N; Dawson, A; Mohamed, F; Christaki, M; Alegakis, A K


    In the present paper, the possibility to use dialkyl phosphate metabolites (DAPs) hair segmental analysis as a biomarker of past acute exposure to organophosphates is examined. Hair samples of four acute poisoning survivors were collected and segmental hair analysis was performed. The total hair samples were divided to 1 cm segments and analysed by gas chromatography-mass spectrometry (GC-MS) for the presence of four DAP metabolites, dimethyl phosphate (DMP), diethyl phosphate (DEP), diethyl thiophosphate (DETP) and diethyl dithiophosphate (DEDTP). Results were examined under the light of pesticide type and time of hair sample collection. Although DAPs were detected all along the hair shaft, higher concentrations (peaks) were detected in the segments proximate to the suicide period. It was also observed that the elevated concentrations of the present metabolites corresponded to the ones produced by the ingested parent compound. Conclusively, measurements of DAPs in the appropriate hair segments of OP-poisoned patients can be used for assessing past acute exposure to organophosphates in certain cases.

  14. Delayed encephalopathy after acute carbon monoxide poisoning

    Mehmet İbrahim Turan


    Full Text Available Carbon monoxide poisoning is a major cause of death following attempted suicide and accidental exposures. Although clinical presentation depends on the duration and the intensity of exposure, the assessment of the severity of intoxication is difficult. A small percentage of patients who show complete initial recovery may develop delayed neurological deficits. Delayed encephalopathy after acute carbon monoxide poisoning is a rare and poor prognosis neurologic disorders and there is no specific treatment. We present a case with early onset of delayed encephalopathy after acute carbon monoxide poisoning with typical cranial imaging findings in a child with atypical history and clinical presentation.

  15. Does modulation of organic cation transporters improve pralidoxime activity in an animal model of organophosphate poisoning?

    Kayouka, Maya; Houzé, Pascal; Baud, Frederic J; Cisternino, Salvatore; Debray, Marcel; Risède, Patricia; Schinkel, Alfred H; Warnet, Jean-Michel


    Pralidoxime is an organic cation used as an antidote in addition to atropine to treat organophosphate poisoning. Pralidoxime is rapidly eliminated by the renal route and thus has limited action. The objectives of this work were as follows. 1) Study the role of organic cation transporters in the renal secretion of pralidoxime using organic cation transporter substrates (tetraethylammonium) and knockout mice (Oct1/2⁻/⁻; Oct3⁻/⁻). 2) Assess whether sustained high plasma concentrations increase pralidoxime antidotal activity toward paraoxon-induced respiratory toxicity. INSERM U705, Faculté de Pharmacie, Université Paris Descartes, 4 Avenue de l'Observatoire, 75006 Paris, France. Rodents: Knockout mice (Oct1/2⁻/⁻; Oct3⁻/⁻) and Sprague-Dawley rats. None. In rats, the renal clearance of pralidoxime was 3.6-fold higher than the creatinine clearance. Pretreatment with tetraethylammonium (75 mg/kg) in rats or deficiencies in organic cation transporters 1 and 2 in mice (Oct1/2⁻/⁻) resulted in a significant increase in plasma pralidoxime concentrations. Lack of Oct3 did not alter plasma pralidoxime concentrations. The antidotal activity of pralidoxime (50 mg/kg intramuscularly) was longer and with greater effect, resulting in a return to normal values when administered to rats pretreated with tetraethylammonium. Pralidoxime is secreted in rats and mice by renal Oct1 and/or Oct2 but not by Oct3. Modulation of organic cation transporter activity increased the plasma pralidoxime concentrations and the antidotal effect of pralidoxime with sustained return within the normal range of respiratory variables in paraoxon-poisoned rats. These results suggest a promising approach in an animal model toward the increase in efficiency of pralidoxime. However, further studies are needed before these results are extended to human poisoning.

  16. Causes of rhabdomyolysis in acute poisonings

    Janković Snežana R.


    Full Text Available Background/Aim. Rhabdomyolysis (RM is potentially lethal syndrome, but there are no enough published data on its frequency and characteristics in acute poisonings. The aim of this study was to determine the causes and severity of RM in acute poisonings. Methods. Patients hospital charts were retrospectively screened during a one-year period in order to identify patients with RM among 656 patients treated due to acute poisonings with different agents. All the patients with RM were selected. Entrance criterion was the value of creatine kinase (CK over 250 U/L. The severity of RM was assessed according to the Poison Severity Score. The patients were divided into three groups: the first one with mild RM (CK from 250 to 1,500 U/L, the second with moderate RM (CK from 1,500 to 10,000 U/L and the third with severe RM (CK greater than 10,000 U/L. Results. RM occurred in 125 (19% of the patients with acute poisonings. It was mainly mild (61%, or moderate (36%, and only in 3% of the patients was severe RM. The incidence of RM was the highest in poisonings with opiates (41%, pesticides (38%, neuroleptics (26%, anticonvulsants (26%, ethyl alcohol (20%, and gases (19%. Psychotropic agents were the most common causes of poisoning, and consequently of RM. Fatal outcomes were registered in 32 (25.60% of all RM patients. The incidence of fatal outcomes in poisonings with mild, moderate and severe RM was 19.73%, 31.11% and 75%, respectively. Conclusion. RM syndrome occurs at a relatively high rate in acute poisonings. Although agent’s toxicity is crucial for the outcome, severe RM and its complications may significantly influence the clinical course and prognosis of poisoning. Routine analysis of CK, as a relevant marker for RM may indicate the development of RM in acute poisoning and initiate prompt therapeutic measures in preventing acute renal failure as the most frequent consequence of extensive rhabdomyolysis.

  17. Clinical Review: Emergency management of acute poisoning

    D.J. van Hoving


    The aim of this commissioned review was to establish concise guidelines for the initial management of the acutely poisoned patient in the Emergency Centre. The American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists are the international leaders in the field of toxicology and the guidelines in their position papers were generally followed. Most of the dosage regimes are according to the South African Medicines Formulary.

  18. Acute Cyanide Poisoning from Jewelry Cleaning Solutions

    Ines Bel Waer


    Full Text Available Cyanide is one of the most lethal and devastating poisons. It causes acute toxicity through smoke inhalation simultaneously with carbon monoxide, or by ingestion of cyanide salts that are commonly used in metallurgy and in jewelry or textile industries. Cyanide intoxication is an extremely rare event; in the present study, we report a case of cyanide poisoning involving a 25-year-old jeweler, who ingested a jewelry cleaning solution containing potassium cyanide in a suicide attempt.

  19. Antidotes for acute cyanide poisoning.

    Borron, Stephen W; Baud, Frederic J


    Cyanide poisoning can present in multiple ways, given its widespread industrial use, presence in combustion products, multiple physical forms, and chemical structures. The primary target of toxicity is mitochondrial cytochrome oxidase. The onset and severity of poisoning depend on the route, dose, physicochemical structure and other variables. Common poisoning features include dyspnea, altered respiratory patterns, abnormal vital signs, altered mental status, seizures, and lactic acidosis. Our present knowledge supports cyanide poisoning treatment based on excellent supportive care with adjunctive antidotal therapy. Multiple antidotes exist and vary in regional availability. All currently marketed antidotes appear to be effective. Antidotal mechanisms include chelation, formation of stable, less toxic complexes, methemoglobin induction, and sulfane sulfur supplementation for detoxification by endogenous rhodanese. Each antidote has advantages and disadvantages. For example, hydroxocobalamin is safer than the methemoglobin inducers in patients with smoke inhalation. Research for new, safer and more effective cyanide antidotes continues.

  20. Zebrafish Models for Human Acute Organophosphorus Poisoning.

    Faria, Melissa; Garcia-Reyero, Natàlia; Padrós, Francesc; Babin, Patrick J; Sebastián, David; Cachot, Jérôme; Prats, Eva; Arick Ii, Mark; Rial, Eduardo; Knoll-Gellida, Anja; Mathieu, Guilaine; Le Bihanic, Florane; Escalon, B Lynn; Zorzano, Antonio; Soares, Amadeu M V M; Raldúa, Demetrio


    Terrorist use of organophosphorus-based nerve agents and toxic industrial chemicals against civilian populations constitutes a real threat, as demonstrated by the terrorist attacks in Japan in the 1990 s or, even more recently, in the Syrian civil war. Thus, development of more effective countermeasures against acute organophosphorus poisoning is urgently needed. Here, we have generated and validated zebrafish models for mild, moderate and severe acute organophosphorus poisoning by exposing zebrafish larvae to different concentrations of the prototypic organophosphorus compound chlorpyrifos-oxon. Our results show that zebrafish models mimic most of the pathophysiological mechanisms behind this toxidrome in humans, including acetylcholinesterase inhibition, N-methyl-D-aspartate receptor activation, and calcium dysregulation as well as inflammatory and immune responses. The suitability of the zebrafish larvae to in vivo high-throughput screenings of small molecule libraries makes these models a valuable tool for identifying new drugs for multifunctional drug therapy against acute organophosphorus poisoning.

  1. ORIGINAL ARTICLE: Acute Poisoning with Organophosphorus Pesticide: Patients Admitted to A Hospital in Bijapur, Karnataka.

    Indira A. Hundekari


    Full Text Available Background: Organophosphorus compounds are the pesticides most often involved in human poisoning. Toxicity of these compounds is due to the inhibition of acetyl cholinesterase at cholinergic junctions of the nervous system. Aims & Objectives: Toxicities of OP pesticidescause adverse effects on many organs and systems hence the present study was planned to study the plasma Cholinesterase, serumcholesterol and thyroid function tests in acute organophosphorus pesticide poisoning. Materials and Methods: Plasma ChE, serumcholesterol and serum triiodothyronine, thyroxine, and thyroid stimulating hormone levels were estimated using standard methods.Result: In our study we found the maximum (95% cases were suicidal poisoning. We found that the incidence of poisoning was more common among age group between 15-35 years and males (57% were more likely to attempt suicide as compared to females (38%. Among the organophosphorus compounds the most commonly used were dimethoate,monocrotophos, chlorpyriphos. 79% organophosphorus poisoned patients recovered, while 21% died. Plasma Cholinesterase levels were significantly (p<0.001 decreased in all grades of organophosphate poisoning as compared to controls. Inhibition of Plasma Cholinesterase occurs at the time of admission due to toxic effect of organophosphorus compounds; but the levels significantly (p<0.001 normalized after treatment i.e. on the last day of hospitalization. Serum total cholesterol levels significantly decreased (p<0.001 in all grades of organophosphate poisoning cases as compared to controls without any change after treatment as compared with the patients before treatment. There was a slight and nonsignificant decrease in serum triiodothyronine and serum thyroxine levels in organophosphorus poisoning cases without anysignificant change in serum thyroid stimulating hormone levels as compared to control. The organophosphorus poisoned patients after treatment do not show more changes in their

  2. Effects of atropine and penehyclidine with different opportunity combination on severe acute organophosphate pesticide poisoning%阿托品与长托宁不同时机联合对重度急性有机磷农药中毒疗效的影响



    Objective To observe the influence of atropine,penehyclidine with different opportunity combination on severe acute organophosphate pesticide poisoning (AOPP).Methods Eighty-nine cases of severe AOPP patients were divided into two groups randomly:began joint group (43 cases) and atropinization combination group (46 cases).The began joint group immediately treated with atropine,penehyclidine at hospital admission.The atropinization combination group combined atropine with penehyclidine to maintain atropinization state after reaching atropinization with atropine.Dynamically observe the changes of CHE activity,recorded the number of poisoning rebound,atropine poisoning,intermediate syndrome,death and atropinization time,length of stay,the clinical efficacy of two groups were analyzed.Results Compared with the begain joint group,in the atropinization combination group the time of atropinization,CHE activity resumed to 50% and hospitalization was obviously shortened [atropinization time:(54.6-± 18.3) min to (65.3 ± 23.1) min (P < 0.01),CHE activity resumed 50% time (4.2 ±1.9)d to (5.3 ±2.6)d (P<0.05),hospital stays:(15.1 ±5.6)d to (18.2 ±6.8) d (P<0.05),poisoning rebound,atropine poisoning incidence was lower poisoning rebound:2.1% to 13.9%,atropine poisoning:4.3% to 18.6% (P < 0.05).IMS incidence,mortality have no significant difference average,(P > 0.05).Conclusions After quickly reached atropinization with atropine,small doses of penehyclidine and the joint use of atropine maintain atropinization state treatment of severe AOPP can reduce the incidence of complications,patients smoothly through dangerous period,reduce hospital stays and cut down medical costs.%目的 观察阿托品、长托宁在不同治疗时机联合对重度急性有机磷农药中毒(AOPP)疗效的影响.方法 将89例重度AOPP患者,随机分为开始联合组(43例)及阿托品化联合组(46例),开始联合组在入院后即行阿托品、长托宁联合治疗,

  3. Acute Poisoning with Methadone (Dolphin (Review

    Georgy A. Livanov


    Full Text Available Most publications report on the use of methadone as a medication, however an increase of the illegal use of methadone has been demonstrated worldwide over the recent years, thus increasing the number of hospitalizations due to acute poisoning with this synthetic opioid. The aim of the present review was to summarize current data on the mechanisms of toxicity, selective toxicity, toxicokinetics and toxicodynamics of methadone (Dolphin. The involvement of CNS, respiratory, cardiovascular and urinary systems in acute poisoning with methadone was dis- cussed. The practice of use of methadone in many countries as a medicine for the replacement therapy for opiate addicts was analyzed. In addition, it was suggested that the results of the use of naloxone antidote therapy in acute opioid poisoning do not always clearly demonstrate its sufficient efficacy. Ways to improve of the intensive therapy of severe acute poisoning by methadone were substantiated; in addition to general critical care methods, treatment with a complex metabolic antihypoxant cytoflavin should be considered. 

  4. Acute Poisoning in Children in Bahia, Brazil

    Dilton Rodrigues Mendonça MSc


    Full Text Available Acute poisoning is a frequent accident in childhood, particularly in children under 4 years of age. This was a descriptive study with data collected from standardized forms of the Poison Control Center and patient record charts. All the cases of acute poisoning in children aged 0 to 14 years during the period 2008 to 2012 were selected. The variables studied comprised characteristics of the events and toxic agents, clinical development, and outcome. A total of 657 cases of acute poisoning, with higher frequency in the age-group from 1 to 4 years (48.7% and male sex (53.4%, were recorded. The occurrences were accidental in 92% of the cases, and 5.8% were due to suicide attempts. Among the toxic agents, medications (28.5%, venomous animals (19.3%, nonvenomous animals (10%, household cleaning products (9.0%, and raticide agents (8.7% predominated. The majority of cases were characterized as light (73.5% and around 18% required hospitalization, and there was low lethality (0.5%.

  5. Acute oral poisoning due to chloracetanilide herbicides.

    Seok, Su-Jin; Choi, Sang-Cheon; Gil, Hyo-Wook; Yang, Jong-Oh; Lee, Eun-Young; Song, Ho-Yeon; Hong, Sae-Yong


    Chloracetanilide herbicides (alachlor, butachlor, metachlor) are used widely. Although there are much data about chronic low dose exposure to chloracetanilide in humans and animals, there are few data about acute chloracetanilide poisoning in humans. This study investigated the clinical feature of patients following acute oral exposure to chloracetanilide. We retrospectively reviewed the data on the patients who were admitted to two university hospitals from January 2006 to December 2010. Thirty-five patients were enrolled. Among them, 28, 5, and 2 cases of acute alachlor, metachlor, butachlor poisoning were included. The mean age was 49.8 ± 15.4 yr. The poison severity score (PSS) was 17 (48.6%), 10 (28.6%), 5 (14.3%), 2 (5.7%), and 1 (2.9%) patients with a PSS of 0, 1, 2, 3, and 4, respectively. The age was higher for the symptomatic patients (1-4 PSS) than that for the asymptomatic patients (0 PSS) (43.6 ± 15.2 vs 55.7 ± 13.5). The arterial blood HCO₃⁻ was lower in the symptomatic patients (1-4 PSS) than that in the asymptomatic patients (0 PSS). Three patients were a comatous. One patient died 24 hr after the exposure. In conclusion, although chloracetanilide poisoning is usually of low toxicity, elder patients with central nervous system symptoms should be closely monitored and cared after oral exposure.

  6. Hyperamylasaemia and acute pancreatitis in paracetamol poisoning

    Schmidt, L E; Dalhoff, K


    BACKGROUND: Hyperamylasaemia and even acute pancreatitis have been reported in patients with paracetamol poisoning. AIMS: To describe the incidence, clinical characteristics, and prognostic implications of hyperamylasaemia in paracetamol poisoning. PATIENTS: Six hundred and two patients transferred...... in 28 of the unselected patients (13%), in 218 of the transferred patients (36%), and in 118 of 148 patients (80%) with fulminant hepatic failure. Only 33 cases of paracetamol-associated acute pancreatitis were diagnosed. A threshold serum amylase of 150 U/L to discriminate non-survivors had sensitivity......, whereas clinical acute pancreatitis occurs rarely. The incidence of hyperamylasaemia increases with the degree of hepatic dysfunction. A serum amylase exceeding 1.5 times the upper normal limit indicates a poor prognosis....


    GE Qin-min; BIAN Fan; WANG Shu-yun; SHEN Sheng-hui


    @@ Most barium poisoning cases were caused by oral intake by mistake. Recent years, barium carbonate poisoning has been rare to be reported. Here we reported a case of acute barium carbonate toxication taken orally on purpose.

  8. Comparative Study of Continuous Pralidoxime Infusion versus Intermittent Dosing: Application of High-Performance Liquid Chromatography Method on Serum of Organophosphate Poisoned Patients

    Girish Thunga


    How to cite this article: Thunga G, Pandey S, Nair S, Mylapuri R, Vidyasagar S, Kunhikatta V, et al. Comparative Study of Continuous Pralidoxime Infusion versus Intermittent Dosing: Application of High-Performance Liquid Chromatography Method on Serum of Organophosphate Poisoned Patients. Asia Pac J Med Toxicol 2013;2:105-10.

  9. A Narrative Review of Acute Adult Poisoning in Iran

    Alinejad, Samira; Zamani, Nasim; Abdollahi, Mohammad; Mehrpour, Omid


    Poisoning is a frequent cause of referral to medical emergencies and a major health problem around the world, especially in developing countries. We aimed to review the epidemiology and pattern of adult poisoning in Iran in order to facilitate the early diagnosis and management of poisoning. The pattern of poisoning is different in various parts of Iran. Pharmaceutical compounds were the most common cause of poisoning in most parts of Iran. Pesticide-related toxicities were more common in northern agricultural regions, whereas bites and stings were seen more commonly in southern Iran. Carbon monoxide poisoning was common in cities with many motor vehicles such as Tehran and in colder climates such as in northern and western regions due to inadequately vented gas appliances such as stoves and heaters. Majoon Birjandi (containing cannabis) is a unique substance used in eastern Iran. Poisoning by opioids, tramadol, and pesticides (organophosphate and aluminum phosphide) has remained a common hazard in Iran. Poisoning-associated morbidity and mortality rates vary by region and have changed over time due to the introduction of new drugs and chemicals. Early diagnosis and proper treatment may be lifesaving; thus, understanding the general pattern of poisoning in different regions is important. PMID:28761199

  10. Gastric lavage in patients with acute poisoning

    Montserrat Amigó Tadín


    Full Text Available Acute poisonings are a frequent complaint in emergency departments and therapy which prevents the absorption of toxic products taken orally is often indicated: one such option is gastric lavage. Gastric lavage is a digestive decontamination technique whose goal is to remove the maximum amount of poison from the stomach and prevent its absorption. The procedure involves inserting a gastric tube into the stomach through the mouth or nose; firstly to aspirate all the stomach contents and then to perform gastric washing manoeuvres. The effectiveness of gastric lavage is limited and involves a risk of iatrogenesis, and therefore the indications and contraindications should be carefully considered and the technique carried out meticulously to increase its effectiveness and reduce complications, primarily bronchoaspiration. Gastric lavage may be used in conjunction with other digestive decontamination techniques such as administration of activated charcoal. This gastric lavage protocol is based on a review of the literature on this procedure and is supported by the expertise of our research group in gastrointestinal decontamination techniques in patients with acute poisoning.

  11. Haemodialysis in acute paracetamol poisoning.

    Serjeant, L; Evans, J; Sampaziotis, F; Petchey, W G


    A woman aged 23 years presented late with clinical and biochemical features of a life-threatening paracetamol (acetaminophen) overdose. Despite instigating N-acetylcysteine treatment, due to evidence of mitochondrial dysfunction together with an exceedingly high paracetamol level, the decision was made to dialyse the patient acutely to remove the parent drug. This was highly effective, and with on-going supportive care, the patient made a full recovery without the need for transplantation. This case highlights the role of extracorporeal therapy as a treatment option in selected cases of paracetamol overdose, consistent with the international guidelines. 2017 BMJ Publishing Group Ltd.

  12. Chest radiographic findings in acute paraquat poisoning

    Na, Gyeong Gyun; Lee, Mi Sook; Kim, Hee Jun; Sun, In O [Presbyterian Medical Center, Jeonju (Korea, Republic of)


    To describe the chest radiographic findings of acute paraquat poisoning. 691 patients visited the emergency department of our hospital between January 2006 and October 2012 for paraquat poisoning. Of these 691, we identified 56 patients whose initial chest radiographs were normal but who developed radiographic abnormalities within one week. We evaluated their radiographic findings and the differences in imaging features based on mortality. The most common finding was diffuse consolidation (29/56, 52%), followed by consolidation with linear and nodular opacities (18/56, 32%), and combined consolidation and pneumomediastinum (7/56, 13%). Pleural effusion was noted in 17 patients (30%). The two survivors (4%) showed peripheral consolidations, while the 54 patients (96%) who died demonstrated bilateral (42/54, 78%) or unilateral (12/54, 22%) diffuse consolidations. Rapidly progressing diffuse pulmonary consolidation was observed within one week on follow-up radiographs after paraquat ingestion in the deceased, but the survivors demonstrated peripheral consolidation.

  13. Acute Anterolateral Myocardial Infarction Due to Aluminum Phosphide Poisoning

    Bita Dadpour


    Full Text Available Aluminum phosphide (AlP is a highly effective rodenticide which is used as a suicide poison. Herein, a 24 year-old man who’d intentionally ingested about 1liter of alcohol and one tablet of AlP is reported. Acute myocardial infarction due to AlP poisoning has been occurred secondary to AIP poisoning. Cardiovascular complications are poor prognostic factors in AlP poisoning

  14. Acetylcholinesterase inhibition as an indicator of organophosphate and carbamate poisoning in Kenyan agricultural workers.

    Ohayo-Mitoko, G.J.A.; Heederik, D.; Kromhout, H.; Omondi, B.E.O.; Boleij, J.S.M.


    Acetylcholinesterase inhibition was determined for 666 Kenyan agricultural workers; 390 (58.6%) mainly pesticide applicators exposed to organophosphate and carbamate pesticides and 276 (41.4%) unexposed controls from four rural agricultural areas during 1993 and 1994. Baseline levels were depressed

  15. Acute Pancreatitis Caused By Mushroom Poisoning

    Samet Karahan Research Fellow


    Full Text Available Of the more than 5000 species of mushrooms known, 100 types are toxic and approximately 10% of these toxic types can cause fatal toxicity. A type of mushroom called Amanita phalloides is responsible for 95% of toxic mushroom poisonings. In this article, we report 2 cases of mushroom poisonings caused by Lactarius volemus, known as Tirmit by the local people. The patient and his wife were admitted to the emergency room with abdominal pain, nausea, and vomiting 20 hours after consuming Lactarius volemus, an edible type of mushroom. The patients reported that they had been collecting this mushroom from the mountains and eating them for several years but had never developed any clinicopathology to date. Further examination of the patients revealed a very rare case of acute pancreatitis due to mushroom intoxication. The male patient was admitted to the intensive care unit while his wife was followed in the internal medicine service, because of her relative mild clinical symptoms. Both patients recovered without sequelae and were discharged. In this article, we aimed to emphasize that gastrointestinal symptoms are often observed in mushroom intoxications and can be confused with acute pancreatitis, thus leading to misdiagnosis of patients. Early diagnosis and appropriate treatment can improve patients’ prognosis and prevent the development of complications.

  16. Reversal of Cardiovascular Toxicity in Severe Organophosphate Poisoning with 20% Intralipid Emulsion Therapy: Case Report and Review of Literature

    Shafat Ahmad Mir


    Full Text Available Background: Cardiac toxicity is one of the life-threatening effects of severe organophosphate (OP poisoning. We presented a patient with severe OP poisoning, in cardiovascular shock poorly responsive to conventional treatments, who could be resuscitated successfully with intravenous lipid emulsion (ILE therapy. Case report: A 26-year-old female was admitted to our emergency department who had ingested unquantifiable amount of parathion. On admission, she was tachycardic, tachypneic and hypotensive with pin-point pupils. Neurological examination revealed Glasgow coma scale (GCS of 6. Immediately, she was admitted to intensive care unit, and was intubated and put under mechanical ventilation. Standard treatments including atropine and pralidoxime (according to WHO protocol were given to the patient. However, the patient did not show favorable response to antidotes and supportive treatments and her condition continued to deteriorate. Because of bradycardia and hypotension, she was given noradrenaline vasopressor support. Due to failure of treatments in improvement of the patient's condition, a single 100 mL bolus (1.5 mL/kg of 20% intralipid was administered intravenously and the same dose repeated 2 minutes later. Over 15 minutes, cardiovascular condition of the patient noticeably improved. ILE was continued up to a total dose of 300 mL when extrasystoles disappeared. The patient could be extubated from ventilator with GCS score of 15 on the 5th day of admission. Discussion: OPs are lipid soluble and ILE can move these kinds of compounds away from the site of toxicity and dissolve them in the plasma which will alleviate their toxic effects. Conclusion: This is the first human case report of OP poisoning which showed efficacy of intralipids as antidotal therapy outside the accepted setting of local anesthetic toxicity.

  17. Risk factors for acute pesticide poisoning in Sri Lanka

    van der Hoek, Wim; Konradsen, Flemming


    This report describes the characteristics of patients with acute pesticide poisoning in a rural area of Sri Lanka and, for intentional self-poisoning cases, explores the relative importance of the different determinants. Data were collected for 239 acute pesticide-poisoning cases, which were...... admitted to two rural hospitals in Sri Lanka. Sociodemographic characteristics, negative life events and agricultural practices of the intentional self-poisoning cases were compared with a control group. Most cases occurred among young adults and the large majority (84%) was because of intentional self-poisoning....... Case fatality was 18% with extremely high case fatality for poisoning with the insecticide endosulfan and the herbicide paraquat. Cases were generally younger than controls, of lower educational status and were more often unemployed. No agricultural risk factors were found but a family history...

  18. [The role of psychologist in clinic of acute poisonings].

    Marczyńska-Wdówik, Agnieszka M


    This paper is a kind of observations' thesis on the role of psychological treatment of patients of the clinic of acute poisonings. Some proposals of affective treatment of potentially suicidal patients are also presented for doctors and other medical advisors.

  19. Serum Metabolomics in Rats after Acute Paraquat Poisoning.

    Wang, Zhiyi; Ma, Jianshe; Zhang, Meiling; Wen, Congcong; Huang, Xueli; Sun, Fa; Wang, Shuanghu; Hu, Lufeng; Lin, Guanyang; Wang, Xianqin


    Paraquat is one of the most widely used herbicides in the world and is highly toxic to humans and animals. In this study, we developed a serum metabolomic method based on GC/MS to evaluate the effects of acute paraquat poisoning on rats. Pattern recognition analysis, including both principal component analysis and partial least squares-discriminate analysis revealed that acute paraquat poisoning induced metabolic perturbations. Compared with the control group, the level of octadecanoic acid, L-serine, L-threonine, L-valine, and glycerol in the acute paraquat poisoning group (36 mg/kg) increased, while the levels of hexadecanoic acid, D-galactose, and decanoic acid decreased. These findings provide an overview of systematic responses to paraquat exposure and metabolomic insight into the toxicological mechanism of paraquat. Our results indicate that metabolomic methods based on GC/MS may be useful to elucidate the mechanism of acute paraquat poisoning through the exploration of biomarkers.

  20. Organophosphate toxicity relating to exposure route and type of agent

    Joosen, M.J.A.; Schans, M.J. van der; Smit, A.B.; Helden, H.P.M. van


    The current medical countermeasures for organophosphate (OP) poisoning are effective to a reasonable extent, yet, there is room for improvement. In this review, suspected causes of acute and long term-effects of OPexposure and possible interventions will be discussed, in relation to the type of nerv

  1. Stability study of a new antidote drug combination (Atropine-HI-6-Prodiazepam) for treatment of organophosphate poisoning.

    Clair, P; Wiberg, K; Granelli, I; Carlsson Bratt, I; Blanchet, G


    The main purpose of this study was to investigate the chemical stability of a new antidote combination for the treatment of organophosphate poisoning. The antidote combination was packed (enclosed) in two plastic compartments separated by a barrier film. One of them contained a powder oxime cholinesterase reactivator (HI-6-monohydrate 1-[[[4-(aminocarbonyl)pyridinio]methoxy]methyl]-2-[(hydro xyimino)meth yl]-pyridinium dichloride). The other contained an anticholinergic (Atropine) and an anticonvulsant (Prodiazepam or Avizafone (L-lysyl-N-(2-benzoyl-4-chlorophenyl)-N-methyl-glycinamide dihydrochloride) drug in a liquid mixture. The plastic compartments were mounted in an autoinjector device to study the dissolution of HI-6 by ejection of the solution. Drug analysis was performed by high-performance liquid chromatography. The results obtained after 6 months show that this new antidote combination is stable. The amount of each antidote is unchanged during the study. Some known degradation products can be detected in small amounts. The autoinjector mechanism used, gives a complete dissolution of HI-6 powder in the liquid mixture throughout the study.

  2. Preparation and characterization of methoxy polyethylene glycol-conjugated phosphotriesterase as a potential catalytic bioscavenger against organophosphate poisoning.

    Jun, Daniel; Musilová, Lucie; Link, Marek; Loiodice, Mélanie; Nachon, Florian; Rochu, Daniel; Renault, Frédérique; Masson, Patrick


    Bioscavengers are considered as promising antidotes against organophosphate poisoning. We focused on a bacterial phosphotriesterase (PTE) expressed in Escherichia coli. The main disadvantage of this non-human catalytic bioscavenger is its relatively short half-life in the organism and strong immunogenicity after repeated administration. Therefore, we prepared different methoxy polyethylene glycol (MPEG)-conjugated recombinant PTE as a potential catalytic bioscavenger with the aim to improve its biological properties. Enzyme was modified with two linear monofunctional MPEG derivatives with reactive aldehyde group of molecular weight 2 kDa and 5 kDa. We optimized reaction conditions (reagent ratios, temperature and duration of modification reaction) and we prepared homogeneous population of fully modified recombinant PTE with molecular weight around 52 kDa and 76 kDa, respectively. Modified PTE was characterized using SDS-PAGE and MALDI-TOF and by determining K(m) and V(max). We also investigated thermal stability of modified enzyme at 37 degrees C. Based on our results, for future in vivo evaluation of pharmacokinetics and pharmacodynamics properties, we selected recombinant PTE modified with 5 kDa MPEG aldehyde for its superior thermal stability.

  3. Prognostic factors of acute aluminum phosphide poisoning

    Louriz M


    Full Text Available Background : In Morocco, acute aluminum phosphide poisoning (AAlPP is a serious health care problem. It results in high mortality rate despite the progress of critical care. Aims : The present paper aims at determining the characteristics of AAlPP and evaluating its severity factors. Setting and design: We studied consecutive patients of AAlPP admitted to the medical intensive care unit (ICU (Ibn Sina Hospital, Rabat, Morocco between January 1992 and December 2007. Materials and Methods : Around 50 parameters were collected, and a comparison was made between survivor and nonsurvivor groups. Statistical Analysis : Data were analyzed using Fisher exact test, Mann-Whitney U test and Cox regression model. Results : Forty-nine patients were enrolled: 31 females and 18 males; their average age was 26± 11 years. The ingested dose of aluminum phosphide was 1.2± 0.7 g. Self-poisoning was observed in 47 cases, and the median of delay before admission to the hospital was 5.3 hours (range, 2.9-10 hours. Glasgow coma scale was 14± 2. Shock was reported in 42.6% of the patients. pH was 7.1± 0.4, and bicarbonate concentration was 16.3± 8.8 mmol/L. Electrocardiogram abnormalities were noted in 28 (57% cases. The mortality rate was 49% (24 cases. The prognostic factors were APACHE II (P= 0.01, low Glasgow coma scale (P= 0.022, shock (P= 0.0003, electrocardiogram abnormalities (P= 0.015, acute renal failure (P= 0.026, low prothrombin rate (P= 0.020, hyperleukocytosis (P= 0.004, use of vasoactive drugs (P< 0.001, use of mechanical ventilation (P= 0.003. Multivariate analysis by logistic regression revealed that mortality in AAlPP correlated with shock (RR = 3.82; 95% CI= 1.12-13.38; P= 0.036 and altered consciousness (RR= 3.26; 95% CI= 1.18-8.99; P= 0.022. Conclusion : AAlPP is responsible for a high mortality, which is primarily due to hemodynamic failure.

  4. Evaluation of MR perfusion abnormalities in organophosphorus poisoning and its correlation with SPECT

    K Uday Bhanu; Niranjan Khandelwal; Sameer Vyas; Paramjeet Singh; Anuj Prabhakar; B R Mittal; Ashish Bhalla


    Aim: Acute organophosphate (OP) pesticide poisoning causes substantial morbidity and mortality worldwide. Many imaging modalities, such as computerized tomography (CT), magnetic resonance imaging (MRI), and single photon emission computed tomography (SPECT) of the brain, have been used for quantitative assessment of the acute brain insult caused by acute OP poisoning. Perfusion defects on SPECT in acutely poisoned patients with OPs have been described, however, MR perfusion abnormalities have...

  5. Pesticide Use and Self-Reported Symptoms of Acute Pesticide Poisoning among Aquatic Farmers in Phnom Penh, Cambodia

    Hanne Klith Jensen


    Full Text Available Organophosphates and carbamates (OPs/CMs are known for their acetylcholinesterase inhibiting character. A cross-sectional study of pesticide handling practices and self-perceived symptoms of acute pesticide poisoning was conducted using questionnaire-based interviews with 89 pesticide sprayers in Boeung Cheung Ek (BCE Lake, Phnom Penh, Cambodia. The study showed that 50% of the pesticides used belonged to WHO class I + II and personal protection among the farmers were inadequate. A majority of the farmers (88% had experienced symptoms of acute pesticide poisoning, and this was significantly associated with the number of hours spent spraying with OPs/CMs (OR = 1.14, CI 95%: 1.02–1.28. The higher educated farmers reduced their risk of poisoning by 55% for each extra personal protective measure they adapted (OR = 0.45, CI 95%: 0.22–0.91. These findings suggest that improving safe pesticide management practices among the farmers and enforcing the effective banning of the most toxic pesticides will considerably reduce the number of acute pesticide poisoning episodes.

  6. Acute tramadol poisoning and its clinical and laboratory findings

    Rahimi, Hamid Reza; Soltaninejad, Kambiz; Shadnia, Shahin


    Background: Tramadol is a centrally acting analgesic with opioid and nonopioid properties, which extensively used in the relief of mild to moderate pain. Tramadol poisoning is a common cause of acute pharmaceutical poisoning in Iran. There are a few studies about clinical and laboratory findings related to acute tramadol poisoning. Therefore, the aim of this study was to demonstrate the clinical and laboratory findings in tramadol acute poisoning cases. Materials and Methods: This was a retrospective descriptive study of patients with acute tramadol poisoning who referred to Loghman Hakim Hospital Poison Center during January to April 2012. Data such as patient's age, sex, time of ingestion, ingested dose, cause of poisoning, mean duration of hospitalization, patient's clinical presentations, laboratory findings, therapeutic measures, and patient's outcome have collected in a predesigned checklist. Results: A total of 144 patients including 111 men (77%) and 33 women (23%) with acute tramadol poisoning was included in this study. The mean ingested dose was 1971.2 mg (100-20000 mg). Seizure (47.91%) was the most frequent clinical symptom. Blood gas on admission showed pH (7.3 ± 0.1), PCO2 (49.7 ± 8.6 mmHg) and HCO3− (24.1 ± 3.8 mEq/L), indicating pure acute respiratory acidosis may be occurred in tramadol-intoxicated patients. There were significant differences between tramadol-intoxicated cases with and without a seizure with regard to the time interval between ingestion and admission on hospital, ingested dose and PCO2. Conclusion: Seizure and rise of PCO2 were the most findings in this study. PMID:25535500

  7. Emergency care outcomes of acute chemical poisoning cases in Rawalpindi

    Ibrar Rafique; Umbreen Akhtar; Umar Farooq; Mussadiq Khan; Junaid Ahmad Bhatti


    Objective: To assess the emergency care outcomes of acute chemical poisoning cases in tertiary care settings in Rawalpindi, Pakistan. Methods: The data were extracted from an injury surveillance study conducted in the emergency departments (ED) of three tertiary care hospitals of Rawalpindi city from July 2007 to June 2008. The World Health Organization standard reporting questionnaire (one page) was used for recording information. Associations of patients' characteristics with ED care outcomes, i.e., admitted vs. discharged were assessed using logistic regression models. Results: Of 62 530 injury cases reported, chemical poisoning was identified in 434 (0.7%) cases. The most frequent patient characteristics were poisoning at home (61.9%), male gender (58.6%), involving self-harm (46.0%), and youth aged 20–29 years (43.3%). Over two-thirds of acute poisoning cases (69.0%) were admitted. Acute poisoning cases were more likely to be admitted if they were youth aged 10–19 years [odds ratio (OR)=4.41], when the poisoning occurred at home (OR=21.84), and was related to self-harm (OR=18.73) or assault (OR=7.56). Conclusions: Findings suggest that controlling access of poisonous substances in youth and at homes might reduce related ED care burden. Safety promotion agencies and emergency physicians can use these findings to develop safety messages.

  8. [Acute lithium poisoning: epidemiology, clinical characteristics, and treatment].

    Burguera Vion, Víctor; Montes, José Manuel; Del Rey, José Manuel; Rivera-Gorrín, Maite; Rodao, José María; Tenorio, Maite; Saiz-Ruiz, Jerónimo; Liaño, Fernando


    Lithium continues to be the treatment of choice for bipolar disorder. Acute lithium poisoning is a potentially serious event. We present a retrospective observational significative study of episodes of acute lithium poisoning during a 52- month period. Poisoning was defined by a blood lithium concentration of 1.5 mEq/L or higher. We analyzed treatment and epidemiologic and clinical characteristics of 70 episodes were identified (incidence density among treated patients, 1.76 per 100 patient-years). The most frequent cause of lithium poisoning was a concurrent medical condition (46%). Most poisonings were mild (74.2%), but neurologic involvement was identified in 40.3%. Electrocardiographic abnormalities were found in 8 cases. Acute renal failure, found in 23 patients (37.1%), was mild in most cases, although 11 patients required hemodialysis. We concluded that acute lithium poisoning is an uncommon complication, but risk needs to be lowered. Patients should be warned to avoid dosage errors and to take special care during concurrent illnesses and while taking other medications.

  9. Therapy against organophosphate poisoning: the importance of anticholinergic drugs with antiglutamatergic properties.

    Weissman, Ben Avi; Raveh, Lily


    Potent cholinesterase inhibitors (e.g., soman, sarin), induce a wide range of deleterious effects including convulsions, behavioral impairments and ultimately, death. Due to the likelihood of various scenarios of military or terrorist attacks by these and other chemical weapons, research has to be aimed at finding optimal therapies. Early accumulation of acetylcholine in synaptic clefts was suggested to trigger an array of toxic events including an excessive release of glutamate, culminating in the activation of its receptors. Stimulation of the N-Methyl-D-Aspartate (NMDA) subtype of these receptors was associated with the neuronal injury that initiates organophosphate-induced brain damage. The notion of a stepwise mechanism yielded treatments based on a combination of an immediate administration of enzyme reactivators and anticholinergic drugs. This strategy dramatically increased survival rates but did not abolish convulsions and failed to prevent the ensuing cognitive dysfunction. Efforts to improve this paradigm by adding anticonvulsants or antiglutamatergic drugs with anti-epileptic characteristics produced dubious results. Under these conditions, benactyzine and caramiphen, agents with anticholinergic and antiglutamatergic properties, provided improved protection when introduced as adjunct agents to oximes, reversible cholinesterase inhibitors and/or specific antimuscarinic drugs such as atropine. In contrast, the specific antimuscarinic drug scopolamine failed to block soman-induced changes in glutamatergic and behavioral parameters even when given prophylactically. These findings along with a large number of additional reports led towards the conclusion that the therapeutic advantage of drugs such as benactyzine and caramiphen could derive from their ability to modulate central cholinergic and glutamate neurotransmission.

  10. Protective effects of penehyclidine hydrochloride on acute lung injury caused by severe dichlorvos poisoning in swine

    CUI Juan; LI Chun-sheng; HE Xin-hua; SONG Yu-guo


    Background Organophosphate poisoning is an important health problem in developing countries which causes death mainly by inducing acute lung injury.In this study,we examined the effects of penehyclidine hydrochloride (PHC),a selective M-receptor inhibitor,on dichlorvos-induced acute lung injury in swine.Methods Twenty-two female swines were randomly divided into control (n=5),dichlorvos (n=6),atropine (n=6),and PHC (n=5) groups.Hemodynamic data,extravascular lung water index (EVLWI),and pulmonary vascular permeability index (PVPI) were monitored; blood gas analysis and acetylcholinesterase (AchE) levels were measured.PaO2/FiO2,cardiac index (Cl),and pulmonary vascular resistance indices (PVRI) were calculated.At termination of the study,pulmonary tissue was collected for ATPase activity determination and wet to dry weight ratio (W/D) testing 6 hours post-poisoning.TUNEL assay,and Bax,Bcl-2,and caspase-3 expression were applied to pulmonary tissue,and histopathology was observed.Results After poisoning,PHC markedly decreased PVRI,increased CI more effectively than atropine.Anticholinergic treatment reduced W/D,apoptosis index (AI),and mitigated injury to the structure of lung; however,PHC reduced AI and caspase-3 expression and improved Bcl-2/Bax more effectively than atropine.Atropine and PHC improved ATPase activities; a significant difference between groups was observed in Ca2+-ATPase activity,but not Na+-K+-ATPase activity.Conclusions The PHC group showed mild impairment in pathology,less apoptotic cells,and little impact on cardiac function compared with the atropine group in dichlorvos-induced acute lung injury.

  11. Hydroxocobalamin for severe acute cyanide poisoning by ingestion or inhalation.

    Borron, Stephen W; Baud, Frédéric J; Mégarbane, Bruno; Bismuth, Chantal


    This chart review was undertaken to assess efficacy and safety of hydroxocobalamin for acute cyanide poisoning. Hospital records of the Fernand Widal and Lariboisière Hospitals were reviewed for intensive care unit admissions with cyanide poisoning for which hydroxocobalamin was used as first-line treatment from 1988 to 2003. Smoke inhalation cases were excluded. Hydroxocobalamin (5-20 g) was administered to 14 consecutive patients beginning a median 2.1 hours after cyanide ingestion or inhalation. Ten patients (71%) survived and were discharged. Of the 11 patients with blood cyanide exceeding the typically lethal threshold of 100 micromol/L, 7 survived. The most common hydroxocobalamin-attributed adverse events were chromaturia and pink skin discoloration. Severe cyanide poisoning of the nature observed in most patients in this study is frequently fatal. That 71% of patients survived after treatment with hydroxocobalamin suggests that hydroxocobalamin as first-line antidotal therapy is effective and safe in acute cyanide poisoning.




    Full Text Available : OBJECTIVES: To determine the common agents, clinical features and outcomes of acute poisoning. MATERIALS AND METHODS: A retrospective study of patients of acute poisoning of more than 14 years age admitted through emergency with a history of intentional, self-inflicted and suicidal poisoning in SRMS-IMS from Jan 2010 to Dec 2012. RESULTS: A total of 58 cases were included with a common age of affection 16 to 25 years and male to female ratio 1.63: 1. Poisoning cases occur throughout the year with maximum prevalence in May and minimum in June. Organophosphorus was the most common poison followed by aluminium phosphide. Vomiting was the most common symptoms followed by altered sensorium. 70.68% patients were discharged, 20.68% expired and 8.62% left against medical advice. Aluminium phosphide was the most common toxin consumed by dead patients. CONCLUSION: Acute poisoning is commonly affecting young population and is caused by variety of toxin. High mortality is associated with aluminum phosphide.

  13. Acute hexogen poisoning after occupational exposure.

    Testud, F; Glanclaude, J M; Descotes, J


    Hexogen (cyclonite, RDX) nitrate explosive is an infrequent cause of poisoning. A 42-year-old man with no prior history of epilepsy experienced grand mal seizures after sieving fine hexogen (RDX) powder for four hours in an ammunition plant. Physical examination was normal on arrival at the emergency room but recurrent seizures occurred six hour after admission. EEG, CT scan and MRI were normal and the patient recovered uneventfully. The available toxicological data on this rare occupational poisoning are reviewed.




    Full Text Available 100 patients were studied to know the common poisons, age, sex, clinical manifestations, response to treatment, motive behind the consumption and prognostic factors. Out of 100 cases, most of them committed this with suicidal intention, 21 - 30 age group, males, insecticide poison consumed were affected. 70% of them had domestic problems as the main reason to commit this extreme step. Those who reached early to the hospital had recovered well with a mortality rate of 7%.

  15. Relationship Between Acute Benzodiazepine Poisoning and Acute Pancreatitis Risk: A Population-Based Cohort Study.

    Liaw, Geng-Wang; Hung, Dong-Zong; Chen, Wei-Kung; Lin, Cheng-Li; Lin, I-Ching; Kao, Chia-Hung


    We designed a population-based retrospective cohort study to investigate the association between the event of benzodiazepine (BZD) poisoning and the risk of acute pancreatitis.In the present study, 12,893 patients with BZD poisoning during 2000 to 2011 were enrolled and matched with 4 comparison patients according to mean age and sex. We determined the cumulative incidences and adjusted hazard ratios of acute pancreatitis.A significant association was observed between BZD poisoning and acute pancreatitis. After adjustment for potential risk factors, the patients with BZD poisoning had a 5.33-fold increased risk of acute pancreatitis compared with the controls without BZD poisoning (HR = 5.33, 95% CI = 2.26-12.60). The results revealed that acute pancreatitis in patients with BZD poisoning occurred in a follow-up time of ≤1 month (HR = 50.0, P risk of acute pancreatitis was no different between the patients with and without BZD poisoning when the follow-up time was >1 month (HR = 1.07, P > .05).This population-based study revealed the positive correlation between the event of BZD poisoning and an increased risk of acute pancreatitis. The findings warrant further large-scale and in-depth investigation.

  16. Acute occupational poisoning by octogen: first case report.

    Testud, François; Descotes, Jacques; Le Meur, Brigitte


    Octogen (HMX) is a polynitramine explosive closely related to hexogen, a known occupational toxin in military munitions plants. No acute human poisoning with octogen has ever been reported. A 28-year-old man with no history of epilepsy was admitted to the Emergency Department for seizures that had developed during the night after a full working day when he manually sieved large amounts of dry octogen. On admission, the clinical examination was normal and all other examinations could not substantiate the development of essential or secondary epilepsy. Elevated octogen concentrations were measured in his plasma, which confirmed occupational exposure to the explosive. The rarity of acute human poisonings by octogen is due to the infrequent use of this explosive and, more importantly, its very low oral bioavailability. However, acute poisoning can occur, but should be easily avoided by implementing adequate preventive measures.

  17. Homeostatic Disorders in Acute Poisoning by Psychotropic Agents

    M. V. Belova


    Full Text Available Objective: to determine the impact of the degree of oxidative stress on homeostatic parameters in critically ill patients with acute poisoning by psychotropic agents (PTA.Materials and methods. The components of lipid peroxidation (LPO and the antioxidative system (AOS, blood rheological and immunological parameters, and the markers of endogenous intoxication were studied in 43 patients with severe acute PTA intoxication before and during intensive detoxification therapy.Results. The first hours of poisoning were marked by LPO-AOS imbalance with a significant preponderance of peroxidation processes, by impaired blood viscous properties, the manifestations of secondary immunodeficiency and endogenous intoxication. There were changes in the study parameters during detoxification therapy and at the early somatogenic stage of the disease.Conclusion. In patients with acute poisoning-induced critical conditions, the degree of oxidative stress affects the time course of homeostatic changes and determines the severity of endotoxicosis at all stages of the disease. 

  18. Acute Pancreatitis in the Course of Meprobamate Poisoning

    Neila Fathallah


    Full Text Available Context We report a case of massive poisoning with meprobamate leading to acute pancreatitis. Case report A 43-year-old patient with a history of schizophrenia and multiple suicide attempts was admitted to the intensive care unit for severe poisoning with meprobamate (voluntary ingestion of 60 g. On admission, the patient was deeply comatose with low blood pressure and hypothermia. Laboratory analysis revealed leukocytosis and high lipase and amylase serum levels. There was no eosinophilia. Abdominal computed tomography showed pancreatitis grade A. The patient was intubated and ventilated, and intravenous dopamine was infused. The patient regained consciousness and was extubated five days later. Improvement in pancreatic tests was noted several days later. The outcome was favorable. Discussion According to the Naranjo probability scale, meprobamate-induced acute pancreatitis was probable. Acute pancreatitis in meprobamate poisoning is exceptional. The pathogenesis of pancreatitis-induced meprobamate poisoning may be explained by two mechanisms: stimulation of pancreatic secretion secondary to cholinergic activation and pancreatic ductal hypertension. Conclusions The signs of severe meprobamate toxicity are numerous including cardiovascular and central nervous symptoms. Acute pancreatitis should also be added as a possible manifestation of meprobamate poisoning.

  19. Assessing the connection between organophosphate pesticide poisoning and mental health: A comparison of neuropsychological symptoms from clinical observations, animal models and epidemiological studies.

    Stallones, Lorann; Beseler, Cheryl L


    Psychiatry and psychology are beginning to recognize the importance of lead, mercury and heavy metals as causal partners in the development of mental disorders. Further, mental health researchers and clinicians are embracing the idea that the combined effects of genetics and environmental exposures can result in perturbations in brain neurochemistry leading to psychiatric disorders. The purpose of this review is to examine the biological foundations for the epidemiological observations previously identified by reviewing the toxicology literature and relating it to epidemiological studies addressing the role of poisoning with organophosphate pesticides (OPs) in neurobehavioral and neuropsychological disorders. The goal of this review is to raise awareness in the mental health community about the possibility that affective disorders might be the result of contributions from environmental and occupational pesticide poisoning. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Extrapolating from animal studies to the efficacy in humans of a pretreatment combination against organophosphate poisoning.

    Levy, Aharon; Cohen, Giora; Gilat, Eran; Kapon, Joseph; Dachir, Shlomit; Abraham, Shlomo; Herskovitz, Miriam; Teitelbaum, Zvi; Raveh, Lily


    The extrapolation from animal data to therapeutic effects in humans, a basic pharmacological issue, is especially critical in studies aimed to estimate the protective efficacy of drugs against nerve agent poisoning. Such efficacy can only be predicted by extrapolation of data from animal studies to humans. In pretreatment therapy against nerve agents, careful dose determination is even more crucial than in antidotal therapy, since excessive doses may lead to adverse effects or performance decrements. The common method of comparing dose per body weight, still used in some studies, may lead to erroneous extrapolation. A different approach is based on the comparison of plasma concentrations at steady state required to obtain a given pharmacodynamic endpoint. In the present study, this approach was applied to predict the prophylactic efficacy of the anticholinergic drug caramiphen in combination with pyridostigmine in man based on animal data. In two species of large animals, dogs and monkeys, similar plasma concentrations of caramiphen (in the range of 60-100 ng/ml) conferred adequate protection against exposure to a lethal-dose of sarin (1.6-1.8 LD(50)). Pharmacokinetic studies at steady state were required to achieve the correlation between caramiphen plasma concentrations and therapeutic effects. Evaluation of total plasma clearance values was instrumental in establishing desirable plasma concentrations and minimizing the number of animals used in the study. Previous data in the literature for plasma levels of caramiphen that do not lead to overt side effects in humans (70-100 ng/ml) enabled extrapolation to expected human protection. The method can be applied to other drugs and other clinical situations, in which human studies are impossible due to ethical considerations. When similar dose response curves are obtained in at least two animal models, the extrapolation to expected therapeutic effects in humans might be considered more reliable.

  1. Pre-hospital treatment of acute poisonings in Oslo

    Nore Anne K


    Full Text Available Abstract Background Poisoned patients are often treated in and discharged from pre-hospital health care settings. Studies of poisonings should therefore not only include hospitalized patients. Aims: To describe the acutely poisoned patients treated by ambulance personnel and in an outpatient clinic; compare patients transferred to a higher treatment level with those discharged without transfer; and study the one-week mortality after pre-hospital discharge. Methods A one-year multi-centre study with prospective inclusion of all acutely poisoned patients ≥ 16 years of age treated in ambulances, an outpatient clinic, and hospitals in Oslo. Results A total of 3757 health service contacts from 2997 poisoning episodes were recorded: 1860 were treated in ambulances, of which 15 died and 750 (40% were discharged without transfer; 956 were treated in outpatient clinic, of which 801 (84% were discharged without transfer; and 941 episodes were treated in hospitals. Patients discharged alive after ambulance treatment were mainly poisoned by opiates (70%, were frequently comatose (35%, had respiratory depression (37%, and many received naloxone (49%. The majority of the patients discharged from the outpatient clinic were poisoned by ethanol (55%, fewer were comatose (10%, and they rarely had respiratory depression (4%. Among the hospitalized, pharmaceutical poisonings were most common (58%, 23% were comatose, and 7% had respiratory depression. Male patients comprised 69% of the pre-hospital discharges, but only 46% of the hospitalized patients. Except for one patient, who died of a new heroin overdose two days following discharge from an ambulance, there were no deaths during the first week after the poisonings in the 90% of the pre-hospital discharged patients with known identity. Conclusion More than half of the poisoned patients treated in pre-hospital treatment settings were discharged without transfer to higher levels. These poisonings were more often

  2. [Acute toloxatone poisoning. Apropos of 122 cases].

