Sample records for fatal fenazaquin intoxication

  1. Fatal diquat intoxication

    Jović-Stošić Jasmina


    Full Text Available Background. Since the introduction of diquat in agriculture practice in 1960's, about 40 cases of poisoning have been described in detail in medical literature. Case report. We presented two cases. A case one, a 35-year-old, previously healthy, woman ingested 14% diquat solution. The poisoning had fulminant course, consisted of severe stomachache, vomiting, cardiocirculatory shock, respiratory failure and cardiac arrest 20 hours post-ingestion. Autopsy revealed myocardial infarction, bronchopneumonia and incipient renal damage. A case two, a 64-year-old man developed severe gastroenteritis, corrosive lesions of mucosal surfaces, acute renal injury, arrhythmias, brain stem infarction and bronchopneumonia. The diagnosis of diquat poisoning was made retrospectively upon the clinical picture and identification of pesticides he had been exposed to. The patient died 18 days post-exposure. The most prominent findings on autopsy were pontine hemorrhage and infarction, bronchopneumonia, left ventricle papillary muscle infarction and renal tubular damage. Conclusion. Cardiocirculatory disturbances led to fatal complications, the heart and brain infarction. We pointed out the heart as one of the most severely affected organs in diquat poisoning.

  2. A fatal intoxication by chloroprene.

    Rickert, Annette; Hartung, Benno; Kardel, Bernd; Teloh, Johanna; Daldrup, Thomas


    Objective Chloroprene, 2-chloro-1,3 butadiene, is a volatile synthetic liquid. The chloroprene monomer is extremely reactive and is used for the production of latexes and synthetic rubber such as Neoprene. Up to now an acute lethal human exposure has been described only once in the literature [19]. The intoxication is associated with nervous system depression, pulmonary edema, narcosis, and respiratory arrest. Case report A 29-year-old chemistry company worker was found unconscious in an empty vessel (depth: 3m) used for chloroprene. The man was dressed in shoes, trousers, a helmet and a respiratory mask. The upper part of the body was unclothed. In spite of reanimation, the man died three hours later in a hospital. All analyses were performed by headspace gas chromatography (HS/GC/FID). In addition, brain, muscle and myocardial muscle were analysed by headspace GC-MS. Results and discussion Autopsy findings: The cause of death could not be determined as the macromorphological findings were unspecific. Toxicology findings The calibration curve of chloroprene in serum shows linearity from 1.0 to 200 μg/ml (r(2)=0.9999) using benzene as internal standard. The LOD is 0.28 μg/ml, the LLOQ is 0.99 μg/ml. Tissues and body fluids were stored at -20 °C till the analysis. Chloroprene was quantified after addition of benzene as the internal standard. It was found in nearly all tissues and body fluids except in the urine and lung. The highest concentrations were detected in the kidney, liver, myocardial muscle and especially in the brain. Furthermore, hexanal was found in all samples except in the urine. The amount of hexanal in some specimens is high, especially in the lung, bile, gastric content and myocardial muscle. Conclusion We assume that a significant amount of chloroprene was not only inhaled but also absorbed through the skin because the man wore a respiratory mask. Presumably the accident would not have happened if the works safety protocols had been followed

  3. Fatal mephedrone intoxication--a case report.

    Adamowicz, Piotr; Tokarczyk, Bogdan; Stanaszek, Roman; Slopianka, Markus


    A death caused by a new designer drug, 4-methylmethcathinone (mephedrone), is reported. Eight small plastic bags containing white powder were found in the jacket of a young dead male. Spot tests conducted by the police officer indicated the presence of 4-bromo-2,5-dimethoxyphenethylamine (2C-B) in the powders. Laboratory routine screening analyses of blood and vitreous humor did not reveal any positive results; therefore, 2C-B was excluded. Analysis of powders was conducted using gas chromatography-mass spectrometry and high-pressure liquid chromatography with diode array detection. The purity of mephedrone found in all powder samples was in the range of 80.4-87.3%. In connection with these findings, blood and vitreous humor samples were analyzed for mephedrone. Analyses were conducted using liquid chromatography-tandem mass spectrometry. Mephedrone was found in blood and vitreous humor at the concentrations of 5.5 and 7.1 µg/mL, respectively, revealing that this was a fatal mephedrone intoxication.

  4. Fatal carbon monoxide intoxication after acetylene gas welding of pipes.

    Antonsson, Ann-Beth; Christensson, Bengt; Berge, Johan; Sjögren, Bengt


    Acetylene gas welding of district heating pipes can result in exposure to high concentrations of carbon monoxide. A fatal case due to intoxication is described. Measurements of carbon monoxide revealed high levels when gas welding a pipe with closed ends. This fatality and these measurements highlight a new hazard, which must be promptly prevented.

  5. Intoxications with the monoamine oxidase inhibitor tranylcypromine: an analysis of fatal and non-fatal events.

    Gahr, Maximilian; Schönfeldt-Lecuona, Carlos; Kölle, Markus A; Freudenmann, Roland W


    Tranylcypromine (TCP) is a non-selective and irreversible monoamine oxidase inhibitor and an effective agent in the treatment of major depression. It features a complex pharmacologic profile and overdoses might induce severe intoxications. To identify typical clinical presentations of TCP-intoxications, range of associated TCP-dosages and possible differences between fatal and non-fatal intoxications a systematic review of all previously published cases of TCP-intoxications was conducted. We detected n=20 reports of TCP-intoxications in the literature (fatalities n=10). Mean age was 36.7 years (median 37); the majority of patients were female (60%). Frequent findings in patients with TCP-intoxications were disturbance of consciousness/cognitive dysfunction (90%), cardio-vascular symptoms (55%), hyperthermia (50%), respiratory distress (45%), delirium (45%), muscular rigidity (30%) and renal failure (20%). Suicidal intent was present in n=18 (90%) patients. First clinical symptoms related to TCP-intoxication developed on average in less than 1 day. The average dosage related to TCP-intoxication was 677 mg. The highest survived TCP-dosage was 4000 mg and the lowest fatal dosage was 170 mg. Patients with fatal intoxications were on average older (40.5 vs. 32.8 years) and developed a more rapid onset of symptoms (0.2 vs. 0.8 days). Death occurred after a mean time of 0.6 days; symptom relief in patients with non-fatal intoxications developed on average after 3.2 days. Considering the large dose spectrum between survived and lethal TCP-dosages individual susceptibility factors might play a role regarding the severity of clinical symptoms independently of the ingested dosage.

  6. Hair analysis to document non-fatal pesticide intoxication cases.

    Dulaurent, S; Gaulier, J M; Baudel, J L; Fardet, L; Maury, E; Lachâtre, G


    We reported two non-fatal cases of intoxication with pesticides namely alachlor and carbofuran. Hair stand samples were collected from two men approximately 1 year after alachlor intoxication for case 1, and 14 days after the last exposure for case 2. Hair analysis was performed using a liquid chromatography-tandem mass spectrometry method. In case 1, alachlor was detected in the 5 analysed hair segments (concentrations between 12 and 136 pg/mg) and its metabolites were not detected. In case 2, carbofuran and its main metabolite (3-hydroxycarbofuran) were detected in the hair strand (global analysis) at the concentrations of 207 and 164 pg/mg, respectively. However, additional data are required in order to interpret such results.

  7. Hypothermia and undressing associated with non-fatal bromazepam intoxication.

    Michaud, K; Romain, N; Giroud, C; Brandt, C; Mangin, P


    A 42-year-old woman with a history of depression was found unconscious, lying near her car in an early autumn morning. The lower part of her body was undressed and there were multiple purple spots and excoriations on the body suggesting at first a sexual assault. On admission to the intensive care unit, she presented a hypothermia with a central temperature of 28.4 degrees C. The biological samples obtained at the hospital were analysed. Blood concentration of bromazepam was 7.7 mg/l, which is above the highest level reported till now in a case of fatal intoxication.

  8. A Rare Cause of Metabolic Acidosis: Fatal Transdermal Methanol Intoxication in an Infant.

    Sahbudak Bal, Zumrut; Can, Fulya Kamit; Anil, Ayse Berna; Bal, Alkan; Anil, Murat; Gokalp, Gamze; Yavascan, Onder; Aksu, Nejat


    Oral methanol intoxication is common, but dermal intoxication is rare. We report a previously healthy 19-month-old female infant admitted to the emergency department (ED) with vomiting and tonic-clonic seizure. On physical examination, she was comatose and presented signs of decompensated shock with Kussmaul breathing. Her left thigh was edematous, with purple coloration. Methanol intoxication was suspected due to high anion gap metabolic acidosis (pH, 6.89; HCO3, acidosis. This case report demonstrates that fatal transdermal methanol intoxication can occur in children, and it is the second report in the English literature of transdermal methanol intoxication in an infant.

  9. Fatal versus non-fatal heroin "overdose": blood morphine concentrations with fatal outcome in comparison to those of intoxicated drivers.

    Meissner, Christoph; Recker, Sabine; Reiter, Arthur; Friedrich, Hans Juergen; Oehmichen, Manfred


    The study was performed to distinguish fatal from non-fatal blood concentrations of morphine. For this purpose, blood levels of free morphine and total morphine (free morphine plus morphine conjugates) in 207 cases of heroin-related deaths were compared to those in 27 drivers surviving opiate intoxication. The majority of both survivors and non-survivors were found to show a concomitant use of depressants including alcohol or stimulants. Blood morphine levels in both groups varied widely, with a large area of overlap between survivors (free morphine: 0-128 ng/ml, total morphine: 10-2,110 ng/ml) and non-survivors (free morphine: 0-2,800 ng/ml, total morphine: 33-5,000 ng/ml). Five (18.5%) survivors and 87 (42.0%) non-survivors exhibit intoxication only by morphine. In these cases, too, both groups overlapped (survivors-free morphine: 28-93 ng/ml, total morphine: 230-1,451 ng/ml; non-survivors-free morphine: 0-2,800 ng/ml, total morphine: 119-4,660 ng/ml). Although the blood levels of free or total morphine do not allow a reliable prediction of survival versus non-survival, the ratio of free/total morphine may be a criterion to distinguish lethal versus survived intoxication. The mean of the ratio of free to total morphine for all lethal cases (N=207) was 0.293, for those that survived (N=27) 0.135, in cases of intoxication only by morphine 0.250 (N=87) and 0.080 (N=5), respectively. Applying a cut-off of 0.12 for free/total morphine and performing ROC analyses, fatal outcome can be predicted in 80% of the cases correctly, whereas 16% of the survivors were classified as dead. Nevertheless, in this study, all cases with a blood concentration of 200 ng/ml and more of free morphine displayed a fatal outcome.

  10. Fatal cytisine intoxication and analysis of biological samples with LC-MS/MS.

    Musshoff, F; Madea, B


    We report about a fatal cytisine intoxication in a 20-year-old man who, according to his mother, had drunken tea prepared from plant material of Laburnum anagyroides with the toxic pyridine-like alkaloid as ingredient, which exhibits pharmacological effects similar to nicotine. Using a liquid chromatographic-mass spectrometric (LC-MS) procedure cytisine was quantified in post-mortem specimens. By exclusion of other causes of death an intoxication was determined as the cause of death with respiratory failure as the pathophysiological mechanism.

  11. Molecular Pathology of Pulmonary Edema in Forensic Autopsy Cases with Special Regard to Fatal Methamphetamine Intoxication.

    Du, Yu; Jin, Hong-Nian; Zhao, Rui; Zhao, Dong; Xue, Ye; Zhu, Bao-Li; Guan, Da-Wei; Xie, Xiao-Li; Wang, Qi


    Pulmonary edema is a common finding in fatal methamphetamine intoxication. However, the underlying mechanism remains poorly understood. This study investigated the molecular pathology of alveolar damage involving pulmonary edema in forensic autopsy cases. Seven candidate reference genes (RPL13A, YWHAZ, GUSB, SDHA, GAPDH, B2M, and ACTB) were evaluated in the lung by the geNorm module in qBase(plus) software. RPL13A, YWHAZ, and GUSB were identified as the most stable reference genes. Using these validated reference genes, intrapulmonary mRNA expressions of matrix metalloproteinases (MMPs), intercellular adhesion molecule-1 (ICAM-1), claudin-5 (CLDN-5), and aquaporins (AQPs) were examined. Relative mRNA quantification using TaqMan real-time PCR assay demonstrated higher expressions of all markers except for AQP-5 in fatal METH intoxication cases. These findings suggested alveolar damage and compensatory response in fatal METH intoxication cases. Systematic analysis of gene expressions using real-time qPCR is a useful tool in forensic death investigation.

  12. Fatal aconitine intoxication or thyroid storm? A case report.

    Arlt, E M; Keller, T; Wittmann, H; Monticelli, F


    The case of a female in the latter half of her teens found dead in her father's apartment is reported. A glass containing liquid and plant remnants was found at the death scene. There were no indications of any intervention or the application of force by a third party. Autopsy showed unremarkable findings. Toxicological investigations revealed lethal doses of aconitine, a highly poisonous alkaloid and the major active compound of Aconitum napellus, in all specimens. Plant remnants were identified as A. napellus leaves by a botanist and toxicological examination of the liquid in the glass on site showed extremely high concentrations of aconitine. Additionally, laboratory results revealed that the young female was suffering from thyrotoxicosis factitia, an uncommon form of hyperthyroidism caused by misuse or overdosing of thyroid hormones in order to loose weight. A rare but serious and often fatal complication of hyperthyroidism is thyroid storm. Eventually the condition of thyroid storm due to thyrotoxicosis factitia could have contributed to the woman's death from aconitine poisoning.

  13. Fatal intoxications associated with the designer opioid AH-7921.

    Kronstrand, R; Thelander, G; Lindstedt, D; Roman, M; Kugelberg, F C


    AH-7921 (3,4-dichloro-N-[(1-dimethylamino)cyclohexylmethyl]benzamide) is a designer opioid with ∼80% of morphine's µ-agonist activity. Over a 6-month period, we encountered nine deaths where AH-7921 was involved and detected in blood from the deceased. Shortly after the last death, on August 1 2013, AH-7921 was scheduled as a narcotic and largely disappeared from the illicit market in Sweden. AH-7921 was measured by a selective liquid chromatography-MS-MS method and the concentrations of AH-7921 ranged from 0.03 to 0.99 µg/g blood. Six of our cases had other drugs of abuse on board and most had other medications such as benzodiazepines, antidepressants and analgesics. However, the other medicinal drugs encountered were present in postmortem therapeutic concentrations and unlikely to have contributed to death. In addition to the parent compound, we identified six possible metabolites where two N-demethylated dominated and four mono-hydroxylated were found in trace amounts in the blood. In conclusion, deaths with AH-7921 seem to occur both at low and high concentrations, probably a result of different tolerance to the drug. Hence, it is reasonable to assume that no sharp dividing line exists between lethal and non-lethal concentrations. Further, poly-drug use did not seem to be a major contributing factor for the fatal outcome.

  14. A fatal intoxication related to MDPV and pentedrone combined with antipsychotic and antidepressant substances in Cyprus.

    Liveri, Katerina; Constantinou, Maria A; Afxentiou, Maria; Kanari, Popi


    This is a case report of a fatal intoxication in Cyprus related to 3,4-methylenedioxypyrovalerone (MDPV) and 2-(methylamino)-1-phenylpentan-1-one (pentedrone) intake combined with antipsychotic and antidepressant substances. A 42- year old man with a history of serious psychiatric illness was found unresponsive in his bed. Seized materials were also found close to his body. The forensic autopsy reported myocardial infarction due to multidrug intoxication. Toxicology screening in blood and urine was applied. Biological specimens were analysed by enzyme immunoassay procedure and GC/MS. MDPV, pentedrone and etizolam detected and quantitated in blood and urine. Other drugs quantitated in blood were also olanzapine, mirtazapine, and ephedrine. This was the first fatal case reported in Cyprus associated with new psychoactive substances. Additionally, this was the first case reported to Early Warning System of the European Monitoring Center of Drugs and Drug Abuse (EMCDDA), related to multidrug intoxication, attributed to the consumption of cathinones, designer benzodiazepines, and other drugs. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. Two Fatal Intoxications Due to Tramadol Alone: Autopsy Case Reports and Review of the Literature.

    Gioia, Sara; Lancia, Massimo; Bacci, Mauro; Suadoni, Fabio


    Since tramadol was marketed, it has been widely prescribed as a pain killer because of its relatively safe profile among opioids.Nevertheless, intoxication can occur: overdose can lead to fatal outcomes mostly in association with other drugs, via the potential interaction with serotonergic antidepressant medications, as well as the potential for increased central nervous system (CNS) depression.Fatal outcomes only attributable to tramadol are a rare entity. In this case report, 2 fatal cases are described due to tramadol stand-alone intoxication with peculiar characteristics.In case 1, gas chromatography - mass spectrometry analysis detected tramadol in all specimens (32 μg/mL in the heart blood, 23.9 μg/mL in the femoral blood, 3.3 μg/mL in the bile, and 1.4 μg/mL in the urine). No other CNS depressants were detected by toxicological analysis.In case 2, gas chromatography - mass spectrometry analysis detected tramadol in all specimens (7.5 μg/mL in the heart blood, 5.8 μg/mL in the femoral blood, and 18 μg/mL in the urine). No other CNS depressants were detected by toxicological analysis.Review of the literature was performed to clarify the actual knowledge on this topic.

  16. Fatal accidents at work in agriculture associated with alcohol intoxication in Lower Silesia in Poland

    Tomasz Jurek


    Full Text Available Background: Determining the prevalence of alcohol intoxication and the level of intoxication in victims of fatal occupational accidents is necessary to improve work safety. The circumstances of the accident and the time between alcohol consumption and death are important factors. Material and Methods: A retrospective review of 18 935 medico-legal autopsy reports and toxicological reports performed in the Department of Forensic Medicine at the Wroclaw Medical University, Poland, in the years 1991–2014. The study protocol included circumstances, time and cause of death, injuries, quantitative testing for the presence of ethyl alcohol, gender and age. Results: There were 98 farm-related fatalities. There were 41.8% (N = 41 of victims who had been intoxicated – 95.1% (N = 39 of them were males aged 19–70 years old, 4,9% (N = 2 were females aged 37–65 years old. In 8 cases the blood alcohol concentration (BAC was 50–150 mg/dl; in 15 cases it was 150–250 mg/dl and in 18 cases it was > 250 mg/dl. In 21 cases, the BAC was determined using alternative material and 76% (N = 16 victims were in the alcohol elimination phase with 19% (N = 4 victims in the alcohol absorption phase. The most common causes of death were traffic accidents, drowning and deaths resulting from being caught in or hit by moving parts of machinery or equipment. Conclusions: Alcohol consumption is a crucial risk factor in fatal agricultural accidents. In order to establish the time of alcohol consumption, all victims of agricultural accidents should be tested for alcohol concentration in their blood and urine or vitreous. Improving safety at work requires that the sobriety of employees should be monitored before and during work. Med Pr 2017;68(1:23–30

  17. 40 CFR 180.632 - Fenazaquin; import tolerances for residues.


    ... 40 Protection of Environment 23 2010-07-01 2010-07-01 false Fenazaquin; import tolerances for... § 180.632 Fenazaquin; import tolerances for residues. (a) General. Import tolerances are established for residues of the insecticide and miticide, fenazaquin, 4-tert-butylphenethyl quinazolin-4-yl ether, in or on...

  18. Risk factors for unnatural death: Fatal accidental intoxication, undetermined intent and suicide: Register follow-up in a criminal justice population with substance use problems.

    Olsson, Martin O; Bradvik, Louise; Öjehagen, Agneta; Hakansson, Anders


    Risk factors for suicide and fatal accidental intoxication are extensively studied, while risk factors for intoxications/injuries of undetermined intent are less well known. The latter have shown an overlap with suicides, but also with fatal accidental intoxications. The objective was to analyze potential differences and similarities in the patterns of risk factors for accidental intoxications, injuries/intoxications with undetermined intent, and suicides, respectively. A follow-up register study was conducted, using data from ASI interviews with clients in the criminal justice system in Sweden (n=6744), followed in the National Causes of Death Register. A set of risk factors from the ASI interview were tested in bivariate analysis with the respective cause of death, yielding significant risk factors further analyzed in three Cox regression models. In Cox regression analyses, death from fatal accidental intoxication was associated with male gender (HR 4.09), use of heroin (HR 2.86), and use of cannabis (HR 1.94), and death from intoxication/injury of undetermined intent was associated with use of heroin (HR 3.48), binge drinking of alcohol (HR 2.46) and previous psychiatric hospitalization (HR 2.41), while negatively associated with depression (HR 0.33). Death from suicide was associated with previous suicide attempts (HR 2.78) and use of sedatives (HR 2.17). In this population of criminal justice clients with reported substance use problems, fatal injuries/intoxications with undetermined intent - like fatal accidental intoxications - appear to be associated with substance use variables, and cannot readily be assumed to represent the same background factors as suicide. Copyright © 2016. Published by Elsevier Ireland Ltd.

  19. Near-fatal persistent anion- and osmolal-gap acidosis due to massive gamma-butyrolactone/ethanol intoxication.

    Heytens, Luc; Neels, Hugo; Van Regenmortel, Niels; van den Brink, Wim; Henckes, Manu; Schouwers, Sofie; Dockx, Greet; Crunelle, Cleo L


    We report a case of an ethanol and massive gamma-butyrolactone (GBL) intoxication, the precursor of the recreational drug gamma-hydroxybutyric acid (GHB), resulting in life-threatening metabolic acidosis (pH 6.5) with a highly increased anion- and osmolal gap. Rapid analysis using gas chromatography revealed a GHB plasma concentration of 4400 mg/L, far above the upper limit concentration of 1000 mg/L found in adult fatalities attributed to GBL. Full recovery was established following supportive treatment including haemodialysis. This is the first report of a combined ethanol/GBL intoxication as a cause of high serum anion- and osmolal-gap metabolic acidosis. © The Author(s) 2014 Reprints and permissions:

  20. Two cases of near-fatal gamma-butyrolactone (GBL) ingestion and intoxication.

    van Vugt, R; Hofhuizen, C M


    We present two cases of GBL intoxication. Patient A is a 45-year old man who lost consciousness after drinking a clear unknown liquid. He was brought to the Emergency Departement (ED) after he was intubated. His partner notified the liquid could be GBL, a prodrug for GHB. He regained consciousness 16 hours later in the intensive care unit (ICU) where he could be successfully extubated. Patient B is a 25-year old man who was found unconscious at home with next to him an empty bottle of GBL. He was intubated in the intensive care unit. He could be extubated after 12 hours. GBL intoxication is becoming a more frequent problem and overdosage of GBL can rapidly occur because of its rapid onset and high potency when compared to GHB. We discuss the clinical course and complications after GBL ingestion and intoxication.

  1. Fatal alcohol intoxication in women: A forensic autopsy study from Slovakia

    Straka Lubomir


    Full Text Available Abstract Background Plenty of information related to alcoholism can be found in the literature, however, the studies have mostly dealt with the predominance of male alcoholism and data related to addiction in women are desperately scarce and difficult to find. Basic demographic data focusing on the impact of acute alcohol intoxication on the circumstances of death and social behaviour in the alcohol addicted female population are needed especially in the prevention of alcohol related mortality. Methods A retrospective forensic autopsy study of all accidental deaths due to alcohol intoxication over a 12-year period was performed in order to evaluate the locations, circumstances, mechanisms and causes of death. Results A sample of 171 cases of intoxicated women who died due to blood alcohol concentration (BAC equal to or higher than 2 g/kg was selected. Among them 36.26% (62/171 of women died due to acute alcohol intoxication (AAI. We noted an increase in the number of deaths in women due to AAI from 2 in 1994 up to 5 in 2005 (an elevation of 150% between the years 1994-2005. The age structure of deaths in women due to BAC and AAI followed the Gaussian distribution with a dominant group of women aged 41-50 years (45.16% and 35.09% respectively. The most frequent place of death (98% among women intoxicated by alcohol was their own home. The study suggests a close connection between AAI and violence against women. Conclusions The increasing number of cases of death of women suffering from AAI has drawn attention to the serious problem of alcoholism in women in the Slovak Republic during the process of integration into "western" lifestyle and culture.

  2. A non-fatal intoxication and seven deaths involving the dissociative drug 3-MeO-PCP.

    Johansson, Anna; Lindstedt, Daniel; Roman, Markus; Thelander, Gunilla; Nielsen, Elisabet I; Lennborn, Ulrica; Sandler, Håkan; Rubertsson, Sten; Ahlner, Johan; Kronstrand, Robert; Kugelberg, Fredrik C


    3-methoxyphencyclidine (3-MeO-PCP) appeared on the illicit drug market in 2011 and is an analogue of phencyclidine, which exhibits anesthetic, analgesic and hallucinogenic properties. In this paper, we report data from a non-fatal intoxication and seven deaths involving 3-MeO-PCP in Sweden during the period March 2014 until June 2016. The non-fatal intoxication case, a 19-year-old male with drug problems and a medical history of depression, was found awake but tachycardic, hypertensive, tachypnoeic and catatonic at home. After being hospitalized, his condition worsened as he developed a fever and lactic acidosis concomitant with psychomotor agitation and hallucinations. After 22h of intensive care, the patient had made a complete recovery. During his hospitalization, a total of four blood samples were collected at different time points. The seven autopsy cases, six males and one female, were all in their twenties to thirties with psychiatric problems and/or an ongoing drug abuse. 3-MeO-PCP was identified with liquid chromatography (LC)/time-of-flight technology and quantified using LC-tandem mass spectrometry. In the clinical case, the concentration of 3-MeO-PCP was 0.14μg/g at admission, 0.08μg/g 2.5h after admission, 0.06μg/g 5h after admission and 0.04μg/g 17h after admission. The half-life of 3-MeO-PCP was estimated to 11h. In the autopsy cases, femoral blood concentrations ranged from 0.05μg/g to 0.38μg/g. 3-MeO-PCP was the sole finding in the case with the highest concentration and the cause of death was established as intoxication with 3-MeO-PCP. In the remaining six autopsy cases, other medications and drugs of abuse were present as well. Despite being scheduled in January 2015, 3-MeO-PCP continues to be abused in Sweden. Exposure to 3-MeO-PCP may cause severe adverse events and even death, especially if the user does not receive life-supporting treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Fatal non-accidental alpha-lipoic acid intoxication in an adolescent girl.

    Hadzik, B; Grass, H; Mayatepek, E; Daldrup, T; Hoehn, T


    The aim of our report is to increase awareness that the antioxidant alpha-lipoic acid, which is marketed primarily as weight loss and energy supplement, has potentially lethal effects. A 14-year-old girl ingested in suicidal intention a large amount of alpha-lipoic acid, which led to multiorgan failure and subsequent death within 24 h. Multiorgan failure consisted of decreased myocardial contractility, seizures, anuria, thrombocytopenia, and coagulopathy. Therapy consisted of ventilation, anticonvulsive treatment and circulatory support with high-dose catecholamines. According to alpha-lipoic acid serum levels following ingestion the girl must have ingested a minimum of 10 alpha-lipoic acid tablets of 600 mg each. This is the first report on a fatal case of alpha-lipoic acid ingestion, which is intended to inform physicians, pharmacists and patients about critical side effects of this allegedly innocuous drug.

  4. Effect of household processing on fenazaquin residues in okra fruits.

    Duhan, Anil; Kumari, Beena; Gulati, Rachna


    Fenazaquin (4-[[4 (1,1-dimethylethyl) phenyl] ethoxy]quinazoline) is a new acaricide of the quinazoline class. Residue levels of fenazaquin were determined in unprocessed and processed okra fruits to evaluate the effect of different processes (washing, boiling and washing followed by boiling) in reduction of residues of this pesticide in okra. The study was carried out on okra crop (Variety, Varsha Uphar) in research farm of Chaudhary Charan Singh Haryana Agricultural University, Hisar with application of fenazaquin (Magister 10 EC) @ 125 ga.i./ha (Single Dose, T(1)) and 250 g a.i./ha (Double Dose, T(2)). Samples of okra fruits were collected on 0, 3, 7, 15 days after treatment and at harvest (30 days). Residues were estimated by gas chromatograph equipped with capillary column and nitrogen phosphorus detector. Residues reached below maximum residue limit of 0.01 mg/kg at harvest. The residues dissipated with half-life period of 3.13 days at lower dose and 4.43 days at higher dose. Processing is shown to be very effective in reducing the levels of fenazaquin residues in okra fruits. Maximum reduction (60-61%) was observed by washing + boiling followed by boiling/cooking (38-40%) and then by washing (31-32%).

  5. Using alcohol intoxication goggles (Fatal Vision® goggles) to detect alcohol related impairment in simulated driving.

    McCartney, Danielle; Desbrow, Ben; Irwin, Christopher


    Fatal vision goggles (FVGs) are image-distorting equipment used within driver education programs to simulate alcohol-related impairment. However, there is no empirical evidence comparing the behavioral effects associated with wearing FVGs to alcohol intoxication. The purpose of this study was to determine the validity of FVGs in producing alcohol-related impairment in simulated driving. Twenty-two healthy males (age: 23 ± 3 years, mean ± SD) participated in a placebo-controlled crossover design study involving 4 experimental trials. In each trial, participants completed a baseline level simulated driving task followed by an experimental driving task, involving one of 4 treatments: (1) a dose of alcohol designed to elicit 0.080% breath alcohol concentration (BrAC; AB), (2) an alcohol placebo beverage (PB), (3) FVG (estimated % blood alcohol concentration [BAC] 0.070-0.100+), and (4) placebo goggles (PGs). The driving tasks included 3 separate scenarios lasting ∼5 min each; these were a simple driving scenario, a complex driving scenario, and a hazard perception driving scenario. Selected lateral control parameters (standard deviation of lane position [SDLP]; total number of lane crossings [LCs]) and longitudinal control parameters (average speed; standard deviation of speed [SDSP]; distance headway; minimum distance headway) were monitored during the simple and complex driving scenarios. Latency to 2 different stimuli (choice reaction time [CRT]) was tested in the hazard perception driving scenario. Subjective ratings of mood and attitudes toward driving were also provided during each of the trials. Neither placebo treatment influenced simulated driving performance. Mean BrAC was 0.060 ± 0.010% at the time of driving on the AB trial. Lateral control: In the simple driving scenario, SDLP and LC were not affected under any of the experimental treatments. However, in the complex driving scenario, significantly greater SDLP was observed on both the FVG and AB

  6. Magnetic resonance imaging features of brain and spinal cord injury in a fatal case of isopropanol intoxication

    Mahajan PS


    Full Text Available Parag Suresh Mahajan,1 Joyal Jacob Mathew,2 Abhilash Pulincherry Jayaram,1 Vidya Chander Negi,1 Mohamed Milad Abu Hmaira21Department of Radiology, 2Department of Medicine, Al-Khor Hospital, Hamad Medical Corporation, Doha, QatarAbstract: A 60-year-old man presented with headache, dizziness, and disorientation one day after consumption of isopropanol along with ethanol. Computed tomography (CT of the brain performed immediately was unremarkable. The patient collapsed within the hospital 30 minutes after the CT scan was done, and remained comatose until death, showing no improvement with symptomatic treatment. Magnetic resonance imaging of the brain and spine done 6 days after admission revealed bilaterally symmetrical hyperintensities involving the cerebral and cerebellar cortex and white matter, basal ganglia, thalami, and brainstem on T2-weighted, fluid attenuated inversion recovery and diffusion weighted images; similar hyperintensities were seen involving the swollen and edematous cervical spinal cord and cerebellar tonsillar herniation compressing the proximal cervical cord. Petechial hemorrhages were also noted within the brainstem. These features are compatible with toxic injury to the brain and cervical spinal cord. To our knowledge, the magnetic resonance imaging features of brain and spinal cord injury and cerebellar tonsillar herniation, secondary to isopropanol intoxication have not been reported in the published literature before.Keywords: alcohol intoxication, computed tomography, isopropyl alcohol, ethyl alcohol, toxicity

  7. A fatal intoxication following the ingestion of 5-methoxy-N,N-dimethyltryptamine in an ayahuasca preparation.

    Sklerov, Jason; Levine, Barry; Moore, Karla A; King, Theodore; Fowler, David


    A case of a 25-year-old white male who was found dead the morning after consuming herbal extracts containing beta-carbolines and hallucinogenic tryptamines is presented. No anatomic cause of death was found at autopsy. Toxicologic analysis of the heart blood identified N,N-dimethyltryptamine (0.02 mg/L), 5-methoxy-N,N-dimethyltryptamine (1.88 mg/L), tetrahydroharmine (0.38 mg/L), harmaline (0.07 mg/L), and harmine (0.17 mg/L). All substances were extracted by a single-step n-butyl chloride extraction following alkalinization with borate buffer. Detection and quantitation was performed using liquid chromatography-electrospray mass spectrometry. The medical examiner ruled that the cause of death was hallucinogenic amine intoxication, and the manner of death was undetermined.

  8. Marijuana intoxication

    Cannabis intoxication; Intoxication - marijuana (cannabis); Pot; Mary Jane; Weed; Grass; Cannabis ... The intoxicating effects of marijuana include relaxation, ... to fast and predictable signs and symptoms. Eating marijuana ...

  9. Photodecomposition of an acaricide, fenazaquin, in aqueous alcoholic solution.

    Bhattacharyya, Jayati; Banerjee, Hemanta; Bhattacharyya, Anjan


    Fenazaquin (I) is a new acaricide of the quinazoline class. The photodecomposition of I was studied in aqueous methanolic and 2-propanolic solution under UV light (30 h) and sunlight (70 h) separately. The photolytic half-lives in aqueous methanolic solution were found to be 17.1 h (UV) and 38.1 h (sunlight), whereas these were 12.9 h (UV) and 29.2 h (sunlight) for aqueous 2-propanolic solution; all followed a first-order reaction kinetics. Six photoproducts were obtained: beta-phenyl (p-tert-butyl) ethyl alcohol (II), 4-hydroxyquinazoline (III), p-tert-butyl vinyl benzene (IV), 2,4-dihydroxyquinazoline (V), phenyl (p-tert-butyl) acetic acid (VI), and 2-methyl-2-[4'-(2' '-hydroxyethyl)phenyl]propanoic acid (VII). Compounds VI and VII could be isolated only from aqueous 2-propanolic solution under sunlight irradiation. The major degradation products are formed as a result of cleavage of the ether bridge linking the quinazoline and phenyl ring systems of the molecule, oxidation of the tert-butyl substituent, and oxidation of the heterocyclic portion of the quinazoline ring. A probable mechanism of formation of the photoproducts is also suggested.

  10. Degradation studies of fenazaquin in soil under field and laboratory conditions.

    Duhan, Anil; Kumari, Beena


    Degradation of fenazaquin in sandy loam soil was investigated under field and laboratory conditions. Fenazaquin (Magister 10EC) was applied @ 125 and 250 g a.i./ha in field and in pot under field capacity moisture in laboratory. Samples drawn periodically were analyzed on GC-NPD. The residues of fenazaquin in both the doses and conditions dissipated almost 90% in 90 days. Half-life period were 32.04 and 31.35 days at two doses, respectively at field conditions and 30.10 and 28.94 days at laboratory conditions. Dissipation was approximated to first order kinetics in both conditions having correlation coefficient ranging from -0.9848 to -0.9914.

  11. Investigation in tea on fate of fenazaquin residue and its transfer in brew.

    Kumar, Vipin; Tewary, Dhananjay Kumar; Ravindranath, Sringapuram Desikachar; Shanker, Adarsh


    Fenazaquin is a non-systemic acaricide/insecticide used widely in controlling mites and other related pests in fruits, vegetables and tea. The objective of this research was to investigate the disappearance trend in tea of fenazaquin residue level and its transfer in brew. Fenazaquin was applied on a tea crop at two rates, 125 and 250 g AI/ha in wet and dry seasons under field conditions. Samples (green shoots, made tea and its brew) were analyzed for fenazaquin and quantification was by high performance liquid chromatography using a UV detector. The residue dissipated faster in the wet season than in the dry season. Seven days after the treatment (normal round of plucking) the residues observed in the green shoots at the two rates were 2.17, 3.07 mg/kg and 2.04, 2.84 mg/kg in the wet and dry seasons, respectively. However, the degradation rale in both seasons followed first-order kinetics. Half-lives in green shoots were in range 1.43-1.70 and 2.10-2.21 days and in made tea 1.59-1.73 and 1.87-1.94 days for wet and dry seasons, respectively. During processing of green shoots to made tea considerable loss (42-70%) of residue was observed. The transfer of residue from made tea brew was in the range 3-22%. In brew residue were below 0.02 mg/l after 5 days of application at both the rates in either of the seasons. The estimated intake with brew (normal consumption of 10 cup/day/adult) thus would be below the acceptable daily intake for fenazaquin (0.005 mg/kg-body weight). To avoid health hazards due to the toxic effect of residues in brew, a waiting period for plucking the tea shoots after fenazaquin application of more than 5 days for both the seasons at recommended rate (125 g AI/ha) may be suggested and considered quite safe.

  12. Sublethal effects of fenazaquin on life table parameters of the predatory mite Amblyseius swirskii (Acari: Phytoseiidae).

    Alinejad, Marzieh; Kheradmand, Katayoon; Fathipour, Yaghoub


    Knowledge of the impact of acaricides on predatory mites is crucial for integrated pest management programs. The present study evaluated the sublethal effect of fenazaquin (Pride(®) 20 % SC, Behavar, Iran) on life table parameters of the subsequent generation of the predatory mite, Amblyseius swirskii Athias-Henriot (Acari: Phytoseiidae), fed on Tetranychus urticae Koch under laboratory conditions [26 ± 1 °C, 70 ± 3 % RH and 16:8 (L:D) h]. The sublethal concentrations including LC10, LC20 and LC30 were determined using a dose-effect assay. The total development time of both sexes enhanced with an increase in concentration. The oviposition period and total fecundity decreased in dose-dependent manner. The intrinsic rate of increase (r) and finite rate of increase (λ) significantly descended with concentration enhancing from LC10 to LC30, compared with the control. The net reproductive rate (R 0) ranged between 2.76 and 7.37 offspring. Overall, the results indicated that fenazaquin had negative effects on development and life table parameters of the subsequent generation of A. swirskii. In conclusion, fenazaquin is not a compatible acaricide with A. swirskii and should not be used with this predatory mite in integrated management of T. urticae.

  13. Lithium Intoxication

    Sermin Kesebir


    Full Text Available Lithium has been commonly used for the treatment of several mood disorders particularly bipolar disorder in the last 60 years. Increased intake and decreased excretion of lithium are the main causes for the development of lithium intoxication. The influence of lithium intoxication on body is evaluated as two different groups; reversible or irreversible. Irreversible damage is usually related with the length of time passed as intoxicated. Acute lithium intoxication could occur when an overdose of lithium is received mistakenly or for the purpose of suicide. Patients may sometimes take an overdose of lithium for self-medication resulting in acute intoxication during chronic, while others could develop chronic lithium intoxication during a steady dose treatment due to a problem in excretion of drug. In such situations, it is crucial to be aware of risk factors, to recognize early clinical symptoms and to conduct a proper medical monitoring. In order to justify or exclude the diagnosis, quantitative evaluation of lithium in blood and toxicologic screening is necessary. Following the monitoring schedules strictly and urgent intervention in case of intoxication would definitely reduce mortality and sequela related with lithium intoxication. In this article, the etiology, frequency, definition, clinical features and treatment approaches to the lithium intoxication have been briefly reviewed.

  14. [Fatal poisoning caused by aconite monk's hood (Aconitum napellus)].

    Feldkamp, A; Köster, B; Weber, H P


    Severe intoxications after ingestion of monk's hood are rare in childhood. We report a case of fatal intoxication in a 20 months old child. There is no specific therapy available. A review of the literature is added.

  15. Fatal intoxication due to ackee (Blighia sapida) in Suriname and French Guyana. GC-MS detection and quantification of hypoglycin-A.

    Gaillard, Yvan; Carlier, Jérémie; Berscht, Marc; Mazoyer, Cédric; Bevalot, Fabien; Guitton, Jérôme; Fanton, Laurent


    Between 1998 and 2001 the deaths of 16 Surinamese children were recorded along the Maroni River, which forms the border between Suriname and French Guyana. After a metabolic origin was eliminated, ethnobotanical research in the field led to a hypothesis of intoxication through the ingestion of ackee. Ackee (Blighia sapida) is a large green leafy tree of West African origin. Its unripe fruit contains large quantities of two toxic molecules: hypoglycin-A and hypoglycin-B, the former being the more toxic. We have developed a GC-MS procedure allowing us to demonstrate the presence of hypoglycin-A in the gastric fluid of one of the deceased children, and to compare the content of hypoglycin-A in fruit collected on the road to Paramaribo in Suriname (5.1mg/g) with samples from Burkina Faso (8.1mg/g) and Jamaica (9.2mg/g). Field research showed the misuse of this little-known plant by Maroon witch doctors. The Bushinengue witch doctors were informed about the dangers of ackee, and no new cases have been reported to date.

  16. Side-effects of fenazaquin on a cellular model of Paramecium.

    Benbouzid, Houneïda; Berrebbah, Houria; Djebar, Mohammed-Réda; Smagghe, Guy


    Our biodiversity has long been preserved, but the main constituents of our environment have been particularly affected by the addition of molecules resulting from agricultural and industrial activities. It is well accepted that these changes may stress some species, making them more vulnerable. In this project, we determined the disruptive side-effects of a pesticide on several biochemical endpoints and the behaviour of a microorganism as the ciliate protist Paramecium sp. Here we used fenazaquin [4-(4-tert-butylphenethoxy)quinazoline] that belongs to the quinazoline class of chemicals and that is a pesticide intended to control mites and insects; its route of exposure is ingestion and dermal, and its mode of action is the disruption of the biochemistry of insect mitochondria. In our experiments with fenazaquin at 40, 60 and 80 nM, we recorded disturbances in protein and glutathione, in glutathione S-transferase, and a decrease in consumption of oxygen. The results are discussed in relation to potential risks and mechanisms of action. In addition, the data can be used as reference values in further testing with other pesticides and chemistries.

  17. Comparison at Necropsy of Heart Weight in Women Aged 20 to 29 Years With Fatal Trauma or Chemical Intoxication Versus Fatal Natural Cause (A Search for the Normal Adult Heart Weight).

    Blackbourne, Brian D; Vasudevan, Anupama; Roberts, William C


    The present obesity epidemic makes determining the normal heart weight in adults difficult. This study examines the heart weight at autopsy in 104 women aged 20 to 29 years who died in 1978 to 1980 before the overweight epidemic ensued. Of the 104 cases, the hearts weighed ≤300 g in 86 (83%) and >300 g in 18 (17%). Of the 67 cases dying from an unnatural cause (trauma or chemical intoxication), only 3 (4%) had hearts weighing >300 g; of the 37 patients dying from a variety of natural causes, 15 (41%) had hearts weighing >300 g (p hearts in them ranged from 120 to 400 g (mean 262 ± 51; median 257 g); of the 22 cases (21%) in whom the BMI was >25 kg/m(2), the hearts ranged from 230 to 850 g (mean 351 ± 142; median 300 g). In conclusion, the cases dying from an unnatural cause had smaller mean heart weights than those women dying from a natural cause and those with a normal BMI (≤25 kg/m(2)) had smaller mean heart weights than those with a BMI >25 kg/m(2). The normal heart weight in young women dying from an unnatural cause with few exceptions is <300 g. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Opioid intoxication

    ... easily result in intoxication. The provider prescribes a sleep medicine (sedative) in addition to the opioid. The provider ... an opioid with certain other drugs, such as sleep medicines or alcohol Taking the opioid in ways not ...

  19. Fatal intoxication by 5F-ADB and diphenidine: Detection, quantification, and investigation of their main metabolic pathways in humans by LC/MS/MS and LC/Q-TOFMS.

    Kusano, Maiko; Zaitsu, Kei; Taki, Kentaro; Hisatsune, Kazuaki; Nakajima, Jun'ichi; Moriyasu, Takako; Asano, Tomomi; Hayashi, Yumi; Tsuchihashi, Hitoshi; Ishii, Akira


    Despite the implementation of a new blanket scheduling system in 2013, new psychoactive substance (NPS) abuse remains a serious social concern in Japan. We present a fatal intoxication case involving 5F-ADB (methyl 2-[1-(5-fluoropentyl)-1H-indazole-3-carboxamido]-3,3-dimethylbutanoate) and diphenidine. Postmortem blood screening by liquid chromatography/quadrupole time-of-flight mass spectrometry (LC/Q-TOFMS) in the information-dependent acquisition mode only detected diphenidine. Further urinary screening using an in-house database containing NPS and metabolites detected not only diphenidine but also possible 5F-ADB metabolites; subsequent targeted screening by LC/tandem mass spectrometry (LC/MS/MS) allowed for the detection of a very low level of unchanged 5F-ADB in postmortem heart blood. Quantification by standard addition resulted in the postmortem blood concentrations being 0.19 ± 0.04 ng/mL for 5F-ADB and 12 ± 2.6 ng/mL for diphenidine. Investigation of the urinary metabolites revealed pathways involving ester hydrolysis (M1) and oxidative defluorination (M2), and further oxidation to the carboxylic acid (M3) for 5F-ADB. Mono- and di-hydroxylated diphenidine metabolites were also found. The present case demonstrates the importance of urinary metabolite screening for drugs with low blood concentration. Synthetic cannabinoids (SCs) fluorinated at the terminal N-alkyl position are known to show higher cannabinoid receptor affinity relative to their non-fluorinated analogues; 5F-ADB is no exception with high CB1 receptor activity and much greater potency than Δ(9) -THC and other earlier SCs, thus we suspect its acute toxicity to be high compared to other structurally related SC analogues. The low blood concentration of 5F-ADB may be attributed to enzymatic and/or non-enzymatic degradation, and further investigation into these possibilities is underway. Copyright © 2017 John Wiley & Sons, Ltd.

  20. [Fatal poisonings with propoxur].

    Pfordt, J; Magerl, H; Vock, R


    The insecticide propoxur (2-isopropoxyphenyl-N-methylcarbamate) acts by blocking cholinesterase. This inhibition is fast and, unlike that brought about by organophosphorus compounds, reversible. The toxicity of propoxur to man is stated to be low compared with that of parathion. Only a small number of fatal intoxications have been published; at the Würzburg University Institute of Legal Medicine eight cases have been observed since 1978. In seven cases death occurred after deliberate oral ingestion of solutions of propoxur with suicidal intent, while in the other, intoxication was accidental, following inhalation of an aerosol containing propoxur. Organs and body fluids were investigated toxicologically and histologically. The results are presented and discussed. Special attention is paid to the combination of propoxur and alcohol.

  1. Baclofen Intoxication

    Canan Bor


    Full Text Available Baclofen is a β-(ρ-chlorophenyl derivative of the neurotransmitter gamma-aminobutyric acid (GABA and is usually prescribed for spasticity of spinal cord origin, intractable hiccup, trigeminal neuralgia, hemifacial spasm, and tardive dyskinesia. The usual recommended daily dose ranges from 40-80 mg, and the total dose should not exceed 80 mg per day. A 41 year old woman using baclofen for migraine therapy intended suicide after a bitter headache attack by taking 37 tablets, 10 mg in each. On arrival to emergency room, she was conscious and co-operable, but somnolent, her pupils were normoisocoric and light reflex was intact bilaterally. On her follow up, respiratory insufficiency and unconsciousness was observed so she was entubated orotracheally and transferred to intensive care unit (ICU for advanced tests and therapy. No pathology was determined on cranial CT. On ICU follow up, she was unconscious and mechanically ventilated, her Glasgow Coma Scale was 3/15 (E1M1VE and pupils were mid-dilated with no light reflex. Since she was again conscious, oriented and co-operable on 19th hour of arrival to ICU and 20th hour of arrival to emergency room, spontaneous breathing trials was started. Extubation was carried out on her 31th hour of arrival to ICU and 32th hour of arrival to emergency room. In conclusion; since baclofen overdose may cause deep coma, it should also be included in differential diagnosis. According to our opinion, performing diagnostic toxicological tests is not always possible that’s why history and physical examination is fundamental in case of baclofen intoxication and we can get good results by giving frequent neurological examination, supportive and extracorporeal therapy in such a case.

  2. Acute intoxication with guaifenesin, diphenhydramine, and chlorpheniramine.

    Wogoman, H; Steinberg, M; Jenkins, A J


    Mixed drug reactions are frequently encountered in emergency department overdose cases and also in fatal intoxications. Assessment of the relative contribution of each drug in producing adverse effects is often compounded by lack of case history and the paucity of cases reported in the literature. This report describes a fatal intoxication with three common over-the-counter medications: guaifenesin, diphenhydramine, and chlorpheniramine. A 48-year-old woman was found dead in the attic bedroom of her residence. Specimens obtained at autopsy for toxicologic analysis included heart blood, urine, bile, gastric contents, vitreous humor, and cerebrospinal fluid. The over-the-counter drugs were identified and quantitated by acid/neutral or basic liquid-liquid extraction followed by gas chromatographic analysis with nitrogen phosphorus detection. Concentrations of guaifenesin, diphenhydramine, and chlorpheniramine detected in the heart blood were 27.4, 8.8, and 0.2 mg/L, respectively. The cause of death was determined to be acute intoxication by the combined effects of guaifenesin, diphenhydramine, and chlorpheniramine, and the manner of death was determined to be suicide. To our knowledge, the blood guaifenesin concentration in this case is the highest reported concentration to date associated with an acute intoxication.

  3. Suicide attempt with a mix of synthetic cannabinoids and synthetic cathinones: Case report of non-fatal intoxication with AB-CHMINACA, AB-FUBINACA, alpha-PHP, alpha-PVP and 4-CMC.

    Klavž, Janez; Gorenjak, Maksimiljan; Marinšek, Martin


    We report on a case of intoxication with a mix of new psychoactive substances. A 38-year-old male was brought to the emergency department (ED) following the ingestion of an unknown drug in a suicide attempt. During the transport, he became progressively more somnolent and unresponsive to painful stimuli. Urine and stomach content were collected on admission to be screened for drugs of abuse and medicinal drugs. After admission, the patient's next of kin presented five small grip seal plastic bags containing different powders/crystals, and they were sent for analysis along with urine and stomach content to the toxicology laboratory. An easy and rapid sample preparation technique was applied for the extraction of urine and stomach content. Samples were extracted with liquid-liquid extraction (LLE) technique and analysed using gas chromatography-mass spectrometry (GC-MS). A small amount of powder material from the bags was diluted in methanol and injected directly into the GC-MS instrument. Obtained spectra (EI) were evaluated against SWGDRUG library. Five different designer drugs were identified in the powder material, including synthetic cannabinoids (AB-CHMINACA, AB-FUBINACA) and synthetic cathinones (alpha-PHP, alpha-PVP and 4-CMC). With the exception of 4-CMC, all of these substances were also detected in the stomach content along with the prescription drugs. This is the first time that a positive identification of these five drugs has been made by a clinical laboratory in Slovenia.

  4. Fatal poisoning among patients with drug addiction

    Simonsen, Kirsten Wiese; Christoffersen, Dorte J; Banner, Jytte; Linnet, Kristian; Andersen, Ljubica V


    INTRODUCTION: Fatal poisonings among drug addicts in Denmark in 2012 were examined. Cause of death, abuse pattern and geographic differences are discussed and data are compared with previous studies.METHODS: All fatal poisonings examined at the three institutes of forensic medicine in Denmark in 2012 were included in the study.RESULTS: A total of 188 fatal intoxications were recorded. The median age increased from 37.5 in 2007 to 41.5 in 2012. The majority were men (77%). Methadone (59%) was ...

  5. [Fatalities in the bathtub].

    Trübner, K; Püschel, K


    A retrospective analysis concerning deaths in the bathtub was carried out in the Institute of Legal Medicine in Hamburg. The study includes 245 death cases between 1971 and 1988 (1% of all autopsies). 66 cases proved to be natural deaths, 76 were classified as suicides, 39 as accidents and 13 as homicides; 51 fatalities remained unclear with respect to one of these groups. Among the natural deaths sudden cardiac deaths were dominating (n = 39), among the suicides the intoxications (n = 37) and electrocutions (n = 20), and among the accidents the intoxications by carbon monoxide (n = 17) and electrocutions (n = 12). Out of 13 homicides only 2 were committed directly in the bathtub: One by drowning of a child and one by electric current via a hair dryer; in the other cases the dead body was put into the bathtub post mortem. About 50% of the victims were alcoholized. Signs of drowning were present in about 40% of all cases; the most frequent finding was emphysema aquosum.

  6. [Acute intoxication with isopropanol].

    Steinmann, D; Faber, T; Auwärter, V; Heringhaus, C


    Isopropanol is an ingredient of commonly used industrial and household agents. Intoxication can occur unintentionally, in suicide attempts or by alcohol abusers when used as a substitute for ethanol. Symptoms involve the gastrointestinal tract, the central nervous system, and the cardiovascular system at higher doses. Mortality is especially high in patients with deep coma and marked hypotension. This report describes a case of life-threatening isopropanol intoxication of a prison inmate successfully treated by haemodialysis.

  7. Femme fatale

    Francisco Javier Tardío Gastón


    Full Text Available Our history is full of myths and topics. Therefore the image of femme fatale is frequent in the works of all periods and places. The author of this article first analyzes how the history and literature consistently showed and defined these women, and then presents examples that come from ancient Greece. The art is powered by their power of seduction and the article explains how this femme fatale appeared in literature and film. The article concludes with a brief overview of various arguments concerning women and feminism, present in the literary criticism.

  8. [Fatal outcome of an hydrogen sulfide poisoning].

    Querellou, E; Jaffrelot, M; Savary, D; Savry, C; Perfus, J-P


    We report a case of fatal outcome poisoning by massive exposure to hydrogen sulfide of a sewer worker. This rare event was associated with a moderate intoxication of two members of the rescue team. The death was due to asystole and massive lung oedema. Autopsy analysis showed diffuse necrotic lesions in lungs. Hydrogen sulfide is a direct and systemic poison, produced by organic matter decomposition. The direct toxicity mechanism is still unclear. The systemic toxicity is due to an acute toxicity by oxygen depletion at cellular level. It is highly diffusable and potentially very dangerous. At low concentration, rotten egg smell must trigger hydrogen sulfide suspicion since at higher concentration it is undetectable, making intoxication possible. In case of acute intoxication, there is an almost instantaneous cardiovascular failure and a rapid death. Hydrogen sulfide exposure requires prevention measures and more specifically the use of respiratory equipment for members of the rescue team.

  9. Lipid Therapy for Intoxications

    Robben, Joris Henricus; Dijkman, Marieke Annet


    This review discusses the use of intravenous lipid emulsion (ILE) in the treatment of intoxications with lipophilic agents in veterinary medicine. Despite growing scientific evidence that ILE has merit in the treatment of certain poisonings, there is still uncertainty on the optimal composition of t

  10. Lipid Therapy for Intoxications

    Robben, Joris Henricus; Dijkman, Marieke Annet


    This review discusses the use of intravenous lipid emulsion (ILE) in the treatment of intoxications with lipophilic agents in veterinary medicine. Despite growing scientific evidence that ILE has merit in the treatment of certain poisonings, there is still uncertainty on the optimal composition of t

  11. Driving While Intoxicated.

    Brick, John

    Alcohol intoxication increases the risk of highway accidents, the relative risk of crash probability increasing as a function of blood alcohol content (BAC). Because alcohol use is more prevalent than use of other drugs, more is known about the relationship between alcohol use and driving. Most states presume a BAC of .10% to be evidence of drunk…

  12. A case of survival after chlorfenapyr intoxication with acute pancreatitis.

    Ku, Jae Eun; Joo, Young Seon; You, Je Sung; Chung, Sung Phil; Lee, Hahn Shick


    Chlorfenapyr is a moderately hazardous insecticide. There have been previous reports of chlorfenapyr intoxication, but none have reported patient survival or an association with pancreatitis. A 61-year-old woman was brought to the emergency department with vomiting after ingesting 10 mL chlorfenapyr in a suicide attempt 1 hour before. The patient was treated with gastric lavage and activated charcoal, then transferred to the intensive care unit. Initial laboratory data were unremarkable except for elevated amylase/lipase levels (134/222 U/L), which were even higher 7 days later and remained elevated for 2 weeks. Abdominal computed tomography showed diffuse pancreatic swelling. The patient improved with conservative care and was discharged to home 19 days after admission. This is the first reported case of survival after chlorfenapyr intoxication. We recommend early aggressive management in the emergency department and close monitoring in the intensive care unit to detect and treat potentially fatal deterioration after chlorfenapyr intoxication.

  13. Surprising hair analysis results following acute carbofuran intoxication.

    Dulaurent, S; Gaulier, J M; Zouaoui, K; Moesch, C; François, B; Lachâtre, G


    We present two non fatal cases of intoxication with carbofuran (CBF) documented by hair analysis. Carbofuran and 3-hydroxycarbofuran (OHCBF, its main metabolite) hair concentrations were determined using a liquid chromatography-tandem mass spectrometry method. The obtained results were surprising if we consider several hair analyses previously published and based on a theory of the presence of xenobiotic in the only segment that comprised its intake. Among the two intoxication cases, we noticed the presence of CBF and OHCBF in hair segments corresponding to 45 days before, and more than 100 days after, the day of intoxication. Additionally, repeated hair samplings and subsequent analysis revealed a decrease of the carbofuran's concentration during the hair life.

  14. A multi-drug intoxication fatality involving Xyrem (GHB).

    Akins, Brianne E; Miranda, Estuardo; Lacy, J Matthew; Logan, Barry K


    Gamma-hydroxybutyrate (GHB) is best known as a recreational depressant drug, whose use has also been implicated in drug facilitated sexual assault cases. It is also available as a therapeutic agent (Xyrem) used for the treatment of daytime sleepiness or cataplexy associated with narcolepsy. This is a report of a case of a 53-year-old woman undergoing treatment with Xyrem for narcolepsy. The decedent was also prescribed tramadol, gabapentin, cetirizine, modafinil, carisoprodol, and Xyrem. Toxicological analysis of the blood revealed GHB 165.6 mg/L, and 90.7 mg/L in the urine. Blood GHB concentrations in the range 156-260 mg/L have been reported to induce moderately sound sleep. The combined use of central nervous system depressant drugs, together with her problematic sleep apnea, and snoring (both contraindications for GHB use) were determined to have caused this subject's death. The manner of death was determined to be accidental.

  15. Toxicological findings in a fatal multidrug intoxication involving mephedrone.

    Gerace, Enrico; Petrarulo, Michele; Bison, Fabrizio; Salomone, Alberto; Vincenti, Marco


    The distribution of mephedrone in the body fluids and tissues of a subject found dead after the concomitant intake of cocaine and mephedrone is reported. Mephedrone (4-methylmethcathinone) is a designer drug of the phenethylamine family that is able to cause central nervous system stimulation, psychoactivity and hallucinations and that is becoming popular among youth as a recreational drug. Mephedrone has been available in Europe since 2007, and it is sold through the internet and by local shops as bath salt or plant food. In the case reported here, a 25-year-old man was found dead in the apartment of a friend after a night spent in several local clubs. A fragment of a blue diamond-shaped pill was found in the pocket of the trousers worn by the decedent. During the autopsy, no evidence of natural disease or trauma was found to account for this death. Blood, urine and gastric content samples were collected and submitted for toxicological analysis. Moreover, bile, brain, lung and hair samples were collected as additional matrices. The content of the pill was submitted to a general screening analysis in order to determine its composition. Mephedrone was detected in the blood, urine, gastric contents and in the additional matrices using an expressly validated GC/MS method. The blood and urine concentrations were 1.33mg/L and 144mg/L, respectively. Contextually, cocaine and cocaethylene were found in the blood and urine specimens. The distribution of mephedrone in the body organs was evaluated by analyzing the brain, bile and lung specimens. Hair analysis revealed a past exposure to mephedrone, ketamine, MDMA and cocaine. Sildenafil was identified as the main component of the blue, diamond-shaped pill. The quantitative determination of mephedrone in several body fluids and tissues provides significant knowledge about the distribution of this new drug of abuse in the human body after massive ingestion.

  16. Accidental acute alcohol intoxication in infants: review and case report.

    Minera, Gabriella; Robinson, Evan


    Acute alcohol intoxication in children younger than 18 months old is both rarely documented and rarely fatal. Previous case reports suggest hypoglycemia and faster than normal rates of alcohol elimination found in children with acute alcohol intoxication compared with adults, but data are lacking. A 2-month-old infant presented with a decreased mental status after accidental ingestion of alcohol. He was diagnosed with acute alcohol intoxication, with a blood alcohol level of 330 mg/dL and was hyperglycemic (167 mg/dL). Alcohol elimination rate was calculated to be 21.6 mg/dL/h, similar to that in adults. To our knowledge, this case is the second youngest documented patient with accidental alcohol intoxication via ingestion in the United States. We present a rare case report of acute alcohol intoxication in an infant and a review of the literature. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although rare in the literature, poison control data suggests that alcohol poisoning in very young children is not rare. Emergency physicians should be prepared for the management of infants with alcohol poisoning. This case report and review brings attention to this subject and briefly discusses ethanol metabolism in infants. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. [Intoxication of botulinum toxin].

    Chudzicka, Aleksandra


    Botulinum toxin is an egzotoxin produced by Gram positive bacteria Clostridium botulinum. It is among the most potent toxins known. The 3 main clinical presentations of botulism are as follows: foodborne botulism, infant botulism and wound botulism. The main symptom of intoxication is flat muscles paralysis. The treatment is supportive care and administration of antitoxin. In prevention the correct preparing of canned food is most important. Botulinum toxin is accepted as a biological weapon.

  18. Acute Theophylline Intoxication: Case Report

    Zehra Baykal Tutal


    Full Text Available Theophylline is an efficient bronchodilatator, which is used in the treatment of the disease such like Chronic Obstructive Pulmoner Disease (COPD neonatal apnea, bradycardial syndrome. Blood levels of theophylline above 15 ug/ml have risk of intoxication. Acute and chronic intoxication can be seen. Nausea, vomitin, agitation, palpitation and metabolic abnormalities such as, hyperglisemia, hypokalemia, impairment in acid base equilibrium and leukocytosis can be seen in acute theophylline intoxication. Acute theophylline intoxications can result life threatening situations such as convulsions, ventricular arrhythmias and death. Theophylline intoxications are often iatrogenic. In this case, the clinical course of a patient with COPD who took theophylline with the intention of suicide attempt is to mentioned and discussion of diagnosis, treatment and clinical course of acute theophylline intoxication was to aimed.

  19. [Autoerotic fatalities in Greater Dusseldorf].

    Hartung, Benno; Hellen, Florence; Borchard, Nora; Huckenbeck, Wolfgang


    Autoerotic fatalities in the Greater Dusseldorf area correspond to the relevant medicolegal literature. Our results included exclusively young to middle-aged, usually single men who were found dead in their city apartments. Clothing and devices used showed a great variety. Women's or fetish clothing and complex shackling or hanging devices were disproportionately frequent. In most cases, death occurred due to hanging or ligature strangulation. There was no increased incidence of underlying psychiatric disorders. In most of the deceased no or at least no remarkable alcohol intoxication was found. Occasionally, it may be difficult to reliably differentiate autoerotic accidents, accidents occurring in connection with practices of bondage & discipline, dominance & submission (BDSM) from natural death, suicide or homicide.

  20. Unpacking intoxication, racialising disability.

    Chen, Mel Y


    This article examines concepts whose strictly medical applications have only partly informed their widespread use and suggests that demonstrably shared logics motivate our thinking across domains in the interest of a politically just engagement. It considers exchanges between the culturally complex concepts of 'toxicity' and 'intoxication', assessing the racialised conditions of their animation in several geopolitically--and quite radically--distinct scenarios. First, the article sets the framework through considering the racial implications of impairment and disability language of 'non-toxic' finance capital in the contemporary US financial crisis. Shifting material foci from 'illiquid financial bodies' to opiates while insisting that neither is 'more' metaphorically toxic than the other, the article turns to address the role of opium and temporality in the interanimations of race and disability in two sites of 19th-century British empire: Langdon Down's clinic for idiocy, and China's retort on opium to Queen Victoria. The article concludes with a provocation that suggests yet another crossing of borders, that between researcher and researched: 'intoxicated method' is a hypothetical mode of approach that refuses idealised research positions by 'critically disabling' the idealised cognitive and conceptual lens of analysis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  1. Chelation in metal intoxication

    Aaseth, Jan; Skaug, Marit Aralt; Cao, yang


    The present review provides an update of the general principles for the investigation and use of chelating agents in the treatment of intoxications by metals. The clinical use of the old chelators EDTA (ethylenediamine tetraacetate) and BAL (2,3-dimercaptopropanol) is now limited due to the incon......The present review provides an update of the general principles for the investigation and use of chelating agents in the treatment of intoxications by metals. The clinical use of the old chelators EDTA (ethylenediamine tetraacetate) and BAL (2,3-dimercaptopropanol) is now limited due...... to the inconvenience of parenteral administration, their own toxicity and tendency to increase the neurotoxicity of several metals. The hydrophilic dithiol chelators DMSA (meso-2,3-dimercaptosuccinic acid) and DMPS (2,3-dimercapto-propanesulphonate) are less toxic and more efficient than BAL in the clinical treatment...... of heavy metal poisoning, and available as capsules for oral use. In copper overload, DMSA appears to be a potent antidote, although d-penicillamine is still widely used. In the chelation of iron, the thiols are inefficient, since iron has higher affinity for ligands with nitrogen and oxygen, but the new...

  2. Surfactant therapy restores gas exchange in lung injury due to paraquat intoxication in rats

    K.L. So; E. de Buijzer; D.A.M.P.J. Gommers (Diederik); U. Kaisers; P.J.J. van Genderen (Perry); B.F. Lachmann (Burkhard)


    textabstractParaquat is a weed killer which causes often fatal lung damage in humans and other animals. There is evidence that the pulmonary surfactant system is involved in the pathophysiology of respiratory failure after paraquat intoxication and, therefore, the possi

  3. Chelation in Metal Intoxication

    Swaran J.S. Flora


    Full Text Available Chelation therapy is the preferred medical treatment for reducing the toxic effects of metals. Chelating agents are capable of binding to toxic metal ions to form complex structures which are easily excreted from the body removing them from intracellular or extracellular spaces. 2,3-Dimercaprol has long been the mainstay of chelation therapy for lead or arsenic poisoning, however its serious side effects have led researchers to develop less toxic analogues. Hydrophilic chelators like meso-2,3-dimercaptosuccinic acid effectively promote renal metal excretion, but their ability to access intracellular metals is weak. Newer strategies to address these drawbacks like combination therapy (use of structurally different chelating agents or co-administration of antioxidants have been reported recently. In this review we provide an update of the existing chelating agents and the various strategies available for the treatment of heavy metals and metalloid intoxications.

  4. Fatal poisoning among patients with drug addiction

    Simonsen, Kirsten Wiese; Christoffersen, Dorte J; Banner, Jytte;


    in 2012 were included in the study. RESULTS: A total of 188 fatal intoxications were recorded. The median age increased from 37.5 in 2007 to 41.5 in 2012. The majority were men (77%). Methadone (59%) was the main intoxicant. The decrease in the frequency of heroin/morphine deaths since 1997 (71......%) continued, declining to 44% in 2002, 33% in 2007 and finally to 27% in 2012. Few deaths from central stimulants (amphetamine and cocaine) occurred. Multiple drug use was common and consisted mainly of opioids, cocaine, amphetamine, cannabis, benzodiazepines and alcohol. Heroin/morphine use was most frequent...

  5. Unintentional Cannabis Intoxication in Toddlers.

    Claudet, Isabelle; Mouvier, Sébastien; Labadie, Magali; Manin, Cécile; Michard-Lenoir, Anne-Pascale; Eyer, Didier; Dufour, Damien


    In France, cannabis consumption is illegal. The health impact of its increasing use and higher tetrahydrocannabinol (THC) concentrations is still poorly documented, particularly that of unintentional pediatric intoxications. We sought to evaluate the French national trend of admissions for unintentional cannabis intoxication in children over an 11-year period (2004-2014). A retrospective, national, multicenter, observational study of a pediatric cohort. All children aged cannabis intoxication (compatible symptoms and positive toxicological screening results) during the reference period were included. Twenty-four PEDs participated in our study; 235 children were included, and 71% of the patients were 18 months old or younger. Annual admissions increased by a factor of 13. Hashish resin was the main form ingested (72%). During the study period, the evolution was characterized by a national increase in intoxications, younger intoxicated children (1.28 ± 0.4 vs 1.7 ± 0.7 years, P = .005), and more comas (n = 38) (P = .05, odds ratio 3.5 [1.02-11.8]). Compared with other intoxications, other PED admissions, and the same age population, cannabis-related admissions were greater. There was a potential link between the increased incidence of comas and increased THC concentration in resin seized in France over the period. Children are collateral victims of changing trends in cannabis use and a prevailing THC concentration. Intoxicated children are more frequent, are younger, and have intoxications that are more severe. This raises a real issue of public health. Copyright © 2017 by the American Academy of Pediatrics.


    Chibishev, Andon; Markoski, Velo; Smokovski, Ivica; Shikole, Emilija; Stevcevska, Aleksandra


    Acute intoxications with corrosive substances can cause severe chemical injuries of the upper gastrointestinal tract, most often located in the mouth, pharynx, esophagus, stomach and duodenum. If a patient survives the acute phase of intoxication, regenerative response may result in esophageal and/or gastric stenosis, and increased risk of esophageal and gastric cancer. Such intoxication may be fatal due to perforation or tracheal necrosis. Enteral nutrition is a nutritional method when nutritional substances are administered through specially designed tubing placed through the nose or percutaneously, directly into the GIT. The aim of this study is to describe the methods of artificial nutrition in patients with acute corrosive intoxications and the importance of nutritional support in the treatment of these intoxications. Nutrition in the treatment of acute corrosive intoxications is one of the most important therapeutic processes that largely contribute to faster recovery of the post-corrosive injuries of upper GIT, stabilization of biologic, immunologic and metabolic parameters, and reduction of length of stay in hospital Aim of the treatment of acute corrosive intoxications is to prevent perforation and progressive fibrosis, and esophageal and gastric stenosis. There are different and often conflicting positions, on the conservative treatment of acute corrosive intoxications in adults. Such treatment mainly consists of anti-secretory treatment, antibiotics and intensive hyper-alimentation, aiming to prevent late post-corrosive intoxications. It is considered that nutritional support plays a major role in maintenance of metabolic processes and prevention of severe metabolic complications that could additionally aggravate the condition and impair the treatment.

  7. Capacities of Follow-up of the Severity of Acute Barbiturate Intoxications and their Prediction

    I. I. Vorobyeva


    Full Text Available Seventy-eight patients with moderate, severe, and fatal (n = 12 acute intoxication with barbiturates, as evidenced by the measurements of their blood concentrations were examined. Cardiointervalography was made during follow-up ECG in all the patients in order to determine the tension index (TI, a cumulative measure of the tone of the autonomic nervous system. Comparison of clinical, laboratory, and cardiointervalographic data showed that sympathicotonia (TI, 90—160 conventional units was predominant in moderate intoxication with barbiturates (their concentration was 16.14±3.2 ^g/ml, there was hypersympathicotonia (TI, more than 160 conventional units in severe intoxication (the concentration of barbiturates, 30.56±7.6 ^g/ml; the increased tone of the parasympathetic portion of the autonomic nervous system — vagotonia (TI, less than 30 conventional units in fatal intoxication (the concentration of barbiturates, 37.3±6.6 ^g/ml. Moreover, TI decreased with the age of patients and increased with combined intoxication with barbiturates and alcohol (its blood concentration was more than 1 g/l.

  8. Motorcycle fatalities in Malaysia

    Muhammad Marizwan Abdul Manan; András Várhelyi


    Malaysia has the highest road fatality risk (per 100,000 population) among the ASEAN countries and more than 50% of the road accident fatalities involve motorcyclists. This study has collected and analysed data from the police, government authorities, and national and international research institutes. Only fatality data are used due to the severe underreporting of severe injuries (up to 600%) and slight injuries (up to 1400%). The analysis reveals that the highest numbers of motorcycle fatal...

  9. Fatal poisoning among patients with drug addiction.

    Simonsen, Kirsten Wiese; Christoffersen, Dorte J; Banner, Jytte; Linnet, Kristian; Andersen, Ljubica V


    Fatal poisonings among drug addicts in Denmark in 2012 were examined. Cause of death, abuse pattern and geographic differences are discussed and data are compared with previous studies. All fatal poisonings examined at the three institutes of forensic medicine in Denmark in 2012 were included in the study. A total of 188 fatal intoxications were recorded. The median age increased from 37.5 in 2007 to 41.5 in 2012. The majority were men (77%). Methadone (59%) was the main intoxicant. The decrease in the frequency of heroin/morphine deaths since 1997 (71%) continued, declining to 44% in 2002, 33% in 2007 and finally to 27% in 2012. Few deaths from central stimulants (amphetamine and cocaine) occurred. Multiple drug use was common and consisted mainly of opioids, cocaine, amphetamine, cannabis, benzodiazepines and alcohol. Heroin/morphine use was most frequent on Funen and in South Jutland. Cocaine was most frequently detected in East Denmark, while amphetamine was more frequent in West Denmark. The number of fatal poisonings among drug addicts has stabilised around 200. The increase in methadone deaths continued and, as in 2007, methadone was the main intoxicant. The increase in methadone deaths seems to be associated with use of methadone in substitution treatment. Nevertheless, methadone treatment also seems to save lives, as indicated by the increasing median age. Use of antidepressants and antipsychotics increased to a high level compared with 2007, indicating that a considerable number of drug addicts also have psychiatric illness. none. not relevant.

  10. Peganum harmala L. Intoxication in a Pregnant Woman

    Mohamed Adnane Berdai


    Full Text Available Peganum harmala L. is a plant widely distributed in the Mediterranean region. It is commonly used in traditional medicine in Morocco as sedative and abortifacient but exposes users to the risk of overdose and poisoning. The pharmacologically active compounds of this plant include a number of β-carboline and quinazoline alkaloids responsible of its pharmacological and toxicological effects. We report the case of a 24-year-old woman, 22 weeks pregnant, intoxicated with the seeds of Peganum harmala L. On admission, she had disturbance of consciousness, uterine contraction, and oliguria. Laboratory tests revealed renal failure and liver injury, and she benefited then from hemodialysis. During hospitalization, she was intubated after deterioration of consciousness and presented a spontaneous expulsion of the fetus. After extubation, she kept unusual sequelae: cerebellar ataxia and peripheral polyneuropathy. Physicians in regions using Peganum harmala L. as traditional medicine must be able to detect symptoms of its toxicity, in order to establish early gastrointestinal decontamination. The prognosis of this intoxication is variable; most cases can be managed successfully; but in high doses of intoxication, evolution can be fatal.

  11. Water intoxication in adult cattle.

    Kawahara, Naoya; Ofuji, Sosuke; Abe, Sakae; Tanaka, Ai; Uematsu, Masami; Ogata, Yoshimi


    Water intoxication is a common disorder in calves and is usually characterized by transient hemoglobinuria. In contrast, the condition is very rare in adult cattle, with few reports on naturally occurring cases. In the present report, four female Japanese Black cattle, aged 16-25 months, showed neurological signs when they drank water following a water outage. Hemoglobinuria was not grossly observed, while severe hyponatremia was revealed by laboratory tests. Autopsy indicated cerebral edema with accumulation of serous fluid in expanded Virchow-Robin spaces. These results indicate the possibility of water intoxication associated with cerebral edema due to severe dilutional hyponatremia in adult cattle.

  12. [Intentional paracetamol intoxication in children

    Bisschops, L.L.; Bisschops, W.A.; Vroegop, M.P.; Rossum, L.K. van; Kramers, C.


    As paracetamol is widely used and easily available acetaminophen auto-intoxication is frequently seen. In the majority of patients no complications will occur, but in a small group it may lead to liver damage and death. Children are less susceptible to complications than adults. Cornerstone of treat

  13. Fatalities in Swedish skydiving.

    Westman, Anton; Björnstig, Ulf


    Exact risk patterns in skydiving fatalities are not well known, but incomplete world injury data indicate that many are preventable. A comprehensive national material for Sweden of 37 skydiving fatalities 1964-2003 were reviewed to identify risk factors. In relation to jump volume, the period 1994-2003 had a fatality rate 11 times lower than 1964-1973. Student skydivers had the highest risk of fatal outcome, often caused by instability in freefall leading to unstable parachute activation with subsequent line entanglement, or parachute activation failure. Unintentional water landings also contributed to student fatality, with life jacket malfunctions, neglect to use life jackets, and automatic reserve parachute activation devices activated by water as aggravating factors. One-third of all fatalities had an inflated and operational parachute at some point prior to injury. A drastic worldwide increase in fatal landing incidents with fast wing parachutes during the 1990s did not occur in Sweden. Every fourth fatality caused by rapid deceleration against ground or water survived impact and died during transports or in hospitals. Rescue units and health care providers can improve management of skydiving incidents from knowledge about the incident and injury mechanisms we have described, and the skydiving community can target risk factors in preventive safety work.

  14. Autopsy report for a caffeine intoxication case and review of the current literature

    Yamamoto, Takuma; Yoshizawa, Katsuhiko; Kubo, Shin-ichi; EMOTO, Yuko; Hara, Kenji; Waters, Brian; Umehara, Takahiro; Murase, Takehiko; Ikematsu, Kazuya


    Caffeine (1,3,7-trimethylxanthine) is a popular mild central nervous system stimulant found in the leaves, seeds and fruits of various plants and in foodstuffs such as coffee, tea, and chocolate, among others. Caffeine is widely used and is not associated with severe side effects when consumed at relatively low doses. Although rarely observed, overdoses can occur. However, only a few fatal caffeine intoxication cases have been reported in the literature. Herein, we report the pathological exa...

  15. Motorcycle fatalities in Malaysia

    Muhammad Marizwan Abdul Manan


    Full Text Available Malaysia has the highest road fatality risk (per 100,000 population among the ASEAN countries and more than 50% of the road accident fatalities involve motorcyclists. This study has collected and analysed data from the police, government authorities, and national and international research institutes. Only fatality data are used due to the severe underreporting of severe injuries (up to 600% and slight injuries (up to 1400%. The analysis reveals that the highest numbers of motorcycle fatalities occur in rural locations (61%, on primary roads (62% and on straight road sections (66%. The majority are riders (89%, 16 to 20 years old (22.5%, and 90% of the motorcycles are privately owned. Of those involved in fatal accidents, 75% of the motorcyclists wear helmets, and 35% do not have proper licences. The highest number of fatalities by type of collision is ‘angular or side’ (27.5%. Although fatal motorcyclist crashes mostly involve ‘passenger cars’ (28%, motorcyclists are responsible for 50% of the collisions either by crashing singly (25% or with other motorcyclists (25%. While male motorcyclists predominate (94% of fatalities, female motorcyclists aged 31 to 70, possessing ‘no licence’, not wearing helmets and travelling during the day, account for a higher percentage than male motorcyclists. Malaysia must acquire more motorcycle exposure data and establish an injury recording system and database based on hospital-records. To reduce motorcycle fatalities, it first has to understand why young male motorcyclists are prone to fatal crashes in the evenings and on weekends on rural primary roads, especially on straight road sections.

  16. Glasgow coma scale score in the prognosis of acute carbamate insecticide intoxication.

    Moon, Jeong Mi; Chun, Byeong Jo; Lee, Byung Kook


    Carbamate is a widely used insecticide, and fatality due to carbamate insecticide intoxication has been reported. However, no studies have addressed the factors associated with outcome of patients poisoned by carbamate insecticide. The present study sought to identify the independent factors that could help predict the development of medical complications as a result of carbamate intoxication. Fifty two patients presenting with acute carbamate insecticide ingestion at Chonnam National University Hospital were enrolled in this retrospective observational case series. The morbidities that needed intensive treatment such as hypotension, respiratory failure, and death were regarded as complications. To identify the associated factors to these complications, objective variables that are easily assessed at presentation, such as age, initial Glasgow coma scale (GSC) and corrected QT (QTc) prolongation, were analyzed by univariate and multivariate stepwise logistic regression analyses. Of the 52 patients, 35 (67.3%) had medical complications within 24 hours after carbamate insecticide intoxication and seven (13.5%) died. Respiratory failure was the most common medical complication. The significant factors determined by univariate analysis were initial GCS, elevated lactate, and QTc prolongation. However, initial GCS (≤13) was the only independent factor determined by multivariate analysis that was associated with serious complications requiring intensive medical treatment. Carbamate insecticide intoxication is not a mild disease, as previously thought, having a mortality rate of 13.8% and a morbidity rate of 67.3%. Initial GCS ≤ 13 can be used as a significant factor to identify carbamate insecticide-intoxicated patients who will experience complications.

  17. Intoxicated eyewitnesses: Better than their reputation?

    Compo, Nadja Schreiber; Evans, Jacqueline R; Carol, Rolando N; Villalba, Daniella; Ham, Lindsay S; Garcia, Tracy; Rose, Stefan


    According to law enforcement, many witnesses are intoxicated either at the time of the crime, the interview, or both (Evans et al., Public Policy Law 15(3):194-221, 2009). However, no study to date has examined whether intoxicated witnesses' recall is different from sober witnesses' and whether they are more vulnerable to misinformation using an ecologically valid experimental design. Intoxicated, placebo, and sober witnesses observed a live, staged theft, overheard subsequent misinformation about the theft, and took part in an investigative interview. Participants generally believed they witnessed a real crime and experienced a real interview. Intoxicated witnesses were not different from placebo or sober witnesses in the number of accurate details, inaccurate details, or "don't know" answers reported. All the participants demonstrated a misinformation effect, but there were no differences between intoxication levels: Intoxicated participants were not more susceptible to misinformation than sober or placebo participants. Results are discussed in the light of their theoretical and applied relevance.

  18. Variable Classification of Drug-Intoxication Suicides across US States: A Partial Artifact of Forensics?

    Ian R H Rockett

    Full Text Available The 21st-century epidemic of pharmaceutical and other drug-intoxication deaths in the United States (US has likely precipitated an increase in misclassified, undercounted suicides. Drug-intoxication suicides are highly prone to be misclassified as accident or undetermined. Misclassification adversely impacts suicide and other injury mortality surveillance, etiologic understanding, prevention, and hence clinical and public health policy formation and practice.To evaluate whether observed variation in the relative magnitude of drug-intoxication suicides across US states is a partial artifact of the scope and quality of toxicological testing and type of medicolegal death investigation system.This was a national, state-based, ecological study of 111,583 drug-intoxication fatalities, whose manner of death was suicide, accident, or undetermined. The proportion of (nonhomicide drug-intoxication deaths classified by medical examiners and coroners as suicide was analyzed relative to the proportion of death certificates citing one or more specific drugs and two types of state death investigation systems. Our model incorporated five sociodemographic covariates. Data covered the period 2008-2010, and derived from NCHS's Multiple Cause-of-Death public use files.Across states, the proportion of drug-intoxication suicides ranged from 0.058 in Louisiana to 0.286 in South Dakota and the rate from 1 per 100,000 population in North Dakota to 4 in New Mexico. There was a low correlation between combined accident and undetermined drug-intoxication death rates and corresponding suicide rates (Spearman's rho = 0.38; p<0.01. Citation of 1 or more specific drugs on the death certificate was positively associated with the relative odds of a state classifying a nonhomicide drug-intoxication death as suicide rather than accident or undetermined, adjusting for region and type of state death investigation system (odds ratio, 1.062; 95% CI,1.016-1.110. Region, too, was a

  19. Gamma-hydroxybutyrate and cocaine intoxication in a Danish child

    de Knegt, Victoria Elizabeth; Breindahl, Torben; Harboe, Kirstine Moll


    GHB intoxication must be considered in children with coma and a suspicion of drug intoxication. Furthermore, mixed intoxication with several substances and the possibility of unpredictable symptom profiles should be anticipated to ensure optimal symptomatic treatment of patients....

  20. Fatal residential fire accidents in the municipality of Copenhagen, 1991-1996

    Leth, Peter Mygind; Gregersen, Markil Ebbe Gregers; Sabroe, Svend


    of the theoretical model in which the variables were part of a causal network. RESULTS: The following five variables seemed to be of most importance: (1) localization of the victim close to the source of ignition (OR = 11), (2) physical handicaps (OR = 5), (3) chronic alcoholism (OR = 7), (4) clothing fires (OR = 24......BACKGROUND: The death rate for fatal fire accidents in Denmark has doubled since 1951, mostly due to an increase in the number of fire accidents associated with smoking. The most common cause of residential fire deaths in Denmark today is smoking, often combined with alcohol intoxication...... or handicap. METHODS: This was a case-control study of fatal fire accidents in private homes in the municipality of Copenhagen from 1991 to 1996. The fatal fire accidents were identified from a police register, and the two non-fatal fire accidents registered immediately before and after each fatal fire were...

  1. Acute Hydrocephaly Following Methadone Intoxication in a Child

    Afshin FAYYAZI


    Full Text Available How to Cite this Article: Fayyazi A, Khajeh A, Bagheri M, Ahmadi S. Acute Hydrocephaly Following Methadone Intoxication in a Child. Iranian Journal of ChildNeurology 2012;6(1:35-38.Infantile methadone intoxication has been on the rise since the usage of methadone in opioid detoxification programs. We report a 30-month-old child with encephalopathy and acute hydrocephaly following methadone intoxication. References:1. Nazari H. Clinical approach to methadone toxication.Quarterly journal of Addiction 2007;2:18-20.2. Plummer JL, Gourlay GK, Cherry DA, Cousins MJ.Estimation of methadone clearance: application in themanagement of cancer pain. Pain 1988 Jun;33(3:313-22.3. Davies D, DeVlaming D, Haines C. Methadoneanalgesia for children with advanced cancer. PediatrBlood Cancer 2008 Sep;51(3:393-7.4. Riascos R, Kumfa P, Rojas R, Cuellar H, Descartes F.Fatal methadone intoxication in a child. Emerg Radiol2008 Jan;15(1:67-70.5. Binchy JM, Molyneux EM, Manning J. Accidental ingestion of methadone by children in Merseyside.BMJ 1994 May 21;308(6940:1335-6.6. Li L, Levine B, Smialek JE. Fatal methadone poisoningin children: Maryland 1992-1996. Subst Use Misuse2000 Aug;35(9:1141-8.7. Milroy CM, Forrest AR. Methadone deaths: atoxicological analysis. J Clin Pathol 2000 Apr;53(4:277-81.8. Afzali S, Jafari MR. One year study of chest X-raychanges in opiate-poisoned patients in Hamadan. JQom Uni Med Sci 2010; 4(2:3-7.9. Zamani N, Sanaei-Zadeh H, Mostafazadeh B. Hallmarksof opium poisoning in infants and toddlers. Trop Doct2010 Oct; 40(4:220-2.10. Besharat S, Besharat M, Akhavan Masouleh A, JabbariA, Yazdi HR. Opium intoxication in children under 5years old, Golestan- Iran (2006-07. J Gorgan Uni MedSci Spring 2010;12(1:85-9.11. Izadi Mood N, Gheshlaghi F, Sharafi SE. Fatalpoisoning cases admitted to the emergency departmentof poisoning, Noor Hospital, Isfahan. J Legal Med IslRep Iran 2003;9(31:122-26.12. Boushehri B, Yekta Z, Zareei-Kheirabad A, Kabiri SH

  2. Characteristics of methadone-related fatalities in Norway.

    Bernard, Jean-Paul; Khiabani, Hassan Z; Hilberg, Thor; Karinen, Ritva; Slørdal, Lars; Waal, Helge; Mørland, Jørg


    There are currently over 7000 patients enrolled in opioid maintenance treatment (OMT) programs in Norway. A rise in methadone-related deaths proportional to increasing methadone sales over the period 2000-2006 has been observed, but the causative factors for these fatalities have been elusive. In the present study, individual characteristics, methadone concentrations and additional toxicological findings were analyzed. Methadone intoxication deaths (n = 264) were divided into 3 groups according to toxicological findings in whole blood: group 1 - methadone detected alone, or together with one additional drug at low or therapeutic levels, or a low concentration of ethanol (3 g/L (n = 55). Methadone blood concentrations in decedents who had been enrolled in OMT were higher than for decedents not in treatment, in all groups. Blood methadone concentrations around 1 mg/L were present in fatal multi-drug intoxications in OMT patients. Results suggest that some patients may be at risk of dying when combining therapeutic concentrations of methadone with other psychoactive substances. Somatic disease was a common finding among deceased OMT patients. Concentrations in methadone users not enrolled in OMT were predominantly between 0.3 and 0.4 mg/L and were not related to the presence of other drugs. However, methadone concentrations below 0.1 mg/L may be associated with intoxication following methadone use, both alone and in combination with other drugs. Younger male users (mean age 34 years) seemed to have a higher susceptibility to methadone intoxication.

  3. Refractory cardiopulmonary failure after glyphosate surfactant intoxication: a case report

    Chang Chia-Chu


    Full Text Available Abstract Background Glyphosate is an herbicide considered to be of low toxicity to humans because its effects are specific to plants. However, fatal reactions to glyphosate have been reported after the ingestion of large amounts. Pulmonary edema, shock, and arrhythmia were the reported causes of mortality. Case presentation We present the case of a 57-year-old woman who was admitted to the emergency department unconsciousness after ingestion of glyphosate surfactant in a suicide attempt. Metabolic acidosis, refractory respiratory failure, and shock developed during hospitalization. Despite aggressive supportive care, the patient died in the hospital. Conclusion The toxicokinetics of glyphosate surfactant is complicated. Respiratory failure, metabolic acidosis, tachycardia, elevated creatinine, and hyperkalemia are poor prognostic factors if presented. Physicians should consider using hemodialysis early to improve the outcome of patients with glyphosate surfactant intoxication.


    Munire Babayigit


    Full Text Available Wild honey intoxication (WHI is a rare disease that results from consuming honey produced by Rhododendron polen feeded bees. WHI develops due to grayanotoxin (GT that it contains. WHI might present with mild symptoms of gastrointestinal, cardiovascular and neurological systems or might also present in a life threatining form with AV block and cardiovascular collaps. In this report we aimed to present clinical presentation and treatment of a case of WHI. [J Contemp Med 2013; 3(3.000: 197-199

  5. The risk of body packing: a case of a fatal cocaine overdose.

    Koehler, Steven A; Ladham, Shaun; Rozin, Leon; Shakir, Abdulrezak; Omalu, Bennet; Dominick, Joseph; Wecht, Cyril H


    The process of swallowing or inserting illegal packets of drugs for the purpose of evading law enforcement officers carries risks other than criminal charges. It can be fatal. Individuals engaged in such activities are called "Body Packers" or "Mules". The most frequent cause of the death among body packers is acute drug intoxication due to rupture of the package(s) within the gastrointestinal tract. We present the first documented case of a body packer that died from cocaine intoxication following the rupture of packets of cocaine in Western Pennsylvania.

  6. Intoxication in cattle from Cestrum diurnum.

    Durand, R; Figueredo, J M; Mendoza, E


    Twenty-six Holstein calves with clinical and pathological effects suggesting a toxic plant intoxication were studied. A view of the plants in the region and blood examination (hemogram, albumin, total protein, calcium and phosphorus) and determination of bone calcium were done. Five calves were slaughtered and pathological examinations were performed. Observed metabolic, pathological and clinical alterations were compatible with intoxication from Cestrum diurnum.

  7. Variable Classification of Drug-Intoxication Suicides across US States: A Partial Artifact of Forensics?

    Rockett, Ian R H; Hobbs, Gerald R; Wu, Dan; Jia, Haomiao; Nolte, Kurt B; Smith, Gordon S; Putnam, Sandra L; Caine, Eric D


    The 21st-century epidemic of pharmaceutical and other drug-intoxication deaths in the United States (US) has likely precipitated an increase in misclassified, undercounted suicides. Drug-intoxication suicides are highly prone to be misclassified as accident or undetermined. Misclassification adversely impacts suicide and other injury mortality surveillance, etiologic understanding, prevention, and hence clinical and public health policy formation and practice. To evaluate whether observed variation in the relative magnitude of drug-intoxication suicides across US states is a partial artifact of the scope and quality of toxicological testing and type of medicolegal death investigation system. This was a national, state-based, ecological study of 111,583 drug-intoxication fatalities, whose manner of death was suicide, accident, or undetermined. The proportion of (nonhomicide) drug-intoxication deaths classified by medical examiners and coroners as suicide was analyzed relative to the proportion of death certificates citing one or more specific drugs and two types of state death investigation systems. Our model incorporated five sociodemographic covariates. Data covered the period 2008-2010, and derived from NCHS's Multiple Cause-of-Death public use files. Across states, the proportion of drug-intoxication suicides ranged from 0.058 in Louisiana to 0.286 in South Dakota and the rate from 1 per 100,000 population in North Dakota to 4 in New Mexico. There was a low correlation between combined accident and undetermined drug-intoxication death rates and corresponding suicide rates (Spearman's rho = 0.38; psuicide rather than accident or undetermined, adjusting for region and type of state death investigation system (odds ratio, 1.062; 95% CI,1.016-1.110). Region, too, was a significant predictor. Relative to the South, a 10% increase in drug citation was associated with 43% (95% CI,11%-83%), 41% (95% CI,7%-85%), and 33% (95% CI,1%-76%) higher odds of a suicide

  8. [Intoxication with Monkshood (Aconitum napellus)].

    Tuinema, Rinske M; Uijlings, Ruben; Dijkman, Marieke A; van den Broek, Marcel P H; de Lange, Dylan W


    Three patients presented with an intoxication caused by Aconitum napellus, commonly known as Aconite, Monkshood or Wolfsbane. The first patient, a woman aged 24, was resuscitated after accidental ingestion of plant material 'from nature'. She experienced severe ventricular tachyarrhythmias. After discharge she returned with identical symptoms, which were now interpreted as intentional intoxication in a suicide attempt. She was referred to the Psychiatry department. The second patient was a 2-year-old boy who had cutaneous exposure to Aconite. Except for some red spots around his mouth there were no other symptoms. The third patient was a 34-year-old woman who ate Monkshood, which she mistook for parsley. Alarmed by the bitter taste she contacted the hospital. She was treated with stomach lavage which removed most of the ingested plant material, and with activated charcoal. She had no symptoms during observation in the hospital. Aconite alkaloids are known to cause ventricular arrhythmia by a prolonged activation of sodium channels. Because there is no antidote, treatment is largely supportive but serious arrhythmias and respiratory arrest need to be anticipated.

  9. Preanesthetic care. Intoxication and trauma.

    Watson, T D; Lee, J F


    On the basis of the above discussion, a number of useful guidelines appear for the anesthetic management of alcohol and drug abusers. 1. Because of the decreased ability of intoxicated patients to withstand hemorrhage, blood replacement therapy should probably be instituted earlier than in the nonintoxicated patient. 2. Because the chronic alcoholic may actually be iso-osmotically overhydrated, fluid therapy must be planned with care. 3. Because of the tendency to hypoglycemia, glucose should be added to the fluid management regimen. 4. Because of the enzyme induction effect of chronic ETOH ingestion, anesthetic agents that are in part metabolized (methoxyflurane, halothane, fluroxene) are perhaps best avoided. Increased ability to metabolize anesthetic agents appears to be associated with toxicity. 5. Because ETOH is a CNS depressant and has been shown to have amnesia-inducing properties, supplementation of nitrous oxide-relaxant technique with narcotics or other depressant drugs should be reduced, if not eliminated. 6. Because acutely intoxicated individuals are more prone to hypothermia, their core temperature should be monitored intraoperatively. All intravenous fluids should be warmed and a warming blanket should be employed, if necessary, to maintain body temperature. 7. Because of the sympathomimetic effect of many of the drugs, pulse and blood pressure can be misleading in the assessment of blood loss.

  10. [Thyroid function tests in acute drug intoxication].

    Tseng, F Y; Chen, C S


    It is well known that thyroid function tests may be changed in non-thyroidal illnesses. To understand the influence of acute drug intoxication on thyroid function tests, 31 drug intoxicated patients without previous thyroid disorders and systemic diseases were included in our study. T3, T4, TSH, and resin T3 uptake were checked as soon as they arrived at our emergency service and were compared to that of 58 healthy volunteers. Within 31 patients, 14 were intoxicated by organophosphorous compounds, 6 by sedatives and hypnotics, 3 by strong acid, 2 by paraquet, 2 by rodenticides (warfarin), 2 by lysol and the other 2 were intoxicated by acetaminophen. The mean T3 and TSH levels were significantly lower in the drug intoxicated group. Among the 31 patients, 14 (45.2%) had a low T3, 2 (6.5%) had a low T3 and T4, and 6 (19.3%) had an elevated T4. All of the patients with an elevated T4 were intoxicated by organophosphates. If we divided the 31 patients into 2 subgroups: organophosphate intoxicated group and non-organophosphate intoxicated group, T4 and FT4I were significantly higher in the former group. Thyroid function tests became normal after treatment in 27 patients, discharged in good general condition. T3 and T4 became extremely low in 4 patients before they expired. The present study confirms that acute drug intoxication, like other non-thyroidal illnesses, affects thyroid function tests. Acute organophosphate intoxication may cause transient hyperthyroxinemia.

  11. Intoxications due to ingestion of gamma-butyrolactone: organ distribution of gamma-hydroxybutyric acid and gamma-butyrolactone.

    Lenz, Daniel; Rothschild, Markus A; Kröner, Lars


    In Europe, the misuse of gamma-hydroxybutyric acid (GHB) and its analogues has increased within the recent years. Here, 2 fatalities and 1 nonfatal intoxication resulting from ingestion of gamma-butyrolactone (GBL), a precursor of GHB, are presented. GHB was quantified involving the conversion to GBL by application of a gas chromatography-mass spectrometry (GC/MS) method. Besides quantitation of GHB equivalents ("total GBL"), all specimens of case 1 were analyzed for the metabolic precursor GBL itself (absolute GBL). The cause of death in each case was attributed to GHB intoxication; the manner of death was suicide in the first case and accidental in the second one. Another yet nonfatal GHB intoxication was reported by an emergency department concerning a 36-year-old woman who was hospitalized due to her comatose state and loss of adverse effects reflexes. Here nail polish remover pads were used as source for GBL.

  12. Prophylaxis Against Nerve Agent Intoxications

    Jiri Patocka


    Full Text Available The acute toxicity of organophosphates is usually attributed to their irreversible inhibitionof an enzyme acetylcholinesterase that hydrolyses the neurotransmitter acetylcholine. Theresultant increase in concentration of acetylcholine at the cholinergic synapses of the peripheraland central nervous system, and neuromuscular junction is manifested by over-stimulation ofthe cholinergic neurotransmission. Current antidotal regimens for organophosphate poisoningconsisting of a post-exposure therapy with anticholinergics such as atropine, acetylcholinesterasereactivators (oximes, benzodiazepines have some limitations. Therefore, effective prophylaxisbefore intoxication is of a special interest. Four fundamental prophylactic methods are: (iprotection of acetylcholinesterase against irreversible inhibition by organophosphates usingdifferent reversible inhibitors, (ii protection against neurotoxic effect of organophosphates usingbenzodiazepines, memantine, NMDA receptor blockers, (iii administration of cholinesterasepreparations of different sources (sometimes commercially available at present acting asbioscavengers, and (iv gene therapy being a new treatment modality under intensive researchusing enzymes hydrolysing/splitting organophosphates with the aim to eliminate toxic agentbefore it is transported to the target organs.