    Azoyan, P; Garnier, R; Baud, F J; Efthymiou, M L


    Toloxatone is a new monoamine oxidase inhibitor. One hundred and twenty two cases of poisoning with this drug are reported. In this series, the minimal toxic dose was 2 g. The first symptoms appeared about one hour after ingestion. In most cases, only drowsiness and mild adrenergic effects were observed. In a few cases of massive overdose, coma, pyramidal irritation, and myoclonic jerks occurred. In 3 cases of severe poisoning, toloxatone was associated with tricyclic antidepressants. Symptoms were similar to those reported in intoxications associating classical monoamine oxidase inhibitors and tricyclic antidepressants: muscular rigidity, hyperthermia and cardiovascular collapse. Two of these patients died.

  3. 阿托品化定量管理在有机磷中毒患者护理中的应用%Application of the Quantitative Management of Atropine in the Nursing Care for Organophosphate Poison-ing Patients

    徐立; 赵芳芳; 郑佳佳; 胡敏; 张玲


    目的:探讨阿托品量化的优质管理,降低有机磷中毒患者出现阿托品中毒现象的概率。方法通过对阿托品化量表的使用,比较量表使用前后对照组和实验组出现的阿托品中毒现象及有机磷中毒反跳的发生率。结果阿托品化量表使用管理后,救治过程中阿托品中毒现象及有机磷中毒反跳现象的发生率,与量表使用管理前比较差异显著( P<0.05)。结论量表的使用管理不仅增强护理人员对患者用药观察的准确度,更减少患者阿托品中毒及有机磷中毒反跳的现象发生。%Objective To explore high -quality quantitative management of atropine and to reduce the risk of atropine poisoning in organophosphate poisoning patients .Methods To compare the incidences of the atro-pine poisoning and the bounce organophosphorus poisoning between the experimental group and the control group before and after using the atropine scale .Results There is significant difference in the incidences of atropine poi-soning and bounce organophosphorus poisoning before and after the use of the scale (P<0.05).Conclusion The use of the scale can not only increase the accuracy of medication observation , but also reduce the adverse reaction of atropine poisoning and bounce organophosphorus poisoning .

  4. Cases of organophosphate poisoning treated with high-dose of atropine in an intensive care unit and the novel treatment approaches.

    Karakus, Ali; Celik, Muhammet Murat; Karcioglu, Murat; Tuzcu, Kasim; Erden, Ersin Sukru; Zeren, Cem


    Organophosphate poisoning is a life-threatening condition, which is being responsible for the symptoms due to cholinergic effects. Clinical status and blood levels of cholinesterase are used its diagnosis. While atropine and pralidoxime (PAM) appear as essential medications, hemofiltration treatments and lipid solutions have been widely studied in recent years. In this study, the importance of high-dose atropine therapy and early intervention and novel treatment approaches are discussed. Records of a total of 25 patients treated for organophosphate poisoning in the intensive care unit (ICU) between April 2007 and December 2011 were evaluated retrospectively. Of the 25 patients, 14 (56%) were male and 11 (44%) were female with a mean age of 34.8 ± 17.66 years (range: 14-77 years). The patients were most frequently admitted in June (n = 4) and July (n = 4) (16%). Of the 25 patients, 22 patients (88%) were poisoned by oral intake, two (8%) by inhalation, and one (4%) by dermal route. Of them, 20 patients (80%) took organophosphates intentionally for suicidal purposes, while five (20%) cases poisoned due to accidental exposure. The scores of Glasgow Coma Scale of nine patients (36%) were below 8 point upon admission to hospital. The highest dose of atropine given was 100 mg intravenously on admission and 100 mg/h/day during follow-up. The total dose given was 11.6 g/12 days. A total of 11 patients (44%) were on mechanical ventilation for a mean duration of 5.73 ± 4.83 days. The mean duration of ICU stay was 6.52 ± 4.80 days. Of all, 23 patients (92%) were discharged in good clinical condition and one patient (4%) was referred to another hospital. This study suggests that atropine can be administered until secretions disappear and intensive care should be exerted in follow-up of these patients. In addition, in case of necessity for high doses, sufficient amounts of atropine and PAM should be available in hospitals.

  5. Profile of acute poisoning in three health districts of Botswana

    Mary Kasule


    Full Text Available Background: This study sought to characterise acute poisoning cases seen in three health districts of Botswana.Method: A retrospective review of patients’ records was conducted and included patients treated from January 2004 to December 2005. Data on the demographic status of the patients, information about the poisonous agent(s involved, and the circumstances and outcomes of the poisoning incidents were recorded on a pre-tested data collection form.Results: A total of 590 cases of acute poisoning were included in the analysis. The most affected age category was that of children aged less than six years, who constituted 33.4% of the cases. Most incidents were recorded in the urban district of Gaborone. Seventy-eight percent (78% of the incidents were accidental, with the remainder being intentional. The poisonous agents involved were pharmaceuticals (26.6%, natural toxins (25.6%, household products (14.6%, foods (14.4%, alcohol (6.9%, traditional medicines (4.7%, unspecified agents (3.2%, and agrochemicals (2.7%. The most common route of poison exposure was by oral (82.2%, followed by dermal contact (16.5%, while the inhalation of gases occurred in 1.2% of cases. An incidence rate of 4.7/1000, a case fatality rate of 3.8/100, and 1.5% of deaths were recorded over the two-year period.Conclusion: In conclusion, it can be stated that acute poisoning involved mainly young children and resulted in an incidence rate of 4.7/1000, a case fatality rate of 3.8/100, and 1.5% of deaths over the two-year period. There were differences based on age category, gender and residence of the victims, the types of toxic agents involved, as well as the circumstances and the outcomes of the poisoning incidents. Given the fact that pharmaceuticals, natural toxins, household products and foods were the agents most commonly involved, targeted interventions should take these differences into account in addressing the problem of acute poisoning.

  6. Acute pesticide poisoning--a global public health problem

    Konradsen, Flemming


    Acute pesticide poisoning has become a major public health problem worldwide, following the intensification of agriculture and the promotion of agro-chemicals in low and middle income countries, with more than 300,000 deaths each year. The easy availability of highly toxic pesticides in the homes...

  7. Occurrence of a Severe Acute Livestock Poisoning by Borehole ...

    Occurrence of a Severe Acute Livestock Poisoning by Borehole Water in Marsabit ... The borehole had been out of use for 3 years and after its rehabilitation, 7,000 animals died ... The signs progressed into methemoglobinuria, sever pain, trebling, ... and cooked appearance of visceral organs were observed at postmortem.

  8. Acute metheamoglobinemia due to nitrobenzene poisoning: Case series

    Harish Kumar S, Ujjawal Kumar, Raghavendra Prasad B N, Kiran BJ, Anil Kumar M


    Full Text Available Nitrobenzene is a nitrite compound; its toxic effects are due to its ability to convert hemoglobin to methaemoglobin by oxidizing iron. The clinical features of nitrobenzene poisoning vary based on the concentration of methaemoglobin in blood. Immediate identification based on clinical features, odour of the compound with supporting evidence of increased methaemoglobin levels will help in a timely intervention thus preventing fatal outcome. Early haemodynamic and ventilator support along with administration of methylene blue as an antidote has been proved crucial in saving some lives. An acute nitrobenzene poisoning presenting with methaemoglobinemia is becoming quite common in this part of the country. Here authorsreport a series of cases of nitrobenzene poisoning where immediate clinical evaluation, with repeated intravenous methylene blue saved three patients, but two patients presenting late and with heavy exposure could not be saved

  9. Correlation between Cholinesterase and Paraoxonase 1 Activities: Case Series of Pesticide Poisoning Subjects

    S Austin Richard


    Full Text Available Introduction: Acute exposure to pesticide due to suicidal poisoning is the most extensive cause of pesticide exposure, compared with all other causes including agricultural or industrial exposure. Organophosphate (OP and carbamate group of pesticides can inhibit acetylcholinesterase; on the other hand, paraoxonase1 can detoxify organophosphate poisoning by hydrolyzing organophosphate metabolites. Methods: We have compared the serum paraoxonase1 status and cholinesterase activity of subjects who attempted to commit suicide by consuming OP pesticide. Cholinesterase and paraoxonase1 activity were measured spectrophotometrically using butyrylthiocholine and phenyl acetate as substrates, respectively. Results: A positive correlation was found between serum paraoxonase1 activity and cholinesterase activity among pesticide consumed subjects. Conclusion: Our results suggest that subjects with higher paraoxonase1 activity may have a better chance of detoxifying the lethal effect of acute organophosphate poisoning.

  10. Acute mercury poisoning: a case report

    Aktas Can


    Full Text Available Abstract Background Mercury poisoning can occur as a result of occupational hazard or suicide attempt. This article presents a 36-year-old case admitted to emergency department (ED due to exposure to metallic mercury. Case Presentatıon A 36-year-old woman presented to the ED with a three-day history of abdominal pain, diarrhea and fever. One week ago her daughter had brought mercury in the liquid form from the school. She had put it on the heating stove. One day later, her 14-month old sister baby got fever and died before admission to the hospital. Her blood pressure was 134/87 mmHg; temperature, 40.2°C; heart rate 105 bpm and regular; respiration, 18 bpm; O2 saturation, 96%. Nothing was remarkable on examination and routine laboratory tests. As serine or urinary mercury levels could not be tested in the city, symptomatic chelation treatment with N-acetyl cysteine (NAC was instituted with regard to presumptive diagnosis and history. At the 7th day of admission she was discharged without any sequelae or complaint. At the discharge day blood was drawn and sent for mercury levels which turned out to be 30 μg/dL (normal range: 0 - 10 μg/dL. Conclusion Public education on poisoning and the potential hazards of mercury are of vital importance for community health.

  11. Acute aluminium phosphide poisoning, what is new?

    Yatendra Singh


    Full Text Available Aluminium phosphide (AlP is a cheap solid fumigant and a highly toxic pesticide that is commonly used for grain preservation. AlP has currently generated interest with increasing number of cases in the past four decades because of its increased use for agricultural and nonagricultural purposes, and also its easy availability in the markets has led to its increased misuse to commit suicide. Ingestion is usually suicidal in intent, uncommonly accidental and rarely homicidal. The poison affects all systems, shock, cardiac arrhythmias with varied ECG changes and gastrointestinal features being the most prominent. Diagnosis is made on the basis of clinical suspicion, a positive silver nitrate paper test to phosphine, and gastric aspirate and viscera biochemistry. Treatment includes early gastric lavage with potassium permanganate or a combination of coconut oil and sodium bicarbonate, administration of charcoal and palliative care. Specific therapy includes intravenous magnesium sulphate and oral coconut oil. Unfortunately, the lack of a specific antidote Results in very high mortality and the key to treatment lies in rapid decontamination and institution of resuscitative measures. This article aims to identify the salient features and mechanism of AlP poisoning along with its management strategies and prognostic variables.

  12. Oximes in organophosphorus poisoning

    Cherian M


    Full Text Available Acute organic insecticide poisoning is a major health problem all over the world, particularly in the developing countries, where organophosphates (OPs are the most common suicidal poisons with high morbidity and mortality and account for a large proportion of patients admitted to intensive care units. Other insecticides less commonly used are organocarbamates, organochlorides, and pyrethroids, which are less toxic and are associated with less morbidity and mortality. Patients with poisoning present with a wide spectrum of gastrointestinal, neurological, and cardiac manifestations. A strong clinical suspicion is necessary to make an early diagnosis and to start appropriate therapy. Treatment is primarily supportive and includes decontamination, anticholinergics, protection of the airway, and cardiac and respiratory support. The use of oximes has been controversial and may be associated with higher mortality owing to a higher incidence of type-II paralysis. They may have other toxic side effects. This paper reviews the literature on OP poisoning.

  13. Hydroxocobalamin treatment of acute cyanide poisoning from apricot kernels

    Cigolini, Davide; Ricci, Giogio; Zannoni, Massimo; Codogni, Rosalia; De Luca, Manuela; Perfetti, Paola; Rocca, Giampaolo


    Clinical experience with hydroxocobalamin in acute cyanide poisoning via ingestion remains limited. This case concerns a 35-year-old mentally ill woman who consumed more than 20 apricot kernels. Published literature suggests each kernel would have contained cyanide concentrations ranging from 0.122 to 4.09 mg/g (average 2.92 mg/g). On arrival, the woman appeared asymptomatic with a raised pulse rate and slight metabolic acidosis. Forty minutes after admission (approximately 70 min postingestion), the patient experienced headache, nausea and dyspnoea, and was hypotensive, hypoxic and tachypnoeic. Following treatment with amyl nitrite and sodium thiosulphate, her methaemoglobin level was 10%. This prompted the administration of oxygen, which evoked a slight improvement in her vital signs. Hydroxocobalamin was then administered. After 24 h, she was completely asymptomatic with normalised blood pressure and other haemodynamic parameters. This case reinforces the safety and effectiveness of hydroxocobalamin in acute cyanide poisoning by ingestion. PMID:22694886

  14. An Unusual Cause of Supraventricular Tachycardia: Acute Carbon Monoxide Poisoning

    Suat Zengin


    Full Text Available      Carbon monoxide (CO is a toxic gas produced by the incomplete combustion of carbon-containing compounds. Exposure to high concentrations of CO can be letha and is the most common cause of death from poisoning worldwide. Cardiac manifestations after exposure to CO, including myocardial ischemia, heart failure, and arrhythmias, have been reported. A 28-year-old a patient was admitted to our emergency department with altered consciousness as a consequence of acute domestic exposure to CO from a stove. His carboxyhemoglobin level was 39%. The oxygen treatment was started promptly, and therapeutic red cell exchange was performed. An electrocardiogram revealed supraventricular tachycardia (SVT, and an echocardiographic examination demonstrated normal cardiac functions. To the best of our knowledge, this study is the second to report a case of SVT attack due to acute CO intoxication. This paper discusses the management of this complication in patients poisoned with CO.

  15. Cases of Acute Poisoning in Southeast Anatolia of Turkey

    Cahfer Güloğlu


    Full Text Available This study was conducted to determine the biological effects of acute poisoning, nature ofagents involved and pattern of poisoning during 2000 in Diyarbakır City in Southeast AnatolianRegion of Turkey.Data from hospital records of all admissions to Emergency Department (ED of Dicle UniversityHospital following acute poisoning collected retrospectively were analysed for the period January toDecember in 2000. Present study included 44 (25.9% male (M and 126 (74.1% female (F, a total170 consecutive patients. A M/F ratio was found as 1.0/3.5 in the study.Mean age of cases was 23.3±6.3 years old; 63 (37.1% of them were under age of 20 years oldand 147 (86.5% of them were under age of 30 years old. Cases of intoxication have admitted insummer season (93 of 170 patients, especially in April, May and July (24, 26 and 30 patients,respectively. Sixty-two (36.5% cases due to accidental, 108 (63.5% cases due to suicidal goal. Thecases of suicidal purposeful intoxications were mostly determined in females (77 cases, 71.3%,p<0.05, and singles (74 cases, 68.5%, p<0.05. There were only two deaths (1.2% among the 170admissions of acute poisonings during hospitaliztion. One of the deaths was due to pesticides; otherone was due to abuse of medical drug. According to physical examination, tachycardia (59, 34.7%,vomit history (55, 32.4%, and unconsciousness (42, 24.7% were frequently observed; however,hypersecretion (15, 8.8%, bradycardia (5, 2.9%, convulsion (8, 4.7%, and hipertension (2, 1.2%,were seen rarely. Cases who poisoned with pesticide compared other cases have had significantlyhigher rate of convulsion (6, 10.2%, miosis (6, 10.2%, and hypersecretion (12, 20.3% (p=0.018,p<0.0001 and p<0.0001, respectively.In our region, pesticides intoxication especially affected to young unmarried females, and mostof them resulted from suicidal purpose. The annual rate of poisoning-related ED visits and mortalitywere within the reported ranges, psychoactive agents being

  16. An unusual presentation of mad honey poisoning: acute myocardial infarction.

    Akinci, Sinan; Arslan, Uğur; Karakurt, Kamber; Cengel, Atiye


    An unusual type of food poisoning is commonly seen in the Black Sea coast of Turkey due to grayanotoxin containing toxic honey so called "mad honey" ingestion. In cases of toxication bradycardia and rhythm disturbances are commonly observed. Herein, we present a case of a patient who was admitted to the hospital because of acute myocardial infarction with normal coronary arteries after "mad honey" ingestion.

  17. Renal cortex copper concentration in acute copper poisoning in calves

    Luis E. Fazzio


    Full Text Available The aim of this study was to estimate the diagnostic value of renal cortex copper (Cu concentration in clinical cases of acute copper poisoning (ACP. A total of 97 calves that died due to subcutaneous copper administration were compiled in eleven farms. At least, one necropsy was conducted on each farm and samples for complementary analysis were taken. The degree of autolysis in each necropsy was evaluated. The cases appeared on extensive grazing calf breeding and intensive feedlot farms, in calves of 60 to 200 kg body weight. Mortality varied from 0.86 to 6.96 %, on the farms studied. The first succumbed calf was found on the farms between 6 and 72 hours after the susbcutaneous Cu administration. As discrepancies regarding the reference value arose, the local value (19.9 parts per million was used, confirming the diagnosis of acute copper poisoning in 93% of the analyzed kidney samples. These results confirm the value of analysis of the cortical kidney Cu concentration for the diagnosis of acute copper poisoning.

  18. Early continuous dialysis in acute glyphosate-surfactant poisoning

    Knežević Violeta


    Full Text Available Introduction. Treating severe acute glyphosate-surfactant poisoning requires intensive therapy including dialysis. Cases of hemoperfusion and hemodialysis use in renal failure induced by herbicide ingestion have been reported in the current medical literature. We present a case report of successful patient treatment with continuous venovenous hemodiafiltration in acute glyphosate-surfactant poisoning. Case Outline. A 36-year-old male patient attempted suicide by drinking approximately 300 ml of glyphosate-surfactant about an hour before coming to our Clinic. On admittance the patient was somnolent, normotensive, acidotic and hyperkalemic. Six hours after poison ingestion there was no positive response to symptomatic and supportive therapy measures. The patient became hypotensive, hypoxic with oliguric acute renal failure, so that post-dilution continuous veno-venous hemodiafiltration was started. During the treatment the patient became hemodinamically stabile, diuresis was established along with electrolyte and acid-base status correction and a gradual decrease of blood urea nitrogen and creatinine levels. After a single 27.5-hour treatment, clinical condition and renal function parameters did not require further dialysis. Complete recovery of renal function was achieved on the fifth day. Conclusion. Early introduction of continuous veno-venous hemodiafiltration with other intensive therapy measures led to complete recovery in a hemodinamically instable patient.

  19. Optimization of Treatment Policy for Acute Carbon Monoxide Poisoning

    R. N. Akalayev


    Full Text Available Objective: to evaluate the efficiency of combination use of hyperbaric oxygenation, succinate-containing solutions, and anti-edematous agents in patients with acute carbon monoxide poisoning. Subjects and methods. The results of treatment were analyzed in 32 patients admitted in 2009—2011 for severe acute carbon monoxide poisoning and a Glasgow coma score of 6—8. The patients were divided into 2 groups: 1 patients whose combination therapy involved hyperbaric oxygenation, Succinasol infusions, and L-lysine-aescinate injections; 2 those who received traditional therapy. All the patients underwent complex clinical, laboratory, and neurophysiologic examinations. Results. Just 24 hours after the combination use of Succinasol and L-lysine-aescinate, Group I patients were observed to have substantially reduced lactate, the content of the latter approached the normal value following 48 hours, which was much below the values in the control group. The similar pattern was observed when endogenous intoxication parameters were examined. During the performed therapy, the level of consciousness and that of intellect according to the MMSE and FAB scales were restored more rapidly in the study group patients than in Group 2. Conclusion. The combination use of hyperbaric oxygenation, the succinate-containing solution Succinasol, and the anti-edematous agent L-lysine-aescinate considerably enhances the efficiency of intensive therapy for acute carbon monoxide poisoning. Key words: carbon monoxide, toxic hypoxic encephalopathy, combination therapy, hyperbaric oxygenation, succinic acid, L-lysine-aescinate.

  20. Bioconcentration and Acute Intoxication of Brazilian Freshwater Fishes by the Methyl Parathion Organophosphate Pesticide

    João Bosco de Salles


    Full Text Available Three species of freshwater Brazilian fishes (pacu, Piaractus mesopotamicus; piavussu, Leporinus macrocephalus, and curimbatá, Prochilodus lineatus were exposed to an acute dose of 5 ppm methyl parathion organophosphate pesticide. Three to five individuals per species were exposed, one at a time, to 40 liters tap water spiked with Folidol 600. Pesticide concentrations and cholinesterase (ChE activities were evaluated in serum, liver, brain, heart, and muscle. The bioconcentration of methyl parathion was similar for all studied fishes. Brain tissue showed the highest pesticide concentration, reaching 80 ppm after exposure for 30 min to methyl parathion. Three to 5 hours of 5 ppm methyl parathion exposure provoked the death of all P. lineatus at 92% brain AChE inhibition, whereas fish from the other two species survived for up to 78 hours with less than 80% brain AChE inhibition. Our results indicate that acute toxic effects of methyl parathion to fish are correlated with brain AChE sensitivity to methyl paraoxon.

  1. Bioconcentration and Acute Intoxication of Brazilian Freshwater Fishes by the Methyl Parathion Organophosphate Pesticide

    Bosco de Salles, João; Matos Lopes, Renato; de Salles, Cristiane M. C.; Cassano, Vicente P. F.; de Oliveira, Manildo Marcião; Cunha Bastos, Vera L. F.; Bastos, Jayme Cunha


    Three species of freshwater Brazilian fishes (pacu, Piaractus mesopotamicus; piavussu, Leporinus macrocephalus, and curimbatá, Prochilodus lineatus) were exposed to an acute dose of 5 ppm methyl parathion organophosphate pesticide. Three to five individuals per species were exposed, one at a time, to 40 liters tap water spiked with Folidol 600. Pesticide concentrations and cholinesterase (ChE) activities were evaluated in serum, liver, brain, heart, and muscle. The bioconcentration of methyl parathion was similar for all studied fishes. Brain tissue showed the highest pesticide concentration, reaching 80 ppm after exposure for 30 min to methyl parathion. Three to 5 hours of 5 ppm methyl parathion exposure provoked the death of all P. lineatus at 92% brain AChE inhibition, whereas fish from the other two species survived for up to 78 hours with less than 80% brain AChE inhibition. Our results indicate that acute toxic effects of methyl parathion to fish are correlated with brain AChE sensitivity to methyl paraoxon. PMID:26339593

  2. Contributing Factors for Morbidity and Mortality in Patients with Organophosphate Poisoning on Mechanical Ventilation: A Retrospective Study in a Teaching Hospital

    Patil, Gurulingappa; Nikhil, M.


    Introduction One of the most common causes of poisoning in agricultural based developing countries like India is due to Organophosphorus (OP) compound. Its widespread use and easy availability has increased the likelihood of poisoning with these compounds. Aim To study the morbidity and mortality in patients with acute OP poisoning requiring mechanical ventilation. Materials and Methods This was a retrospective study constituting patients of all age groups admitted to the Intensive Care Unit (ICU) with diagnosis of OP poisoning between January 2015 to December 2015. Of 66 OP poisoning cases those patients who went against medical advice, 20 were excluded from the study and thus 46 patients were included. Diagnosis was performed from the history taken either from the patient or from the patient’s relatives and presenting symptoms. Demographic data, month of the year, age of patient, mode of poisoning, cholinesterase levels, duration of mechanical ventilation and mortality were recorded. Data are presented as mean±SD. Results A 97.83% (45/46) of cases were suicidal. Out of 46, 9 were intubated and mechanically ventilated. Duration of mechanical ventilation varied from less than 48 hours to more than 7 days. Mortality rate was 50%, 0% and 100% in those who required mechanical ventilation for more than 7 days, 2 to 7 days and poisoning, cholinesterase levels and duration of ventilation were independent predictors of death and all of them contributed to the mortality. Overall mortality rate in those who required mechanical ventilation was 22.22%. Conclusion Morbidity and mortality due to OP poisoning is directly proportional to the age, severity of poisoning and duration of mechanical ventilation and inversely proportional to serum cholinesterase level. PMID:28208980

  3. 阿托品不同给药方式治疗有机磷中毒的疗效分析%Comparison of Different Methods of Administering Atropine in the Treatment of Organophosphate Poisoning

    李志; 何伟峰; 邹海军


    目的:探讨临床救治有机磷中毒的患者使用阿托品时采用不同给药方式的疗效差异.方法:将我院在2007年6月~2010年10月收治的101例急性有机磷中毒的患者随机分为三组,I组患者给予阿托品人工静脉推注;II组患者先给予阿托品人工静脉推注,患者达到阿托品化后采用微量泵给药;III组患者直接使用用微量泵给药,比较三组患者的疗效和并发症.结果:II组患者和III组患者的疗效优于I组患者,并发症低于I组患者,p<0.05;III组患者阿托品化时间最长,与I组和II组比较,p<0.05.结论:采用阿托品人工静脉推注,待患者阿托品化再给予微量泵给药,其疗效较好,不良反应少,患者阿托品化更稳定,值得在临床推广使用.%Objective:Clinical treatment of patients with organophosphate poisoning atropine administered in different ways when the difference in efficacy.Methods:In our hospital in June 2007~October 2010 treated 101 cases of acute organophosphate poisoning were randomly divided into three groups, I group were treated with intravenous injection of atropine and artificial; Ⅱ patients are atropine artificial intravenous injection, the patient achieved using micro-pump after atropine administration; Ⅲ patients directly with micro-pump delivery, three groups of patients compared the efficacy and complications.Results:Group Ⅱ and Ⅲ patients were more effective than group I patients, complications than group I patients, p <0.05; Ⅲ longest of atropine in patients with Group Ⅰ and Ⅱ group, p <0.05. Conclusion:The use of artificial intravenous injection of atropine, atropine and then be given to patients with micro-pump delivery, the better effect, adverse reactions, patients with atropine is more stable, it is in clinical use.

  4. Advances in study of drugs controlling seizures in organophosphate poisoning%控制急性有机磷中毒惊厥药物的研究概况

    刘黎; 孙金秀


    急性有机磷中毒(acute organophosphate poisoning,AOPP)后,常出现全身抽搐和惊厥的症状,如果处理不当会导致不可逆的脑损伤.惊厥主要是由AChE活性被抑制所致的胆碱能神经系统过度兴奋导致的,有证据表明惊厥的过程可能还与兴奋性氨基酸(谷氨酸)受体的激活有关.本文主要讨论了对急性有机磷中毒引起惊厥有治疗作用的药物:苯二氮NFDA1类药物、兴奋性氨基酸受体拮抗剂、BDZ受体的部分激动剂、可逆性胆碱酯酶的抑制剂及其他的一些药物,以供实验和临床研究参考.

  5. Acute arsenic poisoning: clinical, toxicological, histopathological, and forensic features.

    Tournel, Gilles; Houssaye, Cédric; Humbert, Luc; Dhorne, Christine; Gnemmi, Viviane; Bécart-Robert, Anne; Nisse, Patrick; Hédouin, Valéry; Gosset, Didier; Lhermitte, Michel


    This report describes a suicide case by acute arsenic intoxication via intravenous injection. A 30-year-old woman injected arsenic As (V) (sodium arseniate disodique: Disodium Hydrogena Arsenik RP) in a successful suicide attempt. Three hours following administration, the woman developed severe digestive symptoms. She was admitted to a hospital and transferred to the intensive care unit within 12 h of the massive administration of arsenic. Despite therapeutic efforts, over the next 2 h she developed multiorgan failure and died. A postmortem examination was performed. Pulmonary edema and congestion of liver were apparent. As (V) and As (III) were determined by high performance liquid chromatography and inductively coupled plasma mass spectrometry after mineralization of samples by concentrated nitric acid. Toxicological analysis revealed high concentrations of arsenic in biological fluids as well as in organs. Histopathological examination showed a typical indication of myocarditis. These findings were in agreement with acute arsenic poisoning. The symptoms developed by this young woman (intoxication by intravenous administration) were comparable to oral intoxication. The clinical signs, survival time, and administration type are discussed in light of the literature on acute and chronic arsenic poisoning. © 2010 American Academy of Forensic Sciences.

  6. Acute salicylate poisoning: risk factors for severe outcome.

    Shively, Rachel M; Hoffman, Robert S; Manini, Alex F


    Salicylate poisoning remains a significant public health threat with more than 20,000 exposures reported annually in the United States. We aimed to establish early predictors of severe in-hospital outcomes in Emergency Department patients presenting with acute salicylate poisoning. This was a secondary data analysis of adult salicylate overdoses from a prospective cohort study of acute drug overdoses at two urban university teaching hospitals from 2009 to 2013. Patients were included based on confirmed salicylate ingestion and enrolled consecutively. Demographics, clinical parameters, treatment and disposition were collected from the medical record. Severe outcome was defined as a composite occurrence of acidemia (pH <7.3 or bicarbonate <16 mEq/L), hemodialysis, and/or death. Out of 1997 overdoses screened, 48 patients met inclusion/exclusion criteria. Patient characteristics were 43.8% male, median age 32 (range 18-87), mean initial salicylate concentration 28.1 mg/dL (SD 26.6), and 20.8% classified as severe outcome. Univariate analysis indicated that age, respiratory rate, lactate, coma, and the presence of co-ingestions were significantly associated with severe outcome, while initial salicylate concentration alone had no association. However, when adjusted for salicylate concentration, only age (OR 1.13; 95% CI 1.02-1.26) and respiratory rate (OR 1.29; 95% CI 1.02-1.63) were independent predictors. Additionally, lactate showed excellent test characteristics to predict severe outcome, with an optimal cutpoint of 2.25 mmol/L (78% sensitivity, 67% specificity). In adult Emergency Department patients with acute salicylate poisoning, independent predictors of severe outcome were older age and increased respiratory rate, as well as initial serum lactate, while initial salicylate concentration alone was not predictive.

  7. Prophylactic administration of non-organophosphate cholinesterase inhibitors before acute exposure to organophosphates: assessment using terbufos sulfone.

    Lorke, Dietrich E; Nurulain, Syed M; Hasan, Mohamed Y; Kuča, Kamil; Petroianu, Georg A


    Poisoning with organophosphorus compounds (OPCs) poses a serious threat worldwide. OPC-induced mortality can be significantly reduced by prophylactic administration of reversible acetylcholinesterase (AChE) inhibitors. The only American Food and Drug Administration (FDA)-approved substance for such pre-treatment (to soman exposure) is presently pyridostigmine, although its efficacy is controversial. In search for more efficacious and broad-spectrum alternatives, we have assessed in vivo the mortality-reducing efficacy of a group of five compounds with known AChE inhibitory activity (pyridostigmine, physostigmine, ranitidine, tacrine and K-27), when given in equitoxic dosage (25% of LD01 ) 30 min before exposure to the OPC terbufos sulfone. Protection was quantified in rats by determining the relative risk of death (RR) using Cox analysis, with RR = 1 for animals given only terbufos sulfone, but no pre-treatment. All tested AChE inhibitors reduced terbufos sulfone-induced mortality significantly (p ≤ 0.05) as compared with the non-treatment group (RR = 1: terbufos sulfone only). Best in vivo protection from terbufos sulfone-induced mortality was achieved, when K-27 was given before terbufos sulfone exposure (RR = 0.06), which was significantly (P ≤ 0.05) superior to the pre-treatment with all other tested compounds, for example tacrine (RR = 0.21), pyridostigmine (RR = 0.28), physostigmine (RR = 0.29) and ranitidine (RR = 0.33). The differences in efficacy between tacrine, pyridostigmine, physostigmine and ranitidine were not statistically significant. Prophylactic administration of an oxime (such as K-27) in case of imminent OPC exposure may be a viable option.

  8. Acute lead poisoning in two users of illicit methamphetamine

    Allcott, J.V. III; Barnhart, R.A.; Mooney, L.A.


    Acute lead poisoning can present a difficult diagnostic dilemma, with symptoms that mimic those of hepatitis, nephritis, and encephalopathy. The authors report two cases in intravenous methamphetamine users who presented with abnormal liver function values, low hematocrit values, basophilic stippling of red blood cells, and elevated blood lead levels. Both patients excreted large amounts of lead in their urine after treatment with edetic acid, followed by resolution of their symptoms. Lead contamination was proved in one drug sample. Basophilic stippling of the red blood cells was the one key laboratory result that led to the definitive diagnosis in both cases.

  9. Prediction of patient survival in cases of acute paraquat poisoning.

    Hong, Sae-Yong; Lee, Ji-Sung; Sun, In O; Lee, Kwang-Young; Gil, Hyo-Wook


    Paraquat concentration-time data have been used to predict the clinical outcome following ingestion. However, these studies have included only small populations, although paraquat poisoning has a very high mortality rate. The purpose of this study was to develop a simple and reliable model to predict survival according to the time interval post-ingestion in patients with acute paraquat poisoning. Data were retrospectively collected for patients who were admitted with paraquat poisoning to Soonchunhyang University Choenan Hospital between January 2005 and December 2012. Plasma paraquat levels were measured using high-performance liquid chromatography. To validate the model we developed, we used external data from 788 subjects admitted to the Presbyterian Medical Center, Jeonju, Korea, between January 2007 and December 2012. Two thousand one hundred thirty six patients were included in this study. The overall survival rate was 44% (939/2136). The probability of survival for any specified time and concentration could be predicted as (exp(logit))/(1+exp(logit)), where logit = 1.3544+[-3.4688 × log10(plasma paraquat μg/M[Formula: see text])]+[-2.3169 × log10(hours since ingestion)]. The external validation study showed that our model was highly accurate for the prediction of survival (C statics 0.964; 95% CI [0.952-0.975]). We have developed a model that is effective for predicting survival after paraquat intoxication.

  10. Acute cyanide poisoning among jewelry and textile industry workers.

    Coentrão, Luís; Moura, Daniel


    Limited work has focused on occupational exposures that may increase the risk of cyanide poisoning by ingestion. A retrospective chart review of all admissions for acute cyanide poisoning by ingestion for the years 1988 to 2008 was conducted in a tertiary university hospital serving the largest population in the country working in jewelry and textile facilities. Of the 9 patients admitted to the hospital during the study period, 8 (7 males, 1 female; age 36 ± 11 years, mean ± SD) attempted suicide by ingestion of potassium cyanide used in their profession as goldsmiths or textile industry workers. Five patients had severe neurologic impairment and severe metabolic acidosis (pH 7.02 ± 0.08, mean ± SD) with high anion gap (23 ± 4 mmol/L, mean ± SD). Of the 5 severely intoxicated patients, 3 received antidote therapy (sodium thiosulfate or hydroxocobalamin) and resumed full consciousness in less than 8 hours. All patients survived without major sequelae. Cyanide intoxication by ingestion in our patients was mainly suicidal and occurred in specific jobs where potassium cyanide is used. Metabolic acidosis with high anion is a good surrogated marker of severe cyanide poisoning. Sodium thiosulfate and hydroxocobalamin are both safe and effective antidotes.

  11. Prediction of patient survival in cases of acute paraquat poisoning.

    Sae-Yong Hong

    Full Text Available Paraquat concentration-time data have been used to predict the clinical outcome following ingestion. However, these studies have included only small populations, although paraquat poisoning has a very high mortality rate. The purpose of this study was to develop a simple and reliable model to predict survival according to the time interval post-ingestion in patients with acute paraquat poisoning. Data were retrospectively collected for patients who were admitted with paraquat poisoning to Soonchunhyang University Choenan Hospital between January 2005 and December 2012. Plasma paraquat levels were measured using high-performance liquid chromatography. To validate the model we developed, we used external data from 788 subjects admitted to the Presbyterian Medical Center, Jeonju, Korea, between January 2007 and December 2012. Two thousand one hundred thirty six patients were included in this study. The overall survival rate was 44% (939/2136. The probability of survival for any specified time and concentration could be predicted as (exp(logit/(1+exp(logit, where logit = 1.3544+[-3.4688 × log10(plasma paraquat μg/M[Formula: see text


    Saif Zil


    Full Text Available BACKGROUND : O rganophosphate pesticides are the most important cause of severe toxicity and death worldwide. Outbreaks of organophosphorus poisoning has increased specially in Bihar and south india after introduction of Mid - day meals schemes . AIM : To study the clinical profile of patients with organophosphorus poisoning outbreak, and efficacy of poison severity score as a triage to predict complications. MATERIALS AND METHODS : Thirty four students referred from primary health care to our tertiary care hospital. Medical History, physical examination and in some cases pseudocholinesterase was done. Medical records were retrospectively analysed and patients were divided into three groups (A, B, C based on poison severity score. Inclusion and exclusion criteria were developed. The Incidence of complications were studied in each group. Patients were also divide into those achieving early atropinisation versus late atropisation and compared . Statistical probability of each group was calculated with CHI SQUARE test. RESULTS : All patients were male children between 12 to 16 years (mean age being13.6 years. Group A, Group B, Group C had 11, 20, 3 patients respectively. Overall vomiting (88%, abdominal pain (79% and depressed mental status (55% were the commonest symptoms . The rate of complication in Group A, Group B ,Group C were 18%,35% and 100%respectively, however a p value calculated(6.84 Vs 9.49 with CHI SQUARE test was not significant. The commonest complications were cardiovascular, followed by respiratory and renal failure. Two patients developed multiple organ dysfunction and has to be referred. Retrospectively a mong 1 8 patients were atropinised early, 3 had complications and among 16 atropinised late, 9 developed complications. By using CHI SQUARE test the p value calculated was significant ( 3.94 >3.84 . CONCLUSION : Poison severity score reliably predicts the incidence of complication and help in triage of patients in outbreaks of

  13. Successful Treatment of Acute Boron Poisoning Induced Neurotoxicity by Haemodialysis: A Case Report

    Pradeep Hosagoudar


    Full Text Available Boric acid is commonly used as pesticide, disinfectant and wood preservative. Acute boron poisoning may manifest with vomiting, diarrhea, abdominal pain, headache, altered sensorium, seizure etc. Treatment of acute boron poisoning is conservative, no specific antidote is available.

  14. Severe but reversible acute kidney injury resulting from Amanita punctata poisoning

    Eunjung Kang


    Full Text Available Mushroom-related poisoning can cause acute kidney injury. Here we report a case of acute kidney injury after ingestion of Amanita punctata, which is considered an edible mushroom. Gastrointestinal symptoms occurred within 24 hours from the mushroom intake and were followed by an asymptomatic period, acute kidney injury, and elevation of liver and pancreatic enzymes. Kidney function recovered with supportive care. Nephrotoxic mushroom poisoning should be considered as a cause of acute kidney injury.

  15. 急性有机磷中毒临床综合治疗分析%The combined therapy of acute organophosphorus pesticide poisoning clinical observation

    丁宗发; 伍松涛


    Objective:To study on acute organophosphate poisoning of clinical characteristic and clinical treatment Methods; A retrospective analysis of 55 cases in our hospital with acute organophosphate pesticide poisoning patients with clinical data from JAN 20005 to JAN 2010. Observe the clinical characteristics. Results: 55 cases with acute organophosphate poisoning pass a system comprehensive treatment of the cure rate reaches a percentage of 94. 55. Extensive skin contact and respiratory suction poisoning patients cure rate was a percentage of 100%, two cases death. Conclusion: Clinicians should be timely, accurate, rapid and complete gastric lavage as soon as possible, in sufficient quantities, repeated, sustained the right of use of atropine and atropine rapidly as soon as possible for the first time in sufficient quantities to use PAM, it is key to prevent complications place.%目的:探讨急性有机磷中毒的临床特点和临床诊治方法.方法:回顾性分析我院2005年1月-2010年1月救治的55例急性有机磷农药中毒患者的临床资料,观察其临床特点.结果:55例急性有机磷中毒的患者,经过系统的综合治疗治愈率达94.55%.广泛皮肤接触和呼吸道吸中毒的患者治愈率为100%,死亡2例.结论:及早、正确、快速、彻底洗胃,及早、足量、反复、特续,正确使用阿托品及快速阿托品化,及早,首次足量使用解磷,并注意患者饮食以及积极防治相关并发症等都是保障患者康复的关键.

  16. Cases of acute poisoning admitted to Clinical Hospital Merkur in Zagreb in 1999.

    Prkacin, I; Vujanić, S; Dabo, N; Palcić, I; Naumovski-Mihalić, S


    This paper describes 170 cases of acute poisoning in 60 men and 110 women admitted to emergency room from January through November 1999. Ninety-eight percent of acute poisonings were self-inflicted, and 90% occurred at home. Drugs were used in 134 (79%) suicide attempts. Eighty-one acute poisonings were caused by benzodiazepines (48%) and 19 by antidepressants (11%). Alcohol intoxication, alone or combined with the intake of psychoactive drug (28 cases, 16%) predominated in men. Cocaine was the most common narcotic drug, taken by 31 patients (16%). Other acute poisonings involved ecstasy (4 cases), CO (6 cases), and HCl inhalation (2 cases). Previous suicide attempts due to depression were found in 68 patients (40%). Fifty patients (29%) were comatose on admission, 24 were transferred to intensive care, and 3 died. Data such as these can be very useful for handling self-inflicted acute poisonings and for planning long-term health care activities.

  17. Acute carbon monoxide poisoning: animal models: a review.

    Penney, D G


    Animals have been used for well over a century in an attempt to understand the toxicology, physiology, and pathology of acute carbon monoxide poisoning. Whether the toxic effects of this gas result from primary hypoxia, as in hypoxic hypoxia to which it is frequently compared, or from direct tissue effects since it enters cells and binds to certain vital components, remains a point of controversy. Acute severe poisoning in man and animals affects primarily the cardiovascular and nervous systems, and frequently produces neurologic dysfunction. Morphologically, tissue damage is usually confined to the white matter. The root cause is at best poorly understood and major investigative efforts have been made toward its elucidation. Many studies with rats, cats and primates indicate a major role for CO-induced hypotension, which serves to compromise blood flow and exacerbate acidosis. The likely cellular mechanisms in this process are only now becoming apparent. This review critically examines the recent as well as a few older CO-animal studies. In scope, they fall into several broad categories: general cardiopulmonary effects, metabolic and tissue effects, general resistance (i.e. tolerance), effects on the central nervous system including blood flow, neurochemistry, morphology and behavior, and finally, experimental therapeutic approaches.

  18. Acute poisoning in children; changes over the years, data of pediatric clinic department of toxicology

    Alije Keka


    Conclusion: In our study drugs and house cleaning products are the most frequent agents causing accidental poisoning in children less than 5 years-old, this age of children is the most susceptible in terms of morbidity. Compared with the previous studies in Pediatric Clinic of Pristina, drugs are still the most frequent cause of acute poisoning in children; the number of poisoning with pesticides has fallen but has increased the number of poisoning with cleaning products. All preventive measures against poisoning should be taken including preventive strategies of education at national level especially in drug and household product storage.

  19. Severe acute caffeine poisoning due to intradermal injections: Mesotherapy hazard

    Perković-Vukčević Nataša


    Full Text Available Introduction. Caffeine is indicated in the treatment of migraine headaches, as well as neonatal apnea and bradycardia syndrome. In mild poisoning, the most prevalent symptoms are nausea, vomiting, diarrhea, tremor, anxiety and headache. In more severe cases, symptoms consist of heart rythym abnormalities, myocardial infarction and seizures. Due to its common lipolytic effect, caffeine is used in mesotherapy, usually in combination with drugs of similar effect. We presented a patient with acute iatrogenic caffeine poisoning. Case report. A 51-year-old woman, with preexisting hypertension and hypertensive cardiomyopathy was subjected to cosmetic treatment in order to remove fat by intradermal caffeine injections. During the treatment the patient felt sickness, an urge to vomit, and a pronounced deterioration of general condition. Upon examination, the patient exhibited somnolence, hypotension and nonsustained ventricular tachycardia, which was sufficient enough evidence for further hospitalization. On admission to the intensive care unit the patient was anxious with increased heart rate, normotensive, with cold, damp skin, and visible traces of injection sites with surrounding hematomas on the anterior abdominal wall. Paroxysmal supraventricular tachycardia (PSVT on electrocardiographic monitoring was found. The laboratory analysis determined a lowered potassium level of 2.1 mmol/L (normal range 3,5 - 5.2 mmol/L, and a toxicological analysis (liquid chromatography with ultraviolet detection proved a toxic concentration of caffeine in plasma - 85.03 mg/L (toxic concentration over 25 mg/L. On application of intensive therapy, antiarrhythmics, and substitution of potassium, as well as both symptomatic and supportive therapy, there was a significant recovery. The patient was discharged without any sequele within four days. Conclusion. A presented rare iatrogenic acute caffeine poisoning occured due to massive absorption of caffeine from the

  20. Pattern and outcome of acute poisoning cases in a tertiary care hospital in Karnataka, India

    Ramesha K


    Full Text Available Background and Objective: Acute poisoning is a medical emergency. It is important to know the nature, severity and outcome of acute poisoning cases in order to take up appropriate planning, prevention and management techniques. This study aimed to assess the pattern and outcome of acute poisoning cases in a tertiary care hospital in Karnataka. Materials and Methods: This is a retrospective hospital record-based study conducted in a tertiary care hospital attached to a medical institution in Karnataka. The study included 136 cases and data regarding age, sex, time elapsed after intake; circumstances of poisoning, name of the poisonous substance, chemical type, duration of hospitalization, severity and outcome were collected in the prestructured proforma. Results: Incidence was more common among males (75.4% compared to females (24.3. Most cases of acute poisoning presented among 20- to 29-year age group (31.2% followed by 12- to 19-year age group (30.2%. A majority of poisoning cases (36.0% were due to organophosphorus compound (OPC. Total mortality was found to be 15.4%. Mortality rate due to corrosives was significantly high compared with OPC poisoning (χ2 = 4.12, P = 0.04. Of the 56 patients of OPC and carbamate poisoning, 13 patients (23.2% had respiratory arrest and required respiratory support. Time lapse had a significant role on the mortality in cases of acute poisoning (χ2 = 10.9, P = 0.01. Conclusion: Poisoning is more common in young males. The overall mortality is substantially high, mainly contributed by self-poisoning with insecticides and corrosives. Early care in a tertiary care center may help to reduce mortality in India.

  1. [Decontamination and antidotes in acute cases of poisoning].

    Kupferschmidt, Hugo; Züst, Ariane; Rauber-Lüthy, Christine


    In acute poisoning the maintenance or reconstitution of vital functions is the first and most critical action. All subsequent therapies and the prognosis depend on the identification of the causative agent and on information about substance-specific toxicity. Despite incomplete evidence the concept of harm reduction by decreased absorption of the toxicants and by shortening the course of illness is consistent with toxicokinetic-dynamic principles and is therefore still used by clinical toxicologists. All these treatment options have to be seen within the context of the prognosis and the time course of an individual case of poisoning. Treatment options of gastrointestinal decontamination are (in decreasing order of importance) single-dose activated charcoal, whole bowel irritation, and gastric lavage. Induced emesis by ipecac syrup is not practiced anymore. Enhanced elimination techniques are multiple-dose activated charcoal, urine alkalinization, and extracorporeal techniques such as hemodialysis and hemoperfusion. Enhanced elimination is only beneficial in toxicants with long half-life. Antidotes are directed against specific agents and therefore may be used only in a limited number of cases. The procurement of specific antidotes, often hardly available and not approved, is facilitated if the supply is organized in a transparent and standardized manner.

  2. Pattern of Acute Poisoning Attending a Tertiary Care Hospital of Western Nepal

    Raju Prasad Shakya


    Full Text Available Introduction: Poisoning with various substances is a major public health problem and a reason for significant morbidity and mortality throughout the globe. It is one of the most common presentation in an emergency department. This study was conducted to determine the sociodemographic, poisoning types, and mode of poisoning in cases attending a tertiary hospital of Western Nepal.   Methods: A retrospective observational study of two years was conducted from July 2014 to June 2016. Demography details, name of poisonous substance, and reasons for poisoning were reviewed and analyzed using descriptive statistics.   Results: A total of 65 cases of poisoning were recorded. The occurrence was more common in female (n=44, 67.7% than in male (n=21, 32.3% with a F:M ratio of 2.1:1.  Poisoning  was most  common in the age group of 11-20 years (32.3%. Most of the cases were students (37% followed by farmers (26%. The most commonly abused poisoning substance were organophosphorous compounds, zinc-phosphate,  and  kerosene in adults, adolescents, and children respectively. Oral route was the most common (99% route of administration. Suicidal attempt, as a mode of poisoning, accounted for 70.8% of total poisoning cases.   Conclusion: Female and young people are at greater risk of acute poisoning. Insecticide was the most common agent and self administer poisoning was the most common mode of poisoning. The occurrence of poisoning and its morbidity and mortality can be reduced by developing and implementation of effective prevention strategies like restricting easy poison sales, establishing drug and poison information centers,  and community awareness programs.

  3. [The comparative analysis of acute poisoning characteristics between cities and rural areas in Guangxi].

    Jiang, Dong-fang; Liu, Qing-hua


    To compare the acute-poisoning characteristics between city and rural areas of Guangxi Province in order to provide clinical data for the formation of treatment strategies of acute poisoning in Guangxi. Data of acute poisoning patients as treated in 36 municipal and 12 county hospitals, and also 15 rural clinics in 11 cities of Guangxi during 2005 to 2009 were collected and analyzed according to poisoning population, poisoning site, poisoning process, and poisoning degree. By analysing 3678 and 2153 cases of acute poisoning patients in rural and urban areas, the gender [χ (2) = 5.53, P professional (3.10% vs. 1.30%), taken by mistake (21.85% vs. 20.91%), homicide (0.30% vs. 0.28%), and suicide (39.07% vs. 18.77%), and by pesticide (60.94% vs. 12.13%), plant (7.08% vs. 2.88%) and animal poisons (7.73% vs. 6.56%), belonging to severe poisoning (25.86% vs. 19.04%) were higher than those in town. In the town, poisoning occurred predominantly in female (55.09% vs. 51.90%), age below 19 years old (23.78% vs. 19.44%), unemployed (33.35% vs. 13.76%), student (17.53% vs. 8.43%), industrial workers (31.95% vs. 2.69%), executives (10.84% vs. 0.22%) and other professional (3.53% vs. 0.05%); occurred in schools (8.78% vs. 0.82%), restaurants (5.48% vs. 1.55%), place of entertainment (1.63% vs. 1.09%), by accidental (52.23% vs. 31.27%), therapeutic (4.46% vs. 2.56%), and other reasons (2.04% vs. 1.85%); by chemicals (33.19% vs. 8.55%), medicines (24.31% vs. 9.12%), and other types of poison (20.92% vs. 6.59%); light and medium degree of poisoning (44.87% vs. 41.22%, 36.09% vs. 32.93%) were higher than those in rural areas. Regarding the acute poisoning in Guangxi, the composition of population, the poisoning sites and causes, the types of poisons, the poisoning degree are distinctly different between urban and rural areas.

  4. 1286例急性中毒患者临床特点回顾及分析%Clinical characteristics of acute poisoning: retrospective analysis of 1286 cases

    刘利峰; 夏鹄; 刘先华; 吴航滨; 宋海晶; 曹娟; 乔莉


    目的 探讨急性中毒患者病因学构成、临床特点及与治疗、预后的关系.方法 对我院十年间急性中毒患者病因、临床特点及治疗、预后分析.结果 本院急诊抢救室十年间共收治急性中毒患者1 286 人.男:女为1:1.70,平均年龄(33.73±14.94)岁,明显低于就诊人群总发病年龄,青中年是中毒高发年龄.药物中毒占急性中毒总数的51.09%,其中镇静类药物占28.30%.酒精中毒是造成中毒患者意识障碍最主要原因(58.24% ).死亡率最高的是有机磷中毒,为4.95%,占死亡总数的71.43%.口服中毒是最常见的中毒途径,占91.76%.自杀是主要的中毒原因,占中毒患者总数的57%,并以女性占绝大多数为71.20%,平均年龄亦低于其他中毒原因,均有统计学差异均(P <0.001).结论 急性中毒有自身的临床特点.早期、正确的判断及处理是治疗关键.社会、家族关心是减少发生的根本.%Objective To explore the correlation between the etiology constructions, clinical characteristics and the treatment, as well as its prognosis for acute poisoning patients. Methods An analysis on all acute poisoning patients admitted in our emergency room in the past ten years was performed. Results In a total of 1286 acute poisoning patients admitted in past ten years, the proportion of male to female was 1:1.70 with an average age of 33.73 ±14.94, which was obvious lower than the average age in general. Among the causes of poisoning, 51.09% were caused by alcoholism of which sedative medicine accounted for 28.3% . 4.95% organophosphate poisoning patients died, accounting for 71.43% of the total acute poisoning deaths. Oral ingestion, the most frequent route of poisoning, took 91.76% of the total poisoning cases. Suicide had become the major cause for being poisoned, accounting 57% of the total poisoning cases with an obvious younger age in average than other types of poisoning (P<0.001), of which female suicide took 71

  5. Analysis of Nine Cases of Acute Thallium Poisoning

    WANG Qiwei; HUANG Xiaojiang; LIU Liang


    In this study nine cases of thallium poisoning in a series of homicidal poisoning were analyzed in order to provide more information concerning thallium poisoning. It was found that the most common clinical feature of thallium poisoning was peripheral neuropathy and paraesthesia was more common than amyasthenia. Understanding of these clinical characteristics of thallium poisoning was helpful to early identification and differential diagnosis. Since the early administration of Prussian Blue, as a specific antidote for thallium poisoning, can substantially improve the prognosis, it is of great importance to establish a correct and early diagnosis.

  6. Electrochemical Assay of Effects of Organophosphate Poisoning on Acetylcholinesterase from Pheretima via2,6-Dimethyl-p-benzoquinone

    WU Wu-ai; LI Jun; GAO Bao-ping; GUO Man-dong


    Electroanalytical techniques could be a reliable and promising alternative to classical and sophisticatcd methods because of their simplicity(small and portable),easy use,the ability to deliver fast response with high sensitivity and selectivity.A square wave voltammetric method was developed for the assessment of organophosphorus(OPs) compound impact on acetylcholinesterase(AChE) of Pheretima with 2,6-dimethyl-p-benzoquinone(2,6-DMBQ) as a redox indicator.The substrate of acetylthiocholine is hydrolyzed by AChE and the produced thiocholine reacts with 2,6-DMBQ to give an obvious shift of electrochemical signal.The reduction peak of 2,6-DMBQ is located at around -0.18 V which is far away from the oxidation potential of possible interference components often present in biosample.The decreased rate of reduction current was related with the activity of AChE.The inhibition of parathion-methyl on AChE was assessed.The inhibiton rate of OPs on AChE activity increased quickly during the first 10min inhibition,and after that the value of inhibition rate approached to be constant.AChE lost almost 29.3% of activity after 10 min incubation with 1 μg/mL parathion-methyl and 67.5% of activity with 10 μg/mL parathion-methyl,while the activity that corresponds to 40 μg/mL parathion-methyl was nearly completely inhibited(94.9%).Compared to cyclic voltammetry and amperometry,Square wave voltammetry(SWV) method is a high sensitive electroanalysis with fast scan-rate(only several seconds for one signal value) which is useful to prevent the electrodes from possible fouling or passivation.This method can be employed to assess the inhibition of organophosphate on AChE and investigate OPs impact on environmental animals.

  7. Poisoning

    ... team will provide additional treatment. They can use methods to get rid of the poison before it causes more harm. Some types of poison have antidotes. These work by reversing the poison’s effects and curing it. Treatment also includes measures to relieve symptoms. ...

  8. Causes of Acute Poisoning Hospital admission in Shahid Beheshti Hospital of Yasuj, 2008

    S Mohammad Hosseini


    Full Text Available Background & aim: About 7% of patient referred to hospital are various forms of poisoning. This study was performed to determine the major causes of acute poisoning leading to Hospitalization at Shahid Beheshti Hospital of Yasuj, Iran. Methods: This descriptive study was performed from August 2007 to July 2008 on 470 cases of poisonings referred to Shahid Beheshti hospital of Yasuj. Demographic characteristics, time of poisoning, poisoning factor, history of previous poisoning, history of psychiatric disease, medication and other therapeutic intervention based on questionnaires and interviews with patients or companions of patients were recorded. Data were analyzed by Chi-Square Test. Results: Majority of poisoned patients were single females, in the age range of 21-30 years, unemployed, lived in urban areas, and had at least a diploma. The majority of cases were intentional poisoning with a history of depression, previous poisoning and attempted suicide. Significant relationship were seen between poisoning, age, sex, and job, (p0.05. Conclusion: With respect to the results of this study, the majority of these poisonings occurred among young, single and unemployed females due to suicide and drug intoxication. Necessary actions should be done in drug usage and maintenance, taking action against non-prescription drugs and giving proper public education to families.

  9. Delayed onset neuropathy along with recurrent laryngeal nerve palsy due to organophosphate poisoning and the role of physiotherapy rehabilitation

    Jaimala Vijay Shetye


    Full Text Available Organophosphorus poisoning is a major global cause of health problems and the leading cause of mortality and morbidity in the developing countries. In this, the inhibition of acetyl-choline esterase and neurotoxic esterase along with nicotinic receptor involvement produces three well-identified and documented clinical phases: The initial cholinergic phase, which is a medical emergency often requiring management in an intensive care unit; the intermediate syndrome, during which prolonged ventilator care is necessary; and finally delayed neurotoxicity. Vocal cord paralysis is rare and leads to aphonia. Role of physiotherapy rehabilitation is substantial in all three stages and aims at early weaning off from mechanical ventilator until the functional independence and community integration of the patient.

  10. The value of APACHE Ⅱ scoring system in assessment of seyerity and prognosis of patients with organophosphate insecticide poisoning%APACHE Ⅱ评分对有机磷中毒患者病情评估的意义

    胡念丹; 黄敏; 李文强


    Objective:To evaluate the severity and the prognosis of the organophosphate insecticide poisoning by using APACHE Ⅱ scoring system. Method: Fifty-one patients with organophosphate insecticide poisoning admitted in our hospital were studied retrospectively. Data associated with APACHE Ⅱ scoring system were recorded and analyzed statistically.Result:The APACHE Ⅱ score of the 51 patients enrolled in our study were ranged from 3 to 28. The APACHE Ⅱ score was (21.43 ± 5.41)in the 7 deaths and (8. 75 ± 3.29 )in the 44 survivors. There was significant differences between the two groups(P<0.01). Conclusion:APACHE Ⅱ scoring system may have some value in predict the prognosis of organophosphate insecticide poisoning.%目的:探讨应用急性生理和慢性健康状况(APACHE Ⅱ)评分评估有机磷农药中毒患者的病情严重程度及预后的意义.方法:回顾性分析我院有机磷农药中毒患者51例,记录与APACHE Ⅱ评分系统相关的数据,并对患者的APACHE Ⅱ评分进行统计学分析.结果:51例患者APACHE Ⅱ评分3~28分.7例死亡患者APACHE Ⅱ评分(21.43±5.41)分,44例存活患者APACHE Ⅱ评分(8.75±3.29)分,两组之间差异有统计学意义(P<0.01).结论:APACHE Ⅱ评分对中毒的预后预测可能有一定的作用.

  11. [Clinical manifestation and influential factors in patients with acute arsenic poisoning].

    Liu, Wei-Wei; Yang, Zhi-Qian; Zhang, Cheng; Zhang, Yi-Li; Jiang, Wen-Zhong; Wu, Yi-Xing; Liu, Yi-Min; Gu, Li-Cheng


    To investigate the clinical characteristics of acute arsenic poisoning and its influential factors. Clinical data of 47 cases of arsenic poisoning were collected and analyzed. Two cases of observation, 40 cases of mild acute poisoning, and 5 severe acute poisoning were investigated in this group. Myocardial enzyme activity was correlated with age and urine arsenic concentrations. Myocardial enzyme, the liver ALT, total bilirubin (TBil) and indirect bilirubin (IBil) were negatively correlated with vomiting frequency, with statistical significance (P arsenic concentration was correlated with vomiting frequency and amount of soup drunk, with statistically significant difference (P arsenic concentrations, cardiac enzymes and liver enzyme concentration. Acute arsenic poisoning can lead to multiple organ damage. The damage is relevant with amount of arsenic intake, vomiting, diarrhea and urinary frequency arsenic concentration. So early use of gastric lavage, vomiting, poison discharges, and adequate application of effective antidote (Na-DMPS) as soon as possible, symptomatic treatment and the reinforced monitoring, are the rescue key for patients with acute arsenic poisoning.

  12. [Acute gamma-butyrolactone poisoning with withdrawal syndrome].

    Chwaluk, Paweł; Rejmak, Grazyna


    Gamma-butyrolactone (GBL) is a solvent that are part of many consumer products and in most countries can be legally purchased in the form of almost pure substance. After ingestion GBL is rapidly converted to gamma-hydroxybutyric acid (GHB). In recent years, GBL became a legal alternative to GHB, which is used widely since 1990s as a club drug and date rape drug. It is believed that abuse of GBL is not frequent in Europe, except for certain specific groups, mainly in urban centers in the west of the continent. We present a case of acute GBL poisoning with the withdrawal syndrome in 23-year-old man living in a rural area in eastern Poland. The patient was admitted to the Intensive Care Unit (ICU) because of coma of unknown origin. On admission erosions of the lips and mouth was seen. Ethyl alcohol was not present in blood sample, urine screening tests for drugs were negative. During his stay in the ICU patient required ventilatory support, was periodically agitated with muscular jerks and opisthotonos. The later medical history revealed that the patient from two years used GBL, which purchased as wheels cleaner. The tolerance developed, and the interruption of use of substance triggered symptoms of withdrawal. GBL abuse occurs in different social groups and is at risk for acute toxicity and the development of physical dependence.

  13. Features and Prognostic Factors for Elderly With Acute Poisoning in the Emergency Department

    Yu-Hui Hu


    Conclusion: Our results demonstrated that elderly patients with acute poisoning had a mortality rate of 9.6%. Suicide attempts resulted in more serious complications. The risk factors for mortality were herbicide intoxication, hypotension and respiratory failure.

  14. Reversible brain damage following acute organic solvents' poisoning determined by magnetic resonance


    Introduction. Acute exposure to the effects of volatile solvents is characterized by the abrupt onset of symptoms and signs of poisoning, and relatively fast recovery in the majority of cases. Case report. We report a 24-year-old patient with an acute, accidental poisoning with a mixture of volatile organic solvents (most probably toluene, styrene and xylene), which led to the development of upward gaze paresis, diplopia, hemiparesis, ataxic gate, and the late onset truncal ataxia episodes. A...

  15. Organophosphate Induced Neuropathy - An Epidemic Case Report at Civil Hospital, Ahmedabad.

    M.M. Prabhakar


    Full Text Available Introduction: Organophosphates are the important biochemical substance, generally used as insecticides, nematocides, fungicides, solvents, plasticizers, drugs, herbicides and chemical warfare nerve agents. The most common route of entry of OPs in to body, is through insecticides, whether suicidal or accidental. Acute poisoning of OP is frequently observed in developing countries. Organophosphates cause inhibition of acetylcholinesterase enzyme in the body which leads to accumulation of acetylcholine. Acetylcholine is very important for nerve function. The Prevalence of OP poisoning is around 1 million per year. Aim: Aim of this study was to do an epidemic case study the effect of Organophosphet on peripheral nerves. Material and method: 17 (9 male and 8 female Patients with organophosphate consumptions were clinically assessed and were tested by NCV study at Physiotherapy Department of Civil Hospital, Ahmedabad. Results and Conclusions: The Study of 17 organophosphate poison consumption revealed that there was Electrophysiological evidence of demyelinating and axonal type of pure motor polyneuropathy affecting LL >Ul with normal sensory nerve conduction.

  16. Neurological Effects of Acute Carbon Monoxide Poisoning in Children

    Coskun YARAR


    Full Text Available Carbon monoxide poisoning (COP is one of the most common causes of mortality and morbidity due to poisoning in all over the world. Although the incidence of COP has not been known exactly in the childhood, almost one-third of CO exposures occurred in children. The data regarding COP in children are inconclusive. Children may be more vulnerable to CO exposure than adults as a result of their high respiration and metabolic rates, high oxygen metabolism, and immature central nervous system. Recent researches proposed new theories about neurological effects of CO toxicity. The clinical presentations associated acute COP may be various and nonspecific. Unrecognized CO exposure may lead to significant morbidity and mortality. CO exposed children often become symptomatic earlier, and recover more rapidly, than similarly CO exposed adults. Mild clinical signs and symptoms associated with COP are headache, dizziness, weakness, lethargy, and myalgia; however, severe signs and symptoms such as blurred vision, syncope, convulsion, coma, cardiopulmonary arrest and death can also accompany with COP. Neurologic manifestations can include altered mental status at different degrees, neck stiffness, tremor, ataxia, and positive Babinski's sign. Delayed neurologic sequels (DNS of COP might be seen in children like adults. DNS symptoms and signs in children include memory problems, mental retardation, mutism, fecal and urinary incontinence, motor deficits, facial palsy, psychosis, chronic headache, seizures, and epilepsy. After CO exposure children must be cared to detect and treat DNS. Although hyperbaric oxygen therapy (HBOT is reported to prevent development of DNS, its indications, application duration and procedures are controversial in both of the children and adults. Although their predictive values are limited, exposing to CO more than eight hours and suffering from CO-induced coma, cardiac arrest, lactic acidosis, high COHb levels, and pathologic findings

  17. Validity of referral hospitals for the toxicovigilance of acute poisoning in Sri Lanka.

    Senarathna, L; Buckley, N A; Jayamanna, S F; Kelly, P J; Dibley, M J; Dawson, A H


    To identify the hospital admission data set that best captures the incidence of acute poisoning in rural Sri Lanka. Data were collected on all acute poisoning cases admitted to 34 primary and 1 referral hospital in Anuradhapura district from September 2008 to January 2010. Three admission data sets were compared with the "true" incidence of acute poisoning to determine the systematic bias inherent to each data set. "True" incidence was calculated by adding all direct admissions (not transfers) to primary hospitals and to the referral hospital. The three data sets were: (i) all admissions to primary hospitals only; (ii) all admissions to the referral hospital only (direct and referrals), and (iii) all admissions to both primary hospitals and the referral hospital ("all admissions"). The third is the government's routine statistical method but counts transfers twice, so for the study transferred patients were counted only once through data linkage. Of 3813 patients admitted for poisoning, 3111 first presented to a primary hospital and 2287 (73.5%) were later transferred to the referral hospital, where most deaths (161/177) occurred. All data sets were representative demographically and in poisoning type, but referral hospital data yielded a more accurate case-fatality rate than primary hospital data or "all admissions" data. Admissions to primary hospitals only or to the referral hospital only underestimated the incidence of acute poisoning by about 20%, and data on "all admissions" overestimated it by 60%. Admission data from referral hospitals are easily obtainable and accurately reflect the true poisoning incidence.

  18. Using poisons information service data to assess the acute harms associated with novel psychoactive substances.

    Wood, D M; Hill, S L; Thomas, S H L; Dargan, P I


    Novel psychoactive substances (NPS) can cause significant acute toxicity but usually little is known about their toxicity when they enter the recreational drug scene. Current data sources include online user forums, user questionnaires, case reports/series, and deaths; however, these are limited by their focus on sub-populations and generally include severe cases and specific geographical areas. Approximately 54% of countries have at least one poisons information service (in 2012 there were 274 worldwide) providing advice to healthcare professionals and/or the public on poisoning. They provide advice on recreational drug and NPS toxicity. In 2012, 2.5% of telephone enquiries to the UK National Poisons Information Service and 2.4% of enquiries to US poisons centres related to recreational drugs. Data are collected at population level and can be used to complement other data sources with clinical details on acute NPS toxicity and geographical/time patterns of toxicity. Like other acute NPS toxicity data, poisons centre data should be interpreted within their limitations, notably the absence of analytical confirmation and reliance on secondary reporting of clinical features. This manuscript demonstrates the breadth and depth of poisons information service data in the literature with a focus on mephedrone and synthetic cannabinoid-receptor agonists. In our opinion it would be possible to develop a more robust and systematic reporting system using a network of poisons information services both within and across countries that would be complimentary to other datasets on acute NPS toxicity and allow more accurate data triangulation.

  19. Acute Poisoning in Children Referred to Qazvin Children Hospital (2009 to 2012



    Full Text Available Background Acute poisoning in children (APC is a preventable cause of pediatric emergency visits. Patterns of acute poisoning in children are different in various regions and times. Objectives The aim of this study was to assess the epidemiology of acute poisoning in children, who were referred to the emergency department of Qods teaching hospital in Qazvin, Iran. Methods In this descriptive, cross-sectional study, all children younger than 13 years old, admitted to the Qods teaching hospital in Qazvin (Iran, were assessed during September 2009 to September 2012. Demographic and clinical symptoms and signs of poisoned cases, poisonous agents and outcome of patients were studied. Results Four hundreds and thirty-four (2.59% of total hospital admission patients with APC were admitted to the emergency department during the study period; 63.36% were male. Overall, 345 (79.5% cases were under 6 years old. Drugs (265 cases were common agents for APC. The ingestion route was responsible in 391 of APC. Methadone, benzodiazepines and kerosene were the most frequent poisonous agents. Neurologic symptoms and signs (256 cases were the most common presentation of APC. Forty-five patients (10.36% were admitted to the PICU. Three deaths (%0.06 occurred with monoxide carbon and methadone poisoning. Monoxide carbon poisoning was the deadliest agent. Conclusions Acute poisoning in children is a serious preventable cause of hospital admissions. It is one of the differential diagnoses in patients with sudden onset of neurological, alimentary, respiratory symptoms and signs, who are visited at the emergency department. Parental awareness and education about keeping potential poisoning agents safely is essential to reduce APC in children.

  20. [Poison cases and types of poisons based on data obtained of patients hospitalized from 1995-2009 with acute poisoning in the second internal ward in a multi-profile provincial hospital in Tarnow].

    Lata, Stanisław; Janiszewski, Jacek


    The thesis presents a short history and organization of an acute poisoning centre in the1995 functioning within the internal diseases department in a multi-profile provincial hospital. The data show the number of patients treated beetween 1995-2009 an the types of toxic substances that caused poisoning. The conclusions presented refer to the role of the centre to help people suffering from acute poisoning within the city of Tarnow.

  1. Metabolic changes in rat urine after acute paraquat poisoning and discriminated by support vector machine.

    Wen, Congcong; Wang, Zhiyi; Zhang, Meiling; Wang, Shuanghu; Geng, Peiwu; Sun, Fa; Chen, Mengchun; Lin, Guanyang; Hu, Lufeng; Ma, Jianshe; Wang, Xianqin


    Paraquat is quick-acting and non-selective, killing green plant tissue on contact; it is also toxic to human beings and animals. In this study, we developed a urine metabonomic method by gas chromatography-mass spectrometry to evaluate the effect of acute paraquat poisoning on rats. Pattern recognition analysis, including both partial least squares discriminate analysis and principal component analysis revealed that acute paraquat poisoning induced metabolic perturbations. Compared with the control group, the levels of benzeneacetic acid and hexadecanoic acid of the acute paraquat poisoning group (intragastric administration 36 mg/kg) increased, while the levels of butanedioic acid, pentanedioic acid, altronic acid decreased. Based on these urinary metabolomics data, support vector machine was applied to discriminate the metabolomic change of paraquat groups from the control group, which achieved 100% classification accuracy. In conclusion, metabonomic method combined with support vector machine can be used as a useful diagnostic tool in paraquat-poisoned rats.

  2. Salvianolic Acids Attenuate Rat Hippocampal Injury after Acute CO Poisoning by Improving Blood Flow Properties

    Li Guan


    Full Text Available Carbon monoxide (CO poisoning causes the major injury and death due to poisoning worldwide. The most severe damage via CO poisoning is brain injury and mortality. Delayed encephalopathy after acute CO poisoning (DEACMP occurs in forty percent of the survivors of acute CO exposure. But the pathological cause for DEACMP is not well understood. And the corresponding therapy is not well developed. In order to investigate the effects of salvianolic acid (SA on brain injury caused by CO exposure from the view point of hemorheology, we employed a rat model and studied the dynamic of blood changes in the hemorheological and coagulative properties over acute CO exposure. Compared with the groups of CO and 20% mannitol + CO treatments, the severe hippocampal injury caused by acute CO exposure was prevented by SA treatment. These protective effects were associated with the retaining level of hematocrit (Hct, plasma viscosity, fibrinogen, whole blood viscosities and malondialdehyde (MDA levels in red blood cells (RBCs. These results indicated that SA treatment could significantly improve the deformation of erythrocytes and prevent the damage caused by CO poisoning. Meanwhile, hemorheological indexes are good indicators for monitoring the pathological dynamic after acute CO poisoning.

  3. Intoxicação por organofosforados em búfalos (Bubalus bubalis no Rio Grande do Sul Organophosphate poisoning in buffaloes (Bubalus bubalis in southern Brazil

    Fabiane Borelli Grecco


    Full Text Available Descreve-se um surto de intoxicação por organofosforados (ORFs em búfalos (Bubalus bubalis na região sul do Rio Grande do Sul. Os animais foram submetidos à aplicação de Expertan® pour-on (clorpirifós na dose de 12mg/kg de peso animal para controle de infestação por piolhos e desenvolveram sinais clínicos de intoxicação em um período variável entre 7-45 dias após a exposição ao produto. Os sinais clínicos caracterizaram-se por anorexia, diarréia, salivação intensa, incoordenação motora, tremores musculares, paresia e paralisia flácida, decúbito lateral e morte. Em conseqüência da intoxicação morreram 61 búfalos de um total de 267 animais sob risco. Foram realizadas três necropsias de búfalos que morreram 24-72 horas após o início dos sinais clínicos. As lesões macroscópicas caracterizaram-se por congestão e hemorragias intestinais, enfisema e edema pulmonares. Não foram observadas alterações microscópicas significativas em nenhum dos animais. Apesar da ausência de alterações histológicas no sistema nervoso central e periférico, os achados epidemiológicos, clínicos, macroscópicos e toxicológicos sugerem o diagnóstico de neurotoxicidade tardia induzida por ORFs.This paper describes organophosphate (ORF poisoning in a herd of water buffaloes (Bubalus bubalis in southern Brazil, which were treated with a single dose of 12mg/kg body weight of Expertan® pour-on (chlorpyriphos to control ectoparasites. Clinical signs, observed 7-45 days after exposure, were diarrhea, hypersalivation, ataxia, muscular tremors, weakness of pelvic limbs, paresis and flaccid paralysis and lateral recumbence. Out of 267 buffaloes 61 died. Necropsy of three animals that died 24-72 hours after onset of clinical signs, revealed congestion and serosal hemorrhages scattered along the bowel, emphysema and edema of the lungs. No significant histopathological changes were found. Residues of chlorpyriphos were detected in liver

  4. A case report of massive acute boric acid poisoning.

    Corradi, Francesco; Brusasco, Claudia; Palermo, Salvatore; Belvederi, Giulio


    Boric acid comes as colourless, odourless white powder and, if ingested, has potential fatal effects including metabolic acidosis, acute renal failure and shock. An 82-year-old male was brought to the emergency room 3 h after unintentional ingestion of a large amount of boric acid. Clinical course was monitored by collecting data at admittance, 12 h after admission, every 24 h for 5 days and again 1 week after admission. During the first 132 h, serum and urinary concentrations of boric acid were measured. Serum boric acid levels decreased from 1800 to 530 microg/ml after haemodialysis and from 530 to 30 microg/ml during the forced diuresis period. During dialysis, boric acid clearance averaged 235 ml/min with an extraction ratio of 70%. The overall patient's condition steadily improved over 84 h after admission. In conclusion, early treatment with forced diuresis and haemodialysis may be considered for boric acid poisoning, even if signs of renal dysfunction are not apparent, to prevent severe renal damage and its complications.

  5. 浅析抢救有机磷中毒次生阿托品过量%Analysis of secondary consequences of atropine overdose in the rescue of organophosphate poisoning



    目的:为了更好地避免有机磷中毒抢救中因应用阿托品过量产生的次生后果.方法:筛查出236例有机磷中毒患者中,因抢救有机磷中毒使用阿托品过量(中毒)的 32 例临床资料.结果:30 例病人经调整阿托品用量及积极综合对症治疗后最终痊愈出院,两例既往有糖尿病的患者因合并肺部感染死于呼吸衰竭.结论:正确地应用阿托品是抢救成功的关键.%Objective: To avoid the secondary consequences of atropine overdose in the rescue of organophosphate poisoning. Methods: The clinical data of 32 case treated with atropine overdose was selected among 236 cases of organophosphate poisoning. Results: 30 cases of patients after adjusting the dosage of atropine and active comprehensive symptomatic treatment eventually recovered and discharged, while 2 cases with diabetes combined with pulmonary infection died of respiratory failure. Conclusion: The correct application of atropine is a key to the success of the rescue.

  6. Knowledge and Practices Relating to Acute Pesticide Poisoning Among Health Care Providers in Selected Regions of Tanzania

    Elikana Lekei


    Full Text Available Background: Acute pesticide poisoning (APP is commonly underdiagnosed in Tanzania. Studies in developing countries suggest that a lack of diagnostic skills among health care providers (HCPs undermines surveillance for APP. This study aimed at characterizing experience and skills of Tanzanian HCPs regarding APP diagnosis and management. Methodology: The population included HCPs responsible for managing APP in Kilimanjaro and Arusha regions (n = 91. The resulting sample included 66 respondents (response rate: 73%. The data were collected in 2005 using a standardized questionnaire. Results: Half of all respondents (50% reported handling at least 1 APP case with 15% reporting handling more than 5 cases in the past. Reported experience of handling an APP case was marginally higher in respondents who reported ⩾4 years of work experience in the health sector compared with those with <4 years of work experience (odds ratio = 1.32; 95% confidence interval = 0.9-1.5. Most of the respondents had high knowledge of exposure routes, reporting awareness of oral (98.5%, inhalational (93.9%, and dermal (77% routes. The study revealed low awareness of pesticide classification by chemical groups (29% or World Health Organization hazard (0% and weak knowledge on pesticide label instructions (55%. Organophosphates accounted for 35% of the pesticide products reported by respondents as being responsible for poisoning. Some treatment options were incorrectly reported as first aid options, and some reported first aid options were wrong or inappropriate. Conclusions: The study revealed that HCPs in northern Tanzania lack adequate skills to diagnose and manage APP. For effective surveillance of APP, there is a need to include training on hazards, classification, diagnosis, and health effects in the training programmes for all HCPs in Tanzania.

  7. Etiological characterization of acute poisonings in the emergency department

    Khlifi Malek


    Full Text Available Introduction: An investigation of emergency department (ED poisonings was conducted to characterize poisoning demographics and evaluate correlations with select co-morbidities. Methods: The study population evaluated consisted of 649 poisoning cases admitted between 2004 and 2007 to an inner-city, level 1 emergency department. Results: Ethnicity, age, and gender had a substantial impact on the population distribution as poisoning cases were predominantly African Americans (79.9% between 36 and 45 years old with a 1:3 male to female ratio. Intentional illicit drug overdose was the most prevalent cause of poisoning, heroin being the most frequent substance found in 35.4% ( n = 230 of cases, followed by cocaine overdose at 31.7% ( n = 206, concomitant heroin and cocaine overdose at 4.3% ( n = 28, multiple drug poisoning at 5.5% ( n = 36, and antidepressant/antipsychotic poisoning at 6% ( n = 39. Significant correlations were found between heroin poisoning and asthma (F = 20.29, DF = 1, P = 0.0001, cocaine poisoning and hypertension (F = 33.34, DF = 1, P = 0.0001, and cocaine poisoning and cardiovascular disease (F = 35.34, DF = 1, P = 0.0001. A change in the pattern of illicit drug use from injection to inhalation was detected and the resulting increase of inhalation and insufflation of illicit substances may partially explain the correlation found between heroin use and asthma. Conclusions: These results provide supporting evidence that deliberate poisoning with illicit drugs remains a serious healthcare issue that significantly aggravates co-morbidities and raises treatment costs by increasing both the rate of hospitalization and hospital length of stay.

  8. Intoxicação por organofosforado em bovinos no Rio Grande do Sul Poisoning by organophosphate in cattle in southern Brazil

    José C Oliveira-Filho


    Full Text Available Descreve-se um surto de intoxicação por organofosforado (ORF em bovinos na mesorregião centro ocidental do Rio Grande do Sul. A água fornecida a 49 bovinos foi contaminada com ORF e carbamato (CM. Vinte bovinos morreram após quadro clínico de poucas horas. Foram observados os clássicos sinais clínicos de hiperestimulação do sistema parassimpático incluindo incoordenação motora, agressividade, sialorreia, tremores musculares e, em alguns casos, diarreia. Na necropsia e histopatologia não foram observadas alterações morfológicas significativas. ORF e CM foram detectados por cromatografia em camada delgada em amostras de tecido de dois bovinos afetados. Adicionalmente, uma amostra da água consumida pelos bovinos foi positiva para ORF e CM e outras duas foram positivas para ORF. Uma análise quantitativa realizada por cromatografia gasosa no conteúdo do abomaso de um bovino afetado, revelou 0,93µg/g de mancozebe (CM e 0,07 µg/g de forato (ORF.An outbreak of organophosphate (ORF poisoning in cattle occurred in the central-midwestern region of Rio Grande do Sul, Brazil. The water available for 49 cattle was contaminated with ORF and carbamate (CM. Twenty cows died after a clinical course that lasted for few hours. The classical clinical signs of over stimulation of the parasympathetic nervous system were observed, including motor incoordination, aggressiveness, drooling, muscle tremors and, on occasion, diarrhea. Significant morphological changes were not observed at necropsy or at histopathological examination. ORF e CM were detected by thin layer chromatography in tissue samples of two affected cattle and in a sample from the water consumed by the affected cattle. Additionally, two other water samples accessed by the affected cattle were positive for ORF. A quantitative analysis carried out by gas chromatography in the abomasum contents of an affected cow revealed 0.93µg/g of mancozebe (CM and 0.07µg/g of phorate (ORF.

  9. Emergency Room of the Hospital associated with the University of Salerno: acute poisoning registered from April 2009 to September 2011

    N. M. Vitola


    Full Text Available An ever growing number of patients go to the emergency room (ER for toxic exposure to various causal agents. Yet, the actual number of acute poisoning still remains unknown and the epidemic data are only partly available. Cases of acute poisoning in the ER of Salerno Hospital from April 2009 to September 2011 (30 months’ period are reported. Data are divided according to the criteria of gender, age, aetiologic agent, place and reasons of poisoning, and risk evaluation. Out of the total 220,165 patients, the acute poisoning cases were 1,347 (0.61%. Among these, 189 (14.1% patients were admitted to hospital while 3 (0.2% died. Alcool acute poisonings are the most frequent (43.6%, followed by drugs poisonings (30.6%. Acute poisonings are more common among males (59.9% and in people aged 20-50 years. Out of all the acute poisoning cases, 27.8% requested a consult to the Anti-Poisoning Centre. The results aim at contributing to the epidemic research for acute poisoning in ER.

  10. Hospital Performance Indicators and Their Associated Factors in Acute Child Poisoning at a Single Poison Center, Central Saudi Arabia.

    Alanazi, Menyfah Q; Al-Jeriasy, Majed I; Al-Assiri, Mohammed H; Afesh, Lara Y; Alhammad, Fahad; Salam, Mahmoud


    Admission rate and length of stay (LOS) are two hospital performance indicators that affect the quality of care, patients' satisfaction, bed turnover, and health cost expenditures. The aim of the study was to identify factors associated with higher admission rates and extended average LOS among acutely poisoned children at a single poison center, central Saudi Arabia.This is a cross-sectional, poison and medical chart review between 2009 and 2011. Exposures were child characteristics, that is, gender, age, body mass index (BMI), health history, and Canadian 5-level triage scale. Poison incident characteristics were, that is, type, exposure route, amount, form, home remedy, and arrival time to center. Admission status and LOS were obtained from records. Chronic poisoning, plant allergies, and venomous bites were excluded. Bivariate and regression analyses were applied. Significance at P Poison substances were pharmaceutical drugs (63%) versus chemical products (37%). Main exposure route was oral (98%). Home remedy was observed in (21.9%), which were fluids, solutes, and/or gag-induced vomiting. Almost (52%) arrived to center >1 h. Triage levels: non-urgent cases (58%), less urgent (11%), urgent (18%), emergency (12%), resuscitative (1%). Admission rate was (20.6%) whereas av. LOS was 13 ± 22 h. After adjusting and controlling for confounders, older children (adj.OR = 1.19) and more critical triage levels (adj.OR = 1.35) were significantly associated with higher admission rates compared to younger children and less critical triage levels (adj.P = 0.006) and (adj.P = 0.042) respectively. Home remedy prior arrival was significantly associated with higher av. LOS (Beta = 9.48, t = 2.99), compared to those who directly visited the center, adj.P = 0.003.Hospital administrators are cautioned that acutely poisoned children who received home remedies prior arrival are more likely to endure an extended LOS. This non-conventional practice


    刘拴虎; 王志祥; 王春霞; 刘雅丽


    [目的]探讨检测有机磷中毒患者尿白蛋白和尿β-2微球蛋白的临床意义.[方法]选择某院2008年1月~2010年11月收治的35例有机磷中毒患者作为研究对象,另选正常健康体检者30例作为对照组,β2-MG检测使用美国雅培公司提供的AXSYM化学发光仪,采用微粒子酶免(MEIA)法进行检测.尿白蛋白检测采用黄金标记目测免疫测定法,使用德国宝灵曼公司生产的尿微白蛋白试条(Micral-TestⅡ)进行测定.[结果]中毒后1 d检测两组患者的尿白蛋白和尿β2微球蛋白的含量发现,尿β微球蛋白、尿白蛋白含量均较正常对照组升高明显(P﹤0.05,P﹤0.01),且随着中毒程度的加重,尿β微球蛋白、尿白蛋白含量增高更明显(P﹤0.05).有机磷中毒患者血清CK、CK-MB、LDH及cTnI均明显高于正常对照组(P﹤0.05).[结论]联合检测有机磷中毒患者的尿白蛋白和尿β2微球蛋白,及同时检测心肌酶谱与肌钙蛋白,有助于早期发现肾损害及中毒程度,提高抢救成功率和判断预后.%[Objective]To investigate the detection of urinary albumin in patients with organophosphate poisoning and urinary β-2 microglobulin in clinical significance.[Methods]35 cases with organophosphate poisoning in our hospital in January 2008-November 2010 were treated as a research subjects, chose another 30 cases of normal healthy volunteers as control group, β2-MG was detected using Abbott's AXSYM chemical companies chemiluminescence, using microparticle enzyme immunoassay (MEIA) method for testing.Urinary albumin detected by gold labeled visual immunoassay, using the German company Boehringer Mannheim urine microalbumin test strip (Micral-Test Ⅱ ) to determine.[Results]1d after poisoning, urinary albumin and urinary β2-microglobulin levels were detected in patients, which found that urinary β-microglobulin, urine albumin levels increased significantly comparing with normal control group (P < 0.05, P < 0.01), and

  12. Noninvasive Biomonitoring Approaches to Determine Dosimetry and Risk Following Acute Chemical Exposure: Analysis of Lead or Organophosphate Insecticide in Saliva

    Timchalk, Chuck; Poet, Torka S.; Kousba, Ahmed A.; Campbell, James A.; Lin, Yuehe


    There is a need to develop approaches for assessing risk associated with acute exposures to a broad-range of chemical agents and to rapidly determine the potential implications to human health. Non-invasive biomonitoring approaches are being developed using reliable portable analytical systems to quantitate dosimetry utilizing readily obtainable body fluids, such as saliva. Saliva has been used to evaluate a broad range of biomarkers, drugs, and environmental contaminants including heavy metals and pesticides. To advance the application of non-invasive biomonitoring a microfluidic/ electrochemical device has also been developed for the analysis of lead (Pb), using square wave anodic stripping voltammetry. The system demonstrates a linear response over a broad concentration range (1 2000 ppb) and is capable of quantitating saliva Pb in rats orally administered acute doses of Pb-acetate. Appropriate pharmacokinetic analyses have been used to quantitate systemic dosimetry based on determination of saliva Pb concentrations. In addition, saliva has recently been used to quantitate dosimetry following exposure to the organophosphate insecticide chlorpyrifos in a rodent model system by measuring the major metabolite, trichloropyridinol, and saliva cholinesterase inhibition following acute exposures. These results suggest that technology developed for non-invasive biomonitoring can provide a sensitive, and portable analytical tool capable of assessing exposure and risk in real-time. By coupling these non-invasive technologies with pharmacokinetic modeling it is feasible to rapidly quantitate acute exposure to a broad range of chemical agents. In summary, it is envisioned that once fully developed, these monitoring and modeling approaches will be useful for accessing acute exposure and health risk.

  13. [Homeostasis changes during rehabilitation period after acute chemical poisoning].

    Badalian, A V; Luzhnikov, E A; Gol'dfarb, Iu S; Godkov, M A; Khvatov, V B; Bitkova, E E; El'kov, A N; Il'iashenko, K K; Nikulina, V P; Matveev, S B


    The article deals with review of 78 patients of rehabilitation toxicological unit. The patients received resuscitation and detoxification. All patients were divided into three groups; 1st group--patients after poisoning with psychopharmaceuticals, 2nd group--patients after poisoning with cauterizing liquids and 3rd group--patients with encephalopathy after poisoning with neurotoxin (psychopharmaceuticals, narcotics and ethanol). Disorders of rheology, haemostasis and endotoxicosis accrued in all groups. These disorders were a signs of the erythrocytes and platelets aggregation developing and viscoelasticity disorder. Homeostasis changes during rehabilitation period need an accurate diagnostics for purposeful treatment of the defined disorders.




    Full Text Available Childhood poisoning is a significant public health problem. Poisoning though an important cause of morbidity and mortality in children, has received little attention over the years. Objective: To determine the clinical profile and outcome of acute poisoning in children admitted to tertiary care hospital in South In dia. MATERIALS AND METHODS: We retrospectively reviewed the hospital records of all children aged 1 month to 18 years with definite history of poisoning during the 2 - years period from January 2013 to December 2014. We took the profile of all cases and note d their outcome. RESULTS: 50 patients presented with acute poisoning during the study period. Majority of children were in the age group between 12 to 18 years (30 cases, 60%. Median age of our patients was 10 years. The majority of our patients resided i n urban areas. Drugs (40%, Kerosene oil (24% and Insecticides (20% were the agents most frequently implicated. 52% cases were suicidal in nature and the above children belonged to age group of 12 to 18 years. Almost all cases in 1 - 6 years age group were accidental in nature. One case of kerosene oil consumption died whereas outcome in other cases was good. CONCLUSION: Poisoning in pediatric age group is a common problem. Incidence of poisoning with suicidal intension is increasing with accidental poisoni ng due to kerosene oil consumption is still common in younger age group

  15. An interesting cause of pulmonary emboli: Acute carbon monoxide poisoning

    Sevinc, A.; Savli, H.; Atmaca, H. [Gaziantep University, Gaziantep (Turkey). School of Medicine


    Carbon monoxide poisoning, a public health problem of considerable significance, is a relatively frequent event today, resulting in thousands of hospitalizations annually. A 70-year-old lady was seen in the emergency department with a provisional diagnosis of carbon monoxide poisoning. The previous night, she slept in a tightly closed room heated with coal ember. She was found unconscious in the morning with poor ventilation. She had a rare presentation of popliteal vein thrombosis, pulmonary emboli, and possible tissue necrosis with carbon monoxide poisoning. Oxygen treatment with low-molecular-weight heparin (nadroparine) and warfarin therapy resulted in an improvement in both popliteal and pulmonary circulations. In conclusion, the presence of pulmonary emboli should be sought in patients with carbon monoxide poisoning.


    Petko Marinov


    Full Text Available Purpose: Poisoning with drugs occupies a leading position among the causes of acute intoxications. Etiological distribution of medicated poisoning in different countries, even if they are adjacent, is different. In the most studies it was reported that the highest incidence of poisoning is with benzodiazepines or other psychoactive drugs. A retrospective analysis of acute poisoning with benzodiazepines and other hypnotic drugs in the Varna region for 25 years period – from 1991 to 2015 was carried out. Material and Methods: The number of patients who received hospital treatment after poisoning with benzodiazepines is 1741, and those with other hypnotics is 293, representing respectively 26.37% and 4.44% of all drug intoxications. Results: The share of poisoning with benzodiazepines and hypnotics compared to all acute intoxications is 11.66%. They are more common in women – 1566 (77%. Men are 468 (23%, the ratio of men to women was 3.34:1. The largest number of intoxications is in the age group up to 24 years - 1123 (55.2%, and only 4.1% of patients over 60 years. Intentional suicide attempts are 1896 (93.2%. Death is registered in 8 (0.4% patients.

  17. Medical treatment of acute poisoning with organophosphorus and carbamate pesticides.

    Jokanović, Milan


    Organophosphorus compounds (OPs) are used as pesticides and developed as warfare nerve agents such as tabun, soman, sarin, VX and others. Exposure to even small amounts of an OP can be fatal and death is usually caused by respiratory failure. The mechanism of OP poisoning involves inhibition of acetylcholinesterase (AChE) leading to inactivation of the enzyme which has an important role in neurotransmission. AChE inhibition results in the accumulation of acetylcholine at cholinergic receptor sites, producing continuous stimulation of cholinergic fibers throughout the nervous systems. During more than five decades, pyridinium oximes have been developed as therapeutic agents used in the medical treatment of poisoning with OP. They act by reactivation of AChE inhibited by OP. However, they differ in their activity in poisoning with pesticides and warfare nerve agents and there is still no universal broad-spectrum oxime capable of protecting against all known OP. In spite of enormous efforts devoted to development of new pyridinium oximes as potential antidotes against poisoning with OP only four compounds so far have found its application in human medicine. Presently, a combination of an antimuscarinic agent, e.g. atropine, AChE reactivator such as one of the recommended pyridinium oximes (pralidoxime, trimedoxime, obidoxime and HI-6) and diazepam are used for the treatment of OP poisoning in humans. In this article the available data related to medical treatment of poisoning with OP pesticides are reviewed and the current recommendations are presented.

  18. Comparison of two commonly practiced atropinization regimens in acute organophosphorus and carbamate poisoning, doubling doses vs. ad hoc: a prospective observational study.

    Perera, P M S; Shahmy, S; Gawarammana, I; Dawson, A H


    There is a wide variation and lack of evidence in current recommendations for atropine dosing schedules leading to subsequent variation in clinical practice. Therefore, we sought to examine the safety and effectiveness of a titrated vs. ad hoc atropine treatment regimen in a cohort of patients with acute cholinesterase inhibitor pesticide poisoning. A prospective cohort study was conducted in three district secondary referral hospitals in Sri Lanka using a structured data collection form that collected details of clinical symptoms and outcomes of cholinesterase inhibitor pesticide poisoning, atropine doses, and signs of atropinization. We compared two hospitals that used a titrated dosing protocol based on a structured monitoring sheet for atropine infusion with another hospital using an ad hoc regime. During the study, 272 symptomatic patients with anticholinesterase poisoning requiring atropine were admitted to the three hospitals. Outcomes of death and ventilation were analyzed for all patients, 226 patients were prospectively assessed for atropine toxicity. At baseline, patients in the titrated dose cohort had clinical signs consistent with greater toxicity. This in part may be due to ingestion of more toxic organophosphates. They received less pralidoxime and atropine, and were less likely to develop features of atropine toxicity, such as delirium (1% vs. 17%), hallucinations (1% vs. 35%), or either (1% vs. 35%) and need for patient restraint (3% vs. 48%) compared with the ad hoc dose regime. After adjusting for the pesticides ingested, there was no difference in mortality and ventilatory rates between protocols. Ad hoc high dose atropine regimens are associated with more frequent atropine toxicity without any obvious improvement in patient outcome compared with doses titrated to clinical effect. Atropine doses should be titrated against response and toxicity. Further education and the use of a structured monitoring sheet may assist in more appropriate

  19. Acute poisoning in children; changes over the years, data of pediatric clinic department of toxicology

    Keka Alije; Ramosaj A; Toro H; Azemi M; Baloku A; Sylaj B; Lenjani B; Kyseni K


    Objective:To present the frequency, etiology, changes over the years of acute poisoning in children admitted toPediatricClinic ofPristina and to determine the extent and characteristics of the problem, according to which related preventive measures can be taken.Methods:Retrospectively we have analyzed the epidemiology of accidental and suicidal poisonings in children hospitalization inPediatricClinicDepartment ofToxicology during the year2012. Our data we compared with data from previous studies on acute poisoning in children in the PediatricClinic conducted during the years1976-1985 and2001.Results:During the year2012, inPediatricClinic ofPristina5723 children were hospitalized,136 of them or2.3% were treated due to acute poisoning inDepartment ofToxicology,82 of them was boys and54 was girls, rate boys girls was1.5:1.The majority of cases101 or74.2% were under five years with peak age three and35% or25.7% were over five years.The most of the cases was accidentally97% and only 2.9% was suicidal and all of them were over the age of ten.Drugs were the most common agent causing the poisoning71(52.2%) followed by house cleaning products38(27.9%), food10(5.8%), pesticides7(5.14%), rare agent that caused poisoning were: narcotic substances, plant, heavy metals, alcohol, carbon monoxide, carburant.Poisoning occurred mostly in spring and the peak was observed inMay,(1.17% of all patients).January was the month of lowest rate of poisoning. During the years1976-1985, inPediatricClinic ofPristina900 children were hospitalized due to acute poisoning,44.11% were from drugs,15.88% from pesticides,65(7.2%), while during2001 in the unit care intensive were hospitalized66 children due to acute poisoning, among them51.5% were poisoning from drugs,30.03 from pesticides,12.2% from cleaning products.Conclusion:In our study drugs and house cleaning products are the most frequent agents causing accidental poisoning in children less than5 years-old, this age of children is the most

  20. 急救重度有机磷中毒伴呼吸衰竭的急救对策及预后分析%Analysis of the Emergency Measures for Severe Organophosphate Poisoning with Respiratory Failure and the Prognosis

    林健球; 郑永汉


    Objective To analyze the first-aid method for patients with severe organophosphate poisoning and respiratory failure, and the ther-apeutic value of pralidoxime for the patients. Methods 58 cases of patients with severe organophosphate poisoning and respiratory failure admitted in our hospital from July, 2010 to June, 2013 were selected as the subjects, and they were randomly divided into two groups. The control group was treated with the general treatment method, and the experimental group was treated with prali-doxime. The treatment effect of two groups was observed and compared. Results The patients in the experimental group had short-er time with a ventilator, lower rate of tracheotomy, higher withdrawal probability of ventilator within 3d, the differences between two groups were statistically significant (P<0.05); the mortality of the experimental group was lower than that of the control group (P<0.05). Conclusion Pralidoxime given to the patients with severe organophosphate poisoning and respiratory failure for first-aid treatment can improve the treatment effect; patients need shorter time of needing for ventilation with shorter respiratory failure time, which is worthy of application.%目的:分析研究重度有机磷中毒伴呼吸衰竭患者的急救方法,分析解磷定对患者的治疗价值。方法选择2010年7月-2013年6月该院重度有机磷中毒伴呼吸衰竭的患者58例为研究对象,随机分为两组。对照组使用一般治疗方法,实验组使用解磷定治疗,对比观察两组治疗后的效果。结果实验组患者带机时间短,气管切开率低,患者3d内脱机率高,两组对比差异有统计学意义(P<0.05);实验组病死率低于对照组患者(P<0.05)。结论对重症有机磷中毒伴呼吸衰竭患者给予解磷定急救治疗可以提高救治效果,患者撤机快,呼吸衰竭时间缩短,值得应用。

  1. An unusual case of reversible acute kidney injury due to chlorine dioxide poisoning.

    Bathina, Gangadhar; Yadla, Manjusha; Burri, Srikanth; Enganti, Rama; Prasad Ch, Rajendra; Deshpande, Pradeep; Ch, Ramesh; Prayaga, Aruna; Uppin, Megha


    Chlorine dioxide is a commonly used water disinfectant. Toxicity of chlorine dioxide and its metabolites is rare. In experimental studies, it was shown that acute and chronic toxicity were associated with insignificant hematological changes. Acute kidney injury due to chlorine dioxide was not reported. Two cases of renal toxicity due to its metabolites, chlorate and chlorite were reported. Herein, we report a case of chlorine dioxide poisoning presenting with acute kidney injury.

  2. Multimodality evoked potentials in patients with delayed encephalopathy after acute carbon monoxide poisoning

    Xiahong Wang; Bo Xiao; Renjun Gu; Lan Xiao; Yi Yang; Yinhui Hao; Nini Wang; Junlin Mu; Jinggang Yin


    Objective: To evaluate the diagnostic and prognostic values in patients with delayed encephalopathy after acute carbon monoxide poisoning. Methods: The tibial nerve somatosensory evoked potentials (SEPs), vision evoked potentials (VEPs), and brain stem audition evoked potentials(BAEPs) were performed in 32 healthy adults and 43 patients with delayed encephalopathy after acute carbon monoxide poisoning. Results: This paper indicated abnormalities of tibial nerve SEPs in 31 patients (31/43, 72.1%), VEPs in 17 patients (17/28, 60.7%), and BAEPs in 14 patients (14/43, 32.6%). These results showed that the greatest diagnostic value was SEPs, followed by VEPs and, BAEPs with the lowest sensitivity. Conclusion: Multimodality evoked potentials (EPs) can be used for evaluating the diagnostic and prognostic values in cases of delayed encephalopathy after acute carbon monoxide poisoning.

  3. Successful Treatment of Severe Metabolic Acidosis Due to Acute Aluminum Phosphide Poisoning With Peritoneal Dialysis: a Report of 2 Cases.

    Bashardoust, Bahman; Farzaneh, Esmaeil; Habibzadeh, Afshin; Seyyed Sadeghi, Mir Salim


    Aluminum phosphide poisoning is common in our region. It can cause severe metabolic acidosis and persistent hypotension, which lead to cardiogenic shock and subsequently mortality. Oliguric or anuric acute kidney injury is seen in almost all patients with aluminum phosphide poisoning. Renal replacement therapies are recommended in these patients to improve metabolic acidosis and increase the rate of survival. We report 2 cases of severe acute aluminum phosphide poisoning treated successfully with peritoneal dialysis.

  4. In vivo evaluation of cholinesterase activity, oxidative stress markers, cyto- and genotoxicity of K048 oxime–a promising antidote against organophosphate poisoning.

    Zunec, Suzana; Kopjar, Nevenka; Zeljezić, Davor; Kuca, Kamil; Musilek, Kamil; Lucić Vrdoljak, Ana


    K048 is a member of K-oximes, a new oxime class that has recently been confirmed effective against poisoning by the nerve agent tabun and several pesticides. The toxicity profile of the K048 oxime has not been fully characterized and its optimal therapeutic dose has not yet been established. Earlier studies report excellent results with K048 in reactivating tabun-phosphorylated AChE and in the therapy of tabun-poisoned mice. It possesses a low acute toxicity and exerts an acceptable toxicity profile on isolated human peripheral blood lymphocytes in vitro. Intraperitoneal administration of K048 in rats resulted in an LD50 of 238.3 mg/kg. In this in vivo study, we investigated cholinesterase (ChE) activity and oxidative stress marker levels (lipid peroxidation and superoxide dismutase activity) in the plasma of exposed rats after administering the compound at 25% of its LD50. Lymphocyte viability was evaluated using an acridine orange/ethidium bromide in situ fluorescent assay. The levels of primary DNA damage in rat white blood cells were measured using the alkaline comet assay. The compound applied at 25% of its LD50 did not significantly affect ChE activity and lipid peroxidation and did not cause significant changes in the SOD activity in plasma. The cytotoxicity profile of K048 in the tested dose was also acceptable, and it did not possess significant DNA-damaging potential. The obtained results are promising for further evaluations of the K048 oxime, which should include tests on a broader concentration range and longer incubation times.

  5. Acute Poisoning in Children: A Hospital-Based Study in Arak, Iran (2008-2012

    Ali Arjmand Shabestari


    Full Text Available Background: Poisoning is one of the important reasons for children’s admission to hospital. Knowledge of epidemiology of poisoning in each region plays an important role in planning prevention, care, and treatment of patients. This study was conducted to determine the characteristics of acute poisoning epidemiology in children attending pediatric wards of Amirkabir Hospital in Arak in a five-year period (March 2008 to March 2012. Methods: This descriptive cross-sectional study was conducted on 224 children admitted for poisoning. Data were retrospectively collected from patients’ files and analyzed using SPSS 16 software. Results: Of the total population, 54.9% were boys and the rest were girls. Mean age of children was 3.54±2.99 years, and the most common age range was 1-3 years (50.9%. The highest rate of children’s admission due to poisoning was in the winter (30.8%. The most common causes of poisoning included drugs (65.2%, kerosene (7.1%, and food poisoning (5.4%. The most common poisoning drugs, included benzodiazepines (21.9%, gastrointestinal drugs (19.9%, opioid analgesics (15.1%. The most prevalent drugs were methadone, metoclopramide, and clonazepam. At admission, the most common presenting symptoms were neurological (51.3%, and gastrointestinal symptoms (38.4%. Conclusion: High prevalence of poisoning with groups of drugs mentioned could indicate community-wide excessive use of these drugs, as well as negligence of families in keeping them out of children’s reach. Therefore, raising knowledge and awareness about variety of poisoning and how to prevent them, through holding workshops, national media, schools, and health centers can be a valuable step toward upkeep of children’s health.

  6. Acute kidney injury and disseminated intravascular coagulation due to mercuric chloride poisoning

    Dhanapriya, J.; Gopalakrishnan, N.; Arun, V.; Dineshkumar, T.; Sakthirajan, R.; Balasubramaniyan, T.; Haris, M.