  13. New Drugs for Pretreatment of Organophosphonate Intoxication


    COPY A D L£> SRI PROJECT PYU-4681 NEW DRUGS FOR PRETREATMENT OF ORGANOPHOSPHONATE INTOXICATION FINAL REPORT AD-B145 250 Daniel W. Parish, Allen...BB WORK UNIT ACCESSION NO. 099 11. TITLE (indud* Security Oaofficattofl) New Drugs for Pretreatment of Organophosphonate Intoxication...undertaken for the U.S. Army Medical Research and Development Command (MRDC) under Contract DAMD17-88-C-8001, " New Drugs for Pretreatment of

  14. Fatal asthma or anaphylaxis?

    Rainbow, J; Browne, G


    The incidence of anaphylaxis is under-reported. Children with asthma are frequently atopic and prone to allergic reactions. Parents and clinicians may attribute wheeze of rapid onset to acute severe asthma, rather than recognising an anaphylactic event. Two cases of fatal anaphylaxis are reported who were initially diagnosed as acute severe asthma, and responded poorly to bronchodilator treatment. Survivors of "acute asphyxic asthma" should be screened for reactions to common allergens that p...

  15. Histamine, histamine intoxication and intolerance.

    Kovacova-Hanuskova, E; Buday, T; Gavliakova, S; Plevkova, J


    Excessive accumulation of histamine in the body leads to miscellaneous symptoms mediated by its bond to corresponding receptors (H1-H4). Increased concentration of histamine in blood can occur in healthy individuals after ingestion of foods with high contents of histamine, leading to histamine intoxication. In individuals with histamine intolerance (HIT) ingestion of food with normal contents of histamine causes histamine-mediated symptoms. HIT is a pathological process, in which the enzymatic activity of histamine-degrading enzymes is decreased or inhibited and they are insufficient to inactivate histamine from food and to prevent its passage to blood-stream. Diagnosis of HIT is difficult. Multi-faced, non-specific clinical symptoms provoked by certain kinds of foods, beverages and drugs are often attributed to different diseases, such as allergy and food intolerance, mastocytosis, psychosomatic diseases, anorexia nervosa or adverse drug reactions. Correct diagnosis of HIT followed by therapy based on histamine-free diet and supplementation of diamine oxidase can improve patient's quality of life.

  16. Profound Hypoglycemia with Ecstasy Intoxication

    Perliveh Carrera


    Full Text Available Background. 3,4-Methylenedioxymethamphetamine (MDMA or ecstasy is a synthetic drug that is commonly abused for its stimulant and euphoric effects. Adverse MDMA effects include hyperthermia, psychomotor agitation, hemodynamic compromise, renal failure, hyponatremia, and coma. However, endogenous hyperinsulinemia with severe persistent hypoglycemia has not been reported with MDMA use. Case Report. We report the case of a 29-year-old woman who remained severely hypoglycemic requiring continuous intravenous infusion of high-dose dextrose solutions for more than 24 hours after MDMA intoxication. Serum insulin and C-peptide levels confirmed marked endogenous hyperinsulinemia as the cause of the severe hypoglycemia. Why Should an Emergency Physician Be Aware of This? Immediate and frequent monitoring of blood glucose should be instituted in patients presenting with MDMA ingestion particularly if found to be initially hypoglycemic. Early recognition can help prevent the deleterious effects of untreated hypoglycemia that can add to the morbidity from MDMA use. Clinicians need to be aware of this side effect of MDMA so they can carefully monitor and treat it, especially in patients presenting with altered mental status.

  17. Forensic aspects of water intoxication: four case reports and review of relevant literature.

    Radojevic, Nemanja; Bjelogrlic, Bojana; Aleksic, Vuk; Rancic, Nemanja; Samardzic, Mira; Petkovic, Stojan; Savic, Slobodan


    Water intoxication (WI) is a rare condition that originates from over-consumption of water, with a potentially fatal outcome. Increased water intake (polydipsia) is followed by urination of high amount of diluted urine (polyuria) which are the main initial symptoms of WI. We present four case reports of WI. Two of them are unusual pediatric clinical cases using medical documentation and police case files, one of which is related to child abuse, and the other to a psychiatric disorder. The other two cases are fatal adult cases submitted to autopsy from a psychiatric hospital. Also, we present a diagnostic algorithm for polydipsia and polyuria before death. WI is usually seen in patients with psychiatric disorders, victims of child abuse or torture, drug abusers or it can be iatrogenically induced.

  18. Effects of experimental amitraz intoxication in cats

    S.F. Andrade


    Full Text Available This work studied the effects of experimental amitraz intoxication in cats. Sixteen cats were randomly divided equally into two groups: amitraz group - animals received 1.5% amitraz at 1mg/kg IV; and the control group - animals without amitraz. Physiological parameters from blood, cardiorespiratory system, and sedation indicators were quantified over time up to 360 minutes. Blood profile, urea, creatinine, alananine aminotransferase and aspartate aminotransferase were not affected by amitraz. Sedation, loss of reflexes, hypothermia, bradycardia, bradyarrhythmia, hypotension, bradypnea, mydriasis, besides transitory hyperglycemia, hypoinsulinemia and decrease of cortisol levels were observed in cats experimentally exposed to amitraz. The alpha2-adrenergic effects induced by amitraz intoxication in cats are very similar to the same effects reported in others species, contributing with more information about this type of intoxication to veterinary toxicology.

  19. Electrocardiogram of rabbits experimentally intoxicated with carbaryl.

    Kossakowski, S


    Experiments were carried out on 24 rabbits intoxicated intragastrically with carbaryl in single doses of 500, 750, 1000 and 1250 mg/kg. Electrocardiograms (ECGs) were performed in 3 limb leads before and 1, 2, 4, 6h and 1, 2, 4, 6, 14d after intoxication and in a final stage of lethal intoxications--in a continuous manner. It has been found that, depending on the intensification of disease, ECG changes were characterized by the decreased heart rate with stimulations coming from the left ventricle, premature supraventricular stimulations, increased T wave amplitude and its reversion. These changes, except two lethal cases (1250 mg/kg), were compensated but the compensatory heart abilities decreased with increasing carbaryl doses.

  20. Acute Hydrocephaly Following Methadone Intoxication in a Child

    Afshin FAYYAZI


    Full Text Available Infantile methadone intoxication has been on the rise since the usage of methadone in opioid detoxification programs. We report a 30-month-old child with encephalopathy and acute hydrocephaly following methadone intoxication.

  1. Treatment of theophylline intoxication using continuous venovenous haemofiltration

    Koeijers, J.J.; Verhoeven, C.L.; Boersma, H.H.; van Mook, W.N.K.A


    Theophylline intoxication can cause serious complications such as seizures, cardiac arrhythmias and eventually cardiac arrest. Because of these potentially life-threatening clinical manifestations of theophylline intoxication, treatment methods that rapidly eliminate the drug are essential. These me

  2. Chronic lead intoxication; Chronische Bleiintoxikation

    Wieseler, B.; Leng, G. [Duesseldorf Univ. (Germany). Inst. fuer Hygiene; Lenz, S.; Schultz, C. [Klinikum Remscheid GmbH, Remscheid (Germany); Wilhelm, M. [Bochum Univ. (Germany). Inst. fuer Hygiene, Sozial- und Umweltmedizin


    The case of a female 68 years old patient is described. Here, a chronic lead intoxication was diagnosed after a two year old medical history with increasing attacks of colic-like abdominal pain often described as life-threatening. After repeated hospitalizations and intensive search for the cause of the symptoms, porphyria and anemia was found to be a sign of a chronic lead poisoning. The blood lead concentrations were always about a level of 600 {mu}g/L. The source of exposure could not be found by now. Neither home inspection nor environmental investigations have shown a recent source of lead intake by the patient. However, a possible occupational source of lead exposure at a blast furnace was established by anamnesis for 1952 to 1962. Thus, osteoporosis induced lead mobilisation was suspected. Noticeable are the results of the six abdominal survey radiographies taken during hospitalization within one year; three radiographies were taken following clinical admission and three before discharge of the patient. In comparison, the course shows a chronic relapsing alimentary supply from metallic particles of unknown genesis. The patient was treated with the sodium salt of 2,3-dimercapto-1-propansulfonic acid (DMPS, Dimaval{sup TM}). She was free of complain afterwards. Following therapy, the blood lead concentrations fell under a level of 400 {mu}m/L, but after several weeks the lead level raised up to the original level of 600 {mu}g/L. (orig.) [Deutsch] Es wird eine 68jaehrige Patientin vorgestellt, bei der nach fast zweijaehriger Krankengeschichte, die gekennzeichnet war durch rezidivierende, teils als lebensbedrohlich geschilderte Bauchkoliken, eine chronische Bleiintoxikation diagnostiziert wurde. Erst nach wiederholten stationaeren Krankenhausaufenthalten mit intensiver Suche nach der Krankheitsursache wurden das Krankheitsbild und die Laborwerte durch Zusatzuntersuchungen ergaenzt, so dass sich in der festgestellten Porphyrie und Anaemie die Diagnose der

  3. Inhibiting oral intoxication of botulinum neurotoxin A complex by carbohydrate receptor mimics.

    Lee, Kwangkook; Lam, Kwok-Ho; Kruel, Anna-Magdalena; Mahrhold, Stefan; Perry, Kay; Cheng, Luisa W; Rummel, Andreas; Jin, Rongsheng


    Botulinum neurotoxins (BoNTs) cause the disease botulism manifested by flaccid paralysis that could be fatal to humans and animals. Oral ingestion of the toxin with contaminated food is one of the most common routes for botulism. BoNT assembles with several auxiliary proteins to survive in the gastrointestinal tract and is subsequently transported through the intestinal epithelium into the general circulation. Several hemagglutinin proteins form a multi-protein complex (HA complex) that recognizes host glycans on the intestinal epithelial cell surface to facilitate BoNT absorption. Blocking carbohydrate binding to the HA complex could significantly inhibit the oral toxicity of BoNT. Here, we identify lactulose, a galactose-containing non-digestible sugar commonly used to treat constipation, as a prototype inhibitor against oral BoNT/A intoxication. As revealed by a crystal structure, lactulose binds to the HA complex at the same site where the host galactose-containing carbohydrate receptors bind. In vitro assays using intestinal Caco-2 cells demonstrated that lactulose inhibits HA from compromising the integrity of the epithelial cell monolayers and blocks the internalization of HA. Furthermore, co-administration of lactulose significantly protected mice against BoNT/A oral intoxication in vivo. Taken together, these data encourage the development of carbohydrate receptor mimics as a therapeutic intervention to prevent BoNT oral intoxication.

  4. Porcine model characterizing various parameters assessing the outcome after acetaminophen intoxication induced acute liver failure

    Thiel, Karolin; Klingert, Wilfried; Klingert, Kathrin; Morgalla, Matthias H; Schuhmann, Martin U; Leckie, Pamela; Sharifi, Yalda; Davies, Nathan A; Jalan, Rajiv; Peter, Andreas; Grasshoff, Christian; Königsrainer, Alfred; Schenk, Martin; Thiel, Christian


    AIM To investigate the changes of hemodynamic and laboratory parameters during the course of acute liver failure following acetaminophen overdose. METHODS Eight pigs underwent a midline laparotomy following jejunal catheter placement for further acetaminophen intoxication and positioning of a portal vein Doppler flow-probe. Acute liver failure was realized by intrajejunal acetaminophen administration in six animals, two animals were sham operated. All animals were invasively monitored and received standardized intensive care support throughout the study. Portal blood flow, hemodynamic and ventilation parameters were continuously recorded. Laboratory parameters were analysed every eight hours. Liver biopsies were sampled every 24 h following intoxication and upon autopsy. RESULTS Acute liver failure (ALF) occurred after 28 ± 5 h resulted in multiple organ failure and death despite maximal support after further 21 ± 1 h (study end). Portal blood flow (baseline 1100 ± 156 mL/min) increased to a maximum flow of 1873 ± 175 mL/min at manifestation of ALF, which was significantly elevated (P 0.01). CONCLUSION Declining portal blood flow and subsequent severe thrombocytopenia after acetaminophen intoxication precede fatality in a porcine acute liver failure model. PMID:28321158

  5. Safety Issues of Chinese Medicine:A Review of Intoxication Cases in Hong Kong

    NG; Kit-ying; CHENG; Chuen-lung


    Chinese medicine (CM) has been widely used in Hong Kong for centuries. In fact, CM practitioners currently provide over 20% of the medical consultations in Hong Kong and about 60% of the population has previously used CM. In 1999, the Legislative Council passed the Chinese Medicine Ordinance with aims to govern practice, use, trading, and manufacturing of CM in Hong Kong. While it is usually safe to use CM under proper application and guidance, there have been frequent reports on intoxication and fatalities. The misuse of potent/toxic CM, because of misidentification or overdose, can cause severe aconite, aristolochic acid, anticholinergic, podophyllin, grayanotoxin, pyrrolizidine alkaloids, matrine, gelsemine, teucvin, and strychnine poisoning. In this review, we summarized CM intoxication cases in Hong Kong, concentrating on the discussion of toxic and adverse effects as well as the quality control of CM. By increasing the awareness of CM toxicity, we hope to enhance the regulatory process and stimulate further research on their toxic dose, toxic ingredients, intoxication mechanisms, and quality control.

  6. Paraquat: A fatal poison

    J Shashibhushan


    Full Text Available Paraquat (1, 1′-dimethyl-4, 4′-dipyridylium is a bipyridilium herbicide used widely in our country and is a highly toxic compound. This compound is very notorious to cause rapid development of renal, liver, and respiratory failure with very high mortality due to lack of specific antidote and dearth of high-quality evidence-based treatment. Respiratory system involvement is the most common cause of death in these people. We hereby report a fatal case of a 30-year-old male with a history of paraquat consumption. The patient developed oliguric renal failure, deterioration of liver function, and acute respiratory distress syndrome over next few days. Different treatment modalities were tried to manage patient′s condition. In this case, none of the strategies worked well, and death ensued due to multi-organ dysfunction syndrome.

  7. Traffic fatalities and economic growth.

    Kopits, Elizabeth; Cropper, Maureen


    This paper examines the relationship between traffic fatality risk and per capita income and uses it to forecast traffic fatalities by geographic region. Equations for the road death rate (fatalities/population) and its components--the rate of motorization (vehicles/population) and fatalities per vehicle (F/V)--are estimated using panel data from 1963 to 1999 for 88 countries. The natural logarithm of F/P, V/P, and F/V are expressed as spline (piecewise linear) functions of the logarithm of real per capita GDP (measured in 1985 international prices). Region-specific time trends during the period 1963-1999 are modeled in linear and log-linear form. These models are used to project traffic fatalities and the stock of motor vehicles to 2020. The per capita income at which traffic fatality risk (fatalities/population) begins to decline is 8600 US dollars (1985 international dollars) when separate time trends are used for each geographic region. This turning point is driven by the rate of decline in fatalities/vehicles as income rises since vehicles/population, while increasing with income at a decreasing rate, never declines with economic growth. Projections of future traffic fatalities suggest that the global road death toll will grow by approximately 66% over the next twenty years. This number, however, reflects divergent rates of change in different parts of the world: a decline in fatalities in high-income countries of approximately 28% versus an increase in fatalities of almost 92% in China and 147% in India. The road death rate is projected to rise to approximately 2 per 10,000 persons in developing countries by 2020, while it will fall to less than 1 per 10,000 in high-income countries.

  8. Fatal motorcycle accidents and alcohol

    Larsen, C F; Hardt-Madsen, M


    A series of fatal motorcycle accidents from a 7-year period (1977-1983) has been analyzed. Of the fatalities 30 were operators of the motorcycle, 11 pillion passengers and 8 counterparts. Of 41 operators 37% were sober at the time of accident, 66% had measurable blood alcohol concentration (BAC...

  9. Children intoxications: what is abuse and what is not abuse.

    Dinis-Oliveira, Ricardo Jorge; Magalhães, Teresa


    The curiosity and the natural tendency to explore the environment put young children at an increased risk of poisoning over older children and adults. Poisonings are a significant area of concern from 1 year of age and progressively contribute more to overall rates of morbidity and mortality until children reach adulthood. Particularly, the abuse of children by poisoning is also highly common with thousands of fatalities. A practical strategy is presented that aims to alert health, forensic, and law enforcement professionals to this problem and to demystify the preconception that it is a rare form of abuse or neglect. Compounds that are foreign to a living organism (xenobiotics) and those present within body (endobiotics), mainly involved in children intoxications and contextual examples related to exposure are also reviewed. Particular concern is given to concepts in the field of children poisoning. The described history and the clinical and toxicological evaluation are discussed, and harmonized protocols regarding correct procedures for sample collection to forensic toxicological analysis are proposed. Since children are particularly vulnerable to the toxic effects of high doses of xenobiotics and endobiotics, special consideration on the preparation of the environment that surrounds children in order minimize all possible risks will be also considered.

  10. A patient with clove oil intoxication

    Dyrbye, B.A.; Dubois, L.; Vink, R.; Horn, J.


    The article discusses the case of a 67-year-old man who was brought to the emergency room because of inability to speak and confusion. His medical history revealed hypertension and alcohol abuse. His neurological symptoms and laboratory abnormalities are caused by intoxication with clove oil combine


    F. Cheraghali M. Taymori


    Full Text Available Unintentional drug intoxication is still a major cause of morbidity and mortality in young children. In order to study the epidemiological pattern of childhood drug poisoning in Golestan province, all cases diagnosed with poisoning from 1997 to 2002 in the only pediatric hospital in province were recruited. During this period 563 cases of poisoned children were hospitalized in Taleqani hospital, of these 305 cases were due to drug poisoning. Opium was responsible for more than half of the poisoning cases, and 91% of deaths, among drug intoxicated children. Metoclopramide, benzodiazepines, tricyclic antidepressants and anticonvulsants were among the other frequent causes of poisoning. Neurological symptoms were the most prominent symptoms of poisoning and more than 80% of cases showed some neurological symptoms. Mortality rate among the cases was 3.6% and of total of 11 deaths, 10 were poisoned with opium. About 61% of cases were hospitalized between 24-48 hrs. Most of the poisoning cases in young children were unintentional and in many cases, their parents played a critical role in their intoxication. This role specially is crucial in infants and children under one year of age. Parents in Golestan province use opium widely for symptomatic treatment of routine illnesses in their young children and overdose of opium may cause severe intoxication and even death of the child.

  12. Platelet aggregation associated with ethanol intoxication

    Volk, S.; Walenga, J.; Fareed, J.; Schumacher, H. (Loyola Univ. Medical Center, Maywood, IL (USA))


    Alcohol is known to produce profound effects on blood; during chronic intoxication, prolongation of bleeding time has been reported. Utilizing human platelet rich plasma, we have studied the effect of alcohol on epinephrine, arachidonic acid and ADP induced aggregation. Control responses were obtained with saline from which the relative inhibition by alcohol was calculated. These studies were carried out at a concentration of 1.25-5.0 mg/ml which represents 0.125-0.5% alcohol blood levels. From 25 normal male and female volunteers, without prior hemostatic defects or drug ingestion, a dose-dependent inhibition by alcohol of all three agonist induced aggregations was noted. Alcohol itself did not produce any aggregation response. These studies demonstrate that alcohol at levels which are reached during intoxication is capable of impairing platelet function. The implication of this finding on the bleeding complications in healthy intoxicated patients may be significant during traumatic events, and individuals taking antiplatelet drugs may present a more serious hemostatic deficit during alcohol intoxication.

  13. Non specific drug distribution in an autopsy case report of fatal caffeine intoxication.

    Ishikawa, Takaki; Yuasa, Isao; Endoh, Minoru


    Caffeine has long been recognized as an addictive substance that causes autonomic nerve effect, and is known to increase catecholamine secretion from the adrenal glands. In recent years, the risk of ingesting toxic levels of caffeine has increased because of the easy availability of analgesics, CNS (Central Nervous System) stimulant medicine and dietary supplements at shops, health stores and through online purchases. We report the death of a young female resulting from the ingestion for suicide of an online purchased sleepiness-preventing medicine containing caffeine. The autopsy findings included pulmonary edema and congestion plus cutaneous emphysema. The stomach contents included a dark-brown viscous fluid without tablet or food residue. Toxicological examination revealed the presence of caffeine in the right heart blood (154.2 μg/mL) and stomach contents (197.5 μg/mL) (lethal blood level, >80 μg/mL). The highest caffeine content was in the bile (852.3 μg/mL). Biochemical findings showed that catecholamine concentration in the peripheral blood in the iliac vein was elevated. Immunostaining of catecholamine was weak in the adrenal medulla. We recommend highlighting the toxicity risk of ingesting substances with a high caffeine concentration, and we propose that caffeine concentrations should be included in the comprehensive routine forensic toxicological tests for all cases.

  14. Bioenergetics failure and oxidative stress in brain stem mediates cardiovascular collapse associated with fatal methamphetamine intoxication.

    Faith C H Li

    Full Text Available BACKGROUND: Whereas sudden death, most often associated with cardiovascular collapse, occurs in abusers of the psychostimulant methamphetamine (METH, the underlying mechanism is much less understood. The demonstration that successful resuscitation of an arrested heart depends on maintained functionality of the rostral ventrolateral medulla (RVLM, which is responsible for the maintenance of stable blood pressure, suggests that failure of brain stem cardiovascular regulation, rather than the heart, holds the key to cardiovascular collapse. We tested the hypothesis that cessation of brain stem cardiovascular regulation because of a loss of functionality in RVLM mediated by bioenergetics failure and oxidative stress underlies the cardiovascular collapse elicited by lethal doses of METH. METHODOLOGY/PRINCIPAL FINDINGS: Survival rate, cardiovascular responses and biochemical or morphological changes in RVLM induced by intravenous administration of METH in Sprague-Dawley rats were investigated. High doses of METH induced significant mortality within 20 min that paralleled concomitant the collapse of arterial pressure or heart rate and loss of functionality in RVLM. There were concurrent increases in the concentration of METH in serum and ventrolateral medulla, along with tissue anoxia, cessation of microvascular perfusion and necrotic cell death in RVLM. Furthermore, mitochondrial respiratory chain enzyme activity or electron transport capacity and ATP production in RVLM were reduced, and mitochondria-derived superoxide anion level was augmented. All those detrimental physiological and biochemical events were reversed on microinjection into RVLM of a mobile electron carrier in the mitochondrial respiratory chain, coenzyme Q10; a mitochondria-targeted antioxidant and superoxide anion scavenger, Mito-TEMPO; or an oxidative stress-induced necrotic cell death inhibitor, IM-54. CONCLUSION: We conclude that sustained anoxia and cessation of local blood flow that leads to bioenergetics failure and oxidative stress because of mitochondrial dysfunction, leading to acute necrotic cell death in RVLM underpins cardiovascular collapse elicited by lethal doses of METH.

  15. Fatal Intoxications Due to Administration of Isosorbide Tablets Contaminated with Pyrimethamine.

    Imran, Muhammad; Shafi, Humera; Mahmood, Zahid; Sarwar, Mohammad; Usman, Hafiz Faisal; Tahir, Mohammad Ashraf; Ashiq, Muhammad Zar


    In January 2012, 664 cases of pyrimethamine toxicity and 151 deaths were reported among cardiac patients that had recently received free medicines from pharmacy of Punjab Institute of Cardiology, Lahore, Pakistan. These patients, ages ranged from 58 to 75 years, were prescribed simvastatin, clopidogrel, aspirin soluble, isosorbide mononitrate, and amlodipine. On examination of medications being given to them, it was found that a particular batch of isosorbide mononitrate tablets was contaminated with 50 mg pyrimethamine. Cardiac patients were taking isosorbide contaminated with pyrimethamine twice daily (100 mg pyrimethamine/day), whereas therapeutic dose of pyrimethamine for malaria is 25 mg/week. Postmortem urine, cardiac blood, and femoral blood specimens of three deceased males were submitted to author's laboratory for analysis. Postmortem toxicological analysis revealed that pyrimethamine concentration fell within the range of 1-10 μg/mL by liquid chromatography. Clinical, autopsy, histopathological, and toxicological findings strongly suggested toxicity due to pyrimethamine accumulation that resulted in deaths of these cardiac patients.

  16. A non-fatal intoxication with a high-dose sodium nitrate

    Joosen, Dorien; Stolk, Leo; Henry, Ronald


    A 67-year-old man accidentally ingested 75 g of sodium nitrate. He had instant gastrointestinal symptoms. On physical examination, he was respiratorily and haemodynamically stable and there were no signs of central or peripheral cyanosis. Repeated methaemoglobin levels were normal and he made an une

  17. Resource utilization and outcomes of intoxicated drivers

    Camera Lindsay J


    Full Text Available Abstract Background The high risk behavior of intoxicated drivers, impaired reaction time, lack of seat belt use, and increased incidence of head injury raises questions of whether pre-hospital use of alcohol leads to a higher injury severity score and worse clinical outcomes. We therefore compared intoxicated and non-intoxicated drivers of motor vehicle crashes with respect to outcome measurements and also describe the resources utilized to achieve those outcomes at our Level 1 trauma center. Methods Retrospective descriptive study (Jan 2002-June 2007 of our trauma registry and financial database comparing intoxicated drivers with blood alcohol levels (BAC > 80 mg/dl (ETOH > 80 with drivers who had a BAC of 0 mg/dl (ETOH = 0. Drivers without a BAC drawn or who had levels ranging from 1 mg/dL to 80 mg/dL were excluded. Data was collected on demographic information (age, gender, injury severity score or ISS, outcome variables (mortality, complications, ICU and hospital LOS, ventilator days and resource utilization (ED LOS, insurance, charges, costs, payments. Statistical analysis: p 80; stratified chi square. Results Out of 1732 drivers, the combined study group (n = 987 of 623 ETOH = 0 and 364 ETOH > 80 had a mean age of 38.8 ± 17.9, ISS of 18.0 ± 12.1, and 69.8%% male. There was no difference in ISS (p = 0.67 or complications (p = 0.38. There was a trend towards decreased mortality (p = 0.06. The ETOH = 0 group had more patients with a prolonged ICU LOS (≥ 5 days, ventilator days (≥ 8 days, and hospital LOS (> 14 days when compared to the ETOH > 80 group (p 80 group tended to be self pay (4.9% vs. 0.7%, p Conclusions The data suggests that intoxicated drivers may have better outcomes and a trend towards reduced mortality. They appeared to be less likely to have prolonged hospital LOS, ICU LOS, and ventilator days. We also observed that intoxicated drivers were more likely to be self-pay, less likely to have charges > $50K, and less likely

  18. Suicide by antidepressant intoxication identified at autopsy in Vienna from 1991-1997: the favourable consequences of the increasing use of SSRIs.

    Frey, R; Schreinzer, D; Stimpfl, T; Vycudilik, W; Berzlanovich, A; Kasper, S


    In the area of Vienna, any person dying under questionable circumstances is examined at the Institute of Forensic Medicine, where the cause of death is determined by means of autopsy and chemical analysis. Our study on fatal intoxications was performed in the period between 1991 and 1997, when selective serotonin reuptake inhibitors (SSRIs) were establishing themselves on the market, reaching the top of prescription statistics. Tricyclic antidepressants (TCAs) were involved in 30 single- and 127 multiple-substance intoxications, with amitriptyline and doxepin being the most frequently used drugs. SSRIs were involved in five multiple-substance intoxications. The f-value, which refers to the number of deaths per million defined daily doses prescribed, was found to be significantly (Pantidepressants declined significantly (Pantidepressants did not coincide with an increased number of deaths caused by these drugs.

  19. Abamectin: an uncommon but potentially fatal cause of pesticide poisoning

    Y. V. Bansod


    Full Text Available Human intoxication with abamectin is not frequently reported. It is an uncommon but potentially fatal cause of pesticide poisoning. In contrast to common organophosphate poisoning the toxic effects of avermectin in humans are not clearly defined. Ingestion of a large dose of avermectin may be associated with life-threatening complications. The therapy for avermectin poisoning is mainly symptomatic and supportive. The prognosis of patients with avermectin poisoning is likely to be favorable unless they are complicated by severe hypotension or aspiration. We hereby report a case with abamectin poisoning with neurological toxicity and respiratory failure which responded to supportive line of therapy. [Int J Res Med Sci 2013; 1(3.000: 285-286

  20. [Fatal electrocution in prison].

    Grellner, Wolfgang


    The clarification of deaths from electric current can be difficult when electric skin marks are missing or overlooked. In the following, the fatal electric accident of a 21-year-old man in prison is reported with a scene which primarily seemed to be inconspicuous. The autopsy disclosed typical electric marks in the skin of the left thumb and the corresponding part of the left index finger. A second inspection of the jail room, which was large enough for three men, but occupied by the deceased alone, led to the finding of widely spread utensils (two forks with signs of corrosion and deformation of the prongs, radio cable with socket, water container) for the self-construction of a kind of "immersion heater" for the heating of water. The man must have suffered electrocution when touching the prongs of the forks. Death supposedly occurred due to disturbances of the cardiac rhythm after a longer interval of maintained ability to act. The case again proves the difficulties in the detection and examination of possible electric deaths in which unusual sources of electricity must be considered.

  1. Allegheny County Fatal Accidental Overdoses

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Fatal accidental overdose incidents in Allegheny County, denoting age, gender, race, drugs present, zip code of incident and zip code of residence. Zip code of...

  2. Clinically and electrophysiologically diagnosed botulinum intoxication.

    Kotan, Dilcan; Aygul, Recep; Ceylan, Mustafa; Yilikoglu, Yalcin


    In this case report, clinical and electrophysiological findings of 43-year-old female patient who developed Clostridium botulinum intoxication after consumption of home-made canned food are presented. Following the sudden onset of severe nausea and vomiting, diplopia, blurred vision, bilateral ptosis, weakness, speech and swallowing difficulties have developed and the patient declared that she has just tasted the canned beans after she had rinsed them several times. The case, where serological tests cannot be performed, was diagnosed clinically and treated with antitoxin immediately. During follow-up, consecutive nerve stimulation was performed and significant incremental response was observed. There was an improvement in symptoms within 2 weeks, and in 5 or 6 weeks the symptoms had disappeared completely. Electrodiagnostic studies revealed that the findings turned to normal. The case showed that immediate antitoxin treatment is life-saving even the diagnosis of botulinum intoxication is based on clinical findings.

  3. Cardiogenic shock due to acute tramadol intoxication.

    Perdreau, Elodie; Iriart, Xavier; Mouton, Jean-Baptiste; Jalal, Zakaria; Thambo, Jean-Benoît


    Tramadol is a common analgesic, widely prescribed because of its efficiency and safety. We report the case of a 7-year-old child admitted in cardiac intensive care unit for cardiogenic shock due to tramadol intoxication. Without any past history, the child was admitted at emergency room for generalised convulsion, followed by respiratory distress. Cardiogenic shock was suspected after clinical examination and chest X-ray and confirmed by transthoracic echocardiography showing low left ventricular ejection fraction (1 mg/L) and O-desmethyltramadol (>1.5 mg/L). Hemodynamic support by inotropic drug infusion and diuretics was necessary. Left ventricular function normalised after 2 days of treatment allowing drug infusion weaning. Cardiac magnetic resonance imaging performed 3 days after admission confirmed normal left ventricular ejection fraction and volumes without evidence of late gadolinium enhancement. Cardiogenic shock due to tramadol intoxication is rare but exists. Negative inotropic effect of high doses of tramadol has been suspected. Quick recovery is possible.

  4. Gamma-hydroxybutyric acid (GHB) measurement by GC-MS in blood, urine and gastric contents, following an acute intoxication in Belgium.

    Bodson, Q; Denooz, R; Serpe, P; Charlier, C


    Gamma-hydroxybutyrate (GHB, sodium oxybate) is a compound related to neuromodulator gamma-aminobutyric acid (GABA), emerging as a recreational drug of abuse and as a rape drug. GHB-related emergencies have dramatically increased in the 1990s, but a decrease is observed since 2000. We describe the case of an acute GHB intoxication in a 28-year-old male who fell unconscious after ingestion of a mouthful of an unknown beverage, and required medical support for 2 days. A cocaine abuse was also detected by preliminary toxicological screening, but the clinical presentation was not typical of cocaine intoxication. A simple liquid-liquid extraction was used for quantitation of GHB, followed by disilyl-derivatization and analysis in selective ion monitoring (SIM) mode by gas chromatography-mass spectrometry (GC-MS), using GHB-d6 as internal standard. High concentrations of GHB were detected in urine (3020 mg/L) and gastric contents (71487 mg/L) at admission. After a 6-hours delay, GHB was still present in urine at 2324 mg/L and in blood at 43 mg/L. The clinical symptoms of cocaine intoxication were diminished by GHB consumption, and the cerebral scan was modified. Attention must thus be paid to acute intoxications with surprising clinical symptoms, and GHB has probably to be added to the preliminary toxicological screening. Data available regarding GHB are briefly reviewed, and our results are compared with previously published reports of non-fatal GHB intoxication.

  5. Spontaneous bladder rupture in acute alcohol intoxication

    Bahjat Barakat


    Full Text Available Spontaneous bladder rupture is a rare condition that can be followed by an acute alcohol intoxication and can be associated with significant morbidity and mortality. We report a case diagnosed in a alcoholic young male who was admitted to our emergency room for epigastric pain. The case demonstrates the difficulties with diagnosis and the need for physicians who work in an emergency room to be aware of this condition.

  6. Methamphetamine intoxication in a dog: case report

    Pei, Zengyang; Zhang, Xu


    Background Methamphetamine abuse has undergone a dramatic worldwide increase, and represents a significant and global issue for public health. Incidents of methamphetamine intoxication and death in humans are relatively commonplace. Because of its increasing illicit availability, together with legitimate use in human medicine, accidental or intentional exposure to methamphetamine in dogs is becoming a more likely scenario. Case presentation A 3-year-old, 3.7 kg intact female Miniature Poodle ...

  7. Interstitial Pulmonary Edema Following Bromocarbamide Intoxication

    Sugihara, H.; Hagedorn, M.; Bōttcher, D.; Neuhof, H.; Mittermayer, Ch.


    Bromocarbamides are sleep-inducing drugs which can lead, in man, to intoxication and death due to respiratory failure. To prove whether hemodynamic factors or the changed endothelial permeability induce pulmonary edema, animal experiments were performed. The fine structural changes in pulmonary edema in rabbits were observed at 60, 90 and 120 minutes after oral administration. The major findings were a) large blebs between capillary endothelium and alveolar epithelium and b) interstitial edema of the vessel wall. The bleb contents were much less electron dense than the blood contents in the capillary. Colloidal carbon did not enter the bleb or the edematous interstitial tissue. Exogenous peroxidase uptake in pinocytotie vesicles increased in pathologic cases. The hemodynamic measurements in animal receiving artificial respiration which maintained the blood pO2 at a steady state showed similar blebs in the pulmonary vessels, indicating that anoxia is not the major cause of the vascular lesion. Moreover, pulmonary arterial pressure and pulmonary vascular resistance could be held in the normal range in artificially respirated animals under bromocarbamide intoxication. Thus, hemodynamic factors are not likely to play a pathogenetic role in bringing about pulmonary edema. The chief, early factor is the increased endothelial permeability due to increased cytoplasmic transport. From this a practical suggestion for treating patients with bromocarbamide intoxication is derived: the usual fluid replacement in shock patients should be handled with great care to avoid fluid overload of the lung. ImagesFig 1Fig 2Fig 3Fig 4Fig 5Fig 6 PMID:4835993

  8. [Intoxications specific to the Aquitaine region].

    Bédry, R; Gromb, S


    Some intoxications are more specifically linked to the Aquitaine region than to other regions of France, due to environmental circumstances (fauna, flora, climate) or traditional activities (gastronomy). Three types of intoxications are particular in this area. Pine processionary caterpillar envenomations (Thaumetopoea pityocampa), a Southern Europe pinewood parasite, are frequently encountered in the Landes' forest. They are responsible of ocular and/or skin lesions with urticaria or contact dermatitis, seldom associated with immediate IgE hypersensitivity. According to the south Atlantic coastal region geology and the marine streams, venomous marine animals are mainly located in Charente-Maritime for jellyfish, in Gironde and in Landes for weeverfish and in Atlantic Pyrenees for sea anemone. Usually not dangerous, first-aid workers treat most cases of these envenomations. Some endemic mushrooms (Tricholoma auratum) which grow on the dunes of the Atlantic coastal region, are usually considered as very good comestibles, but were recently responsible for serious intoxications: T.auratum was responsible of several cases of rhabdomyolysis, without neurological involvement, nor renal or hepatic lesion. Three deaths were notified. Animal studies confirmed the responsibility of the mushrooms.

  9. Spirituality, intoxication and addiction: six forms of relationship.

    Room, Robin


    The paper considers six connections between spirituality and intoxication or addiction. They are: intoxication as a means of communication with a spiritual world; intoxication as destroying spirituality; shared use and intoxication as creating and validating community; spirituality and religion as a means of collective sobering-up; spirituality in individual sobering up; and abstinence as a spiritual practice, a witness, or a badge of membership in a spiritual community. Intoxication can either enhance or impede spirituality, both at individual and collective levels. Spirituality is often important in sobering up, both individually and collectively, and abstinence is a part of spiritual or religious practice in some traditions. But a full account must acknowledge the diversity in the interactions of spirituality and intoxication or addiction.

  10. Main characteristics of train-pedestrian fatalities on Finnish railroads.

    Silla, Anne; Luoma, Juha


    The aim of this study was to describe the frequency of fatalities, timing of collisions and characteristics of persons killed in train-pedestrian collisions on Finnish railways during 2005-2009. In addition, the Finnish results were compared with those collected in Sweden. The Finnish data were combined from five different sources. The results showed that 311 pedestrians were killed in train-pedestrian collisions, including 264 suicides, 35 accidents and 12 unclassified events. For each event type, most of the victims were male. Most suicide victims were in the 20-29 year age group and on average younger than people who chose some other form of suicide. About half of all victims were intoxicated by alcohol, medicines and/or drugs. Both suicides and accidents occurred most often at the end of the week but no specific peak for time of year was found. Suicides occurred most frequently from afternoon to night and accidents during the rush hours. Most train-pedestrian fatalities happened in densely populated areas. In conclusion, the effective prevention of railway suicides and accidents calls for a systems approach involving effective measures introduced by authorities responsible for urban planning, railways, education and public health.

  11. [Fatal methadone poisoning: observations at the CHU of Liege].

    Denooz, R; Charlier, C


    All methadone-associated deaths from October 2002 to April 2005 are analysed. A regular increase in these fatal intoxications has been recorded, in Belgium as in other countries, due, in particular, to an intensified prescription of this product, of which illicit use as street dope becomes problematic. Over the 30 months period covered by the study, 26 deaths related to methadone were listed, of which 3 occurred in accidental circumstances. In the other 23 cases, methadone can be found, yet always associated with psychotropic substances, mainly benzodiazepines (18 cases), narcotics (15 cases) and finally alcohol (5 cases). Based upon the nature of the products combined with methadone, records have been divided in two groups: In the first group (17 observations), xenobiotics at (infra)therapeutic levels are detected. In the other group (6 observations), xenobiotics at high and toxic levels are detected. Blood methadone concentrations are not so different between the 2 groups of individuals since the median values and the extreme values are worth respectively 308, and 110-11300 microg/L, for the first group and 776 and 93-2080 microg/L for the second group. There is thus an important overlap between the therapeutic blood methadone concentrations (150-400 microg/L) and blood concentrations observed in fatalities.Thus, it is necessary that all information and post-mortem results must be examined in a critical way to identify and justify cause of the death.

  12. Death by band-aid: fatal misuse of transdermal fentanyl patch.

    Bakovic, Marija; Nestic, Marina; Mayer, Davor


    We present a case of fatal intoxication by the application of a transdermal fentanyl patch upon a superficial bleeding abrasion of a 2-year-old girl. The grandmother discovered the body of the child in bed at approximately 7 a.m. External examination revealed a properly developed, nourished, and hydrated child, with some vomit in the nostrils and inside the mouth. There was no evidence of trauma besides small contusions and abrasions on the knees, with a patch placed over the largest abrasion. Closer inspection revealed that this was transdermal fentanyl patch. Internal examination and microscopic analysis revealed regurgitation of stomach content, cerebral and pulmonary edema, and liver congestion. Toxicology analysis revealed trace levels of fentanyl in the blood just above the limit of detection (2 ng/mL), while concentrations in the urine, liver, and kidney were approximately 102, 28, and 10 ng/mL, respectively. Investigation discovered that the child injured her knee while playing the evening before. The grandmother applied the patch to cover the injury, unaware that she had used a fentanyl transdermal patch instead of simple band-aid. Although fatal intoxications are uncommon among young children in high-income countries, it is of major interest to raise awareness of such events especially since a great majority of these are preventable. The presented case points at the need for more thorough education of users and more strict rules in prescribing and handling of this potent medicine. As well, we find this case to be a useful contribution to the evaluation of postmortem fentanyl concentrations in fatal intoxication in a small child.




    The principle of actio libera in causa or the effect of a perpetrator's voluntary intoxication on the existence of a criminal act is controversial in international criminal law. The present legislation, as contained in the Rome Statute, is a compromise between different legal systems. It allows the exclusion of a criminal act based on the fact that the perpetrator was involuntarily intoxicated and he or she cannot be ascribed guilt for the act of intoxication and the criminal act. In the Rome...

  14. Attention to advertising and memory for brands under alcohol intoxication

    Orquin, Jacob Lund; Jeppesen, Heine B.; Scholderer, Joachim


    of alcohol while viewing the ad. This paper examines the effect of alcohol intoxication on attention to and memory for advertisements in two experiments. Study 1 used a forced exposure manipulation and revealed increased attention to logos under alcohol intoxication consistent with the psychopharmacological...... prediction that alcohol intoxication narrows attention to the more salient features in the visual environment. Study 2 used a voluntary exposure manipulation in which ads were embedded in a magazine. The experiment revealed that alcohol intoxication reduces voluntary attention to ads and leads...

  15. Diving fatality investigations: recent changes.

    Edmonds, Carl; Caruso, James


    Modifications to the investigation procedures in diving fatalities have been incorporated into the data acquisition by diving accident investigators. The most germane proposal for investigators assessing diving fatalities is to delay the drawing of conclusions until all relevant diving information is known. This includes: the accumulation and integration of the pathological data; the access to dive computer information; re-enactments of diving incidents; post-mortem CT scans and the interpretation of intravascular and tissue gas detected. These are all discussed, with reference to the established literature and recent publications.



    The present project was carried out to study the effects of acute and chronic mercury intoxication in Grass carp (Ctenopharyngodon idella). For acute phase experiment, 48 fish were divided into four equal groups (A, B, C and D). Groups B, C and D were given HgCl2 at sublethal dose as 0.4, 0.5 and 0.6 mg/L, respectively, while group A acted as control. Skin, gills and kidneys were isolated from the fish after 48 and 96 hours for pathological studies. For chronic phase, 72 fish were divided int...

  17. Paraquat intoxication and associated pathological findings in three dogs in South Africa.

    Williams, June H; Whitehead, Zandri; Van Wilpe, Erna


    Paraquat is a bipyridylium non-selective contact herbicide commonly used worldwide. When ingestion occurs by humans and animals either accidentally, intentionally or maliciously, paraquat selectively accumulates in the lungs resulting in the production of oxygen-free radicals, causing membrane damage and cell death. Intoxicated subjects typically show progressive and fatal pulmonary haemorrhage, collapse and oedema. In individuals surviving the acute phase, pulmonary fibrosis develops. Gastrointestinal-, renal- and central nervous system clinical signs may also occur. Owing to the lack of effective treatment and absence of an antidote, the prognosis is poor. The clinical presentation, clinicopathological findings and treatment are briefly described of three dogs from one South African household, intoxicated with paraquat. Macroscopic and microscopic lesions in one dog that was necropsied, as well as pulmonary ultrastructure are detailed and illustrated for academic reference. All dogs presented with tachypnoea and dyspnoea 2-3 days after accidental paraquat ingestion. Treatment was aimed at reducing gastrointestinal absorption, enhancing elimination by diuresis and avoiding further oxidative damage by administration of antioxidants. All dogs, however, became progressively hypoxic despite treatment and were euthanised. Paraquat toxicity should be a differential diagnosis in dogs with unexplained progressive respiratory and gastrointestinal signs and renal failure. The local veterinary profession should be aware of accidental or intentional paraquat toxicity of animals. Existing literature, variations possible in canine clinical signs, measured parameters, lesions, as well as possible treatments, promising experimental antidotes and management options are discussed.

  18. Paraquat intoxication and associated pathological findings in three dogs in South Africa

    June H. Williams


    Full Text Available Paraquat is a bipyridylium non-selective contact herbicide commonly used worldwide. When ingestion occurs by humans and animals either accidentally, intentionally or maliciously, paraquat selectively accumulates in the lungs resulting in the production of oxygen-free radicals, causing membrane damage and cell death. Intoxicated subjects typically show progressive and fatal pulmonary haemorrhage, collapse and oedema. In individuals surviving the acute phase, pulmonary fibrosis develops. Gastrointestinal-, renal- and central nervous system clinical signs may also occur. Owing to the lack of effective treatment and absence of an antidote, the prognosis is poor. The clinical presentation, clinicopathological findings and treatment are briefly described of three dogs from one South African household, intoxicated with paraquat. Macroscopic and microscopic lesions in one dog that was necropsied, as well as pulmonary ultrastructure are detailed and illustrated for academic reference. All dogs presented with tachypnoea and dyspnoea 2–3 days after accidental paraquat ingestion. Treatment was aimed at reducing gastrointestinal absorption, enhancing elimination by diuresis and avoiding further oxidative damage by administration of antioxidants. All dogs, however, became progressively hypoxic despite treatment and were euthanised. Paraquat toxicity should be a differential diagnosis in dogs with unexplained progressive respiratory and gastrointestinal signs and renal failure. The local veterinary profession should be aware of accidental or intentional paraquat toxicity of animals. Existing literature, variations possible in canine clinical signs, measured parameters, lesions, as well as possible treatments, promising experimental antidotes and management options are discussed.

  19. Chernobyl Accident Fatalities and Causes


    died shortly after hospital admission from symptorns of acute radiation sickness, CVA must have been the Kiev fatality on suffered a cerebrovascular ... cerebrovascular acci- unfavorable prognosis IState Committee dent victim with anl estimated close of 3 G\\. 19861. the four bone marrow transplant...ber 1987. Aledical Handling of Skin Lesions Folloti- ing High Level Accidental Irradiation, UNSCEAR (United Nations Scientific Institute Curie, Paris

  20. A case of fatal idiosyncratic reaction to the designer drug 3,4-methylenedioxypyrovalerone (MDPV) and review of the literature.

    Desharnais, Brigitte; Dazé, Yann; Huppertz, Laura M; Mireault, Pascal; Skinner, Cameron D


    The stimulant designer drug 3,4-methylenedioxypyrovalerone (MDPV) was first synthesized by Boehringer Ingelheim in 1969 and introduced on the black market in 2006. Only a small number of fatal intoxication cases have been reported in the literature, all with significant blood MDPV concentrations. In this report, we describe one fatality attributed to an idiosyncratic reaction to MDPV. The victim displayed agitation, violent behavior and delirium followed by cardiac arrest. Hyperthermia was observed at the hospital. The MDPV cardiac and femoral blood concentrations were 6 ng/mL. The presence of excited delirium syndrome and MDPV, a drug with a pharmacology similar to cocaine, leads to the conclusion that the victim suffered a fatal adverse reaction to MDPV. This is the first published case of idiosyncratic reaction to MDPV.

  1. Acute intoxications: differences in management between six Dutch hospitals.

    Duineveld, C.; Vroegop, M.; Schouren, L.; Hoedemaekers, A.; Schouten, J.A.; Moret-Hartman, M.; Kramers, C.


    CONTEXT: Acute intoxications are frequently seen in Dutch hospitals. Based on single-centre studies and the fact that there are no clear guidelines, we hypothesised that hospital admission of acute intoxications may vary. Furthermore, decontamination treatment of poisonings may differ between hospit

  2. Acute intoxications: differences in management between six Dutch hospitals.

    Duineveld, C.; Vroegop, M.; Schouren, L.; Hoedemaekers, A.; Schouten, J.A.; Moret-Hartman, M.; Kramers, C.


    CONTEXT: Acute intoxications are frequently seen in Dutch hospitals. Based on single-centre studies and the fact that there are no clear guidelines, we hypothesised that hospital admission of acute intoxications may vary. Furthermore, decontamination treatment of poisonings may differ between

  3. Neuronal Death Following Soman Intoxication: Necrosis or Apoptosis?


    progression of apoptotic cell death in the rat piriform cortex after soman intoxication. At various time intervals after seizure onset, animals were...We investigated the temporal progression of apoptotic cell death in the rat piriform cortex after soman intoxication. At various time intervals...and neuronal loss after acute soman exposure included the piriform cortex, hippocampus, septum, entorhinal cortex, dentate gyrus, amygdala, and

  4. A Methanol Intoxication Outbreak From Recreational Ingestion of Fracking Fluid.

    Collister, David; Duff, Graham; Palatnick, Wesley; Komenda, Paul; Tangri, Navdeep; Hingwala, Jay


    Single-patient methanol intoxications are a common clinical presentation, but outbreaks are rare and usually occur in settings in which there is limited access to ethanol and methanol is consumed as a substitute. In this case report, we describe an outbreak of methanol intoxications that was challenging from a public health perspective and discuss strategies for managing such an outbreak.

  5. Efficacy of prophylaxis and treatment against soman intoxication

    Philippens, I.H.C.H.M.; Jongsma, M.J.; Vanwersch, R.A.P.


    The efficacy against lethality and post-intoxication incapacitation after 2x LD50 soman of different subacute pretreatment scenarios of 12 days was tested with or without post-intoxication therapy in guinea pigs. These pretreatment regimes were 1) the currently used pretreatment with pyridostigmine

  6. Efficacy of pretreatment and treatment against soman intoxication

    Philippens, I.H.C.H.M.; Jongsma, M.J.; Vanwersch, R.A.


    The efficacy against lethality and post-intoxication incapacitation after 2x LD50 soman of different subacute pretreatment scenarios of 12 days was tested with or without post-intoxication therapy in guinea pigs. These pretreatment regimes were 1) the currently used pyridostigmine (PYR, 0.04 mg/kg/h

  7. Acute intoxications: differences in management between six Dutch hospitals.

    Duineveld, C.; Vroegop, M.; Schouren, L.; Hoedemaekers, A.; Schouten, J.A.; Moret-Hartman, M.; Kramers, C.


    CONTEXT: Acute intoxications are frequently seen in Dutch hospitals. Based on single-centre studies and the fact that there are no clear guidelines, we hypothesised that hospital admission of acute intoxications may vary. Furthermore, decontamination treatment of poisonings may differ between hospit

  8. Neuromuscular disorders in chronic alcohol intoxication

    A. Yu. Emelyanova


    Full Text Available The paper reviews the present-day Russian and foreign literature on neuromuscular disorders in chronic alcohol intoxication. The most common manifestations of alcohol disease include alcoholic polyneuropathy (PNP and alcohol-induced skeletal muscle injury. The clinical polymorphism of alcoholic PNP is discussed. The paper considers a chronic sensory automatic form due to the direct toxic effects of ethanol and its metabolites during long-term alcohol intoxication, as well as acute/subacute sensorimotor neuropathy, the basis for the pathogenesis of which is B group vitamins, predominantly thiamine, deficiency that develops in the presence of drinking bouts concurrent with malnutrition and/or alcohol-related gastrointestinal tract diseases. In addition to nonuse of alcohol and a properly balanced diet, antioxidant therapy with alphalipoic acid and neurotropic B group vitamins is considered to be pathogenetic therapy for neuropathy. The most common and least studied clinicalform of alcohol-induced musculoskeletal injury is chronic alcoholic myopathy (AM, the diagnostic standard for which is morphometricand immunohistochemical examination of a muscle biopsy specimen. The morphological base for this form of myopathy is predominantly type 2 muscle fiber atrophy caused by impaired protein synthesis and a decreased regenerative potential of muscle fiber. The efficacy of antioxidants and leucine-containing amino acid mixtures in the treatment of chronic AM is discussed.

  9. Hemolytic uremic syndrome associated with paraquat intoxication.

    Jang, Ha Nee; Bae, Eun Jin; Hwang, Kyungo; Kang, Yeojin; Yun, Seongeun; Cho, Hyun Seop; Chang, Se-Ho; Park, Dong Jun


    We report a case of a 66-year-old patient with paraquat intoxication resulting in the requirement for hemoperfusion, hemodialysis, and plasma exchange. His initial serum paraquat level was 0.24 µg/mL (0.0-0.1 µg/mL). Activated charcoal (50 g) was administered orally, and high-dose N-acetylcysteine (150 mg/kg) was administered intravenously. In addition, immediate 4 h hemoperfusion was also performed for three consecutive days after admission. Hemodialysis was started on the 4th day after admission because of uremia. On the 9th day after admission, laboratory findings demonstrated hemolytic uremic syndrome (HUS): microangiopathic hemolytic anemia (MAHA), thrombocytopenia, elevated reticulocyte count, and lactate dehydrogenase (LDH). Plasma exchange was performed three times consecutively. Anemia and thrombocytopenia were improved, and LDH was normalized after plasma exchange. Urine output increased to 2240 mL/day on the 18th day after admission, and hemodialysis was discontinued. He is currently being observed at our follow-up clinic without renal impairment or pulmonary dysfunction for 1.5 years since discharge. We should suspect paraquat-associated HUS when thrombocytopenia and anemia are maintained for a long time after paraquat intoxication.

  10. Age trajectories of stroke case fatality

    Olsen, Tom Skyhøj; Andersen, Zorana Jovanovic; Andersen, Klaus Kaae


    Mortality rates level off at older ages. Age trajectories of stroke case-fatality rates were studied with the aim of investigating prevalence of this phenomenon, specifically in case-fatality rates at older ages.......Mortality rates level off at older ages. Age trajectories of stroke case-fatality rates were studied with the aim of investigating prevalence of this phenomenon, specifically in case-fatality rates at older ages....

  11. Plasma carnitine concentrations after chronic alcohol intoxication.

    Kępka, Alina; Waszkiewicz, Napoleon; Zalewska-Szajda, Beata; Chojnowska, Sylwia; Płudowski, Paweł; Konarzewska, Emilia; Szulc, Agata; Ladny, Jerzy Robert; Zwierz, Krzysztof; Szajda, Sławomir Dariusz


    Carnitine transports fatty acids from the cytoplasm to the mitochondrial matrix, where the fatty acids are oxidized. Chronic alcohol consumption reduces the concentration of carnitine and interferes with oxidative processes occurring in the cell. The assessment of carnitine concentrations in plasma of chronically intoxicated alcohol dependent persons in a 49-day abstinence period. The study included 31 patients (5 women and 27 men) aged from 26 to 60 years (44.6 ± 8.9) and 32 healthy subjects (15 women and 17 men) aged 22-60 years (39.8 ± 9.4). The patients' alcohol dependence ranged from 2 to 30 years (13.6 ± 7.5). Examined subjects consumed 75-700 g of ethanol/day (226.9 ± 151.5). Plasma concentrations of free and total carnitine were measured three times: at the first (T0), 30th (T30) and 49th (T49) day of hospital detoxification. Free (FC) and total (TC) carnitine were determined by the spectrophotometric method. Plasma acylcarnitine (AC) concentration was calculated from the difference between TC and FC; then the AC/FC ratio was calculated. To determine statistically significant differences for related variables, Student's t-test was used. At T0, alcoholics had significantly lower concentration of FC and TC (p < 0.05) in plasma, as compared to the control group. In comparison to controls, at T30, plasma TC and FC (p < 0.01) as well as AC (p < 0.001) were reduced. The lowest concentration of TC, FC and AC (p < 0.001)was found at T49. The ratio of AC/FC at T0 had a tendency to be higher in alcoholics than in the control group (p = 0.05), whereas at T49 it was significantly lower in alcoholics as compared to the control subjects (p < 0.05). Chronic alcohol intoxication causes a plasma deficiency of carnitine. Forty-nine days of abstinence showed a significant decrease in the concentration of TC, FC and AC. Further research is necessary to clarify whether a low level of plasma carnitine after chronic alcohol intoxication is caused by the uptake of blood

  12. Mitragynine concentrations in two fatalities.

    Domingo, Olwen; Roider, Gabriele; Stöver, Andreas; Graw, Matthias; Musshoff, Frank; Sachs, Hans; Bicker, Wolfgang


    Two cases of fatalities are reported of which the recreational use of Mitragyna speciosa ("kratom") could be confirmed. One of these cases presents with one of the highest postmortem mitragynine concentrations published to date. Our results show that even extremely high mitragynine blood concentrations following the consumption of kratom do not necessarily have to be the direct cause of death in such fatalities as a result of an acute overdose. The two cases are compared with regard to the differences in mitragynine concentrations detected and the role of mitragynine in the death of the subjects. Irrespective of the big differences in mitragynine concentrations in the postmortem blood samples, mitragynine was not the primary cause of death in either of the two cases reported here. Additionally, by rough estimation, a significant difference in ratio of mitragynine to its diastereomers in the blood and urine samples between the two cases could be seen.

  13. Drugs of abuse: management of intoxication and antidotes.

    Montoya, Ivan D; McCann, David J


    Illicit drug intoxications are an increasing public health problem for which, in most cases, no antidotes are clinically available. The diagnosis and treatment of these intoxications requires a trained clinician with experience in recognizing the specific signs and symptoms of intoxications to individual drugs as well as polydrug intoxications, which are more the rule than the exception. To make the diagnosis, the clinical observation and a urine toxicology test are often enough. Evaluating the blood levels of drugs is frequently not practical because the tests can be expensive and results may be delayed and unavailable to guide the establishment of a treatment plan. Other laboratory tests may be useful depending on the drug or drugs ingested and the presence of other medical complications. The treatment should be provided in a quiet, safe and reassuring environment. Vital signs should be closely monitored. Changes in blood pressure, respiratory frequency and temperature should be promptly treated, particularly respiratory depression (in cases of opiate intoxication) or hyperthermia (in cases of cocaine or amphetamine intoxication). Intravenous fluids should be administered as soon as possible. Other psychiatric and medical complication should receive appropriate symptomatic treatment. Research on immunotherapies, including vaccines, monoclonal and catalytic antibodies, seems to be a promising approach that may yield specific antidotes for drugs of abuse, helping to ameliorate the morbidity and mortality associated with illicit drug intoxications.

  14. Methylbromide intoxication: a clinical case study.

    Breeman, Wim


    The port of Rotterdam, The Netherlands, is the world's largest container port. In 2006, one of these containers caused a chemical incident. Methylbromide is used in some countries as a pesticide for the fumigation of maritime containers. Because of an insufficiently performed detoxification, this insecticide intoxicated several employees and some of the ambulance crew and Mobile Medical Team (MMT). The victims displayed symptoms of sore throat, irritated eyes, and hypersalivation. One of the victims suffered from multiple epileptic seizures. Two victims were admitted to the intensive care unit for respiratory support. Three other employees showed milder symptoms and received supportive care but were not admitted to the hospital. This complicated case shows that the safety of the ambulance crew and MMT must be guaranteed. It also demonstrates that healthcare providers cannot always oversee the accident scene and that there are some pitfalls that are almost impossible to prevent.

  15. Intravenous pyridoxine in acute ethanol intoxication.

    Mardel, S; Phair, I; O'Dwyer, F; Henry, J A


    Intravenous pyridoxine was evaluated as an agent for the reversal of ethanol-induced central nervous depression in a randomised double blind controlled study of 108 patients presenting with a clinical diagnosis of acute ethanol intoxication to two accident and emergency departments. Level of consciousness, measured by a modified Glasgow coma scale, showed no significant change after a single 1 g dose of intravenous pyridoxine when compared to controls given saline. The mean fall in blood alcohol concentration after one hour was 33 mg dl-1 (7.2 mmol l-1) in both groups suggesting that pyridoxine has no antidotal action and no short term effect on the rate of metabolism of ethanol.

  16. Acute cattle intoxication from Nerium oleander pods.

    Soto-Blanco, B; Fontenele-Neto, J D; Silva, D M; Reis, P F C C; Nóbrega, J E


    Seven outbreaks of acute intoxication from oleander (Nerium oleander) in cattle were reported in Northeast of Brazil. A total of 92 cattle were poisoned by oleander in 7 different herds; 57 animals died (67% of affected cattle). All cases reported here occurred during dry season. Two of the outbreaks resulted from offering oleander triturated and mixed with fodder. In the other cases, accidental ingestion of residual parts of oleander derived from pruning or cutting plants on grazing land were responsible. Clinical signs were diverse; the most common were locomotion disturbances, diarrhoea, depression and sudden death. Postmortem findings varied from no significant lesions to widespread haemorrhage. The presence of oleander leaves in the rumen was noted in all cases. The lack of information about the toxicity of oleanders was the main cause for the accident, which prompt us to stimulate wide divulgation of the common toxic plants.

  17. Intoxications involving MDPV in Sweden during 2010-2014: Results from the STRIDA project.

    Beck, Olof; Franzen, Lisa; Bäckberg, Matilda; Signell, Patrick; Helander, Anders


    In the recent years, there have been an increasing number of new psychoactive substances (NPS) available through marketing and sale on the Internet. The stimulant 3,4-methylenedioxypyrovalerone (MDPV) is a potent dopamine reuptake inhibitor, which can cause serious intoxications requiring intensive care and even fatality. This report from the STRIDA project presents the prevalence, laboratory results, and clinical features in a series of intoxications involving MDPV over a 5-year period. Observational case series of consecutive patients with admitted or suspected intake of NPS presented at hospitals in Sweden from 2010 to 2014. Blood and/or urine samples were collected from intoxicated patients with admitted or suspected intake of NPS presenting at hospitals over the country. Analysis of NPS was performed by a liquid chromatography-tandem mass spectrometry multicomponent method. Clinical data were collected when caregivers consulted the Swedish Poisons Information Centre and also retrieved from medical records. The severity of poisoning was graded retrospectively using the poisoning severity score. During the 5-year study period, the number of MDPV-related inquiries to the Poisons Information Centre was 662 out of a total ∼4500 suspected NPS-related inquiries (∼15%), and 201 analytically confirmed MDPV intoxications were enrolled in the study. The study period covered the period when the use of MDPV in Sweden was at its peak and also the decline to an almost zero level. The age range of patients was 18-68 (mean 36, median 35) years, and 71% were males. The MDPV concentrations in serum ranged between 1.0 ng/mL and 1509 ng/mL (mean 63.6, median 20) and between 1.0 ng/mL and 81 000 ng/mL (mean 3880, median 1160) in urine. The urinary values were also creatinine corrected for variation in urine dilution, and the MDPV/creatinine ratio ranged between 0.10 ng/mmol and 2480 ng/mmol (mean 247, median 92.6). There was a statistically significant association


    Petko Marinov


    Full Text Available Purpose: Methanol (CH3OH is a monohydric alcohol, vastly used both in housekeeping and industry. Although the acute methanol intoxications are rare, they may include life-threatening symptoms, substantial lethality and negative consequences such as neurological disorders and vision damage. Aim of the work is to conduct a retrospective study on the acute methanol intoxications within Varna region for a 10-year period (2006-2015. Material/Methods: This study covers 39 patients of the Clinic for Intensive Treatment of Acute Intoxications and Toxicoallergies at Naval Hospital – Varna, all of which had their diagnosis confirmed, including gas chromatography methods. Results: Methanol intoxication prevalence showed male/female ratio close to 2.9:1. The major part of the cases concerned economically active population, the age group of 25-60 being the most affected. In all instances an oral methanol intake has been involved. Death occurred in 14 cases (35.9%

  19. [Protective effects of metaprot and ethomerzol in carbophos intoxications].

    Vorob'eva, V V; Zarubina, I V; Shabanov, P D


    The mechanisms of protective action of thiobenzimidazole derivatives metaprot and ethomerzol (25 and 50 mg/kg) have been studied on a model of carbophos intoxication (256.0 +/- 8.7 mg/kg) in rats. Both compounds recovered the resistance to physical loads in forced swimming test, normalized the activity of aspartate and alanine transaminases, and reduced bilirubin, creatinine, and urea nitrogen levels in the blood serum. The intoxication was accompanied with increasing concentration of malonic dialdehyde and decreasing level of recovered glutation in the blood, as well as with the signs of endogenic intoxication. Metaprot and ethomerzol diminished disorders of both the lipid peroxidation and endogenic intoxication processes. Thus, the antihypoxic, antioxidant, actoprotective, energotropic, and reparative effects of metaprot and ethomerzol have been proved. Ethomerzol was more effective than metaprot in these tests.

  20. Intralipid emulsion treatment as an antidote in lipophilic drug intoxications.

    Eren Cevik, Sebnem; Tasyurek, Tanju; Guneysel, Ozlem


    Intravenous lipid emulsion (ILE) is a lifesaving treatment of lipophilic drug intoxications. Not only does ILE have demonstrable efficacy as an antidote to local anesthetic toxicity, it is also effective in lipophilic drug intoxications. Our case series involved 10 patients with ingestion of different types of lipophilic drugs. Intravenous lipid emulsion treatment improved Glasgow Coma Scale or blood pressure and pulse rate or both according to the drug type. Complications were observed in 2 patients (minimal change pancreatitis and probable ILE treatment-related fat infiltration in lungs). In our case series, ILE was used for different lipophilic drug intoxications to improve cardiovascular and neurologic symptoms. According to the results, it was found that ILE treatment is a lifesaving agent in lipophilic drug intoxications and it can be used in unconscious patients who have cardiac and/or neurologic symptoms but no history of a specific drug ingestion.

  1. Severe childhood amitriptyline intoxication and plasmapheresis: a case report.

    Karacı, Mehmet; Özçetin, Mustafa; Dilsiz, Günter; Güçlü-Songür, Yaşar Gözde


    Tricyclic antidepressant intoxication is one of the most frequently encountered and life-threatening causes of intoxication among referrals to emergency departments due to drug intoxication. There is no known antidote against any of the tricyclic antidepressants. The American Society for Apheresis (ASFA) recommends plasmapheresis to support primary treatment in this type of drug poisoning, which does not respond to certain and traditional treatments. We present a 15-year-old girl who ingested amitriptyline with suicidal intent. On admission, she was in a comatose state (Glasgow Coma Scale score: 5), with no spontaneous respiration and presence of pathological reflexes. Due to the intake history of lethal doses and the severe clinical picture, plasmapheresis was performed. She was discharged on her fifth day of hospitalization.Due to the high plasma protein binding property of amitriptyline, plasma exchange therapy should be considered in cases of severe amitriptyline intoxication as a life-saving therapeutic modality.

  2. [Fatal exposure to Aconitum napellus].

    German Jørgensen, Jørgen Rahr; Andersen, Anne Elsborg


    Fatal exposure to poisonous plants in northern Europe is a rare condition. In this case report we describe an intended poisoning with Aconitum napellus (monkshood), which contains the toxin aconitine. The lethal dose in adults is 3-6 mg. The toxin affects excitable cells such as neurons and myocytes causing degrees of unconsciousness, hypotension and cardiac arrhythmias. There is no antidote and treatment is symptomatic. We describe a patient who had eaten monkshood. She was treated with infusion of lidocaine and survived. After 24 hours of treatment and monitoring she was discharged from the intensive care unit.

  3. [Fatal poisoning due to Indigofera].

    Labib, S; Berdai, M-A; Bendadi, A; Achour, S; Harandou, M


    Indigo, also known in Morocco as Nila, is a dye widely used in the coloring of Moroccan handicrafts. It is obtained from fermentation reactions on the leaves and branches of true indigo, Indigofera tinctoria, which is a widespread plant in tropical Africa and Asia. We report a case of fatal poisoning in a 3-year-old child after administration of indigo for therapeutic purposes. Death resulted from multiple organ failure. The toxicity of this compound is little known in the literature and deserves to be explored through toxicokinetic and toxicodynamic studies, in order to better determine the toxic constituents of the dye.

  4. Myocardial perfusion at fatal infarction

    Hvid-Jacobsen, K; Møller, J T; Kjøller, E;


    In a consecutive study of myocardial scintigraphy in acute ischemic syndrome, four patients had 99mTc-hexamibi injected intravenously before they developed fatal cardiogenic shock. Planar scintigraphy was performed after death. Slices of the hearts after autopsy were analyzed for scintigraphic......, where 83%-92% of the myocardium showed ischemia as defined by a 99mTc-hexamibi uptake below an arbitrary limit on half maximum uptake. Myocardial hypoperfusion might thus aggravate the functional impairment at myocardial infarction and lead to cardiogenic shock....

  5. [Sudden unilateral sensorineural hearing loss after carbon monoxide intoxication].

    Michalska-Piechowiak, Teresa; Miarzyńska, Maria; Perlik-Gattner, Irena


    A case of unilateral sensorineural hearing loss of the left ear after carbon monoxide intoxication was presented. The diagnosis was based upon an interview, medical examinations and audiometric investigations. Results of diagnostic evaluations, clinical presentation and treatment were discussed. Hearing improvement was obtained after 6 days of treatment and normal hearing returned after 14 days. Patients who suffer from CO intoxication are at risk of hearing impairment, therefore, there is a need for audiometric follow up in these patients.

  6. Seizure disorders and anemia associated with chronic borax intoxication.

    Gordon, A S; Prichard, J S; Freedman, M H


    During the course of investigation of two infants with seizure disorders it was discovered that both had been given large amounts of a preparation of borax and honey which resulted in chronic borate intoxication. In one child a profound anemia developed as well. The symptoms of chronic borate intoxication are different from those of the acute poisoning with which we are more familiar. The borax and honey preparations are highly dangerous and should no longer be manufactured or distributed for sale.

  7. Forensic issues in cases of water birth fatalities.

    Byard, Roger W; Zuccollo, Jane M


    Birth under water has become a widely disseminated technique that is promoted to improve the quality of labor. The case of a 42-week gestation male infant is reported who died of respiratory and multiorgan failure secondary to florid pneumonia and sepsis due Pseudomonas aeruginosa following a water birth. Other infants who have been delivered underwater have drowned or have had near-drowning episodes with significant hyponatremia and water intoxication. Local and disseminated sepsis has been reported, with respiratory distress, fevers, hypoxic brain damage, and seizures. There have also been episodes of cord rupture with hemorrhage. The postmortem investigation of such cases requires a complete autopsy of the infant, with examination of the placenta. Full details of the pregnancy and delivery and inspection of the birthing unit are also needed. A septic workup of the infant and placenta should be undertaken along with sampling of water from the birthing unit and microbiological swabbing of the equipment. Vitreous sodium levels may reveal electrolyte disturbances. While fatal cases appear rare, this may change if water births gain in popularity.

  8. Chronic arsenic intoxication diagnostic score (CAsIDS).

    Dani, Sergio Ulhoa; Walter, Gerhard Franz


    Arsenic and its compounds are well-established, potent, environmentally widespread and persistent toxicants with metabolic, genotoxic, mutagenic, teratogenic, epigenetic and carcinogenic effects. Arsenic occurs naturally in the Earth's crust, but anthropogenic arsenic emissions have surmounted the emissions from important natural sources such as volcanism. Inorganic arsenicals exhibit acute and chronic toxicities in virtually all cell types and tissues, and hence arsenic intoxication affects multiple systems. Whereas acute arsenic intoxication is rare and relatively easy to diagnose, chronic arsenic intoxication (CAsI) is common but goes often misdiagnosed. Based on a review of the literature as well as our own clinical experience, we propose a chronic arsenic intoxication diagnostic score (CAsIDS). A distinctive feature of CAsIDS is the use of bone arsenic load as an essential criterion for the individual risk assessment of chronic arsenic intoxication, combined with a systemic clinical assessment. We present clinical examples where CAsIDS is applied for the diagnosis of CAsI, review the main topics of the toxicity of arsenic in different cell and organ systems and discuss the therapy and prevention of disease caused or aggravated by chronic arsenic intoxication. CAsIDS can help physicians establish the diagnosis of CAsI and associated conditions. Copyright © 2017 John Wiley & Sons, Ltd.


    M. S. Khan, S. A. Khan, Z. I. Chaudhary, M. N. Khan,1 A. Aslam , K. Ashraf2, R. M. Ayyub and M. F. Rai.


    Full Text Available The present project was carried out to study the effects of acute and chronic mercury intoxication in Grass carp (Ctenopharyngodon idella. For acute phase experiment, 48 fish were divided into four equal groups (A, B, C and D. Groups B, C and D were given HgCl2 at sublethal dose as 0.4, 0.5 and 0.6 mg/L, respectively, while group A acted as control. Skin, gills and kidneys were isolated from the fish after 48 and 96 hours for pathological studies. For chronic phase, 72 fish were divided into five groups (E, F, G, H and I, containing 12 fish each except group E which contained 24 fish. Groups F, G, H and I were given HgCl2 at sublethal dose of 0.3 mg/L for 4, 8, 12 and 16 days, respectively, while group E acted as control. Skin, gills and kidneys were isolated from each group (F, G, H and I after 4, 8, 12 and 16 days respectively for pathological studies. During chronic phase in the treatment groups normal histology of epidermis was disturbed with increased number of immature cells. Overall, skin layers were atrophied and withered. Histopathology of gills showed hyperplasia of epithelial cells of gill filaments, fusion of secondary lamellae giving a club shaped appearance of filaments and contraction and sloughing of respiratory epithelium in groups F, G, H and I. Histopathological examination of kidneys also showed a wide range of toxicity lesions and destruction in treatment groups (F, G, H and I. Disintegration and disorganization of cells of both renal and haemopoitic systems including dilatation of capillaries and thickening of basal lumen were observed. Mild to sever tubular epithelial degeneration, karyolysis, dilation and shrinkage of Bowman’s capsule and glomerulus were also observed. In chronic phase experiment, fish showed clinical signs including restlessness, difficult breathing, fin flickering and jerky movements. Suppressed growth rate was also observed in treatment groups (F, G, H and I. During acute phase, after 48 hours, these

  10. Fatal case of dichloromethane poisoning.

    Goullé, J P; Lacroix, C; Vaz, E; Rouvier, P; Proust, B


    A 47-year-old man was found dead in a factory where dichloromethane (DCM) tanks were stocked. He was making an inventory of the annual stock of DCM contained in several tanks (5- to 8000-L capacity) by transferring the solvent into an additional tank with the help of compressed air. During this operation, one of the tanks overflowed and the man, who was not wearing any protection, was intoxicated. Autopsy showed digestive, suprarenal, and liver bleeding. Blood was also found in the trachea. DCM was identified by headspace gas chromatography-mass spectrometry (GC-MS). A headspace gas chromatography-flame ionization detection technique (GC-HS-FID) optimized for quantitation in biological fluids, organs and viscera was established at autopsy. The following concentrations of DCM were found: blood (150 mg/L), urine (2.0 mg/L), gastric content (5.6 mg/L), brain (122 mg/kg), fat (99 mg/kg), liver (44 mg/kg), lung (20 mg/kg), and kidney (15 mg/kg). A study of the storage stability of DCM was carried out on these samples. Ethanol production was measured in some organs. The results are discussed in light of the rarity of existing literature.

  11. Discrepancies between diagnoses of methanol and ethylene glycol intoxication based on determinations performed in the regional clinical toxicology centre and in the department of forensic medicine

    Tomasz Cywka


    Full Text Available The situations in which autopsy blood toxicology results do not confirm methanol and/or ethylene glycol intoxications diagnosed during patients` hospitalizations are frequently observed in the Department of Forensic Medicine in Lublin. Material and methods: In order to verify inconsistent findings, serum samples of 18 individuals, routinely stored in the regional clinical toxicology centre after testing, were re-examined using the specific method of gas chromatography (GC. Results: None of the fatal methanol intoxications was confirmed; toxic concentration of glycol was detected only in one case whereas the remaining determinations were negative or revealed “congeneric” concentrations. In cases of negative results of chromatographic re-analyses, the difference between hospital analysis and GC results were on average 29.6 mg% (max. 127.7 mg% for glycol and 31.8 mg% (max. 80.0 mg% for methanol. Severe metabolic acidosis was found in all hospitalized patients. In the hospital setting, “intoxications” were diagnosed even when low concentrations of methanol or glycol (below the cut-off values were detected with spectrophotometry, which is the method still used in the hospital laboratory. The diagnosis of methanol intoxication in a car accident victim was particularly bizarre; as were the methanol intoxication diagnoses established in cases of acute diabetes-associated complications (4, pancreatitis (1, pneumonia (2 and peritonitis (1, gastrointestinal haemorrhage (1, and decompensated hepatic cirrhosis (1. The therapeutic management based on those diagnoses was incorrectly targeted at the non-existing intoxication that was considered the cause of patient’s deteriorating condition. Conclusions : Our findings indicate inadequate knowledge of physicians to interpret and critically verify toxicological results. Moreover, low cost and speed of spectrophotometric analysis should not veil its significant limitations: mainly low specificity and

  12. Amphetamines as potential inducers of fatalities: a review in the district of Ghent from 1976-2004.

    De Letter, Els A; Piette, Michel H A; Lambert, Willy E; Cordonnier, Jan A C M


    Abuse of amphetamine (AMP) and its derivatives, such as 3,4-methylenedioxymethamphetamine (MDMA, 'Ecstasy'), 3,4-methylenedioxyethylamphetamine (MDEA, MDE), and 3,4-methylenedioxyamphetamine (MDA) is an important public issue. Fatalities following ingestion of these substances are not infrequent in current forensic practice. The aim of this study was twofold. Firstly, considering the wide range of blood levels reported in fatalities, to provide insight into the interpretation of a quantified blood level and, secondly, to examine and discuss possible causes, mechanisms and manners of death. All the medico-legal files between January 1976 and December 2004 were skimmed through to investigate whether amphetamine and/or derivatives were involved in the fatal outcome. Particularly, in addition to overdose cases due to or including amphetamines, all amphetamines-related fatalities were examined. In addition to AMP, MDMA, MDEA, and MDA, two other amphetamine derivatives, namely 4-methylthioamphetamine (4-MTA) and para-methoxyamphetamine (PMA) were considered. In 34 fatalities, amphetamines were involved and the majority were men, under the age of 25 years. A wide range of blood levels was found: e.g. MDMA blood concentrations in cases of 'pure' intoxication were found between 0.27 and 13.51 microg/ml. The age and sex distribution as well as the broad range of quantified amphetamines blood levels were in line with those reported in the literature. In our study group, 'pure' intoxications with amphetamines, polydrug overdoses, and the combination of amphetamines use and polytrauma were the most prominent causes of death. Considering the manner of death in these fatalities, unintentional overdoses were most frequent, though suicides, traffic accidents, and criminal offences associated with amphetamines use also accounted for significant percentages. Acute to subacute cardiopulmonary failure was the most frequent mechanism of death, followed by (poly)trauma, mechanical

  13. [Medico-legal certification of fatal cases after drug: abuse in the light of modern toxicological analysis].

    Kłys, M; Klementowicz, W; Bujak-Gizycka, B; Kołodziej, J; Trela, F


    Introduction of modern instrumental methods for toxicological analysis make possible a detection and identification of xenobiotics in different kind of multicomponents biological samples (plant sources of narcotics, body fluids and tissues of abusers) on a low concentration level. In this way a range of possibilities for the interpretation of toxicological results was enlarged. General medicolegal trends are strictly connected with modern analytics and they can be discussed on the basis of drug--users and fatal cases of intoxications with narcotics. Toxicological findings of these cases were worked out by means of modern analytical method--liquid chromatography with mass detection (LC/MS).

  14. Benzylpenicillin, acetylcysteine and silibinin as antidotes in human hepatocytes intoxicated with alpha-amanitin.

    Magdalan, Jan; Ostrowska, Alina; Piotrowska, Aleksandra; Gomułkiewicz, Agnieszka; Podhorska-Okołów, Marzena; Patrzałek, Dariusz; Szelag, Adam; Dziegiel, Piotr


    Fatalities due to mushroom poisonings are increasing worldwide, with high mortality rate resulting from ingestion of amanitin-producing species. Intoxications caused by amanitin-containing mushrooms represent an unresolved problem in clinical toxicology since no specific and fully efficient antidote is available. The objective of this study was a comparative evaluation of benzylpenicillin (BPCN), acetylcysteine (ACC) and silibinin (SIL) as an antidotes in human hepatocytes intoxicated with alpha-amanitin (alpha-AMA). All experiments were performed on cultured human hepatocytes. Cytotoxicity evaluation of cultured cells using MTT assay and measurement of lactate dehydrogenase (LDH) activity was performed at 12, 24 and 48h of exposure to alpha-AMA and/or antidotes. The significant decline of cell viability and significant increase of LDH activity were observed in all experimental hepatocyte cultures after 12, 24 and 36h exposure to alpha-AMA at concentration 2microM. Exposure of the cells to alpha-AMA resulted also in significant reduction of cell spreading and attachment. However, addition of tested antidotes to experimental cultures significantly stimulated cell proliferation and attachment. In cell cultures exposed simultaneously to alpha-AMA and tested antidotes cytotoxic parameters (MTT and LDH) were not significantly different from control incidences. The cytoprotective effect of all antidotes was not dose-related, which reflects a high efficacy of all these substances. Administration of studied antidotes was not associated with any adverse effects in hepatocytes. The administration of ACC, BPCN or SIL to human hepatocyte cultures showed a similar strong protective effect against cell damage in alpha-AMA toxicity.

  15. Retrospective Evaluation of Intoxication Cases Presented to Sivas Numune Hospital

    Yadigar Yılmaz


    Full Text Available Aim: In this study, we aimed to evaluate the epidemiological and demographic features and prognosis of all patients admitted to the emergency department and followed in intensive care unit due to poisoning. Methods: We resrospectively evaluated the patients over 14 years of age, who attended to the emergency department and was followed in our intensive care unit due to poisoning, were evaluated according to their demographic characteristics, anamnesis and prognosis. Results: Of 1894 patients, who were admitted to the emergency department, 1034 were female (54.8%. The mean age was 32.76±14.88 years. 36.4% of these patients were suicide attempters. Three hundred twenty-eight patients (17.3% were admitted to the intensive care unit. Two hundred thirty-four (17.3% were females and the mean age was 27.98±13.87 years. Of those patients, 263 (80.2% were treated for drug intoxications, 33 (10.1% for carbonmonoxide (CO intoxications, 18 (5.5% for food intoxications, 4 (1.2% for insecticide poisoning, 4 (1.2% for bee sting, 3 (0.9% for rat poison intoxications, 1 (0,3% for alcohol intoxication, and 1 (0.3% was treated for snakebite. 80.5% of them were suicide attempters. The most frequently taken drugs were antidepressants (25.8%. Conclusion: Intoxication cases admitted to the emergency department and intensive care unit were mostly young women, and drug overdose was the most common attempted method of suicide. The most frequent used drugs were antidepressants. In this study, we determined the patient profile of intoxication in Sivas province. (The Medical Bulletin of Haseki 2013; 51: 178-82

  16. Dataset on psychosocial risk factors in cases of fatal and near-fatal physical child abuse.

    Pierce, Mary Clyde; Kaczor, Kim; Acker, Deborah; Webb, Tina; Brenzel, Allen; Lorenz, Douglas J; Young, Audrey; Thompson, Richard


    This article presents the psychosocial risk factors identified in the cases of 20 children less than four years of age who were victims of fatal or near-fatal physical abuse during a 12 month period in the Commonwealth of Kentucky. These data are related to the article "History, injury, and psychosocial risk factor commonalities among cases of fatal and near-fatal physical child abuse" (Pierce et al., 2017) [1].

  17. Off-road vehicle fatalities: A comparison of all-terrain vehicle and snowmobile accidents in Sweden

    Torfinn Gustafsson


    Full Text Available This study investigates accident fatalities involving two types of off-road vehicles: snowmobiles and all-terrain vehicles (ATVs. All snowmobile fatalities in Sweden from the 2006/2007 season through the 2011/2012 season, and all ATV fatalities from 2007 through 2012, were retrospectively examined. A total of 107 fatalities—57 snowmobile-related and 50 ATV-related—were found. Most deaths occurred on weekends (71% of the snowmobile-related and 72% of the ATV-related. A majority of the fatalities were males (91% and 94%, with the largest share in the age group 40–49 years (19% and 24%. The most common causes of death were blunt trauma (56% and 66%, drowning (30% vs 6%, and traumatic asphyxia (9% vs 14%. Among victims who were tested (95% vs 92%, a very high share was found to be inebriated (59% vs 61%, and mean blood alcohol concentration was also high (1.9 vs 1.7 g/l. Forty-seven percent of snowmobile-related fatalities and 48% of ATV-related fatalities had a blood alcohol concentration above 1.0 g/l. This means that there was a very strong association between off-road vehicle fatalities and drunken riding; steps to prevent riding while intoxicated seem to be the most important preventive measure. Automatic measures such as alcolocks are probably the most effective. The obvious at-risk group to target is middle-aged men with high alcohol consumption.

  18. Acute isoniazid intoxication: seizures, acidosis and coma.

    Temmerman, W; Dhondt, A; Vandewoude, K


    Isoniazid (INH) is the most widely used of the antituberculosis drugs. An acute overdose is potentially fatal and is characterized by the clinical triad of repetitive seizures unresponsive to the usual anticonvulsants, metabolic acidosis with a high anion gap and coma. The diagnosis of INH overdose should be considered in any patient who presents with an unexplained metabolic acidosis and convulsions. The cornerstone of therapy consists in pyridoxine (vitamin B6) and the dose should be equal to the amount of INH ingested. When conservative therapy fails or in case of renal insufficiency, dialysis must be considered. Severe central nervous toxicity can also be caused by chronic ingestion of higher than therapeutic doses of INH. In those cases pyridoxine-therapy can be useful as well. In the present paper a case of acute overdose of INH is reported, followed by a review of the literature.

  19. Fatal poisoning among patients with drug addiction

    Simonsen, K. W.; Christoffersen, D. J.; Banner, J.;


    Introduction: Fatal poisonings among drug addicts in Denmark in 2012 were examined. Cause of death, abuse pattern and geographic differences are discussed and data are compared with previous studies. Methods: All fatal poisonings examined at the three institutes of forensic medicine in Denmark in...

  20. Gasoline Prices and Motor Vehicle Fatalities

    Grabowski, David C.; Morrisey, Michael A.


    Fatal motor vehicle crashes per capita remained relatively stable over the 1990s, in spite of new traffic safety laws and vehicle innovations. One explanation for this stability is that the price of gasoline declined, which resulted in more vehicle miles traveled and potentially more fatalities. By using 1983-2000 monthly gasoline price and…

  1. [Intoxication syndrome concomitant with recurrent streptococcal tonsillitis and its correction].

    Pavelkina, V F; Laseeva, M G


    The objective of the present work was to study selected features of intoxication in the patients presenting with recurrent tonsillitis (RT) and managed by means of the combination of basal therapy with reamberine, a preparation showing the detoxication activity. A total of 70 patients with moderately severe recurrent streptococcal tonsillitis induced by infection with group A beta-hemolytic streptococci were available for the examination. Characteristics of endogenous intoxication were explored. The study has demonstrated that recurrent tonsillitis is associated with the development of the pronounced symptoms of endogenous intoxication (EI) as suggested by the enhanced leukocytic index of intoxication (LII) and the elevated levels of medium molecular weight molecules (MWM) with the simultaneous impairment of detoxication properties of albumin. Collectively, these changes are indicative of incompleteness of the pathological process that may be regarded as an unfavourable prognostic factor and suggests the risk of development of tonsillogenic pathology, its relapses, and chronization of the process. Taken together, these findings indicate the necessity of developing novel approaches to the treatment of recurrent tonsillitis with special reference to the use of pharmaceutical products possessed of detoxication activity. Reamberine introduced in the combined treatment of RT was shown to decrease the severity of intoxication as confirmed by normalization of LII and MWM levels as well as the improvement of detoxication properties of albumin. It is concluded that therapeutic efficacy of reamberine opens up wide prospects for its clinical applications.

  2. Predictors of Poor Prognosis in Aluminum Phosphide Intoxication

    Fakhredin Taghaddosi Nejad


    Full Text Available Background: Aluminum phosphide as a fumigant is extensively used for wheat preservation from rodents and bugs especially in silos worldwide. There is increasing number of acute intoxication with this potentially lethal compound because of its easy availability. We have tried to locate predictors of poor prognosis in patients with aluminum phosphide intoxication in order to find patients who need more strict medical cares. Methods: All cases of aluminum phosphide intoxication that had been referred to our hospital during April 2008 to March 2010 were studied by their medical dossiers. Pertinent data including vital signs, demographic features, clinical and lab findings, and incidence of any complication were collected and analyzed by the relevant statistical methods. Results: Sixty seven cases of aluminum phosphide intoxication were included in the study. 44.8% of them were male. 97% of cases were suicidal. Mean amount of ingestion was 1.23+/- 0.71 tablets. Mortality rate was 41.8%. ECG abnormality and need for mechanical ventilation had negative relation with outcome. Conclusion: Correlation between some findings and complications with outcome in aluminum phosphide intoxication can be used as guidance for risk assessment and treatment planning in the patients.

  3. Accidental and experimental Closantel intoxication in Uruguayan sheep

    Rodolfo Rivero


    Full Text Available Abstract An outbreak of Closantel intoxication in sheep in Uruguay is described. The outbreak occurred in a group of 1300 weaning lambs treated orally with a 10% solution of Closantel. One hundred forty eight lambs showed clinical signs of intoxication and 14 died. The clinical signs included mydriasis, nystagmus, and negative pupillary reflex, bilateral blindness, bump into objects, and lateral movement of the head. No macroscopic lesions were observed. The histological lesions of the retina were cytoplasmic vacuolization in ganglion cells and in cells of the inner and outer nuclear layers with different degrees of atrophy. Vacuolization and axonal degeneration were observed in the optic nerve, with multifocal areas of fibrosis and infiltration by lymphocytes and Gitter cells. To reproduce the intoxication, four sheep were given two, four and 10 times the therapeutic dose of Closantel (0.1g/kg of BW. Only the animals receiving 10 times the recommended dose showed clinical signs. The histological examination of the lesions in experimental sheep showed similar results to those described in the accidental outbreak, except for the absence of optic nerve fibrosis and inflammation, characterizing an acute phase. Axonal myelin sheaths loss, fibroblasts and collagen fibers were observed in the ultrastructural study of the optic nerve of accidental intoxicated animals. The optic nerve of experimentally intoxicated animals had vacuoles that separated the myelin sheaths of axons. To prevent outbreaks it is suggested to weigh the animals before Closantel administration to avoid errors in dose calculation.

  4. Alcohol consumption and escalatory aggression in intoxicated and sober dyads.

    Leonard, K E


    It has been suggested that alcohol ingestion facilitates escalatory processes in aggressive interactions. The present study examined interaction patterns in intoxicated, sober and mixed dyads. Thirty pairs of men college students were randomly assigned to these conditions. Subjects who received alcohol received .964 g of absolute alcohol per kg of body weight. At the beginning of each trial in a reaction-time competition, each member of the dyad selected the shock level that he wanted his opponent to receive if the opponent was slower on the trial. Further, each member was informed by feedback lights of the shock level that his opponent had selected for him. The results indicated that the intoxicated dyads selected higher shock levels than did the sober dyads. Mixed dyads tended to select lower shock levels than intoxicated dyads but higher shock levels than sober dyads. However, these differences were not statistically significant. Additionally, intoxicated dyads escalated in aggression over the first block of six trials, whereas neither sober nor mixed dyads evidenced such an escalation. One interpretation of these findings is that the cognitive disruption caused by the alcohol interfered with the subjects' ability to evaluate the consequences of their behavior and to interpret the behavior of their opponents. A second interpretation is that, because of the expectancy effects associated with alcohol consumption, intoxicated dyads did not feel constrained to a nonaggressive stance. Finally, the value of the dyadic-interaction paradigm in the study of alcohol-related violence was discussed.

  5. Attention to advertising and memory for brands under alcohol intoxication.

    Orquin, Jacob L; Jeppesen, Heine B; Scholderer, Joachim; Haugtvedt, Curtis


    In an attempt to discover new possibilities for advertising in uncluttered environments marketers have recently begun using ambient advertising in, for instance, bars and pubs. However, advertising in such licensed premises have to deal with the fact that many consumers are under the influence of alcohol while viewing the ad. This paper examines the effect of alcohol intoxication on attention to and memory for advertisements in two experiments. Study 1 used a forced exposure manipulation and revealed increased attention to logos under alcohol intoxication consistent with the psychopharmacological prediction that alcohol intoxication narrows attention to the more salient features in the visual environment. Study 2 used a voluntary exposure manipulation in which ads were embedded in a magazine. The experiment revealed that alcohol intoxication reduces voluntary attention to ads and leads to a significant reduction in memory for the viewed ads. In popular terms consuming one or two beers reduces brand recall from 40 to 36% while being heavily intoxicated further reduces brand recall to 17%.

  6. Methyltin intoxication in six men; toxicologic and clinical aspects

    Rey, C.; Reinecke, H.J.; Besser, R.


    Neurologic and psychiatric symptoms such as headache, tinnitus, defective hearing, changing desorientation and aggressiveness are initial symptoms of methyltin chloride intoxication. Some patients also developed epileptic equivalents, such as dreamy attacks and central ventilation transaminases. Laboratory findings included low levels of serum potassium, leucocytosis and elevated transaminases. The excretion rate of tin in the urine correlated with the severity of the intoxication. There was no measurable effect of plasma separation or d-penicillamine therapy on tin excretion in the urine or on the clinical picture. The long-term prognosis of severely intoxicated persons is poor. To prevent such events workers need to be warned of the risk and dangers of working with organo-metallic compounds. The effectiveness of protective clothes and gas masks should be checked. In exposed workers regular testing is advised of tin concentrations in the urine.

  7. [Extended hemoperfusion in the treatment of acute carbamazepine intoxication].

    Peces, R; Azorín, S; Peces, C; Selgas, R


    Carbamazepine is used in the treatment of epilepsy, and also prescribed in neuralgic pain syndromes, and certain affective disorders. Carbamazepine intoxication with suicide attempt is a relatively common clinical problem that can result in coma, respiratory depression, arrhythmia, hemodynamic instability and death. The drug's relatively high molecular weight, elevated volume of distribution and intense protein-binding render it difficult to extracorporeal removal, but published experience with hemoperfusion or hemodialysis present variable results. We describe a case report involving carbamazepine intoxication who was successfully treated with charcoal hemoperfusion. With this treatment the half-life of carbamazepine was reduced with rapid lowering of carbamazepine levels and clinical improvement. Based on our experience in this patient and a review of previously reported cases, extended charcoal hemoperfusion should be considered for serious carbamazepine intoxication because free as well as bound drug fractions are eliminated via this technique.

  8. [Hemoperfusion in the treatment of acute valproic acid intoxication].

    Peces, R; Fernández, E J; Sánchez, R J; Peces, C; Montero, A; Selgas, R


    Valproic acid is increasingly used in the treatment of epilepsy, and also prescribed for bipolar affective disorders, schizoaffective disorders, schizophrenia and migraine prophylaxis. Valproic acid intoxication with suicide attempt is a relatively common clinical problem that can result in coma, respiratory depression, pancytopenia, hemodynamic instability and death. The drug's relatively low molecular weight, small volume of distribution and saturable protein-binding render it potentially amenable to exracorporeal removal (hemodialysis, hemoperfusion or hemofiltration ), but published experience is scarce. We describe a case report involving valproic acid intoxication with ingestion of ethanol, who was successfully treated with charcoal hemoperfusion. With this treatment the half-life of valproic acid was reduced with rapid lowering of valproic acid levels and clinical improvement. Based on our experience in this patient and a review of previously reported cases, charcoal hemoperfusion should be considered for serious valproic acid intoxication because free as well as bound drug fractions are eliminated via this technique.

  9. Fatal Necrotizing Fasciitis following Episiotomy

    Faris Almarzouqi


    Full Text Available Introduction. Necrotizing fasciitis is an uncommon condition in general practice but one that provokes serious morbidity. It is characterized by widespread fascial necrosis with relative sparing of skin and underlying muscle. Herein, we report a fatal case of necrotizing fasciitis in a young healthy woman after episiotomy. Case Report. A 17-year-old primigravida underwent a vaginal delivery with mediolateral episiotomy. Necrotizing fasciitis was diagnosed on the 5th postpartum day, when the patient was referred to our tertiary care medical center. Surgical debridement was initiated together with antibiotics and followed by hyperbaric oxygen therapy. The patient died due to septic shock after 16 hours from the referral. Conclusion. Delay of diagnosis and consequently the surgical debridement were most likely the reasons for maternal death. In puerperal period, a physician must consider necrotizing fasciitis as a possible diagnosis in any local sings of infection especially when accompanied by fever and/or tenderness. Early diagnosis is the key for low mortality and morbidity.

  10. Attention to advertising and memory for brands under alcohol intoxication

    Orquin, Jacob Lund; Jeppesen, Heine B.; Scholderer, Joachim


    In an attempt to discover new possibilities for advertising in uncluttered environments marketers have recently begun using ambient advertising in, for instance, bars and pubs. However, advertising in such licensed premises have to deal with the fact that many consumers are under the influence...... of alcohol while viewing the ad. This paper examines the effect of alcohol intoxication on attention to and memory for advertisements in two experiments. Study 1 used a forced exposure manipulation and revealed increased attention to logos under alcohol intoxication consistent with the psychopharmacological...

  11. Behavioral assessment of NIH Swiss mice acutely intoxicated with tetramethylenedisulfotetramine.

    Flannery, Brenna M; Silverman, Jill L; Bruun, Donald A; Puhger, Kyle R; McCoy, Mark R; Hammock, Bruce D; Crawley, Jacqueline N; Lein, Pamela J


    Tetramethylenedisulfotetramine (TETS) is a potent convulsant poison that is thought to trigger seizures by inhibiting the function of the type A gamma-aminobutyric acid receptor (GABAAR). Acute intoxication with TETS can cause vomiting, convulsions, status epilepticus (SE) and even death. Clinical case reports indicate that individuals who survive poisoning may exhibit long-term neuropsychological issues and cognitive deficits. Therefore, the objective of this research was to determine whether a recently described mouse model of acute TETS intoxication exhibits persistent behavioral deficits. Young adult male NIH Swiss mice received a seizure-inducing dose of TETS (0.15mg/kg, ip) and then were rescued from lethality by administration of diazepam (5mg/kg, ip) approximately 20min post-TETS-exposure. TETS-intoxicated mice typically exhibited 2 clonic seizures prior to administration of diazepam with no subsequent seizures post-diazepam injection as assessed using behavioral criteria. Seizures lasted an average of 72s. Locomotor activity, anxiety-like and depression-relevant behaviors and cognition were assessed at 1week, 1month and 2months post-TETS exposure using open field, elevated-plus maze, light↔dark transitions, tail suspension, forced swim and novel object recognition tasks. Interestingly, preliminary validation tests indicated that NIH Swiss mice do not respond to the shock in fear conditioning tasks. Subsequent evaluation of hot plate and tail flick nociception tasks revealed that this strain exhibits significantly decreased pain sensitivity relative to age- and sex-matched C57BL/6J mice, which displayed normal contextual fear conditioning. NIH Swiss mice acutely intoxicated with TETS exhibited no significant anxiety-related, depression-relevant, learning or memory deficits relative to vehicle controls at any of the time points assessed with the exception of significantly increased locomotor activity at 2months post-TETS intoxication. The general absence

  12. Copper intoxication inhibits aerobic nucleotide synthesis in Streptococcus pneumoniae

    Johnson, Michael D. L.; Kehl-Fie, Thomas E.; Rosch, Jason W.