    Mercury is a toxic heavy metal and occurs in organic and inorganic forms. Inorganic mercury includes elemental mercury and mercury salts. Mercury salts are usually white powder or crystals, and widely used in indigenous medicines and folk remedies in Asia. Inorganic mercury poisoning causes acute kidney injury (AKI) and gastrointestinal manifestations and can be life-threatening. We describe a case with unknown substance poisoning who developed AKI and disseminated intravascular coagulation (DIC). Renal biopsy showed acute tubular necrosis. Later, the consumed substance was proven to be mercuric chloride. His renal failure improved over time, and his creatinine normalized after 2 months. PMID:27194836

  7. Minoxidil poisoning presenting as acute coronary syndrome: a rare case scenario

    Shrikant Kalyanrao Panchal


    Full Text Available We present a case of severe minoxidil poisoning (3000 mg with resultant severe hypotension, tachycardia and subendocardial ischemia initially treated crystalloid, dopamine, aspirin, clopidogrel on the lines of acute coronary syndrome with partial haemodynamic improvement. After getting the history of minoxidil poisoning, the patient was treated with bolus doses of norepinephrine, and norepinephrine infusion, resulting in resolution of hypertension, tachycardia and reversal of ischemia. Topical minoxidil is commonly used agent for male pattern baldness. It also has got antihypertensive action when ingested, acute coronary syndrome and compensatory tachycardia with successful management with norepinephrine bolus and infusion. [Int J Res Med Sci 2014; 2(2.000: 784-785

  8. Management of Treatment and Prevention of Acute OP Pesticide Poisoning by Medical Informatics, Telemedicine and Nanomedicine

    Ganesh Chandra Sahoo


    Full Text Available Acute organophosphorous pesticide (OP poisoning kills a lot of people each year. Treatment of acute OP poisoning is of very difficult task and is a time taking event. Present day informatics methods (telemedicine, bioinformatics methods (data mining, molecular modeling, docking, cheminformatics, and nanotechnology (nanomedicine should be applied in combination or separately to combat the rise of death rate due to OP poisoning. Use of informatics method such as Java enabled camera mobiles will enable us early detection of insecticidal poisoning. Even the patients who are severely intoxicated (suicidal attempts can be diagnosed early. Telemedicine can take care for early diagnosis and early treatment. Simultaneously efforts must be taken with regard to nanotechnology to find lesser toxic compounds (use less dose of nanoparticle mediated compounds: nano-malathion as insecticides and find better efficacy of lesser dose of compounds for treatment (nano-atropine of OP poisoning. Nano-apitropine (atropine oxide may be a better choice for OP poisoning treatment as the anticholinergic agent; apitropine and hyoscyamine have exhibited higher binding affinity than atropine sulfate. Synthesis of insecticides (malathion with an antidote (atropine, apitropine in nanoscale range will prevent the lethal effect of insecticides.

  9. Comparative analysis of acute toxic poisoning in 2003 and 2011: analysis of 3 academic hospitals.

    Jang, Hak-Soo; Kim, Jung-Youn; Choi, Sung-Hyuk; Yoon, Young-Hoon; Moon, Sung-Woo; Hong, Yun-Sik; Lee, Sung-Woo


    Social factors may affect the available sources of toxic substances and causes of poisoning; and these factors may change over time. Additionally, understanding the characteristics of patients with acute toxic poisoning is important for treating such patients. Therefore, this study investigated the characteristics of patients with toxic poisoning. Patients visiting one of 3 hospitals in 2003 and 2011 were included in this study. Data on all patients who were admitted to the emergency departments with acute toxic poisoning were retrospectively obtained from medical records. Total 939 patients were analyzed. The average age of patients was 40.0 ± 20 yr, and 335 (36.9%) patients were men. Among the elements that did not change over time were the facts that suicide was the most common cause, that alcohol consumption was involved in roughly 1 of 4 cases, and that there were more women than men. Furthermore, acetaminophen and doxylamine remained the most common poisoning agents. In conclusion, the average patient age and psychotic drug poisoning has increased over time, and the use of lavage treatment has decreased.

  10. Acute formic acid poisoning in a rubber plantation worker

    Dattatrai Kashinath More


    Full Text Available Among the workers in a rubber plantation in South India, ingestion of formic acid either accidentally or with suicidal intention is a common problem. Formic acid is diluted and used for coagulation of rubber latex. Easy availability makes formic acid a common poison. The aim of this article is to study the case of formic acid poisoning, its complications and management. Patient was managed symptomatically. Antidote was not used and no nasogastric aspiration was done. Patient had dysphagia; nutrition was maintained with open gastrostomy done on day 5 and subsequent enteral feeding. Measures to prevent anticipated complications were undertaken. Stricture of the esophagus is a common complication leading to long-term morbidity. After initial management, all patients should be on follow-up for prevention and management of strictures. Workers should be educated on complications of formic acid poisoning and easy availability should be curtailed by enforcing remedial measures.




    Full Text Available INTRODUCTION: Acute accidental poisoning in children is a big problem anywhere in the world. Studies done elsewhere in India showed a wide range of incidence of the problem. Hence, it was felt important to study its magnitude and associated characteristics as of now. OBJECTIVE: The current study was taken up to know the magnitude among children admitted in JNIMS, Imphal which is a newly established medical institute and also to study the characteristics like age, gender, type of poison, duration of hospital-stay and outcome of the cases. MATERIALS & METHODS: Retrospective data of all acute accidental poisoning cases among children admitted in the Pediatrics Ward, JNIMS, Imphal during the period July 2008 - December 2013 were analyzed by using descriptive statistics. RESULT: Of all the 13,663 children admitted, 148 cases were because of acute accidental poisoning giving an incidence rate of 1.08%. The male is to female ratio was 1.31:1. The last three years of the study period showed a slightly increasing trend in the incidence. Children aged 1-4 years were the most commonly affected (65.54%. Kerosene oil was by far the commonest (42% of all the poisonous substances consumed. Food poisoning, poisoning with organic compounds, poisoning with medicinal drugs and poisoning with corrosives comprised 21%, 12%, 9% and 8% respectively of all the cases. There was no mortality. DISCUSSION: The incidence rate of 1.08% as found out from the current study was on the lower side as compared to reports of previous studies done in other parts of the country. Yet, it was two-fold of the incidence reported from RIMS which is situated in the same State. Parental negligence in storing poisonous substances in the household was implicated. They need to be made aware for keeping harmful poisonous substances in safe places out of the reach of children. CONCLUSION: Community-based studies are recommended for estimating more accurately the magnitude of the problem in the

  12. Acute penitrem A and roquefortine poisoning in a dog

    Walter, Sean L.


    Penitrem A and roquefortine poisonings were diagnosed in a Laborador retriever following garbage consumption. Clinical signs of mycotoxicosis included polypnea, tachycardia, and ataxia that quickly progressed to lateral recumbency and seizures. Removal of the mycotoxins from the stomach soon after ingestion allowed the dog to recover within 72–96 hours.

  13. The profile evolution of acute severe poisoning in Spain.

    Nogué, S; Marruecos, L; Nolla, J; Monteís, J; Ferrer, A; Civeira, E


    About 5% of the patients admitted to emergency departments with poisonings are seriously ill and need admission to intensive care units (ICUs). This paper presents the result of three multicentric studies carried out in Spain during the last ten years. A study was made of 6 ICUs in 1980, 41 in 1987 and 15 in 1990 with a total of 596 patients. The average age (36) remained stable throughout, but the number of female cases decreased each time. The most frequent cause (79%) was attempted suicide. The products used most frequently were therapeutic drugs (82, 71 and 58%) followed by drugs of abuse, and then agricultural, household and industrial products. We observed a progressive decrease in barbiturates (54, 15 and 2%) and an increase in benzodiazepines and cyclic antidepressants. Therapeutic methods used were mostly gastric lavage (64%), activated charcoal (35%), forced diuresis (43%), extracorporeal therapy (11%) and antidotes. The mortality rate fluctuated between 6.4 and 9.1%, being significantly higher with poisoning by non-therapeutic drugs. In conclusion, the most common poisoning admitted to our ICUs was by psychoactive drugs in suicide attempts. We observed the under-use of activated charcoal and an excessive usage of kidney and extracorporeal methods. The prognosis was worse for poisonings with non-therapeutic drugs.

  14. Acute Carbon Monoxide Poisoning Resulting in ST Elevation Myocardial Infarction: A Rare Case Report

    Po-Chao Hsu


    Full Text Available Acute carbon monoxide (CO poisoning with cardiac complications is well documented in the literature. However, ST segment elevation is a rare presentation, and most of these cases with ST elevation have revealed non-occlusive or normal coronary arteries. We report a case of CO poisoning complicated with ST elevation myocardial infarction. Emergency coronary angiography revealed total occlusion of the left anterior descending artery and primary percutaneous coronary intervention was performed. This report of a rare case should remind physicians that cardiovascular investigations, including electrocardiography, must be performed in cases with CO poisoning because mortality might increase if reperfusion therapy or appropriate medical treatments are not performed in patients with acute coronary artery occlusion.

  15. Development of Peptide Nanotube-Modified Biosensors for Gas-Phase Organophosphate Detection



  16. Oral administration of lactulose: a novel therapy for acute carbon monoxide poisoning via increasing intestinal hydrogen production.

    Fan, Dan-Feng; Hu, Hui-Jun; Sun, Xue-Jun; Meng, Xiang-En; Zhang, Yu; Pan, Shu-Yi


    It has been known that the pathophysiology of carbon monoxide (CO) poisoning is related to hypoxia, the increased production of reactive oxygen species (ROS) and oxidative stress. Studies have shown that the novel, safe and effective free radical scavenger, hydrogen, has neuroprotective effects in both acute CO poisoning and delayed neuropsychological sequelae in CO poisoning. Orally administered lactulose, which may be used by some intestinal bacteria as a food source to produce endogenous hydrogen, can ameliorate oxidative stress. Based on the available findings, we hypothesize that oral administration of lactulose may be a novel therapy for acute CO poisoning via increasing intestinal hydrogen production.

  17. Risk factors for the development of pneumonia in acute psychotropic drugs poisoning

    Vučinić Slavica


    Full Text Available Background/Aim. Pneumonia is the most frequent complication in acute psychotropic drugs poisoning, which results in substantial morbidity and mortality, but which also increases the costs of treatment. Risk factors for pneumonia are numerous: age, sex, place of the appearance of pneumonia, severity of underlying disease, airway instrumentation (intubation, reintubation, etc. The incidence of pneumonia varies in poisoning caused by the various groups of drugs. The aim of this study was to determine the incidence and risk factors for pneumonia in the patients with acute psychotropic drugs poisoning. Methods. A group of 782 patients, out of which 614 (78.5% with psychotropic and 168 (21.5% nonpsychotropic drug poisoning were analyzed prospectively during a two-year period. The diagnosis of pneumonia was made according to: clinical presentation, new and persistent pulmonary infiltrates on chest radiography, positive nonspecific parameters of inflammation, and the microbiological confirmation of causative microorganisms. To analyze predisposing risk factors for pneumonia, the following variables were recorded: sex, age, underlying diseases, endotracheal intubation, coma, severity of poisoning with different drugs, histamine H2 blockers, corticosteroids, mechanical ventilation, central venous catheter. The univariate analysis for pneumonia risk factors in all patients, and for each group separately was done. The multivariate analysis was performed using the logistic regression technique. Results. Pneumonia was found in 94 (12.02% of the patients, 86 of which (91.5% in psychotropic and 8 (8.5% in nonpsychotropic drug poisoning. In the psychotropic drug group, pneumonia was the most frequent in antidepressant (47%, and the rarest in benzodiazepine poisoning (3.8%. A statistically significant incidence of pneumonia was found in the patients with acute antidpressant poisoning (p < 0.001. Univariate analysis showed statistical significance for the

  18. Reversible brain damage following acute organic solvents' poisoning determined by magnetic resonance

    Dujmović Irena


    Full Text Available Introduction. Acute exposure to the effects of volatile solvents is characterized by the abrupt onset of symptoms and signs of poisoning, and relatively fast recovery in the majority of cases. Case report. We report a 24-year-old patient with an acute, accidental poisoning with a mixture of volatile organic solvents (most probably toluene, styrene and xylene, which led to the development of upward gaze paresis, diplopia, hemiparesis, ataxic gate, and the late onset truncal ataxia episodes. After 6 weeks, he recovered completely, while his extensive brain MRI lesions in the caudate nuclei, laterobasal putaminal regions, bilateral anterior insular cortex, central midbrain tegmental area withdrew completely after 4 months. Conclusion. Acute toxic encephalopathy should be a part of the differential diagnosis in any patient with acute neurobehavioral and neurological deficit.

  19. Toxicoepidemiology of acute poisoning cases in a secondary care hospital in rural South India: A five-year analysis

    T H Indu


    Full Text Available Objective: To ascertain the trend of poisoning cases admitted to the Government District Headquarters Hospital, a secondary care center in Udhagamandalam, Nilgiris District, Tamil Nadu, India, over a five-year period. Materials and Methods: The number of cases that presented to the hospital annually (incidence, mortality, and case fatality rates, socio-demographic pattern, and the nature of the poison were noted. Results: A total of 1860 poisoning cases (80 deaths were reported during the period from October 2008 to September 2013. The incidence of poisoning was found to increase every year. The average incidence was 1.60 per 1000 population, while the average case fatality rate and mortality rates were 40.51 and 0.07, respectively. A total of 1148 (62% were males. The majority of cases were seen in the 21-30 age group (41.24%. The poisonings were largely deliberate self-harm (n = 1,755; 94.35%, followed by accidental (n = 85; 4.57%. Agrochemicals were the main choice of poisoning agents and among these, organophosphates were the major cause. Conclusion: The data generated can help policy makers take decisions on the sale and availability of pesticides in this region.

  20. The effects of acute hydrogen sulfide poisoning on cytochrome P450 isoforms activity in rats.

    Wang, Xianqin; Chen, Mengchun; Chen, Xinxin; Ma, Jianshe; Wen, Congcong; Pan, Jianchun; Hu, Lufeng; Lin, Guanyang


    Hydrogen sulfide (H2S) is the second leading cause of toxin related death (after carbon monoxide) in the workplace. H2S is absorbed by the upper respiratory tract mucosa, and it causes histotoxic hypoxemia and respiratory depression. Cocktail method was used to evaluate the influences of acute H2S poisoning on the activities of cytochrome P450 isoforms CYP2B6, CYP2D6, CYP3A4, CYP1A2, CYP2C19, and CYP2C9, which were reflected by the changes of pharmacokinetic parameters of six specific probe drugs, bupropion, metoprolol, midazolam, phenacetin, omeprazole, and tolbutamide, respectively. The experimental rats were randomly divided into two groups, control group and acute H2S poisoning group (inhaling 300 ppm for 2 h). The mixture of six probes was given to rats by oral administration and the blood samples were obtained at a series of time points through the caudal vein. The concentrations of probe drugs in rat plasma were measured by LC-MS. The results for acute H2S poisoning and control groups were as follows: there was a statistically significant difference in the AUC and C max for bupropion, metoprolol, phenacetin, and tolbutamide, while there was no statistical pharmacokinetic difference for midazolam and omeprazole. Acute H2S poisoning could inhibit the activity of CYP2B6, CYP2D6, CYP1A2, and CYP2C9 in rats.

  1. Acute pesticide poisoning among female and male cotton growers in India

    Mancini, F.; Bruggen, van A.H.C.; Jiggins, J.L.S.; Ambatipudi, A.C.; Murphy, H.


    A season-long assessment of acute pesticide poisoning among farmers was conducted in three villages in India. Fifty female cotton growers reported the adverse effects experienced after exposures to pesticides by themselves and by their male relatives (n = 47). The study documented the serious conseq

  2. The Effects of Acute Hydrogen Sulfide Poisoning on Cytochrome P450 Isoforms Activity in Rats

    Xianqin Wang


    Full Text Available Hydrogen sulfide (H2S is the second leading cause of toxin related death (after carbon monoxide in the workplace. H2S is absorbed by the upper respiratory tract mucosa, and it causes histotoxic hypoxemia and respiratory depression. Cocktail method was used to evaluate the influences of acute H2S poisoning on the activities of cytochrome P450 isoforms CYP2B6, CYP2D6, CYP3A4, CYP1A2, CYP2C19, and CYP2C9, which were reflected by the changes of pharmacokinetic parameters of six specific probe drugs, bupropion, metoprolol, midazolam, phenacetin, omeprazole, and tolbutamide, respectively. The experimental rats were randomly divided into two groups, control group and acute H2S poisoning group (inhaling 300 ppm for 2 h. The mixture of six probes was given to rats by oral administration and the blood samples were obtained at a series of time points through the caudal vein. The concentrations of probe drugs in rat plasma were measured by LC-MS. The results for acute H2S poisoning and control groups were as follows: there was a statistically significant difference in the AUC and Cmax for bupropion, metoprolol, phenacetin, and tolbutamide, while there was no statistical pharmacokinetic difference for midazolam and omeprazole. Acute H2S poisoning could inhibit the activity of CYP2B6, CYP2D6, CYP1A2, and CYP2C9 in rats.

  3. Organophosphate-Related Alterations in Myelin and Axonal Transport in the Living Mammalian Brain


    Rusyniak DE, Nanagas KA. 2004. Organophosphate poisoning . Sem Neurol.24:197–204. Silva AC, Lee JH, Aoki I, Koretsky AP. 2004. Manganese-enhanced...Sungurtekin H, Gurses E, Balci C. 2006. Evaluation of several clinical scoring tools in organophosphate poisoned patients. Clin. Toxicol (Phila) 44:121...1 AD_________________ Award Number: W81XWH-12-1-0536 TITLE: " Organophosphate -Related Alterations in Myelin and Axonal

  4. Effects of acute organophosphate ingestion on cognitive function, assessed with the mini mental state examination

    S S Jayasinghe


    Full Text Available Background : Chronic damage to the central nervous system resulting in cognitive impairment has been shown with repeated, low doses of organophosphorus (OP exposure over month or years. Aim: The study aimed to find out whether there is any cognitive impairment following acute OP exposure that could be detected by a simple screening instrument, the Mini Mental State Examination (MMSE, in clinical settings. Settings and Design: A cohort study. Materials and Methods: The study was conducted with matched controls. Consecutive patients admitted to the hospital with acute ingestion of OP were recruited. Cognitive function was assessed with the MMSE, digit span test, test of long-term memory function and concentration. Patients were assessed twice: at 1 and 6 weeks of exposure. Statistical Analysis: Continuous variables were analyzed with the paired and unpaired T-tests. Non-normally distributed data were analyzed with the Mann-Whitney U test and Wilcoxon Signed Rank test. Discrete variables were analyzed with the Chi-square test. Results: There were 60 patients and 61 controls. The mean age (SD of the patients and controls was 31.5 (11.6 and 31.3 (11.8 years, respectively. Forty-two patients turned up for the second assessment. Significant impairment of cognitive function was seen in the total score of MMSE (95% CI -2.5 to -0.3, orientation (95% CI -1 to -0.2 and language (95% CI -0.9 to -0.1 domains of MMSE, digit span test (95% CI 0.1-1.7 and test of long-term memory function (95% CI 0.3-2.3 in the first assessment compared with the controls. When the results of the second assessment were compared with the controls, no significant differences were seen. Conclusion: Although there was a slight transient cognitive impairment detected with the screening tests following acute OP ingestion, no long-term cognitive defects was detected.

  5. Ulinastatin suppresses endoplasmic reticulum stress and apoptosis in the hippocampus of rats with acute paraquat poisoning

    Hai-feng Li


    Full Text Available Lung injury is the main manifestation of paraquat poisoning. Few studies have addressed brain damage after paraquat poisoning. Ulinastatin is a protease inhibitor that can effectively stabilize lysosomal membranes, prevent cell damage, and reduce the production of free radicals. This study assumed that ulinastatin would exert these effects on brain tissues that had been poisoned with paraquat. Rat models of paraquat poisoning were intraperitoneally injected with ulinastatin. Simultaneously, rats in the control group were administered normal saline. Hematoxylin-eosin staining showed that most hippocampal cells were contracted and nucleoli had disappeared in the paraquat group. Fewer cells in the hippocampus were concentrated and nucleoli had disappeared in the ulinastatin group. Western blot assay showed that expressions of GRP78 and cleaved-caspase-3 were significantly lower in the ulinastatin group than in the paraquat group. Immunohistochemical findings showed that CHOP immunoreactivity was significantly lower in the ulinastatin group than in the paraquat group. Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling staining showed that the number of apoptotic cells was reduced in the paraquat and ulinastatin groups. These data confirmed that endoplasmic reticular stress can be induced by acute paraquat poisoning. Ulinastatin can effectively inhibit this stress as well as cell apoptosis, thereby exerting a neuroprotective effect.

  6. Ulinastatin suppresses endoplasmic reticulum stress and apoptosis in the hippocampus of rats with acute paraquat poisoning

    Hai-feng Li; Shi-xing Zhao; Bao-peng Xing; Ming-li Sun


    Lung injury is the main manifestation of paraquat poisoning. Few studies have addressed brain damage after paraquat poisoning. Ulinastatin is a protease inhibitor that can effectively stabilize lysosomal membranes, prevent cell damage, and reduce the production of free radicals. This study assumed that ulinastatin would exert these effects on brain tissues that had been poisoned with paraquat. Rat models of paraquat poisoning were intraperitoneally injected with ulinastatin. Simultaneously, rats in the control group were administered normal saline. Hematoxylin-eosin staining showed that most hippocampal cells were contracted and nucleoli had disappeared in the paraquat group. Fewer cells in the hippocampus were concentrated and nucleoli had dis-appeared in the ulinastatin group. Western blot assay showed that expressions of GRP78 and cleaved-caspase-3 were signiifcantly lower in the ulinastatin group than in the paraquat group. Immunohistochemical ifndings showed that CHOP immunoreactivity was signiifcantly lower in the ulinastatin group than in the paraquat group. Terminal deoxynucleotidyl transferase-medi-ated dUTP nick end labeling staining showed that the number of apoptotic cells was reduced in the paraquat and ulinastatin groups. These data conifrmed that endoplasmic reticular stress can be induced by acute paraquat poisoning. Ulinastatin can effectively inhibit this stress as well as cell apoptosis, thereby exerting a neuroprotective effect.

  7. Clinical analysis of 85 cases with acute treatment of organophosphorus pesticide poisoning%85例急性有机磷农药中毒救治的临床分析

    朱华; 赵春秋; 钟伟


    Objective:To investigate the treatment experience of acute organophosphorus pesticide poisoning. Methods:We record the treatment process and analyze the treatment effect of the 85 patients with organophosphate poisoning who were admitted by hospital.Results:In 85 cases of patients with acute pesticide poisoning of organic phosphorus,80 cases were cured,5 deaths,the success rate was 94%.Conclusion:Thorough effective repeated gastric lavage, rapid application of anticholinergics penehyclidine hydrochloride (Changtuoning) and cholinesterase agents (pralidoxime chloride) was the key to rescue the patients who with critical acute organophosphorus pesticide poisoning and we found that active prevention of complications occurrence can improve the success rate.%目的:探讨急性有机磷农药中毒的救治经验与体会。方法:对85例有机磷农药中毒患者的治疗过程进行记录,分析治疗效果。结果:85例急性有机磷农药中毒患者,救治成功80例,死亡5例,成功率94%。结论:急性有机磷农药中毒的抢救关键是尽快、彻底、有效反复地洗胃,快速应用抗胆碱药盐酸戊乙奎醚(长托宁)及胆碱酯酶复能剂(氯磷定),积极预防并发症的发生,可提高抢救成功率。

  8. Using bosentan to treat paraquat poisoning-induced acute lung injury in rats.

    Zhongchen Zhang

    Full Text Available BACKGROUND: Paraquat poisoning is well known for causing multiple organ function failure (MODS and high mortality. Acute lung injury and advanced pulmonary fibrosis are the most serious complications. Bosentan is a dual endothelin receptor antagonist. It plays an important role in treating PF. There is no related literature on the use of bosentan therapy for paraquat poisoning. OBJECTIVE: To study the use of bosentan to treat acute lung injury and pulmonary fibrosis as induced by paraquat. METHOD: A total of 120 adult Wister male rats were randomly assigned to three groups: the paraquat poisoning group (rats were intragastrically administered with paraquat at 50 mg/kg body weight once at the beginning; the bosentan therapy group (rats were administered bosentan at 100 mg/kg body weight by intragastric administration half an hour after paraquat was administered, then the same dose was administered once a day; and a control group (rats were administered intragastric physiological saline. On the 3rd, 7th, 14th, and 21st days following paraquat exposure, rats were sacrificed, and samples of lung tissue and venous blood were collected. The levels of transforming growth factor-β1 (TGF-β1, endothelin-1 (ET-1, and hydroxyproline (HYP in the plasma and lung homogenate were determined. Optical and electronic microscopes were used to examine pathological changes. RESULT: The TGF-β1, ET-1, and HYP of the paraquat poisoning group were significantly higher than in the control group, and they were significantly lower in the 21st day therapy group than in the paraquat poisoning group on the same day. Under the optical and electronic microscopes, lung tissue damage was observed to be more severe but was then reduced after bosentan was administered. CONCLUSION: Bosentan can reduce inflammation factor release. It has a therapeutic effect on acute lung injury as induced by paraquat.

  9. Analysis of characteristics of acute poisoning caused by various poisons in Guangxi, China%广西各类毒物致急性中毒分析

    胡德宏; 张振明; 刘清华; 蒋东方


    Objective To investigate the characteristics of acute poisonings caused by various poisons in Guangxi,China.Methods A retrospective investigation was performed in 5859 cases of acute poisonings who were admitted to 63 hospitals in 11 cities,as well as 531 types of poisons involved.The poisons were categorized into 6 groups; each group of cases was stratified by the rural or urban settings,frequency of poisoning,and cause of poisoning to analyze the numbers of cases and constituent ratios.Results Most types of poisons (68.74%) belonged to drugs (217 types) and pesticides (148 types).Most cases of poisonings (61.63%) were caused by pesticides (n=2547) and chemicals (n=1064).Pesticides,poisons of plant origins,and poisons of animal origins were responsible for most of the cases in rural settings; 88.46%,79.10%,and 66.74% of the cases of these poison categories happened in rural settings.Chemicals,drugs,and other poisons were responsible for most of the cases in urban settings; 70.20%,61.74%,and 63.73% of the cases of these poison categories happened in urban settings.The numbers of cases in 5-year-poisoning groups were the highest in all categories of poisons,accounting for 85.24%,88.57%,55.16%,70.79%,68.36%,and 66.44% of cases of respective categories.Most cases of poisonings by chemicals,poisons of animal origin,and other poisons were accident-related (86.24%,72.66%,and 46.71% of the poison categories).Most cases of poisonings by pesticides and drugs were suiciderelated (59.39% and 33.52% of the poison categories).Most cases by poisons of plant origin were caused by accidental ingestion (70.36% of the poison category).Conclusion Most of the acute poisonings in Guangxi area are caused by pesticides and chemicals; the most common causes of poisoning are accidents,accidental ingestion,and suicide.There are significant differences in the causes of acute poisonings between the urban and rural settings.%目的 探讨广西各类毒

  10. Evidence-based care in patients receiving heterozygous renal replacement therapy after organophosphate poisoning *%杂合肾脏替代治疗救治有机磷中毒患者的循证护理



    目的探讨循证护理在使杂合肾脏替代治疗救治有机磷中毒患者中的效果。方法选择2009年1月1日至2012年12月31日重庆医科大学附属第一医院收治的有机磷中毒患者共52例,将其随机均分为常规护理组(采用常规护理模式)、循证护理组(采用循证护理模式)。评价患者精神状态、生活质量、认知能力、累计阿托品用量、胆碱酯酶恢复时间、对护理质量的满意度。结果两组患者入院时一般资料、各项评分资料差异无统计学意义(P>0.05);入院1周后,与常规护理组相比,循证护理组精神状态、生活质量、认知能力均优于常规护理组,差异有统计学意义(P<0.05);循证护理组累计阿托品用量更小、胆碱酯酶恢复时间更快、对护理质量的满意度更高(P<0.05)。结论有机磷中毒患者行杂合肾脏替代治疗时,采用循证护理模式进行护理,可显著改善患者的精神状态、生活质量、自我认知能力,并显著促进患者身体机能的恢复、提升疗效和护理质量。%Objective To investigate the efficacy of evidence-based nursing (EBN) in patients receiving heter-ozygous renal replacement ( HRR) therapy after organophosphate poisoning .Methods 52 patients with organophos-phate poisoning ,treated in this hospital from Jan .1 2009 to Dec .31 2012 ,were randomly divided into control group , receiving routine nursing ,and observation group ,receiving EBN .Mental state ,quality of life ,cognitive ability ,cumu-lative dosage of atropine ,cholinesterase recovery time and degree of satisfaction with the quality of care were evalua -ted .Results General data and score of various evaluation were without difference between the two groups at admis -sion (P> 0 .05) .Compared with control group ,1 week after admission ,state of mind ,quality of life and cognitive a-bilities were better in experiment group (P< 0 .05) .Atropine

  11. Acute Lantana camara poisoning in a Boer goat kid : case report

    A. Ide


    Full Text Available Acute Lantana camara poisoning in a Boer goat kid is described. The animal was part of a flock of boer goats that was introduced from the Kalahari thornveld, where the plant does not occur, to an area where the plant grew abundantly. At necropsy, the animal was severely icteric, dehydrated and constipated, with hepatosis, distention of the gall-bladder and nephrosis, but no skin lesions. Histopathological findings of the liver confirmed moderate hepatosis with single-cell necrosis and bile stasis. The pathology is consistent with that described in acute Lantana poisoning in cattle, sheep and goats. The absence of photosensitisation may be attributed to relatively mild liver damage, or the rapid course of this toxicosis.

  12. Research progress in immunological mechanism of delayed encephalopathy after acute carbon monoxide poisoning

    Kai FENG


    Full Text Available Delayed encephalopathy after acute carbon monoxide poisoning (DEACMP is a syndrome constituted by acute dementia, psychiatric symptoms, pyramidal and extrapyramidal symptoms, which can be developed after the original clinical symptoms of carbon monoxide poisoning recovered. Lots of studies have been done to explain the mechanisms of DEACMP, and more and more researches have demonstrated that the immunological mechanism may be involved in or play an important role on the pathogenesis of the process. This article will review the researches of immunological mechanism of DEACMP in recent years and give some prompts to clinical study in the future. doi: 10.3969/j.issn.1672-6731.2014.10.006

  13. 对于危急重症有机磷中毒患者的临床急救分析%For Emergency and Severe Cases Organophosphate Poisoning Patients With Analysis of the Clinical First Aid

    姜启栋; 张雪梅


    Objective To Analysis and study of critical patients with severe organophosphate poisoning clinical first aid measures.Methods 80 cases of patients with organophosphorus poisoning treatment were Randomly selected in our hospital for emergency and severe cases, 80 patients were divided into two groups, on average, one group as the control group, and adopts the method of conventional first aid, another group as the observation group, while conventional first aid methods to the treatment of patients with blood perfusion observe the clinical effect of first aid of two groups were com-pared.Results Compare two groups of patients, the observation group total effective rate was higher than the control group after treatment, the difference was statistically significant, P<0.05).Conclusions Emergency blood perfusion methods in clinical treatment effect to endanger severe organophosphate poisoningis better, short time and patients recover fast, is suitable for the widely clinical use.%目的:分析研究危急重症有机磷中毒患者的临床急救措施。方法选取在本院治疗危急重症有机磷中毒患者80例,将80例患者平均分成两组,其中一组为对照组,采取常规的急救方法,另一组为观察组,在采取常规急救的方法的同时予以血液灌流对患者进行治疗,观察比较两组患者的临床急救效果。结果观察比较两组患者,观察组治疗后总有效率高于对照组,差异有统计学意义,P<0.05。结论对于危及重症有机磷中毒急救采取血液灌流的方法在临床上治疗效果更好,治疗时间短,患者病情恢复快,适合临床的广泛使用。

  14. Survival without peripheral neuropathy after massive acute arsenic poisoning: Treated by 2,3-dimercaptopropane-1-sulphonate.

    Lu, P-H; Tseng, J-C; Chen, C-K; Chen, C-H


    Massive acute arsenic poisoning is rare yet potentially life-threatening. 2,3-dimercaptopropane-1-sulphonate (DMPS) appears to have the appropriate chelating property. However, clinical experience on the use of DMPS in massive arsenic poisoning is limited. A 37-year-old woman attempted suicide by ingesting 37.5 g of arsenic trioxide. DMPS was promptly initiated based on history and clinical symptoms. The patient recovered completely, with no complications or side effects of the therapy. TDMPS is useful for the treatment of massive acute arsenic poisoning. © 2017 John Wiley & Sons Ltd.

  15. Effect of hemoperfusion on internal environment of patients with acute poisoning

    Hua Li; Wen-Qiang Li


    Objective:To explore the effect of hemoperfusion on the internal environment of patients with acute poisoning.Methods: A total of 36 patients with the acute poisoning who received the hemoperfusion treatment in Department of Emergency Medicine of this hospital were selected as the research subjects and a retrospective study was performed on them. At the beginning, 30 min and 120 min of hemoperfusion treatment, the blood was taken from the blood-collecting point of artery with cardiopulmonary bypass to detect the blood pH, partial pressure of CO2, partial pressure of oxygen, blood lactic acid, potassium, sodium, free calcium, bicarbonate ion and blood glucose level. The above indicators at the different time point were compared. Results:At the beginning, 30 min and 120 min of hemoperfusion, there was no significant difference in the partial pressure of CO2, pH, blood potassium, blood sodium, bicarbonate ion and free calcium between groups. But at the beginning, 30 min and 120 min of hemoperfusion, there was the significant difference in the partial pressure of oxygen, lactic acid and blood glucose between groups.Conclusion:There is no significant effect on the internal environment of patients with acute poisoning who receive the hemoperfusion treatment.

  16. Successful usage of intravenous lipid emulsion in treatment of acute verapamil poisoning: A case report

    Vuković-Ercegović Gordana


    Full Text Available Introduction. During the last few years, intravenous lipid emulsions have been effectively used in treatment of acute poisonings with lipophilic substances, including verapamil. Case report. A 37-year-old women presented 1 hour after ingestion of 2.8 g verapamil with hypotension and complete heart block. Because of the applied standard therapy failure and further patients impairment, Intralipid® 20% was used. Sinus rhythm was restored, arterial blood pressure increased and verapamile concentrations, both total and free decreased. Conclusion. Intravenous lipid emulsion can be important in treatment of severe acute intoxication and cardiotoxicity caused by verapamil.

  17. Management of exogenous intoxication by carbamates and organophosphates at an emergency unit.

    Leão, Sydney Correia; Araújo, José Fernandes de; Silveira, Alessandro Rodrigues; Queiroz, Alex André Ferreira; Souto, Maria Júlia Silveira; Almeida, Rodrigo Oliveira; Maciel, Diego Carvalho; Rodrigues, Tânia Maria de Andrade


    to evaluate and indicate the procedure to be followed in the health unit, both for diagnosis and the treatment of acute exogenous intoxications by carbamates or organophosphates. a descriptive study based on retrospective analysis of the clinical history of patients diagnosed with intoxication by carbamates or organophosphates admitted at the emergency unit of the Hospital de Urgências de Sergipe Governador João Alves (HUSE) between January and December of 2012. Some criteria were evaluated, such as: intoxicating agent; patient's age and gender; place of event, cause, circumstances and severity of the intoxication; as well as signs and symptoms of the muscarinic, nicotinic and neurological effects. seventy patients (average age: 25 ± 19.97) formed the study's population. It was observed that 77.14% of them suffered carbamate intoxication. However, organophosphate intoxications were more severe, with 68.75% of patients presenting moderate to severe forms. Suicide attempt was the leading cause of poisoning, with 62 cases (88.57% of total). Atropine administration was an effective therapeutic approach for treating signs and symptoms, which included sialorrhea (p = 0.0006), nausea (p = 0. 0029) and emesis (p exogenous intoxication by carbamates or organophosphates.

  18. Acute pesticide poisoning--a global public health problem

    Konradsen, Flemming


    of farming communities has made pesticides the preferred means of suicide with an extremely high case fatality. Similarly, the extensive use of pesticides exposes the community to both long-term and acute occupational health problems. A concerted effort is urgently needed to address the situation....

  19. Acute methoxetamine and amphetamine poisoning with fatal outcome: A case report

    Marek Wiergowski


    Full Text Available Methoxetamine (MXE is a psychoactive substance distributed mostly via the Internet and is not liable to legal regulation in Poland. MXE has a toxicity profile similar to that of ketamine but longer-lasting effects. The paper describes a case of acute poisoning that resulted from recreational use of MXE and amphetamine and ended in death. In mid-July 2012, a 31-year old man was admitted to the clinical toxicology unit in Gdańsk because of poisoning with an unknown psychoactive substance. The patient was transported to the emergency department (ED at 5:15 a.m. in a very poor general condition, in a deep coma, with acute respiratory failure, hyperthermia (> 39°C and generalized seizures. Laboratory tests showed marked leukocytosis, signs of massive rhabdomyolysis, hepatic failure and beginning of acute renal failure. Despite intensive therapy, the patient died 4 weeks after the poisoning in the course of multi-organ dysfunction syndrome. Chemical and toxicological studies of serum and urine samples collected on the poisoning day at 1:40 p.m. confirmed that amphetamine and MXE had been taken earlier that day. Concentration of amphetamine in the serum (0.06 μg/ml was within the non-toxic range, while MXE (0.32 μg/ml was within the toxic range of concentrations. Amphetamine was also detected in the patient's hair, which suggested a possibility of its use within the last dozen weeks or so. The serious clinical course of intoxication and co-existence of amphetamine and MXE in the patient's blood and urine suggest the possibility of adverse interactions between them.

  20. Prevalence of pulmonary edema among the deceased cases with acute Methadone poisoning: A report from Iran

    Eizadi-Mood, Nastaran; Naeini, Seyed Amir Hossein Madani; Hedaiaty, Mahrang; Sabzghabaee, Ali Mohammad; Moudi, Maryam


    Objective: Methadone poisoning is common in our society, mainly in drug addicts. One of its lethal complications is pulmonary edema. Therefore, we evaluated the prevalence of pulmonary edema in the deceased cases with methadone poisoning and its possible relationship with some medical variables. Methods: In this cross-sectional study which was done in 2014, we have investigated the deceased patients with methadone toxicity who underwent autopsy at Isfahan Forensic Medicine Department (Iran). All variables including age, gender, and autopsy findings were recorded and analyzed. Demographic characteristics and medical complications of the patients were compared between the patients with or without pulmonary edema in the autopsy findings. Findings: There were 64 cases who died with methadone poisoning during the 1-year study period. The average age of cases (±standard deviation) was 32.1 ± 10.29 years, among which 92.2% were male. Based on the autopsy findings, 64.1% were diagnosed with pulmonary edema. There was no statistically significant relationship between pulmonary edema and age, gender, history of addiction, and hepatic or cardiovascular complications. Conclusion: Pulmonary edema is a common finding in deceased methadone poisoning cases and must be considered and ruled out in patients with acute methadone toxicity. PMID:27843967

  1. Acute glyphosate-surfactant poisoning with neurological sequels and fatal outcome

    Potrebić Olivera


    Full Text Available Introduction. Clinical picture of severe glyphosatesurfactant poisoning is manifested by gastroenteritis, respiratory disturbances, altered mental status, hypotension refractory to the treatment, renal failure, shock. Single case report indicated possible neurotoxic sequels of glyphosatesurfactant exposure with white matter lesions and development of Parkinsonism. We described a patient with massive white matter damage which led to vigil coma and lethal outcome. Case report. A 56-year old woman ingested about 500 mL of herbicide containing glyphosate isopropylamine salt. The most prominent manifestation of poisoning included hypotension, coma, hyperkaliemia, respiratory and renal failure. The patient was treated in intensive care unit by symptomatic and supportive therapy including mechanical ventilation and hemodialysis. The patient survived the acute phase of poisoning, but she developed vigil coma. Nuclear magnetic imagining revealed extensive bilateral lesions of the brain stem white matter and pons. Conclusion. The outcome of reported poisoning may be the consequence of glyphosate-surfactant neurotoxic effect or/and ischemia, especially in the episodes of marked hypotension during hemodialysis. Considering recommendation of early hemodialysis as the treatment of choice, even before renal failure development, we point out the importance of careful planning of dialysis modality in hemodynamically instable patient and recommend continuous dialysis methods.

  2. Lipid emulsions in the treatment of acute poisoning: a systematic review of human and animal studies.

    Jamaty, Chloé; Bailey, Benoit; Larocque, Alexandre; Notebaert, Eric; Sanogo, Karine; Chauny, Jean-Marc


    To assess the evidence regarding the efficacy and safety of intravenous fat emulsion (IFE) in the management of poisoned patients. We performed a systematic review of the literature with no time or language restriction. The electronic databases were searched from their inception until June 1, 2009 (Medline, EMBASE, ISI web of science, Biological abstract, LILACS, ChemIndex, Toxnet, and Proquest). We also examined the references of identified articles and the gray literature. The target interventions eligible for inclusion were administration of any IFE before, during, or after poisoning in human or animals. All types of studies were reviewed. Eligibility for inclusion and study quality scores, based on criteria by Jadad and the STROBE statement, were evaluated by independent investigators. The primary outcome was mortality. Secondary outcomes included neurologic, hemodynamic, and electrocardiographic variables, as well as adverse effects. Of the 938 publications identified by the search strategies, 74 met the inclusion criteria. We identified 23 animal trials, 50 human, and 1 animal case reports. Overall, the quality of evidence was weak and significant heterogeneity prevented data pooling. Available data suggest some benefits of IFE in bupivacaine, verapamil, chlorpromazine, and some tricyclic antidepressants and beta-blockers toxicity. No trial assessed the safety of IFE in the treatment of acute poisoning. The evidence for the efficacy of IFE in reducing mortality and improving hemodynamic, electrocardiographic, and neurological parameters in the poisoned patients is solely based on animal studies and human case reports. The safety of IFE has not been established.

  3. Acute collective gas poisoning at work in a manure storage tank.

    Żaba, Czesław; Marcinkowski, Jerzy T; Wojtyła, Andrzej; Tężyk, Artur; Tobolski, Jarosław; Zaba, Zbigniew


    Cases of deaths in manure or septic tanks are rare in legal-medical practice, more frequently as unfortunate occupational accidents. Poisoning with toxic gases, especially with hydrogen sulfide, is reported as the cause of death, while the exhaustion of oxygen in the air is omitted with the simultaneous excess of carbon dioxide. In such cases, determination of the direct cause of death constitutes a big problem because post-mortem examination does not reveal the specific changes. A case of acute collective poisoning by gases in a manure storage tank is presented of 5 agricultural workers, 2 of whom died. While explaining the cause of poisoning and deaths, toxicological blood tests were performed in the victims of the accident, as well as gases inside the manure storage tank. The post-mortem examinations and toxicological blood tests performed did not allow determination of the direct cause of death. Toxicological tests of gases from inside the manure tank showed a very low concentration of oxygen, with a simultaneous very high concentration of carbon dioxide, and a considerable level of hydrogen sulfide. The cause of fainting of three and deaths of two workers was not the poisoning with hydrogen sulfide, but oxygen deficiency in the air of the tank.

  4. Prediction and validation of hemodialysis duration in acute methanol poisoning.

    Lachance, Philippe; Mac-Way, Fabrice; Desmeules, Simon; De Serres, Sacha A; Julien, Anne-Sophie; Douville, Pierre; Ghannoum, Marc; Agharazii, Mohsen


    The duration of hemodialysis (HD) in methanol poisoning (MP) is dependent on the methanol concentration, the operational parameters used during HD, and the presence and severity of metabolic acidosis. However, methanol assays are not easily available, potentially leading to undue extension or premature termination of treatment. Here we provide a prediction model for the duration of high-efficiency HD in MP. In a retrospective cohort study, we identified 71 episodes of MP in 55 individuals who were treated with alcohol dehydrogenase inhibition and HD. Four patients had residual visual abnormality at discharge and only one patient died. In 46 unique episodes of MP with high-efficiency HD the mean methanol elimination half-life (T1/2) during HD was 108 min in women, significantly different from the 129 min in men. In a training set of 28 patients with MP, using the 90th percentile of gender-specific elimination T1/2 (147 min in men and 141 min in women) and a target methanol concentration of 4 mmol/l allowed all cases to reach a safe methanol of under 6 mmol/l. The prediction model was confirmed in a validation set of 18 patients with MP. High-efficiency HD time in hours can be estimated using 3.390 × (Ln (MCi/4)) for women and 3.534 × (Ln (MCi/4)) for men, where MCi is the initial methanol concentration in mmol/l, provided that metabolic acidosis is corrected.

  5. The characteristics of emergency department presentations related to acute herbicide or insecticide poisoning in South Korea between 2011 and 2014.

    Moon, Jeong Mi; Chun, Byeong Jo; Cho, Yong Soo


    The aim of this study was to examine epidemiologic data regarding acute herbicide or insecticide poisoning in adults from 2011 to 2014 at the national level in South Korea. Further, the association between governmental regulations involving pesticides and changes in pesticide poisoning occurrences over time was determined. Data were obtained from the emergency department (ED)-based Injury In-depth Surveillance system conducted by the Korea Center for Disease Control and Prevention (KCDC). Governmental regulations on pesticides were downloaded from the homepage of the Korea Rural Development Administration. Pesticides were classified according to guidelines provided by the World Health Organization (WHO) and by the respective Resistance Action Committee (RAC). Trends in the number of ED presentations and case fatality rate (CFR) due to pesticide poisoning were investigated. The overall CFR due to poisoning from herbicides or insecticides in adults in South Korea was 16.8% during 2011-2014. However, CFR significantly decreased over the 4-year period. The ED presentations of paraquat (PQ) poisoning fell significantly, whereas poisoning due to glyphosate, glufosinate, or combined herbicides increased markedly over the 4 years. Between 2011 and 2013, PQ was the most common pesticide poisoning, whereas glyphosate became the most frequent in 2014. PQ produced the highest rate of fatality followed by endosulfan. Although the frequency of PQ poisoning decreased, which may be attributed to governmental regulations, the CFR and incidence of pesticide poisoning in adults remain a public health concern that needs to be addressed.

  6. The role of glutamate and the immune system in organophosphate-induced CNS damage.

    Eisenkraft, Arik; Falk, Avshalom; Finkelstein, Arseny


    Organophosphate (OP) poisoning is associated with long-lasting neurological damage, which is attributed mainly to the excessive levels of glutamate caused by the intoxication. Glutamate toxicity, however, is not specific to OP poisoning, and is linked to propagation of damage in both acute and chronic neurodegenerative conditions in the central nervous system (CNS). In addition to acute excitotoxic effects of glutamate, there is now a growing amount of evidence of its intricate immunomodulatory effects in the brain, involving both the innate and the adaptive immune systems. Moreover, it was demonstrated that immunomodulatory treatments, aimed at regulating the interaction between the resident immune cells of the brain (microglia) and the peripheral immune system, can support buffering of excessive levels of glutamate and restoration of the homeostasis. In this review, we will discuss the role of glutamate as an excitotoxic agent in the acute phase of OP poisoning, and the possible functions it may have as both a neuroprotectant and an immunomodulator in the sub-acute and chronic phases of OP poisoning. In addition, we will describe the novel immune-based neuroprotective strategies aimed at counteracting the long-term neurodegenerative effects of glutamate in the CNS.

  7. Duration of an induced resistance of sheep to acute poisoning by Crotalaria retusa seeds

    Lisanka Angelo Maia


    Full Text Available The aim of this study was to determine the duration of the resistance after the end of the ingestion of non-toxic doses of Crotalaria retusa seeds. Ten sheep were divided into 3 groups of 3 animals each and a control group with 1 sheep. To induce resistance, sheep in groups 1, 2 and 3 received 20 daily doses of 2g kg-1 of C. retusa seeds, followed by 7 daily doses of 4g kg-1. To determine the duration of resistance the sheep in groups 1, 2 and 3 were challenged orally, 3, 7 and 15 days, respectively, after receiving the last dose of 4g kg-1, with a single dose of 5g kg-1. Sheep of groups 1 and 2 did not develop overt signs of poisoning. Two sheep of group 3, challenged 15 days after the end of the resistance induction period, showed signs of acute poisoning and died. These results suggest that the induced resistance of sheep to acute poisoning by C. retusa seeds is of short duration, from 7 to 15 days.

  8. Acute mercury poisoning among children in two provinces of Turkey.

    Carman, Kursat Bora; Tutkun, Engin; Yilmaz, Hinc; Dilber, Cengiz; Dalkiran, Tahir; Cakir, Baris; Arslantas, Didem; Cesaretli, Yildirim; Aykanat, Selin Aktaş


    Elemental mercury exposure occurs frequently and is potentially a toxic, particularly in children. Children are often attracted to elemental mercury because of its color, density, and tendency to form beads. Clinical manifestations of elemental mercury intoxication vary depending on its form, concentration, route of ingestion, and the duration of exposure. We present data on 179 pediatric cases of elemental mercury poisoning from exposure to mercury in schools in two different provinces of Turkey. Of all patients, 160 children had both touched/played with the mercury and inhaled its vapors, while 26 children had only inhaled the mercury vapor, two children reported having tasted the mercury. The median duration of exposure was 5 min (min 1-max 100), and 11 (6 %) children were exposed to the mercury for more than 24 h at home. More than half of the children (51.9 %) were asymptomatic at admission. Headache was the most common presenting complaint. The results of physical and neurological examinations were normal in 80 (44.6 %) children. Mid-dilated/dilated pupils were the most common neurological abnormality, and this sign was present in 90 (50.2 %) children. Mercury levels were measured in 24-h urine samples daily, and it was shown that the median urinary level of mercury was 29.80 μg/L (min, 2.40 μg/L; max, 4,687 μg/L). A positive correlation was also found between the duration of exposure and urinary mercury levels (r = 0.23, p = 0.001). All patients were followed up for 6 months. On the first follow-up visit performed 1 month after discharge, the neurological examinations of all patients were normal except for those patients with peripheral neuropathy and visual field defects. On the last follow-up visit at the sixth month, only two children still experienced visual field defects. In conclusion, this study is one of the largest case series of mercury intoxication of students in schools. Elemental mercury exposure can be potentially toxic, and its

  9. [Clinical symptoms and circumastances of acute poisonings with fly agaric (Amanita muscaria) and panther cap (Amanita pantherina)].

    Łukasik-Głebocka, Magdalena; Druzdz, Artur; Naskret, Maciej


    Mushroom poisonings in Poland are quite common, especially in summer and autumn, but fly agaric (Amanita muscaria) and panther cap (Amanita pantherina) are rather rare cause of these intoxications. Fly agaric is a cause of deliberate poisoning, whereas panther cap poisoning also happens accidentally. The main toxins of these two mushrooms are ibotenic acid (pantherine, agarine), muscimol, muscazone and muscaridine. The other bioactive substances are stizolobic and stizolobinic acids and aminodicarboxyethylthiopropanoic acids. All these compounds are responsible for diverse picture of intoxication. An analysis of patients with Amanita muscaria and Amanita pantherina poisoning hospitalized in the Poznan Departament of Toxicology revealed that symptoms occurred after 30 minutes to 2 hours with vomiting, hallucinations, restlessness, increased psychomotor drive and central nervous system depression. Other antycholinergic symptoms like tachycardia and increased blood pressure, mydriasis, dry and red skin were seen only in a few cases. Acute respiratory failure was the most dangerous symptom observed in the course of poisoning.

  10. Long QT syndrome and torsades de pointes induced by acute sulpiride poisoning.

    Chang, Jia-How; Weng, Te-I; Fang, Cheng-Chung


    Sulpiride, a selective dopamine D2 antagonist and a substituted benzamide derivative, is considered a safe antipsychotic and antidepressant agent with few adverse effects on the cardiovascular system. Sulpiride-induced torsades de pointes is rare. We report a case of long QT syndrome and torsades de pointes induced by ingestion of 1.5 g of sulpiride. Ventricular arrhythmia was initially treated with amiodarone, without success. Eventually, lidocaine and magnesium sulfate successfully terminated the ventricular arrhythmia. The patient was discharged uneventfully after 3 days of hospitalization. This case illustrates the fact that acute sulpiride poisoning may lead to life-threatening ventricular arrhythmia. Early recognition followed by effective therapy is crucial. Intensive cardiac monitoring is recommended for sulpiride poisoning.

  11. Comparative Study on the Process Characteristics of Group-acute-poisoning and Sporadic-acute-poisoning in Guangxi Area%广西地区群发性与散发性急性中毒特点研究

    蒋东方; 胡德宏; 张振明; 刘清华


    目的 探讨广西地区群发性与散发性急性中毒的特点.方法选取2005-2009年广西11个市的36家市级医院、12家县级医院和15个乡镇卫生院收治的急性中毒患者6 010例为研究对象,其中群发组641例,散发组5 369例.由专家制定调查方案与表格,统计中毒地点(家里、学校、工作场地、餐馆、娱乐场所或其他)、中毒原因(意外性、职业性、误食性、医疗性、自杀性或其他)、毒物类别(化学类、农药类、医药类、植物类、动物类、感染类或其他)、中毒程度(轻、中、重度)、治疗效果(治愈、后遗症、死亡).结果 群发组与散发组中毒地点构成比较,差异有统计学意义(χ2=1 408.57,P=0.00);两组家里、学校、工作场地、餐馆和其他场地中毒率比较,差异均有统计学意义(P<0.05).群发组与散发组中毒原因构成比较,差异有统计学意义(χ2=527.46,P=0.00);两组意外性、误食性、医疗性、自杀性和其他原因中毒发生率比较,差异均有统计学意义(P<0.05).群发组与散发组毒物类别构成比较,差异有统计学意义(χ2=1 276.14,P=0.00);两组化学类、农药类、医药类、植物类、动物类、感染类和其他类毒物中毒发生率比较,差异均有统计学意义(P<0.05).群发组与散发组不同中毒程度比较,差异有统计学意义(u=-12.50,P=0.00).群发组与散发组治疗效果比较,差异无统计学意义(u=-0.41,P=0.68).结论 群发性急性中毒的人群聚集性较强,对毒物的"未知性"较明显,致中毒毒物种类多,中毒程度较轻;而散发性急性中毒,中毒环境的人群聚集性较弱,中毒原因较多,对毒物多有所认识,致中毒的毒物种类较少,中毒程度较重.%Objective To study the process characteristics of group - acute - poisoning and sporadic - acute - poisoning in Guangxi area. Methods 6 010 patients with acute poisoning admitted to 36 municipal hospitals, 12 county hospitals and

  12. Impairment of striatal mitochondrial function by acute paraquat poisoning.

    Czerniczyniec, Analía; Lanza, E M; Karadayian, A G; Bustamante, J; Lores-Arnaiz, S


    Mitochondria are essential for survival. Their primary function is to support aerobic respiration and to provide energy for intracellular metabolic pathways. Paraquat is a redox cycling agent capable of generating reactive oxygen species. The aim of the present study was to evaluate changes in cortical and striatal mitochondrial function in an experimental model of acute paraquat toxicity and to compare if the brain areas and the molecular mechanisms involved were similar to those observed after chronic exposure. Sprague-Dawley rats received paraquat (25 mg/Kg i.p.) or saline and were sacrificed after 24 h. Paraquat treatment decreased complex I and IV activity by 37 and 21 % respectively in striatal mitochondria. Paraquat inhibited striatal state 4 and state 3 KCN-sensitive respiration by 80 % and 62 % respectively, indicating a direct effect on respiratory chain. An increase of 2.2 fold in state 4 and 2.3 fold in state 3 in KCN-insensitive respiration was observed in striatal mitochondria from paraquat animals, suggesting that paraquat redox cycling also consumed oxygen. Paraquat treatment increased hydrogen peroxide production (150 %), TBARS production (42 %) and cardiolipin oxidation/depletion (12 %) in striatal mitochondria. Also, changes in mitochondrial polarization was induced after paraquat treatment. However, no changes were observed in any of these parameters in cortical mitochondria from paraquat treated-animals. These results suggest that paraquat treatment induced a clear striatal mitochondrial dysfunction due to both paraquat redox cycling reactions and impairment of the mitochondrial electron transport, causing oxidative damage. As a consequence, mitochondrial dysfunction could probably lead to alterations in cellular bioenergetics.