    Copper is universally toxic in excess, a feature exploited by the human immune system to facilitate bacterial clearance. The mechanism of copper intoxication remains unknown for many bacterial species. Here, we demonstrate that copper toxicity in Streptococcus pneumoniae is independent from oxidative stress but, rather, is the result of copper inhibiting the aerobic dNTP biosynthetic pathway. Furthermore, we show that copper-intoxicated S. pneumoniae is rescued by manganese, which is an essential metal in the aerobic nucleotide synthesis pathway. These data provide insight into new targets to enhance copper-mediated toxicity during bacterial clearance. PMID:25730343

  13. Post-mortem whole body computed tomography of opioid (heroin and methadone) fatalities: frequent findings and comparison to autopsy

    Winklhofer, Sebastian; Stolzmann, Paul [University of Zurich, Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, Zurich (Switzerland); University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Surer, Eddie; Ampanozi, Garyfalia; Thali, Michael; Schweitzer, Wolf [University of Zurich, Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, Zurich (Switzerland); Ruder, Thomas [University of Zurich, Department of Forensic Medicine and Radiology, Institute of Forensic Medicine, Zurich (Switzerland); University Hospital Bern, Institute of Diagnostic, Interventional and Pediatric Radiology, Bern (Switzerland); Elliott, Marina [Simon Fraser University, Department of Archaeology, Burnaby, BC (Canada); Oestreich, Andrea; Kraemer, Thomas [University of Zurich, Department of Forensic Pharmacology and Toxicology, Institute of Forensic Medicine, Zurich (Switzerland); Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland)


    To investigate frequent findings in cases of fatal opioid intoxication in whole-body post-mortem computed tomography (PMCT). PMCT of 55 cases in which heroin and/or methadone had been found responsible for death were retrospectively evaluated (study group), and were compared with PMCT images of an age- and sex-matched control group. Imaging results were compared with conventional autopsy. The most common findings in the study group were: pulmonary oedema (95 %), aspiration (66 %), distended urinary bladder (42 %), cerebral oedema (49 %), pulmonary emphysema (38 %) and fatty liver disease (36 %). These PMCT findings occurred significantly more often in the study group than in the control group (p < 0.05). The combination of lung oedema, brain oedema and distended urinary bladder was seen in 26 % of the cases in the study group but never in the control group (0 %). This triad, as indicator of opioid-related deaths, had a specificity of 100 %, as confirmed by autopsy and toxicological analysis. Frequent findings in cases of fatal opioid intoxication were demonstrated. The triad of brain oedema, lung oedema and a distended urinary bladder on PMCT was highly specific for drug-associated cases of death. (orig.)

  14. Epidemiology & preventive aspects of railway suicides and fatalities related to trespassing accidents.

    Kumar, Sachil; Verma, Anoop K; Bhattacharya, Sandeep; Singh, Uma Shankar


    Suicide and trespass are major contributors to risk on the railway, resulting in around 170-180 fatalities per year in Lucknow region, as well as associated major disruption to the rail network. Lucknow is the capital city of the state of Uttar Pradesh in India. The analysis included train-pedestrian fatalities during 2007-2012. The data for 2007-2012 were collected from the autopsy reports of the university, case sheets from the hospital, the general prosecutor's investigations report and the inquest reports from police. The results show that the majority of victims were males. Half of the suicide victims were 20-39 years old. Accidents happened most frequently in situations when a person was walking on the tracks/in front of train (22.7%) or were crossing the tracks illegally (20.9%). Among all train-pedestrian fatalities, about half of the victims (42.8%) were intoxicated by alcohol. Female suicide victims suffered from mental health problems more frequently (55.8%) than male suicide victims. Overall, there is no reason to believe that train-pedestrian fatalities are unavoidable. By contrast, the effective prevention of railway suicides and accidents should be based on a systems approach involving effective measures introduces by several organisations such as government, railway organisations, various authorities (such as public health, education, enforcement, urban planning) and communities. Same measures can often be used to prevent both trespassing and suicides, even though their effectiveness may depend on the target group. In addition, there are measures specifically targeted to prevent either trespassing or suicides. Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  15. Analysis of strychnine and brucine in postmortem specimens by RP-HPLC: a case report of fatal intoxication.

    Wang, Zhaohong; Zhao, Jingzhen; Xing, Junbo; He, Yi; Guo, Dean


    A sensitive method for the identification and quantitation of the toxic alkaloids strychnine and brucine from postmortem specimens has been established. After solid-phase extraction using Oasis MCX cartridges the extracts were analyzed by high-performance liquid chromatography with diode-array detection. The limit of detection was 0.5 ng/mL blood for strychnine and brucine, and the limit of quantitation was 5 ng/mL blood for strychnine and brucine. The method was applied for the analysis of blood and gastric contents of a 34-year-old female who died after ingestion of a packet of herbal medicine powder containing the seeds of Strychnos nux-vomica L. Strychnine and brucine were detected in all the samples. The concentration in our case is consistent with that in previous reports.

  16. Fatal poisoning among patients with drug addiction

    Simonsen, Kirsten Wiese; Christoffersen, Dorte J; Banner, Jytte


    INTRODUCTION: Fatal poisonings among drug addicts in Denmark in 2012 were examined. Cause of death, abuse pattern and geographic differences are discussed and data are compared with previous studies. METHODS: All fatal poisonings examined at the three institutes of forensic medicine in Denmark...... on Funen and in South Jutland. Cocaine was most frequently detected in East Denmark, while amphetamine was more frequent in West Denmark. CONCLUSIONS: The number of fatal poisonings among drug addicts has stabilised around 200. The increase in methadone deaths continued and, as in 2007, methadone...

  17. Fatal poisoning among patients with drug addiction

    Simonsen, K. W.; Christoffersen, D. J.; Banner, J.


    Introduction: Fatal poisonings among drug addicts in Denmark in 2012 were examined. Cause of death, abuse pattern and geographic differences are discussed and data are compared with previous studies. Methods: All fatal poisonings examined at the three institutes of forensic medicine in Denmark...... on Funen and in South Jutland. Cocaine was most frequently detected in East Denmark, while amphetamine was more frequent in West Denmark. ConclusionS: The number of fatal poisonings among drug addicts has stabilised around 200. The increase in methadone deaths continued and, as in 2007, methadone...

  18. Injuries and Fatalities on Sailboats in the United States 2000-2011: An Analysis of US Coast Guard Data.

    Ryan, Kevin M; Nathanson, Andrew T; Baird, Janette; Wheelhouse, Jenna


    Prior sailing injury studies have been small, focused investigations. This large, population-based study examined the mechanisms and factors contributing to sailboat-related injuries and deaths. A retrospective data analysis of the Boating Accident Report Database compiled by the US Coast Guard between 2000 and 2011 was performed. The database was analyzed looking at frequency of events. For each subgroup, proportions were determined and 95% CIs were calculated. These data, used in conjunction with the 2011 US Coast Guard National Recreational Boating Survey, were used to estimate a fatality rate. Two hundred seventy-one sailing-related fatalities and 841 injuries were reported. A fatality rate was calculated at 1.19 deaths per million sailing person-days. Weather or hazardous waters were listed as primary contributing factors in 28.0% (95% CI, 22.7-33.4) of deaths; 70.1% (95% CI, 64.7-75.6) of deaths occurred after falling overboard or capsizing. Drowning was the most common cause of death (73.1%; 95% CI, 67.8-78.4), and 81.6% of victims were not wearing a life jacket. Alcohol intoxication contributed to 12.2% (95% CI, 8.3-16.1) of deaths. Operator- or passenger-preventable factors contributed to 52.7% (95% CI, 49.3-56.1) of all injuries; 51.6% (95% CI, 46.1-57.1) of injuries on nonmotorized sailboats were the result of capsizing, and 46.4% (95% CI, 42.1-50.7) of all injuries on motorized sailboats were the result of collisions or grounding. The calculated fatality rate is similar to that of alpine skiing. Falls overboard and capsizing were the most common fatal accidents. Operator inattention, inexperience, and alcohol use were common preventable factors contributing to fatal and nonfatal injury. Copyright © 2016 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  19. Fatal brodifacoum poisoning in a pony

    Ayala, Ignacio; Rodríguez, Mª Jesús; Martos, Nieves; Zilberschtein, José; Ruíz, Isidro; Motas, Miguel


    Fatal brodifacoum poisoning in a pony is described; this condition has not previously been reported in ponies. Discussion of what factors in the pony’s history and treatment may have predisposed to the severity and ultimate death is provided.

  20. Chronic Vitamin D Intoxication in Captive Iberian Lynx (Lynx pardinus)

    Muñoz, Luis; Raya, Ana; Lopez, Guillermo; Aguilera-Tejero, Escolástico


    To document the biochemical and pathologic features of vitamin D intoxication in lynx and to characterize mineral metabolism in healthy lynx, blood samples were obtained from 40 captive lynx that had been receiving excessive (approximately 30 times the recommended dose) vitamin D3 in the diet, and from 29 healthy free ranging lynx. Tissue samples (kidney, stomach, lung, heart and aorta) were collected from 13 captive lynx that died as a result of renal disease and from 3 controls. Vitamin D intoxication resulted in renal failure in most lynx (n = 28), and widespread extraskeletal calcification was most severe in the kidneys and less prominent in cardiovascular tissues. Blood minerals and calciotropic hormones in healthy lynx were similar to values reported in domestic cats except for calcitriol which was higher in healthy lynx. Changes in mineral metabolism after vitamin D intoxication included hypercalcemia (12.0 ± 0.3 mg/dL), hyperphosphatemia (6.3 ± 0.4 mg/dL), increased plasma calcidiol (381.5 ± 28.2 ng/mL) and decreased plasma parathyroid hormone (1.2 ± 0.7 pg/mL). Hypercalcemia and, particularly, hyperphosphatemia were of lower magnitude that what has been previously reported in the course of vitamin D intoxication in other species. However, extraskeletal calcifications were severe. The data suggest that lynx are sensitive to excessive vitamin D and extreme care should be taken when supplementing this vitamin in captive lynx diets. PMID:27243456

  1. Digoxin intoxication: An old enemy in modern era

    Bahadir Kirilmaz; Serkan Saygi; Hasan Gungor; Ugur Onsel Turk; Emin Alio(g)lu; Serdar Akyuz; Fatih Asgun; Istemihan Tengiz; Ertugrul Ercan


    Objectives Although development of new treatment modalities limited digoxin usage, digoxin intoxication is still an important issuewhich could be easily overlooked. In this report, we analyzed a case series definitively diagnosed as digoxin intoxication in the modern era.Methods We analyzed 71 patients hospitalized with digoxin intoxication confirmed by history, complaints, clinical and electrocardiograph(ECG) findings, and serum digoxin levels > 2.0 ng/mL, during a five year period. The demographic and clinical data, indications for digoxinuse, digoxin dosage, concurrent medications, laboratory data, hospital monitoring, and ECG findings were obtained from all patients.Results Thirty-eight of 71 patients (53.5%) had symptoms of heart failure during admission or later. Sixty-four percent of patients wereolder than 75 years. The percentage of females was 67%. Atrial fibrillation, hypertension and gastrointestinal complaints were more frequentin the females (64% in females, 30% in males, P = 0.007; 81% in female, 52% in males, P = 0.01; 50% in female, 17.3% in males, P = 0.008,respectively). The mortality rate during the hospital course was 7%. Conclusions This report demonstrated the reduced mortality rates inpatients with digoxin intoxication over the study period. Gastrointestinal complaints are the most common symptoms in this population.

  2. Zinc protects renal function during cadmium intoxication in the rat.

    Jacquillet, G; Barbier, O; Cougnon, M; Tauc, M; Namorado, M C; Martin, D; Reyes, J L; Poujeol, P


    This study investigates the effect in the rat of chronic CdCl2 intoxication (500 microg Cd2+/kg, daily i.p. injection for 5 days) on renal function and the changes in tight junction proteins claudin-2, claudin-3, and claudin-5 present in rat kidney. We also studied the effect of coadministration of ZnCl2 (500 microg Zn2+/kg) during chronic CdCl2 intoxication. Our results indicate that 1) most of the filtered Cd2+ is reabsorbed within the kidney; 2) chronic Cd2+ intoxication can induce a change in renal handling of ions without altering glomerular filtration rate; 3) a delayed nephropathy, showing Fanconi-like features, appears more than 5 days after the end of CdCl2 exposure; 4) epithelial integrity is altered by chronic Cd2+ intoxication affecting the expression and localization of claudin tight junction proteins; and 5) cotreatment with Zn2+ protects against the renal toxic effects of Cd2+, preventing altered claudin expression and inhibiting apoptosis. In conclusion, these results show that Cd2+ toxicity and cellular toxic mechanisms are complex, probably affecting both membrane transporters and tight junction proteins. Finally, Zn2+ supplementation may provide a basis for future treatments.

  3. Mass-media publicity campaign on driving while intoxicated.

    Wesemann, P.


    Mass media publicity campaigns against driving while intoxicated have been conducted in the netherlands for a number of years. A new, more aggressive approach was introduced in 1984 with the slogan "alcohol ..... all too easily a crime". Goals of this campaign were (1) internationalization of the le

  4. Long-term neurotoxic effects of dimethylamine borane intoxication.

    Liu, Chi-Hung; Wang, Hsuan-Min; Lin, Kun-Ju; Kuo, Hung-Chou; Weng, Yi-Hsin; Shih, Tung-Sheng; Huang, Chin-Chang


    To investigate the long-term neurotoxic effects in a patient with acute dimethylamine borane (DMAB) intoxication. A 38-year-old man, working in a semiconductor factory, with acute DMAB intoxication presented with confusion, and drowsiness, followed by cognitive impairments and motor-predominant axonal polyneuropathy. We performed serial neurobehavioral assessments and functional neuroimaging studies, including brain (99m)Tc-TRODAT single photon emission computed tomography (SPECT) and brain positron emission tomography (PET) scan to monitor the long-term central nervous system (CNS) effects of DMAB intoxication. Neurobehavioral tests revealed a persistent impairment in episodic memory of visual retention semantic category retrieval and working memory of digit span (backward). Brain (99m)Tc-TRODAT SPECT scan showed a lower radioactivity uptake in the left striatum and F-18 FDG PET scan revealed a relatively decreased cerebral metabolism at the anterior cingulate gyrus and both frontal regions. Follow-up neurobehavioral tests showed that the cognitive improvements were mainly documented in intelligence, attention function, conceptual shift, perceptual motor speed, verbal learning and working memory but were limited in visual memory and executive functions. Patients with acute DMAB intoxication may have a long-lasting CNS toxicity on the cognitive dysfunction, parkinsonism, and an impaired metabolic activity of the brain. Clinical improvements may sustain during the long-term follow-up period. Copyright © 2012 Elsevier B.V. All rights reserved.

  5. Chronic Vitamin D Intoxication in Captive Iberian Lynx (Lynx pardinus.

    Ignacio Lopez

    Full Text Available To document the biochemical and pathologic features of vitamin D intoxication in lynx and to characterize mineral metabolism in healthy lynx, blood samples were obtained from 40 captive lynx that had been receiving excessive (approximately 30 times the recommended dose vitamin D3 in the diet, and from 29 healthy free ranging lynx. Tissue samples (kidney, stomach, lung, heart and aorta were collected from 13 captive lynx that died as a result of renal disease and from 3 controls. Vitamin D intoxication resulted in renal failure in most lynx (n = 28, and widespread extraskeletal calcification was most severe in the kidneys and less prominent in cardiovascular tissues. Blood minerals and calciotropic hormones in healthy lynx were similar to values reported in domestic cats except for calcitriol which was higher in healthy lynx. Changes in mineral metabolism after vitamin D intoxication included hypercalcemia (12.0 ± 0.3 mg/dL, hyperphosphatemia (6.3 ± 0.4 mg/dL, increased plasma calcidiol (381.5 ± 28.2 ng/mL and decreased plasma parathyroid hormone (1.2 ± 0.7 pg/mL. Hypercalcemia and, particularly, hyperphosphatemia were of lower magnitude that what has been previously reported in the course of vitamin D intoxication in other species. However, extraskeletal calcifications were severe. The data suggest that lynx are sensitive to excessive vitamin D and extreme care should be taken when supplementing this vitamin in captive lynx diets.

  6. Sudden onset unexplained encephalopathy in infants: think of cannabis intoxication.

    Lavi, Eran; Rekhtman, David; Berkun, Yackov; Wexler, Isaiah


    The use of cannabis as both a therapeutic agent and recreational drug is common, and its availability is increasing as a result of legalization in many countries. Among older children, the manifestations of cannabis intoxication are numerous and include both neurological and systemic manifestations that are frequently non-specific. There have been only a few reports detailing cannabis intoxication in infants and toddlers. We describe three infants who presented to the emergency department with encephalopathic signs without prominent systemic manifestations. During the initial interview of caregivers, no history of exposure to neurotoxic agents was obtained. All three patients were subsequently diagnosed with cannabis intoxication based on urine toxic screens for delta-9-tetrahydrocannabinol (THC). The infants recovered with supportive care that included fluids and monitoring. The non-specific symptomatology of cannabis intoxication in infants together with the wide differential for unexplained acute onset encephalopathy may delay diagnosis and lead to inappropriate procedures and interventions such as antimicrobial treatments and imaging studies. Healthcare personnel of emergency rooms, urgent care centers, and general clinics should be aware of the potential risk of cannabis ingestion in young infants. A thorough medical history and toxic screen are warranted in all infants with unexplained decreased sensorium.

  7. Heart Rate Variability in Children with Tricyclic Antidepressant Intoxication

    Ener Cagri Dinleyici


    Full Text Available The aim of this study was to evaluate HRV in children requiring intensive care unit stays due to TCA poisoning between March 2009 and July 2010. In the time-domain nonspectral evaluation, the SDNN (P<0.001, SDNNi (P<0.05, RMSDD (P<0.01, and pNN50 (P<0.01 were found to be significantly lower in the TCA intoxication group. The spectral analysis of the data recorded during the first 5 minutes after intensive care unit admission showed that the values of the nLF (P<0.05 and the LF/HF ratio (P=0.001 were significantly higher in the TCA intoxication group, while the nHF (P=0.001 values were significantly lower. The frequency-domain spectral analysis of the data recorded during the last 5 minutes showed a lower nHF (P=0.001 in the TCA intoxication group than in the controls, and the LF/HF ratio was significantly higher (P<0.05 in the intoxication group. The LF/HF ratio was higher in the seven children with seizures (P<0.001. These findings provided us with a starting point for the value of HRV analysis in determining the risk of arrhythmia and convulsion in TCA poisoning patients. HRV can be used as a noninvasive testing method in determining the treatment and prognosis of TCA poisoning patients.

  8. Alcohol Advertising and Motor Vehicle Fatalities

    Henry Saffer


    The purpose of this paper is to empirically estimate the effect of alcohol advertising on motor vehicle fatalities. The concept of an industry level advertising response function is developed and other empirical issues in estimating the effects of advertising are reviewed. The data set consists of quarterly observations, from 1986 to 1989, for 75 advertising markets in the United States and includes 1200 observations. Since motor vehicle fatalities and alcohol advertising are jointly determin...

  9. Efficacy of chelation therapy to remove aluminium intoxication.

    Fulgenzi, Alessandro; De Giuseppe, Rachele; Bamonti, Fabrizia; Vietti, Daniele; Ferrero, Maria Elena


    There is a distinct correlation between aluminium (Al) intoxication and neurodegenerative diseases (ND). We demonstrated how patients affected by ND showing Al intoxication benefit from short-term treatment with calcium disodium ethylene diamine tetraacetic acid (EDTA) (chelation therapy). Such therapy further improved through daily treatment with the antioxidant Cellfood. In the present study we examined the efficacy of long-term treatment, using both EDTA and Cellfood. Slow intravenous treatment with the chelating agent EDTA (2 g/10 mL diluted in 500 mL physiological saline administered in 2 h) (chelation test) removed Al, which was detected (using inductively coupled plasma mass spectrometry) in urine samples collected from patients over 12 h. Patients that revealed Al intoxication (expressed in μg per g creatinine) underwent EDTA chelation therapy once a week for ten weeks, then once every two weeks for a further six or twelve months. At the end of treatment (a total of 22 or 34 chelation therapies, respectively), associated with daily assumption of Cellfood, Al levels in the urine samples were analysed. In addition, the following blood parameters were determined: homocysteine, vitamin B12, and folate, as well as the oxidative status e.g. reactive oxygen species (ROS), total antioxidant capacity (TAC), oxidized LDL (oxLDL), and glutathione. Our results showed that Al intoxication reduced significantly following EDTA and Cellfood treatment, and clinical symptoms improved. After treatment, ROS, oxLDL, and homocysteine decreased significantly, whereas vitamin B12, folate and TAC improved significantly. In conclusion, our data show the efficacy of chelation therapy associated with Cellfood in subjects affected by Al intoxication who have developed ND.

  10. Antibody protection against botulinum neurotoxin intoxication in mice.

    Cheng, Luisa W; Stanker, Larry H; Henderson, Thomas D; Lou, Jianlong; Marks, James D


    Adulteration of food or feed with any of the seven serotypes of botulinum neurotoxin (BoNT) is a potential bioterrorism concern. Currently, there is strong interest in the development of detection reagents, vaccines, therapeutics, and other countermeasures. A sensitive immunoassay for detecting BoNT serotype A (BoNT/A), based on monoclonal antibodies (MAbs) F1-2 and F1-40, has been developed and used in complex matrices. The epitope for F1-2 has been mapped to the heavy chain of BoNT/A, and the epitope of F1-40 has been mapped to the light chain. The ability of these MAbs to provide therapeutic protection against BoNT/A intoxication in mouse intravenous and oral intoxication models was tested. High dosages of individual MAbs protected mice well both pre- and postexposure to BoNT/A holotoxin. A combination therapy consisting of antibodies against both the light and heavy chains of the toxin, however, significantly increased protection, even at a lower MAb dosage. An in vitro peptide assay for measuring toxin activity showed that pretreatment of toxin with these MAbs did not block catalytic activity but instead blocked toxin entry into primary and cultured neuronal cells. The timing of antibody rescue in the mouse intoxication models revealed windows of opportunity for antibody therapeutic treatment that correlated well with the biologic half-life of the toxin in the serum. Knowledge of BoNT intoxication and antibody clearance in these mouse models and understanding of the pharmacokinetics of BoNT are invaluable for future development of antibodies and therapeutics against intoxication by BoNT.

  11. Electroretinogram and Histopathologic Changes of the Retina after Methanol Intoxication

    CHEN Jie-min; ZHU Guang-you; ZHAO Zi-qin; XIA Wen-tao


    In order to study the functional and structural alterations of the retina in SD rat model after methanol intoxication,35 rats were divided randomly into five groups administrated with saline,3-day high dose,7-day high dose,3-day low dose and 7-day low dose methanol separately.The retinal function of each group was assessed by flash electroretinogram (F-ERG) 3 and 7 days after methanol poisoning.The microstructure and ultrastructure of the retina were observed at the same time.The high-dose methanol intoxication induced irreversible retinal functional and structural damages 3 days after poisoning,which included prolonged latency and reduced amplitude of the Max-reaction of F-ERG.These injuries were aggravated 7 days after poisoning.Meanwhile,the latency and amplitude of the Cone-reaction of F-ERG were also affected 3 days after poisoning,but there were no further worsening tendency 7 days after poisoning.The retinal histological analysis showed cellular edema,heteromorphy and disarrangement,tissular loosen of the inner nuclear layer and photoreceptors layer.The mitochondrial damage began at the photoreceptors layer and developed further into the inner nuclear layer.The low-dose methanol intoxication only caused transient damage of the retina.Our results showed that the function and structure of the photoreceptor and inner nuclear layer were the primary target of methanol intoxication and that the rod cells were more sensitive to methanol intoxication than the cone cells.The mitochondrial damage developed from outer layer to inner layer of the retina.

  12. Value of CT in the Discrimination of Fatal from Non-Fatal Stercoral Colitis

    Wu, Cheng Hsien; Huang, Chen Chin; Wang, Li Jen; Wong, Yon Cheng; Wang, Chao Jan; Lo, Wang Chak; Lin, Being Chuan; Wan, Yung Liang; Haueh, Chuen [Chang Gung Memorial Hospital, Chang Gung University, Taoyuan (China)


    Clinical presentation and physical signs may be unreliable in the diagnosis of stercoral colitis (SC). This study evaluates the value of computed tomography (CT) in distinguishing fatal from non-fatal SC. Ten patients diagnosed as SC were obtained from inter-specialist conferences. Additional 13 patients with suspected SC were identified via the Radiology Information System (RIS). These patients were divided into two groups; fatal and non-fatal SCs. Their CT images are reviewed by two board-certified radiologists blinded to the clinical data and radiographic reports. SC occurred in older patients and displayed no gender predisposition. There was significant correlation between fatal SC and CT findings of dense mucosa (p 0.017), perfusion defects (p = 0.026), ascites (p = 0.023), or abnormal gas (p = 0.033). The sensitivity, specificity, and accuracy of dense mucosa were 71%, 86%, and 81%, respectively. These figures were 75%, 79%, and 77% for perfusion defects; 75%, 80%, and 78% for ascites; and 50%, 93%, and 78% for abnormal gas, respectively. Each CT sign of mucosal sloughing and pericolonic abscess displayed high specificity of 100% and 93% for diagnosing fatal SC, respectively. However, this did not reach statistical significance in diagnosing fatal SC. CT appears to be valuable in discriminating fatal from non-fatal SC.


    M. Y. Marzhokhova


    Full Text Available The Purpose of this research was to study indicators syndrome of endogenous intoxication in patients with erysipelas and herpes infection that can be used to predict relapse in these diseases.Based on the goal were examined in 54 patients with primary, erythematous form of erysipelas of different localization and 42 patients with the localized form of herpes infection in the dynamics of these diseases.Determined the level of substances of low and medium molecular weight (HV and SMM, and oligopeptides, as well as the Integral index of intoxication by the method of M. I. Malakhov (1994 and Lowry (1991. To assess the value of the Integral index of intoxication in the prediction of relapses were calculated odds ratio.Revealed the dependence of studied parameters of disease and completeness of recovery.Level measurement HV and SMM and oligopeptides allows us to calculate the Integral index of intoxication, which can be used as a prognostic criterion of recurrence as erysipelas, and herpes infection.

  14. Highway Safety: Trends in Highway Fatalities 1975-1987


    pattern of fatalities as the overall trend. This pattern applies to many of the general fatality statis- tics we present, and, in all cases, it serves as a...Fatalities 1975-87 Appemfx IV Vehicle-Related Statistics Figure IV.17: Vehicle Fatalities by Direction of Principal Impacto NNNumber of PddUlsils lwam 0 1975

  15. Accidental fatal poisoning of a dog by Dieffenbachia picta (dumb cane).

    Loretti, Alexandre Paulino; da Silva Ilha, Marcia Regina; Ribeiro, Rita Elaine Streda


    A single case of accidental fatal poisoning by Dieffenbachia picta, (dumb cane) (Araceae) in a 9-y-old female Poodle is described. Clinical signs included severe, locally extensive erosive/ulcerative glossitis accompanied by marked dyspnea of acute onset. The animal did not respond to emergency procedures to relieve severe respiratory distress; fatal asphyxiation ensued from edema of the glottis a few hours after the first clinical signs were observed. According to the owner, the dog had access to a tall, potted dumb cane plant and chewed the thick stem of the plant intensely. The owner did not authorize a necropsy of the animal. The diagnosis of Dieffenbachia picta poisoning was based on the history of accidental consumption of dumb cane and clinical signs. A comparison of this single case with other reports of dumb cane poisoning suggests that dogs poisoned by Dieffenbachia species usually recover uneventfully with conservative management and that death from asphyxiation is a rare but possible consequence of this intoxication. Severe edematous swelling of the glottis with occlusion of the larynx airway passage can occur in those cases in which large amounts of sap are quickly squeezed from the plant during intense chewing. Death would occur if owners do not seek veterinary care immediately and if emergency procedures are not instituted on time.

  16. Spider Bite: A Rare Case of Acute Necrotic Arachnidism with Rapid and Fatal Evolution

    Giglio, Anna Maria; Scozzafava, Annamaria; Filippelli, Orazio; Serafino, Giuseppe; Verre, Mario


    The spider bites are quite frequent and often resolve quickly without leaving outcomes; only some species are capable of causing necrotic and systematic lesions in humans. Among them, we should mention the genus Loxosceles. The venom released from the spider bite of Loxosceles species is composed of proteins, enzymes, and nonenzymatic polypeptides. The phospholipase D family was identified as the active component of the venom. This family of enzymes is responsible for the local and systemic effects observed in loxoscelism. Phospholipases D interact with cell membranes triggering alterations which involve the complement system and activation of neutrophils and they cause the dermonecrotic skin lesions and systemic effects. We describe a fatal case of acute intoxication caused by a spider bite probably belonging to the species Loxosceles. The initial lesion was localized to a finger of a hand. Clinical course was worsening with deep necrotic lesions on limb, shock, hemolysis, acute kidney failure, and disseminated intravascular coagulation. All therapies were ineffective. This is the first fatal case described in Europe. PMID:27651958

  17. Spider Bite: A Rare Case of Acute Necrotic Arachnidism with Rapid and Fatal Evolution

    Mario Pezzi


    Full Text Available The spider bites are quite frequent and often resolve quickly without leaving outcomes; only some species are capable of causing necrotic and systematic lesions in humans. Among them, we should mention the genus Loxosceles. The venom released from the spider bite of Loxosceles species is composed of proteins, enzymes, and nonenzymatic polypeptides. The phospholipase D family was identified as the active component of the venom. This family of enzymes is responsible for the local and systemic effects observed in loxoscelism. Phospholipases D interact with cell membranes triggering alterations which involve the complement system and activation of neutrophils and they cause the dermonecrotic skin lesions and systemic effects. We describe a fatal case of acute intoxication caused by a spider bite probably belonging to the species Loxosceles. The initial lesion was localized to a finger of a hand. Clinical course was worsening with deep necrotic lesions on limb, shock, hemolysis, acute kidney failure, and disseminated intravascular coagulation. All therapies were ineffective. This is the first fatal case described in Europe.

  18. Frequency of Acute Hepatitis Following Acute Paraphenylene Diamine Intoxication.

    Ishtiaq, Rizwan; Shafiq, Sadaf; Imran, Ali; Masroor Ali, Qazi; Khan, Raheel; Tariq, Hassan; Ishtiaq, Daniyal


    Paraphenylene diamine (PPD) ingestion is manifesting as one of the more common ways of committing suicide in Southern Punjab, Pakistan, especially Bahawalpur. PPD is an ingredient of a compound commonly known "Kala Pathar" which means "Black Stone" in Urdu. It is readily available in the market at low cost and is used to dye hair and fur. Its intoxication inhibits cellular oxidation and affects the muscles causing rhabdomyolysis. This leads to myoglobinuria followed by renal failure and edema of face and throat resulting in respiratory difficulty. Very little is known about the impact of PPD intoxication on liver tissue. The purpose of the study was to find out the frequency of acute hepatitis following PPD intoxication. We reviewed the medical records of 109 patients with PPD intoxication admitted to Medical Unit-2, Bahawalpur Victoria Hospital from January 1, 2015, to June 30, 2015, in a descriptive, cross-sectional study. We noted the frequency of acute hepatitis and other complications, and we recorded the demographic features, clinical features, and outcomes of these patients. Our study included 32 men (29%) and 77 women (71%). The mean age was 22 ± 3.4 years, and most patients were young women aged 15 to 24 years. Suicidal ingestion was the leading cause of admission for 101 patients (93%). The most common clinical presentation was cervicofacial edema (95%), throat pain (88%), dysphonia (95%), cola-colored urine (100%), and oliguria (95%). Rhabdomyolysis (86%), acute hepatitis (51%), and acute renal failure (63%) were the most common clinical conditions following poisoning. Overall mortality was noted in 39 patients (36%) while all other patients achieved complete clinical recovery (64%). In patients with mortality, 20 of 39 (51%) developed acute hepatitis. Most patients (95%) in our study underwent tracheostomy. The frequency of acute hepatitis in PPD intoxication is high in this population, especially in young women. Measures need to be instituted

  19. Global estimates of fatal occupational accidents.

    Takala, J


    Data on occupational accidents are not available from all countries in the world. Furthermore, underreporting, limited coverage by reporting and compensation schemes, and non-harmonized accident recording and notification systems undermine efforts to obtain worldwide information on occupational accidents. This paper presents a method and new estimated global figures of fatal accidents at work by region. The fatal occupational accident rates reported to the International Labour Office are extended to the total employed workforce in countries and regions. For areas not covered by the reported information, rates from other countries that have similar or comparable conditions are applied. In 1994, an average estimated fatal occupational accident rate in the whole world was 14.0 per 100,000 workers, and the total estimated number of fatal occupational accidents was 335,000. The rates are different for individual countries and regions and for separate branches of economic activity. In conclusion, fatal occupational accident figures are higher than previously estimated. The new estimates can be gradually improved by obtaining and adding data from countries where information is not yet available. Sectoral estimates for at least key economic branches in individual countries would further increase the accuracy.

  20. Fire fatality study: demographics of fire victims.

    Barillo, D J; Goode, R


    Injury or death caused by fire is frequent and largely preventable. This study was undertaken to define the populations, locations, times and behaviours associated with fatal fires. Seven hundred and twenty-seven fatalities occurring within the State of New Jersey, between the years 1985 and 1991, were examined retrospectively. Most deaths were attributed to a combination of smoke inhalation and burn injury. Five hundred and seventy-four fatalities occurred in residential fires. Smoking materials were the most common source of ignition for residential fires. More than half of the fatal residential fires started between the hours of 11 p.m. and 7 a.m. Children and the elderly represented a disproportionate percentage of fire victims. Victims under the age of 11 years or over the age of 70 years constituted 22.1 per cent of the state population but 39.5 per cent of all fire fatalities. Fire-prevention efforts should target home fire safety, and should concentrate on children and the elderly. The development of fire-safe smoking materials should be encouraged.

  1. Gender differences in natural language factors of subjective intoxication in college students: an experimental vignette study.

    Levitt, Ash; Schlauch, Robert C; Bartholow, Bruce D; Sher, Kenneth J


    Examining the natural language college students use to describe various levels of intoxication can provide important insight into subjective perceptions of college alcohol use. Previous research (Levitt et al., Alcohol Clin Exp Res 2009; 33: 448) has shown that intoxication terms reflect moderate and heavy levels of intoxication and that self-use of these terms differs by gender among college students. However, it is still unknown whether these terms similarly apply to other individuals and, if so, whether similar gender differences exist. To address these issues, the current study examined the application of intoxication terms to characters in experimentally manipulated vignettes of naturalistic drinking situations within a sample of university undergraduates (n = 145). Findings supported and extended previous research by showing that other-directed applications of intoxication terms are similar to self-directed applications and depend on the gender of both the target and the user. Specifically, moderate intoxication terms were applied to and from women more than men, even when the character was heavily intoxicated, whereas heavy intoxication terms were applied to and from men more than women. The findings suggest that gender differences in the application of intoxication terms are other-directed as well as self-directed and that intoxication language can inform gender-specific prevention and intervention efforts targeting problematic alcohol use among college students. Copyright © 2013 by the Research Society on Alcoholism.

  2. Combined intoxication with methylone and 5-MeO-MIPT.

    Shimizu, Eiji; Watanabe, Hiroyuki; Kojima, Takashi; Hagiwara, Hiroko; Fujisaki, Mihisa; Miyatake, Ryosuke; Hashimoto, Kenji; Iyo, Masaomi


    Although preclinical studies suggest that methylone (2-methylamino-1-[3,4-methylenedioxyphenyl]propan-1-one) and 5-MeO-MIPT (5-methoxy-N-methyl,N-isopropyl tryptamine) may have psychostimulant properties, the scientific reports about the clinical effects of these agents are scant. We describe a 27-year-old male patient with substance intoxication after a single ingestion of the mixture of methylone and 5-MeO-MIPT. Though he bought the drug as pure methylone powder via an internet order, our chemical analyses indicated that the drug was composed of about 60% methylone (120 mg) and 38% 5-MeO-MIPT (76 mg). This case report suggests that clinicians should be alert to the possibility of the emergence of methylone or 5-MeO-MIPT intoxication, and substance-related mental disorder may be complicated by combined use of other psychoactive drugs.

  3. [Anticholinergic syndrome after intoxication by lupine seeds (Tourmos)].

    Awada, Adnan; Atallah, David; Zoghbi, Antoine


    Yellow lupine seeds (Tourmos) are frequently used as snack in Lebanon but their potential toxicity is extremely rare (five published cases) and often undiagnosed. Two patients presented with anticholinergic syndrome (mydriasis, mouth dryness, palpitations, general malaise) after ingestion of 200-500 g of bitter lupine seeds (not soaked enough in water). No other cause of intoxication was found, and symptoms disappeared spontaneously in 24-36h. Yellow lupine seeds need a long preparation (boiling then soaking with several changes of water) to debitter before consumption. The spontaneous bitter taste is mainly due to the presence of a toxic substance with anticholinergic properties, lupanine. An insufficient preparation or a preference for bitter lupin can result in intoxication.

  4. Unintentional baclofen intoxication in the management of alcohol use disorder.

    Reichmuth, Philipp; Blanc, Anne-Laure; Tagan, Damien


    In recent years, there has been a growing interest in using baclofen for the management of alcohol use disorder. This off-label indication usually involves high doses of the medication. We report a case of severe baclofen overdose in a 66-year-old man. The patient was found severely agitated, and he presented with delirium and auditory hallucinations. At hospital admission, his daily dose was 180 mg baclofen. He was admitted to the intensive care unit for sedation and supportive care. When sedation was withdrawn, the patient presented with a normal neurological status. In this clinical context, baclofen intoxication was suspected. This was confirmed by measuring blood baclofen levels. This intoxication was probably mediated by a combination of risk factors including a high daily dose of baclofen and acute renal failure, conducive to drug accumulation.


    P. Meshgi


    Full Text Available A survey on lead intoxication in lead mine workers was carried out among Khanehsorme, lead miners in NajafAabad and also in Ab-bagh lead miners in Shahreza, both located in district of Esfahan, Iran. The studies were carried out on 62 miners out of 82 employees in Khanehsorme, 25 miners out of 27 employees in Ab-bagh lead miners and 47 rural inhabitants in the surroundings of mines were selected as the Control group. Clinical examinations were done. Age and sex group, working hours, type of work, and duration of service and previous occupation of workers were questioned. The determination of lead in urine was done according to Truhaut et Boudene's method and the content of blood Hemoglobin was performed according to Sali method. Results obtained in lead miners in comparison with the control group showed the absorption of lead and consequently lead intoxication was observed some extent.

  6. [Evaluation of the endogenous intoxication syndrome in food toxic infections].

    Marzhokhova, M Iu; Zhelikhazheva, Zh M


    To study the endogenous intoxication syndrome in patients with food toxic infections is essential in revealing the pathogenetic mechanisms underlying this disease. For this, the authors measured the level of low and average molecular weight, as well as their protein component--oligopeptides in plasma, red blood cells, and urine in the course of the disease. There were increased levels of the study parameters, which depended on the stage and degree of a pathological process. The determination of the level of low and average molecular weight and oligopeptides in plasma, red blood cells, and urine may serve as a marker of the intoxication syndrome; the level of the study parameters may be used as additional criteria for the severity of the process, the prediction of disease development and comorbidity, and as a criterion for recovery completeness.

  7. A case of survival after chlorfenapyr intoxication with acute pancreatitis

    Ku, Jae Eun; Joo, Young Seon; You, Je Sung; Chung, Sung Phil; Lee, Hahn Shick


    Chlorfenapyr is a moderately hazardous insecticide. There have been previous reports of chlorfenapyr intoxication, but none have reported patient survival or an association with pancreatitis. A 61-year-old woman was brought to the emergency department with vomiting after ingesting 10 mL chlorfenapyr in a suicide attempt 1 hour before. The patient was treated with gastric lavage and activated charcoal, then transferred to the intensive care unit. Initial laboratory data were unremarkable excep...

  8. Alcohol Intoxication Impact on Outcome from Traumatic Injury


    prior to initiating the fixed-pressure hemorrhage to allow for maximal NOS inhibition ( Salter and others 1995). To confirm NOS inhibition by L...hypothalamic slices. Brain Res Bull. 43:121-125. Lobo IA, Harris RA. 2008. GABAA receptors and alcohol. Pharmacology, Biochemistry and Behavior 90: 90–4...Rev Physiol 49:413-35. Pories SE, Gamelli RL, Vacek P, Goodwin G, Shinozaki T, Harris F. 1992. Intoxication and injury. J Trauma. 32:60-64. Probst R

  9. Vitamin A intoxication from reef fish liver consumption in Bermuda.

    Dewailly, E; Rouja, P; Schultz, E; Julien, P; Tucker, T


    We report three historical cases of severe vitamin A intoxication in anglers who had consumed reef fish liver caught in Bermuda. The subsequent analyses of 35 fish livers from seven different fish species revealed that very high concentrations of vitamin A exist in tropical fish liver, even in noncarnivorous fish species. Large variations in concentrations were observed between specimens and between species. The angling population and (especially) pregnant women should be advised of this potential health threat.

  10. The "Madness" of Friedrich Hölderlin: an iatrogenic intoxication.

    Horowski, R


    The German poet Hölderlin, assumed to have suffered from schizophrenia, in fact has been the victim of a combined calomel and cantharidine intoxication administered by his physician Autenrieth. This new theory explains much better his behavioural changes and also his neurological and other concomitant symptoms; it can be tested by analysing a very few of his hairs for the presence of these compounds.

  11. Plasma carnitine concentrations after chronic alcohol intoxication 

    Alina Kępka; Napoleon Waszkiewicz; Beata Zalewska-Szajda; Sylwia Chojnowska; Paweł Płudowski; Emilia Konarzewska; Agata Szulc; Jerzy Robert Ładny; Krzysztof Zwierz; Sławomir Dariusz Szajda


    Background: Carnitine transports fatty acids from the cytoplasm to the mitochondrial matrix, where the fatty acids are oxidized. Chronic alcohol consumption reduces the concentration of carnitine and interferes with oxidative processes occurring in the cell.Aim: The assessment of carnitine concentrations in plasma of chronically intoxicated alcohol dependent persons in a 49-day abstinence period.Material/Methods: The study included 31 patients (5 women and 27 men) aged from 26 to 60 years (44...

  12. Acute pancreatitis and acute renal failure complicating doxylamine succinate intoxication.

    Lee, Yang Deok; Lee, Soo Teik


    Doxylamine succinate is an antihistaminic drugwith additional hypnotic, anticholinergic and local anesthetic effects first described in 1948. In Korea and many other countries, it is a common-over-the counter medication frequently involved in overdoses. Clinical symtomatology of doxylamine succinate overdose includes somnolence, coma, seizures, mydriasis, tachycardia, psychosis, and rhabdomyolysis. A serious complication may be rhabdomyolysis with subsequent impairment of renal function and acute renal failure. We report a case of acute renal failure and acute pancreatitis complicating a doxylamine succinate intoxication.

  13. Drug Intoxicated Irregular Fighters: Complications, Dangers, and Responses


    norms offer that chance. Outside agencies, NGOs and the UN Office of the High Commissioner for Refugees ( UNHCR ) should begin to put such...has argued, the desire to seek intoxication may be a “fourth drive” in human beings after hunger, thirst, and sex .2 Such a drive appears to have an...regional stability. For example, carnival activities in Yugoslavia sent waves of refugees throughout Europe and eventually led to a Western military

  14. Optic atrophy and cerebral infarcts caused by methanol intoxication: MRI

    Hsu, H.H. [Dept. of Diagnostic Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei (Taiwan, Province of China); Chen, C.Y. [Dept. of Diagnostic Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei (Taiwan, Province of China); Chen, F.H. [Dept. of Diagnostic Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei (Taiwan, Province of China); Lee, C.C. [Dept. of Diagnostic Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei (Taiwan, Province of China); Chou, T.Y. [Dept. of Diagnostic Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei (Taiwan, Province of China); Zimmerman, R.A. [Children`s Hospital of Philadelphia, PA (United States). Dept. of Radiology


    We present the MRI findings of cerebral and optic pathway damage in the acute and subacute stages of methanol intoxication. In the acute stage, CT and MRI showed bilateral haemorrhagic necrosis of the corpus striatum and infarcts in the anterior and middle cerebral arterial territories. MRI in the subacute stage demonstrated atrophy of the optic chiasm and prechiasmatic optic nerves in addition to the cerebral infarcts. The patient survived, with total blindness. (orig.)

  15. Use of haloperidol in PCP-intoxicated individuals.

    MacNeal, James J; Cone, David C; Sinha, Vinnita; Tomassoni, Anthony J


    Emergency medical workers often experience violence while performing their job functions. Phencyclidine (PCP)-intoxicated patients are often violent and difficult to control physically. A chemical restraint is frequently needed to assist in protecting both patients and staff from agitated persons. This study evaluated haloperidol as a chemical restraint in PCP-intoxicated patients. This is a retrospective case series of all PCP-positive patients who received haloperidol for behavioral control from April 2008 to April 2011 at a single large (944 bed), urban, tertiary-care hospital. All patients receiving haloperidol and having a toxicology screen positive for PCP were identified using an electronic medical record. Identified cases were then manually reviewed by investigators for adverse events. Subjects included 59 adult patients who were acutely agitated requiring chemical restraint or sedation with haloperidol, and who tested positive for PCP. There were 20 females and 39 males, ranging in age from 19 to 54 years. Patients received haloperidol via the PO, IM, or IV routes in doses ranging from 1 to 10 mg. There were two adverse events (mild hypoxia and mild hypotension) found during chart review; neither were serious nor required change in patient disposition. In this study, haloperidol does not seem to cause harm when used in the management of PCP-intoxicated patients. Caution must always be exercised in the use of chemical restraint; further prospective study is warranted.

  16. [Acute oral suicidal intoxication with captan--a case report].

    Chodorowski, Zygmunt; Sein Anand, Jacek; Waldman, Wojciech


    According to the best of our knowledge the second case of acute intoxication with captan was described. In this paper a 22-year old female was admitted to the Department of Toxicology with a nausea, weakness, numbness of upper limbs and substernal pain. She said that these symptoms began two hours after suicidal ingestion of 5.0 g of captan. At admission the patient was alert. Temperature was 37 degrees C, heart rate 100-120 b/min., BP 100-120/60-70 mm Hg and breathing rate 17/min. WBC were slightly elevated 12.4 x 10(3)/microl as well as the creatine kinase activity 329 U/L. ECG showed inversion of a T segment in V1-V4 leads. ECHO-sound made in 4th and 120th day after the onset of intoxication showed no changes, with EF--70%. Temporary increase of creatine kinase activity as well as the presence of inverted T segment in V1-V4 leads may suggest cardiotoxic effects of captan during acute intoxication.

  17. Treatments for Pulmonary Ricin Intoxication: Current Aspects and Future Prospects

    Yoav Gal


    Full Text Available Ricin, a plant-derived toxin originating from the seeds of Ricinus communis (castor beans, is one of the most lethal toxins known, particularly if inhaled. Ricin is considered a potential biological threat agent due to its high availability and ease of production. The clinical manifestation of pulmonary ricin intoxication in animal models is closely related to acute respiratory distress syndrome (ARDS, which involves pulmonary proinflammatory cytokine upregulation, massive neutrophil infiltration and severe edema. Currently, the only post-exposure measure that is effective against pulmonary ricinosis at clinically relevant time-points following intoxication in pre-clinical studies is passive immunization with anti-ricin neutralizing antibodies. The efficacy of this antitoxin treatment depends on antibody affinity and the time of treatment initiation within a limited therapeutic time window. Small-molecule compounds that interfere directly with the toxin or inhibit its intracellular trafficking may also be beneficial against ricinosis. Another approach relies on the co-administration of antitoxin antibodies with immunomodulatory drugs, thereby neutralizing the toxin while attenuating lung injury. Immunomodulators and other pharmacological-based treatment options should be tailored according to the particular pathogenesis pathways of pulmonary ricinosis. This review focuses on the current treatment options for pulmonary ricin intoxication using anti-ricin antibodies, disease-modifying countermeasures, anti-ricin small molecules and their various combinations.

  18. Cyanide intoxication induced exocytotic epinephrine release in rabbit myocardium.

    Kawada, T; Yamazaki, T; Akiyama, T; Sato, T; Shishido, T; Inagaki, M; Tatewaki, T; Yanagiya, Y; Sugimachi, M; Sunagawa, K


    Cyanide intoxication, which has been used as a model of energy depletion at cardiac sympathetic nerve terminals, causes non-exocytotic release of norepinephrine (NE). However, the effect of cyanide intoxication on cardiac epinephrine (Epi) release remains unknown. Using cardiac microdialysis in the rabbit, we measured dialysate Epi and NE concentrations as indices of myocardial interstitial Epi and NE levels, respectively. Local administration of sodium cyanide (30 mM) through the dialysis probe increased both Epi and NE levels (from 11.3+/-2.3 to 32.3+/-4.4 pg/ml and from 33.6+/-6.1 to 389.0+/-71.8 pg/ml, respectively, mean+/-S.E., P<0.01). Local desipramine (100 microM) administration suppressed the cyanide induced NE response without affecting the Epi response. In contrast, local omega-conotoxin GVIA (10 microM) administration partially suppressed the cyanide induced NE response and totally abolished the Epi response. In conclusion, cyanide intoxication causes N-type Ca(2+) channel dependent exocytotic Epi release as well as inducing N-type Ca(2+) channel independent non-exocytotic NE release.