  13. Organophosphate intermediate syndrome with neurological complications of extrapyramidal symptoms in clinical practice

    Mark B. Detweiler


    Full Text Available Organophosphates (OPs are ubiquitous in the world as domestic and industrial agricultural insecticides. Intentional poisoning as suicides attempts are clinical phenomena seen in emergency departments and clinics in agricultural areas. Intermediate syndrome with the neurological complication of extra pyramidal symptoms following acute OP ingestion may occur in pediatric and adult cases. While death is the most serious consequence of toxic OP doses, low levels of exposure and nonfatal doses may disrupt the neurobehavioral development of fetuses and children in addition to bring linked to testicular cancer and male and female infertility. These are disturbing. Chronic and acute toxicity from OPs are barriers to the health of our present and future generations. Symptoms and treatment of acute and chronic OP exposure are briefly referenced with inclusion of the intermediate syndrome. Suggestions for local and systemic reduction of the acute and long term consequences of OP ingestion are opined.

  14. Potentialities of Program Analysis of Probable Outcome in Patients with Acute Poisoning by Mushrooms

    V. I. Cherniy


    Full Text Available The authors have developed a method for predicting a probable outcome in patients with acute poisoning by mushrooms, by examining the data of routine laboratory studies and dynamic interphase tensiometry and rheometry of sera from patients. Sixty-eight patients with acute mushroom intoxication were followed up. According to the outcome of the disease, they were divided into two groups: A survivors and B (deceased. In the sera of the deceased, the time of T monolayer relaxation and the angle of L1 tensiogram slope were 2.5 greater and PN3-PN4 and L2/L1 were 6 and 3.7 times less, respectively, than those in the survivors. Based on these data, by using the discriminant analysis, the authors have derived a classification rule that permits prediction of the outcome of the disease with a high degree of probability, by examining the results of dynamic interphase tensiometry and the data of routine laboratory studies of blood samples from patients with acute poisoning by mushrooms. The derived rule is of high significance (p<0.05.

  15. Therapeutic efficacy of charcoal hemoperfusion in patients with acute severe dichlorvos poisoning

    AiPENG; Fan-qingMENG; Lan-fangSUN; Zhan-shengJI; Yu-huiLI


    AIM: To assess the efficacy of hemoperfusion (HP) in the treatment of the patients with acute severe dichlorvos(DDVP) poisoning. METHODS: One hundred and eight patients with acute severe DDVP poisoning in the two teaching hospitals were enrolled. Sixty-seven patients were treated with HP (HP group) and forty-one patients accepted traditional treatment only as the control. Serum concentration of DDVP was determined by gas chromatography. RESULTS: The duration of coma, impaired consciousness, ICU stay, and mechanical ventilation was significantly shorter in the HP group than that in the control. The cumulative dosages (mg) of atropine required either in the first 24 h on admission (442±436 vs 899±485 in the control, P<0.01) or within the hospital (568±574vs 1228±982 in the control, P<0.01) were markedly reduced in the HP patients. The lower incidence of mechanical ventilation required (13.4 % vs 36.6 % P<0.01), respiratory muscular paralysis (4.5 % vs 17.1%, P<0.05) and the lower mortality of death (7.5 % vs 34.1%, P<0.01) were observed in the HP group. HP could accelerate the recovery of suppressed cholinesterase activity. After the procedure, the DDVP level was decreased from (11±4) to(7±3) mg/L in parallel with a decline in APACHE II Score or dopamine dose and a rise in Glasgow Coma Scale(P<0.05). In addition, the mean values of peak clearance and reduction rate were (87±17) mL/min and 44 %±11%,respectively. CONCLUSION: The rapid fall in blood DDVP level and the dramatic clinical response suggest that HP is effective in the treatment of acute severe DDVP poisoning.

  16. Slow Repetitive Nerve Stimulation in Patients with Acute Organophosphorus Poisoning after Clinical Recovery

    Sudheera Jayasinghe


    Full Text Available Background: Prolonged inhibition of acetylcholine esterase may lead to the intermediate syndrome. Neuromuscular junction (NMJ dysfunction has been shown with repetitive nerve stimulation (RNS. Subclinical NMJ dysfunction may also occur. We aimed to examine the NMJ function following acute organophosphorus (OP poisoning by using exercise modified slow RNS. Methods: A cohort study was conducted with matched controls. Patients with acute OP poisoning were enrolled. NMJ function, muscle power and tendon reflexes were assessed at discharge and six weeks after exposure. NMJ function was assessed with exercise modified supramaximal slow RNS of the median nerve. Results: There were 68 patients and 71 controls. Mean (SD age of patients and controls were 32 (12 and 33 (12 years. In some particular amplitude, the decrement response was statistically significant. They were decrement response at rest, at fourth amplitude (95% CI: -0.2 to -2.7 and two minutes post-exercise at fourth and fifth amplitudes (95% CI: -0.8 to -5, -1 to -5 respectively in the second assessment compared to controls, decrement response at rest at fourth and fifth amplitudes (95% CI: -4 to -0.5, -3.9 to -0.01 respectively and two minutes post-exercise at fourth amplitude (95% CI: -5 to -0.8 in the second assessment compared to the first assessment. Patients in the first assessment and controls showed more than 8% decrement response either to the second, fourth or fifth stimuli in seven and five occasions respectively. Conclusion:  There was no significant neuromuscular junction dysfunction assessed by exercise modified slow repetitive stimulation following acute exposure to OP. Since, NMJ dysfunctions are likely to occur following OP poisoning, other electrodiagnostic modalities such as SF-EMG are probably more efficient to assess these abnormalities.

  17. The Effects of Acute Hydrogen Sulfide Poisoning on Cytochrome P450 Isoforms Activity in Rats

    Xianqin Wang; Mengchun Chen; Xinxin Chen; Jianshe Ma; Congcong Wen; Jianchun Pan; Lufeng Hu; Guanyang Lin


    Hydrogen sulfide (H2S) is the second leading cause of toxin related death (after carbon monoxide) in the workplace. H2S is absorbed by the upper respiratory tract mucosa, and it causes histotoxic hypoxemia and respiratory depression. Cocktail method was used to evaluate the influences of acute H2S poisoning on the activities of cytochrome P450 isoforms CYP2B6, CYP2D6, CYP3A4, CYP1A2, CYP2C19, and CYP2C9, which were reflected by the changes of pharmacokinetic parameters of six specific probe d...

  18. Nursing care of patients with acute organophosphate poisoning%急性有机磷中毒病人的护理



    @@ 有机磷农药是目前我国使用最广泛的农药,对人畜均有毒性,可经呼吸道、胃肠道及完整皮肤吸收,吸收后大多在肝脏进行生物转化,其中毒机制是抑制体内胆碱酯酶.我院急诊科对急性有机磷中毒病人,采用相应的护理措施,协助医生最大限度地抢救了病人的生命.现将护理介绍如下.

  19. Minamata disease revisited: an update on the acute and chronic manifestations of methyl mercury poisoning.

    Ekino, Shigeo; Susa, Mari; Ninomiya, Tadashi; Imamura, Keiko; Kitamura, Toshinori


    The first well-documented outbreak of acute methyl mercury (MeHg) poisoning by consumption of contaminated fish occurred in Minamata, Japan, in 1953. The clinical picture was officially recognized and called Minamata disease (MD) in 1956. However, 50 years later there are still arguments about the definition of MD in terms of clinical symptoms and extent of lesions. We provide a historical review of this epidemic and an update of the problem of MeHg toxicity. Since MeHg dispersed from Minamata to the Shiranui Sea, residents living around the sea were exposed to low-dose MeHg through fish consumption for about 20 years (at least from 1950 to 1968). These patients with chronic MeHg poisoning continue to complain of distal paresthesias of the extremities and the lips even 30 years after cessation of exposure to MeHg. Based on findings in these patients the symptoms and lesions in MeHg poisoning are reappraised. The persisting somatosensory disorders after discontinuation of exposure to MeHg were induced by diffuse damage to the somatosensory cortex, but not by damage to the peripheral nervous system, as previously believed.

  20. Acute mercury poisoning presenting as fever of unknown origin in an adult woman: a case report.

    Cicek-Senturk, Gonul; Altay, Fatma Aybala; Ulu-Kilic, Aysegul; Gurbuz, Yunus; Tutuncu, Ediz; Sencan, Irfan


    Mercury intoxication may present in a wide range of clinical forms from a simple disease to fatal poisoning. This article presents a case of acute mercury poisoning, a rare condition that presents challenges for diagnosis with fever of unknown origin. A 52-year-old Caucasian woman was admitted to the hospital with high fever, sore throat, a rash over her entire body, itching, nausea, and extensive muscle pain. She had cervical, bilateral axillary and mediastinal lymphadenopathies. We learned that her son and husband had similar symptoms. After excluding infectious pathologies, autoimmune diseases and malignancy were investigated. Multiple organs of our patient were involved and her fever persisted at the fourth week of admission. A repeat medical history elicited that her son had brought mercury home from school and put it on the hot stove, and the family had been exposed to the fumes for a long period of time. Our patient's serum and urine mercury levels were high. She was diagnosed with mercury poisoning and treated accordingly. Mercury vapor is a colourless and odorless substance. Therefore, patients with various unexplained symptoms and clinical conditions should be questioned about possible exposure to mercury.

  1. Are calcium oxalate crystals involved in the mechanism of acute renal failure in ethylene glycol poisoning?

    McMartin, Kenneth


    Ethylene glycol (EG) poisoning often results in acute renal failure, particularly if treatment with fomepizole or ethanol is delayed because of late presentation or diagnosis. The mechanism has not been established but is thought to result from the production of a toxic metabolite. A literature review utilizing PubMed identified papers dealing with renal toxicity and EG or oxalate. The list of papers was culled to those relevant to the mechanism and treatment of the renal toxicity associated with either compound. ROLE OF METABOLITES: Although the "aldehyde" metabolites of EG, glycolaldehyde, and glyoxalate, have been suggested as the metabolites responsible, recent studies have shown definitively that the accumulation of calcium oxalate monohydrate (COM) crystals in kidney tissue produces renal tubular necrosis that leads to kidney failure. In vivo studies in EG-dosed rats have correlated the severity of renal damage with the total accumulation of COM crystals in kidney tissue. Studies in cultured kidney cells, including human proximal tubule (HPT) cells, have demonstrated that only COM crystals, not the oxalate ion, glycolaldehyde, or glyoxylate, produce a necrotic cell death at toxicologically relevant concentrations. COM CRYSTAL ACCUMULATION: In EG poisoning, COM crystals accumulate to high concentrations in the kidney through a process involving adherence to tubular cell membranes, followed by internalization of the crystals. MECHANISM OF TOXICITY: COM crystals have been shown to alter membrane structure and function, to increase reactive oxygen species and to produce mitochondrial dysfunction. These processes are likely to be involved in the mechanism of cell death. Accumulation of COM crystals in the kidney is responsible for producing the renal toxicity associated with EG poisoning. The development of a pharmacological approach to reduce COM crystal adherence to tubular cells and its cellular interactions would be valuable as this would decrease the renal

  2. Brain temperature measured by {sup 1}H-magnetic resonance spectroscopy in acute and subacute carbon monoxide poisoning

    Fujiwara, Shunrou; Nishimoto, Hideaki; Murakami, Toshiyuki; Ogawa, Akira; Ogasawara, Kuniaki [Iwate Medical University, Department of Neurosurgery, Morioka, Iwate (Japan); Yoshioka, Yoshichika [Osaka University, Laboratory of Biofunctional Imaging, WPI Immunology Frontier Research Center, Osaka (Japan); Matsuda, Tsuyoshi [MR Applications and Workflow Asia Pacific, GE Healthcare Japan, Tokyo (Japan); Beppu, Takaaki [Iwate Medical University, Department of Neurosurgery, Morioka, Iwate (Japan); Iwate Medical University, Department of Hyperbaric Medicine, Iwate (Japan)


    Brain temperature (BT) is associated with the balance between cerebral blood flow and metabolism according to the ''heat-removal'' theory. The present study investigated whether BT is abnormally altered in acute and subacute CO-poisoned patients by using {sup 1}H-magnetic resonance spectroscopy (MRS). Eight adult CO-poisoned patients underwent 3-T magnetic resonance imaging in the acute and subacute phases after CO exposure. MRS was performed on deep cerebral white matter in the centrum semiovale, and MRS-based BT was estimated by the chemical shift difference between water and the N-acetyl aspartate signal. We defined the mean BT + 1.96 standard deviations of the BT in 15 healthy controls as the cutoff value for abnormal BT increases (p < 0.05) in CO-poisoned patients. BT of CO-poisoned patients in both the acute and subacute phases was significantly higher than that of the healthy control group. However, BT in the subacute phase was significantly lower than in the acute phase. On the other hand, no significant difference in body temperature was observed between acute and subacute CO-poisoned patients. BT weakly correlated with body temperature, but this correlation was not statistically significant (rho = 0.304, p = 0.2909). The present results suggest that BT in CO-poisoned patients is abnormally high in the acute phase and remains abnormal in the subacute phase. BT alteration in these patients may be associated with brain perfusion and metabolism rather than other factors such as systemic inflammation and body temperature. (orig.)

  3. Seizure activity post organophosphate exposure.

    Tattersall, John


    Electrographic seizures are a feature of organophosphate anticholinesterase intoxication. Clinical studies of pesticide poisonings suggest that seizures are more common in children than in adults. Since flaccid paralysis, a characteristic sign of organophosphate poisoning, can mask convulsions, the most reliable indicator of seizures is the electroencephalogram, but this has not been widely used in clinical studies. Seizures can rapidly progress to status epilepticus, contributing to mortality and, in survivors, to neuronal damage and neurological impairment. Anticonvulsant drugs can significantly reduce the lethal and toxic effects of these compounds. A benzodiazepine, usually diazepam, is the treatment currently indicated for control of seizures. Animal studies have indicated that the early phase of seizure activity (0-5 min after seizure onset) is purely cholinergic, predominantly involving muscarinic mechanisms. Seizure activity subsequently progresses through mixed cholinergic and noncholinergic modulation (5-40 min) into a final noncholinergic phase. Neuropathology caused by seizures is most likely associated with glutamatergic excitotoxicity. Future prospects for improved treatments include new benzodiazepines, glutamate receptor antagonists, antimuscarinics with additional antiglutamatergic activity and adenosine receptor antagonists.

  4. Neurotoxicity and reactive astrogliosis in the anterior cingulate cortex in acute ciguatera poisoning.

    Zhang, Xu; Cao, Bing; Wang, Jun; Liu, Jin; Tung, Vivian Oi Vian; Lam, Paul Kwan Sing; Chan, Leo Lai; Li, Ying


    Ciguatoxins (CTXs) cause long-term disturbance of cerebral functions. The primary mechanism of neurotoxicity is related to their interaction with voltage-gated sodium channels. However, until now, the neurological targets for CTXs in the brain of intact animals have not been described. In our study, 1 day following oral exposure to 0.26 ng/g of Pacific ciguatoxin 1 (P-CTX-1), we performed in vivo electrophysiological recordings in the rat anterior cingulate cortex (ACC) and identified the increase in spontaneous firings and enhanced responses to visceral noxious stimulation. Local field recordings characterized the P-CTX-1-induced synaptic potentiation and blockage of the induction of electrical stimulation-induced long-term potentiation in the medial thalamus (MT)-ACC pathway. Furthermore, intracerebroventricular administration of P-CTX-1 at doses of 1.0, 5.0, and 10 nM produced a dose-dependent increase in ACC neuronal firings and MT-ACC synaptic transmission. Further studies showed upregulated Na(+) channel expression in astrocytes under pathological conditions. We hypothesized that the astrocytes might have been activated in the ciguatera poisoning in vivo. Increases in glial fibrillary acid protein expression were detected in reactive astrocytes in the rat ACC. The activation of astroglia was further indicated by activation of the gap junction protein connexin 43 and upregulation of excitatory amino acid transporter 2 expression suggesting that glutamate was normally rapidly cleared from the synaptic cleft during acute ciguatera poisoning. However, neurotoxicity and reactive astrogliosis were not detected in the ACC after 7 days of P-CTX-1 exposure. The present results are the first characterization of P-CTX-1-invoked brain cortex neuronal excitotoxicity in vivo and supported the theme that neuron and astroglia signals might play roles in acute ciguatera poisoning.

  5. Utility of the Measurement of Carboxyhemoglobin Level at the Site of Acute Carbon Monoxide Poisoning in Rural Areas

    Makoto Onodera


    Full Text Available Objective. This study examined the hypothesis that correlations exist between the carbon monoxide exposure time and the carboxyhemoglobin concentration at the site of carbon monoxide poisoning, using a pulse carbon monoxide oximeter in rural areas or the carboxyhemoglobin concentration measured at a given medical institution. Background. In previous studies, no definitive relationships between the arterial blood carboxyhemoglobin level and the severity of carbon monoxide poisoning have been observed. Method. The subjects included patients treated for acute carbon monoxide poisoning in whom a medical emergency team was able to measure the carboxyhemoglobin level at the site of poisoning. We examined the relationship between the carboxyhemoglobin level at the site of poisoning and carbon monoxide exposure time and the relationships between the arterial blood carboxyhemoglobin level and carbon monoxide exposure time. Results. A total of 10 patients met the above criteria. The carboxyhemoglobin levels at the site of poisoning were significantly and positively correlated with the exposure time (rs = 0.710, p=0.021, but the arterial blood carboxyhemoglobin levels were not correlated with the exposure time. Conclusion. In rural areas, the carboxyhemoglobin level measured at the site of carbon monoxide poisoning correlated with the exposure time.

  6. Hydrogen peroxide potentiates organophosphate toxicosis in chicks

    Banan K. Al-Baggou


    Full Text Available Objective: The purpose of the present study was to examine the effect of hydrogen peroxide(H2O2 on the acute toxicity of organophosphate insecticides dichlorvos and diazinon and their inhibitoryactions on plasma, brain and liver cholinesterase activities. Material and Methods: H2O2 was given indrinking water (0.5% v/v for 2 weeks in unsexed day old chicks, a regimen known to induce oxidativestress in this species. A control group received drinking tap water. All experiments were conducted onthe chicks at the age of 15 days after exposure to H2O2. The acute (24 h oral LD50 values of dichlorvosand diazinon in the insecticidal preparations as determined by the up-and-down method in the controlchicks were 9.4 and 15.6 mg/kg, respectively. Results: The poisoned chicks manifested signs ofcholinergic toxicosis within one hour after the dosing including salivation, lacrimation, gasping, frequentdefecation, drooping of wings, tremors, convulsions and recumbency. The acute (24 h oral LD50 valuesof dichlorvos and diazinon in chicks provided with H2O2 were reduced to 3.5 and 6.5 mg/kg, by 63 and58%, respectively when compared to respective control LD50 values. The intoxicated chicks also showedcholinergic signs of toxicosis as described above. Plasma, brain and liver cholinesterase activities of thechicks exposed to H2O2 were significantly lower than their respective control (H2O values by 25, 28 and27%, respectively. Oral dosing of chicks with dichlorvos at 3 mg/kg significantly inhibited cholinesteraseactivities in the plasma, brain and liver of both control (42-67% and H2O2-treated (15-59% chicks.Diazinon at 5 mg/kg, orally also inhibited cholinesterase activities in the plasma, brain and liver of bothcontrol (36-66% and H2O2-treated (15-30% chicks. In the H2O2 groups, dichlorvos inhibition of livercholinesterase activity and diazinon inhibition of liver and brain cholinesterase activities weresignificantly lesser than those of the respective values of

  7. Abnormal pancreatic enzymes and their prognostic role after acute paraquat poisoning.

    Li, Yi; Wang, Meng; Gao, Yanxia; Yang, Wen; Xu, Qun; Eddleston, Michael; Li, Li; Yu, Xuezhong


    Ingestion of paraquat causes multi-organ failure. Prognosis is best estimated through measurement of blood paraquat concentrations but this facility is not available in most hospitals. We studied the prognostic significance of abnormal pancreatic enzymes for survival. Patients with acute paraquat poisoning were recruited. An extensive series of blood tests including serum amylase were serially checked. Patients were sorted according to their serum amylase activity (normal [660 U/L]), and survival compared between groups. 177 patients were enrolled to the study, of whom 67 died and 110 survived. 122 (70.62%), 27 (15.25%) and 25 (14.13%) patients were in the normal, mildly elevated and elevated amylase activity groups, respectively. The case fatality in the elevated group was 100% compared to 17% in the normal group (P paraquat death prediction: amylase, PaCO2, leukocyte number, and neutrophil percentage. Models using pancreatic enzyme activity showed good prediction power. We have found that abnormal pancreatic enzymes are useful prognostic marker of death after acute paraquat poisoning. Including serum amylase activity into a prognostic model provides a good prognostication.

  8. Intoxicaciones medicamentosas (II: Analgésicos y anticonvulsivantes Acute pharmacologic poisoning (II: Analgesics and anticonvulsants

    P. Munné


    Full Text Available En este segundo capítulo sobre Intoxicaciones Medicamentosas Agudas abordamos dos grupos de sustancias de enorme trascendencia desde el punto de vista de su uso y morbimortalidad. Dentro del grupo de los anagésicos-antiinflamatorios desarrollamos el paracetamol y los salicilatos, de enorme disponibilidad para la población. En cuanto a los anticonvulsivantes, aunque están poco implicados en el conjunto de las intoxicaciones medicamentosas agudas, sus efectos pueden ser graves. Nos ceñimos a cuatro fármacos: ácido valproico, fenobarbital, carbamacepina, y fenitoína. Finalmente dedicamos un apartado a la isoniacida, fármaco que, con el rebrote de la tuberculosis, presenta interés toxicológico.In this second chapter on Acute Drugs Poisoning we deal with two groups of substances of great transcendence from the point of view of their use and morbidity/mortality. Within the group of analgesic-anti-inflammatory drugs we consider paracetamol and the salicylates, which are easily available to the population. With respect to the anticonvulsants, although they are barely involved in the ensemble of acute drug poisonings, their effects can be serious. We concentrate on four drugs: valproic acid, phenobarbitol, carbamacepine, and phenytoin. Finally, a section is dedicated to isoniazid, a drug that, with the renewed incidence of tuberculosis, is of toxicological interest.

  9. Ophthalmic findings in acute mercury poisoning in adults: A case series study.

    Aslan, Lokman; Aslankurt, Murat; Bozkurt, Selim; Aksoy, Adnan; Ozdemir, Murat; Gizir, Harun; Yasar, Ibrahim


    The aim of this study is to report ophthalmic findings of acute mercury poisoning in 48 adults referred to emergency department. Full ophthalmologic examination including the best corrected visual acuity, external eye examination, reaction to light, a slit-lamp examination, funduscopy, intraocular pressure measurements, and visual field (VF) and color vision (CV) tests were performed at the presentation and repeated after 6 months. The parametric values of VF test, the mean deviation (MD), and pattern standard deviation (PSD) were recorded in order to compare patients and the 30 healthy controls. The mean parameter of color confusion index in patients was found to be statistically different than controls (p < 0.01). The MD and PSD in patients were different from controls statistically significant (p < 0.01 and p < 0.01, respectively). There was no correlation between the ocular findings and the urine and blood mercury levels. Methyl mercury, held in the school laboratory for experimental purpose, may be a source of poisoning. In this case series, we showed that acute exposure to mercury had hazardous effect on the visual system, especially CV and VF. We propose that emphasizing the public education on the potential hazards of mercury is crucial for preventive community health.

  10. Medical Recapitulate%Role of Nrf-2 Gene in the Pathogenesis of Brain Damage Following Acute Carbon Monoxide Poison-ing

    郑然(综述); 李琴; 邹勇(审校)


    Acute brain damage and delayed encephalopathy are two main clinical manifestations of brain damage after carbon monoxide(CO) exposure,and seriously affect the life quality and prognosis of patients with CO poisoning.Hyperbaric oxygen is considered as the main therapy for brain damage after acute CO poi-soning.However,there are many controversies on its clinical application .The pathogenesis of brain damage after acute CO poisoning is poorly elucidated.The activation of nuclear factor erythrocyte two related factors-2 ( Nrf-2) may benefit the therapy for inflammatory and apoptosis mechanism triggered by CO poisoning .Thus, research on the role of Nrf-2 gene in the pathogenesis of brain damage following acute CO poisoning can pro-vide new ideas for the targeted therapy for the acute brain damage and delayed encephalopathy following CO poisoning.%一氧化碳中毒后的急性脑损伤和迟发型脑病严重影响患者的预后及生存质量。高压氧作为临床治疗一氧化碳中毒性脑损伤的主要方法争议颇多,而一氧化碳中毒性脑损伤的发病机制目前也尚未明确。核因子红细胞2相关因子2(Nrf-2)的激活可能对一氧化碳中毒引发的炎症、凋亡等发挥较好的治疗作用。因此,研究Nrf-2在一氧化碳中毒性脑损伤发病机制中的作用可为一氧化碳中毒后急性脑损伤和迟发型脑病的靶向治疗提供新思路。

  11. Lithium Poisoning

    Baird-Gunning, Jonathan; Lea-Henry, Tom; Hoegberg, Lotte C G


    is required. The cause of lithium poisoning influences treatment and 3 patterns are described: acute, acute-on-chronic, and chronic. Chronic poisoning is the most common etiology, is usually unintentional, and results from lithium intake exceeding elimination. This is most commonly due to impaired kidney...... function caused by volume depletion from lithium-induced nephrogenic diabetes insipidus or intercurrent illnesses and is also drug-induced. Lithium poisoning can affect multiple organs; however, the primary site of toxicity is the central nervous system and clinical manifestations vary from asymptomatic...... supratherapeutic drug concentrations to clinical toxicity such as confusion, ataxia, or seizures. Lithium poisoning has a low mortality rate; however, chronic lithium poisoning can require a prolonged hospital length of stay from impaired mobility and cognition and associated nosocomial complications. Persistent...

  12. An evaluation of acute hydrogen sulfide poisoning in rats through serum metabolomics based on gas chromatography-mass spectrometry.

    Zhang, Meiling; Deng, Mingjie; Ma, Jianshe; Wang, Xianqin


    Hydrogen sulfide (H2S) is the second leading cause of toxin-related deaths in the operational site. Its main target organs of toxic effects are the central nervous system and respiratory system. In this study, we developed a serum metabonomic method, based on gas chromatography-mass spectrometry (GC/MS), to evaluate the effect of acute poisoning by hydrogen sulfide on rats. Pattern recognition analysis, including both principal component analysis (PCA) and partial least squares-discriminate analysis (PLS-DA), revealed that acute hydrogen sulfide poisoning induced metabolic perturbations. Compared to the control group, the level of urea, glucose, glyceryl stearate in rat serum of the poisoning group increased after two hours, and the level of glucose, docosahexaenoic acid, glyceryl stearate and arachidonic acid in rat serum of the poisoning group increased after 48 h, while the L-valine, galactose, L-tyrosine levels decreased. Our results indicate that metabonomic methods based on GC/MS may be useful to elucidate acute hydrogen sulfide poisoning through the exploration of biomarkers.

  13. Does Early-Life Exposure to Organophosphate Insecticides Lead to Prediabetes and Obesity?

    Slotkin, Theodore A.


    Human exposures to organophosphate insecticides are ubiquitous. Although regarded as neurotoxicants, increasing evidence points toward lasting metabolic disruption from early-life organophosphate exposures. We gave neonatal rats chlorpyrifos, diazinon or parathion in doses devoid of any acute signs of toxicity, straddling the threshold for barely-detectable cholinesterase inhibition. Organophosphate exposure during a critical developmental window altered the trajectory of hepatic adenylyl cyc...

  14. Comparative assessment of blood and urine analyses in patients with acute poisonings by medical, narcotic substances and alcohol in clinical toxicology.

    Ostapenko, Yury Nikolaevich; Lisovik, Zhanna Andreevna; Belova, Maria Vladimirovna; Luzhnikov, Evgeny Alekseevich; Livanov, Alexandr Sergeevich


    Acute poisonings by medical, narcotic substances and alcohol are actual in Russia in the recent years. Comparison of analytic facilities of modern analytical techniques: chromatographic (HPLC, GC, GC-MS) and immuno-chemical (FPIA) in clinical toxicology for urgent diagnostics, assessment of the severity of acute poisoning and the efficacy of the treatment in patients with acute poisonings by psychotropic drugs, narcotics and alcohol have been done. The object of the study were serum, blood, urine of 611 patients with acute poisonings by amitriptyline, clozapine, carbamazepine, opiates and also alcohol. Threshold concentrations (threshold, critical and lethal) of the toxicants and their active metabolites which corresponded to different degrees of poisoning severity have been determined. The most comfortable and informative screening method for express diagnostics and assessment of severity of acute poisonings by psychotropic drugs and narcotics showed the HPLC with using automatic analyzers. FPIA using the automatic analyzer could be applied for screening studies, if group identification is enough. GC-FID method is advisable in case of poisoning by medical substances and narcotics in view of repeated investigation for assessment of the efficacy of the therapy. GC-MS could be advisable for confirming the results of other methods. GC-TCD possess high sensitivity and specificity and is optimal for express differential diagnostics and quantitative assessment of acute poisoning by ethanol and other alcohols.

  15. Prediction and validation of the duration of hemodialysis sessions for the treatment of acute ethylene glycol poisoning.

    Iliuta, Ioan-Andrei; Lachance, Philippe; Ghannoum, Marc; Bégin, Yannick; Mac-Way, Fabrice; Desmeules, Simon; De Serres, Sacha A; Julien, Anne-Sophie; Douville, Pierre; Agharazii, Mohsen


    The duration of hemodialysis (HD) sessions for the treatment of acute ethylene glycol poisoning is dependent on concentration, the operational parameters used during HD, and the presence and severity of metabolic acidosis. Ethylene glycol assays are not readily available, potentially leading to undue extension or premature termination of HD. We report a prediction model for the duration of high-efficiency HD sessions based retrospectively on a cohort study of 26 cases of acute ethylene glycol poisoning in 24 individuals treated by alcohol dehydrogenase competitive inhibitors, cofactors and HD. Two patients required HD for more than 14 days, and two died. In 19 cases, the mean ethylene glycol elimination half-life during high-efficiency HD was 165 minutes (95% confidence interval of 151-180 minutes). In a training set of 12 patients with acute ethylene glycol poisoning, using the 90th percentile half-life (195 minutes) and a target ethylene glycol concentration of 2 mmol/l (12.4 mg/dl) allowed all cases to reach a safe ethylene glycol under 3 mmol/l (18.6 mg/dl). The prediction model was then validated in a set of seven acute ethylene glycol poisonings. Thus, the HD session time in hours can be estimated using 4.7 x (Ln [the initial ethylene glycol concentration (mmol/l)/2]), provided that metabolic acidosis is corrected. Copyright © 2017 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

  16. Reducing the Incidence of Acute Pesticide Poisoning by Educating Farmers on Integrated Pest Management in South India

    Mancini, F.; Jiggins, J.L.S.; O'Malley, M.


    Sixty-five farmers reported on pesticide use and the signs and symptoms of acute pesticide poisoning when using two different plant protection strategies: in 2003 using chemical controls and in 2004 using an approach to Integrated Pest Management (IPM) based on an ecological analysis of the field

  17. Acute lead poisoning with eosinophilic meningoencephalitis in calves on a farm receiving land application of sewage sludge

    Dorn, C.R.; Tuomari, D.; Reddy, C.; Logan, T.J.


    A total of 3 cases of acute lead poisoning in calves was confirmed by atomic absorption spectrophotometric analysis of biological samples, presence of an acute lead exposure source, clinical signs of impaired vision in one case and eosinophilic meningoencephalitis in another case. One of two other calves which died approximately 2 months earlier had nervous signs and it is likely that they also had lead poisoning. Dams of two of the cases did not have elevated lead levels. Municipal sewage sludge had been applied to most fields on the farm during the preceding 5 year period. There had been approximately a doubling of the lead content in the soil; however, the foodstuffs produced on the farm had low lead concentrations. The extremely high lead levels in the abomasal contents and feces of calves eliminated sludge as the source of the lead in this acute poisoning episode. The contents of oil filters, accessible to calves but not to adult cattle, had lead levels as high as 26,922 micrograms/g and was the most likely lead source responsible for this lead intoxication. It appears that the manifestation of eosinophilic meningoencephalitis in lead poisoning cases may occur in young calves as well as in cows and in acute as well as in chronic intoxications.

  18. Reducing the Incidence of Acute Pesticide Poisoning by Educating Farmers on Integrated Pest Management in South India

    Mancini, F.; Jiggins, J.L.S.; O'Malley, M.


    Sixty-five farmers reported on pesticide use and the signs and symptoms of acute pesticide poisoning when using two different plant protection strategies: in 2003 using chemical controls and in 2004 using an approach to Integrated Pest Management (IPM) based on an ecological analysis of the field co

  19. Management of exogenous intoxication by carbamates and organophosphates at an emergency unit

    Sydney Correia Leão


    Full Text Available Summary Objectives: to evaluate and indicate the procedure to be followed in the health unit, both for diagnosis and the treatment of acute exogenous intoxications by carbamates or organophosphates. Methods: a descriptive study based on retrospective analysis of the clinical history of patients diagnosed with intoxication by carbamates or organophosphates admitted at the emergency unit of the Hospital de Urgências de Sergipe Governador João Alves (HUSE between January and December of 2012. Some criteria were evaluated, such as: intoxicating agent; patient's age and gender; place of event, cause, circumstances and severity of the intoxication; as well as signs and symptoms of the muscarinic, nicotinic and neurological effects. Results: seventy patients (average age: 25±19.97 formed the study's population. It was observed that 77.14% of them suffered carbamate intoxication. However, organophosphate intoxications were more severe, with 68.75% of patients presenting moderate to severe forms. Suicide attempt was the leading cause of poisoning, with 62 cases (88.57% of total. Atropine administration was an effective therapeutic approach for treating signs and symptoms, which included sialorrhea (p=0.0006, nausea (p=0. 0029 and emesis (p lt0.0001. The use of activated charcoal was shown effective, both in combating the signs and symptoms presented by both patient groups (p <0.0001. Conclusion: it is concluded that the use of atropine and activated charcoal is highly effective to treat the signs and symptoms developed by patients presenting acute exogenous intoxication by carbamates or organophosphates.

  20. Paraquat poisoning: an experimental model of dose-dependent acute lung injury due to surfactant dysfunction

    M.F.R. Silva


    Full Text Available Since the most characteristic feature of paraquat poisoning is lung damage, a prospective controlled study was performed on excised rat lungs in order to estimate the intensity of lesion after different doses. Twenty-five male, 2-3-month-old non-SPF Wistar rats, divided into 5 groups, received paraquat dichloride in a single intraperitoneal injection (0, 1, 5, 25, or 50 mg/kg body weight 24 h before the experiment. Static pressure-volume (PV curves were performed in air- and saline-filled lungs; an estimator of surface tension and tissue works was computed by integrating the area of both curves and reported as work/ml of volume displacement. Paraquat induced a dose-dependent increase of inspiratory surface tension work that reached a significant two-fold order of magnitude for 25 and 50 mg/kg body weight (P<0.05, ANOVA, sparing lung tissue. This kind of lesion was probably due to functional abnormalities of the surfactant system, as was shown by the increase in the hysteresis of the paraquat groups at the highest doses. Hence, paraquat poisoning provides a suitable model of acute lung injury with alveolar instability that can be easily used in experimental protocols of mechanical ventilation

  1. Sodium Nitrite and Sodium Thiosulfate Are Effective Against Acute Cyanide Poisoning When Administered by Intramuscular Injection.

    Bebarta, Vikhyat S; Brittain, Matthew; Chan, Adriano; Garrett, Norma; Yoon, David; Burney, Tanya; Mukai, David; Babin, Michael; Pilz, Renate B; Mahon, Sari B; Brenner, Matthew; Boss, Gerry R


    The 2 antidotes for acute cyanide poisoning in the United States must be administered by intravenous injection. In the out-of-hospital setting, intravenous injection is not practical, particularly for mass casualties, and intramuscular injection would be preferred. The purpose of this study is to determine whether sodium nitrite and sodium thiosulfate are effective cyanide antidotes when administered by intramuscular injection. We used a randomized, nonblinded, parallel-group study design in 3 mammalian models: cyanide gas inhalation in mice, with treatment postexposure; intravenous sodium cyanide infusion in rabbits, with severe hypotension as the trigger for treatment; and intravenous potassium cyanide infusion in pigs, with apnea as the trigger for treatment. The drugs were administered by intramuscular injection, and all 3 models were lethal in the absence of therapy. We found that sodium nitrite and sodium thiosulfate individually rescued 100% of the mice, and that the combination of the 2 drugs rescued 73% of the rabbits and 80% of the pigs. In all 3 species, survival in treated animals was significantly better than in control animals (log rank test, Pcyanide poisoning in 3 clinically relevant animal models of out-of-hospital emergency care. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  2. Cardiac and renal nitrosative-oxidative stress after acute poisoning by a nerve agent Tabun.

    Dimov, Dimo; Hadjiolova, Radka; Kanev, Kamen; Tomova, Radka; Michova, Anna; Todorov, Todor; Murdjev, Rumen; Boneva, Temenujka; Dimova, Ivanka


    We hypothesized that Tabun poisoning, as well as other organophosphorous treatment, cause specific organs' oxidative changes that have not previously been substantiated investigated. In this regard, a marker for nitrosative-oxidative stress in the main haemodynamic organs (heart and kidney) could reveal the existence of such changes. In this study, for the first time we studied the nitrosative/oxidative stress in heart and kidney after acute Tabun (Ethyl N,N- Dimethylphosphoramidocyanidate) poisoning measuring by immunohistochemistry the expression of 3-nitrotyrosine--a marker for nitrosative-oxidative stress. We investigated nitrotyrozine expression in three different groups of animals (with at least 3 animals in each group): the first group was treated with 0.5 LD50 Tabun and organs were collected after 24 h; the second group received vehicle for the same period; in the third group a highly specific re-activator was applied immediately after Tabun application. Heart and kidney were collected after 24 h. The levels of nitrotyrozine production significantly increased (more than 3 times) in cardiomyocytes after Tabun. The application of re-activator slightly reduced these levels not reaching the basal heart levels. Nitrotyrozine expression in kidney increased more than 2 times after Tabun and application of re-activator did not change it significantly. In conclusion, our study evidently demonstrated that Tabun trigger oxidative-nitrosative stress in heart and kidney and these cellular effects should be protected by an additional anti-oxidant therapy, since acetylcholinesterase re-activator is not efficient in this manner.

  3. Hypersensitivity Reaction and Acute Respiratory Distress Syndrome in Pyrethroid Poisoning and Role of Steroid Therapy

    Jisa George


    Full Text Available Background: Pyrethroids are generally of low toxicity to humans, but in suicidal poisonings which are usually associated with ingestion of high doses, they lead to severe systemic effects. Case Report: A 30-year old woman presented to emergency department with a history of intentional ingestion of about 15 mL of prallethrin around 3 days earlier. She complained of shortness of breath along with chest pain for the last 2 days. She reported no vomiting or stomach pain prior to presentation to hospital. On chest auscultation, breath sounds were mildly decreased in bilateral infrascapular areas with generalized crepitation. Arterial blood gas analysis revealed respiratory alkalosis. Chest X ray and computed tomography of thorax revealed widespread confluent areas of consolidation with interlobular septal thickening involving bilateral parahilar regions suggestive of acute respiratory distress syndrome (ARDS. The patient did not respond to broad spectrum antibiotic coverage, diuretics and oxygen inhalation. Intravenous methylprednisolone (2 mg/kg/day divided 6 hourly was started and slowly tapered off during the next days. The patient discharged after 3 weeks in good health. Discussion: As pyrethroids can affect sodium channels, the osmotic gradient of alveolar epithelium probably disrupts and therefore, alveolar infiltrations gradually spread over lungs. In addition, there is a possibility of hypersensitivity reactions to pyrethroids, which can cause progressive inflammation and involve respiratory tract in severe cases. Conclusion: Pyrethroid poisoning can lead to ARDS. Steroid therapy may help such patients tide over the pulmonary crisis.

  4. Toxicological Investigation of Acute Carbon Monoxide Poisoning in Four Occupants of a Fuming Sport Utility Vehicle

    Martin Nnoli


    Full Text Available Background: This toxicological investigation involves a report on the death of four occupants of a sport utility vehicle on one of the major busy Federal roads of Nigeria where they were held for up to three hours in a traffic jam while the car was steaming. Methods: Autopsy was executed using the standard procedure and toxicological analysis was done using simple spectrophotometric method to establish the level of carboxyhaemoglobin (HbCO in peripheral blood in the four occupants. Results: The autopsy report indicated generalized cyanosis, sub-conjuctival hemorrhages, marked laryngo-trachea edema with severe hyperemia with frothy fluid discharges characteristic of carbon monoxide poisoning. Toxicological report of the level of HbCO in part per million (ppm in the peripheral blood of the four occupants was A= 650 ppm; B= 500 ppm; C= 480 ppm, and D= 495 ppm against the maximum permissible level of 50 ppm. Conclusion: The sudden death of the four occupants was due to excessive inhalation of the carbon monoxide gas from the exhaust fumes leaking into the cabin of the car. The poor road network, numerous potholes, and traffic jam in most of roads in Nigeria could have exacerbated a leaky exhaust of the smoky second hand SUV car leading to the acute carbon monoxide poisoning.

  5. Rhabdomyolysis following Acute Extended-Release Quetiapine Poisoning: A Case Report

    Antonios Liolios


    Full Text Available Background. During the past few years, there have been a number of case reports concerning rhabdomyolysis following quetiapine poisoning; however, there has been none concerning the medication in its extended-release form. Methods. We present the case report of a 48-year-old man presenting a major depressive disorder and borderline personality disorder, who after voluntary intoxication with 12000 mg of quetiapine extended-release developed signs of acute rhabdomyolysis. Results. The rhabdomyolysis was confirmed by the laboratory and the clinical findings, with elevated levels of creatinine, creatine phosphokinase, and CRP. Discussion. We would like to pinpoint the importance of this complication and our concern of prescribing it for psychiatric patients with chronic somatic comorbidities.

  6. 急性百草枯中毒的救治体会%Treatment experience of acute paraquat poisoning

    赵兴勤; 杨庆忠; 张晓娟; 马丽; 田建元


    目的 探讨急性百草枯(paraquat,PQ)中毒的治疗方法.方法 对12例急性百草枯中毒住院患者的治疗效果与转归进行回顾性分析.结果 5例患者存活,占41.2%;4例自动出院,占33.3%;3例患者临床死亡,占25.0%.结论 急性百草枯农药中毒可以导致多脏器损害;早期积极治疗可以降低患者死亡率.%Objective In this study,we investigated the treatment methods in order to reduce mortality in acute paraquat poisoning. Methods The retrospective analysis was made on clinical data of 12 patients with oral paraquat poisoning in our hospital. Results 5 cases survived,4 cases discharged and 3 cases died. Conclusion Acute paraquat pesticide poisoning can cause multiple organ damage. The early aggressive therapy can reduce mortality in acute paraquat poisoning.

  7. Intoxicación aguda por plaguicidas Acute poisoning from pesticides

    Jaime Jesús Durán-Nah


    Full Text Available OBJETIVO: Describir la epidemiología de la intoxicación aguda por plaguicidas (IAP en el Hospital General O'Horán de Mérida, Yucatán, México. MATERIAL Y MÉTODOS: Se revisaron los expedientes de 33 pacientes ³ 13 años, tratados en una unidad de cuidados intensivos (UCI, entre 1994 y 1998. Se recopilaron variables demográficas y clínicas relevantes, y se aplicó estadística descriptiva. RESULTADOS: En la población estudiada predominó el sexo masculino (82% del medio rural (70%, y la edad media fue de 34 ± 15.8 años. El intento de suicidio fue causa frecuente de IAP (79%, y en 33% de los casos la intoxicación se produjo por la utilización de organofosforados. La mortalidad fue de 12%. CONCLUSIONES: La IAP fue baja entre los sujetos del medio rural, por lo que los resultados de este estudio parecen no reflejar la realidad del problema. Es importante añadir que los plaguicidas son utilizados con relativa frecuencia para el intento de suicidio.OBJECTIVE: To describe the epidemiologic pattern of acute pesticide poisoning (APP in a general hospital in Merida, Yucatan, Mexico. MATERIAL AND METHODS: From 1994 to 1998, 33 patients 13 years of age or older with diagnosis of APP were studied. Descriptive statistics were used to analyze information. RESULTS: Males were frequently affected (82%, specially those coming from rural areas (60%. The mean age of the group was 34 ± 15.8 years. In 79% of the cases, pesticides were used to commit suicide and 33% of poisoning cases were due to organophospate pesticides. The mortality rate was 12%. CONCLUSIONS: In this small sample, acute poisoning from pesticides in the agricultural setting may be underestimated, since it was less frequent than in the general population. APP was more commonly used by indigent people to commit suicide.

  8. Characteristics and determinants of adult patients with acute poisoning attending the accident and emergency department of a teaching hospital in Qatar.

    Khudair, I F; Jassim, Z; Hanssens, Y; Alsaad, W A


    Data about etiologic and demographic characteristics of acute poisoning in adults in Qatar are lacking. This prospective observational study was undertaken to analyze characteristics and possible determinants of acute poisoning in adults in Qatar. During 2010, 18,073 patients attended the emergency department of Hamad General Hospital, a teaching hospital in Qatar. Out of them, 599 (3.3%) patients were diagnosed as "poisoning case" with either chemical or pharmaceutical substances. The prevalence rate of poisoning incidence was 35.3/100,000 population. Seven patients died, corresponding with a case-fatality rate of 0.39/1000. The majority were male (65%) and the mean age was 34 years. The poisons involved were mainly chemicals (61.6%) and pharmaceuticals (38.4%). Female, mainly single, suffered more intentional poisoning compared to male. Of the patients aged 60 years and above (7.2%), the majority (95.3%) suffered unintentional poisoning with pharmaceuticals; 56% with warfarin, 12% with digoxin and 7% with insulin. Multivariate analysis shows that female gender, single status, younger than 35 years of age, being poisoned by pharmaceutical products, and the need for hospitalization are significant determinants for acute intentional poisoning after adjusting all other possible covariates. The findings of this study can be used to establish awareness and prophylactic campaigns in Qatar.

  9. Predicting poor outcome in patients with intentional carbon monoxide poisoning and acute respiratory failure: A retrospective study

    Chih-Hao Shen


    Full Text Available Purpose: Intentional carbon monoxide (CO poisoning has become the commonly used method of suicide in some Asian countries. The objective of this study was to identify the predictors that impact the outcome of intentional CO-poisoned patients with acute respiratory failure. Materials and Methods: This is a retrospective observational study of 796 consecutive patients diagnosed with acute CO poisoning that presented to the emergency department (ED. Patients who were CO poisoned with intentional exposure and acute respiratory failure were enrolled and divided into two groups. The poor outcome group consisted of in-hospital death, the presence of persistent neurological sequelae, and the presence of delayed neurologic sequelae. The good outcome group consisted of other enrolled patients. Demographic and clinical data of the two groups were extracted for analysis. Results: A total of 148 patients were enrolled in this study. Of the eligible subjects, 67.6% (100 were identified with positive toxicology screening results. On arriving ED, parameters associated with patients with a poor outcome included hypotension, myocardial injury, prolonged lag times from the first ED arrival to initiation of hyperbaric oxygen therapy, higher white blood cell count, and higher serum levels of blood urea nitrogen, creatine kinase, and troponin-I (P < 0.05. Positive toxicology screening result did not relate to the outcome. Multivariate analysis showed that the myocardial injury was an independent factor for poor outcome (odds ratio, 2.750; 95% confidence interval, 1.168-6.474; P = 0.021. Conclusions: Myocardial injury is an independent predictor of in-hospital death and neurologic sequelae in patients with intentional CO poisoning and acute respiratory failure.

  10. Liver histopathology of the fish brachydanio rerio hamilton-buchman after acute exposure to sublethal levels of the organophosphate dimethoate 500

    Edson de Lara Rodrigues


    Full Text Available Among the new substances that were synthesised by the chemical industiy during the last decades, with the aim to improve human prosperity, some cause negative effects on non target organisms like fish. Among the pesticides, the organophosphates (OP are widely used in cattle management, agriculture and aquaculture activities. Brachydanio rerio Hamilton-Buchman, 1822 is used world-wide in fish-tests for the establishment of the lethal levels of pesticides. Nevertheless, these fish show morphological changes in their hepatocytes when exposed experimentally for 24 hours to the sublethal dose of 0.025 µl/l of the OP Dimethoate 500, in acute tests. Right hours after exposure, a high density of cells with cytoplasmic granulation is seen as well as focal necrosis. The main changes that occurred in the first 24 hours of exposure were the loss of the typical polygonal cell shape and of detectable cell limits, lateral migration of nuclei, nuclear size and shape, condensation of chromatin and pycnosis, increased cytoplasmic granulation followed by vacuolisation. After 48 hours in clean water, 72 hours from contamination, besides significant morphological changes and necrosis, focal regeneration of the hepatocytes, canaliculi, ducts and sinusoids were seen. Even having been exposed to the half of the dose considered as safe according to the general pesticide allowance rules, significant changes of the liver tissue were observed.

  11. Toxic Agents Responsible for Acute Poisonings Treated at Four Medical Settings in Iran during 2012-2013: A Report from Iran's National Drug and Poison Information Center

    Talat Ghane


    Conclusion: Pharmaceutical products, substances of abuse and pesticides are the most common causes of poisoning-related admissions to referral Iranian poison treatment centers. Effective measures to reduce poisoning with these substances should be done.

  12. Black-spot poison ivy dermatitis. An acute irritant contact dermatitis superimposed upon an allergic contact dermatitis.

    Hurwitz, R M; Rivera, H P; Guin, J D


    A black spot in the epidermis over a blister of poison ivy dermatitis is an uncommon finding. Four patients with the phenomenon are described. Histologic and histochemical studies were made on biopsy material and the blackish deposit on the skin surface was compared with black deposits in and on leaves of the species of poison ivy. This examination revealed a yellow, amorphous substance on the stratum corneum of the lesions and a similar substance in and on leaves of the poison ivy plant, Toxicodendron radicans ssp. negundo. Associated with the pigmentary deposits there were distinct changes of acute irritant contact dermatitis superimposed upon allergic contact dermatitis. Our findings support the view that the black material is the oleoresin of the plant, and that this substance behaves both as an irritant and an allergen.

  13. Acute Poisoning in Elderly; a Five-Year Study (2008-2013 in Hamadan, Iran

    Saeed Afzali


    Conclusion: Deliberate self-harm and poisoning with opioids especially methadone showed a high prevalence in elderly poisoned patients in Hamadan, Iran.  It seems that drug trafficking control, addiction rehabilitation therapies and suicide prevention programs for elderly can be helpful in poisoning reduction in this age group in this part of the country.

  14. Diagnosis & Treatment of Poisoning by Pesticides.

    Environmental Protection Agency, Washington, DC. Office of Pesticide Programs.

    This report succinctly discusses the steps necessary to diagnose and treat poisoning from pesticides, especially organophosphates, carbamates and chlorinated hydrocarbons. Immediate and continuing steps in the care of poisoning victims are outlined with supportive information on where to locate emergency assistance. (CS)

  15. A retrospective study of paradigm and outcome of acute poisoning cases in a tertiary care teaching hospital in Southern India

    Arulmurugan C.


    Results: Incidence was high among males (60.36% compared to females (39.64%. Most of the cases of acute poisoning were in the age group 10 to 30 years (60.95% followed by 30 to 50 years age group (30.77%. A majority of poisoning cases (27.2% were due to organophosphorus (OPC insecticide. Total mortality was found to be 5.32%. Mortality rate due to Paraquat, Abrus Pretorius seeds was significantly high compared with OPC because there is no specific antidote. Time lapse had a very significant role in the mortality in cases of poisoning. Conclusions: Poisoning is common with young males. The mortality is high, in cases of self-poisoning with parquet and abrus seeds. Despite the highest consumption rate, no mortality was observed with organophosphorus because of early medical intervention and specific antidote. Early medical care in a tertiary care hospital will help to reduce significant mortality in India. [Int J Res Med Sci 2015; 3(10.000: 2654-2657

  16. Severe acute poisoning with homemade Aconitum napellus capsules: toxicokinetic and clinical data.

    Moritz, Fabienne; Compagnon, Patricia; Kaliszczak, Isabelle Guery; Kaliszczak, Yann; Caliskan, Valérie; Girault, Christophe


    Aconitum napellus is an extremely dangerous plant that contains various toxic diterpenoid alkaloids, mainly aconitine primarily concentrated in the roots. We report a case of acute intoxication of a 21-year-old man admitted to our Emergency Department after the ingestion, in order to sleep, of three homemade Aconitum napellus capsules. Capsules were measured to contain 237 mg of root and 19 microg of aconitine. The patient experienced the first symptoms on wakening 5 hours later with generalized paresthesia, nausea, diarrhea, vertigo, thoracic pain dyspnea, and dyschromatopsia. At admission, 7 hours after intake electrocardiographic analysis showed a sinusal bradycardia with polymorphic and bigeminal ventricular extrasystolia. Cardiovascular and neurological symptoms disappeared, respectively within 11 and 13 hours of ingestion. The patient was discharged from the ICU on day 2. Plasmatic concentrations at H7, H9, H14 H19, and after ingestion were, respectively, of 1.75, 0.75, 0.35, and 0.02 ng/mL. The calculated half-life of aconitine was 3 hours. To our knowledge, this is the first reported case with an aconitine toxicokinetic-effect relationship. The authors stress that clinicians must be aware of possible occurrence of acute poisoning with Aconitum napellus in European countries and in the United States as herbal medicine is becoming increasingly popular.

  17. A hospital base epidemiology and pattern of acute adult poisoning across Iran: a systematic review

    Moradi, Malihe; Ghaemi, Kazem; Mehrpour, Omid


    Introduction Poisoning is one of the most important health issues in the world. There is no exact statistic regarding the epidemiology of poisoning in Iran. The aim of this systematic review was to study the epidemiology of poisoning of adults in Iran. Methods All the published papers regarding the epidemiology and patterns of adult poisonings in different parts of Iran were reviewed in bibliographical databases, including SID, Iran Medex, Medlib, Magiran and Embase, Scopus, PubMed, and Google Scholar, without time limitation up to March 21, 2016. We searched for the terms poisoning, Iran, and epidemiology. After the final analysis, 38 articles that fulfilled all the required conditions were selected. Result In this article, we show that in most Iranian cities, except Ahvaz, pharmaceutical drugs, especially psychiatric pharmaceutical drugs, are the most common cause of poisoning in adults. In the Southwest region of Iran, poisoning due to envenomation is a very common. Although pesticide and opioid poisonings are less common, they are an important cause of death due to poisoning in Iran. Conclusion Pharmaceutical drugs are the most common cause of poisoning in most Iranian cities and it is recommended not to store pharmaceutical drugs at home and to set special rules regarding proper description of pharmaceutical drugs. More public health instruction is essential in the Southwest cities of Iran in order to reduce animal poisonings. PMID:27790337


    Chandra Indira


    Full Text Available BACKGROUND : Organophophorous poisoning constitutes one of the most frequent poisoning in clinical practice all over the country and especially in this area where agriculture is the chief economic occupation. Acute organophophorous poisoning ranks foremost in the list of agents which causes acute pesticide poisoning in the developing countries. Acute poisoning, accidental or due to deliberate ingestion or inhalation of these organophosphate chemicals is an important and one of the most common medical emergencies. Hence the present stud y is undertaken to assess severity of poisoning, management and outcome of organophosphorous poisoning cases admitted in Government General Hospital, Kakinada, A. P. AIMS/OBJECTIVES: 1. Assessment of severity of Organophosphorous poisoning according to Dri esbach’s criteria 2. To study the morbidity and mortality in these patients. MATERIALS AND METHOD S: In this descriptive study fifty patients with organophosphorous insecticide poisoning were evaluated by clinical examination. They were investigated, treate d and their treatment outcome were analyzed. RESULTS: 1. Chlorpyriphos and monocrotophos(together 66% were the most commonly used pesticides. 2. 82% cases reached the hospital within 6 hours for commencement of treatment and were mostly of moderate to se vere degree of OP poisoning while mild cases of accidental poisoning reached after 12 hours. Hence the mortality is high in the former group only. 3. When the severity of poisoning was graded by applying Dreisbach's criteria at the time of admission 34% ha d severe degree of poisoning, 26% had moderate poisoning while 40% of cases presented with mild degree of poisoning. (Most of the cases were accidental inhalation and skin contact exposure. 4. Among the patients belonging to moderate to severe degree of p oisoning 30% of patients were put on assisted mechanical ventilation, indications being uncontrolled pulmonary secretions, continuing hypoxia, not

  19. 有机磷中毒合并呼吸衰竭患者继发肺部感染的相关危险因素分析%Risk Factors of Pulmonary Infection Secondary to Organophosphate Poisoning Combined with Respiratory Failure

    赵翔宇; 殷安康; 王逸; 刘涵; 郭明


    目的:探讨临床有机磷中毒合并呼吸衰竭患者继发肺部感染的相关危险因素。方法回顾性分析2005年1月至2015年1月扬州市第一人民医院收治的250例有机磷中毒合并呼吸衰竭患者的临床资料为研究对象,分析并发肺部感染患者的情况及其相关危险因素。结果250例有机磷中毒合并呼吸衰竭患者中,并发肺部感染170例,肺部感染发生率为68.0%。肺部感染患者与肺部非感染患者合并误吸、呼吸机使用、入住重症监护室时间、手卫生状况和胆碱酯酶活性以及高敏C反应蛋白比较差异有统计学意义( P<0.05)。合并误吸、呼吸机使用和手卫生以及胆碱酯酶活性均是有机磷中毒合并呼吸衰竭患者并发肺部感染的危险因素( P <0.05)。结论合并误吸和手卫生以及呼吸机使用与胆碱酶活性降低均是影响有机磷中毒合并呼吸衰竭患者继发肺部感染的危险因素,临床中应引起足够的重视,并依据危险因素制订控制措施,减少肺部感染的情况发生。%Objective To investigate the risk factors of pulmonary infection secondary to organophos-phate poisoning with respiratory failure.Methods A retrospective analysis of clinical data of 250 patients of organophosphate poisoning with respiratory failure from Yangzhou City First People′s Hospital from Jan.2005 to Jan.2015 was done,and the pulmonary infection situation and related risk factors were analyzed .Results Among the 250 patients of organophosphate poisoning with respiratory failure patients,170 cases had pulmonaryinfection,making an rate of 68.0%.The pulmonary aspiration,ventilator,admission to intensive careunit time,hand hygiene,cholinesterase activity and high sensitivity C-reactive protein of pulmonary infectedpatients and non-infected patients had statistically significant differences(P <0.05).The combined aspiration,ventilator use,hand hygiene and cholinesterase

  20. Research progress on delayed encephalopathy after acute carbon monoxide poisoning%急性一氧化碳中毒迟发性脑病研究进展



    @@ 急性一氧化碳(CO)中毒迟发性脑病(Delayed encephalopathy after acute canbon monoxide poisoning,DEACMP)系指急性CO中毒(Acute carbon monoxide poisoning,ACOP)患者经抢救,中毒症状缓解或消失2~30 d后,再度出现的神经精神症状.

  1. Clinical effect of combination of hemoperfusion and plasmapheresis in the treatment of elderly patients with severe organophosphate poisoning%血液灌流与血浆置换联合抢救老年重度有机磷中毒的疗效



    目的:探究老年有机磷中毒重度型应用血浆置换联合血液灌流疗法的临床效果。方法有机磷中毒老年患者100例,按治疗方式的不同分为对照组和治疗组,每组50例。对照组进行血液灌流疗法,治疗组进行血液灌流联合血浆置换疗法,观察两组患者各项生化指标、临床疗效和并发症的情况。结果两组治疗后各项生化指标均有改善,但治疗组的指标水平明显优于对照组;治疗组的阿托品中毒、中间综合征、病死和反跳等并发症的发生率显著低于对照组,差异具有统计学意义(P<0.05)。结论血液灌流联合血浆置换抢救老年重度有机磷中毒,有效的减少了患者并发症的发生,降低了患者各项生化指标的数值,提高了患者预后的生活水平,值得在临床上推广。%ObjectiveTo discuss the clinical effect of combination of hemoperfusion and plasmapheresis in the treatment of elderly patients with severe organophosphate poisoning.MethodsDivided 100 elderly patients with severe organophosphate poisoning into control group and treatment group according to different treatment methods, each with 50 cases. Control group was given hemoperfusion therapy while treatment group was given combined therapy of hemoperfusion and plasmapheresis. Biochemical indicators, clinical effects and complications of two groups were observed.ResultsBiochemical indicators of both groups improved after treatment, but indicator levels of treatment group were obviously higher than control group; occurrence rates of atropinismus, intermediate syndrome, fatality and rebound were obviously lower than control group(P<0.05). ConclusionCombination of hemoperfusion and plasmapheresis for rescue of elderly patients with severe organophosphate poisoning effectively reduces occurrences of complications, decreases values of biochemical indicators and improves prognostic life levels of patients, so it is worthy of clinical

  2. Protective effect of HI-6 and trimedoxime combination in mice acutely poisoned with tabun, dichlorvos or heptenophos

    Antonijević Biljana; Vučinić Slavica; Ćupić V.


    The aim of this study was to compare the protective effect of two individual oximes (HI-6 and trimedoxime) with their combination in mice acutely poisoned with tabun, dichlorvos or heptenophos. Oxime HI-6 did not protect experimental animals against either dichlorvos, heptenophos or tabun. Trimedoxime was very effective against all three OPs. The ED-500 doses of trimedoxime necessary to protect 50% of animals after the simultaneous administration of OPs and...

  3. Protective effect of HI-6 and trimedoxime combination in mice acutely poisoned with tabun, dichlorvos or heptenophos

    Antonijević Biljana; Vučinić Slavica; Ćupić V.


    The aim of this study was to compare the protective effect of two individual oximes (HI-6 and trimedoxime) with their combination in mice acutely poisoned with tabun, dichlorvos or heptenophos. Oxime HI-6 did not protect experimental animals against either dichlorvos, heptenophos or tabun. Trimedoxime was very effective against all three OPs. The ED-500 doses of trimedoxime necessary to protect 50% of animals after the simultaneous administration of OPs and oxime were 42.18, 14.97 and 3...

  4. Gastric Lavage in Acute Organophosphorus Pesticide poisoning (GLAOP – a randomised controlled trial of multiple vs. single gastric lavage in unselected acute organophosphorus pesticide poisoning

    Cao YuPing


    Full Text Available Abstract Background Organophosphorus (OP pesticide poisoning is the most common form of pesticide poisoning in many Asian countries. Guidelines in western countries for management of poisoning indicate that gastric lavage should be performed only if two criteria are met: within one hour of poison ingestion and substantial ingested amount. But the evidence on which these guidelines are based is from medicine overdoses in developed countries and may be irrelevant to OP poisoning in Asia. Chinese clinical experience suggests that OP remains in the stomach for several hours or even days after ingestion. Thus, there may be reasons for doing single or multiple gastric lavages for OP poisoning. There have been no randomised controlled trials (RCTs to assess this practice of multiple lavages. Since it is currently standard therapy in China, we cannot perform a RCT of no lavage vs. a single lavage vs. multiple lavages. We will compare a single gastric lavage with three gastric lavages as the first stage to assess the role of gastric lavage in OP poisoning. Methods/Design We have designed an RCT assessing the effectiveness of multiple gastric lavages in adult OP self-poisoning patients admitted to three Chinese hospitals within 12 hrs of ingestion. Patients will be randomised to standard treatment plus either a single gastric lavage on admission or three gastric lavages at four hour intervals. The primary outcome is in-hospital mortality. Analysis will be on an intention-to-treat basis. On the basis of the historical incidence of OP at the study sites, we expect to enroll 908 patients over three years. This projected sample size provides sufficient power to evaluate the death rate; and a variety of other exposure and outcome variables, including particular OPs and ingestion time. Changes of OP level will be analyzed in order to provide some toxic kinetic data. Discussion the GLAOP study is a novel, prospective cohort study that will explore to the toxic

  5. ORIGINAL ARTICLES Paediatric organophosphate poisoning - a ...

    Aspects of the emerging ethical-legal framework are ambiguous and .... References. 1. Human Sciences Research Council/Medical Research Council. ... VanWyk C. Clinical trials, medical research and cloning in South Africa. Tydskrif vir.


    Francis Solange Vieira Tourinho


    Full Text Available Objetivo: Identificar os principais rótulos diagnósticos de enfermagem e suas respectivas intervenções de enfermagem para o individuo vítima da intoxicação por organofosforados.Método: Trata-se de revisão integrativa, utilizando para tal as bases LILACS/PUBMED e publicações impressas relacionadas à temática.Resultados: O levantamento dos sinais/sintomas deste tipo de acidente possibilitou o julgamento clínico e elaboração dos 10 principais rótulos Diagnósticos de Enfermagem com base na North American Nursing Diagnosis Association-International, determinando o planejamento das Intervenções de Enfermagem de acordo com a Nursing Interventions Classification. Conclusão: a identificação dos diagnósticos e intervenções de enfermagem permite perceber o paciente como um todo, levando em consideração as diversas complicações que podem surgir biológicas psicológica e socialmente.   Descritores: Cuidados de Enfermagem; Compostos Organofosforados; Envenenamento.

  7. Tolerance Following Organophosphate Poisoning of Tracheal Muscle


    methylparathion and pa-athion in sunfish and mice. Toxicol. Appl. Pharmacol. 28: 97-109, 1974. 23 Rimele , T. J., W. A. Rogers, and T. S. Gaginella...77: 1225-1234, 1979. K\\ 24. Gaginella, T. S.» T. J. Rimele , T. M. 0’Dorisio, and R. J. Dorff. Pharmacologic identification of muscarinic

  8. Child labor and acute pesticide poisoning in Nicaragua: failure to comply with children's rights.

    Corriols, Marianela; Aragón, Aurora


    Since 1995, Nicaragua has adopted several legal instruments to comply with children's rights, including international conventions and a minimum working age of 14 years. However, records from the Ministry of Health's Pesticide Program show continuing occupational acute pesticide poisonings (APP) among children five to 14-years-old from 1995 to 2006. We reviewed and described all reported APPs and estimated the yearly incidence and underreporting rates. Of 2069 APP cases, 432 were occupational. Annual incidence rates (range: 1-4.7/100,000) have been decreasing since 1997. Six fatal and most non-fatal cases were related to work in tobacco and basic grain crops. Based on underreporting data, we estimate actual incidence during the period studied to be 18,516 (95% CI, 3840-33,204) cases among five- to fourteen-year-olds. With regard to child labor and pesticide exposure, children's rights violations still exist and must be abolished in both formal employment and in the informal economy, including in family-based agricultural activities.

  9. Do not overlook acute isoniazid poisoning in children with status epilepticus.

    Caksen, Hüseyin; Odabas, Dursun; Erol, Mehmet; Anlar, Omer; Tuncer, Oguz; Atas, Bülent


    A previously healthy 2-year-old girl was admitted with generalized convulsive status epilepticus. She was in a stupor and could respond only to painful stimuli. She also had severe metabolic acidosis. Although initial liver function tests were normal, they were found to be moderately high on the fifth day of admission; however, they dropped to their normal ranges on the twelfth day of admission. Initially, the patient was diagnosed as having idiopathic status epilepticus, and classic anticonvulsant agents, including diazepam, phenytoin, and then phenobarbital, were given. However, her seizures did not subside, and diazepam infusion was initiated. After initiation of diazepam infusion, the seizures were completely controlled. On the fourth day of admission, her parents said that she had accidentally received 20 tablets (a total dose of 2000 mg) of isoniazid just before admission to our hospital. Later, we injected 200 mg of pyridoxine intravenously. During follow-up, her general condition improved, and anticonvulsant agents were discontinued because an electroencephalogram was found to be norma. She was discharged from the hospital on the twelfth day of admission. At the fourth month of follow-up, she was seizure free. Because of this case, we would like to re-emphasize that acute isoniazid poisoning should also be considered in a child with unexplained status epilepticus.

  10. [The intermediate syndrome during organophosphorus pesticide poisoning].

    Benslama, A; Moutaouakkil, S; Charra, B; Menebhi, L


    Acute intoxication by organophosphate pesticides is frequent in Morocco. We report two cases of malathion poisoning complicated by intermediate syndrome. The purpose of this work is to describe distinctive features of this syndrome, it arises 48-96 h after the cholinergic crisis and it is characterized by respiratory paresis with difficulties of weaning from the assisted respiratory, deficit of proximal limbs, neck flexors, and cranial nerves. This syndrome coincides with the prolonged inhibition of the acetylcholinesterase, and is not due to the necrosis of muscular fiber's necrosis. Both clinical and electromyographic features are explained by a combined pre- and postsynaptic dysfunction of the neuromuscular transmission. The difficulty of this syndrome lies in its rarity and also its severity, because of the respiratory failure, which justifies medical supervision in intensive care unit, for at least 96 h, in expectation for the respiratory distress, all the more cholinergic syndrome is intense.

  11. Clinical analysis of 206 cases of acute poisoning in children%206例小儿急性中毒的临床分析

    彭庆明; 邹卫红; 郭毅; 贺丽梅


    Objective To investigate the etiology and clinical characteristics of pediatric acute poisoning. Methods The clinical data of 206 cases of acute poisoning in children in our hospital were retrospectively analyzed. Results In 206 patients with poisoning,90 cases (43.7%) were food poisoning,45 cases (21.8%) with drug poisoning, 30 cases (14.6%)of pesticide poisoning,18 cases (8.7%) of rodenticide poisoning,12 cases (5.8%)of chemical poisoning,11 cases (5.3%) of CO poisoning;among them 191 cases were cured or improved,6 cases of death, transferred 5 cases,4 cases gave up treatment. Conclusion Pediatric acute poisoning involving children of all ages,the number of rural areas is more than urban,and most of the digestive tract poisoning,to eating, wrongly as much;prevention and treatment of acute poisoning in children should be based on prevention,treatment time is the key to treatment of acute poisoning.%目的:了解小儿急性中毒的病因及临床特点。方法回顾性分析对本院206例急性中毒患儿的临床资料。结果在206例中毒患儿中,食物中毒90例(43.7%),药物中毒45例(21.8%),农药中毒30例(14.6%),鼠药中毒18例(8.7%),化学品中毒12例(5.8%),CO中毒11例(5.3%);其中治愈好转191例,死亡6例,转院5例,放弃治疗4例。结论小儿急性中毒涉及儿童各年龄段,农村多于城镇,且绝大多数经消化道中毒,以误食、误服为多;小儿急性中毒的防治应以预防为主,救治开始时间是急性中毒抢救治疗的关键。

  12. Rare alleles within the CYP2E1 (MEOS system) could be associated with better short-term health outcome after acute methanol poisoning.

    Hubacek, Jaroslav A; Pelclova, Daniela; Seidl, Zdenek; Vaneckova, Manuela; Klempir, Jiri; Ruzicka, Evzen; Ridzon, Petr; Urban, Pavel; Fenclova, Zdenka; Petrik, Vit; Diblik, Pavel; Kuthan, Pavel; Miovsky, Michal; Janikova, Barbara; Adamkova, Vera; Zakharov, Sergey


    Genetic polymorphisms influence the metabolism of ethanol and methanol, but the potential effects of genetic predisposition on the clinical course, outcome and short-term health sequelae of acute methanol poisoning are unknown. To evaluate the role of the MEOS system in methanol poisoning, we analysed the effect of three polymorphisms (RsaI - rs2031920; PstI - rs3813867; insertion/deletion I/D) within the CYP2E1 enzyme (MEOS system) in 50 adult survivors of methanol poisoning and compared their genotype frequencies with 460 controls. The minor allele frequencies of all three polymorphisms were below 5% in both groups. We did not detect significant differences in the genotype frequencies between survivors of methanol poisoning and controls (p = 0.34 for the RsaI variant; p = 0.59 for the PstI variant and p = 0.21 for the I/D polymorphism). The carriers of at least one minor allele in the CYP2E1 gene had less severe clinical symptoms and better short-term outcome after acute poisoning. Variants within the CYP2E1 gene are likely not significant genetic determinants of acute methanol poisoning (if survivors are analysed), but they may influence the severity of methanol poisoning and its visual/central nervous system (CNS) outcome.

  13. Protective effect of HI-6 and trimedoxime combination in mice acutely poisoned with tabun, dichlorvos or heptenophos

    Antonijević Biljana


    Full Text Available The aim of this study was to compare the protective effect of two individual oximes (HI-6 and trimedoxime with their combination in mice acutely poisoned with tabun, dichlorvos or heptenophos. Oxime HI-6 did not protect experimental animals against either dichlorvos, heptenophos or tabun. Trimedoxime was very effective against all three OPs. The ED-500 doses of trimedoxime necessary to protect 50% of animals after the simultaneous administration of OPs and oxime were 42.18, 14.97 and 32.08 μmol/kg in dichlorvos, heptenophos and tabun poisoning, respectively. Half-time of efficacy in the tabun protocol was approximately three and two times longer than in the protocol for heptenophos and dichlorvos, respectively indicating also that trimedoxime is very potent in counteracting tabun toxicity. Addition of trimedoxime significantly improved the protective effect of HI-6 in acute tabun poisoning. When dichlorvos or heptenophos were used, addition of trimedoxime generally improved the antidotal effect of HI-6, but still lower protection was obtained than in the case when trimedoxime alone was administered. The investigations of different oxime combinations have indicated that application of a mixture of two oximes represents a promising antidotal approach.

  14. Kind and estimated stocking amount of antidotes for initial treatment for acute poisoning at emergency medical centers in Korea.

    Sohn, Chang Hwan; Ryoo, Seung Mok; Lim, Kyoung Soo; Kim, Won; Lim, Hoon; Oh, Bum Jin


    Antidotes for toxicological emergencies can be life-saving. However, there is no nationwide estimation of the antidotes stocking amount in Korea. This study tried to estimate the quantities of stocking antidotes at emergency department (ED). An expert panel of clinical toxicologists made a list of 18 emergency antidotes. The quantity was estimated by comparing the antidote utilization frequency in a multicenter epidemiological study and the nation-wide EDs' data of National Emergency Department Information System (NEDIS). In an epidemiological study of 11 nationwide EDs from January 2009 to December 2010, only 92 (1.9%) patients had been administered emergency antidotes except activated charcoal among 4,870 cases of acute adult poisoning patients. Comparing with NEDIS data, about 1,400,000 patients visited the 124 EDs nationwide due to acute poisoning and about 103,348 adult doses of the 18 emergency antidotes may be required considering poisoning severity score. Of these, 13,224 (1.9%) adult doses of emergency antidotes (575 of atropine, 144 of calcium gluconate or other calcium salts, 2,587 of flumazenil, 3,450 of N-acetylcysteine, 5,893 of pralidoxime, 287 of hydroxocobalamin, 144 of sodium nitrite, and 144 of sodium thiosulfate) would be needed for maintaining the present level of initial treatment with emergency antidotes at EDs in Korea.

  15. A one-year observational study of all hospitalized acute poisonings in Oslo: complications, treatment and sequelae

    Lund Cathrine


    Full Text Available Abstract Objectives Changes in poisoning trends may affect both complications and outcomes in patients with acute poisoning. This study reports the treatments given and the frequency of complications, also related to treatment, mortality and sequelae related to various toxic agents. Methods All acute poisonings in adults (≥16 years admitted to the five hospitals in Oslo were included consecutively during one year (2008 to 2009 in an observational cross-sectional multicenter study. A standardized form was completed by the treating physician, which covered the study aims. Results There were 1065 admissions in 912 patients. The median length of hospital stay was one day, and 49% were observed in an intensive care unit (ICU. Active treatment was given to 83%, and consisted of supportive therapy (70%, antidote(s (38%, activated charcoal (16% and gastric lavage (9%. The most commonly used antidotes were flumazenil (19%, naloxone (17% and N-acetylcysteine (11%. The rate of treatment-related complications was 2.4% (21/884. Neither flumazenil, naloxone, nor the combination, was associated with convulsions or other complications. Among those receiving N-acetylcysteine, 5% (6/120 developed allergic reactions, one of which mandated discontinuation of treatment. Nineteen percent presented in a coma. Complications developed in 30%, compared with 18% in a 2003 study, mainly respiratory depression (12%, prolonged QTc interval (6% and hypotension (5%. Eight patients died (0.8% and five (0.5% survived with permanent sequelae, mainly anoxic brain damage. Discussion Few patients stayed more than two days. The use of the ICU was liberal, considering that only one out of five presented in a coma. Antidotes were frequently given diagnostically. Although N-acetylcysteine induced allergic reactions, most were mild and treatment discontinuation was only necessary once. The frequency of complications had almost doubled in five years, although the poisoning pattern was


    Basavaraj R


    Full Text Available BACKGROUND AND OBJECTIVES: Organophosphorus compound poisoning is the most common medico toxic emergency in India the increase in pesticide use in agriculture has paralleled the increase in the use of these products for deliberate self-warm. Respiratory failure is the most common complication of OP poisoning leading to death. Early recognition and prompt ventilator support may improve survival. Owing to limited availability of resources, all OP poisoning patients are not managed in ICUs in Indian setup. It is therefore important that clinical features and criteria to predict the need for ventilator support be identified at initial examination. Hence this study was undertaken to assess the severity of organophosphorus compound poisoning both clinically by using Peradeniya scoring and by estimating serum choline esterase levels. METHODS: Cross sectional study was done at basaveswar teaching and general hospital attached to MR Medical College. Cases with history of exposure to organophosphorus compound within previous 24 hours were chosen after applying inclusion and exclusion criteria. Patients were evaluated for Peradeniya OP poisoning scale and serum cholinesterase levels for assessment of severity of poisoning. Serum cholinesterase levels and Peradeniya OP poisoning scale were studied to predict the need for ventilator support. The results were analyzed using Chi-square test. STATISTICAL ANALYSIS: It was done using pearson’s chi square test. RESULTS: In this study requirement of ventilator support was seen in 36% of patients. Mortality in our study was 18%. Only 15.6% of patients with mild grade of poisoning according to Peradeniya OP poisoning scale required ventilator support, whereas 84.4% did not require ventilator support. Most of patients with moderate (70.6% and severe poisoning (100% according to Peradeniya OP poisoning scale required ventilator support. 93.7% of patients with serum cholinesterase levels more than 50% did not require

  17. Protective effect of HI-6 and trimedoxime combination in mice acutely poisoned with tabun, dichlorvos or heptenophos

    Antonijević, Biljana; Vučinić, Slavica; Ćupić, V.


    The aim of this study was to compare the protective effect of two individual oximes (HI-6 and trimedoxime) with their combination in mice acutely poisoned with tabun, dichlorvos or heptenophos. Oxime HI-6 did not protect experimental animals against either dichlorvos, heptenophos or tabun. Trimedoxime was very effective against all three OPs. The ED-500 doses of trimedoxime necessary to protect 50% of animals after the simultaneous administration of OPs and oxime were 42.18, 14.97 and 32.08 μ...

  18. Acute carbon monoxide poisoning in an animal model: the effects of altered glucose on morbidity and mortality.

    Penney, D G


    An animal model in which the common carotid artery and the jugular vein serving one side of the brain are occluded by indwelling catheters has been used during the past few years to investigate acute carbon monoxide (CO) poisoning. This article reviews the recent research examining the pattern of changes in blood glucose concentration which results from CO exposure, and the manner in which altered glucose concentration alters neurologic outcome and mortality. At present it appears that either greatly depressed glucose or greatly elevated glucose during and/or after CO exposure increases morbidity and mortality. Cyanide (CN) poisoning, in contrast to CO, produces a different pattern of changes in blood glucose and lactate, and unlike CO, fails to slow cardiac AV conduction and ventricular repolarization. Through the use of magnetic resonance imaging and spectroscopic techniques, cerebral cortical edema and the changes in brain phosphagens have been assessed following CO poisoning in the rat. The published results as well as data from recent pilot studies are discussed in the light of our current understanding of CO toxicology.

  19. An unusual case of homicide by use of repeated administration of organophosphate insecticides.

    De Letter, E A; Cordonnier, J A C M; Piette, M H A


    We present an unusual murder case by use of repeated administration of organophosphate insecticides. A 49-year-old woman suffering from mental retardation, epileptic fits and acromegaly was poisoned by her husband. At first, her death was considered as a 'sudden and unexpected' natural death. Abdominal abscesses of pancreatic origin found at autopsy were compatible with repeated administration of pesticides with anticholinergic action. In her medical history at least one episode consistent with an organophosphate intoxication was retrieved. Thorough inquiry revealed that the victim had ingested phosphamidon and/or omethoate orally. Organophosphate intoxication should be considered when unexplained neurological symptoms are associated with pancreatic disturbances.

  20. The Antidotal Effects of High-dosage γ-Aminobutyric Acid on Acute Tetramine Poisoning as Compared with Sodium Dimercaptopropane Sulfonate

    SUN Peng; HAN Jiyuan; WENG Yuying


    To investigate the therapeutic effect of high-dosage γ-aminobutyric acid (GABA) on acute tetramine (TET) poisoning, 50 Kunming mice were divided into 5 groups at random and the antidotal effects of GABA or sodium dimercaptopropane sulfonate (Na-DMPS) on poisoned mice in different groups were observed in order to compare the therapeutic effects of high-dosage GABA with those of Na-DMPS. Slices of brain tissue of the poisoned mice were made to examine pathological changes of cells. The survival analysis was employed. Our results showed that both high-dosage GABA and Na-DMPS could obviously prolong the survival time, delay onset of convulsion and muscular twitch, and ameliorate the symptoms after acute tetramine poisoning in the mice.Better effects could be achieved with earlier use of high dosage GABA or Na-DMPS. There was no significant difference in prolonging the survival time between high-dose GABA and Na-DMPS used immediately after poisioning. It is concluded that high-dosage GABA can effectively antagonize acute toxicity of teramine in mice. And it is suggested that high-dosage GABA may be used as an excellent antidote for acute TET poisoning in clinical practice. The indications and correct dosage for clinical use awaits to be further studied.

  1. Technetium-99m diethylenetriaminepentaacetic acid radioaerosol scintigraphy in organophosphate induced pulmonary toxicity: experimental study.

    Yavuz, Yucel; Kaya, Eser; Yurumez, Yusuf; Sahin, Onder; Bas, Orhan; Fidan, Huseyin; Sezer, Murat


    The aim of this experimental study was to investigate pathological signs of lung damages caused by acute organophosphate (OP) poisoning by using Tc-99m DTPA radioaerosol scintigraphy and histopathological investigation. Fourteen rabbits were divided into two equal groups (n = 7). Group 1 (control group) received normal saline (same volume of fenthion, 2 ml/kg) via orogastric tube. Group 2 (OP toxicity group) received 150 mg/kg of fenthion (diluted fenthion, 2 ml/kg) via orogastric tube. Six hours later, Tc-99m-DTPA aerosol inhalation lung scintigraphy was performed in both groups. Then all rabbits were anesthetized with ketamine hydrochloride (35 mg/kg, i.p.) and xysilazine (5 mg/kg, i.p.), and sacrificed by intracardiac blood discharge. The lungs were then removed. There was a significant difference in T1/2 values of Tc-99m DTPA clearance between control group and OP toxicity group (p = 0.04). Intraparenchymal vascular congestion and thrombosis, intraparenchymal hemorrhage, respiratory epithelial proliferation, number of macrophages in the alveolar, and bronchial lumen, alveolar destruction, emphysematous changes, and bronchoalveolar hemorrhage scores were significantly higher in the rabbits exposed to OP compared with the control group (p lung scintigraphy was found to be a sensitive determination of acute lung damage in OP poisoning.

  2. Rapid Evaluation of the Severity and Prognosis of Acute Carbon Monoxide Poisoning

    Z. N. Marupov


    Full Text Available Objective: to assess whether cardiointervalography (CIG might be used to define the health status of patients with carbon monoxide poisoning. Subjects and methods. The autonomic nervous system (ANS was studied in 114 patients aged 16 to 80 years with carbon monohydrate poisoning who were treated at the N. V. Sklifosovsky Research Institute of Emergency Care, Moscow, in 2004—2009. Cardiointervalographic readings were analyzed in relation to condition severity and disease outcome. Results. Within the first hours after carbon monoxide poisoning, the function of the ANS was found to be impaired, which was associated with the development of hypersym-pathicotonia caused by the increased activity of its sympathetic part and the decreased tone of the parasympathet-ic one. The magnitude of hypersympathicotonia depended on the severity of poisoning and the outcome of the disease. The preponderance of ANS parasympathetic part tone suggests disturbed adaptive and compensatory mechanisms and poor prognosis. Conclusion. Cardiointervalography is recommended for the objective evaluation of the severity of carbon monoxide poisoning and the efficiency of performed treatment and prediction of the outcome of the disease. Key words: carbon monoxide, autonomic nervous system, cardiointervalography, adaptive and compensatory mechanisms.

  3. Relationship between Acute Organophosphorus Pesticide Poisoning and Damages Induced by Free Radicals


    Objective To study the relationship between abnormal reactions of free radicals in bodies of patients with acute organophosphorus pesticide poisoning (AOPP) and damages induced by free radicals. Methods 58 AOPP patients and 58 healthy adult volunteers (HAV) were enrolled in an independent samples control design, in which spectrophotometric methods were used to determine the concentrations of nitric oxide (NO) and lipoperoxides (LPO) in plasma, and LPO in erythrocytes, vitamin C (VC), vitamin E (VE) and b-carotene (b-CAR) in plasma as well as activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px) and acetylcholinesterase (AChE) in erythrocytes. Results Compared with the average values of every biochemical parameter in the HAV group, the average values of LPO in plasma and in erythrocytes, and NO in plasma in the AOPP group were significantly increased (P=0.000001), while the average values of VC, VE, a-CAR in plasma as well as SOD, CAT, GSH-Px and AChE in erythrocytes in the AOPP group were significantly decreased (P=0.000001). The findings of Pearson product-moment correlation analysis between the value of AChE in erythrocytes and the values of above biochemical parameters for 58 AOPP patients showed that there was a significant linear negative correlation between AChE in erythrocytes and LPO, NO in plasma, and LPO in erythrocytes (P=0.000001~0.001319), while there was a significant linear positive correlation between AChE in erythrocytes and VC, VE, a-CAR in plasma as well as SOD, CAT, GSH-Px in erythrocytes (P=0.000013~0.000824). The results of discriminant analysis of above chemical parameters for 58 AOPP patients and 58 HAV suggested that the correct rates of discriminant analysis were increased to 100 % when the values of AChE and LPO in plasma and in erythrocytes, or AChE and others, were jointly used for the discriminant analysis. Conclusion The findings of the present study suggest that a series of free radical

  4. [Acute accidental poisoning in children: aspects of their epidemiology, aetiology, and outcome at the Charles de Gaulle Paediatric Hospital in Ouagadougou (Burkina Faso)].

    Kouéta, Fla; Dao, Lassina; Yé, Diarra; Fayama, Zéinabou; Sawadogo, Alphonse


    Accidents are a daily concern in the paediatric ward because of their frequency, diversity and severity. Acute accidental poisoning (AAP) accounts for an important portion of these. To help improvement management of AAP, we conducted a retrospective study covering a period of 2 years from January 2005 to December 2006 at Charles de Gaulle Paediatric University Hospital in Ouagadougou. Of 9390 admissions during the study period, 123 children, or 1.3%, were admitted for poisoning. A cumulative average of 11 were admitted monthly, with a peak of 16 patients in April 2005 and 2006, together. AAP was most common among children aged 1 to 4 years. Their mean age was 3 years and ranged from 6 days to 12 years. Boys outnumbered girls, with a sex ratio of 1.2. Mothers of more than half (61%) of the children poisoned worked in the home. Household products accounted for 44.7% of AAPs, followed by drug (22.7%) and food (22%) poisoning. Kerosene and other petroleum products topped the list of household products, with 54.5%. Tranquilizers (46.4%) and dairy products (37%) dominated the drug and food poisoning categories. Immediate outcome was fatal in 3% of cases, and three quarters of these deaths occurred during drug poisoning of children aged 1 to 4 years. The mean hospital stay was 2 days, and ranged from 0 to 9 days. Health officials, the media, and community outreach must all help to increase awareness about the dangers of poisoning and of preventive measures.

  5. [BIS values were useful on the evaluation of consciousness recovery in acute Vegetamin-A poisoning: report of a case].

    Matsumoto, Hironori; Umakoshi, Kensuke; Kikuchi, Satoshi; Takeba, Jun; Aibiki, Mayuki


    A 37-year-old man was admitted to our hospital with acute phenobarbital poisoning. On arrival, he was in deep coma with respiro-circulatory depressions. The serum concentration of the agent was elevated to 149.04 μg/mL which was consistent with a lethal concentration level. He underwent a gastric lavage, administration of activated charcoal, urinary alkalinazation and bowel irrigation. Respiro-circulatory status was recovered rapidly, while the serum concentration of phenobarbital did not decrease smoothly. Although the concentration of the agent decreased to 77.07 μg/mL that should be a comatose level, BIS values were gradually elevated, and then eventually the patient regained his consciousness. Because he was a chronic user of Vegetamin-A containing phenobarbital, the serum level might not have been correlated with symptoms. BIS values were highly reflective of the consciousness level, so it could be a useful indicator for predicting the consciousness levels of patients in deep coma with acute poisoning from hypnotic agents.

  6. 有机磷中毒合并呼吸衰竭发生医院感染的预防措施探讨%Risk factors of nosocomial infections in organophosphate poisoning patients complicated with respiratory failure and the preventive countermeasures



    目的 研究有机磷中毒合并呼吸衰竭医院感染发生率及危险因素,探讨相应的防范措施,使有机磷中毒合并呼吸衰竭医院感染能够得到有效预防.方法 回顾性分析2008年12月-2012年8月收治的114例有机磷中毒发生医院感染患者的相关临床资料,分析出现医院感染的危险因素,并提出相应的护理防范措施.结果 呼吸道感染占首位,感染率为68.42%;合并误吸、血糖水平、超敏C-反应蛋白、胆碱酯酶的活性、手卫生、使用呼吸机、住ICU的时间与医院感染率均有一定的相关性;影响患者发生医院感染的主要危险因素依次为使用呼吸机(OR=19.513、P=0.000)、胆碱酯酶活性(OR=2.116、P=0.013)、合并误吸(OR=2.401、P=0.019)、手卫生问题(OR=2.408、P=0.021).结论 有机磷中毒合并呼吸衰竭医院感染严重威胁患者的生活质量,针对相应的危险因素,合理应用抗菌药物、加强口腔护理、保证严格的无菌操作、熟练操作技能、密切关注患者病情、严格管理制度是十分必要的.%OBJECTIVE To study the incidence and the risk factors of nosocomial infections in organophosphate poisoning patients complicated with respiratory failure and explore the appropriate precautions so as to effectively prevent the nosocomial infections.METHODS The clinical data of totally 114 organophosphate poisoning patients complicated with nosocomail infections who were treated in the hospital from Dec 2008 to Aug 2012 were retrospectively analyzed,the risk factors of the nosocomial infections were analyzed,and corresponding nursing countermeasures were put forward.RESULTS The incidence of respiratory tract infections was the highest (68.42%).The incidence of the nosocomial infections was related to the combined aspiration,blood glucose level,high-sensitivity C-reactive protein,use of ventilator,activity of cholinesterase,hand hygiene,or length of ICU stay; the main risk factors associated

  7. Recommendations for the role of extracorporeal treatments in the management of acute methanol poisoning

    Roberts, Darren M; Yates, Christopher; Megarbane, Bruno


    in Poisoning workgroup aimed to develop evidence-based consensus recommendations for extracorporeal treatment in methanol poisoning. DESIGN AND METHODS: Utilizing predetermined methods, we conducted a systematic review of the literature. Two hundred seventy-two relevant publications were identified...... to methanol: coma, seizures, new vision deficits, metabolic acidosis with blood pH ≤7.15, persistent metabolic acidosis despite adequate supportive measures and antidotes, serum anion gap higher than 24 mmol/L; or, serum methanol concentration 1) greater than 700 mg/L (21.8 mmol/L) in the context...

  8. Recognition and Management of Pesticide Poisonings. Third Edition.

    Morgan, Donald P.

    This manual aids health professionals in recognizing and treating pesticide poisonings. Suggested treatments are appropriate for implementation in the small hospitals and clinics which usually receive the victims of pesticide poisoning. Classes of compounds covered include: (1) organophosphate cholinesterase-inhibiting pesticides; (2) carbamate…

  9. An in vivo zebrafish screen identifies organophosphate antidotes with diverse mechanisms of action.

    Jin, Shan; Sarkar, Kumar S; Jin, Youngnam N; Liu, Yan; Kokel, David; Van Ham, Tjakko J; Roberts, Lee D; Gerszten, Robert E; Macrae, Calum A; Peterson, Randall T


    Organophosphates are a class of highly toxic chemicals that includes many pesticides and chemical weapons. Exposure to organophosphates, either through accidents or acts of terrorism, poses a significant risk to human health and safety. Existing antidotes, in use for over 50 years, have modest efficacy and undesirable toxicities. Therefore, discovering new organophosphate antidotes is a high priority. Early life stage zebrafish exposed to organophosphates exhibit several phenotypes that parallel the human response to organophosphates, including behavioral deficits, paralysis, and eventual death. Here, we have developed a high-throughput zebrafish screen in a 96-well plate format to find new antidotes that counteract organophosphate-induced lethality. In a pilot screen of 1200 known drugs, we identified 16 compounds that suppress organophosphate toxicity in zebrafish. Several in vitro assays coupled with liquid chromatography/tandem mass spectrometry-based metabolite profiling enabled determination of mechanisms of action for several of the antidotes, including reversible acetylcholinesterase inhibition, cholinergic receptor antagonism, and inhibition of bioactivation. Therefore, the in vivo screen is capable of discovering organophosphate antidotes that intervene in distinct pathways. These findings suggest that zebrafish screens might be a broadly applicable approach for discovering compounds that counteract the toxic effects of accidental or malicious poisonous exposures.

  10. Analysis on structural characteristics of poison system in acute poisoning of Guangxi%广西急性中毒毒物体系构成特点分析

    蒋东方; 张振明; 刘清华


    A total of 6004 cases of acute poisoning with 532 kinds of related poisons from 63hospitals were analyzed.According to the classification of pharmaceutical,pesticide,chemical,animal,plant and other poisons,the numbers of poison categories were 217,148,61,34,36 and 36 kinds accounting for 40.8%,27.8%,11.5%,6.4%,6.8%,6.7% of total number of poisons respectively.According to the case count,they were divided into three groups of low,medium and high morbidity and their poison numbers were 462,59 and 11 kinds accounting for 86.8%,11.1%,2.1% of total number of poisons respectively.According to the types of poisons,they were divided into five groups of poisoning 1,2,3,4,5 years and their poison numbers were 320,91,34,33 and 54 kinds accounting for 60.2%,17.1%,6.4%,6.2%,10.1% of total number of poisons respectively.According to the time of poisoning,they were divided into three groups of 1-year,discontinuous and perennial poisoning and their poison numbers were 320,158 and 54 kinds accounting for 60.2%,29.7%,10.1% of total number of poisons respectively.%分析63家医院收治的6004例急性中毒病例的相关毒物,共有532种,按医药、农药、化学、动物、植物、其他分为6类,各类毒物数为217、148、61、34、36、36种,分别占总毒物数的40.8%、27.8%、11.5%、6.4%、6.8%、6.7%.将各类毒物按中毒病例数分为低、中、高发病3组,各组毒物数分别为462(86.8%)、59(11.1%)、11(2.1%)种.各类毒物按中毒发生年数分为5个组,各类毒物合计数分别为320(60.2%)、91(17.1%)、34(6.4%)、33(6.2%)、54(10.1%)种.各类毒物按发生中毒的时间分为1年、间断、常年中毒3个组,各类毒物合计数分别为320(60.2%)、158 (29.7%)、54(10.1%)种.

  11. A study of neurologic symptoms on exposure to organophosphate pesticides in the children of agricultural workers

    Rastogi S


    Full Text Available Pesticides are used extensively throughout the world in agriculture and in pest control as well as for community health purposes. Organophosphate (OP pesticide self-poisoning is an important clinical problem in rural regions of the developing world that kills an estimated 200,000 people every year. Unintentional poisoning kills far fewer people but is an apparent problem in places where highly toxic OP pesticides are available. Neurologic dysfunction is the best documented health effect of pesticide exposure. High-level exposure has both acute and long-term neurologic signs and symptoms, and adverse effects have been reported in most type of pesticides, including organophosphate (OP, carbamate, organochlorine, and pyrethroid insecticides, herbicides, fungicides, and fumigants. Acute OP pesticide exposure can involve in wide range of both central and peripheral neurologic symptoms. Increased neurologic symptom prevalence may provide early evidence of neurologic dysfunctions, before clinically measurable signs are evident. In this study, we analyzed the cross-sectional data on neurologic signs and symptoms from 225 rural children, both males (n = 132 and females (n = 93 who were occupationally and paraoccupationally exposed to methyl OPs (dichlorvos, fenthion, malathion, methyl parathion and ethyl OPs (chlorpyrifos, diazinon, ethyl parathion as they belonged to agricultural families handling, mixing, and spraying the OP pesticides. The children completed a specially designed questionnaire (Q16 on neurologic symptoms associated with pesticide exposure with their parental help. A suitable reference group consisting of rural children (n = 50 never involved in pesticide handling (neither outdoor nor indoor belonging to similar socioeconomic strata included in the study to compare the prevalence of various neurologic symptoms between the two groups. Among all the neurologic self-reported symptoms, headache, watering in eyes, and burning sensation in

  12. Four-Year Study on Acute Poisoning Cases Admitted to a Tertiary Hospital in Bangladesh: Emerging Trend of Poisoning in Commuters

    Mohammad Shafiqul Bari


    Conclusion:Commuter or travel-related poisoning is an emerging public health threat in this part of Bangladesh. Public awareness should be raised and school-based educational programs should be emphasized regarding the commuter poisoning and the consequence of accepting and eating food from strangers.

  13. Is prevention of acute pesticide poisoning effective and efficient, with Locally Adapted Personal Protective Equipment?

    Varma, Anshu; Neupane, Dinesh; Ellekilde Bonde, Jens Peter


    BACKGROUND: Farmers' risk of pesticide poisoning can be reduced with personal protective equipment but in low-income countries farmers' use of such equipment is limited. OBJECTIVE: To examine the effectiveness and efficiency of Locally Adapted Personal Protective Equipment to reduce organophospha...

  14. acute poisoning in the community and its associated mortality at the ...


    , Lusaka, Zambia ... poisoning by drugs or chemicals, is an important medical .... Herbal medicines. 1 ... HIV/AIDS. 13. 9.9. Others. 11. 8.4. None. 83. 63.4. Table 5: Co-morbidities (n=131) ... This age-group is associated with pregnancy, child-.

  15. A Yearlong Epidemiologic Study on Unintentional Acute Carbon Monoxide Poisoning in Fars Province, Southwest Iran

    Alireza Mirahmadizadeh


    Conclusion: Generally, the incidence and fatality rate of CO poisoning in the current study were comparable to those of the world statistics, but higher than in developed counties. Attention and emphasis on the safety of gas heaters, stoves, and other gas-powered appliances in residential places should be enforced.

  16. Is prevention of acute pesticide poisoning effective and efficient, with Locally Adapted Personal Protective Equipment?

    Varma, Anshu; Neupane, Dinesh; Ellekilde Bonde, Jens Peter;


    BACKGROUND: Farmers' risk of pesticide poisoning can be reduced with personal protective equipment but in low-income countries farmers' use of such equipment is limited. OBJECTIVE: To examine the effectiveness and efficiency of Locally Adapted Personal Protective Equipment to reduce organophospha...

  17. Food Poisoning

    ... Want to Know About Puberty Train Your Temper Food Poisoning KidsHealth > For Kids > Food Poisoning Print A ... find out how to avoid it. What Is Food Poisoning? Food poisoning comes from eating foods that ...

  18. Pralidoxime in acute organophosphorus insecticide poisoning--a randomised controlled trial.

    Michael Eddleston


    Full Text Available Poisoning with organophosphorus (OP insecticides is a major global public health problem, causing an estimated 200,000 deaths each year. Although the World Health Organization recommends use of pralidoxime, this antidote's effectiveness remains unclear. We aimed to determine whether the addition of pralidoxime chloride to atropine and supportive care offers benefit.We performed a double-blind randomised placebo-controlled trial of pralidoxime chloride (2 g loading dose over 20 min, followed by a constant infusion of 0.5 g/h for up to 7 d versus saline in patients with organophosphorus insecticide self-poisoning. Mortality was the primary outcome; secondary outcomes included intubation, duration of intubation, and time to death. We measured baseline markers of exposure and pharmacodynamic markers of response to aid interpretation of clinical outcomes. Two hundred thirty-five patients were randomised to receive pralidoxime (121 or saline placebo (114. Pralidoxime produced substantial and moderate red cell acetylcholinesterase reactivation in patients poisoned by diethyl and dimethyl compounds, respectively. Mortality was nonsignificantly higher in patients receiving pralidoxime: 30/121 (24.8% receiving pralidoxime died, compared with 18/114 (15.8% receiving placebo (adjusted hazard ratio [HR] 1.69, 95% confidence interval [CI] 0.88-3.26, p = 0.12. Incorporating the baseline amount of acetylcholinesterase already aged and plasma OP concentration into the analysis increased the HR for patients receiving pralidoxime compared to placebo, further decreasing the likelihood that pralidoxime is beneficial. The need for intubation was similar in both groups (pralidoxime 26/121 [21.5%], placebo 24/114 [21.1%], adjusted HR 1.27 [95% CI 0.71-2.29]. To reduce confounding due to ingestion of different insecticides, we further analysed patients with confirmed chlorpyrifos or dimethoate poisoning alone, finding no evidence of benefit.Despite clear reactivation of

  19. Intravenous Lipid Emulsion as an Antidote for the Treatment of Acute Poisoning: A Bibliometric Analysis of Human and Animal Studies.

    Zyoud, Sa'ed H; Waring, W Stephen; Al-Jabi, Samah W; Sweileh, Waleed M; Rahhal, Belal; Awang, Rahmat


    In recent years, there has been increasing interest in the role of intravenous lipid formulations as potential antidotes in patients with severe cardiotoxicity caused by drug toxicity. The aim of this study was to conduct a comprehensive bibliometric analysis of all human and animal studies featuring lipid emulsion as an antidote for the treatment of acute poisoning. The Scopus database search was performed on 5 February 2016 to analyse the research output related to intravenous lipid emulsion as an antidote for the treatment of acute poisoning. Research indicators used for analysis included total number of articles, date (year) of publication, total citations, value of the h-index, document types, countries of publication, journal names, collaboration patterns and institutions. A total of 594 articles were retrieved from Scopus database for the period of 1955-2015. The percentage share of global intravenous lipid emulsion research output showed that research output was 85.86% in 2006-2015 with yearly average growth in this field of 51 articles per year. The USA, United Kingdom (UK), France, Canada, New Zealand, Germany, Australia, China, Turkey and Japan accounted for 449 (75.6%) of all the publications. The total number of citations for all documents was 9,333, with an average of 15.7 citations per document. The h-index of the retrieved documents for lipid emulsion research as antidote for the treatment of acute poisoning was 49. The USA and the UK achieved the highest h-indices, 34 and 14, respectively. New Zealand produced the greatest number of documents with international collaboration (51.9%) followed by Australia (50%) and Canada (41.4%) out of the total number of publications for each country. In summary, we found an increase in the number of publications in the field of lipid emulsion after 2006. The results of this study demonstrate that the majority of publications in the field of lipid emulsion were published by high-income countries. Researchers from

  20. Reversible cerebral periventricular white matter changes with corpus callosum involvement in acute toluene-poisoning.

    Lin, Chih-Ming; Liu, Chi-Kuang


    Substance poisoning, such as toluene intoxication, has seldom been reported in the relevant literature. The documented cerebral neuroimaging has mostly described reversible symmetrical white matter changes in both the cerebral and cerebellar hemispheres. This paper presents 2 patients with toluene poisoning, whose brain magnetic resonance imaging studies showed a similar picture that included extra involvement over the corpus callosum; however, such corpus callosum involvement has never been mentioned and is quite rare in the literature. We discussed the underlying neuropathological pathways in this article. Hopefully, these cases will provide first-line clinicians with some valuable information with regard to toluene intoxication and clinical neuroimaging presentations. Copyright © 2014 by the American Society of Neuroimaging.

  1. Effect of a brief outreach educational intervention on the translation of acute poisoning treatment guidelines to practice in rural Sri Lankan hospitals: a cluster randomized controlled trial.