  19. Case report of acute vitamin D intoxication in an infant

    Radlović Nedeljko


    Full Text Available Introduction. Vitamin D intoxication represents a rare and potentially serious pathological condition caused by the excess of calcium and phosphorus. We are presenting an infant with vitamin D intoxication due to excessive daily administration, as well as therapeutic procedures that prevented its adverse effects. Case Outline. A 1.5-month-old female infant, born at term, exclusively breastfed and without any complaints and abnormalities of physical findings, was observed due to the data that during the preceding month, by her mother’s mistake, she had received about 200,000 IU of vitamin D3. Laboratory analyses showed a high serum level of 25(OHD (>400 nmol/L and calcium (2.72 mmol/L, lowered PTH (6.6 pg/ml and high urinary calcium/creatinine ratio (1.6, while other findings, including urotract ultrasonography image, were within normal limits. Treatment based on the discontinuation of vitamin D administration, infant’s forced water intake, as well as the application of 2-month prednisolone and 4-month phenobarbitone and furosemide, resulted in complete normalization of the laboratory indicators of vitamin D overdose, as well as the prevention of its adverse effects. Conclusion. By timely recognition and adequate treatment, including triple therapy with prednisolone, phenobarbitone and furosemide, adverse effects of acute vitamin D intoxication can be prevented.

  20. Methanol intoxication: pathological changes of central nervous system (17 cases).

    Karayel, Ferah; Turan, Arzu A; Sav, Aydin; Pakis, Isil; Akyildiz, Elif U; Ersoy, Gokhan


    The nervous system has increased susceptibility for methanol intoxication. The aim of this study is to investigate various central nervous system lesions of methanol intoxication in 17 cases autopsied in the mortuary department of the Council of Forensic Medicine in Istanbul, Turkey. The reasons of methanol intoxication in the cases was likely the unwitting ingestion of methanol while drinking illegal alcohol. Survival times ranged from several hours to days. In 8 cases (47%), cerebral edema and in 9 cases (53%) at occipital, temporal and parietal cortex, basal ganglia and pons, petechial bleeding was observed. In addition to these findings, hemorrhagic necrosis were observed in thalamus, putamen, and globus pallidus in 5 cases (29.4%) and, in cerebral cortex in another 3 cases (17.6%). In 3 of the cases (17.6%) in which cerebral edema was found, herniation findings accompanied to the situation and in 2 cases (11.7%), pons bleeding was observed. Around the basal ganglia, in 2 of the cases with hemorrhagic necrosis, the situation ended with a ventricular compression. In 7 cases (41%), the associated findings of chronic ischemic changes in cortical neurons, lacunae formation, degeneration of granular cell layer of the cerebellum, and reactive gliosis were considered as the results of chronic alcoholism.

  1. Fatal and non-fatal burn injuries with electrical weapons and explosive fumes.

    Kroll, Mark W; Ritter, Mollie B; Williams, Howard E


    While generally reducing morbidity and mortality, electrical weapons have risks associated with their usage, including eye injuries and falls. With the presence of explosive fumes or fuels there also exists the possibility of burn injury. We searched for cases of fatal and non-fatal major burns with TASER(®) electrical weapon usage where there was a possibility that the weapon ignited the explosion. We confirmed 6 cases of fatal burn injury and 4 cases of major non-fatal burns out of 3.17 million field uses. The mean age was 35.5 ± 9.7 years which is consistent with the typical arrest-related death. Moderate, minor, and noninjurious fires - typically due to a cigarette lighters in a pocket, petrol, recreational inhalants, or body spray were also noted. The use of electrical weapons presents a small but real risk of death from fatal burn injury. It also presents a small risk of major non-fatal burn injury. The ignition of petrol fumes dominates these cases of major fatal and nonfatal burns. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  2. Anticipating early fatality: friends', schoolmates' and individual perceptions of fatality on adolescent risk behaviors.

    Haynie, Dana L; Soller, Brian; Williams, Kristi


    Past research indicates that anticipating adverse outcomes, such as early death (fatalism), is associated positively with adolescents' likelihood of engaging in risky behaviors. Health researchers and criminologists have argued that fatalism influences present risk taking in part by informing individuals' motivation for delaying gratification for the promise of future benefits. While past findings highlight the association between the anticipation of early death and a number of developmental outcomes, no known research has assessed the impact of location in a context characterized by high perceptions of fatality. Using data from Add Health and a sample of 9,584 adolescents (51% female and 71% white) nested in 113 schools, our study builds upon prior research by examining the association between friends', school mates', and individual perceptions of early fatality and adolescent risk behaviors. We test whether friends' anticipation of being killed prior to age 21 or location in a school where a high proportion of the student body subscribes to attitudes of high fatality, is associated with risky behaviors. Results indicate that friends' fatalism is positively associated with engaging in violent delinquency, non-violent delinquency, and drug use after controlling for individual covariates and prior individual risk-taking. Although friends' delinquency accounts for much of the effect of friends' fatalism on violence, none of the potential intervening variables fully explain the effect of friends' fatalism on youth involvement in non-violent delinquency and drug use. Our results underscore the importance of friendship contextual effects in shaping adolescent risk-taking behavior and the very serious consequences perceptions of fatality have for adolescents' involvement in delinquency and drug use.

  3. Husband/Partner Intoxication and Intimate Partner Violence Against Women in the Philippines.

    Kerridge, Bradley T; Tran, Phu


    This study examined husband/partner intoxication and experience with physical, sexual, and emotional intimate partner violence against women (IPVAW) using data derived from a nationally representative survey conducted in the Philippines in 2013. Multivariate logistic regression analyses were used to examine the association between intoxication and 3 different types of intimate partner violence against women. Multinomial logistic regression was used to examine intoxication and severity of violence. In this sample, 28.8% of women reported experiencing any form of intimate partner violence and 92.9% of women reported their partner being intoxicated at least sometimes. Intoxication was significantly associated with all 3 types of intimate partner violence, while the odds of experiencing one form of IPVAW versus no form of IPVAW and 2 forms of IPVAW versus 1 form of IPVAW was greater among women reporting frequency of husband/partner intoxication as often.

  4. Acute Intoxication by Transdermal Opium Application in Infants: Two Case Reports

    Iraj Sedighi


    Full Text Available Background: Acute opium intoxication is one of the most common causes of poisoning in children in Iran. Although most cases are accidental, traditional misuse of opium for symptomatic therapy of various childhood diseases also contributes to high rate of opium intoxication in Iran. Cases: Here, we report two cases of opium intoxication in infants resulted from transdermal application of opium on burned skin. To our knowledge this is the first case report of intoxication from transdermal misuse of opium. Conclusion: Health care providers should be aware about signs and symptoms of opium intoxication in children. Opium intoxication should be suspected in each child with history of a recent burn injury that presented with decreased level of consciousness.

  5. [Dosis sola facit venenum: outcome of intoxications in a Swiss university hospital].

    Muster, C; Exadaktylos, A; Haberkern, M


    Poisoning is a frequent disease in an emergency division. During four years we observed patients with poisoning related to there reason of intoxication, the degree of severity, age group and sex, and tried to make conclusions about lethal outcome on behalf of our data. The severity was defined by the «poison severity scale» (PSS). 1515 patients with intoxication in four years were documented. 152 (10%) of them had a severe intoxication or lethal outcome. In women suicide predominated as reason of severe intoxication, whereas in men an abuse of alcool and drugs was mostly seen. A multidisciplinary approach is important for handling intoxicated patients. Our investigation showed a good somatical outcome of patients with severe intoxication. Mortality was 5% (7/152 patients).

  6. [Acute intoxication in adults - what you should know].

    Zilker, Th


    Ingestion of household products and plants are the leading cause for calls to the poison control centres as far as children are involved. Severe intoxication in children has become infrequent due to childproofed package and blister packs for drugs. Chemical accidents in adults give rise to hospital admission in only 5 %. Suicidal selfpoisonings are still a challenge for paramedics, emergency and hospital doctors. Natural toxins as amatoxins, cholchicine and snakebites can lead to severe intoxication. Sedatives, antidepressants and analgesics are the drugs which are often used for suicidal intent due to their availability. Quetiapine and paracetamol are the drugs which are ingested for attempted suicide/ suicide mostly. The treatment of poisoning centers on the severity which can be judged by the poison severity score, the Reed classification or the GCS.Most intoxicated patients can be treated symptomatically or by intensive care measurements. Antidotal treatment however is needed for some specific poisonings.Exact sample drawing is essential for diagnostic and forensic purposes. There is no evidence based proof for the effectiveness of primary detoxification from the gastrointestinal tract like forced emesis, gastric lavage or the use of cathartics. Early after the ingestion of a harmful substance the administration of activated charcoal seems advisable. Hemodialysis can remove water soluble substances with a small volume of distribution. Multiple charcoal administration may exhibit some influence on secondary detoxification. Provision of evidence of the efficacy for newer antidotes like hydroxocobalamin in smoke inhalation, fomepizol for toxic alcohols and silibinin for amanita poisoning are emerging. Two recently recommended therapeutic principles have still to demonstrate their ability: Firstly the treatment of patients with calcium receptor antagonistic and beta-receptor antagonistic agents poisoning by high dose of insulin plus glucose, secondly the

  7. Estimating cost ratio distribution between fatal and non-fatal road accidents in Malaysia

    Hamdan, Nurhidayah; Daud, Noorizam


    Road traffic crashes are a global major problem, and should be treated as a shared responsibility. In Malaysia, road accident tragedies kill 6,917 people and injure or disable 17,522 people in year 2012, and government spent about RM9.3 billion in 2009 which cost the nation approximately 1 to 2 percent loss of gross domestic product (GDP) reported annually. The current cost ratio for fatal and non-fatal accident used by Ministry of Works Malaysia simply based on arbitrary value of 6:4 or equivalent 1.5:1 depends on the fact that there are six factors involved in the calculation accident cost for fatal accident while four factors for non-fatal accident. The simple indication used by the authority to calculate the cost ratio is doubted since there is lack of mathematical and conceptual evidence to explain how this ratio is determined. The main aim of this study is to determine the new accident cost ratio for fatal and non-fatal accident in Malaysia based on quantitative statistical approach. The cost ratio distributions will be estimated based on Weibull distribution. Due to the unavailability of official accident cost data, insurance claim data both for fatal and non-fatal accident have been used as proxy information for the actual accident cost. There are two types of parameter estimates used in this study, which are maximum likelihood (MLE) and robust estimation. The findings of this study reveal that accident cost ratio for fatal and non-fatal claim when using MLE is 1.33, while, for robust estimates, the cost ratio is slightly higher which is 1.51. This study will help the authority to determine a more accurate cost ratio between fatal and non-fatal accident as compared to the official ratio set by the government, since cost ratio is an important element to be used as a weightage in modeling road accident related data. Therefore, this study provides some guidance tips to revise the insurance claim set by the Malaysia road authority, hence the appropriate method

  8. Fatal dengue hemorrhagic fever in adults: emphasizing the evolutionary pre-fatal clinical and laboratory manifestations.

    Ing-Kit Lee

    Full Text Available BACKGROUND: A better description of the clinical and laboratory manifestations of fatal patients with dengue hemorrhagic fever (DHF is important in alerting clinicians of severe dengue and improving management. METHODS AND FINDINGS: Of 309 adults with DHF, 10 fatal patients and 299 survivors (controls were retrospectively analyzed. Regarding causes of fatality, massive gastrointestinal (GI bleeding was found in 4 patients, dengue shock syndrome (DSS alone in 2; DSS/subarachnoid hemorrhage, Klebsiella pneumoniae meningitis/bacteremia, ventilator associated pneumonia, and massive GI bleeding/Enterococcus faecalis bacteremia each in one. Fatal patients were found to have significantly higher frequencies of early altered consciousness (≤24 h after hospitalization, hypothermia, GI bleeding/massive GI bleeding, DSS, concurrent bacteremia with/without shock, pulmonary edema, renal/hepatic failure, and subarachnoid hemorrhage. Among those experienced early altered consciousness, massive GI bleeding alone/with uremia/with E. faecalis bacteremia, and K. pneumoniae meningitis/bacteremia were each found in one patient. Significantly higher proportion of bandemia from initial (arrival laboratory data in fatal patients as compared to controls, and higher proportion of pre-fatal leukocytosis and lower pre-fatal platelet count as compared to initial laboratory data of fatal patients were found. Massive GI bleeding (33.3% and bacteremia (25% were the major causes of pre-fatal leukocytosis in the deceased patients; 33.3% of the patients with pre-fatal profound thrombocytopenia (<20,000/µL, and 50% of the patients with pre-fatal prothrombin time (PT prolongation experienced massive GI bleeding. CONCLUSIONS: Our report highlights causes of fatality other than DSS in patients with severe dengue, and suggested hypothermia, leukocytosis and bandemia may be warning signs of severe dengue. Clinicians should be alert to the potential development of massive GI bleeding

  9. Salade malade: malignant ventricular arrhythmias due to an accidental intoxication with Aconitum napellus

    Weijters, B.J.; Verbunt, R.J.A.M.; Hoogsteen, J.; Visser, R.F.


    Intoxication with Aconitum napellus is rare in our regions. Aconite alkaloids can cause ventricular arrhythmia by a prolonged activation of sodium channels. Because the margin of safety is low between the analgesic and toxic dose, intoxication is not rare when Aconite is used in herbal medicine. We present a case in which a 39-year-old male was accidentally intoxicated with Aconite. Even though no antidote or adequate therapy is available he was successfully resuscitated. (Neth Heart J 2008;1...

  10. Hemophagocytic lymphohistiocytosis and Pelger-Huët anomaly associated with colchicine intoxication

    Baris Malbora


    Full Text Available Colchicine is frequently used in the treatment of familial Mediterranean fever (FMF. First symptoms of colchicine intoxication are gastrointestinal disturbances, such as abdominal cramps, diarrhea, pancytopenia and so on. Herein, we report a female FMF patient with pancytopenia and hemophagocytic lymphohitiocytosis (HLH, following colchicine intoxication for committing suicide. To our knowledge, this is the first reported case of a patient with HLH associated with colchicine intoxication.

  11. A Fatal Complication of Dermatomyositis: Spontaneous Pneumomediastinum

    Ezgi Demirdöğen Çetinoğlu


    Full Text Available Interstitial lung disease (ILD is a negative prognostic factor associated with increased morbidity and mortality in patients with dermatomyositis (DM. Spontaneous pneumomediastinum is a rare complication of DM and it can be fatal. We present a 48-year-old woman with DM and ILD complicated by pneumomediastinum without pneumothorax and subcutaneous emphysema.

  12. Can We Reduce Workplace Fatalities by Half?

    David Soo Quee Koh


    Full Text Available Singapore, an island republic of over 5 million inhabitants, has 3.1 million workers. Most are employed in the service, finance and tourist/transport industry. Significant numbers work in manufacturing, construction and heavy industry. Following a series of construction and shipyard accidents with multiple deaths in 2004, the government announced its intention to reduce workplace fatalities from 4.9 to 2.5 per 100,000 by 2015. There was strong political will to achieve this target. The strategic approaches were to build workplace safety and health (WSH capabilities; implement legislative changes with enforcement; promote benefits of WSH and recognize best practices, and enhance partnership with stakeholders. The anticipated outcomes were to reduce workplace fatality and injury rates; have WSH as an integral part of business; and establish a progressive and pervasive WSH culture. With these measures, the workplace fatality rate declined from 4.9/100,000 in 2004, to 2.2/100,000 in 2010. However, other confounding factors could also account for this decline, and have to be considered. The next target, announced by Singapore’s Prime Minister in 2008, is to further reduce the workplace fatality rate to 1.8/100,000 by 2018, and to have “one of the best workplace safety records in the world”.

  13. Fatal case of Listeria innocua bacteremia.

    Perrin, Monique; Bemer, Michel; Delamare, Catherine


    Listeria innocua is widespread in the environment and in food. This species has to date never been described in association with human disease. We report a case of fatal bacteremia caused by L. innocua in a 62-year-old patient.

  14. Fatal accidents among Danes with multiple sclerosis

    Brønnum-Hansen, Henrik; Hansen, Thomas; Koch-Henriksen, Nils


    We compared the rate of fatal accidents among Danes with multiple sclerosis (MS) with that of the general population. The study was based on linkage of the Danish Multiple Sclerosis Registry to the Cause of Death Registry and covered all 10174 persons in whom MS was diagnosed during the period 1953...

  15. A fatal poisoning involving Bromo-Dragonfly

    Andreasen, Mette Findal

    This poster reports a fatal overdose case involving Bromo-Dragonfly. Bromo-Dragonfly is a common name for 1-(8-bromobenzo[1,2-b; 4,5-b´]difuran-4-yl)-2-aminopropane. Structurally, it is closely related to phenylethylamines like 2C-B and DOB. Bromo-Dragonfly is considered an extremely potent hallu...

  16. Meeste suurim meistriteos - femme fatale / Marianne Kõrver

    Kõrver, Marianne, 1980-


    15.-21. maini on kinos Sõprus Manifesti filminädal, mis pühendatud prantsuse mängufilmidele, kus keskne karakter on femme fatale - saatuslik naine, meeste hukutaja. Ajalooline lühiülevaade selle naisetüübi kujutamisest religioonist kinokunstini

  17. Fatal lawn mower related projectile injury

    Colville-Ebeling, Bonnie; Lynnerup, Niels; Banner, Jytte


    the operator or a bystander is impacted by an object mobilized from the grass by the rotating mower blades. This type of injury often leaves only modest external trauma, which increases the risk of overlooking an entry wound. In this paper we present a case of a fatal lawn mower related projectile injury which...

  18. Fatal Monocytic Ehrlichiosis in Woman, Mexico, 2013

    Sosa-Gutierrez, Carolina G.; Solorzano-Santos, Fortino; Walker, David H.; Torres, Javier; Serrano, Carlos A.


    Human monocytic ehrlichiosis is a febrile illness caused by Ehrlichia chaffeensis, an intracellular bacterium transmitted by ticks. In Mexico, a case of E. chaffeensis infection in an immunocompetent 31-year-old woman without recognized tick bite was fatal. This diagnosis should be considered for patients with fever, leukopenia, thrombocytopenia, and elevated liver enzyme levels. PMID:27088220

  19. A Fatal Complication of Dermatomyositis: Spontaneous Pneumomediastinum

    Ezgi Demirdöğen Çetinoğlu; Ediz Dalkılıç; Muharrem Erol; Nilüfer Aylin Acet; Ahmet Ursavaş; Ercüment Ege


    Interstitial lung disease (ILD) is a negative prognostic factor associated with increased morbidity and mortality in patients with dermatomyositis (DM). Spontaneous pneumomediastinum is a rare complication of DM and it can be fatal. We present a 48-year-old woman with DM and ILD complicated by pneumomediastinum without pneumothorax and subcutaneous emphysema.

  20. Active Surveillance of Child Abuse Fatalities.

    Schloesser, Patricia; And Others


    Birth and death certificates were correlated with information in the state Child Abuse and Neglect Registry on 104 abuse-related fatalities. Significant findings included young age of parents at first pregnancy; high rate of single parenthood; and lower educational achievement among mothers. A model for data collection is discussed. (Author/BRM)

  1. Fatal anaphylactoid reaction following ioversol administration

    Jansman, Frank G. A.; Kieft, Hans; Harting, Johannes W.


    We report a fatal intravenous ioversol administration in a 60-year old male patient. Although the introduction of new low-osmolar non-ionogenic contrast media with a more favourable efficacy-toxicity balance has diminished the side-effects significantly, everyone involved in radiodiagnostic procedur

  2. Fatal accidents among Danes with multiple sclerosis

    Brønnum-Hansen, Henrik; Hansen, Thomas; Koch-Henriksen, Nils


    We compared the rate of fatal accidents among Danes with multiple sclerosis (MS) with that of the general population. The study was based on linkage of the Danish Multiple Sclerosis Registry to the Cause of Death Registry and covered all 10174 persons in whom MS was diagnosed during the period 1953......-1996. The end of follow-up was 1 January 1999. We calculated standardized mortality ratios (SMRs) for various types of fatal accidents. A total of 76 persons (48 men and 28 women) died from accidents, whereas the expected number of fatalities from such causes was 55.7 (31.4 men and 24.3 women). Thus, the risk...... for death from accidents among persons with MS was 37% higher than that of the general population (SMR = 1.37). We found no significant excess risk for fatal road accidents (SMR = 0.80). The risk for falls was elevated (SMR = 1.29) but not statistically significantly so. The risks were particularly high...

  3. Fatal cerebral oedema in adult diabetic ketoacidosis.

    Haringhuizen, A.; Tjan, D.H.; Grool, A.; Vugt, R. van; Zante, A.R. van


    In this report, a case of adult onset fatal cerebral oedema as a rare complication of diabetic ketoacidosis (DKA) is described and confirmed at post-mortem pathological examination. The pathogenesis of cerebral oedema due to DKA is still unknown. Potential mechanisms include the administration of so

  4. A fatal case of pure metaphyseal chondroblastoma.

    Binesh, Fariba; Moghadam, Reza Nafisi; Abrisham, Jalil


    The chondroblastoma (CB) is a rare cartilaginous tumour; it represents less than 1% of all bone tumours. It is mostly localised at the level of the epiphysis of long bones. We report a fatal case of pure metaphyseal CB of the tibia in a 9-year-old boy whose pulmonary metastases developed soon after operative therapy of the primary tumour.

  5. A fatal poisoning involving Bromo-Dragonfly

    Andreasen, Mette Findal

    This poster reports a fatal overdose case involving Bromo-Dragonfly. Bromo-Dragonfly is a common name for 1-(8-bromobenzo[1,2-b; 4,5-b´]difuran-4-yl)-2-aminopropane. Structurally, it is closely related to phenylethylamines like 2C-B and DOB. Bromo-Dragonfly is considered an extremely potent...

  6. Experimental study on therapy of ultraviolet blood irradiation and oxygenation in acute soman intoxication in rabbits

    ZHANG Xian-qing; MU Shi-jie; ZHANG Xiao-di; CHEN Rui; XIA Ai-jun; LIANG Xin; HAI Chun-xu


    Objective: To study the therapy effect of ultraviolet blood irradiation and oxygenation(UBIO) on blood AChe activity and lung injury due to acute soman intoxication in rabbits. Methods :Forty rabbits were randomly divided into 4 groups: normal control group, intoxication group, routine therapy group and UBIO therapy group. Blood AChe activity and artery blood gas were analyzed 2 h after intoxication. ACP and AKP activities in BALF were determined respectively. Results:Blood AChe activity in intoxication group was lower than that in normal control group (P<0. 05). BALF ACP and AKP activities in intoxication group were higher than that in normal control group. Blood AChe activities in UBIO therapy group increased and were higher than that in intoxication and routine therapy groups. Compared with intoxication group, BALF ACP and AKP activities were decreased (P<0.05) in UBIO therapy group,while artery blood pH, PaO2 and SaO2 increased (P<0.05). Conclusion: UBIO therapy can elevate blood AChe activity and alleviate lung injury induced by soman intoxication. So it may be a new way to treat acute soman intoxication.

  7. The Defense of Involuntary Intoxication by Prescribed Medications: An Appellate Case Review.

    Piel, Jennifer


    The defense of involuntary intoxication has long been an exception to the general notion that intoxication is not a defense to criminal liability. The consumption of medications prescribed by a physician can form the basis of an involuntary-intoxication defense. In this article, I review cases where defendants relied on the use of prescribed medications for an involuntary-intoxication defense. The medications most frequently implicated by defendants are listed by name and by class. From the case law, I provide a summary of the defense and a review of the pitfalls of the defense to serve as practice pointers for forensic evaluators.

  8. Intoxication par la paraphényléne-diamine (takaout au Maroc: à propos de 24 cas

    Ali Derkaoui


    Full Text Available La paraphénylène-diamine (PPD est une amine aromatique dérivée de l’aniline, utilisée depuis 1863 par les femmes dans un but cosmétique comme teinture capillaire noire ou adjuvant de henné dans plusieurs pays d’Afrique et de Moyen Orient. Le but de notre travail était de décrire les caractéristiques cliniques, paracliniques et évolutives de nos patients et de les comparer avec les données de la littérature. Il s’agissait d’une étude rétrospective portant sur les cas admis en réanimation (2003-2010. Les critères d’inclusion étaient d’ordre clinique, paraclinique, thérapeutique et évolutif. Durant la période de l’étude 24 patients ont été inclus provenant de la région de Fés-Boulmane. L’intoxication à la (PPD représentait 26% de l’ensemble des intoxications admises au cours de la même période. L âge moyen était de 23,6 plus or minus 11 ,6 ans. Il existait une prédominance féminine avec un sex-ratio de 4,7. L’intoxication était volontaire dans 82,6 %, accidentelle dans 8,6 %, et criminelle dans 4,3%. Le syndrome de rhabdomyolyse caractéristique de cette intoxication était retrouvé chez 60% de nos patients, l’atteinte respiratoire chez 56,5%, l’atteinte cardiaque était présente dans 30% des cas et 17,4% des patients avaient présentés une insuffisance rénale. La prise en charge thérapeutique se basait sur l’apport volémique massif, alcalinisation des urines ainsi que l’administration de corticoïdes et de diurétiques. Le recours à une trachéotomie de sauvetage était nécessaire chez 7 patients. Trois de nos patients avaient bénéficié d’une épuration extra rénale. L’évolution était fatale chez 47,8% des cas. La PPD représente ainsi la principale cause de mortalité toxique dans notre contexte. L’intoxication à la PPD, représente la première cause de rhabdomyolyse toxique dans notre contexte. Elle est responsable d’une mortalité très élevée. Ce qui

  9. Detection of enteropathogens in fatal and potentially fatal diarrhea in Cairo, Egypt.

    Shukry, S; Zaki, A. M.; DuPont, H L; Shoukry, I; el Tagi, M; Hamed, Z


    A 1-year study of the etiology of acute diarrhea complicated by severe (10%) dehydration, active bleeding, shock and cardiovascular collapse, pneumonia, acute renal failure, or seizures in infants under 18 months of age was performed in Cairo, Egypt. Of 145 infants, 19 (13%) died or left the hospital moribund; the remaining 126 patients were classified as having potentially fatal illness. A variety of enteropathogens were identified with approximately equal frequency in the fatal and nonfatal...

  10. ENFOQUE DEL PACIENTE CON INTOXICACIÓN AGUDA POR PLAGUICIDAS ORGANOS FOSFORADOS Organophosphorates: acute intoxication practical issues

    Carlos Mauricio Hurtado Clavijo


    Full Text Available Un gran número de insecticidas organofosforados se usan en todo el mundo a diario. Las intoxicaciones ocurren generalmente de forma accidental por exposición laboral, o intencional, con fines suicidas. Los organofosforados producen sus efectos tóxicos a través de la inhibición de la acetilcolinesterasa, la enzima responsable de la hidrólisis del neurotransmisor acetilcolina, produciendo ácido acético y colina, productos químicamente inertes. La unión entre los organofosforados y la acetilcolina es una unión irreversible espontáneamente, sin embargo, puede ser reversible con el uso de antídotos específico llamados oximas. La administración temprana de pralidoxima es crucial y muy útil si se inicia en las primeras seis horas luego de la intoxicación aguda. La atropina produce un beneficio clínico dramático para los síntomas muscarínicos del síndrome colinérgico. Pueden ocurrir complicaciones importantes en los pacientes por intoxicación con organofosforados, como hipotensión, arritmias cardíacas fatales, síndrome intermedio, distres respiratorio, neumonía y aún disfunción cerebral severa.Every day more organic phosphorus insecticides, are used in the entire world. Intoxications happen generally accidentally for exhibition work, or intentional as suicides. Organic phosphorus compounds, produces toxic effects, through the inhibition of the acetylcholinesterase, the enzyme responsible for the hydrolisys of the acetylcholine, neurotransmisor producing acetic acid and colina, chemically inert products. The binding between the organic phosphorus compounds and the acetylcholine is spontaneously and irreversible, however, it can be reversible with the use of an antidote specific called oximas. The early administration of pralidoxima is crucial, great benefits are obtained if it begins in the first six hours after the acute intoxication. Atropine produces a dramatic clinical benefit for the symptoms muscarinic of the syndrome

  11. The turning point in the number of traffic fatalities

    Brüde, Ulf; Elvik, Rune


    The number of traffic fatalities reached a peak in many highly motorised countries around 1970. Some previous studies have suggested that the turning point in the number of traffic fatalities was inevitable and did not reflect a change in the underlying trends influencing the number of traffic...... fatalities. Other studies suggest that trends in traffic growth and fatality rate changed from before to after the turning point. This paper proposes two hypotheses about the turning point in the number of traffic fatalities. One hypothesis is that the long-term trends in traffic growth and fatality rate...... were the same before and after the turning point. The other hypothesis is that the long-term trends in traffic growth and fatality rate were different before and after the turning point was reached, in particular that the annual percentage decline in fatality rate became greater after the turning point...

  12. Rising gasoline prices increase new motorcycle sales and fatalities

    Zhu, He; Wilson, Fernando A; Stimpson, Jim P; Hilsenrath, Peter E


    ...) and new motorcycle fatalities (r = 0.92). ARIMA analysis estimated that a US$1 increase in gasoline prices would result in 295,000 new motorcycle sales and, consequently, 233 new motorcycle fatalities...

  13. Children in Hot Cars Result in Fatal Consequences

    ... this! Home » Health Tips » Holiday and Seasonal Children in Hot Cars Result in Fatal Consequences Emergency physicians are warning the public ... throbbing headache, dizziness, nausea, confusion and disorientation. READ IN SUMMER Children in Hot Cars Result in Fatal ...

  14. Fatal Lemierre's syndrome as a complication of chronic otitis media ...

    Fatal Lemierre's syndrome as a complication of chronic otitis media with cholesteatoma. ... South African Journal of Child Health ... This case report illustrates that untreated chronic middle ear infection can lead to potentially fatal complications ...

  15. Characterization of a Mouse Model of Oral Potassium Cyanide Intoxication.

    Sabourin, Patrick J; Kobs, Christina L; Gibbs, Seth T; Hong, Peter; Matthews, Claire M; Patton, Kristen M; Sabourin, Carol L; Wakayama, Edgar J


    Potassium cyanide (KCN) is an inhibitor of cytochrome C oxidase causing rapid death due to hypoxia. A well-characterized model of oral KCN intoxication is needed to test new therapeutics under the Food and Drug Administration Animal Rule. Clinical signs, plasma pH and lactate concentrations, biomarkers, histopathology, and cyanide and thiocyanate toxicokinetics were used to characterize the pathology of KCN intoxication in adult and juvenile mice. The acute oral LD50s were determined to be 11.8, 11.0, 10.9, and 9.9 mg/kg in water for adult male, adult female, juvenile male, and juvenile female mice, respectively. The time to death was rapid and dose dependent; juvenile mice had a shorter mean time to death. Juvenile mice displayed a more rapid onset and higher incidence of seizures. The time to observance of respiratory signs and prostration was rapid, but mice surviving beyond 2 hours generally recovered fully within 8 hours. At doses up to the LD50, there were no gross necropsy or microscopic findings clearly attributed to administration of KCN in juvenile or adult CD-1 mice from 24 hours to 28 days post-KCN challenge. Toxicokinetic analysis indicated rapid uptake, metabolism, and clearance of plasma cyanide. Potassium cyanide caused a rapid, dose-related decrease in blood pH and increase in serum lactate concentration. An increase in fatty acid-binding protein 3 was observed at 11.5 mg/kg KCN in adult but not in juvenile mice. These studies provide a characterization of KCN intoxication in adult and juvenile mice that can be used to screen or conduct preclinical efficacy studies of potential countermeasures.

  16. 78 FR 38096 - Fatality Analysis Reporting System Information Collection


    ... Number NHTSA-2012-0168] Fatality Analysis Reporting System Information Collection AGENCY: National... comments on the following proposed collections of information: (1) Title: Fatal Analysis Reporting System... damage associated with motor vehicle accidents. The Fatality Analysis Reporting System (FARS) is a major...

  17. Severe methemoglobinemia due to food intoxication in infants.

    Murone, Anne-Joëlle Bosset; Stucki, Pascal; Roback, Mark G; Gehri, Mario


    The purpose of this case report is to illustrate food intoxication in infants as a consequence of fennel ingestion. Four cases of methemoglobinemia (MetHb) are presented here. Each patient ate homemade fennel purée a few hours prior to arriving to the emergency department with cyanosis unresponsive to oxygen, in the absence of suspected cyanotic heart disease. All 4 patients received treatment with methylene blue and fully recovered. Our cases emphasize that improper handling and storing of vegetables can lead to life-threatening MetHb.

  18. Cytogenetic investigations on leucocytes of cattle intoxicated with fluoride

    Leonard, A.; Deknudt, G.; Decat, G.; Leonard, E.D.


    The sources of atmospheric fluoride include the burning of soft coal and the manufacturing of aluminium, steel, lead, copper, nickel, phosphate fertilizers, brick and pottery kilns. Cattle which grazed in the vicinity of a plant manufacturing enamel and which displayed signs of chronic fluoride poisoning such as osteosclerosis and mottled enamel or dental fluorosis were investigated for the presence of structural chromatid and chromosome aberrations. Venous blood was incubated for 48 h, and 100 cells were analyzed for each animal. No statistical difference in the incidence of such anomalies was observed between the controls and the intoxicated animals.

  19. Prophylaxis and Treatment of Cyanide Intoxication. Cyanide - Mechanism of Prophylaxis.


    AD-A142 380 PROPHYLAXIS AND TREATMENT OF CYANIDE INTOXICATION I/f CYANIDE - MECHANISM OF PROPHYLAXISU) WASHINGTON STATE UNIV PULLMAN d L WAY 15 APR...invaluable contributions to completion of this work. My thanks to fellow students Linda Baker, for helping write a computer program which provided...8217 COMPILED BY KORIAT, LICHTENSTEIN, AND FISCHHOFF(1980) 25 ’PROGRAM DEVELOPED BY 26 ’JOHN R. TIFFANY AND LINDA S. BAKER 27 30 LI$:’A’:L2$:’A’:L3$:’B’:L4$:’B

  20. A fatal case of peripartum cardiomyopathy.

    Cohen, Ronny; Mallet, Thierry; Mirrer, Brooks; Loarte, Pablo; Gale, Michael; Kastell, Paul


    Peripartum cardiomyopathy is a life-threatening cardiac condition affecting pregnant women either late in pregnancy or early in the post-partum period. The latest studies show a dramatic improvement in the mortality rates of women affected with this disorder, which has been correlated with advances in medical therapy for heart failure. However, patients continue to die of this condition. The following case report describes a typical patient with peripartum cardiomyopathy diagnosed on clinical grounds, along with echocardiogram findings of severe systolic dysfunction and global hypokinesis consistent with dilated cardiomyopathy. Emergency cesarean delivery had to be performed for fetal distress. There was significant improvement of the patient's condition with standard pharmacological management for heart failure at the time of discharge. However, five weeks after discharge, fatal cardiac arrest occurred. It is hoped that this article will raise awareness about this rare but potentially fatal condition and promote understanding of its main clinical features, diagnostic criteria, and conventional pharmacological management.

  1. Fatal combination of moclobemide overdose and whisky.

    Bleumink, G S; van Vliet, A C M; van der Tholen, A; Stricker, B H Ch


    The antidepressant moclobemide (Aurorix) is a reversible inhibitor of monoamine oxidase-A. Pure moclobemide overdose is considered to be relatively safe. Mixed drug overdoses including moclobemide are potentially lethal, especially when serotonergical drugs are involved. So far, only one fatality due to moclobemide mono-overdose has been reported. We report here on a fatality following the ingestion of a moclobemide overdose in combination with half a bottle of whisky. Although dietary restrictions during moclobemide therapy are not considered necessary, the combination of large quantities of moclobemide and tyramine-containing products seems to be lethal, probably because monoamine oxidase-A selectivity is overwhelmed after massive overdoses. Since there is no specific antidote and treatment is only symptomatic, the severity of an overdose with moclobemide must not be underestimated.

  2. Case report of fatal Mycobacterium tilburgii infection.

    Akpinar, Timur; Bakkaloglu, Oguz K; Ince, Burak; Tufan, Fatih; Kose, Murat; Poda, Mehves; Tascioglu, Didem; Koksalan, O Kaya; Saka, Bulent; Erten, Nilgun; Buyukbabani, Nesimi; Kilicaslan, Zeki; Tascioglu, Cemil


    There are few reports concerning Mycobacterium tilburgii infection in humans because this bacterium is non-cultivatable. Herein, using new molecular techniques, we report the case of an immunocompromised patient with fatal disseminated lymphadenitis that was caused by M. tilburgii.26 years old Caucasian HIV negative female patient presented with abdominal pain. Her clinical assessment revealed disseminated lymphadenitis, that was acid fast bacilli positive. Further molecular evaluation showed the causative agent as M. tilburgii. Despite anti mycobacterial therapy and careful management of intervening complications patient died because of an intraabdominal sepsis. This is the first fatal M. tilburgii infection in the literature. This case points the importance of careful management of patient's immune status and intervening infections besides implementation of effective drug treatment.

  3. Alcoholic beverages as determinants of traffic fatalities

    José Mª Arranz; Gil, Ana I.


    The most important contribution of this research lies in considering the impact of wine, beer and liquors on the ratio of traffic fatalities because each kind of alcoholic beverage is characterized by different ethanol content. The data, drawn for case of Spain, validate our theoretical hypothesis. Our findings support the strategy of incrementing alcohol taxes in order to reduce the negative externalities of alcohol abuse. However, it is necessary to implement non-economic policies because o...

  4. Cathelicidin Insufficiency in Patients with Fatal Leptospirosis

    Min, Jin-na; Mannam, Praveen; Srivastava, Anup; Yao, Yi; Hacker, Kathryn P.; Raddassi, Khadir; Montgomery, Ruth R.; Shaw, Albert C.; Araújo, Guilherme C.; Nery, Nivison; Relman, David A.; Reis, Mitermayer G.; Ko, Albert I.


    Leptospirosis causes significant morbidity and mortality worldwide; however, the role of the host immune response in disease progression and high case fatality (>10–50%) is poorly understood. We conducted a multi-parameter investigation of patients with acute leptospirosis to identify mechanisms associated with case fatality. Whole blood transcriptional profiling of 16 hospitalized Brazilian patients with acute leptospirosis (13 survivors, 3 deceased) revealed fatal cases had lower expression of the antimicrobial peptide, cathelicidin, and chemokines, but more abundant pro-inflammatory cytokine receptors. In contrast, survivors generated strong adaptive immune signatures, including transcripts relevant to antigen presentation and immunoglobulin production. In an independent cohort (23 survivors, 22 deceased), fatal cases had higher bacterial loads (P = 0.0004) and lower anti-Leptospira antibody titers (P = 0.02) at the time of hospitalization, independent of the duration of illness. Low serum cathelicidin and RANTES levels during acute illness were independent risk factors for higher bacterial loads (P = 0.005) and death (P = 0.04), respectively. To investigate the mechanism of cathelicidin in patients surviving acute disease, we administered LL-37, the active peptide of cathelicidin, in a hamster model of lethal leptospirosis and found it significantly decreased bacterial loads and increased survival. Our findings indicate that the host immune response plays a central role in severe leptospirosis disease progression. While drawn from a limited study size, significant conclusions include that poor clinical outcomes are associated with high systemic bacterial loads, and a decreased antibody response. Furthermore, our data identified a key role for the antimicrobial peptide, cathelicidin, in mounting an effective bactericidal response against the pathogen, which represents a valuable new therapeutic approach for leptospirosis. PMID:27812211

  5. Primary cutaneous amebiasis with a fatal outcome.

    Al-Daraji, Wael Ismail; Husain, Ehab A; Ilyas, Mohammed; Robson, Alistair


    We report a fatal case of disseminated amebiasis in a young African woman, which initially presented with an ulcerated cutaneous lesion on the left flank. The causative organism was confirmed by examination of a wet drop preparation from the ulcer discharge and by skin biopsy. The patient was not immunosuppressed and was treated unsuccessfully with metronidazole. Postmortem examination revealed the presence of intestinal amebiasis complicated by a liver abscess.

  6. Clash of Desires: Detective vs. Femme Fatale

    Veronika Pituková


    Full Text Available This article discusses the theme of desire presented in American hard-boiled detective fiction and its subsequent transformation on the screen in form of films noir of the 1940’s. The works in focus are novels The Maltese Falcon by Dashiell Hammett, Farewell, My Lovely by Raymond Chandler and Build My Gallows High by Daniel Mainwaring and their film noir adaptations – The Maltese Falcon (1941, Murder, My Sweet (1944 and Out of the Past (1947. The proposed paper seeks to offer a contrastive analysis of the novels and the films and situate them in their respective social and cultural contexts. The central conflict of this article is presented by the clash between the femme fatale’s and detective’s desires. Hard-boiled novels present femme fatale as a dame with a past, a spider woman, and the detective as a hero with no future, caught in her web of intrigues. The only way out for the detective is to suppress the sexual desire for the woman and hold strong to his professional code. The femme fatale’s desire for more and for better is deadly and dangerous for those who succumb to her lure, but the detective’s desire for truth can be fatal for the dark lady too.  This clash presented in the novels is confronted with the 1940’s Hollywood production. When the detective frees himself from the sexual lure of the fatal woman he has a chance to live and even bring her to justice, but she can still escape or decide herself what to do with her destiny. Both, the dame and the hero are victims of their desires. The 1940’s films noir’s femme fatales have to pay for their crimes, no matter how crafty, seductive or manipulative they are.  Thus these films present the masculine dominance as strong and undefeated.

  7. Cunninghamella echinulata causing fatally invasive fungal sinusitis.

    LeBlanc, Robert E; Meriden, Zina; Sutton, Deanna A; Thompson, Elizabeth H; Neofytos, Dionissios; Zhang, Sean X


    We report a fatal case of invasive fungal sinusitis caused by Cunninghamella echinulata in a febrile, neutropenic 15-year-old male with relapsing acute leukemia. The isolate was recovered from a nasal biopsy from the right middle meatus, and microscopic examination of the tissue revealed angioinvasion and necrosis. Human infection caused by this organism has not been well documented; however, this report alerts us to its life-threatening potential.

  8. Recent trends in cyclist fatalities in Australia.

    Boufous, Soufiane; Olivier, Jake


    The study examines trends in bicycling fatalities reported to the Australian police between 1991 and 2013. Trends were estimated using Poisson regression modelling. Overall, cycling fatalities decreased by 1.9% annually between 1991 and 2013. However, while deaths following multivehicle crashes decreased at a rate of 2.9% per annum (95% CI -4.0% to -1.8%), deaths from single vehicle crashes increased by 5.8% per annum (95% CI 4.1% to 7.5%). Over the study period, the average age of cyclists who died in single vehicle crashes (45.3 years, 95% CI 41.5 to 49.1) was significantly higher than cyclists who died in multivehicle crashes (36.2 years, 95% CI 34.7 to 37.7). The average age of deceased cyclists increased significantly for both types of crashes. The observed increase in single vehicle crashes need to be closely monitored in Australia and internationally. In-depth studies are needed to investigate the circumstances of fatal single bicycle crashes in order to develop appropriate countermeasures.

  9. Bacterial Intoxication Evokes Cellular Senescence with Persistent DNA Damage and Cytokine Signaling

    Blazkova, Hana; Krejcikova, Katerina; Moudry, Pavel;


    to such intoxication are mechanistically incompletely understood. Here we show that both normal and cancer cells (BJ, IMR-90 and WI-38 fibroblasts, HeLa and U2-OS cell lines) that survive the acute phase of intoxication by Haemophilus ducreyi CDT possess the hallmarks of cellular senescence. This characteristic...

  10. 32 CFR 636.5 - Army administrative actions against intoxicated drivers.


    ... 32 National Defense 4 2010-07-01 2010-07-01 true Army administrative actions against intoxicated drivers. 636.5 Section 636.5 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY... INSTALLATIONS) Fort Stewart, Georgia § 636.5 Army administrative actions against intoxicated drivers. For...

  11. 32 CFR 634.12 - Army administrative actions against intoxicated drivers.


    ... 32 National Defense 4 2010-07-01 2010-07-01 true Army administrative actions against intoxicated drivers. 634.12 Section 634.12 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY... § 634.12 Army administrative actions against intoxicated drivers. Army commanders will take...

  12. Current status of rodenticide intoxication in Brazil: a preliminary survey from 2009 to 2011

    Solange Papini


    Full Text Available The chemical control of rodents with anticoagulant products, especially derivatives of the coumarin chemical group, is legally authorised in Brazil. These products provide effective control and are safe for humans. However, the use of illegal 'rodenticides' has increased in many Brazilian cities recently, accompanied by increased numbers of suicides, homicides, and intoxications. The National Toxicology Information System (Sinitox registers the number of rodenticide intoxications, including suicides, but does not differentiate between the legal and illegal rodenticides. Intoxications by rodenticides outnumber those by illicit drugs and pesticides. A survey of data from 2005-2011 revealed an average of about 3,800 intoxications per year, about 60% of which were suicides. Many of these intoxications probably involved illegal rodenticides, some with unknown chemical compositions, which confound the data on rodenticide intoxication. This evaluation of Sinitox data highlighted the need to ensure the proper use of the term 'rodenticide' when registering intoxication cases. Intoxication by-products that are not rodenticides, but are erroneously used for this purpose, should be classified separately to improve the quality of information.

  13. Evaluation of Available Treatment Guidelines for the Management of Lithium Intoxication

    Wilting, Ingeborg; Egberts, Antoine C. G.; Heerdink, Eibert R.; Ververs, Tessa F. T.; Meulenbelt, Jan; Nolen, Willem A.

    Intoxications with lithium carry considerable risk for long-term morbidity and even mortality. Consequently, any patient suspected of lithium intoxication requires immediate and appropriate care. The objectives of this study were to assess the completeness and the applicability of generally

  14. Hyperbaric oxygen therapy may overcome nitric oxide blockage during cyanide intoxication

    Polzik, Peter; Hansen, Marco Bo; Olsen, Niels Vidiendal


    PURPOSE: To determine the effects of a blockade of nitric oxide (NO) synthesis on hyperbaric oxygen (HBO₂) therapy during cyanide (CN) intoxication. METHODS: 39 anesthetized female Sprague-Dawley rats were exposed to CN intoxication (5.4 mg/kg intra-arterially) with or without previous nitric oxide...

  15. Regulatory Self-Efficacy as a Moderator of Peer Socialization Relating to Italian Adolescents' Alcohol Intoxication

    Rabaglietti, Emanuela; Burk, William J.; Giletta, Matteo


    The present study investigated regulatory self-efficacy (RSE) as a predictor of friendship and adolescent alcohol intoxication and as a moderator of peer socialization processes related to alcohol intoxication. The longitudinal sample included 457 Italian adolescents (262 females and 195 males) ranging in age of 14 to 20 years (M = 16.1 years of…

  16. Regulatory Self-efficacy as a Moderator of Peer Socialization Relating to Italian Adolescents' Alcohol Intoxication

    Rabaglietti, E.; Burk, W.J.; Giletta, M.


    The present study investigated regulatory self-efficacy (RSE) as a predictor of friendship and adolescent alcohol intoxication and as a moderator of peer socialization processes related to alcohol intoxication. The longitudinal sample included 457 Italian adolescents (262 females and 195 males)

  17. Acute Alcohol Intoxication in Patients with Mild Traumatic Brain Injury: Characteristics, Recovery and Outcome

    Scheenen, Myrthe; de Koning, Myrthe; van der Horn, Harm; van der Naalt, Joukje; Spikman, Jacoba


    Objectives. To investigate the incidence of acute alcohol intoxication (AAI) at the time of sustaining mild traumatic brain injury (mTBI), describe the characteristics of this intoxicated subgroup, and evaluate recovery and outcome in comparison to sober mTBI patients. Methods. Multicenter cohort st

  18. Successful treatment of polydipsia, water intoxication, and delusional jealousy in an alcohol dependent patient with clozapine.

    Margetić, Branimir; Aukst-Margetić, Branka; Zarković-Palijan, Tija


    The beneficial effect of clozapine on polydipsia and water intoxication in patients with schizophrenia has been demonstrated many times. The authors report a successful clozapine treatment of polydipsia, intermittent water intoxication, and delusional jealousy of an alcoholic. This is a rare case of clozapine treatment of a non-schizophrenic patient affected by polydipsia.

  19. Regulatory Self-efficacy as a Moderator of Peer Socialization Relating to Italian Adolescents' Alcohol Intoxication

    Rabaglietti, E.; Burk, W.J.; Giletta, M.


    The present study investigated regulatory self-efficacy (RSE) as a predictor of friendship and adolescent alcohol intoxication and as a moderator of peer socialization processes related to alcohol intoxication. The longitudinal sample included 457 Italian adolescents (262 females and 195 males) rang

  20. Phencyclidine analog use in Sweden--intoxication cases involving 3-MeO-PCP and 4-MeO-PCP from the STRIDA project.

    Bäckberg, Matilda; Beck, Olof; Helander, Anders


    3-Methoxy-phencyclidine (3-MeO-PCP) and 4-methoxy-phencyclidine (4-MeO-PCP) are analogs of and drug substitutes for the dissociative substance PCP ("Angel dust"), a recreational drug that was most popular in the 1970s. In Sweden, use of methoxylated PCP analogs was noted starting in mid-2013, according to statistics from the Poisons Information Centre. The objective of this case series was to present clinical and bioanalytical data from analytically confirmed non-fatal intoxications associated with 3-MeO-PCP and/or 4-MeO-PCP within the STRIDA project. Observational case series of consecutive patients with self-reported or suspected exposure to new psychoactive substances (NPS) and who require hospital care. Blood and urine samples were collected from intoxicated patients presenting at emergency departments (ED) or intensive care units (ICU) all over Sweden. NPS analysis was performed by multicomponent liquid chromatographic-tandem mass spectrometric (LC-MS/MS) and LC-high-resolution MS (LC-HRMS) methods. Data on clinical features were collected during Poisons Information Centre consultations and retrieved from medical records. The Poisons Information Centre registered its first call related to methoxylated PCP analogs in July 2013, while analytically confirmed cases first appeared in October 2013. From July 2013 to March 2015, 1243 cases of suspected NPS intoxication originating from ED or ICU were enrolled in the STRIDA project. During the 21-month period, 56 (4.5%) patients tested positive for 3-MeO-PCP and 11 (0.9%) for 4-MeO-PCP; 8 of these cases involved both substances. The 59 patients were aged 14-55 (median: 26) years and 51 (86%) were men. Co-exposure to other NPSs and/or classical drugs of abuse was common with only 7 cases (12%) indicated to be 3-MeO-PCP single-substance intoxications; prominent clinical signs seen in the latter cases were hypertension (systolic blood pressure ≥ 140 mmHg; 7 cases), tachycardia (≥ 100/min; 5 cases), and altered mental

  1. Effects of mixing alcohol with caffeinated beverages on subjective intoxication: A systematic review and meta-analysis

    Benson, S.; Verster, J. C.; Alford, C.; Scholey, A.