    Lalith Senarathna

    Full Text Available BACKGROUND: In developing countries, including Sri Lanka, a high proportion of acute poisoning and other medical emergencies are initially treated in rural peripheral hospitals. Patients are then usually transferred to referral hospitals for further treatment. Guidelines are often used to promote better patient care in these emergencies. We conducted a cluster randomized controlled trial (ISRCTN73983810 which aimed to assess the effect of a brief educational outreach ('academic detailing' intervention to promote the utilization of treatment guidelines for acute poisoning. METHODS AND FINDINGS: This cluster RCT was conducted in the North Central Province of Sri Lanka. All peripheral hospitals in the province were randomized to either intervention or control. All hospitals received a copy of the guidelines. The intervention hospitals received a brief out-reach academic detailing workshop which explained poisoning treatment guidelines and guideline promotional items designed to be used in daily care. Data were collected on all patients admitted due to poisoning for 12 months post-intervention in all study hospitals. Information collected included type of poison exposure, initial investigations, treatments and hospital outcome. Patients transferred from peripheral hospitals to referral hospitals had their clinical outcomes recorded. There were 23 intervention and 23 control hospitals. There were no significant differences in the patient characteristics, such as age, gender and the poisons ingested. The intervention hospitals showed a significant improvement in administration of activated charcoal [OR 2.95 (95% CI 1.28-6.80]. There was no difference between hospitals in use of other decontamination methods. CONCLUSION: This study shows that an educational intervention consisting of brief out-reach academic detailing was effective in changing treatment behavior in rural Sri Lankan hospitals. The intervention was only effective for treatments with

  2. Legalon® SIL: the antidote of choice in patients with acute hepatotoxicity from amatoxin poisoning.

    Mengs, Ulrich; Pohl, Ralf-Torsten; Mitchell, Todd


    More than 90% of all fatal mushroom poisonings worldwide are due to amatoxin containing species that grow abundantly in Europe, South Asia, and the Indian subcontinent. Many cases have also been reported in North America. Initial symptoms of abdominal cramps, vomiting, and a severe cholera-like diarrhea generally do not manifest until at least six to eight hours following ingestion and can be followed by renal and hepatic failure. Outcomes range from complete recovery to fulminant organ failure and death which can sometimes be averted by liver transplant. There are no controlled clinical studies available due to ethical reasons, but uncontrolled trials and case reports describe successful treatment with intravenous silibinin (Legalon® SIL). In nearly 1,500 documented cases, the overall mortality in patients treated with Legalon® SIL is less than 10% in comparison to more than 20% when using penicillin or a combination of silibinin and penicillin. Silibinin, a proven antioxidative and anti-inflammatory acting flavonolignan isolated from milk thistle extracts, has been shown to interact with specific hepatic transport proteins blocking cellular amatoxin re-uptake and thus interrupting enterohepatic circulation of the toxin. The addition of intravenous silibinin to aggressive intravenous fluid management serves to arrest and allow reversal of the manifestation of fulminant hepatic failure, even in severely poisoned patients. These findings together with the available clinical experience justify the use of silibinin as Legalon® SIL in Amanita poisoning cases.

  3. Acute poisoning due to alkalis used during industrial cleaning of soft drinks' glass containers: a case report.

    Stefanidou, M; Georgiou, M; Koupparis, M; Koutselinis, A


    Corrosive alkalis are used in the soft drink and beer industries for the cleaning of the non-disposable glass containers using several different methods. It is well understood that complete cleaning of these vessels by multiple and well-organized rinsing is an absolute necessity. In cases of disturbance of this process, some residuals of alkaline agents may be retained in the glass containers, causing severe health risks to consumers. This case of acute poisoning due to caustic alkalis concerns a young woman who consumed carbonated lemonade from a non-disposable glass container. Clinical signs and symptoms and the treatment of the affected woman are described. Toxicological analysis of the soft drink consumed led to the detection, identification and quantitative determination of the presence of the alkalis.

  4. Miotoxicidade por organofosforados Organophosphate myotoxicity

    Maria J. Cavaliere


    Full Text Available Os organofosforados são um grupo de compostos químicos amplamente utilizados em agropecuária como inseticidas, ocasionando intoxicações acidentais em animais e humanos, e mesmo sendo utilizados em tentativas de suicídio. A toxicidade desses produtos decorre sobretudo de insuficiência cárdio-respiratória por compromentimento do sistema nervoso autônomo. Sabe-se que alguns destes compostos induzem em animais de experimentação e em humanos, uma miopatia caracterizada por degeneração de células musculares, comprometendo sobretudo a musculatura respiratória. Baseado no fato de que este comprometimento contribui para a piora da função respiratória, propõe-se um protocolo de avaliação rotineira de miotoxicidade por compostos organofosforados, através de uma bateria mínima e suficiente de colorações e reações histoquímicas para quantificação da necrose muscular. Utilizaram-se como modelo experimental, grupos de ratos albinos (Wistar intoxicados com o organofosforado paraoxon, com e sem antídotos (atropina ou pralidoxima. Verificou-se nos grupos tratados com paraoxon e paraoxon mais atropina, necrose de fibras musculares no diafragma, que atingia em determinadas áreas até 15% das fibras. No grupo tratado com paraoxon mais pralidoxima, a necrose foi mínima, evidenciando o papel mioprotetor deste último antídoto.Organophosphates comprise a group of chemical compounds extensively used in farming as insecticides, which cause accidental poisoning in animals and men and are also used in suicide attempts. The toxicity of these compounds is due especially to the cardiac and respiratory impairment in consequence of autonomic nervous system disorders. However, it is known that some of these products induce a myopathy in experimental animals and humans. This myopathy is characterized by muscle cell degeneration, involving above all the respiratory muscles. Based on the fact that this involvement certainly enhances the

  5. Experience of Diagnosis and Treatment of Patients with Organophosphorus Pesticide Poisoning%有机磷中毒的诊治心得体会



    目的对有机磷中毒的诊断和治疗进行讨论。方法将1例急性有机磷中毒临床资料进行回顾并将治疗结果进行分析。结果患者康复出院。结论对有机磷中毒患者进行准确快速的诊断后及时给与复能剂与解毒剂,防止阿托品中毒,在改善患者的治愈率及身心健康方面所起的作用是明显的。%Objective To discuss the diagnosis and treatment of organophosphate poisoning. Methods Review the case of acute organophosphate poisoning clinical information and treatment results were analyzed. Results Patients rehabilitation hospital discharge.Conclusion Accurate rapid diagnosis to patients with organophosphorus poisoning after timely give reply to agent and antidote, prevent atropine poisoning, in improving the patient's cure rate and the role of the physical and mental health is obvious.

  6. One case of acute Alocasia macrorrhiza poisoning and management%急性海芋中毒救治1例

    谢立璟; 王英伟; 龙鑫; 孙承业


    A 44-year-old man took the tuber of Alocasia macronhiza by mistake. Several minutes after ingestion of the tuber, he presented with numbness of lip, sore throat, nausea, vomiting, salivation, dyspnea, and dysphonia. Twenty minutes after poisoning, he was hospitalized and diagnosed as having acute laryngeal edema. He received diphenhydramine 20 mg and dexamethasone 5 mg via IV push, followed by an IV infusion of dexaroethasone 10 mg. Meanwhile oxygen inhalation, liver protective treatment, and other symptomatic treatment were given. Five hours after poisoning, his symptoms gradually resolved and, 50 days later, he recovered. Alocasia macronhiza is a poisonous plant of Alocasia Sckott in the family Araceae, and it contains sapotoxin and calcium oxalate which can induce neurological and gastrointestinal disorder after ingestion of the plant. The latent period from exposure to onset of symptoms is 10 to 30 minutes and death might occur in patients with severe poisoning. Skin contact or eye contact with Alocasia macronhiza juice can cause pruritus, conjunctivitis, and even blindness. Inhalation of Alocasia macronhiza powder can lead to severe mucosal irritation in the eye, nasal cavity, and throat. Poisoning could be diagnosed by the history of contact with the plant and clinical manifestations. There is no specific antidote for Alocasia macronhiza poisoning and main management is symptomatic treatment.%1例44岁男性误食海芋块根,数分钟后出现口唇麻木、咽喉疼痛、恶心、呕吐、流涎、呼吸困难、发音困难等症状,中毒后20 min入院,诊断为急性喉头水肿.给予静脉推注苯海拉明20 mg、地塞米松5mg和静脉滴注地塞米松10 ng等处理,并行吸氧、保肝等对症治疗.中毒5h后症状逐渐好转,50 d后痊愈.海芋是天南星科海芋属有毒植物,含有皂素毒苷及草酸钙等.口服后可致神经和胃肠系统症状,潜伏期一般为10~30 min,严重者可致死亡;皮肤或者眼接触海芋汁

  7. Arrhythmia induced by acute organophosphorous pesticide poisoning: a literature review%有机磷农药中毒心律失常国内文献回顾

    宣丹旦; 郑舒聪; 万伟国; 裘昊旻; 邹和建


    对1979至2010年国内学术期刊上发表的有机磷农药中毒心律失常文献进行统计和分析.共收集到有机磷农药中毒3468例,心电图异常率35.4%~68.4%,平均(53±15)%.最常见心电图表现为ST-T段改变(26.5%)和窦性心动过速(16.6%).有机磷农药中毒程度越重,心电图异常例次与患者人数的比值越高,且越容易发生严重心律失常(x2=33.253,P<0.01),最常见死亡原因是室性心动过速和心室颤动(26.2%).%Literatures on arrhythmia induced by acute organophosphorous pesticide poisoning published in domestic journals from 1979 to 2010 were searched. Total 3468 cases of acute organophosphorous poisoning were collected and analyzed. The average abnormal ECC rate was (53 ±15)%(35. 4% -68. 4% ) in acute organophosphorous poisoning, the most common ECG abnormalities were ST-T segment changes (26. 5% ) and sinus tachycardia (16. 6% ). The rate and severity of ECG abnormalities were increased with the severity of organophosphorous poisoning(x2 = 33. 253,P < 0. 01). The most common causes of death in acute organophosphorous poisoning were ventricular tachycardia and ventricular fibrillation (26.2%).

  8. Outcome of patients in acute poisoning with ethylene glycol--factors which may have influence on evolution.

    Tanasescu, A; Macovei, R A; Tudosie, M S


    acidosis was present up to 55,55% (10 of the 18 patients) in the blood gas analysis on admission, with pH on admission between 6.9 and 7.27, with anion gap ranging between 16.3 mmol/l and 32.6 mmol/l (normal range 8-16 mmol/l). Ten patients also had an increased level of urea and creatinine with a level between 1.24 to 6.85 mg/dl for creatinine (normal range 0.5-1.2 mg/dl) and 49 to 98 mg/dl for urea (normal range 15-43 mg/dl) and developed acute kidney injury that required regular HD sessions. Mechanical ventilation was required for 7 of the 18 patients (38.88%). Five patients died (27.77%). Although metabolic acidosis was corrected under hemodialysis, there were patients who had multiple organ failure and systems: acute respiratory failure requiring ventilator support, acute renal failure requiring dialysis daily sessions, altered state of consciousness. The early diagnostic and exclusion of the other diseases and other poisoning led to a specific treatment of the intoxication. The time from the ingestion of ethylene glycol and the early establishment of therapy is very important for a favorable evolution and can prevent substantial mortality.

  9. Therapeutic efficacy of the adenosine A1 receptor agonist N6-cyclopentyladenosine (CPA) against organophosphate intoxication

    Bueters, T.J.H.; Groen, B.; Danhof, M.; IJzerman, A.P.; Helden, H.P.M. van


    The objective of the present study was to investigate whether reduction of central acetylcholine (ACh) accumulation by adenosine receptor agonists could serve as a generic treatment against organophosphate (OP) poisoning. The OPs studied were tabun (O-ethyl-N-dimethylphosphoramidocyanidate), sarin (

  10. Therapeutic efficacy of the adenosine A1 receptor agonist N6-cyclopentyladenosine (CPA) against organophosphate intoxication

    Bueters, T.J.H.; Groen, B.; Danhof, M.; IJzerman, A.P.; Helden, H.P.M. van


    The objective of the present study was to investigate whether reduction of central acetylcholine (ACh) accumulation by adenosine receptor agonists could serve as a generic treatment against organophosphate (OP) poisoning. The OPs studied were tabun (O-ethyl-N-dimethylphosphoramidocyanidate), sarin (

  11. Acute Cyanide Poisoning: Hydroxocobalamin and Sodium Thiosulfate Treatments with Two Outcomes following One Exposure Event

    Andrew Meillier


    Full Text Available Cyanide is rapidly reacting and causes arrest of aerobic metabolism. The symptoms are diffuse and lethal and require high clinical suspicion. Remediation of symptoms and mortality is highly dependent on quick treatment with a cyanide antidote. Presently, there are two widely accepted antidotes: sodium thiosulfate and hydroxocobalamin. These treatments act on different components of cyanide’s metabolism. Here, we present two cases resulting from the same source of cyanide poisoning and the use of both antidotes separately used with differing outcomes.

  12. Emergency care of acute organophosphate poisoning patient%急性有机磷中毒患者的急救护理

    王娟; 姜涛



  13. Emergency care of 62 cases with acute organophosphate poisoning%62例急性有机磷农药中毒病人的抢救护理




  14. Characteristics of acute poisoning in children and advances in the diagnosis and treatment%小儿急性中毒的特点和诊治进展



    Acute poisoning in children is closely related with the surrounding environment. In China,acute poisoning in children,mainly caused by wrong intake of pesticides,drugs and rodenticide,still leads to high mortality in severe acute poisoning cases. Particular emphasis on safe storage of drugs and toxic chemicals mentioned above may reduce poisoning accidents at the source. Of the suspected poisoning cases, besides the detailed medical history and physical examination, poison identification is the most direct and objective method to confirm the diagnosis and evaluate the poisoning severity. Timely diagnosis, appropriate antidote use, extensive application of blood purification therapy, and emphasis on supportive therapy remain critical for the successful treatment. Accurate and comprehensive clinical epidemiological data are considered to be of informative value to identifying poisoning of different regions, ages and sexes.%儿童急性中毒的发生与周围环境密切相关.我国儿童急性中毒以农药、药物和灭鼠药为主,主要因误服误食所致,重症急性中毒的病死率仍较高.加强对药物和上述毒物的管理,可以从源头减少中毒机会.对疑似中毒的患儿,除详细询问病史和查体外,多数情况下毒物鉴定是明确有元中毒和病情严重程度最直接、客观的方法.及时诊断、合理使用解毒药物、普及血液净化治疗技术、重视支持疗法是成功救治的关键.准确而全面的临床流行病学资料有助于对地区性、年龄阶段性及不同性别的中毒起到警示作用.

  15. Toxicology in the Old Testament. Did the High Priest Alcimus die of acute aconitine poisoning?

    Moog, Ferdinand P; Karenberg, Axel


    The Bible contains several interesting contributions to the history of neurology, as is the case of the High Priest Alkimos, who died suddenly in 159 BC. He was regarded as a stereotypical stroke victim for a long time. The reports on his death in the Septauginta and the later 'Jewish Antiquities' of Flavius Josephus present some typical symptoms of stroke (collapse, loss of speech and death within a short time), but they also describe severe pains, which are very unusual among patients with stroke. Similar symptoms can be found in the case of the Roman emperor Claudius, who was poisoned by his spouse Agrippina. It was thought that she used aconitine, an ingredient of the monkshood plant (Aconitum napellus L.), which imitates an apoplectic insult, but also causes vehement pains. It was therefore possible that something similar had happened to Alkimos, as aconitine was a common poison in ancient times and the surroundings of his death may confirm the suspicion. Reigning during a time of great upheaval, Alkimos was able to maintain his high office chiefly because of the help of the Seleucides. He has just begun construction work on the temple of Jerusalem, an order, which was regarded as a sacrilege by his foes. This impression was enhanced by his subsequent illness which could be considered as a divine punishment.

  16. Light irradiation for treatment of acute carbon monoxide poisoning: an experimental study.

    Tanaka, Taku; Kashimura, Takeshi; Ise, Marii; Lohman, Brandon D; Taira, Yasuhiko


    Because treatment modalities for carbon monoxide (CO) poisoning, especially normobaric oxygen and hyperbaric oxygen therapies, have limited effects and hyperbaric oxygen is not available at the scene where treatment is most needed, we conducted a study to determine and compare rates of carboxyhemoglobin (COHb) dissociation achieved in human in vitro blood samples under light radiation emitted at three levels of illuminance. This was done with a view toward eventual on-site application. We drew blood from 10 volunteers, prepared 10 red blood cell solutions, and subjected each solution to a CO bubbling procedure to increase the COHb saturation. Samples of each bubbled solution were then divided between 3 beakers (beakers A, B, and C) for a total of 30 beakers. The solution in each beaker was exposed to a continuous flow of oxygen at 50 mL/min, and simultaneously for a period of 15 min, the beaker A and B solutions were irradiated with light emitted at 500,000 and 100,000 lux, respectively, from a halogen light source. The beaker C solutions were exposed to room light. At 3, 6, 9, 12, and 15 min, a 50-μL sample was pipetted from each of the 30 beakers for determination of its light absorbance and the COHb dissociation rate. Under each of the experimental conditions, dissociation progressed but at different rates, and starting at 3 min, the differences in rates between conditions were significant (P poisoning.

  17. Correlation of computed tomography, magnetic resonance imaging and clinical outcome in acute carbon monoxide poisoning.

    Ozcan, Namik; Ozcam, Giray; Kosar, Pinar; Ozcan, Ayse; Basar, Hulya; Kaymak, Cetin


    Carbon monoxide is a toxic gas for humans and is still a silent killer in both developed and developing countries. The aim of this case series was to evaluate early radiological images as a predictor of subsequent neuropsychological sequelae, following carbon monoxide poisoning. After carbon monoxide exposure, early computed tomography scans and magnetic resonance imaging findings of a 52-year-old woman showed bilateral lesions in the globus pallidus. This patient was discharged and followed for 90 days. The patient recovered without any neurological sequela. In a 58-year-old woman exposed to carbon monoxide, computed tomography showed lesions in bilateral globus pallidus and periventricular white matter. Early magnetic resonance imaging revealed changes similar to that like in early tomography images. The patient recovered and was discharged from hospital. On the 27th day of exposure, the patient developed disorientation and memory impairment. Late magnetic resonance imaging showed diffuse hyperintensity in the cerebral white matter. White matter lesions which progress to demyelination and end up in neuropsychological sequelae cannot always be diagnosed by early computed tomography and magnetic resonance imaging in carbon monoxide poisoning. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  18. Correlation of computed tomography, magnetic resonance imaging and clinical outcome in acute carbon monoxide poisoning

    Namik Ozcan

    Full Text Available Abstract Background and objectives: Carbon monoxide is a toxic gas for humans and is still a silent killer in both developed and developing countries. The aim of this case series was to evaluate early radiological images as a predictor of subsequent neuropsychological sequelae, following carbon monoxide poisoning. Case 1: After carbon monoxide exposure, early computed tomography scans and magnetic resonance imaging findings of a 52-year-old woman showed bilateral lesions in the globus pallidus. This patient was discharged and followed for 90 days. The patient recovered without any neurological sequela. Case 2: In a 58-year-old woman exposed to carbon monoxide, computed tomography showed lesions in bilateral globus pallidus and periventricular white matter. Early magnetic resonance imaging revealed changes similar to that like in early tomography images. The patient recovered and was discharged from hospital. On the 27th day of exposure, the patient developed disorientation and memory impairment. Late magnetic resonance imaging showed diffuse hyperintensity in the cerebral white matter. Conclusion: White matter lesions which progress to demyelination and end up in neuropsychological sequelae cannot always be diagnosed by early computed tomography and magnetic resonance imaging in carbon monoxide poisoning.

  19. Intoxicaciones medicamentosas (I: Psicofármacos y antiarrítmicos Acute pharmacologic poisoning (I: Psychotropic and antiarrhythmic drugs

    I. Osés


    Full Text Available En la valoración de la Intoxicación Medicamentosa Aguda (IMA en pacientes graves con dosis potencialmente no tóxicas del teórico fármaco responsable es importante insistir en la anamnesis en la coingesta de otros fármacos o tóxicos. Inicialmente se prestará atención a las medidas de soporte vital, oxigenando, protegiendo la vía aérea y expandiendo la volemia. El ECG es una herramienta diagnóstica de primer orden en las IMA, sobre todo por antidepresivos tricíclicos (ADT y medicación cardiovascular. Su monitorización continua durante las primeras 12-24 horas suele ser necesaria en la mayoría de los casos. Las benzodiacepinas no suelen producir intoxicaciones graves. El uso del flumazenilo se reservará a los casos de depresión respiratoria, coma profundo o de causa no filiada. Pueden dar lugar a convulsiones, sobre todo en caso de intoxicación mixta con antidepresivos, y síndrome de abstinencia. Los ADT poseen una potencial gravedad enorme, pudiendo originar arritmias mortales. El rango terapéutico del litio es muy estrecho, pudiendo producirse signos de toxicidad fundamentalmente digestiva y neurológica. En caso de intoxicación por digoxina, se considerará el uso de anticuerpos antidigital en caso de bradiarritmias graves, bloqueos AV o PCR. El glucagón es el antídoto para la intoxicación grave por ß-bloqueantes y para la hipotensión refractaria en caso de calcioantagonistas.In the evaluation of Acute Drug Poisoning (ADP in patients seriously ill with a potentially non-toxic dose of the drug that is theoretically responsible, it is important to insist on anamnesis in the coingestion of other drugs or toxics. Initially attention is given to life support measures, oxygenation, protection of the airway and expanding the volemia. The ECG is a diagnostic tool of the first order in ADPs, above all for tricyclic antidepressants (TAD and cardio-vascular drugs. In the majority of cases continuous monitoring is usually

  20. Survey of patients with acute poisoning seen in the Emergency Department of the University Hospital of Gent between 1983 and 1990.

    Verstraete, A G; Buylaert, W A


    In a prospective study of 4234 patients with acute poisoning in the Emergency Department of the University Hospital of Gent in Belgium between 1983 and 1990, we observed a decline in the number of poisonings from 665 in 1983 to 424 in 1990. This was due to a decrease in the number of deliberate self-poisonings. Fifty-six per cent of patients were female and the most prevalent age group was 20 to 24 years. There was no seasonal variation. The substances most frequently taken were benzodiazepines (55% of the deliberate self-poisonings), ethanol in combination with other substances (35.8%), barbiturates and older hypnotics (18.6%), non-narcotic analgesics (13.3%) and tricyclic antidepressants (11.6%). Carbon monoxide accounted for 65.1% of all the accidental poisonings. With regard to treatment, a reduction in gastric lavage was observed. The patients were transferred to the intensive care unit (29.2%), the psychiatry ward (23.6%) or discharged home (27.8%). Only 0.3% of the patients died in the Emergency Department.

  1. Acute severe poisoning in Spain: clinical outcome related to the implicated drugs.

    Frati, M E; Marruecos, L; Porta, M; Martín, M L; Laporte, J R


    The 91 patients over the age of 10 (57 women and 32 men) with severe self-poisoning admitted to the ICU of a general hospital in Barcelona during the period 1974-1980 have been retrospectively studied. Previous suicidal attempts have been identified among 32 patients; 26 patients presented a history of personality disorders, and 19 had a neurological disease, a chronic physical illness, or a history of alcoholism. Sedative-hypnotic drugs were involved in about half the number of cases, and one fifth of total cases were due to tricyclic antidepressants and phenothiazines. Paracetamol was only involved in 2 cases, and heroin in another 2 cases. Many of the most severe morbidity manifestations were related to overdoses by intermediate-acting barbiturates. Two out of a total of 5 deaths were related to butalbitone overdose. Butalbitone had been ingested as a fixed-dose combination containing butalbitone, propyphenazone, and caffeine, which is freely dispensed as an analgesic in Spain.

  2. Limitations and challenges in treatment of acute chemical warfare agent poisoning.

    Thiermann, Horst; Worek, Franz; Kehe, Kai


    Recent news from Syria on a possible use of chemical warfare agents made the headlines. Furthermore, the motivation of terrorists to cause maximal harm shifts these agents into the public focus. For incidents with mass casualties appropriate medical countermeasures must be available. At present, the most important threats arise from nerve agents and sulfur mustard. At first, self-protection and protection of medical units from contamination is of utmost importance. Volatile nerve agent exposure, e.g. sarin, results in fast development of cholinergic crisis. Immediate clinical diagnosis can be confirmed on-site by assessment of acetylcholinesterase activity. Treatment with autoinjectors that are filled with 2mg atropine and an oxime (at present obidoxime, pralidoxime, TMB-4 or HI-6) are not effective against all nerve agents. A more aggressive atropinisation has to be considered and more effective oximes (if possible with a broad spectrum or a combination of different oximes) as well as alternative strategies to cope with high acetylcholine levels at synaptic sites should be developed. A further gap exists for the treatment of patients with sustained cholinergic crisis that has to be expected after exposure to persistent nerve agents, e.g. VX. The requirement for long-lasting artificial ventilation can be reduced with an oxime therapy that is optimized by using the cholinesterase status for guidance or by measures (e.g. scavengers) that are able to reduce the poison load substantially in the patients. For sulfur mustard poisoning no specific antidote is available until now. Symptomatic measures as used for treatment of burns are recommended together with surgical or laser debridement. Thus, huge amounts of resources are expected to be consumed as wound healing is impaired. Possible depots of sulfur mustard in tissues may aggravate the situation. More basic knowledge is necessary to improve substantially therapeutic options. The use of stem cells may provide a new

  3. Deodorant poisoning

    ... if known) Time it was swallowed Amount swallowed Poison Control Your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere ...

  4. Jimsonweed poisoning

    ... if known Time it was swallowed Amount swallowed Poison Control Your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere ...

  5. Detergent poisoning

    ... if known) Time it was swallowed Amount swallowed Poison Control Your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere ...

  6. Foxglove poisoning

    ... if known Time it was swallowed Amount swallowed Poison Control Your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere ...

  7. Nicotine poisoning

    ... help if this information is not immediately available. Poison Control Your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere ...

  8. Mistletoe poisoning

    ... if known Time it was swallowed Amount swallowed Poison Control Your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere ...

  9. Bee poison

    ... page: // Bee poison To use the sharing features on this page, ... of insect, if possible Time of the sting Poison Control Your local poison center can be reached ...

  10. Philodendron poisoning

    ... if known Time it was swallowed Amount swallowed Poison Control Your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere ...

  11. Nursing research on the staged psychological intervention on improving the therapeutic effect in the treatment of severe organophosphate poisoning%阶段性心理干预提高重度有机磷中毒患者疗效的护理研究

    刘玉峰; 李萍


    Objective: To explore the impact of staged psychological intervention on improving the therapeutic effect in the treatment of severe organophosphate poisoning. Methods: 80 patients who were treated from June 2008 to May 2009 were taken as experimental group and another 80 patients who were treated from June 2007 to May 2008 were taken as control group. The whole treatment courses and the staff who once contacted with the patients were systematically assessed, staged and trained and the staged nursing intervention was implemented in the experimental group; the conventional treatment and nursing care were given to the patients in the control group. The treatment compliance of the patients, the complicated cases with intermediate syndrome and mechanical ventilation time, the time of cholinesterase returned to normal and the days of hospitalization were observed and statistically analyzed in both groups. Results: The comparison of all indicators between the two groups were significantly different (P<0.05 ). Conclusion: The staged psychological intervention can improve patient's treatment compliance, reduce complications and increase the effectiveness in the treatment of severe organophosphate poisoning.%目的:探讨实施阶段性心理干预对重度有机磷中毒患者疗效的影响.方法:将2008年6月~2009年5月重度有机磷中毒患者80例作为实验组,对重度有机磷中毒患者的救治全程、接触患者的全员进行了系统的评估、分期与培训,实施阶段性的护理干预.将2007年6月~2008年5月重度有机磷中毒患者80例作为对照组,实施常规治疗和护理.观察两组患者治疗依从性、并发中间综合征例数及机械通气时间、胆碱酯酶恢复至正常时间、住院天数等指标,并进行统计学分析.结果:经统计学分析,两组患者各项指标比较差异均有统计学意义(P<0.05).结论:对重度有机磷中毒患者实施阶段性心理干预,可以改善患者治疗依从性,

  12. 急性三氯甲烷中毒一例报告%A Case Report on Acute Trichloromethane Poisoning

    姚峰; 冯玉妹; 张雪涛


    [Objective] To report a case of acute occupational trichloromethane poisoning, to alert relevant enterprises to similar episodes and to provide reference for avoiding misdiagnosis. [Methods] The patient received relevant examination after careful inquiry of medical history including previous visiting and treatment in other institutions. Simultaneously field study was performed for comprehensively understanding the cause of disease. [ Results ] The patient was diagnosed acute mild toxic hepatitis due to occupational exposure to trichloromethane. After removal from further exposure and symptomatic treatment, the patient was fully recovered. Two clinic follow-ups respectively after half a year and one year showed restored liver function. [ Conclusion ] Trichloromelhane can lead to liver damage. In this case, the employers' lack of knowledge on the toxicity of trichloromethane failed them to take effective protective measures and finally resulted in occupational poisoning.%[目的] 通过对一例职业性急性三氯甲烷中毒病例的报告,以引起相关企业的重视,采取有效防护措施,避免类似事件的发生.同时给医疗机构提供参考,避免误诊.[方法] 收治患者后详细询问职业史、病史以及外院诊疗经过,完善实验室检查并邀请消化科会诊,同时调查劳动条件,分析病因,集体讨论综合分析后得出诊断.[结果] 患者诊断为三氯甲烷引起的急性轻度中毒性肝病,经对症治疗后痊愈出院,半年及1年随访肝功能均正常.[结论] 三氯甲烷可导致肝脏损害.企业主对三氯甲烷的毒性认识不足,未采取有效防护措施是导致此次事件发生的重要原因.

  13. Evaluation of MR perfusion abnormalities in organophosphorus poisoning and its correlation with SPECT

    K Uday Bhanu


    Full Text Available Aim: Acute organophosphate (OP pesticide poisoning causes substantial morbidity and mortality worldwide. Many imaging modalities, such as computerized tomography (CT, magnetic resonance imaging (MRI, and single photon emission computed tomography (SPECT of the brain, have been used for quantitative assessment of the acute brain insult caused by acute OP poisoning. Perfusion defects on SPECT in acutely poisoned patients with OPs have been described, however, MR perfusion abnormalities have not been described in the literature. MR perfusion Imaging has the advantage of having higher spatial resolution, no radiation, and better availability. Materials and Methods: In this prospective study, 20 patients who ingested OP compounds were included. All the patients underwent brain SPECT on a dual head SPECT gamma camera and MRI brain on a 1.5T MR system. Neurocognitive tests were performed for all patients. Results: SPECT showed perfusion defects in 7 patients and total number of perfusion defects were 29. On MR perfusion, based on the cut-off values of normalized cerebral blood volume (nCBV ratios and normalized cerebral blood flow (nCBF ratios, the total number of patients showing perfusion defects were 6 and 8; and the total number of perfusion defects were 29 and 45, respectively. There was significant difference of the nCBV ratios and nCBF ratios between the control group (n = 20 and positive patients group (n = 6 and n = 8, respectively (P > 0.05. All the defects seen on SPECT were well appreciated on nCBF maps (MRI perfusion suggestive of 100% correlation. Conclusion: MR perfusion imaging can be used as an effective modality for evaluation in acute OP poisoning.

  14. Evaluation of MR perfusion abnormalities in organophosphorus poisoning and its correlation with SPECT.

    Bhanu, K Uday; Khandelwal, Niranjan; Vyas, Sameer; Singh, Paramjeet; Prabhakar, Anuj; Mittal, B R; Bhalla, Ashish


    Acute organophosphate (OP) pesticide poisoning causes substantial morbidity and mortality worldwide. Many imaging modalities, such as computerized tomography (CT), magnetic resonance imaging (MRI), and single photon emission computed tomography (SPECT) of the brain, have been used for quantitative assessment of the acute brain insult caused by acute OP poisoning. Perfusion defects on SPECT in acutely poisoned patients with OPs have been described, however, MR perfusion abnormalities have not been described in the literature. MR perfusion Imaging has the advantage of having higher spatial resolution, no radiation, and better availability. In this prospective study, 20 patients who ingested OP compounds were included. All the patients underwent brain SPECT on a dual head SPECT gamma camera and MRI brain on a 1.5T MR system. Neurocognitive tests were performed for all patients. SPECT showed perfusion defects in 7 patients and total number of perfusion defects were 29. On MR perfusion, based on the cut-off values of normalized cerebral blood volume (nCBV) ratios and normalized cerebral blood flow (nCBF) ratios, the total number of patients showing perfusion defects were 6 and 8; and the total number of perfusion defects were 29 and 45, respectively. There was significant difference of the nCBV ratios and nCBF ratios between the control group (n = 20) and positive patients group (n = 6 and n = 8, respectively) (P > 0.05). All the defects seen on SPECT were well appreciated on nCBF maps (MRI perfusion) suggestive of 100% correlation. MR perfusion imaging can be used as an effective modality for evaluation in acute OP poisoning.

  15. [Mercury poisoning].

    Bensefa-Colas, L; Andujar, P; Descatha, A


    Mercury is a widespread heavy metal with potential severe impacts on human health. Exposure conditions to mercury and profile of toxicity among humans depend on the chemical forms of the mercury: elemental or metallic mercury, inorganic or organic mercury compounds. This article aims to reviewing and synthesizing the main knowledge of the mercury toxicity and its organic compounds that clinicians should know. Acute inhalation of metallic or inorganic mercury vapours mainly induces pulmonary diseases, whereas chronic inhalation rather induces neurological or renal disorders (encephalopathy and interstitial or glomerular nephritis). Methylmercury poisonings from intoxicated food occurred among some populations resulting in neurological disorders and developmental troubles for children exposed in utero. Treatment using chelating agents is recommended in case of symptomatic acute mercury intoxication; sometimes it improves the clinical effects of chronic mercury poisoning. Although it is currently rare to encounter situations of severe intoxication, efforts remain necessary to decrease the mercury concentration in the environment and to reduce risk on human health due to low level exposure (dental amalgam, fish contamination by organic mercury compounds…). In case of occupational exposure to mercury and its compounds, some disorders could be compensated in France. Clinicians should work with toxicologists for the diagnosis and treatment of mercury intoxication.

  16. Harnessing Nature's Diversity: Discovering organophosphate bioscavenger characteristics among low molecular weight proteins.

    Jacob, Reed B; Michaels, Kenan C; Anderson, Cathy J; Fay, James M; Dokholyan, Nikolay V


    Organophosphate poisoning can occur from exposure to agricultural pesticides or chemical weapons. This exposure inhibits acetylcholinesterase resulting in increased acetylcholine levels within the synaptic cleft causing loss of muscle control, seizures, and death. Mitigating the effects of organophosphates in our bodies is critical and yet an unsolved challenge. Here, we present a computational strategy that integrates structure mining and modeling approaches, using which we identify novel candidates capable of interacting with a serine hydrolase probe (with equilibrium binding constants ranging from 4 to 120 μM). One candidate Smu. 1393c catalyzes the hydrolysis of the organophosphate omethoate (kcat/Km of (2.0 ± 1.3) × 10(-1) M(-1)s(-1)) and paraoxon (kcat/Km of (4.6 ± 0.8) × 10(3) M(-1)s(-1)), V- and G-agent analogs respectively. In addition, Smu. 1393c protects acetylcholinesterase activity from being inhibited by two organophosphate simulants. We demonstrate that the utilized approach is an efficient and highly-extendable framework for the development of prophylactic therapeutics against organophosphate poisoning and other important targets. Our findings further suggest currently unknown molecular evolutionary rules governing natural diversity of the protein universe, which make it capable of recognizing previously unseen ligands.

  17. A Randomized Controlled Trial of Puncturing and Bloodletting at Twelve Hand Jing Points to Treat Acute Carbon Monoxide Poisoning as Adjunct to First Aid Treatment: A Study Protocol

    Ying Yue


    Full Text Available Background. Acute carbon monoxide poisoning (ACOP is a significant cause of morbidity and mortality in many countries. Twelve Hand Jing Points (THJP have been believed to be effective to treat all kinds of emergency calls in traditional Chinese medicine (TCM for more than 3000 years. This randomized controlled trial (RCT is designed to evaluate the effectiveness of THJP in curing acute carbon monoxide poisoning in first aid treatment. This paper reports the protocol of the trial. Methods/Design. This RCT is a multicenter, randomized, controlled study undergoing in China. The compliant patients are divided into the bloodletting group and standard of care group. With first aid treatments given to both of the groups, the bloodletting group is bleeding at THJP upon being hospitalized. Primary outcomes and secondary outcomes will be measured and compared between these two groups. Before treatment, immediately after treatment, and 30 minutes, 1 hour, and 4 hours after treatment, patients’ basic vital signs and state of consciousness were observed. Before treatment and 1 and 4 hours after treatment, carboxyhemoglobin concentration in venous blood samples was detected. Discussion. The objective of this study is to provide convincing evidence to clarify the efficacy and safety of THJP for early treatment of acute carbon monoxide poisoning.

  18. Inconceivable Hypokalemia: A Case Report of Acute Severe Barium Chloride Poisoning

    Haibo Tao


    Full Text Available Barium is a heavy divalent alkaline earth metal that has been known as a muscle poison. Barium can cause human toxicity, which may lead to significant hypokalemia and have serious consequences. This paper reports a case of unprecedented barium intoxication in which the patient, who suffered from depression, swallowed at least 3.0 g barium chloride to commit suicide. On admission, the patient presented with nausea, vomiting, stomach burning feeling, dizziness, and weakness. Emergency biochemical testing showed that the patient was suffering from severe hypokalemia (K+ 1.7 mmol/L. His electrocardiogram (ECG prompted atrioventricular blocking, ventricular tachycardia, prolongation of PR interval, ST segment depression with U waves, and T wave inversion. Intravenous potassium supplements were given immediately to correct hypokalemia and regular monitoring of vital signs and fluid balance was arranged. After all-out rescue of our hospital personnel, the condition of the patient is currently stable and he is gradually recovering. This case exemplifies the weaknesses of the management of toxic substances and the lack of mental health education for young people. We hope to get more attention for the supervision of toxic substances and the healthy development of young people.

  19. Confirmation of acute nitrate poisoning differentiating from anthrax in three Indian indigenous cattle

    Kumaresan Nagarajan


    Full Text Available This article reports cases of nitrate poisoning in Indian indigenous cattle breeds comprising two Gir cows aging 4 years each, and one Barugur cow at 1.5 years of age. The cattle with case history of sudden death and oozing of partially clotted blood from the anal opening were brought to the Central University Laboratory (CUL, Center for Animal Health Studies (CAHS, Tamil Nadu Veterinary and Animal Sciences University (TANUVAS for diagnostic investigation with a suspicion of anthrax. According to anamnesis, all the animals were clinically normal and did not reveal any abnormality on the previous day. The animals were fed with recently harvested sorghum leaves and stalks. Smears examined for anthrax were found negative. Biological test (mice inoculation for anthrax was also negative. Gross lesions on necropsy examination of the carcases were suggestive of nitrate intoxication. Finally, nitrate intoxication of these cattle was confirmed by chemical and toxicological analysis of fodder, rumen content, aqueous humor, liver, kidney and urine.

  20. [Study of blood concentration analysis for formate in acute methanol poisoning].

    Morikawa, Go; Okazawa, Katsuko; Shimizu, Takahiro; Otagiri, Sayoko; Fuwa, Fumiko; Nakagawa, Saori; Yamato, Susumu


    A 53-year-old woman ingested about 300 mL of 95% methanol. After immediate ethanol antagonist therapy and hemodialysis, she recovered completely. Few days later, the plasma concentration of methanol and formate was measured. A gas chromatography was used for the plasma methanol concentration measurement, and a colorimetric method was used for plasma formate concentration measurement (Formate Colorimetric Assay Kit; BioVision, California, USA). Patient's plasma methanol concentration before hemodialysis was 676.9 mg/dL and plasma formate concentration was 16.9 mg/dL. By removing blood methanol and formate using hemodialysis before formate accumulations in the body, the patient was discharged without any sequelae. We were able to obtain correlation between a gas chromatography and colorimetric method without gas chromatography-mass spectrometry, with good correlation coefficients. The sensitivity was sufficient for analyzing blood sample. Monitoring formate concentration is useful in determining the treatment and evaluating the prognosis of methanol poisoning. We suggest that this colorimetric method is useful in a facility with no access to a gas chromatography in order to measure a plasma formate concentration.

  1. Organophosphate induced chronic neurotoxicity: Health ...

    Organophosphate induced chronic neurotoxicity: Health, environmental and risk exposure issues in developing nations of the world. ... show that many agents considered toxic and banned in many parts of the industrialized world are still in ...


    Ranjith Kumar


    Full Text Available BACKGROUND Organophosphate insecticides/pesticides are used widely throughout the world. The organophosphorus poisoning is a very serious condition that needs rapid treatment. Emergent and appropriate management is always desirable to prevent the serious complications and high mortality. In this study, we determine the clinical presentation and outcome of organophosphorus poisoning in our institute. MATERIAL AND METHODS This study carried out in Medicine Department, SIMS, Shimoga, from January 1st, 2016 to April 20th 2016. A total of 100 cases of OP poisoning were studied. We included all patients of organophosphate poisoning presented either with signs of muscarinic involvement or signs of nicotinic involvement. Outcome measured according to W.H.O. classification of severity. RESULT Out of a total 100 patients of organophosphate poisoning were admitted, among these 44% were males and 56% females. Average age was 28.9±8.8 years. Nausea and vomiting was the most common clinical feature found in 93% of the patients followed by salivation seen in 91% and Miosis in 87%. According to W.H.O. Classification for Severity of Organophosphate poisoning. Mild 46%, 37% cases were moderate and 17% were severe. Overall mortality rate was 19%. CONCLUSION Present study shows the importance of WHO staging of severity of organophosphorus compound poisoning as mortality increases with severity. Study also showed that delayed arrival, lack of ICU facility and lack of preliminary management at the early stage are the causes of increased mortality in OP compound poisoning. OP compound poisoning needs rapid diagnosis, early and effective treatment to decrease the severity and mortality. These finding shows need for improvement in primary health care facility to decrease morbidity and mortality

  3. Impacts of stress, self-efficacy, and optimism on suicide ideation among rehabilitation patients with acute pesticide poisoning.

    Jun Feng

    Full Text Available The high incidence of pesticide ingestion as a means to commit suicide is a critical public health problem. An important predictor of suicidal behavior is suicide ideation, which is related to stress. However, studies on how to defend against stress-induced suicidal thoughts are limited.This study explores the impact of stress on suicidal ideation by investigating the mediating effect of self-efficacy and dispositional optimism.Direct and indirect (via self-efficacy and dispositional optimism effects of stress on suicidal ideation were investigated among 296 patients with acute pesticide poisoning from four general hospitals. For this purpose, structural equation modeling (SEM and bootstrap method were used.Results obtained using SEM and bootstrap method show that stress has a direct effect on suicide ideation. Furthermore, self-efficacy and dispositional optimism partially weakened the relationship between stress and suicidal ideation.The final model shows a significant relationship between stress and suicidal ideation through self-efficacy or dispositional optimism. The findings extended prior studies and provide enlightenment on how self-efficacy and optimism prevents stress-induced suicidal thoughts.

  4. Impacts of stress, self-efficacy, and optimism on suicide ideation among rehabilitation patients with acute pesticide poisoning.

    Feng, Jun; Li, Shusheng; Chen, Huawen


    The high incidence of pesticide ingestion as a means to commit suicide is a critical public health problem. An important predictor of suicidal behavior is suicide ideation, which is related to stress. However, studies on how to defend against stress-induced suicidal thoughts are limited. This study explores the impact of stress on suicidal ideation by investigating the mediating effect of self-efficacy and dispositional optimism. Direct and indirect (via self-efficacy and dispositional optimism) effects of stress on suicidal ideation were investigated among 296 patients with acute pesticide poisoning from four general hospitals. For this purpose, structural equation modeling (SEM) and bootstrap method were used. Results obtained using SEM and bootstrap method show that stress has a direct effect on suicide ideation. Furthermore, self-efficacy and dispositional optimism partially weakened the relationship between stress and suicidal ideation. The final model shows a significant relationship between stress and suicidal ideation through self-efficacy or dispositional optimism. The findings extended prior studies and provide enlightenment on how self-efficacy and optimism prevents stress-induced suicidal thoughts.

  5. Clinical analyses on the 61 cases of acute poisoning in the senior citizen%老年人急性中毒61例临床分析

    姜俭; 朱涛


    Objective Discusses correlation factor,clinical characteristic and intervention measure which the senior citizen acute is poisoned.Methods Acutely reviewed the old age which in January,2000 during-2006 year December admitted to be poisoned the clinical material,after the sex,the poison invasion way,was poisoned the material type,is poisoned the reason,pre-and the death situation carries on the analysis.Results The old age acute is poisoned the male and female asexual other difference;The poison invasion way by the digestive tract primarily,accounts for 81.9%,the skin absorption next,accounts for 14.7%;Is poisoned the matter by the agricultural chemicals and the medicine primarily,in the agricultural chemicals the methylamine phosphons accounts for first place 54%,in the medicine the calm hypnosis,the anti-neurosis medicine primarily,accounts for 22.9%,cardiovascular medicine next 6.5%;Is poisoned the reason to commit suicide the first place to account for 67.2%;Died 11.4%.Conclusion Strengthens the agricultural chemicals and the drugs management,intervenes senior citizen's psychology,the physiological health,reduces the effective action which the senior citizen is poisoned.%目的 探讨老年人急性中毒的相关因素、临床特点及干预措施.方法 回顾了2000年1月至2006年12月问收治的老年急性中毒临床资料,对性别、毒物侵入途径、中毒物质种类、中毒原因、预后及死亡情况进行分析.结果 老年急性中毒男女无性别差异;毒物侵入途径以消化道为主,占81.9%,皮肤吸收其次,占14.7%;中毒物质以农药和药物为主,农药中甲胺磷占首位(54%),药物中镇静催眠、抗精神病药为主,占22.9%,心血管药其次(6.5%);中毒原因自杀首位占67.2%;死亡占11.4%.结论 加强农药和药品的管理,干预老年人的心理、生理健康,是减少老年人中毒的有效措施.

  6. [Acute ethylene glycol poisoning among patients of Nofer Institute of Occupational Medicine in Łódź, Toxicology Unit, hospitalized in the years 2000-2009].

    Czyewska, Sylwia; Winnicka, Renata; Rzepecki, Jacek; Kołaciński, Zbigniew; Politański, Piotr; Sawicka, Joanna; Krakowiak, Anna


    Acute poisonings with ethylene glycol pose real challenge in the clinical toxicology. The main objective of this study is an analysis of clinical features and identification of prognostic factors in poisoning with ethylene glycol of patients hospitalized in the Toxicology Unit in the years 2000-2009. The medical records of the patients were identified and separated. In the years 2000-2009, 102 patients were hospitalized due to ethylene glycol poisoning, what accounted for 0.38% of total admissions to the unit (26.801 hospitalized people). The mean age of patients amounted 48.05 +/- 12.55 years, the history positive for chronic alcohol abuse was present in 63 (61.76%) cases. Mean values of ethylene glycol concentration were as: in serum 173.14 mg/dl, in urine 6576.46 mg/l. Patients condition on admission varied, with 63 (61.76%) cases described as the severe state. The most frequently noted pathologies were consciousness disturbances and tachycardia. 14 patients died within the analysed group and 63 (61.76%) developed single or multiorgan complications in the course of disease. The most commonly encountered complication were: acute renal failure, anaemia, pneumonia and central nervous system damage. Such parameters as: BE and HCO3 measured on admission should be considered as the prognostic factors, determining the course of the disease and the outcomes of treatment. Poor prognosis may be associated with such clinical features on admission, as: respiratory and circulatory disturbances and cerebral sequelae. The importance of acute poisoning of ethylene glycol is determined both by high frequency of immediate life threatening conditions and by the risk of complications leading to permanent organs damage.

  7. Emergency treatment and nursing care of 5 cases of acute thallium poisoning%急性铊中毒5例的急救与护理

    陆柳; 秦玉梅; 吴丽华; 韦旖旎; 梁启荣


    [Objective] To summarize the nursing experiences of 5 cases of acute thallium poisoning.[Methods] The treatment and nursing process of 5 acute thallium poisoning cases that were treated in Guangxi Research Institute of Occupational Disease Prevention and Treatment in September 2012 was retrospectively analyzed.[.Results] 5 cases of confirmed thallium poisoning were treated with blood perfusion,oral administration of Prussian blue,diuresis,supplying potassium,fluid infusion and liver protection therapy,and were given the intensive nursing.The hospitalization time of 5 cases were15-27 days.All cases were cured,and follow-up showed that all patients got hair regrowth and had no sequelae.[Conclusion] Thallium has strong toxicity.The therapy of Prussian blue combined with blood perfusion as well as individualized nursing has remarkable effect on patients with acute thallium poisoning.%目的 总结5例急性铊中毒的护理体会.方法 回顾分析广西壮族自治区职业病防治研究院2012年9月住院的5例急性铊中毒患者的救治与护理过程.结果 5例确诊为铊中毒患者经血液灌流和口服普鲁士蓝、利尿、补钾、补液、护肝治疗,同时加强护理,5例患者住院时间15~27 d,痊愈出院,随诊重新长出头发及无后遗症.结论 铊毒性强,中毒后应用普鲁士蓝联合血液灌流治疗方案,对患者实施个体化的整体护理,效果显著.

  8. DNA pooling base genome-wide association study identifies variants at NRXN3 associated with delayed encephalopathy after acute carbon monoxide poisoning.

    Wenqiang Li

    Full Text Available Delayed encephalopathy after acute carbon monoxide poisoning (DEACMP is more characteristic of anoxic encephalopathy than of other types of anoxia. Those who have the same poisoning degree and are of similar age and gender have a greater risk of getting DEACMP. This has made it clear that there are obvious personal differences. Genetic factors may play a very important role. The authors performed a genome-wide association study involving pooling of DNA obtained from 175 patients and 244 matched acute carbon monoxide poisoning without delayed encephalopathy controls. The Illumina HumanHap 660 Chip array was used for DNA pools. Allele frequencies of all SNPs were compared between delayed encephalopathy after acute carbon monoxide poisoning and control groups and ranked. A total of 123 SNPs gave an OR >1.4. Of these, 46 mapped in or close to known genes. Forty-eight SNPs located in 19 genes were associated with DEACMP after correction for 5% FDR in the genome-wide association of pooled DNA. Two SNPs (rs11845632 and rs2196447 locate in the Neurexin 3 gene were selected for individual genotyping in all samples and another cohort consisted of 234 and 271 controls. There were significant differences in the genotype and allele frequencies of rs11845632 and rs2196447 between the DEACMP group and controls group (all P-values <0.05. This study describes a positive association between Neurexin 3 and controls in the Han Chinese population, and provides genetic evidence to support the susceptibility of DEACMP, which may be the resulting interaction of environmental and genetic factors.

  9. Acute oxalate poisoning attributable to ingestion of curly dock (Rumex crispus) in sheep.

    Panciera, R J; Martin, T; Burrows, G E; Taylor, D S; Rice, L E


    Ten of 100 mature ewes were afflicted with acute oxalate toxicosis within 40 hours after being temporarily penned in a lot that contained considerable growing Rumex crispus (curly dock). Clinical signs of toxicosis included excess salivation, tremors, ataxia, and recumbency. Affected ewes were markedly hypocalcemic and azotemic. Oxalate crystals were not observed in urine. Gross postmortem lesions were minimal and nondiagnostic in 2 ewes that died peracutely, but perirenal edema and renal tubular degeneration were clearly observable in ewes euthanatized on the third day of toxicosis. Diagnosis of oxalate toxicosis was confirmed by histopathologic findings. Samples of Rumex spp contained 6.6 to 11.1% oxalic acid on a dry-weight basis, a concentration comparable with that in other oxalate-containing plants that have caused acute oxalate toxicosis.

  10. The evaluation of the neuroprotective effects of bispyridinium oximes in tabun-poisoned rats.

    Kassa, Jiri; Karasova, Jana


    Tabun (O-ethyl-N,N-dimethyl phosphoramidocyanidate) belongs to the group of highly toxic organophosphorus compounds that may be used as chemical warfare agents for military as well as terrorist purposes. Tabun differs from other highly toxic organophosphates by the fact that commonly used antidotes are not able adequately to prevent tabun-induced acute toxic effects. The neuroprotective effects of four bispyridinium oximes (K075, trimedoxime, HI-6, obidoxime) in combination with atropine on rats poisoned with tabun at a sublethal dose (150 microg/kg i.m.; 80% of LD50 value) were studied. Tabun-induced neurotoxicity was monitored using a functional observational battery and automatic measurement of motor activity at 24 h and 7 d following tabun challenge. The results indicated that all tested oximes combined with atropine enabled tabun-poisoned rats to survive 7 d following challenge. Trimedoxime combined with atropine was the most effective antidote in decreasing tabun-induced neurotoxicity in the case of sublethal poisonings among all oximes tested. Due to its neuroprotective effects, trimedoxime may be considered to be more suitable oxime for the antidotal treatment of acute tabun exposure than currently used oximes (obidoxime, HI-6) and the newly synthesized oxime K075.

  11. Intravenous cobinamide versus hydroxocobalamin for acute treatment of severe cyanide poisoning in a swine (Sus scrofa) model.

    Bebarta, Vikhyat S; Tanen, David A; Boudreau, Susan; Castaneda, Maria; Zarzabal, Lee A; Vargas, Toni; Boss, Gerry R


    Hydroxocobalamin is a Food and Drug Administration-approved antidote for cyanide poisoning. Cobinamide is a potential antidote that contains 2 cyanide-binding sites. To our knowledge, no study has directly compared hydroxocobalamin with cobinamide in a severe, cyanide-toxic large-animal model. Our objective is to compare the time to return of spontaneous breathing in swine with acute cyanide-induced apnea treated with intravenous hydroxocobalamin, intravenous cobinamide, or saline solution (control). Thirty-three swine (45 to 55 kg) were intubated, anesthetized, and instrumented (continuous mean arterial pressure and cardiac output monitoring). Anesthesia was adjusted to allow spontaneous breathing with FiO2 of 21% during the experiment. Cyanide was continuously infused intravenously until apnea occurred and lasted for 1 minute (time zero). Animals were then randomly assigned to receive intravenous hydroxocobalamin (65 mg/kg), cobinamide (12.5 mg/kg), or saline solution and monitored for 60 minutes. A sample size of 11 animals per group was selected according to obtaining a power of 80%, an α of .05, and an SD of 0.17 in mean time to detect a 20% difference in time to spontaneous breathing. We assessed differences in time to death among groups, using Kaplan-Meier estimation methods, and compared serum lactate, blood pH, cardiac output, mean arterial pressure, respiratory rate, and minute ventilation time curves with repeated-measures ANOVA. Baseline weights and vital signs were similar among groups. The time to apnea and cyanide dose required to achieve apnea were similar. At time zero, mean cyanide blood and lactate concentrations and reduction in mean arterial pressure from baseline were similar. In the saline solution group, 2 of 11 animals survived compared with 10 of 11 in the hydroxocobalamin and cobinamide groups (Pcyanide concentrations became undetectable at the end of the study in both antidote-treated groups, and no statistically significant differences

  12. Long-term cognitive deficits accompanied by reduced neurogenesis after soman poisoning

    Joosen, M.J.A.; Jousma, E.; Boom, T.M. van den; Kuijpers, W.C.; Smit, A.B.; Lucassen, P.J.; Helden, H.P.M. van


    To date, treatment of organophosphate (OP) poisoning shows several shortcomings, and OP-victims might suffer from lasting cognitive deficits and sleep–wake disturbances. In the present study, long-term effects of soman poisoning on learning ability, memory and neurogenesis were investigated in rats,

  13. Long-term cognitive deficits accompanied by reduced neurogenesis after soman poisoning

    Joosen, M.J.A.; Jousma, E.; Boom, T.M. van den; Kuijpers, W.C.; Smit, A.B.; Lucassen, P.J.; Helden, H.P.M. van


    To date, treatment of organophosphate (OP) poisoning shows several shortcomings, and OP-victims might suffer from lasting cognitive deficits and sleep–wake disturbances. In the present study, long-term effects of soman poisoning on learning ability, memory and neurogenesis were investigated in rats,

  14. Long-term cognitive deficits accompanied by reduced neurogenesis after soman poisoning

    Joosen, M.J.A.; Jousma, E.; van den Boom, T.M.; Kuijpers, W.C.; Smit, A.B.; Lucassen, P.J.; van Helden, H.P.M.


    To date, treatment of organophosphate (OP) poisoning shows several shortcomings, and OP-victims might suffer from lasting cognitive deficits and sleep-wake disturbances. In the present study, long-term effects of soman poisoning on learning ability, memory and neurogenesis were investigated in rats,

  15. Study of Effect of Magnesium Sulphate in Management of Acute Organophosphorous Pesticide Poisoning

    Vijayakumar, H. N.; Kannan, Sudheesh; Tejasvi, C.; Duggappa, Devika Rani; Veeranna Gowda, K. M.; Nethra, S. S.


    Background: Organophosphorus compound poisoning (OPCP) is a major public health problem in developing countries like India. Atropine and oximes remain the main-stay of management. Magnesium sulfate (MgSO4) has shown benefit in the management of OPCP. Aims: This study was designed to assess the effect of MgSO4 on outcome in OPCP patients admitted to Intensive Care Unit (ICU). Settings and Design: Double-blind prospective randomized clinical trial in an ICU of tertiary care institution. Methods: One hundred patients (50 in each group) of OPCP, confirmed by history and syndrome of OPCP with low plasma pseudocholinesterase, aged between 18 and 60 years were studied. Magnesium group (Group M) received 4 g of 20% MgSO4 infusion over 30 min at admission to ICU, control group (Group C) received normal saline placebo in the same manner. Patients were assessed for the need for intubation, requirement of atropine, duration of mechanical ventilation, duration of ICU stay, and its effect on mortality. Statistical Analysis: Chi-square test and Fisher's exact test for categorical data, independent sample t-test, and paired t-test for nominal data. Results: Demographics and basal serum magnesium levels were comparable. Atropine requirement was higher in Group C (74.82 ± 22.39 mg) compared to Group M (53.11 ± 45.83 mg) (P < 0.001). A total of 33 patients in Group C and 23 patients in Group M required intubation, respectively (P = 0.043). The mean duration of mechanical ventilation was 4.51 ± 2 days in Group C compared to 4.13 ± 1.6 days in Group M (P = 0.45). ICU stay was 5.36 ± 2.018 days in Group C compared to 4.54 ± 1.581 days in Group M (P = 0.026). There was no significant difference in mortality between the groups. Conclusion: Four grams of MgSO4 given to OPCP patients within 24 h of admission to ICU, decreases atropine requirement, need for intubation, and ICU stay.

  16. [The study of using cordyceps-astragalus-salvia miltiorrhiza to treat acute lung injury induced by paraquat poisoning in rats].

    Li, Q L; Liu, J L; Wang, J R; Jian, X D; Kan, B T; Zhang, Z C


    Objective: To study the therapy of cordyceps-astragalus-salvia miltiorrhiza in treating acute lung injury and pulmonary interstitial fibrosis induced by paraquat poisoning. Methods: All 120 adult Wister male rats were randomly assigned to three groups, the paraquat poisoning group (rats were intragastric administration paraquat 50 mg/kg body weight once at the beginning) , the cordyceps-astragalus-salvia miltiorrhiza therapy group (rats were given cordyceps-astragalus-salvia miltiorrhiza 90 mg/kg body weight intragastric administration half an hour after paraquat was given, then the same dose was given once a day) ; control group (rats were intragastric administration with physiological saline) . At 7th, 14th, 21st, and 28th day rats were sacrificed postanesthetic respectively after paraquat exposure, sample of lung tissue, bronchoalveolar lavage (BAL) , and venous blood were collected. GSH, SOD, TNF-α, TGF-β1, and HYP in plasma, bronchoalveolar lavage (BAL) , and the lung homogenates were determined. Optical microscope was performed to examine pathological changes in lung. Results: Each experimental time point paraquat group and the treatment group rats serum SOD content significantly lower than the control group (P<0.05) . Each experimental time point the treatment group rats serum SOD levels increased significantly than that of paraquat group (P<0.05) . Each experimental time point paraquat group rats serum GSH content significantly lower than that of the control group (P<0.05) . Treatment group rats 7 days time GSH content significantly lower than that of the control group (P<0.05) . Treatment group 21 days, 28 days GSH content was increased significantly than that of the paraquat group (P<0.05) . Each experimental time point paraquat group rats alveolar lavage SOD content was significantly lower than that of the control group (P<0.05) . Treatment group 7 days, 14 days time SOD content was significantly lower than that of the control group (P<0

  17. Acute thiopurine overdose: analysis of reports to a National Poison Centre 1995-2013.

    Claudia Gregoriano

    Full Text Available Literature regarding acute human toxicity of thiopurines is limited to a handful of case reports. Our objectives were to describe all cases of overdose with thiopurines reported to the Swiss Toxicological Information Centre between 1995-2013. A retrospective analysis was performed to determine circumstances, magnitude, management and outcome of overdose with these substances. A total of 40 cases (14 paediatric were reported (azathioprine, n = 35; 6-mercaptopurine, n = 5. Of these, 25 were with suicidal intent, 12 were accidental and 3 were iatrogenic errors. The magnitude of overdose ranged from 1.5 to 43 (median 8 times the usual dose in adults. Twelve cases (30% had attributable symptoms. The majority of these were minor and included gastrointestinal complaints and liver function test and blood count abnormalities. Symptoms were experienced by patients who took at least 1.5-times their usual daily thiopurine dose. Overdoses over two or more consecutive days, even if of modest size, were less well tolerated. One case of azathioprine and allopurinol co-ingestion over consecutive days led to agranulocytosis. Decontamination measures were undertaken in 11 cases (10 activated charcoal, 1 gastric lavage and these developed fewer symptoms than untreated patients. This study shows that acute overdoses with thiopurines have a favourable outcome in the majority of cases and provides preliminary evidence that gastrointestinal decontamination with activated charcoal may reduce symptom development after overdose of these substances if patients present to medical services soon after ingestion.

  18. Acute thiopurine overdose: analysis of reports to a National Poison Centre 1995-2013.

    Gregoriano, Claudia; Ceschi, Alessandro; Rauber-Lüthy, Christine; Kupferschmidt, Hugo; Banner, Nicholas R; Krähenbühl, Stephan; Taegtmeyer, Anne B


    Literature regarding acute human toxicity of thiopurines is limited to a handful of case reports. Our objectives were to describe all cases of overdose with thiopurines reported to the Swiss Toxicological Information Centre between 1995-2013. A retrospective analysis was performed to determine circumstances, magnitude, management and outcome of overdose with these substances. A total of 40 cases (14 paediatric) were reported (azathioprine, n = 35; 6-mercaptopurine, n = 5). Of these, 25 were with suicidal intent, 12 were accidental and 3 were iatrogenic errors. The magnitude of overdose ranged from 1.5 to 43 (median 8) times the usual dose in adults. Twelve cases (30%) had attributable symptoms. The majority of these were minor and included gastrointestinal complaints and liver function test and blood count abnormalities. Symptoms were experienced by patients who took at least 1.5-times their usual daily thiopurine dose. Overdoses over two or more consecutive days, even if of modest size, were less well tolerated. One case of azathioprine and allopurinol co-ingestion over consecutive days led to agranulocytosis. Decontamination measures were undertaken in 11 cases (10 activated charcoal, 1 gastric lavage) and these developed fewer symptoms than untreated patients. This study shows that acute overdoses with thiopurines have a favourable outcome in the majority of cases and provides preliminary evidence that gastrointestinal decontamination with activated charcoal may reduce symptom development after overdose of these substances if patients present to medical services soon after ingestion.


    Anurag Srivastava


    Full Text Available RESEARCH QUESTION What are the clinical features of organophosphorus poisoning? DESIGN Prospective study; Interview technique. SAMPLE SIZE A total of 41 cases of OP poisoning were studied. Muscarinic, Nicotinic, and CNS symptoms according to duration and amount of poisoning are observed in observation. RESULT In this study, those patients who were admitted to our side with complaint of poisoning within 12 hours, muscarinic symptoms of organophosphate poisoning like miosis and pulmonary oedema were present in 100%, salivation was present in 85.7%, sweating was present in 71.4%, and nicotinic symptoms of organophosphate poisoning like neuromuscular paralysis was present in 4.7%. In those patients who were admitted with complaint of organophosphate poisoning more than 12 hours, nicotinic symptoms like fasciculations was present in 15% and neuromuscular paralysis was present in 20%. In CNS symptoms, tremors was present in 4.8% of patients admitted with complaint of poisoning within 12 hours and in 15% of patients admitted with complaints of poisoning more than 12 hours. In those patients who were admitted with complaint of poisoning of more than 5 grams of the substance, muscarinic symptoms like miosis was present in 85.7%, pulmonary oedema was present in 100%, salivation was present in 71.4%, and sweating was present in 42.9%. CNS symptoms like tremor was present in 14.3% of patients admitted with complaint of poisoning of more than 5 grams of the substance as compared to 0% in those who were admitted with complaint of poisoning of less than 5 grams of the substance suggesting that incidence of CNS symptoms (Tremor among poisoning patient was more in those patients who have taken more amount of organophosphate substance

  20. Acute phosphine poisoning aboard a grain freighter. Epidemiologic, clinical, and pathological findings.

    Wilson, R; Lovejoy, F H; Jaeger, R J; Landrigan, P L


    Two children and 29 of 31 crew members aboard a grain freighter became acutely ill after inhaling the toxic fumigant phosphine; one child died. Predominant symptoms were headache, fatigue, nausea, vomiting, cough, and shortness of breath. Abnormal physical findings included jaundice, paresthesias, ataxia, intention tremor, and diplopia. Focal myocardial infiltration with necrosis, pulmonary edema, and widespread small-vessel injury were found at postmortem examination of the dead child. The surviving child showed ECG and echocardiographic evidence of myocardial injury and transient elevation of the MB fraction of serum creatinine phosphokinase. Illness was significantly associated with living or working amidships or on the forward deck areas of the vessel. Phosphine gas was found to have escaped from the holds through a cable housing located near the midships ventilation intake and around hatch covers on the forward deck. The outbreak illustrates the hazards associated with shipboard fumigation.

  1. Ciguatera poisoning.

    Achaibar, Kira C; Moore, Simon; Bain, Peter G


    Ciguatera is a form of poisoning that occurs after eating tropical and subtropical ciguatoxic fish. The ciguatoxins are a family of heat stable, lipid soluble cyclic polyether compounds that bind to and open voltage-sensitive Na(+) channels at resting membrane potential, resulting in neural hyperexcitability, as well as swelling of the nodes of Ranvier. The authors describe a 45-year-old man who developed acute gastrointestinal symptoms in Antigua soon after eating red snapper and grouper, potentially "ciguatoxic fish". This was followed by neurological symptoms 24-48 hours later, including temperature reversal (paradoxical dysaesthesia), intense pruritus and increased nociception as a result of a small fibre peripheral neuropathy. The patient's symptoms and small fibre neuropathy improved over a period of 10 months.

  2. Role of biomarkers of nephrotoxic acute kidney injury in deliberate poisoning and envenomation in less developed countries.

    Mohamed, Fahim; Endre, Zoltan H; Buckley, Nicholas A


    Acute kidney injury (AKI) has diverse causes and is associated with increased mortality and morbidity. In less developed countries (LDC), nephrotoxic AKI (ToxAKI) is common and mainly due to deliberate ingestion of nephrotoxic pesticides, toxic plants or to snake envenomation. ToxAKI shares some pathophysiological pathways with the much more intensively studied ischaemic AKI, but in contrast to ischaemic AKI, most victims are young, previously healthy adults. Diagnosis of AKI is currently based on a rise in serum creatinine. However this may delay diagnosis because of the kinetics of creatinine. Baseline creatinine values are also rarely available in LDC. Novel renal injury biomarkers offer a way forward because they usually increase more rapidly in AKI and are normally regarded as absent or very low in concentration, thereby reducing the need for a baseline estimate. This should increase sensitivity and speed of diagnosis. Specificity should also be increased for urine biomarkers since many originate from the renal tubular epithelium. Earlier diagnosis of ToxAKI should allow earlier initiation of appropriate therapy. However, translation of novel biomarkers of ToxAKI into clinical practice requires better understanding of non-renal factors in poisoning that alter biomarkers and the influence of dose of nephrotoxin on biomarker performance. Further issues are establishing LDC population-based normal ranges and assessing sampling and analytical parameters for low resource settings. The potential role of renal biomarkers in exploring ToxAKI aetiologies for chronic kidney disease of unknown origin (CKDu) is a high research priority in LDC. Therefore, developing more sensitive biomarkers for early diagnosis of nephrotoxicity is a critical step to making progress against AKI and CKDu in the developing world. © 2015 The British Pharmacological Society.

  3. Speciation analysis of arsenic compounds in the serum and urine of a patient with acute arsine poisoning

    Yamanaka K.


    Full Text Available Arsine is one of the most potent hemolytic agents. It is important to clarify arsine metabolism as well as its chemical interactions with biological components. The aim of the present study was to clarify arsine metabolism by arsenic speciation analysis in serum and urine from an acute poisoning patient with hematuria, anemia, and renal and liver dysfunction. Speciation analysis of arsenics in serum and urine was performed using HPLC-ICP-MS. The total arsenic (T-As concentration in serum was 244.8 μg/l at admission and 97.1 μg/l at discharge. In the speciation analysis, four kinds of As compounds derived from arsine metabolism were detected in serum and urine. The concentration of arsenite (AsIII, arsenate (AsV, monomethylarsonic acid (MMA, and dimethylarsinic acid (DMA in serum at admission were 45.8, 5.2, 17.9 and 9.3 μg/l, respectively. The concentrations of AsIII, AsV, and MMA decreased with biological half time (BHT of 30.1, 43.0, and 96.3 h, respectively. Only DMA was increased at discharge. The urinary AsIII, AsV, MMA and DMA concentrations were 223.0, 12.1, 317.5 and 1053.5 μg/l at discharge, and decreased with BHT of 15.1, 20.8, 14.7, and 16.0 d, respectively. The results indicate that arsine was quickly metabolized to AsIII and subsequently up to DMA, with the result that the toxic effects of inorganic arsenic were added to those of arsine toxicity.

  4. Cytotoxicity of organophosphate anticholinesterases.

    Cao, C J; Mioduszewski, R J; Menking, D E; Valdes, J J; Katz, E J; Eldefrawi, M E; Eldefrawi, A T


    Organophosphate (OP) anticholinesterases were found to modulate metabolic activities of human neuroblastoma cells and hepatocytes, which was detectable by the Cytosensor microphysiometer. The nerve gas ethyl-S-2-diisopropylaminoethyl methylphosphorothiolate (VX), at 10 microM, produced significant reduction in cell metabolism within 2 min, as measured by changes in the acidification rate of the medium. The reduction was dose- and time-dependent and irreversible after 4 h of exposure. Two alkaline degradation products of VX produced no cytotoxicity. Exposure for 24 h to 3 microM VX caused 36% and 94% irreversible loss of metabolism in hepatocytes and neuroblastoma cells, respectively. The insecticides parathion and chlorpyrifos stimulated hepatocyte metabolism but inhibited neuroblastoma cells. Their oxons were more active. Exposure of neuroblastoma cells for 4 h to VX, parathion, paraoxon, diisopropylfluorophosphate or chlorpyrifos gave an LC50 of 65, 775, 640, 340, or 672 microM, respectively, whereas 24 h gave an LC50 of 0.7, 3.7, 2.5, 29, and 31 microM, respectively. Preincubation of hepatocytes with phenobarbital enhanced their response to parathion and VX due to metabolic bioactivation. Atropine partially blocked the effects of VX and paraoxon on both cell types, which suggests the involvement of a muscarinic receptor as the target for cytotoxicity. There was no correlation between OP in vivo neurotoxicity and in vitro cytotoxicity. It is suggested that the former results from their cholinesterase inhibition, while the latter results from action on different targets and requires much higher concentrations.

  5. The Judying Significance of ALT Detection for Organophosphorus Poisoning Patient%谷丙转氨酶检测对有机磷中毒患者病情判断的意义

    张大辉; 边剑飞


    Objective: To study the acute organic phosphorus poisoning patient severity of illness and al-anine aminotransferase correlation. Method: Detected 42 cases of patients with acute organophosphate poisoning alanine aminotransferase, and then analyzed the detected values and the relation to the severity of the disease. Result: The patients with acute organic phosphorus poisoning, associated with elevated alanine aminotransferase , and the elevated level of severity is related, in severe cases, alanine aminotransferase detection value was higher than that of the general patients, alanine aminotransferase, the differences were statistically significant (P<0. 05). Conclusion : Acute organophosphate poisoning patients with elevated alanine aminotransferase value is one of the indicators to judge the condition of serious.%目的:探讨急性有机磷中毒病人病情严重程度与谷丙转氨酶的相关性.方法:检测42例急性有机磷中毒病人的谷丙转氨酶,分析其检测值与病情相关性.结果:急性有机磷中毒患者中,伴有谷丙转氨酶升高,而且升高程度与病情严重程度呈正相关,严重病例谷丙转氨酶检测值明显高于一般患者,谷丙转氨酶差异有统计学意义P<0.05.结论:急性有机磷中毒病人谷丙转氨酶升高值是判断病情严重的指标之一.

  6. [Peripheral nerve disease associated with acute renal failure due to bromate poisoning].

    Deshimaru, M; Miyagawa, T; Sumiyoshi, S; Nomura, Y


    A case of 21 year old male with neuropathy caused by renal insufficiency was present. He had taken bromate (mixed powder of potassium bromate and sodium bromate) for the purpose of suicide and suffered from acute renal insufficiency and hard of hearing. Renal dysfunction improved gradually by peritoneal dialysis and hemodialysis. However, on the 32th day after the onset, burning pain appeared in the bilateral feets. Following this, he began to complain of the disturbances of superficial and deep sensory below the ankle jerks and the weakness of his toes. Considering the clinical features, we supposed that the disturbance of the peripheral nerve was caused by uremia due to taking bromate. N. suralis was biopsied on the 80th day after the onset and examined electron microscopically. Electroscopical findings was as follows. Degeneration of the Schwann cells and irregularity or destruction of the myelin sheaths were observed. The axoplasm of the myelinated nerve fiber were relatively preserved as compared with the changes of the myelin sheaths. In the unmyelinated nerve fibers, cavity formations were observed. The findings of regeneration were not observed. From the electron microscopical findings, we speculate that the changes of the Schwann cells and the myelin sheaths are primary resulting from the disturbance of the metabolism of the Schwann cells. We speculate that anemia and hypoproteinemia caused by bromate disturbed regeneration.

  7. Antagonism of Acute Sulfide Poisoning in Mice by Nitrite Anion without Methemoglobinemia.

    Cronican, Andrea A; Frawley, Kristin L; Ahmed, Humza; Pearce, Linda L; Peterson, Jim


    There are currently no FDA-approved antidotes for H2S/sulfide intoxication. Sodium nitrite, if given prophylactically to Swiss Webster mice, was shown to be highly protective against the acute toxic effects of sodium hydrosulfide (∼LD40 dose) with both agents administered by intraperitoneal injections. However, sodium nitrite administered after the toxicant dose did not detectably ameliorate sulfide toxicity in this fast-delivery, single-shot experimental paradigm. Nitrite anion was shown to rapidly produce NO in the bloodstream, as judged by the appearance of EPR signals attributable to nitrosylhemoglobin and methemoglobin, together amounting to less than 5% of the total hemoglobin present. Sulfide-intoxicated mice were neither helped by the supplemental administration of 100% oxygen nor were there any detrimental effects. Compared to cyanide-intoxicated mice, animals surviving sulfide intoxication exhibited very short knockdown times (if any) and full recovery was extremely fast (∼15 min) irrespective of whether sodium nitrite was administered. Behavioral experiments testing the ability of mice to maintain balance on a rotating cylinder showed no motor impairment up to 24 h post sulfide exposure. It is argued that antagonism of sulfide inhibition of cytochrome c oxidase by NO is the crucial antidotal activity of nitrite rather than formation of methemoglobin.

  8. Cost to government health-care services of treating acute self-poisonings in a rural district in Sri Lanka

    Wickramasinghe, Kanchana; Steele, Paul; Dawson, Andrew;


    OBJECTIVE: To estimate the direct financial costs to the Sri Lanka Ministry of Health of treating patients after self-poisoning, particularly from pesticides, in a single district. METHODS: Data on staff, drug, laboratory and other inputs for each patient admitted for self-poisoning were prospect......OBJECTIVE: To estimate the direct financial costs to the Sri Lanka Ministry of Health of treating patients after self-poisoning, particularly from pesticides, in a single district. METHODS: Data on staff, drug, laboratory and other inputs for each patient admitted for self-poisoning were...... pesticides and possibly by improving case management in primary care hospitals. Additional research is needed to assess if increasing infrastructure and staff at peripheral hospitals could reduce the overall cost to the government, optimize case management and reduce pressure on secondary services....

  9. Detection of neutrophil-lymphocyte ratio as a serum marker associated with inlfammations by acute carbon monoxide poisoning

    Mustafa Karabacak; Kenan Ahmet Turkdogan; Abuzer Coskun; Orhan Akpinar; Ali Duman; Mcahit Kapci; Sevki Hakan Eren; Pnar Karabacak


    Objective: To investigate neutrophil–lymphocyte ratio (NLR), which is an indicator of systemic inflammation, in patients with carbon monoxide (CO) poisoning. Methods: We included 528 patients (275 women) who presented with a diagnosis of CO poisoning between June 2009 and March 2014. Control group was composed of 54 patients (24 women). Platelet count and mean platelet volume level were significantly higher in the CO poisoning group. Results: White blood cell level (9.8 ± 3.3vs 8.6 ± 2.9× 103/mL, respectively;P= 0.01), neutrophil count (6.00 ± 2.29vs 4.43 ± 2.04×103/mL, respectively;P Conclusions: The increase ofNLR may indicate the progression of fatal complications due to CO poisoning.

  10. Distribution and Economic Loss Analysis for 38 Hospitalized Children with Acute Poisoning%38例急性中毒住院儿童病例分布及经济损失分析

    宋瑞娟; 宋瑞华; 牛彦青; 王莉


    Objective:To understand the distribution features and economic losses of the hospitalized children with acute poisoning, scientific basis was provided to prevent and control the acute poisoning in children.Methods:A retrospective analysis of 38 cases of acute poisoning in children admitted to the pediatric in Heji Hospital affiliated to Changzhi Medical College from 2007 to 2012.Results:In the children with poisoning,25 cases were male,while 13 caseswere female.Children were divided into four groups according to the age:<1,1~4,5~9,and 10~14,whose distribution were respectively 6 cases,20 cases,4 cases,8 cases.Rural and urban poisoning proportion was 1.38:1.The peak was in September and the indoor poisoning accounted for 86.84%.34.21% poisoning was caused by the drug in acute poisoning,while the same with the chemical poisoning.The economic losses of acute poisoning caused by pesticide was(5 171.03 ±4 843.46)RMB on average,which was the highest.The economic losses caused by plant was (2 062.63±715.78)RMB on average, which was the second highest.Conclusion:The number of male children with acute poisoning in the hospital were larger than the female, and mainly concentrated in 1~4 years old,who lived in rural rather than the city.In addition,drug poisoning was the main type of acute poisoning.Pesticide poisoning made the largest economic loss.Measures should be taken to prevent and control the acute poisoning according to its epidemiological characteristics.%目的:了解急性中毒住院患儿的分布特征和经济损失,为儿童急性中毒的预防、控制提供科学依据。方法:回顾性分析38例儿童急性中毒病例。结果:38例中毒患儿中,男25例,女13例;<1岁、1~4岁、5~9岁、10~14岁年龄组分别为6、20、4、8例;农村、城市中毒比例1.38∶1;9月份为发病高峰期;发生在户内占86.84%。急性中毒中药物中毒和化学性中毒各占34.21%。急性中毒的经济损失

  11. Use of cholinesterase activity in monitoring organophosphate pesticide exposure of cattle produced in tropical areas.

    Pardío, V T; Ibarra, N; Rodríguez, M A; Waliszewski, K N


    The use of cholinesterase activity as a biochemical method for monitoring organophosphate pesticide exposure in cattle is described herein. Determination of cholinesterase activity of whole blood, erythrocyte, and plasma was carried out according to the Ellman modified kinetic method. The mean baseline acetylcholinesterase activities of 9.549 +/- 3.619 IU/mL in whole blood, 9.444 +/- 3.006 IU/mL in erythrocytes, and 0.149 +/- 0.063 IU/mL in plasma were estimated for steers from the control group. Results of multivariate analysis showed that the general responses between the control and experimental groups (in vivo, monitoring and case studies) treated with Coumaphos and Fenthion were statistically different, and the general responses of these experimental groups were statistically different over time as well. Among the fractions that were analyzed, the erythrocyte acetylcholinesterase activity could be adequate for the diagnosis of exposure or acute poisoning in cattle as it showed a good within-run and between-run precision with CVs <10% better than those in plasma.

  12. Insecticide poisoning

    ... this page: // Insecticide poisoning To use the sharing features on this page, please enable JavaScript. Insecticide is a chemical that kills bugs. Insecticide poisoning ...

  13. Methylmercury poisoning

    ... grain that was treated with this from of mercury. Poisoning from eating fish from water that is contaminated ... into the body. Many of the symptoms of mercury poisoning are similar to symptoms of cerebral palsy . In ...

  14. Starch poisoning

    Cooking starch poisoning; Laundry starch poisoning ... Cooking and laundry starch are both made from vegetable products, most commonly: Corn Potatoes Rice Wheat Both are usually considered nonpoisonous (nontoxic), but ...

  15. Copper poisoning

    ... Poisoning and Drug Overdose . 4th ed. Philadelphia, PA: Elsevier Saunders; 2007:chap 75. Holland MG. Pulmonary toxicology. ... Poisoning and Drug Overdose . 4th ed. Philadelphia, PA: Elsevier Saunders; 2007:chap 9. Jones AL, Dargan PI. ...

  16. Poisonous Plants

    ... Publications and Products Programs Contact NIOSH NIOSH POISONOUS PLANTS Recommend on Facebook Tweet Share Compartir Photo courtesy ... U.S. Department of Agriculture Many native and exotic plants are poisonous to humans when ingested or if ...

  17. Poison Prevention

    ... the Word Shop AAP Find a Pediatrician Safety & Prevention Immunizations All Around At Home At Play On ... Listen Español Text Size Email Print Share Poison Prevention Page Content Article Body Post the Poison Help ...

  18. Ethanol poisoning

    ... this page: // Ethanol poisoning To use the sharing features on this page, please enable JavaScript. Ethanol poisoning is caused by drinking too much alcohol. ...

  19. Identification and treatment of poison ivy dermatitis.

    Briant, D; Brouder, G


    Poison ivy dermatitis is an acute self-limiting problem of two or three weeks' duration that can cause significant discomfort. Poison ivy, poison oak and poison sumac cause more cases of allergic contact dermatitis than all the other contact allergens combined. Treatment of poison ivy dermatitis depends on the severity of the reaction. The nurse practitioner can manage the majority of poison ivy cases. However, if there is systemic involvement, a physician consultation is necessary. The patient can best be assisted by assessing the severity of the dermatitis, prescribing an appropriate supportive therapy and teaching preventive measures.

  20. 17 cases of organophosphorus pesticide poisoning combined with acute pancreatitis%有机磷农药中毒并发急性胰腺炎17例

    蔡海英; 张茂


    @@ 急性有机磷农药中毒(acute organophosphorous pesticides poisoning,AOPP)是急诊科较为常见的急症之一,尤其在基层医院更为多见.中、重度AOPP病情变化较多,并发神经、心脏及呼吸系统损害较为常见且报道较多,但对并发胰腺炎往往不被认识,容易导致误诊和漏诊,从而延误治疗甚至危及生命.

  1. Overview of Poisoning

    ... Abbreviations Weights & Measures ENGLISH View Professional English Deutsch Japanese Espaniol Find information on medical topics, symptoms, drugs, ... Insecticide Poisoning Iron Poisoning Lead Poisoning Overview of Food Poisoning Mushroom (Toadstool) Poisoning Plant and Shrub Poisoning ...

  2. Analysis on the characteristics of the acute poisoning processes in Beihai city%北海市急性中毒过程的特点分析



    目的:探讨北海市急性中毒过程的特点。方法采用流行病学调查方法,调查了市、县、乡10个三级医疗单位2005-01~2012-12的2127例急性中毒住院患者,并对相关资料进行分类分析。结果在2127例中毒患者中,中毒地点以发生在家里、学校、工作场地、餐馆、娱乐场所与其他场地的病例数各占86.63%、0.24%、5.37%、3.25%、1.46%、3.06%;中毒途径以经口、呼吸、皮肤中毒病例数各占68.47%、19.01%、12.52%;中毒原因以意外性、自杀性、误食性、医疗性、职业性、他杀性、其他原因中毒的病例数各占36.05%、25.65%、15.20%、7.06%、2.45%、0.24%、13.35%。其中以家里、经口、意外性与自杀性中毒为中毒过程的4个主要特点。进一步分析这4个特点的中毒原因与毒物,其中家里中毒的主要原因与毒物为意外性与农药类中毒病例数最多,各占同类病例数的33.33%、29.18%;经口中毒的主要原因与毒物为自杀性与农药类中毒病例数最多,各占同类病例数的36.70%、31.99%;进一步分析意外性与自杀性中毒的主要毒物,以化学类与农药类毒物中毒病例数为多(各占同类原因总病例数的44.39%、68.62%)。结论北海地区以家里中毒、经口中毒与意外、自杀性原因中毒为急性中毒过程的突出特点,应针对这些特点采取针对性地防控对策。%Objective To study the characteristics of the acute poisoning processes in Beihai city.Methods By the epidemiological study, the 2 127 cases of all-kind-acute poisoning were surveyed from 10 hospitals of the city, county and township in Beihai city.The classification analysis was made by collecting the relevant data of poisoning processes of the cases.Results In all the 2 127 cases, the numbers of poisoning in the poisoning sites of home, school ,workplace , restaurants, entertainment and other places

  3. Alcohol Poisoning

    ... t be awakened is at risk of dying. Alcohol poisoning is an emergency If you suspect that someone has alcohol poisoning — even if you don't see the ... immediately. Never assume the person will sleep off alcohol poisoning. Be prepared to provide information. If you ...

  4. Study on the best marker for myocardial damage of acute organophos-phorus pesticide poisoning%急性有机磷农药中毒心肌损伤最佳标志物的研究

    陈士轩; 滕哈乐; 牛红霞; 褚晓雯; 黄金洪; 肖青; 夏于新; 韩颖


    Objective To explore the best marker for myocardial injury after 6 hours of acute organophosphorus pesti-cide poisoning (AOPP). Methods 86 cases of AOPP patients in Department of Emergency, Electric Power Teaching Hospital of Capital Medical University ("our hospital"for short) from May 2006 to November 2014 were selected as ob-servation group. They were divided into mild poisoning group, moderate poisoning group and severe poisoning group ac-cording to the Occupational Acute Organophosphorus Pesticide Poisoning (GBZ8-2002). All patients were routinely done for 12 lead ECG examination and examined for CK, CK-MB, cTnI in 6 hours after taking poison. Control group was from our hospital outpatient health examination, and CK, CK-MB, cTnI levels were examined the same day. The above three indicators of each group were observed. Results There were statistical differences in CK, CK-MB, cTnI levels between observation group and control group (P 0.05), and there was statistical difference in cTnI level be-tween mild poisoning group and control group (P 0.05). There was statistical difference in CK-MB level between severe poisoning group and moderate poisoning group (P0.05),cTnI水平差异有统计学意义(P0.05),CK-MB水平差异有统计学意义(P<0.05),cTnI水平差异有高度统计学意义(P<0.01)。结论cTnI是判断AOPP心肌损伤的最敏感指标,是AOPP心肌损伤的最佳标志物,CK-MB次之。 CK和心电图对判断AOPP心肌损伤及损伤程度价值不大。

  5. 灾后重建中急性中毒1077例流行病学分析%Epidemiology of 1077 cases of acute poisoning in reconstruction after earthquake

    周玲; 杨鼎君; 袁娟; 刘君; 旷娟; 范文娟; 高梅


    Objective To explore the epidemiology of 1077 cases of acute poisoning in reconstruction after earthquake. Methods 1077 patients with acute poisoning were analyzed. Results The acute alcohol poisoning was 53. 3% followed by pesticide poisoning (20. 97%), drug poisoning (11. 15%), food poisoning (6.13%), carbon monoxide poisoning (5. 48%), drug intoxication (3. 02%). Women was higher than men (P<0. 039). 21-40 years old was the age of high incidence of poisoning. Cause of poisoning within the service poison suicide was the most (59. 24%). Conclusion The acute poisoning occur with sex, age, personality, emotional intelligence and accidents.%目的 探讨灾后重建中急性中毒的流行病学特点及相关原因.方法 对2008年5月22日~2010年12月31日抢救的1077例急性中毒患者,按病种、例次、性别、年龄、中毒意向、就诊方式等进行统计分析,探讨其流行病学特征及相关因素.结果 灾后重建中急性中毒最多的为酒精中毒(53.3%),其次依次为农药中毒(20.97%)、药物中毒(11.15%)、食物中毒(6.13%)、CO中毒(5.48%)、毒品中毒(3.02%).女性高于男性(P<0.039).但男性中毒有增多趋势.21~40岁是中毒的高发年龄段(53.95%).中毒原因以内服毒物自杀最多(59.24%).就诊方式以自来院居多(54.41%).结论 灾后重建中急性中毒的发生与性别、年龄、性格、情商及意外事件等有直接的关系.

  6. Preclinical study comparing the antidotal effect of clonidine with atropine for the treatment of acute malathion poisoning in the albino rats

    Suresha K. R.


    Full Text Available Background: In developing countries 2–3 million people are acutely poisoned by organophosphorus (OP pesticides every year. There is a pressing need for new affordable antidotes and in this context clonidine which has central effect (α2 agonist has been evaluated in the albino rats presenting with signs or symptoms of acute malathion poisoning. And compared with atropine for the acte malathion poisoning in albino rats. Methods: This was a preclinical study conducted on albino rats of either sex weighing 100-150 grams were randomly divided into 4 groups (6/group. Malathion was given at the lethal dose of 54 mg/kg body weight (BW by gavage to each group. Group 1: normal saline intraperioneal (i.p. Group 2: Post treated with atropine 1.5 mg/kg BW (i.p. Group 3: Pre treated with clonidine 1mg/ kg BW (i.p, 10 minutes priore malathion. Group 4: Pre treated with clonidine and post treated with atropine. The above groups were observed for straub tail, muscle fasciculation, piloerection, lacrimation, defecation/ urination; salivation, tremors, gasping and convulsion and were recorded at time 0, 15, 30, 45 and 60 minutes after poisoning. The latency of onset of tremors, loss of righting reflex and tremors were recorded. Results were presented as percentage occurrence and Mean ± SEM. Repeated measure one way ANOVA and Fisher’s Least Significant Difference post hoc test for comparison between groups. P-value of 0.05 or less was considered for statistical significance. Results: The central effects namely straubs tail and whole body tremors are significantly improved compared to control and atropine with clonidine group (p<0.05. However convulsion shows improve in atropine alone and atropine with clonidine groups. The overall survival time has significantly increased compared to control and atropine and atropine with clonidine (P<0.05.Clonidine has not shown any effect on survival time. Conclusions: Clonidine has some central protective effect in

  7. Quantitative structure-toxicity relationship (QSTR) studies on the organophosphate insecticides.

    Can, Alper


    Organophosphate insecticides are the most commonly used pesticides in the world. In this study, quantitative structure-toxicity relationship (QSTR) models were derived for estimating the acute oral toxicity of organophosphate insecticides to male rats. The 20 chemicals of the training set and the seven compounds of the external testing set were described by means of using descriptors. Descriptors for lipophilicity, polarity and molecular geometry, as well as quantum chemical descriptors for energy were calculated. Model development to predict toxicity of organophosphate insecticides in different matrices was carried out using multiple linear regression. The model was validated internally and externally. In the present study, QSTR model was used for the first time to understand the inherent relationships between the organophosphate insecticide molecules and their toxicity behavior. Such studies provide mechanistic insight about structure-toxicity relationship and help in the design of less toxic insecticides. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  8. Pharmacokinetics of digoxin cross-reacting substances in patients with acute yellow Oleander (Thevetia peruviana) poisoning, including the effect of activated charcoal.

    Roberts, Darren M; Southcott, Emma; Potter, Julia M; Roberts, Michael S; Eddleston, Michael; Buckley, Nick A


    Intentional self-poisonings with seeds from the yellow oleander tree (Thevetia peruviana) are widely reported. Activated charcoal has been suggested to benefit patients with yellow oleander poisoning by reducing absorption and/or facilitating elimination. Two recent randomized controlled trials (RCTs) assessing the efficacy of activated charcoal yielded conflicting outcomes in terms of mortality. The effect of activated charcoal on the pharmacokinetics of Thevetia cardenolides has not been assessed. This information may be useful for determining whether further studies are necessary. Serial blood samples were obtained from patients enrolled in an RCT assessing the relative efficacy of single-dose and multiple-dose activated charcoal (SDAC and MDAC, respectively) compared with no activated charcoal (NoAC). The concentration of Thevetia cardenolides was estimated with a digoxin immunoassay. The effect of activated charcoal on cardenolide pharmacokinetics was compared between treatment groups by determining the area under the curve for each patient in the 24 hours following admission, the 24-hour mean residence time, and regression lines obtained from serial concentration points, adjusted for exposure. Erratic and prolonged absorption patterns were noted in each patient group. The apparent terminal half-life was highly variable, with a median time of 42.9 hours. There was a reduction in 24-hour mean residence time and in the apparent terminal half-life estimated from linear regression in patients administered activated charcoal, versus the control group (NoAC). This effect was approximately equal in patients administered MDAC or SDAC. Activated charcoal appears to favorably influence the pharmacokinetic profile of Thevetia cardenolides in patients with acute self-poisoning and may have clinical benefits. Given the conflicting clinical outcomes noted in previous RCTs, these mechanistic data support the need for further studies to determine whether a particular subgroup

  9. Photographic fixative poisoning

    Photographic developer poisoning; Hydroquinone poisoning; Quinone poisoning; Sulfite poisoning ... Quinones Sodium thiosulfate Sodium sulfite/bisulfite Boric acid Photographic fixative can also break down (decompose) to form ...

  10. 职业性急性氮氧化物中毒一例报道%Occupational Acute Nitrogen Oxides Poisoning: A Case Report

    钟皓成; 管继如


    Nitrogen oxides are common irritative gases including NO2, NO, and N2O, etc. NO2 is the main component of gases generated by metal pickling. The patient had worked in pool without any protection for about 3 hours. The NO2 concentration was beyond the national allowable concentration 41 hours after the accident occurred. The exposure to NO2 was confirmed. The patient presented pulmonary edema and was diagnosed as acute severe nitrogen oxides poisoning according to the Diagnostic Criteria of Occupational Acute Nitrogen Oxides Poisoning (GBZ 15-2002).%氮氧化物是常见的刺激性气体之一,包括NO2、NO、N2O等.金属酸洗过程中所产生的氮氧化物主要为NO2.本例患者在清水池底工作约3h,且未佩戴任何防护用具,事故发生41h后地中NO2浓度仍超过国家容许浓度,氮氧化物接触史明确.患者在病程中出现肺水肿.根据GBZ 15-2002《职业性急性氮氧化物中毒诊断标准》,诊断为急性重度氮氧化物中毒.

  11. Ischemia-modified albumin levels in the prediction of acute critical neurological findings in carbon monoxide poisoning

    Murat Daş


    Full Text Available The aim of the study was to determine whether serum ischemia-modified albumin (IMA levels in patients with carbon monoxide (CO poisoning were higher compared with a control group of healthy volunteers. In addition, the study sought to determine if there was a correlation between serum IMA levels and carboxyhemoglobin (COHB levels and other critical neurological findings (CNFs. In this prospective study, the IMA levels of 100 patients with CO poisoning and 50 control individuals were compared. In addition, the IMA and COHB levels were analyzed according to absence or presence CNFs in patients with CO poisoning. The levels of IMA (mg/dL on admittance, and during the 1st hour and 3rd hour, in patients with CO poisoning (49.90 ± 35.43, 30.21 ± 14.81, and 21.87 ± 6.03 were significantly higher, compared with the control individuals (17.30 ± 2.88. The levels of IMA in the 6th hour were not higher compared with control individuals. The levels of IMA on admittance, and during the 1st hour, 3rd hour, and 6th hour, and COHB (% levels in patients who had CNFs were higher compared with IMA levels and COHB levels in patients who had no CNFs (p < 0.001. However, when the multivariate model was created, it was observed that IMA level on admittance was a poor indicator for prediction of CNFs (odds ratio = 1.05; 95% confidence interval, 1.01–1.08. We therefore concluded that serum IMA levels could be helpful in the diagnosis of CO poisoning. However, we believe that IMA levels cannot be used to predict which patients will develop CNFs due to CO poisoning.

  12. Clinical study on pancreatic damage in patients with acute dichlorvos poisoning combined with alcohol poisoning%急性敌敌畏中毒合并急性乙醇中毒患者胰腺损害的临床研究

    张冰; 瞿海龙; 周英莲; 梁璐; 彭广军


    [Objective]To investigate the incidence rate of severe pancreatic damage in patients with acute dichlorvos poisoning combined with alcohol poisoning, in order to guide the clinical early diagnosis and rational treatment. [Methods] 140 acute dichlorvos poisoning cases in Emergency Department of Affiliated Hospital of Hebei University were divided into dichlorvos poisoning group (80 cases) and dichlorvos poisoning combined with alcohol poisoning group (60 cases). The acute pancreatitis was diagnosed through blood and urine amylase detection, and pancreatic CT within 24 hours after admission. The pancreatitis incidence and prognosis of two groups were compared. [Results] There was 20 severe acute pancreatitis cases in dichlorvos poisoning combined with alcohol poisoning group and 14 cases in dichlorvos poisoning group, and the difference between two groups was significant (x2 =4. 67,P<0.05). The incidence rate of complications, operation rate, mortality rate and hospitalization time in dichlorvos poisoning combined with alcohol poisoning group were higher than those in dichlorvos poisoning group [P<0.05). [ Conclusion] Compared with single dichlorvos poisoning group, there is a higher incidence rate of severe pancreatitis in dichlorvos poisoning combined with alcohol poisoning group, and it has high mortality rate and poor prognosis.%目的 探讨急性敌敌畏中毒合并急性乙醇中毒患者重症胰腺炎发生情况,以指导临床早期诊断和合理治疗.方法 将就诊于河北大学附属医院急诊科的140例急性重度敌敌畏中毒患者分为单纯敌敌畏中毒组(80例)、敌敌畏中毒合并乙醇中毒组(60例);于入院后24h内通过血尿中淀粉酶、胰腺CT检查明确胰腺炎诊断;对2组患者胰腺炎发生率及其预后进行比较.结果 急性敌敌畏中毒合并急性乙醇中毒患者20例发生重症胰腺炎,单纯敌敌畏中毒组14例发生重症胰腺炎,两组差异有统计学意义(x2=4.67,P<0.05);

  13. Intentional chlorpyrifos poisoning in pregnant woman and subsequent fetal death

    T H Indu


    Full Text Available Organophosphate poisoning is an important medical emergency exist in agriculture-oriented countries such as India. This case report describes the treatment strategies followed for a management of suicidal intoxication of a pregnant woman by chlorpyrifos compound at a secondary care public hospital, Udhagamandalam, India. The patient was unable to perceive fetal movements and had classic clinical symptoms of organophosphate poisoning such as excess salivation and pinpoint pupil. The patient was administered with 2 g of pralidoxime and 10 ampoules of atropine sulfate (1.2 mg each. The fetotoxic evaluation showed fetal death. The antidote given to the patient was according to the criteria given by the World Health Organization. The late admission of the patient may be considered as a reason for fetal death. Psychosocial, educational programs are highly recommended for the population in this region to reduce the number of intentional poisoning attempts.

  14. Antidotal effect of combinations obidoxime/HI-6 and memantine in mice poisoned with soman, dichlorvos or heptenophos

    Antonijević Biljana


    Full Text Available Introduction/Aim. In acute organophosphate poisoning the issue of special concern is the appearance of muscle fasciculations and convulsions that cannot be adequately antagonised by the use of atropine and oxime therapy. The aim of this study was to examine atidotal effect of obidoxime or HI-6 combinations with memantine in mice poisoned with soman, dichlorvos or heptenophos. Methods. Male Albino mice were pretreated intravenously (iv with increasing doses of oximes and/or memantine (10 mg/kg at various times before poisoning with 1.3 LD-50 of soman, dichlorvos or heptenophos, in order to determine the median effective dose and the efficacy half-time. In a separate experiment, cerebral extravasation of Evans blue dye (40 mg/kg iv was examined after application of memantine (10 mg/kg iv, midazolam (2.5 mg/kg intraperitonealy - ip and ketamine (20 mg/kg ip 5 minutes before soman (1 LD-50 subcutaneously - sc. Results. Coadministration of memantine induced a significant decrease in median effective dose in null time of both HI-6 (7.96 vs 1.79 mmoL/kg in soman poisoning and obidoxime (16.80 vs 2.75 mmoL/kg in dichlorvos poisoning; 21.56 vs 6.63 mmoL/kg in heptenophos poisoning. Memantine and midazolam succeded to counteract the soman-induced proconvulsive activity. Conclusion. Memantine potentiated the antidotal effect of HI-6 against a lethal dose of soman, as well as the ability of obidoxime to antagonize the toxic effects of dichlorvos and heptenophos probably partly due to its anticonvulsive properties.

  15. Clinical research on eye complications of acute chlorine poisoning%急性氯气中毒眼部并发症的临床研究

    季玉玲; 张迎秋; 王涛; 陈晨; 苗娟; 王猛; 张娟美


    •AlM:To observe the eye complications in the cases of acute chlorine gas poisoning. •METHODS:A retrospective review of 121 cases of acute chlorine gas poising with eye irritation, dry eye and other eye complications in Linyi People’s Hospital from February 2009 to February 2013 was performed. •RESULTS: Among 121 patients, 117 cases ( about 96. 7%) had complications of eye irritation and conjunctival and corneal epithelial damage, and the ocular surface damage was aggravated with the increasing level of chlorine gas poisoning. After 3, 6mo being discharged, 32 and 7 patients respectively occurred dry eye among 115 patients followed up. One mild chlorine poisoning patient, during the hormonotherapy of pulmonary complication, complicated with bullous retinal detachment, of which symptoms and physical signs had been improved after stopping hormonotherapy and adding drugs facilitating fluid absorption. One severe chlorine poisoning patient with loss of consciousness during the treatment, had corneal ulcer and after ulcer being healed with drug and conjunctival flap covering surgery, was left permanent leukoma cornea. •CONCLUSlON: Acute chlorine poisoning can cause corneal and conjunctival epithelial damage and dry eye. Ocular complications like bullous retinal detachment associated with hormone application should be paid more attention to in the hormonotherapy. For some patients with severe poisoning, the therapy of corneal and conjunctival epitheliums should be taken seriously in case of irreparable damage in rescuing patient’s life.%目的:观察急性氯气中毒患者眼部并发症的发生情况。  方法:回顾性分析2009-02/2013-02就诊于临沂市人民医院的急性氯气中毒患者121例,其发生眼部刺激症状、干眼及其它一些眼部并发症的情况。  结果:在121例患者中,有117例(96.7%)并发有眼部刺激症状及角结膜上皮的损伤,随着氯气中毒程度的加重,眼表损伤也加重。在115

  16. Impaired mitochondrial functions in organophosphate induced delayed neuropathy in rats.

    Masoud, Anwar; Kiran, Ravi; Sandhir, Rajat


    Acute exposure to organophosphates induces a delayed neurodegenerative condition known as organophosphate-induced delayed neuropathy (OPIDN). The mechanism of OPIDN has not been fully understood as it does not involve cholinergic crisis. The present study has been designed to evaluate the role of mitochondrial dysfunctions in the development of OPIDN. OPIDN was induced in rats by administering acute dose of monocrotophos (MCP, 20 mg/kg body weight, orally) or dichlorvos (DDVP, 200 mg/kg body weight, subcutaneously), 15-20 min after treatment with antidotes [atropine (20 mg/kg body weight) and 2-PAM (100 mg/kg body weight) intraperitoneally]. MDA levels were observed to be higher and thiol content was lower in mitochondria from brain regions of OP exposed animals. This was accompanied by decreased activities of the mitochondrial enzymes; NADH dehydrogenase, succinate dehydrogenase, and cytochrome oxidase. In addition, mitochondrial functions assessed by MTT reduction also confirmed mitochondrial dysfunctions following development of OPIDN. The spatial long-term memory evaluated using elevated plus-maze test was observed to be deficit in OPIDN. The results suggest impaired mitochondrial functions as a mechanism involved in the development of organophosphate induced delayed neuropathy.

  17. Drug Utilization Study on Acute Poisoning Cases Treated at a Tertiary Care Hospital in Western Part of India

    Pratik D. Asari


    Conclusion: Use of antimicrobial medicines for poisoned patients was too high and irrational.  Due to high incidence of snakebites, hospital stockpiles should be regularly checked for availability of antivenom. Educational programs with emphasis on preventive measures for toxic exposures are necessary to create awareness among the general public.

  18. 急性百草枯中毒的综合治疗%A comprehensive therapy on acute paraquat poisoning

    孙树印; 刘云海


    Paraquat is a common herbicides extensively used in agriculture.Recent years,paraquat poisoning get obviously increased,especially the oral poisoning.There is no specific antidote for the poisoning yet,it has extremely high mortality.The main target organ of paraquat is lung,while the multiple organ failure and pulmonary fibrosis are the leading reasons of death.A comprehensive,symptomatic treatment has been the main therapy strategy,and exploring effective antidote has also become a research hotspot.This article will provide a brief overview on all the traditional methods and new trials about treatment of paraquat poisoning.%百草枯是农业常用除草剂,近年来百草枯中毒病人明显增多,且以口服中毒为主,中毒后尚无特效的解毒剂,病死率极高,靶器官主要是肺脏,多脏器功能衰竭和肺纤维化是死亡的主要原因.目前以综合治疗为主,探寻百草枯中毒的有效治疗药物已成为研究热点,本文对临床救治中常用的及近年来新发现的治疗措施作一综述.

  19. A prospective study on clinical profile and incidence of acute kidney injury due to hair dye poisoning

    P. Ramulu


    Conclusions: So in current scenario of emerging hair dye poisoning, it is imperative for a timely intervention by reducing the time of admission in hospital and also early management by clinicians is the need of an hour. [Int J Res Med Sci 2016; 4(12.000: 5277-5282


    Anurag Srivastava


    Full Text Available RESEARCH QUESTION What are the socio-demographic profile trends of Organophosphorus poisoning in Uttar Pradesh. DESIGN Prospective study; Interview technique. SAMPLE SIZE A total of 41 cases of OP poisoning were studied. All the information was recorded on a specially prepared Performa which included age, sex, duration of poisoning, amount of poisoning and way of poisoning. RESULT In this study 85% patients belonged to 15 years’ to 30 years’ age group, most of them 60.9% were female patients; 65.9% patients belonged to rural areas and 34.1% patients belonged to urban areas; 51.2% patients were admitted to our side with complaint of organophosphate poisoning within 12 hours; 41.5% patients were unable to tell the amount of poisoning they exposed; 24.4% had just exposed or taken less than 5 grams of poison and 34.1% had taken the poisoning more than 5 grams. Most of the patients, 78.6% had taken organophosphate for suicidal purpose and 21.4% patients were exposed to poison accidentally. Ratio of suicidal to accidental poisoning in rural areas is 2.4:1 and in urban areas is 3.7:1.