    It has been suggested that mixing alcohol with energy drinks or other caffeinated beverages may alter\\ud the awareness of (or ‘mask’) intoxication. The proposed reduction in subjective intoxication may have\\ud serious consequences by increasing the likelihood of engaging in potentially dangerous activities while\\ud intoxicated. A literature search was conducted to collect all studies measuring subjective intoxication\\ud after administration of alcohol with energy drinks, or with other caffein...

  2. Is pornography consumption associated with condom use and intoxication during hookups?

    Braithwaite, Scott R; Givens, Anneli; Brown, Jacob; Fincham, Frank


    In order to examine whether pornography consumption is associated with risky sexual behaviour among emerging adults, we examined two large samples of those who reported hooking up in the past 12 months (combined n =  1216). Pornography use was associated with a higher likelihood of having a penetrative hookup; a higher incidence of intoxication during hookups for men (but a lower incidence of intoxication during hookups for women); increasing levels of intoxication during hookups for men but decreasing levels of intoxication for women; and a higher likelihood of being in the riskiest category of having a penetrative hookup, without a condom, while intoxicated. For each of these outcomes, our point estimates for Study 2 fell within the 95% confidence intervals from Study 1. Controlling for trait self-control, binge drinking frequency, broader problematic patterns of alcohol use, openness to experience, and attitudes toward casual sex did not change the pattern of results. Implications for interventions to reduce sexual risk are discussed.

  3. [Severe hydrogen sulfide intoxication: a pediatric case of survival].

    Claudet, I; Marcoux, M-O; Karsenty, C; Rittié, J-L; Honorat, R; Lelong-Tissier, M-C


    We report a paediatric case of survival following severe hydrogen sulfide (H2S) gas intoxication. A 13-year-old boy was found submerged to the neck in a manure tank. He was hypothermic, unresponsive with bilateral mydriasis, and had poor oxygen saturation. After intubation, he was transferred to the paediatric intensive care unit of a tertiary care children's hospital. He developed acute respiratory distress syndrome (ARDS) requiring high frequency percussive ventilation. Cardiac evaluation was significant for myocardial infarction and left ventricular function impairment. He completely recovered from the respiratory and cardiac failure. Neurological examinations showed abnormal signals on MRI in the semi-oval center and in the frontal cortex. Follow-up detected partial impairment of axonal fibers of the right external popliteal sciatic nerve. Paediatric cases of survival after H2S intoxication have been rarely reported. Such exposures can evolve to severe ARDS and benefit from high frequency percussive ventilation. Hypothermia and other metabolic abnormalities are now better explained thanks to actual knowledge about endogenous H2S function. Lessons learned from paediatric accidents should result in better information about this threat for farmers and families living in houses with septic tanks, reducing the risk to their own and their children's safety.

  4. AMPA receptor potentiation can prevent ethanol-induced intoxication.

    Jones, Nicholas; Messenger, Marcus J; O'Neill, Michael J; Oldershaw, Anna; Gilmour, Gary; Simmons, Rosa M A; Iyengar, Smriti; Libri, Vincenzo; Tricklebank, Mark; Williams, Steve C R


    We present a substantial series of behavioral and imaging experiments, which demonstrate, for the first time, that increasing AMPA receptor-mediated neurotransmission via administration of potent and selective biarylsulfonamide AMPA potentiators LY404187 and LY451395 reverses the central effects of an acutely intoxicating dose of ethanol in the rat. Using pharmacological magnetic resonance imaging (phMRI), we observed that LY404187 attenuated ethanol-induced reductions in blood oxygenation level dependent (BOLD) in the anesthetized rat brain. A similar attenuation was apparent when measuring local cerebral glucose utilization (LCGU) via C14-2-deoxyglucose autoradiography in freely moving conscious rats. Both LY404187 and LY451395 significantly and dose-dependently reversed ethanol-induced deficits in both motor coordination and disruptions in an operant task where animals were trained to press a lever for food reward. Both prophylactic and acute intervention treatment with LY404187 reversed ethanol-induced deficits in motor coordination. Given that LY451395 and related AMPA receptor potentiators/ampakines are tolerated in both healthy volunteers and elderly patients, these data suggest that such compounds may form a potential management strategy for acute alcohol intoxication.


    Claudio Junior Getter


    Full Text Available The toxic plants are those that by means of contact or ingestion, provoke damage to human and animal health, same times causing death. This study has as purpose, to realize an analysis of the accidents occurs with toxicant plants in Brazil. Many control centers, are working to diminish the cases, that Just during the 1991 to 2000, registered a total of 14774 cases of intoxication and poisoning (I/P in the country. The result show that male is most committed, the age who most show the cases of poisoning is between 01-09 years old, this age prevailed on all country regions. The urban areas is where most occurs often. In the biggest part of the registers the intoxication was accidentally when children’s are playing game with the plants. On this period the number of death were of about 48 cases, a surprise was that the northeast region show almost 50% of the cases. Although wait of the control Center and the scientific community to realize a educative, looking for the sensibilization of the society.

  6. Death due to acute tetrachloroethylene intoxication in a chronic abuser.

    Amadasi, Alberto; Mastroluca, Lavinia; Marasciuolo, Laura; Caligara, Marina; Sironi, Luca; Gentile, Guendalina; Zoja, Riccardo


    Volatile substances are used widespread, especially among young people, as a cheap and easily accessible drug. Tetrachloroethylene is one of the solvents exerting effects on the central nervous system with experiences of disinhibition and euphoria. The case presented is that of a 27-year-old female, found dead by her father at home with cotton swabs dipped in the nostrils. She was already known for this type of abuse and previously admitted twice to the hospital for nonfatal acute poisonings. The swabs were still soaked in tetrachloroethylene. Toxicological and histological investigations demonstrated the presence of an overlap between chronic intake of the substance (with high concentrations in sites of accumulation, e.g., the adipose tissue, and contemporary tissue damage, as histologically highlighted) and acute intoxication as final cause of death, with a concentration of 158 mg/L in cardiac blood and 4915 mg/kg in the adipose tissue. No other drugs or medicines were detected in body fluids or tissues, and to our knowledge, this is the highest concentration ever detected in forensic cases. This peculiar case confirms the toxicity of this substance and focuses on the importance of complete histological and toxicological investigations in the distinction between chronic abuse and acute intoxication.


    Claudia Fahlke


    Full Text Available Although alcohol intoxicated eyewitnesses are common, there are only a few studies in the area. The aim of the current study is to investigate how different doses of alcohol affect eyewitness lineup identification performance. The participants (N = 123 were randomly assigned to a 3 [Beverage: control (0.0 g/kg ethanol vs. lower (0.4 g/kg ethanol vs. higher alcohol dose (0.7 g/kg ethanol] X 2 (Lineup: target-present vs. target-absent between-subject design. Participants consumed two glasses of beverage at an even pace for 15 minutes. Five minutes after consumption the participants witnessed a film depicting a staged kidnapping. Seven days later, the participants returned to the laboratory and were asked to identify the culprit in a simultaneous lineup. The result showed that overall, the participants performed better than chance; however, their lineup performance was poor. There were no significant effects of alcohol intoxication with respect to performance, neither in target-present nor target-absent lineups. The study’s results suggest that eyewitnesses who have consumed a lower (0.4 g/kg ethanol or a higher (0.7 g/kg ethanol dose of alcohol perform at the same level as sober eyewitnesses in a lineup. The results are discussed in relation to the alcohol myopia theory and suggestions for future research are made.

  8. Intoxicated workers: findings from a national Australian survey.

    Pidd, Ken; Roche, Ann M; Buisman-Pijlman, Femke


    To identify prevalence of alcohol and drug use and intoxication at work. A total of 9,828 Australian workers ≥14 years old. Australia 2007. Work-place alcohol use and drug use, intoxication at work, industry and occupation of employment. Secondary analysis of a large nationally representative survey involving descriptive and weighted multivariate logistic regressions. Differential patterns were identified by drug type, worker characteristics and occupational setting, controlling for demographic variables. Nearly 9% of workers surveyed (8.7%) usually drank alcohol at work and 0.9% usually used drugs at work. Attending work under the influence of alcohol was more prevalent (5.6%) than attending work under the influence of drugs (2.0%), and significantly more likely among young, male, never married workers with no dependent children. Hospitality industry workers were 3.5 times more likely than other workers to drink alcohol and two to three times more likely to use drugs at work or attend work under the influence of alcohol or drugs. Other high-risk industries and occupations included construction, financial services, tradespersons and unskilled workers. More than one in 20 Australian workers admit to having worked under the influence of alcohol and almost one in 50 report attending work under the influence of psychoactive drugs. The rates are higher for some industries, such as the hospitality industry, than others. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

  9. [Minoxidil intoxication, the pharmacological agent of a hair lotion].

    Aprahamian, A; Escoda, S; Patteau, G; Merckx, A; Chéron, G


    Accidental intoxications in children are frequent but most of them are without serious consequences. We describe herein the case of a young girl who drank 100 mg of a topical hair lotion with minoxidil. On arrival, she had no symptoms except flush on the face and ears. Four and half hours after ingestion, tachycardia appeared with a pulse above 170 beats per min with hypotension at 76/24 mmHg. The heart rate remained between 170 and 190 beats per min for 12 h and then lowered to between 140 and 160 beats per min. Thirty-six hours after ingestion, the heart beat was at 140 beats per min. Minoxidil is a strong vasodilator used first in the 1970s for severe hypertension. It produces hypotension by direct arteriolar vasodilatation. Only a few cases of minoxidil intoxication have been described in the literature, including only one pediatric case. This young boy had only tachycardia of 160 beats per min for 40 h. Most serious cases have been described in adults. They suffered long-lasting tachycardia, hypotension, and ECG changes. Most patients need a bolus of normal saline fluid and some with hemodynamic problems need vasoactive drugs such as dopamine and/or phenylephrine. All patients need to be under medical supervision for a long time because of the product's very long action. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  10. Toxicological results in a fatal and two non-fatal cases of scopolamine-facilitated robberies.

    Lusthof, K J; Bosman, I J; Kubat, B; Vincenten-van Maanen, M J


    The use of scopolamine as an incapacitating drug, in sexual crimes and robberies, has been known for many decades. However, blood concentrations and doses of scopolamine in those cases are largely unknown. Here we present the toxicological results of one fatal and two non-fatal cases in a series of scopolamine-facilitated robberies. In the fatal case, the concentration of scopolamine in heart blood was 0.30mg/L, about 3000 times higher than the average therapeutic level of 0.0001mg/L (for one dermal patch). In femoral blood, the concentration of scopolamine was much lower (0.0048mg/L), but still 50 times higher than therapeutic levels. The scopolamine concentration in the stomach was very high (20mg/kg) as compared to the heart blood and femoral blood, which explains the very high concentration in heart blood by postmortem leakage from the stomach. In the non-fatal case, the scopolamine concentration in serum, obtained 23h after the incident, was 0.00035mg/L. The estimated concentration of scopolamine at the time of the incident is 0.0035mg/L. In the other non-fatal case, scopolamine was detected in urine and in hair.

  11. Reported fatal and non-fatal incidents involving tourists in Thailand, July 1997-June 1999.

    Leggat, Peter A; Leggat, Frances W


    Objectives. To examine fatal and non-fatal incidents involving tourists in Thailand. Methods. Press records from a major English language newspaper for the period from July 1997 to June 1999 were examined for reports of fatal and non-fatal incidents involving tourists. Results. From July 1997 to June 1999, up to 233 deaths were reported and up to a further 216 were reported injured in incidents involving tourists. One hundred and one deaths and 45 injured were reported following one major domestic jet aircraft crash in southern Thailand, however, it was not stated what proportion of casualties were tourists. Approximately 90 people perished in a single hotel fire in southeast Thailand. Most of the victims were local travellers attending meetings of two Thai companies. Sixteen deaths and 86 injured resulted from five road accidents. The majority of deaths and injuries involved foreigners. Twelve deaths and at least 33 injured resulted from three ferry and tour boat accidents. Most victims were reported to be foreigners. Three deaths and 35 injured resulted from a single cable car accident in northern Thailand. Most of these were Thai tourists, however, four of the injured were foreigners. Eight deaths and six injured resulted from 11 muggings and other violent incidents. All were foreigners. Six deaths were reportedly connected to a scam at the airport in Bangkok involving unlicensed airport taxis. Three deaths and four injured were due to other reported incidents. Conclusions. Newspaper reports of fatal and non-fatal incidents involving tourists in Thailand were probably uncommon, particularly given the volume of tourists entering the Kingdom, although better reporting mechanisms are needed. With the exception of the unusual major incidents, most reported fatal and non-fatal incidents involving tourists were due to road trauma and other transportation accidents, muggings, and occasional water sports and other accidents, which could occur at any major tourist

  12. Analyzing temozolomide medication errors: potentially fatal.

    Letarte, Nathalie; Gabay, Michael P; Bressler, Linda R; Long, Katie E; Stachnik, Joan M; Villano, J Lee


    The EORTC-NCIC regimen for glioblastoma requires different dosing of temozolomide (TMZ) during radiation and maintenance therapy. This complexity is exacerbated by the availability of multiple TMZ capsule strengths. TMZ is an alkylating agent and the major toxicity of this class is dose-related myelosuppression. Inadvertent overdose can be fatal. The websites of the Institute for Safe Medication Practices (ISMP), and the Food and Drug Administration (FDA) MedWatch database were reviewed. We searched the MedWatch database for adverse events associated with TMZ and obtained all reports including hematologic toxicity submitted from 1st November 1997 to 30th May 2012. The ISMP describes errors with TMZ resulting from the positioning of information on the label of the commercial product. The strength and quantity of capsules on the label were in close proximity to each other, and this has been changed by the manufacturer. MedWatch identified 45 medication errors. Patient errors were the most common, accounting for 21 or 47% of errors, followed by dispensing errors, which accounted for 13 or 29%. Seven reports or 16% were errors in the prescribing of TMZ. Reported outcomes ranged from reversible hematological adverse events (13%), to hospitalization for other adverse events (13%) or death (18%). Four error reports lacked detail and could not be categorized. Although the FDA issued a warning in 2003 regarding fatal medication errors and the product label warns of overdosing, errors in TMZ dosing occur for various reasons and involve both healthcare professionals and patients. Overdosing errors can be fatal.

  13. Plasma carnitine concentrations after chronic alcohol intoxication 

    Alina Kępka


    Full Text Available Background: Carnitine transports fatty acids from the cytoplasm to the mitochondrial matrix, where the fatty acids are oxidized. Chronic alcohol consumption reduces the concentration of carnitine and interferes with oxidative processes occurring in the cell.Aim: The assessment of carnitine concentrations in plasma of chronically intoxicated alcohol dependent persons in a 49-day abstinence period.Material/Methods: The study included 31 patients (5 women and 27 men aged from 26 to 60 years (44.6± 8.9 and 32 healthy subjects (15 women and 17 men aged 22-60 years (39.8± 9.4. The patients’ alcohol dependence ranged from 2 to 30 years (13.6± 7.5. Examined subjects consumed 75-700 g of ethanol/day (226.9± 151.5. Plasma concentrations of free and total carnitine were measured three times: at the first (T0, 30th (T30 and 49th (T49 day of hospital detoxification. Free (FC and total (TC carnitine were determined by the spectrophotometric method. Plasma acylcarnitine (AC concentration was calculated from the difference between TC and FC; then the AC/FC ratio was calculated. To determine statistically significant differences for related variables, Student’s t-test was used.Results: At T0, alcoholics had significantly lower concentration of FC and TC (p < 0.05 in plasma, as compared to the control group. In comparison to controls, at T30, plasma TC and FC (p < 0.01 as well as AC (p < 0.001 were reduced. The lowest concentration of TC, FC and AC (p < 0.001was found at T49. The ratio of AC/FC at T0 had a tendency to be higher in alcoholics than in the control group (p = 0.05, whereas at T49 it was significantly lower in alcoholics as compared to the control subjects (p < 0.05.Conclusions: Chronic alcohol intoxication causes a plasma deficiency of carnitine. Forty-nine days of abstinence showed a significant decrease in the concentration of TC, FC and AC. Further research is necessary to clarify whether a low level of plasma carnitine

  14. Fatality as a Feature of Medical Care

    Ruiz-Sada Pablo


    Full Text Available Taking advantage of an interesting clinical scenario, we want to introduce a discussion about fatality in our daily practice and the need to accept that. An 80 year-old man with non-traumatic spontaneous bleeding tendency came to the clinics. Although being on warfarin as a consequence of primary thrombotic prophylaxis due to an atrial fibrillation, full assessment was performed. Not only the rare entity found on him, but also the severe complication that happened afterwards challenged clinicians and led them to risky treatment options.

  15. Fatal measles pneumonitis during Hodgkin's lymphoma.

    Wyplosz, Benjamin; Lafarge, Marion; Escaut, Lélia; Stern, Jean-Baptiste


    The treatment of measles pneumonitis in immunocompromised adults is not established. We describe a patient with Hodgkin's lymphoma who developed acute pneumonia during a measles infection. On day 13, intravenous ribavirin and immunoglobulins were administrated. On day 18, the patient developed acute respiratory failure. An examination of transbronchial pulmonary biopsies showed Warthin-Finkeldey giant cells that are pathognomonic of measles pneumonitis. The patient died despite aggressive supportive care. Our case and a review of literature show that measles pneumonitis is routinely fatal in patients with cancer. We suggest that antiviral drugs should be considered as soon as the diagnosis has been established.

  16. Fatal outbreak of botulism in Greenland

    Hammer, Tóra Hedinsdottir; Jespersen, Sanne; Kanstrup, Jakob


    Botulism commonly occurs when the anaerobic, gram-positive bacterium Clostridium botulinum, under suitable conditions, produces botulinum neurotoxins. Named A-F, these toxins are the immediate causative agent of the clinical symptoms of symmetrical, descending neurological deficits, including...... recovery was complete. Microbiological assays, including toxin neutralization bioassay, demonstrated the presence of neurotoxin E in two survivors. The third survivor was shown by PCR to have the BoNT type E gene in faeces. This is the first report of cases of fatal botulism in Greenland. It underscores...

  17. Fatal Overdose due to Confusion of an Transdermal Fentanyl Delivery System

    Ingo Voigt


    Full Text Available Background. The use of transdermal fentanyl systems has increased over recent years, especially in patients with chronic pain. Large misuse potential and fatal outcomes have been described. Case Presentation. A 58-year-old patient presenting with clinical signs of opioid poisoning (hypoventilation, bradycardia, hypotension, and miosis was admitted to our ICU. The first body check revealed a 75 mcg per hour fentanyl patch at the patient's right scapula. Some months ago, patient's aunt died after suffering from an oncological disease. During breaking up of her household, the patches were saved by the patient. Not knowing the risk of this drug, he mistook it as a heat plaster. Investigations. Laboratory test showed an impaired renal function and metabolic acidosis. Urine drug test was negative at admittance and 12 h later. CCT scan presented a global hypoxic brain disease. Treatment and Outcome. The patient was discharged 30 days after admittance in a hemodynamic stable condition but a vegetative state and transferred to a rehabilitation center. Learning Points. With the ongoing increase in fentanyl patch prescriptions for therapeutic reasons, it is likely that misuse cases will become more relevant. Conventional urine drug screening tests are not able to exclude the diagnosis fentanyl intoxication. History taking should include family member's drug prescriptions.

  18. An Acute Butyr-Fentanyl Fatality: A Case Report with Postmortem Concentrations.

    McIntyre, Iain M; Trochta, Amber; Gary, Ray D; Wright, Jennifer; Mena, Othon


    In this case report, we present an evaluation of the distribution of postmortem concentrations of butyr-fentanyl in a fatality attributed principally to the drug. A man who had a history of intravenous drug abuse was found unresponsive on the bathroom floor of his home. Drug paraphernalia was located on the bathroom counter. Toxicology testing, which initially screened positive for fentanyl by enzyme-linked immunosorbent assay, subsequently confirmed butyr-fentanyl, which was then quantitated by gas chromatography-mass spectrometry-specific ion monitoring (GC-MS SIM) analysis following liquid-liquid extraction. The butyr-fentanyl peripheral blood concentration was quantitated at 58 ng/mL compared with the central blood concentration of 97 ng/mL. The liver concentration was 320 ng/g, the vitreous was 40 ng/mL, the urine was 670 ng/mL and the gastric contained 170 mg. Acetyl-fentanyl was also detected in all biological specimens tested. Peripheral blood concentration was quantitated at 38 ng/mL compared with the central blood concentration of 32 ng/mL. The liver concentration was 110 ng/g, the vitreous was 38 ng/mL, the urine was 540 ng/mL and the gastric contained fentanyl, acetyl-fentanyl and cocaine intoxication, and the manner of death was certified as accident.

  19. 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.

  20. Intoxication of nontarget wildlife with rodenticides in northwestern Kansas.

    Ruder, Mark G; Poppenga, Robert H; Bryan, John A; Bain, Matt; Pitman, Jim; Keel, M Kevin


    The perception of prairie dogs (Cynomys spp.) both as a nuisance species and a keystone species presents a significant challenge to land, livestock, and wildlife managers. Anticoagulant and nonanticoagulant rodenticides are commonly employed to control prairie dog populations throughout their range. Chlorophacinone, and to a lesser extent zinc phosphide, are widely used in northwestern Kansas for controlling black-tailed prairie dog (Cynomys ludovicianus) populations. Although zinc phosphide poisoning of gallinaceous birds is not uncommon, there are few published accounts of nontarget chlorophacinone poisoning of wildlife. We report three mortality events involving nontarget rodenticide poisoning in several species, including wild turkeys (Meleagris gallopavo), a raccoon (Procyon lotor), and an American badger (Taxidea taxus). This includes the first documentation of chlorophacinone intoxication in wild turkeys and an American badger in the literature. The extent of nontarget poisoning in this area is currently unknown and warrants further investigation.

  1. Zinc phosphide intoxication of wild turkeys (Meleagris gallopavo).

    Poppenga, Robert H; Ziegler, Andre F; Habecker, Perry L; Singletary, Don L; Walter, Mark K; Miller, Paul G


    Zinc phosphide (Zn3P2) is a rodenticide used to control a variety of small mammal species. It is available over-the-counter or as a restricted-use pesticide depending on how it is to be applied. The toxicity of Zn3P2 is dependent on the species exposed, whether the animal is able to vomit or not, and whether it is ingested on a full or empty stomach. Nontarget species can be exposed through inadvertent or intentional product misapplication. In this article we describe four mortality events in which wild turkeys (Meleagris gallopavo) were believed to have been intoxicated following the ingestion of baits containing Zn3P2.

  2. Adverse effects and intoxications related to medicinal/harmful plants

    Mateja VONČINA


    Full Text Available Many wild plants around us have beneficial effects on our body and can be used as food. People are more and more interested in the medicinal plants. Many of them began gathering and preparing plants for the relief of symptoms of diseases or as a food dietary. Due to the lack of knowledge of plants, mistaking plants that contain toxins for medical plants may happen and cause adverse effects or even poisoning. The Poison Control Centre in Ljubljana keeps records of patients who have been admitted to the department because of adverse effects from the ingestion of certain plants. We analysed 64 cases, which were registered by the Poison Control Centre between January 2000 and December 2013. The aim of the present study was to determine which plants cause the most intoxications in Slovenia.

  3. [Biological activity of selenorganic compounds at heavy metal salts intoxication].

    Rusetskaya, N Y; Borodulin, V B


    Possible mechanisms of the antitoxic action of organoselenium compounds in heavy metal poisoning have been considered. Heavy metal toxicity associated with intensification of free radical oxidation, suppression of the antioxidant system, damage to macromolecules, mitochondria and the genetic material can cause apoptotic cell death or the development of carcinogenesis. Organic selenium compounds are effective antioxidants during heavy metal poisoning; they exhibit higher bioavailability in mammals than inorganic ones and they are able to activate antioxidant defense, bind heavy metal ions and reactive oxygen species formed during metal-induced oxidative stress. One of promising organoselenium compounds is diacetophenonyl selenide (DAPS-25), which is characterized by antioxidant and antitoxic activity, under conditions including heavy metal intoxication.

  4. [Aspects of psychotherapy in diabetes mellitus with accompanying alcoholic intoxication].

    Sidorov, P I; Novikova, I A; Solov'ev, A G


    120 patients with different types of diabetes mellitus were divided into groups by the presence and intensity of accompanying alcoholic intoxication: group 1--no alcohol intake; group 2--rare alcohol intake; group 3--moderate alcohol intake; group 4--alcoholic abuse. Experimental psychological methods were used together with psychotherapeutic approaches: Wiesbaden's questionnaire (WIPPF), Lusher's and MMPI tests. For each group of the patients some recommendations are given for application of the above techniques. Thus in patients from the 1-3 groups it is worthwhile to perform a positive psychotherapy directed to the development of the body/sensation sphere (according to WIPPF), that is a care about physical and mental state (including autotraining and training of communication). In the alcohol abusing patients the main point should be fantasy/future sphere (according to WIPPF) in the ranges of the same positive psychotherapy directed to forming positive world view and correction of the interpersonal relations.

  5. Hydrotelluric fluorotic intoxication in North Yemen. First results

    Claudon, M.; Viallard, Y.; Elmerich, A.

    The X Ray Department of the French medical mission of Taez receives patients coming from the whole Arab Yemen Republic (country situated in the south of the arab peninsula). Radiology has been a mean of detection and a mean of research of an important centre of osteofluorosis, a disease which had not been studied in this country until then. 47 cases have been collected throughout one year. The hydrotelluric origin of the intoxication has been proved by dosages of the spring waters used for drinking. The main usual clinical and radiological features of the disease are found in that population. The radiological classification proposed by ROHOLM has few clinical correlative interests, but seems available for epidemiological investigation. A first map of the North Yemen for chronic fluorisis has been drawn.

  6. [Chronic thallium intoxication in five German pointers of one litter].

    Gassner, G; Tholen, V; Ternes, W


    The difficulty of diagnosis and therapy of chronic thallium intoxication is described in five German Pointers with the same skin disease. The detection of thallium in cases of skin lesions like the cutaneous erythema with oedema and crusts or in chronic cases with multifocal alopecia is difficult. The first diagnostic information was gathered in this case from the high thallium level in the urine. The thallium concentration in the hair is subject to great variations, even in physiologic conditions. The trichogramme showed in this case pathognomonic changes like adhesion of the hair follicles. Differential diagnosis for this symmetric alopezia without pruritus are hormonal disturbances or, in puppies, the generalized form of demodicosis. The five affected dogs were treated with Fe III-Hexacyanoferrat. The clinical appearance of the skin improved slowly during a period of 1-2 months.

  7. Infections and Intoxications from the Ocean: Risks of the Shore.

    Clemence, Mark A; Guerrant, Richard L


    Marine and coastal regions provide a diverse range of foods and serve as recreation and leisure areas for large numbers of people in many parts of the world. However, they also serve as environments associated with numerous hazards. The number of cases of fish- and shellfish-related food poisonings in the United States has increased in recent years, accounting for over 600,000 illnesses, with 3,000 hospitalizations and 94 deaths annually. Human diseases due to pathogenic Vibrio species can result from both ingestion of contaminated shellfish and exposure of open wounds to contaminated seawater. A variety of infections may result from human interactions with marine life, including sharks, barracudas, and moray eels. This chapter covers some of the risks of the shore, including fish and shellfish intoxications, infections related to Vibrio species, and infections resulting from marine trauma.

  8. ApproachtoAcuteIronIntoxication: A Case Report

    Ülkü Özgül


    Full Text Available In adults, the main causes of iron poisoning are intake suicide attempts and an overdose of iron during pregnancy. The severity of intoxication depends on the amount of iron. When serum iron level exceeds the iron binding capacity of the body, free radicals occurs, leading to lipid peroxidation and cellular membrane damage. In iron poisoning, especially the liver, heart, kidney, lung, and hematologic systems are affected negatively. Acute iron poisoning can cause serious complications resulting in death. Clinical, laboratory observation and early treatment are important. In this case report, we examined to approach the acute iron poisoning with the occasion of high-dose iron intake for suicide attempt. (Journal of the Turkish Society Intensive Care 2011; 9: 107-9ntakeforsuicideattempt. (Journal of theTurkishSocietyIntensiveCare 2011; 9: 107-9

  9. Chelation therapy in intoxications with mercury, lead and copper

    Cao, yang; Skaug, Marit Aralt; Andersen, Ole;


    mobilize deposits of mercury as well as of lead into the urine. These drugs can be administered orally and have relatively low toxicity compared to the classical antidote dimercaptopropanol (BAL). d-Penicillamine has been widely used in copper overload, although 2,3-dimercaptosuccinic acid......In the present review we provide an update of the appropriate use of chelating agents in the treatment of intoxications with compounds of mercury, lead and copper. The relatively new chelators meso-2,3-dimercaptosuccinic acid (DMSA) and 2,3-dimercapto-propanesulphonate (DMPS) can effectively...... or tetrathiomolybdate may be more suitable alternatives today. In copper-toxicity, a free radical scavenger might be recommended as adjuvant to the chelator therapy...

  10. Forensic intoxication with clobazam: HPLC/DAD/MSD analysis


    Clobazam (Castillium®, Urbanil®), a benzodiazepine often used as an anxiolytic and in the treatment of epilepsy, is considered a relatively safe drug. The authors present a fatal case with a 49-year-old female, found dead at home. She had been undergoing psychiatric treatment and was a chronic alcoholic. The autopsy findings were unremarkable, except for multivisceral congestion, steatosis and a small piece of a plastic blister pack in the stomach. Bronchopneumonia, bronchitis and bronchiolit...

  11. Peripheral markers of oxidative stress in chronic mercuric chloride intoxication

    Gutierrez L.L.P.


    Full Text Available The present study was designed to evaluate the time course changes in peripheral markers of oxidative stress in a chronic HgCl2 intoxication model. Twenty male adult Wistar rats were treated subcutaneously daily for 30 days and divided into two groups of 10 animals each: Hg, which received HgCl2 (0.16 mg kg-1 day-1, and control, receiving the same volume of saline solution. Blood was collected at the first, second and fourth weeks of Hg administration to evaluate lipid peroxidation (LPO, total radical trapping antioxidant potential (TRAP, and superoxide dismutase (Cu,Zn-SOD, glutathione peroxidase (GPx, glutathione-S-transferase (GST, and catalase (CAT. HgCl2 administration induced a rise (by 26% in LPO compared to control (143 ± 10 cps/mg hemoglobin in the second week and no difference was found at the end of the treatment. At that time, GST and GPx were higher (14 and 24%, respectively in the Hg group, and Cu,Zn-SOD was lower (54% compared to control. At the end of the treatment, Cu,Zn-SOD and CAT were higher (43 and 10%, respectively in the Hg group compared to control (4.6 ± 0.3 U/mg protein; 37 ± 0.9 pmol/mg protein, respectively. TRAP was lower (69% in the first week compared to control (43.8 ± 1.9 mM Trolox. These data provide evidence that HgCl2 administration is accompanied by systemic oxidative damage in the initial phase of the process, which leads to adaptive changes in the antioxidant reserve, thus decreasing the oxidative injury at the end of 30 days of HgCl2 administration. These results suggest that a preventive treatment with antioxidants would help to avoid oxidative damage in subjects with chronic intoxication.

  12. Cestrum diurnum intoxication in normal and hyperparathyroid pigs.

    Kasali, O B; Krook, L; Pond, W G; Wasserman, R H


    The effect of ingestion of dried leaves of Cestrum diurnum, a plant shown to contain a 1,25-dihydroxycholecalciferol-like principle, was tested in normal pigs fed 1.2% calcium and 1.0% phosphorus for 10 weeks from weaning and in hyperparathyroid pigs fed 0.8% calcium and 1.6% phosphorus for the same periods of time. Addition of 3% Cestrum diurnum leaf meal rapidly resulted in decreased feed consumption and weight gain, hypercalcemia and hypophosphatasemia. In normal pigs, plasma calcium rose to 16 mg/100 ml within one week and remained high for the 4 week experimental period. In hyperparathyroid pigs with hypocalcemia, plasma calcium rose to 12.75 mg/100 ml within one week and later approached 15 mg/100 ml. Ingestion of Cestrum diurnum retarded cell differentiation of growth cartilages. Arrested osteocytic osteolysis was observed within one week with osteopetrosis of epiphyses and metaphyses. The negative effect on the resorbing osteocytes then caused osteonecrosis which, in combination with lack of bone formation because of atrophy of osteoblasts, resulted in osteopenia within 4 weeks. Dystrophic calcinosis occurred within 2 weeks and was widespread after 4 weeks in lungs, kidneys, heart and vessels. Atrophy of parathyroid cells was severe after one week. Hyperparathyroid pigs responded with skeletal lesions, dystrophic calcinosis and parathyroid atrophy more rapidly and severely than normal pigs. The biochemical and anatomical changes in Cestrum diurnum ingestion are closely similar to those in vitamin D3 intoxication in pigs. Whereas pigs can tolerate large amounts of vitamin D3 because of feed-back control of 1 alpha-hydroxylation in the kidney, this control point is by-passed in Cestrum diurnum ingestion and intoxication occurs promptly.

  13. Neurocognitive effects of chronic lead intoxication in Andean children.

    Counter, S A; Buchanan, L H; Rosas, H D; Ortega, F


    Lead (Pb) intoxication in children has been associated with neurodevelopmental disabilities which may result in motor and cognitive impairment. We conducted blood lead (PbB) measurements, neurological examinations and cognitive tests on children living in Ecuadorian villages where Pb is used extensively in the glazing of ceramics. Group I consisted of 55 children with a mean PbB level of 48.0 microg/dl (SD: 26.4, range: 9.2-119.1 microg/dl) who received PbB tests and complete neurological examinations. An appreciable number of the children with elevated PbB levels were normal on specific components of the neurological examination. Among the children who showed neurological deficits, higher PbB levels were associated with abnormal tendon reflexes, finger tapping, visual pursuit, size discrimination, draw-a-person, and math calculation skills. Group II consisted of 41 children with a mean PbB level of 47.4 microg/dl (SD: 22.0, range: 6.6-84.7 microg/dl) who were administered Raven's Coloured Progressive Matrices (RCPM) non-verbal reasoning test. Performance on RCPM was abnormal in 22 (53.7%) of 41 children. Children with abnormal RCPM scores had higher PbB levels (t-test: P=0.030). There was a significant inverse correlation between RCPM scores and PbB levels for children ages 9 years and older (r=-0.618, P=0.011). Males had higher mean PbB levels as a function of age than females (t-test: P=0.037), and more males showed neurocognitive deficits. The results demonstrate a range of neurological responses in children with chronically elevated PbB levels from apparent exceptional neuro-physiological tolerance of PbB intoxication, to some fine motor and cognitive deficits.

  14. Magnetic Resonance Imaging Findings in Chronic Carbon Monoxide Intoxication

    Durak, A. C.; Coskun, A.; Yikilmaz, A.; Erdogan, F.; Mavili, E.; Guven, M. [Hospital of Erciyes Univ., Kayseri (Turkey). Dept. of Radiology


    Purpose: To define the cranial magnetic resonance imaging (MRI) features of the chronic stage of carbon monoxide (CO) poisoning in patients with and without neuropsychiatric sequelae. Material and Methods: Eight patients who had neither symptoms nor neurological sequelae and eight patients with neuropsychiatric sequelae were included in the study. Patients aged between 9 to 57 (mean 32.2 years). All patients had been comatose at initial admittance and awoke after normobaric 100% oxygen therapy within 1-7 days. In this study, the patients were being examined with routine cranial MRI between 1 and 10 years (mean 3.4 years) after exposure to CO. Results: The most common finding was bilateral symmetric hyperintensity of the white matter, which was more significant in the centrum semiovale, with relative sparing of the temporal lobes and anterior parts of the frontal lobes on T2-weighted and FLAIR images in all patients. Cerebral cortical atrophy was seen in 10 patients; mild atrophy of cerebellar hemispheres in 8; and vermian atrophy in 11. Corpus callosum was atrophic in one patient. Bilateral globus pallidus lesions were seen in three patients. The lesions were hypointense on T1-weighted images and hyperintense on T2-weighted and FLAIR images. Conclusion: Patients with severe CO intoxication may develop persistent cerebral changes independently of their neuropsychiatric findings in the chronic stage. They may present with characteristic MRI findings as described here, even if asymptomatic. The history of CO exposure is therefore helpful for recognizing and interpreting the MRI findings of chronic stage CO intoxication.

  15. Fatal traffic accidents and forensic medicine

    Kazuhiko Kibayashi


    Full Text Available In the event of a traffic accident fatality, the death is reported as an “unusual death,” an inquest is conducted, and, if necessary, a forensic autopsy is performed to prove any causal relationship between the accident and the death, identify the vehicle at fault, and determine the cause of the accident. A forensic autopsy of a traffic accident fatality needs to both determine the cause of death and identify the mechanism of injury, an analytical task that requires observation of three major traffic accident factors: the body, the vehicles involved, and the scene of the accident. Also crucial to determining the cause of death is the process of looking into whether the people involved in the accident had any diseases that might affect their driving performance or were under the influence of alcohol or drugs. In order to reduce the number of people killed in traffic accidents, it will be important to promote joint research uniting forensic medicine, clinical medicine, automotive engineering, and road engineering, take measures to limit the impact of inebriated pedestrians and pedestrians suffering from dementia, and ensure proper screening of alcohol and illegal drug consumption in drivers.

  16. A fatal case of oleandrin poisoning.

    Wasfi, Ibrahim A; Zorob, Omar; Al katheeri, Nawal A; Al Awadhi, Anwar M


    The study presents a case of fatal poisoning with oleander leaves in an adult diabetic male. After repeated vomiting, and gastrointestinal distress the patient was admitted at the hospital with cardiac symptoms 1h after the ingestion. Urine samples were assayed immunochemically and by GC-MS for drugs of abuse and for general toxicological screen. Blood was analyzed for alcohol and volatiles by static head space GC-MS. Blood and oleander leaves were analyzed by LC-MS/MS for oleandrin and related compounds, the main cardiac glycosides of Nerium oleander. Oleandrin was detected by LC-MS/MS in the blood sample at a concentration of approximately 10 ng/ml. Another cardiac glycoside with pseudo-molecular ion of m/z 577, a likely structural isomer of oleandrin, was also detected in the blood and oleander leaves. However, by using the response as a function of concentration for oleandrin, this cardiac glycoside was roughly estimated at a concentration of approximately 10 ng/ml in the deceased blood. This would give a total fatal blood concentration of cardiac glycosides of about approximately 20 ng/ml in the deceased blood.

  17. Salade malade: malignant ventricular arrhythmias due to an accidental intoxication with Aconitum napellus.

    Weijters, B J; Verbunt, R J A M; Hoogsteen, J; Visser, R F


    Intoxication with Aconitum napellus is rare in our regions. Aconite alkaloids can cause ventricular arrhythmia by a prolonged activation of sodium channels. Because the margin of safety is low between the analgesic and toxic dose, intoxication is not rare when Aconite is used in herbal medicine. We present a case in which a 39-year-old male was accidentally intoxicated with Aconite. Even though no antidote or adequate therapy is available he was successfully resuscitated. (Neth Heart J 2008;16:96-9.).

  18. Levosimendan as Treatment Option in Severe Verapamil Intoxication: A Case Report and Review of the Literature

    Mirjam Osthoff


    Levosimendan, an inotropic agent, that enhances myofilament response to calcium, increases myocardial contraction and could therefore be beneficial in verapamil intoxication. Here, we report the case of a 60-year-old patient with clinically severe verapamil poisoning who presented with shock, bradycardia, and sopor. Standard therapy including high-dose inotropes failed to ameliorate the signs of intoxication. But additional therapy with levosimendan led to rapid improvement. Based on this observation, the literature is reviewed focusing on utilization of levosimendan in the treatment of calcium channel blocker overdose. We suggest to consider levosimendan as additional treatment option in patients with cardiovascular shock due to verapamil intoxication that are refractory to standard management.

  19. Charcoal Hemoperfusion vs. High Efficiency Hemodialysis in Carbamazepine Intoxication: A Case Report

    Arzu KAHVECİ


    Full Text Available Carbamazapine is a commonly used antiepileptic agent. Neurological abnormalities which can progress to coma, arrhythmias, respiratory depression and eye abnormalities such as nystagmus are seen in an intoxication setting. There is no specific antidote for the treatment of carbamazepine intoxication and supportive therapy is generally recommended. Carbamazepine is not removed through conventional hemodialysis as it highly bound to proteins. Charcoal hemoperfusion has been reported as the standard effective treatment method. Herein we report a 23-year-old woman with high dose carbamazepine overdose treated with high efficiency hemodialysis and charcoal hemoperfusion. We also discuss a comparison of the methods used for carbamazepine intoxication.

  20. Tuberculosis treatment adherence and fatality in Spain

    Vidal Rafael


    Full Text Available Abstract Background The adherence to long tuberculosis (TB treatment is a key factor in TB control programs. Always some patients abandon the treatment or die. The objective of this study is to identify factors associated with defaulting from or dying during antituberculosis treatment. Methods Prospective study of a large cohort of TB cases diagnosed during 2006-2007 by 61 members of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR. Predictive factors of completion outcome (cured plus completed treatment vs. defaulters plus lost to follow-up and fatality (died vs. the rest of patients were based on logistic regression, calculating odds ratios (OR and 95% confidence intervals (CI. Results Of the 1490 patients included, 29.7% were foreign-born. The treatment outcomes were: cured 792 (53.2%, completed treatment 540 (36.2%, failure 2 (0.1%, transfer-out 33 (2.2%, default 27 (1.8%, death 27 (1.8%, lost to follow-up 65 (4.4%, other 4 (0.3%. Completion outcome reached 93.5% and poor adherence was associated with: being an immigrant (OR = 2.03; CI:1.06-3.88, living alone (OR = 2.35; CI:1.05-5.26, residents of confined institutions (OR = 4.79; CI:1.74-13.14, previous treatment (OR = 2.93; CI:1.44-5.98, being an injecting drug user (IDU (OR = 9.51; CI:2.70-33.47 and treatment comprehension difficulties (OR = 2.93; CI:1.44-5.98. Case fatality was 1.8% and it was associated with the following variables: age 50 or over (OR = 10.88; CI:1.12-105.01, retired (OR = 12.26;CI:1.74-86.04, HIV-infected (OR = 9.93; CI:1.48-66.34, comprehension difficulties (OR = 4.07; CI:1.24-13.29, IDU (OR = 23.59; CI:2.46-225.99 and Directly Observed Therapy (DOT (OR = 3.54; CI:1.07-11.77. Conclusion Immigrants, those living alone, residents of confined institutions, patients treated previously, those with treatment comprehension difficulties, and IDU patients have poor adherence and should be targeted for DOT. To reduce fatality rates, stricter monitoring is required

  1. Adolescent alcohol intoxication in the dutch hospital departments of pediatrics: A 2-year comparison study

    Hoof, J.J. van; Lely, N. van der; Bouthoorn, S.H.; Dalen, W.E. van; Pereira, R.R.


    Purpose: To monitor the prevalence of, and the circumstances leading to, adolescent alcohol intoxication admissions in Dutch hospital departments of pediatrics. Methods: Data were collected in 2007 and 2008, using the Dutch Pediatric Surveillance System, in which pediatricians received questionnaire

  2. Delayed Encephalopathy of Carbon Monoxide Intoxication and Treatment with Hyperbaric Oxygen: A Case Report

    Fatma Polat


    Full Text Available Delayed encephalopathy (DE is a neuropsychiatric syndrome that can arise generally within 20 days of acute carbon monoxide (CO intoxication after apparent recovery and involves variable degrees of cognitive deficits, personality changes, movement disorders and focal neurologic deficits. We report a 35-year-old female patient with delayed encephalopathy due to CO intoxication, presenting with cognitive impairment and mild parkinsonism despite receiving hyberbaric oxigen therapy (HBO. Magnetic resonance imaging showed abnormal signal intensity and decreased diffusivity at both caudate nuclei and globus pallidus. She continued to receive additional HBO therapy and complete recovery was reached within six months. The positive effect of early HBO therapy of selected patients in reversing the acute effects of CO intoxication is appearant. We here also review the beneficial effect of HBO in preventing or limitating the late neurocognitive deficits associated with severe CO intoxication.

  3. Levosimendan as treatment option in severe verapamil intoxication: a case report and review of the literature.

    Osthoff, Mirjam; Bernsmeier, Christine; Marsch, Stephan C; Hunziker, Patrick R


    Cardiovascular shock due to verapamil intoxication is often refractory to standard resuscitation methods. Recommended therapy includes prevention of further absorption of the drug, inotropic therapy, calcium gluconate, and hyperinsulinemia/euglycemia therapy. Often further measures are needed such as ventricular pacing or mechanical circulatory support. Still, mortality remains high. Levosimendan, an inotropic agent, that enhances myofilament response to calcium, increases myocardial contraction and could therefore be beneficial in verapamil intoxication. Here, we report the case of a 60-year-old patient with clinically severe verapamil poisoning who presented with shock, bradycardia, and sopor. Standard therapy including high-dose inotropes failed to ameliorate the signs of intoxication. But additional therapy with levosimendan led to rapid improvement. Based on this observation, the literature is reviewed focusing on utilization of levosimendan in the treatment of calcium channel blocker overdose. We suggest to consider levosimendan as additional treatment option in patients with cardiovascular shock due to verapamil intoxication that are refractory to standard management.

  4. Drinking game participation, gender performance and normalization of intoxication among Nigerian university students

    Emeka Dumbili


    Conclusion: DGs appear to normalize heavy drinking and the culture of intoxication on this campus. Measures to monitor alcohol sales outlets around campuses and interventions that target students' leisure spaces should be developed.

  5. Fatal primary meningoencephalitis caused by Naegleria fowleri.

    Shariq, Ali; Afridi, Faisal Iqbal; Farooqi, Badar Jahan; Ahmed, Sumaira; Hussain, Arif


    Naegleria fowleri is a free living parasite which habitats in fresh water reservoirs. It causes a fatal nervous system infection known as primary amoebic meningoencephalitis by invading through cribriform plate of nose and gaining entry into brain. We report a case of primary amoebic meningoencephalitis caused by Naegleria fowleri in Karachi, Pakistan, in a 42 years old male poultry farm worker having no history of swimming. Clinical course was fulminant and death occurred within one week of hospital admission. Naegleria fowleri was detected by wet mount technique in the sample of cerebrospinal fluid collected by lumbar puncture of patient. This is a serious problem and requires immediate steps to prevent general population to get affected by this lethal neurological infection.

  6. Two fatal tiger attacks in zoos.

    Tantius, Britta; Wittschieber, Daniel; Schmidt, Sven; Rothschild, Markus A; Banaschak, Sibylle


    Two captive tiger attacks are presented that took place in Cologne and Münster zoos. Both attacks occurred when the handlers, intent on cleaning the enclosures, entered whilst the tigers accidently retained access to the location, and thus defended their territory against the perceived intruders. Both victims suffered fatal neck injuries from the bites. At Münster, colleagues managed to lure the tiger away from its victim to enable treatment, whilst the Cologne zoo tiger had to be shot in order to allow access to be gained. Whilst it was judged that human error led to the deaths of the experienced zookeepers, the investigation in Münster was closed as no third party was found to be at fault, whereas the Cologne zoo director was initially charged with being negligent. These charges were subsequently dismissed as safety regulations were found to be up to date.

  7. Fatal exit the automotive black box debate

    Kowalick, Tom


    "Fatal Exit: The Automotive Black Box Debate cuts through thirty years of political wrangling and institutional biases to provide an argument for the Motor Vehicle Event Data Recorder (MVEDR). This automotive equivalent of an airplane's flight recorder or black box is intended to solve the mysteries of car crashes and improve the safety of our roads. The reader is taken inside the automotive industry and the government highway safety establishment to foster an understanding of the politics and the positions on all sides of this safety debate. The author takes an unbiased approach, chronologically presenting each argument and uncovering the agendas and mandates of each of the stakeholders." "This publication is essential reading for all consumers who need to have their voices heard on this critical issue, as well as for attorneys, public safety advocates, public policy administrators, engineers, automotive professionals, journalists, and insurance executives."--Jacket.

  8. Fatal overdose of iron tablets in adults.

    Abhilash, Kundavaram P P; Arul, J Jonathan; Bala, Divya


    Acute iron toxicity is usually seen in children with accidental ingestion of iron-containing syrups. However, the literature on acute iron toxicity with suicidal intent in adults is scant. We report, the first instance of two adults with fatal ingestion of a single drug overdose with iron tablets from India. Two young adults developed severe gastro-intestinal bleeding and fulminant hepatic failure 48 h after deliberate consumption of large doses of iron tablets. Serum iron levels measured 36 h after ingestion were normal presumably due to the redistribution of iron to the intracellular compartment. Despite aggressive supportive management in medical intensive care unit of a tertiary care hospital, the patients succumbed to the toxic doses of iron.

  9. When attempts at robbing prey turn fatal.

    Dejean, Alain; Corbara, Bruno; Azémar, Frédéric; Carpenter, James M


    Because group-hunting arboreal ants spread-eagle insect prey for a long time before retrieving them, these prey can be coveted by predatory flying insects. Yet, attempting to rob these prey is risky if the ant species is also an effective predator. Here, we show that trying to rob prey from Azteca andreae workers is a fatal error as 268 out of 276 potential cleptobionts (97.1 %) were captured in turn. The ant workers hunt in a group and use the "Velcro®" principle to cling firmly to the leaves of their host tree, permitting them to capture very large prey. Exceptions were one social wasp, plus some Trigona spp. workers and flies that landed directly on the prey and were able to take off immediately when attacked. We conclude that in this situation, previously captured prey attract potential cleptobionts that are captured in turn in most of the cases.

  10. Measurement and dimension of road fatality in Brunei.

    Haque, Mohammed Ohidul


    In this article, we have investigated the pattern of road fatality in Brunei. It is seen from this analysis that road fatality in Brunei was one of the highest in the world in the early 1990s, but has been significantly reduced over the years, and is now one of the lowest in the world. Preliminary investigation shows that young male drivers are responsible for most road fatalities in Brunei. We have also fitted a linear regression model and found that road fatality is significantly positively related to people aged 18-24 years and new registered vehicles, both of which are expected to grow with the growth of population and economic development. Hence, road fatality in Brunei is also expected to grow unless additional effective road safety countermeasures are introduced and implemented to reduce road toll. Negative coefficient is observed for trend variable, indicating the reduction of road fatality due to the combined effects of improvements of vehicle safety, road design, medical facilities and road safety awareness among road user groups. However, short-term road fatality analysis based on monthly data indicates that the coefficient of the trend variable is positive, implying that in recent months road fatalities are increasing in Brunei, which is supported by media reports. We have compared Brunei's road fatality data with Australia, Singapore and Malaysia and found that Brunei's road fatality rate is lower than Singapore and Malaysia, but higher than Australia. This indicates that there are still opportunities to reduce road fatalities in Brunei if additional effective road safety strategies are implemented like in Australia without interfering in the economic and social development of Brunei.

  11. Identify Melatonin as a Novel Therapeutic Reagent in the Treatment of 1-Bromopropane(1-BP) Intoxication


    Abstract 1-Bromopropane (1-BP) has been used as an alternative for fluoride compounds and 1-BP intoxication may involve lung, liver, and central neural system (CNS). Our previous studies showed that 1-BP impaired memory ability by compromising antioxidant cellular defenses. Melatonin is a powerful endogenous antioxidant, and the objective of this study was to explore the therapeutic role of melatonin in the treatment of 1-BP intoxication. Rats were intragastrically treated with 1-BP with or w...

  12. Acute lead intoxication in a female battery worker: Diagnosis and management

    Hadjichristodoulou Christos; Rachiotis George; Dounias George


    Abstract Lead is a significant occupational and environmental hazard. Battery industry is one of the settings related to lead intoxication. Published information on the use of oral chelating agents for the treatment of anaemia in the context of acute lead intoxication is limited. The patient was a 33 year immigrant female worker in a battery manufacture for 3 months. She complained for malaise that has been developed over the past two weeks. Pallor of skin and conjunctiva was the only sign fo...

  13. Comparative Evaluation of Carbamates as Prophylactic Agents against Organophosphate Intoxication Rats

    A. K. Chatterjee


    Full Text Available Investigates the effects of two well-known carbamates, physostigmine and pyridostigmine against organophosphorous compound and nerve gas toxicity. Physostigmine pretreatment for 30 min enhanced the survival time of rats against DFP intoxication whereas it did not have any effect with sarin poisoning. However, pyridostigmine pretreatment did not produce any significant effect on survival time either against DFP or sarin intoxication. Treatment with atropine along with carbamates further enhanced significantly the survival time against DFP poisoning.

  14. A case of bilateral sudden hearing loss and tinnitus after salicylate intoxication.

    Kim, Sang Min; Jo, Joon-Man; Baek, Moo Jin; Jung, Kyu Hwan


    Salicylate, the active ingredient of aspirin can cause sensorineural hearing loss and tinnitus when plasma concentrations reach a critical level. The ototoxic mechanisms of salicylate remain unclear but hearing and tinnitus usually recovers a few days after intoxication. There have been few reports of salicylate-induced ototoxicity in Korea, and the majority is caused by a low dose of aspirin. Herein, we report a case of sudden hearing loss and tinnitus after acute salicylate intoxication and review recent updates on salicylate ototoxicity.

  15. The Methods of Committing and Alcohol Intoxication of Suicides in Southwestern Croatia from 1996 to 2005

    Čoklo, Miran; Stemberga, Valter; Cuculić, Dražen; Šoša, Ivan; Jerković, Romana; Bosnar, Alan


    Alcohol is the psychoactive substance most frequently associated with suicidal behavior.We hypothesized that the level of alcohol intoxication and the choice of specific methods of committing suicide are related. Suicides in the Southwestern Croatia in a 10-year period, especially regarding the method of committing and alcohol intoxication, were analyzed. Ten various methods of committing suicide were recorded. The average blood alcohol concentration at the moment of suicide was 0...

  16. [Early Detection of Manganese Intoxication Based on Occupational History and T1-weighted MRI].

    Fukutake, Toshio; Yano, Hajime; Kushida, Ryutaro; Sunada, Yoshihide


    Manganese regulates many enzymes and is essential for normal cell function. Chronic manganese intoxication has an insidious and progressive course terminating to atypical parkinsonism with little therapeutic efficacy. For subjects with chronic manganese exposure such as welders, manganese intoxication can be detected early based on the presence of hyperintensity in the globus pallidus on T(1)-weighted MRI and abnormally high urinary excretion of manganese with a chelating agent even in cases of normal serum/urine level of manganese.

  17. Lung function and risk of fatal and non-fatal stroke. The Copenhagen City Heart Study

    Truelsen, T; Prescott, E; Lange, P;


    adjustment for potential confounders: sex, age, smoking, inhalation, body mass index, systolic blood pressure, triglycerides, physical activity in leisure time, education, diabetes mellitus, and antihypertensive treatment. RESULTS: We found an inverse association between FEV1 and risk of first-time stroke....... For each 10% decrease in FEV1 in percentage of expected, the relative risk (RR) increased 1.05 (95% CI : 1.00-1.09, P = 0.03). This represents an approximately 30% higher risk of stroke in the group of people with the lowest lung function as compared to the group with the highest lung function...... function groups. CONCLUSIONS: This study shows that reduced lung function measured in percentage of predicted FEV1 is a predictor of first-time stroke and fatal stroke independent of smoking and inhalation. The high risk of fatal first-ever stroke in the group of people with low lung function may...


    S. R. Pidruchna


    Full Text Available Background.  Associated injury is a worldwide social and economic problem. Age related aspects of endogenous intoxication are not studied comprehensively. Annually, from 44 000 to 65 000 citizens die because of traumatic injuries. As a result, this number increased by 32.6% for the last 10 years.     The detoxification system, as a component of the functional systems of the organism, experiences significant changes in case of polytrauma. Objective. The study was aimed to discover pathogenetic peculiarities of the multiple trauma in age aspect in different disease periods and to explore the level of endogenous intoxication in this condition. Methods. The experiments were performed on 72 white male rats aged 3, 6 and 12 months, which underwent simulation of severe skeletal trauma and examination of the contents of middle mass molecules and endogenous intoxication index (markers of endogenous intoxication in 1, 4 and 24 hours after the associated injury. Results. The most significant increase of the middle mass molecules was fixed in 24 hours after modeling of severe skeletal injuries in all groups of animals, especially it was the most pronounced in 12-month-old animals. The erythrocyte intoxication index reached the highest level in 4 hours after the injury, its increase was most significant in sexually mature adult animals. Conclusion. A significant increasing of endogenous intoxication markers in 12-month-old rats, if compared to 3- and 6-month-old animals, can be caused by the decrease in compensatory protection mechanisms.

  19. Pathophysiological Features of Endogenous Intoxication in Pregnant Women with Arterial Hypertension

    N. V. Kabanova


    Full Text Available Objective: to determine the nature and specific features of development of endogenous intoxication in pregnant women with arterial hypertension. Subjects and materials. Humoral extracellular fluid volume regulation, partial renal functions, placental hormonal function, membranous lipid peroxidation activity, antiradical defense, the parameters of central hemodynamics, endogenous intoxication, and a biochemical coagulogram were studied and differential blood count with the leukocytic ratio indices was estimated in 172 pregnant females with arterial hypertension and 54 healthy pregnant ones in the third trimester. The statistical package «Stadia» was applied. Results. Arterial hypertension caused by pregnancy was ascertained to involve pathogenetically different types: low-, normal-, and high-renin ones. In pregnant women with arterial hypertension, the general pathogenetic homeostatic changes were placental hormonal imbalance, activated membranous lipid peroxidation, impaired lymph outflow, sodium and water retention, hepatic and renal failure, and endogenous intoxication. Conclusion. Placental ischemia appearing as placental hormonal imbalance (extrarenal pressor system was accompanied by a compensatory humoral response: arterial hypertension and metabolic disturbances. Changes in medium-weight molecule 280, leukocytic intoxication index, erythrocytic sorption capacity, and Paramecium test, by confirming the presence of endogenous intoxication in pregnant females with arterial hypertension, were caused by a type of arterial hypertension (by the hemodynamic profile and the type of impaired partial renal functions. Key words: pregnancy, arterial hypertension, endogenous intoxication.

  20. Intoxication due to Papaver rhoeas (Corn Poppy: Five Case Reports

    Yahya Kemal Günaydın


    Full Text Available Introduction. In this paper, we aimed to present five Papaver rhoeas intoxication cases, which is very rare in the literature. Case 1. A 35-year-old female patient was admitted to our emergency room with the complaints of nausea, restlessness, and dyspnea developing 3 hours after eating Papaver rhoeas. On physical examination, her general condition was moderate; she was conscious and the vital findings were normal. The pupils were myotic. She was transferred to the toxicology intensive care unit as she experienced a generalized tonic clonic seizure lasting for three minutes. Case 2. A 41-year-old female patient was brought to our emergency room by 112 ambulance as she had contractions in her arms and legs, unconsciousness, and foam coming from her mouth two hours after Papaver rhoeas ingestion. On physical examination, she was confused, the pupils were myotic, and she was tachycardic. Arterial blood gases analysis revealed lactic acidosis. Case 3. A 38-year-old female patient was admitted to our emergency room with complaints of nausea and vomiting two hours after ingestion of Papaver rhoeas. Her physical examination and tests were normal. Case 4. A 34-year-old male patient was admitted to our emergency room with complaints of numbness and loss of power in his arms and legs one hour after Papaver rhoeas ingestion. He was hospitalized at the toxicology intensive care unit for follow-up and treatment. Dyspnea and bradycardia developed on the follow-up. The oxygen saturation without oxygen support was 90%. ECG revealed sinus bradycardia. The cardiac enzymes did not increase. Case 5. A 42-year-old female patient was brought to our emergency room by 112 ambulance with contractions in her arms and legs and unconsciousness two hours after Papaver rhoeas ingestion. On her physical examination, she was confused and the pupils were myotic. Arterial blood gases analysis revealed lactic acidosis. Conclusion. All patients were followed up for a few days and

  1. Has the great recession and its aftermath reduced traffic fatalities?

    Noland, Robert B; Zhou, Yuhan


    An analysis of state-level data from 1984 to 2014 provides evidence on the relationship between economic recessions and US traffic fatalities. While there are large reductions associated with decreases in household median income, other policy variables tend to have additional and in some cases, larger effects. An increase in the inequality of the income distribution, measured by the Gini index, has reduced traffic fatalities. Graduated licensing policies, cell phone laws, and motorcycle helmet requirements are all associated with reductions in fatalities. Other factors include a proxy for medical technology, and access to emergency medical services (based on the percent of vehicle miles traveled in rural areas); reductions in the latter accounted for a substantial reduction in fatalities and is likely another indicator of reduced economic activity. Changes in the road network, mainly increases in the percent of collector roads has increased fatalities. Population growth is associated with increased traffic fatalities and changes in age cohorts has a small negative effect. Overall, results suggest that there has been a beneficial impact on traffic fatalities from reduced economic activity, but various policies adopted by the states have also reduced traffic fatalities. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Danish diving-related fatalities 1999-2012

    Vinkel, Julie; Bak, Peter; Hyldegaard, Ole


    AIM: The purpose was to explore causative tendencies among diving fatalities to prevent similar injuries in the future. METHODS: We report 33 fatal diving injuries that occurred among Danish divers during the period 1999-2012 in Scandinavian waters. The study was performed as a retrospective over...

  3. Bordetella bronchiseptica and fatal pneumonia of dogs and cats

    Bordetella bronchiseptica frequently causes nonfatal tracheobronchitis, but its role in fatal pneumonia is less well-studied. The objectives of this study were to identify the frequency of Bordetella bronchiseptica infection in fatal cases of bronchopneumonia in dogs and cats and to compare the diag...

  4. Hispanic employees in the workplace: higher rate of fatalities.

    Johnson, Shelly; Ostendorf, Judith


    This article reviews the higher fatality and injury rates among the Hispanic population in the United States, whether legal immigrants, citizens, or illegal immigrants; reviews the current government and private industry regulations and safety programs; proposes additional legislation or programs; and describes the role of the occupational and environmental health nurse in reducing injuries and fatalities in this population.

  5. Analysis of fatal road traffic crashes in Ghana.

    Ackaah, Williams; Adonteng, David O


    The major objective of this study was to identify the risk factors associated with fatal road traffic crashes (RTCs) and to propose remedial measures to address them. Fatal RTC data for the period 2005-2007 in Ghana were analysed using the Micro-computer Accident Analysis Package (MAAP) software. Other transport-related research works were reviewed and incorporated in the article. The study showed that pedestrians accounted for 42% of all road traffic fatalities and nearly one-third (33%) of these crashes occurred during the early night-time hours. Children alone constituted almost one-third of all pedestrian fatalities. The occupants of goods vehicles accounted for 12% of all road traffic fatalities although goods vehicles constitute just about 9% of the total motor vehicle population in Ghana. Pedestrians, especially children bear a disproportionately high share of road traffic fatalities in Ghana. The risk of being killed as a pedestrian in traffic is exacerbated during night time. Excessive vehicular speeds, inappropriate use of goods vehicles for passenger transport, excessive loading and inadequate trauma care are the key contributory risk factors to the high number of road traffic fatalities. Concerted efforts spanning education, engineering, enforcement and trauma care are needed to stem the rise in fatal crashes in Ghana.

  6. Fatal poisonings in Oslo: a one-year observational study

    Heyerdahl Fridtjof


    Full Text Available Abstract Background Acute poisonings are common and are treated at different levels of the health care system. Since most fatal poisonings occur outside hospital, these must be included when studying characteristics of such deaths. The pattern of toxic agents differs between fatal and non-fatal poisonings. By including all poisoning episodes, cause-fatality rates can be calculated. Methods Fatal and non-fatal acute poisonings in subjects aged ≥16 years in Oslo (428 198 inhabitants were included consecutively in an observational multi-centre study including the ambulance services, the Oslo Emergency Ward (outpatient clinic, and hospitals, as well as medico-legal autopsies from 1st April 2003 to 31st March 2004. Characteristics of fatal poisonings were examined, and a comparison of toxic agents was made between fatal and non-fatal acute poisoning. Results In Oslo, during the one-year period studied, 103 subjects aged ≥16 years died of acute poisoning. The annual mortality rate was 24 per 100 000. The male-female ratio was 2:1, and the mean age was 44 years (range 19-86 years. In 92 cases (89%, death occurred outside hospital. The main toxic agents were opiates or opioids (65% of cases, followed by ethanol (9%, tricyclic anti-depressants (TCAs (4%, benzodiazepines (4%, and zopiclone (4%. Seventy-one (69% were evaluated as accidental deaths and 32 (31% as suicides. In 70% of all cases, and in 34% of suicides, the deceased was classified as drug or alcohol dependent. When compared with the 2981 non-fatal acute poisonings registered during the study period, the case fatality rate was 3% (95% C.I., 0.03-0.04. Methanol, TCAs, and antihistamines had the highest case fatality rates; 33% (95% C.I., 0.008-0.91, 14% (95% C.I., 0.04-0.33, and 10% (95% C.I., 0.02-0.27, respectively. Conclusions Three per cent of all acute poisonings were fatal, and nine out of ten deaths by acute poisonings occurred outside hospital. Two-thirds were evaluated as accidental

  7. Uber and Metropolitan Traffic Fatalities in the United States.

    Brazil, Noli; Kirk, David S


    Uber and similar rideshare services are rapidly dispersing in cities across the United States and beyond. Given the convenience and low cost, Uber has been characterized as a potential countermeasure for reducing the estimated 121 million episodes of drunk driving and the 10,000 resulting traffic fatalities that occur annually in the United States. We exploited differences in the timing of the deployment of Uber in US metropolitan counties from 2005 to 2014 to test the association between the availability of Uber's rideshare services and total, drunk driving-related, and weekend- and holiday-specific traffic fatalities in the 100 most populated metropolitan areas in the United States using negative binomial and Poisson regression models. We found that the deployment of Uber services in a given metropolitan county had no association with the number of subsequent traffic fatalities, whether measured in aggregate or specific to drunk-driving fatalities or fatalities during weekends and holidays.

  8. Decision Tree Model for Non-Fatal Road Accident Injury

    Fatin Ellisya Sapri


    Full Text Available Non-fatal road accident injury has become a great concern as it is associated with injury and sometimes leads to the disability of the victims. Hence, this study aims to develop a model that explains the factors that contribute to non-fatal road accident injury severity. A sample data of 350 non-fatal road accident cases of the year 2016 were obtained from Kota Bharu District Police Headquarters, Kelantan. The explanatory variables include road geometry, collision type, accident time, accident causes, vehicle type, age, airbag, and gender. The predictive data mining techniques of decision tree model and multinomial logistic regression were used to model non-fatal road accident injury severity. Based on accuracy rate, decision tree with CART algorithm was found to be more accurate as compared to the logistic regression model. The factors that significantly contribute to non-fatal traffic crashes injury severity are accident cause, road geometry, vehicle type, age and collision type.

  9. Fatal train accidents on Europe's railways: 1980-2009.

    Evans, Andrew W


    This paper presents an analysis of fatal train accident rates and trends on Europe's main line railways from 1980 to 2009. The paper uses a new set of data for the European Union together with Norway and Switzerland, assembled partly under the auspices of the European Railway Agency and partly on the author's own account. The estimated overall trend in the number of fatal train collisions and derailments per train-kilometre is -6.3% per year from 1990 to 2009, with a 95% confidence interval of -8.7% to -3.9%. The estimated accident rate in 2009 is 1.35 fatal collisions or derailments per billion train-kilometres, giving an estimated mean number of fatal accidents in 2009 of 6.0. The overall number of fatalities per fatal accident in 1990-2009 is 4.10, with no apparent long term change over time, giving an estimated mean of 24.6 fatalities per year in train collisions and derailments in 2009. There are statistically significant differences in the fatal train accident rates and trends between the different European countries, although the estimates of the rates and trends for many individual countries have wide confidence limits. The distribution of broad causes of accidents appears to have remained unchanged over the long term, so that safety improvements appear to have been across the board, and not focused on any specific cause. The most frequent cause of fatal train collisions and derailments is signals passed at danger. In contrast to fatal train collisions and derailments, the rate per train-kilometre of serious accidents at level crossings remained unchanged in 1990-2009. The immediate causes of most of the serious level crossing accidents are errors or violations by road users. Copyright © 2010 Elsevier Ltd. All rights reserved.

  10. Diagnostic and therapeutic approach for acute paraquat intoxication.

    Gil, Hyo-wook; Hong, Jung-Rak; Jang, Si-Hyong; Hong, Sae-Yong


    Paraquat (PQ) has known negative human health effects, but continues to be commonly used worldwide as a herbicide. Our clinical data shows that the main prognostic factor is the time required to achieve a negative urine dithionite test. Patient survival is a 100% when the area affected by ground glass opacity is <20% of the total lung volume on high-resolution computed tomography imaging 7 days post-PQ ingestion. The incidence of acute kidney injury is approximately 50%. The average serum creatinine level reaches its peak around 5 days post-ingestion, and usually normalizes within 3 weeks. We obtain two connecting lines from the highest PQ level for the survivors and the lowest PQ level among the non-survivors at a given time. Patients with a PQ level between these two lines are considered treatable. The following treatment modalities are recommended to preserve kidney function: 1) extracorporeal elimination, 2) intravenous antioxidant administration, 3) diuresis with a fluid, and 4) cytotoxic drugs. In conclusion, this review provides a general overview on the diagnostic procedure and treatment modality of acute PQ intoxication, while focusing on our clinical experience.

  11. Polyneuropathy induced by n-hexane intoxication in Taiwan.

    Huang, Chin-Chang


    n-Hexane and methyl n-butyl ketone share a common metabolite, 2,5-hexanedione, a potent neurotoxin. Neurotoxic effects to both peripheral and central nervous systems may occur after occupational exposure or recreational abuse of n-hexane. Initial clinical manifestations include numbness and tingling sensation in the toes and fingers, followed by progressive weakness and areflexia, particularly in the distal limbs. Chronic low-dose n-hexane exposure, often observed in industrial workers, apparently causes axonal loss with sensory impairment. Subacute high-dose n-hexane exposure, often observed in glue-sniffers, can cause axonal swelling and secondary demyelination with muscle wasting and weakness. Electrophysiological studies demonstrate prominent prolongation of distal latencies, slowing of nerve conduction velocities, and conduction block with temporal dispersion particularly in severely intoxicated patients. Pathological hallmarks include giant axonal swelling with secondary demyelination and relative loss of large myelinated fibers. Giant axons are accumulated by 10 nm neurofilaments. The clinical course tends to be biphasic with "coasting" for 2-3 months, followed by a slow recovery for about 1-2 years after cessation of exposure to n-hexane. Prognosis is usually favorable. Severely affected patients may develop sequelae of muscle wasting, foot drop, and spasticity. Increased awareness of the n-hexane neurotoxicity in industrial workers and glue sniffers as well as use of safe solvents and adequate ventilation systems are important for preventing n-hexane toxicity.

  12. Assisted suicide by fentanyl intoxication due to excessive transdermal application.

    Juebner, Martin; Fietzke, Mathias; Beike, Justus; Rothschild, Markus A; Bender, Katja


    Herein, we report a case of an assisted suicide committed by application of 34 matrix-based fentanyl-containing transdermal therapeutic systems (TTS) with different release rates. The TTS were supplied by the husband but administered by the deceased herself. Besides routine systematic toxicological analysis (STA), the concentrations of fentanyl and norfentanyl were determined in the blood (femoral and heart), urine, stomach content, brain, lung tissue, musculus iliopsoas, liver, kidney, bile and in some of the used TTS by LC-MS/MS. Blood levels of fentanyl were 60.6 μg/L in femoral blood and 94.1 μg/L in heart blood. These concentrations are in good concordance with levels described in cases with accidental or lethal suicidal fentanyl patch application. The organ distribution indicates an influence of post-mortem redistribution. The levels of residual fentanyl in the TTS were also determined. STA furthermore revealed supratherapeutic levels of bromazepam. Thus, the cause of death was a combination of fentanyl and bromazepam intoxication. However, considering the determined levels of fentanyl and norfentanyl in the entire set of specimens and the high toxicity in comparison to bromazepam, fentanyl was the leading toxic noxa.

  13. Intoxication delirium following use of synthetic cathinone derivatives.

    Penders, Thomas M; Gestring, Richard E; Vilensky, Dmitry A


    In published reports of hallucinatory delirium following use of "bath salts" analytic laboratory testing has demonstrated the synthetic cathinone derivative methylenedioxypyrovalerone (MDPV). MDPV can cause a false-positive screening immunoassay result for phencyclidine (PCP). Patients using MDPV are prone to development of the syndrome of excited delirium (ExD), a condition also described with PCP. This review summarize reports from several series of cases of delirium associated with MDPV emphasizing the features of both intoxication and excited delirium. Literature review and clinical description of a series of patients from Eastern North Carolina. MDPV is likely the responsible agent in production of both toxic and excited delirium syndromes identified with the recreational use of "bath salts" in the United States over the past two years. Patients using MDPV are prone to the development of toxic delirum with some developing ExD. a condition associated with considerable risk for serious medical morbidity. Commonly used interventions directed at extreme agitation and paranoia may exacerbate the pathophysiology of ExD.

  14. Acute interstitial nephritis with acetaminophen and alcohol intoxication

    Alexopoulou Iakovina


    Full Text Available Abstract Drug-induced acute interstitial nephritis (AIN represents a growing cause of renal failure in current medical practice. While antimicrobials and non-steroidal anti-inflammatory drugs are typically associated with drug-induced AIN, few reports have been made on the involvement of other analgesics. We report our experience in managing a 17-year-old female with AIN and subsequent renal injury following an acetaminophen overdose in conjunction with acute alcohol intoxication. It is well established that acetaminophen metabolism, particularly at high doses, produces reactive metabolites that may induce renal and hepatic toxicity. It is also plausible however, that such reactive species could instead alter renal peptide immunogenicity, thereby inducing AIN. In the following report, we review a possible mechanism for the acetaminophen-induced AIN observed in our patient and also discuss the potential involvement of acute alcohol ingestion in disease onset. The objective of our report is to increase awareness of healthcare professionals to the potential involvement of these commonly used agents in AIN pathogenesis.

  15. Mad honey intoxication: A systematic review on the 1199 cases.

    Silici, Sibel; Atayoglu, A Timucin


    Mad honey, produced by honeybees from the nectars of Rhododendron genus (R. ponticum and R. luteum) flowers, is widely used in indigenous medicine, especially in the treatment of hypertension and sexual dysfunction. However, the consumption of this honey can result in intoxication soon after. The diagnosis of honey poisoning and a full understanding of its treatment is important for both effective and immediate treatment, and also for the prevention of unnecessary costs. Upon the evaluation of approximately 34 years of case reports between 1981 and 2014, it was found that the cases of poisoning were more frequently reported in males (75.17%) and between the ages 41 to 65. The most common complaints related to honey poisoning were dizziness, nausea, presyncope and the ECG findings were: sinus bradycardia (79.58%), complete atrioventricular block (45.83%), atrioventricular block (30.91%), ST-segment elevation (22.63%), and nodal rhythm (11.27%), As a result of the evaluation of 1199 cases, it was found that no deaths were reported. The patients were most frequently treated with 0.5 mg atropine (37.79%), 1 mg atropine (49.73%), salin (iv fluid) (65.35%), and generally the patients were discharged within 24 h after recovery.

  16. High mortality due to accidental salinomycin intoxication in sheep

    Ashrafihelan Javad


    Full Text Available In February 2012, 100% mortality was reported in a herd with 79 local sheep that were kept around of Abhar, Northwest of Iran. The ration for adult sheep was daily mixed (40 kg straw, 25 kg wheat and 2 kg Vit-C premix and accidentally 1 500 g of salinomycin (Salinomycin 12% Premix; Aras Bazar Laboratories, Iran had been added to the ration (22388 mg/kg = 22388 ppm and overnight was fed to herd. At the morning, 78 sheep were founded dead and one of them showed convulsive seizures. Postmortem examination revealed pulmonary congestion and edema, hemorrhages in abomasum, large pale kidney and white streak lines in myocardium. Main histopathologic lesions were extensive subepicardial and intercardiomyofibers hemorrhages, extensive cardiomyolysis and myocarditis in heart, severe hyperemia and extensive acute tubular necrosis (ATN in kidneys and focal necrosis and retention of bile cholangitis in the liver. In this study, on the basis of the history, observation of the ionophore remnant in the ration, clinical signs, gross and histopathological findings, acute salinomycin intoxication is definitely diagnosed.

  17. 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.

  18. Clinical features and management of intoxication due to hallucinogenic drugs.

    Leikin, J B; Krantz, A J; Zell-Kanter, M; Barkin, R L; Hryhorczuk, D O


    Hallucinogenic drugs are unique in that they produce the desired hallucinogenic effects at what are considered non-toxic doses. The hallucinogenic drugs can be categorised into 4 basic groups: indole alkaloid derivatives, piperidine derivatives, phenylethylamines and the cannabinols. The drugs reviewed include lysergic acid diethylamide (LSD), phencyclidine (PCP), cocaine, amphetamines, opiates, marijuana, psilocybin, mescaline, and 'designer drugs.' Particularly noteworthy is that each hallucinogen produces characteristic behavioural effects which are related to its serotonergic, dopaminergic or adrenergic activity. Cocaine produces simple hallucinations, PCP can produce complex hallucinations analogous to a paranoid psychosis, while LSD produces a combination of hallucinations, pseudohallucinations and illusions. Dose relationships with changes in the quality of the hallucinatory experience have been described with amphetamines and, to some extent, LSD. Flashbacks have been described with LSD and alcohol. Management of the intoxicated patient is dependent on the specific behavioural manifestation elicited by the drug. The principles involve differentiating the patient's symptoms from organic (medical or toxicological) and psychiatric aetiologies and identifying the symptom complex associated with the particular drug. Panic reactions may require treatment with a benzodiazepine or haloperidol. Patients with LSD psychosis may require an antipsychotic. Patients exhibiting prolonged drug-induced psychosis may require a variety of treatments including ECT, lithium and l-5-hydroxytryptophan.

  19. Fatal toxic epidermal necrolysis associated with minoxidil.

    Karaoui, Lamis R; Chahine-Chakhtoura, Corinne


    Minoxidil is a direct-acting peripheral vasodilator for the treatment of symptomatic hypertension, or refractory hypertension associated with target organ damage, that is not manageable with a diuretic and two other antihypertensive drugs. The most frequent adverse events associated with minoxidil include hypertrichosis and cardiovascular events related to its powerful antihypertensive effect, and less frequently, rashes, bullous eruptions, and Stevens-Johnson syndrome (SJS). Evidence suggests that SJS and toxic epidermal necrolysis (TEN) are variants of a single disease with common causes and mechanisms, but differing severities. Epidermal detachment is mild in SJS, moderate in overlap SJS-TEN, and severe (> 30% of body surface area) in TEN. We describe a case of minoxidil-associated SJS that evolved into fatal TEN. A 69-year-old African-American woman with a history of chronic kidney disease was admitted to the hospital for a cerebrovascular accident and uncontrolled hypertension. On hospital day 12, oral minoxidil was added to her drug regimen. On day 23, she developed a maculopapular rash on her face that gradually diffused to her chest and back. Vesicles and papular lesions extended to her extremities and mucosal membranes; results of a skin biopsy revealed SJS. A positive Nikolsky's sign (blisters spread on application of pressure) was detected. On days 27-31, diffuse bullae developed with rash exacerbation. Skin detachment exceeded 30% and was consistent with TEN. The patient died on day 39. An evaluation of the causality and time course suggested that minoxidil was the most likely culpable drug, with a Naranjo adverse drug reaction probability scale score indicating that the likelihood of the association was possible (score of 3). The mechanism of this reaction has not been well elucidated. It may be related to an impaired clearance of the minoxidil metabolite, or an immune stimulation resulting in apoptosis and epidermis destruction. To our knowledge, this

  20. Barbiturate ingestion in three adult captive tigers (Panthera tigris and concomitant fatal botulism of one : clinical communication

    J. H. Williams


    Full Text Available Zoo animals, including tigers, have been reported to suffer from barbiturate intoxication, with pentabarbitone being most commonly recorded. Clinical signs range from mild ataxia to general anaesthesia with recovery over hours to days with several factors affecting hepatic barbiturate metabolism and tissue partitioning. Botulism is an often fatal intoxication in man, animals, birds and certain fish. The occurrence in carnivores is uncommon to rare, with only 2 reports found of botulism in felids. This report relates to 3 adult captive cohabiting tigers that simultaneously developed signs of abdominal discomfort, progressive ataxia, recumbency and comatose sleep resembling stage 2 anaesthesia, alternating with periods of distracted wakefulness and ataxic movements. These signs occurred 4 days after being fed the carcass of a horse that had ostensibly died of colic and not been euthanased. The male tiger that was the dominant animal in the feeding hierarchy was worst affected and had to be given intravenous fluids. The female that was lowest in hierarchy was unaffected. After 48-72 hours of treatment at the Onderstepoort Veterinary Academic Hospital the females could eat and made an uneventful recovery. The male tiger showed partial recovery but died during the night a few hours after drinking water on his return to the owner. Necropsy revealed severe oesophageal dilation and impaction with decaying grass; some of this material and water were present in the pharynx and trachea, and had been aspirated causing acute widespread bronchopneumonia. Colon content tested negative for common pesticides but, together with liver, tested positive for barbiturate. Serum taken on the day of admission had tested negative for barbiturate and the residual serum from the 3 animals later tested negative for botulinum toxin. Colon and oesophageal content from the male at necropsy were positive for Clostridium botulinum toxin type C by the mouse bioassay

  1. Fatalities in high school and college football players.

    Boden, Barry P; Breit, Ilan; Beachler, Jason A; Williams, Aaron; Mueller, Frederick O


    Fatalities in football are rare but tragic events. The purpose was to describe the causes of fatalities in high school and college football players and potentially provide preventive strategies. Descriptive epidemiology study. We reviewed the 243 football fatalities reported to the National Center for Catastrophic Sports Injury Research from July 1990 through June 2010. Football fatalities averaged 12.2 per year, or 1 per 100,000 participants. There were 164 indirect (systemic) fatalities (average, 8.2 annually [or 0.7 per 100,000 participants]) and 79 direct (traumatic) fatalities (average, 4.0 annually [or 0.3 per 100,000 participants]). Indirect fatalities were 2.1 times more common than direct fatalities. The risk of a fatality in college compared with high school football players was 2.8 (95% CI, 0.7-8.2) times higher for all fatalities, 3.6 (95% CI, 2.5-5.3) times higher for indirect events, 1.4 (95% CI, 0.6-3.0) times higher for direct injuries, 3.8 (95% CI, 1.8-8.3) times higher for heat illness, and 66 (95% CI, 14.4-308) times higher for sickle cell trait (SCT) fatalities. Most indirect events occurred in practice sessions; preseason practices and intense conditioning sessions were vulnerable periods for athletes to develop heat illness or SCT fatalities, respectively. In contrast, most brain fatalities occurred during games. The odds of a fatality during the second decade, compared with the first decade of the study, were 9.7 (95% CI, 1.2-75.9) for SCT, 1.5 (95% CI, 0.8-2.9) for heat illness, 1.1 (95% CI, 0.8-1.7) for cardiac fatalities, and 0.7 (95% CI, 0.4-1.2) for brain fatalities. The most common causes of fatalities were cardiac failure (n = 100, 41.2%), brain injury (n = 62, 25.5%), heat illness (n = 38, 15.6%), SCT (n = 11, 4.5%), asthma and commotio cordis (n = 7 each, 2.9% each), embolism/blood clot (n = 5, 2.1%), cervical fracture (n = 4, 1.7%), and intra-abdominal injury, infection, and lightning (n = 3, 1.2% each). High school and college

  2. Work-related fatal motor vehicle traffic crashes: Matching of 2010 data from the Census of Fatal Occupational Injuries and the Fatality Analysis Reporting System.

    Byler, Christen; Kesy, Laura; Richardson, Scott; Pratt, Stephanie G; Rodríguez-Acosta, Rosa L


    Motor vehicle traffic crashes (MVTCs) remain the leading cause of work-related fatal injuries in the United States, with crashes on public roadways accounting for 25% of all work-related deaths in 2012. In the United States, the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI) provides accurate counts of fatal work injuries based on confirmation of work relationship from multiple sources, while the National Highway Traffic Safety Administration (NHTSA) Fatality Analysis Reporting System (FARS) provides detailed data on fatal MVTCs based on police reports. Characterization of fatal work-related MVTCs is currently limited by data sources that lack either data on potential risk factors (CFOI) or work-relatedness confirmation and employment characteristics (FARS). BLS and the National Institute for Occupational Safety and Health (NIOSH) collaborated to analyze a merged data file created by BLS using CFOI and FARS data. A matching algorithm was created to link 2010 data from CFOI and FARS using date of incident and other case characteristics, allowing for flexibility in variables to address coding discrepancies. Using the matching algorithm, 953 of the 1044 CFOI "Highway" cases (91%) for 2010 were successfully linked to FARS. Further analysis revealed systematic differences between cases identified as work-related by both systems and by CFOI alone. Among cases identified as work-related by CFOI alone, the fatally-injured worker was considerably more likely to have been employed outside the transportation and warehousing industry or transportation-related occupations, and to have been the occupant of a vehicle other than a heavy truck. This study is the first step of a collaboration between BLS, NHTSA, and NIOSH to improve the completeness and quality of data on fatal work-related MVTCs. It has demonstrated the feasibility and value of matching data on fatal work-related traffic crashes from CFOI and FARS. The results will lead to

  3. Consideraciones en tomo a "La fatal arrogancia"

    Javier Fernández Aguado


    Full Text Available The author makes here an analysis of Friedrick A. Hayek's The Fatal Conceit. This thinker considers that the best political-economical system for human civilization is capitalism, which has arised in an spontaneous, evolutive and adaptative way without any intention or plan thanks to a deus ex machina. Hayek shows himself as an advocate of capitalism and as an enemy of socialism; he despises solidarity and supports egoism as the motor of economy, for, according to him, without it society would not be where it is now. Hayek imports Darwin's evolutionary theory in order to justify economy's blind and fortuitous development, which in turn explains that capitalism is reached through a series of unforeseen and spontaneous events which are overcomed thanks to adaptation. Hayek draws historicist arguments at some poins, in an invalid way, rejecting everything that looks like socialism, and he makes mistakes where philosophical concepts are dealed with. Hayek's continuous reject towards Aristotle and his political-economical thesis obeys to the fact that the author rejects the Catholic Church, which, according to him, gathered the Aristotelian thesis through saint Thomas Aquinas. Hayek proposes a selfish and capitalist moral which one ought to accept if one does not wish for hunger and poverty.

  4. 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.

  5. State and local law enforcement agency efforts to prevent sales to obviously intoxicated patrons.

    Lenk, Kathleen M; Toomey, Traci L; Nelson, Toben F; Jones-Webb, Rhonda; Erickson, Darin J


    Alcohol sales to intoxicated patrons are illegal and may lead to public health issues such as traffic crashes and violence. Over the past several decades, considerable effort has been made to reduce alcohol sales to underage persons but less attention has been given to the issue of sales to obviously intoxicated patrons. Studies have found a high likelihood of sales to obviously intoxicated patrons (i.e., overservice), but little is known about efforts by enforcement agencies to reduce these sales. We conducted a survey of statewide alcohol enforcement agencies and local law enforcement agencies across the US to assess their strategies for enforcing laws prohibiting alcohol sales to intoxicated patrons at licensed alcohol establishments. We randomly sampled 1,631 local agencies (1,082 participated), and surveyed all 49 statewide agencies that conduct alcohol enforcement. Sales to obviously intoxicated patrons were reported to be somewhat or very common in their jurisdiction by 55 % of local agencies and 90 % of state agencies. Twenty percent of local and 60 % of state agencies reported conducting enforcement efforts to reduce sales to obviously intoxicated patrons in the past year. Among these agencies, fewer than half used specific enforcement strategies on at least a monthly basis to prevent overservice of alcohol. Among local agencies, enforcement efforts were more common among agencies that had a full-time officer specifically assigned to carry out alcohol enforcement efforts. Enforcement of laws prohibiting alcohol sales to obviously intoxicated patrons is an underutilized strategy to reduce alcohol-related problems, especially among local law enforcement agencies.

  6. Community Poverty and Child Abuse Fatalities in the United States.

    Farrell, Caitlin A; Fleegler, Eric W; Monuteaux, Michael C; Wilson, Celeste R; Christian, Cindy W; Lee, Lois K


    Child maltreatment remains a problem in the United States, and individual poverty is a recognized risk factor for abuse. Children in impoverished communities are at risk for negative health outcomes, but the relationship of community poverty to child abuse fatalities is not known. Our objective was to evaluate the association between county poverty concentration and rates of fatal child abuse. This was a retrospective, cross-sectional analysis of child abuse fatalities in US children 0 to 4 years of age from 1999 to 2014 by using the Centers for Disease Control and Prevention Compressed Mortality Files. Population and poverty statistics were obtained from US Census data. National child abuse fatality rates were calculated for each category of community poverty concentration. Multivariate negative binomial regression modeling assessed the relationship between county poverty concentration and child abuse fatalities. From 1999 to 2014, 11 149 children 0 to 4 years old died of child abuse; 45% (5053) were poverty concentration had >3 times the rate of child abuse fatalities compared with counties with the lowest poverty concentration (adjusted incidence rate ratio, 3.03; 95% confidence interval, 2.4-3.79). Higher county poverty concentration is associated with increased rates of child abuse fatalities. This finding should inform public health officials in targeting high-risk areas for interventions and resources. Copyright © 2017 by the American Academy of Pediatrics.

  7. Investigation of oxyhemoglobin and carboxyhemoglobin ratios in right and left cardiac blood for diagnosis of fatal hypothermia and death by fire.

    Kanto-Nishimaki, Yuko; Saito, Haruka; Watanabe-Aoyagi, Miwako; Toda, Ritsuko; Iwadate, Kimiharu


    Few large-scale investigations have looked at the oxyhemoglobin ratio (%O2-Hb) or the carboxyhemoglobin ratio (%CO-Hb) in fatal hypothermia and death by fire as applicable to forensic medicine. We therefore retrospectively examined right and left cardiac blood samples for both %O2-Hb and %CO-Hb in 690 forensic autopsy cases. We therefore sought to establish reference values for the above forensic diagnoses, to compare %O2-Hb in fatal hypothermia with or without cardiopulmonary resuscitation (CPR), and to compare the relationship between %CO-Hb and smoking history. All %O2-Hb and %CO-Hb data were obtained during or immediately after autopsies using a portable CO-oximeter. Death by carbon monoxide (CO) intoxication and death by fire were excluded from the analysis involving smoking history. In fatal hypothermia, %O2-Hb in the left cardiac blood was significantly higher than that in the right cardiac blood, providing important evidence for fatal hypothermia. Furthermore, %O2-Hb in the left cardiac blood increases with CPR but that in the right cardiac blood increases in parallel. No correlation was observed between rectal temperature and %O2-Hb in the right and left cardiac blood, indicating that it is unlikely that postmortem cooling increases %O2-Hb in cardiac blood. %CO-Hb in smokers was significantly higher than that in non-smokers, although the number of cigarettes smoked did not appear to be significant. When assessing death by fire, we identified that %CO-Hb of >10% was a reliable marker of antemortem CO inhalation, regardless of smoking history.

  8. Poisonous mushrooms: a review of the most common intoxications.

    Lima, A D L; Costa Fortes, R; Carvalho Garbi Novaes, M R; Percário, S


    Mushrooms have been used as components of human diet and many ancient documents written in oriental countries have already described the medicinal properties of fungal species. Some mushrooms are known because of their nutritional and therapeutical properties and all over the world some species are known because of their toxicity that causes fatal accidents every year mainly due to misidentification. Many different substances belonging to poisonous mushrooms were already identified and are related with different symptoms and signs. Carcinogenicity, alterations in respiratory and cardiac rates, renal failure, rhabidomyolisis and other effects were observed in toxicity studies with various species including edible and therapeutic ones. Proper identification is important to avoid accidents and toxicity studies are necessary to assure the safe use of mushrooms as food and for medicinal purposes.

  9. Road traffic fatalities in Qatar Jordan and UAE

    Elawad, Elmogiera


    ABSTRACT Smeed’s equation is a widely used model for prediction of traffic fatalities but has been found inadequate for use in developing countries. We applied regression analysis to time-series data on vehicles, population and traffic fatalities in the United Arab Emirates (UAE), Jordan and Qatar. The data were fitted to exponential models for fatality prediction, producing an average absolute error of 20.9% for Qatar, 10.9% for Jordan and 5.5% for the UAE. We found a strong linear relations...

  10. Cost Of Treatment In Fatal Diarrhoea In Under Fives

    Kaur Paramjeet


    Full Text Available Research Question: How much is the cost borne out by the family for treatment of fatal diarrhoea in rural settings? Objective: To assess the money spent in the treatment of fatal diarrhoea in under fives. Study design: Cross- sectional. Settings: Rural areas. Sample size: 95 under five deaths amongst 2094 under five children. Participants: Parents of deceased children. Study variables: Causes of deaths, type of treatment facility, cost treatment. Analysis: Simple proportions. Results: It was observed that the cost of treatment of fatal diarrhoea went up when the physicians were changed frequently during the course of treatment and also when a practitioner from outside village was consulted.

  11. Fatal recto-sigmoid rupture by compressed air

    Varun Pai


    Full Text Available Compressed air is a concentrated stream of air at high pressure and high speed that can cause fatal injury to the operator and the people around him when handled inappropriately. The case herein reported is that of a victim of a practical joke, who suffered a fatal recto – sigmoid rupture due to transanal insufflation of compressed air at his workplace. The case highlights the need for implementation of guidelines for safe handling of compressed gases and it also calls for appropriate work place etiquette to avoid such fatal practical jokes at work.

  12. Intoxicación por alcoholes Alcohol intoxication

    J. Roldán


    Full Text Available La intoxicación etílica es la primera toxicomanía en muchos países del mundo. Afecta a todos los tramos de edad, en los dos sexos y en casi todos los grupos sociales. La mortalidad asociada sólo a la intoxicación etílica aguda es excepcional, pero puede ser un importante factor si coexiste con ingesta de otras drogas de abuso. Es responsable directo de más de la mitad de los accidentes de tráfico. El diagnóstico es fácil por la anamnesis y la clínica y se puede confirmar determinando el nivel de etanol en sangre. El tratamiento es de sostén, intentando proteger al paciente de complicaciones secundarias. El metanol o alcohol de quemar se utiliza como disolvente, encontrándose también como adulterante de bebidas alcohólicas. La intoxicación vía oral es la más frecuente. Oxidado en el hígado a través de la enzima alcohol deshidrogenasa, la toxicidad se debe a sus metabolitos, formaldehído y ácido fórmico. La clínica consiste fundamentalmente en cefalea, náuseas, vómitos, hipotensión y depresión del SNC. El nervio óptico es especialmente sensible pudiendo producirse una ceguera total e irreversible. El etilenglicol se utiliza como disolvente y anticongelante; la toxicidad se debe a la acumulación de sus metabolitos. La clínica incluye síntomas comunes con la intoxicación metílica. Puede ocurrir fallo renal por necrosis tubular y depósito de cristales de oxalato.Alcohol intoxication is the principal drug addiction in many countries of the world. It affects all age groups, both sexes and almost all social groups. Mortality associated with acute alcohol poisoning on its own is exceptional, but it can be an important factor if it coexists with recreational drugs. It is directly responsible for more than half of traffic accidents. Diagnosis is easy by means of anamnesis and clinical examination, and can be confirmed by determining the level of ethanol in the bloodstream. Supportive care is the best therapy in order to

  13. [Histopathology of meibomian gland abnormalities in experimental PenCB intoxicated beagle treated with squalane].

    Kohno, T; Ohnishi, Y


    In order to examine the effect of squalane to excrete PCB from the intoxicated animals, histopathological studies of Meibomian gland abnormalities were carried out in experimental PenCB (3,4,5,3',4'-pentachlorobiphenyl) intoxicated beagles treated with squalane. All experimental animals except a control group showed characteristic changes of Meibomian glands: dilation of the duct and squamous metaplasia of the alveolar cells. According to the degree of these findings, five stages were divided in the processes of Medibomian gland changes. The PenCB intoxicated dogs initially showed mild pathological changes of the glands and later moderate to severe degrees of findings. In the PenCB intoxicated animals treated with squalane, severe degree of Meibomian gland findings were found in the early stage and mild to moderate abnormalities in the late stage. The concentration of PenCB in blood varied in each animal, and the animals with advanced Medibomian gland abnormalities tended to have high level of PenCB concentration in blood. In conclusion, the effect of squalane to excrete PCB from the intoxicated animals were not determined in this study.

  14. Occupational pesticide intoxications among farmers in Bolivia: a cross-sectional study

    Huici Omar


    Full Text Available Abstract Background Pesticide use and its consequences are of concern in Bolivia due to an intensive and increasing use. Methods To assess the magnitude and reasons for occupational pesticide intoxication, a cross-sectional study with interviews and blood-tests was performed among 201 volunteer farmers from 48 villages in the temperate and subtropical valleys in the eastern part of the Andes Mountains in Bolivia. Of these 171 male farmers using pesticides in their agricultural production were used in the statistical analysis, including linear- and logistic regression analysis. Results This study documented a frequent use of the most toxic pesticides among farmers who have had almost no instructions in how to use pesticides and protect themselves against the dangers of intoxication, reflected in the hazardous practices used when handling pesticides. Symptoms of intoxications were common in connection with spraying operations. The risk of experiencing symptoms and the serum cholinesterase activity were influenced by whether or not organophosphates were used and the number of times sprayed. The experience of symptoms was moreover influenced by the hygienic and personal protective measures taken during spraying operations while this had no influence on the serum cholinesterase level. Conclusion The study showed that occupational pesticide intoxications were common among farmers and did depend on multiple factors. Pesticide use is probably one of the largest toxicological problems in Bolivia, and a coordinated action by authorities, society and international bodies is needed to limit the number of intoxications and the environmental pollution.

  15. Exogenous drug intoxication among young people of Rio Grande do Sul

    Elisa Inês Klinger


    Full Text Available Background and objective: the wide variety of drugs available in the market, brought important changes in the aspect of drug use, however, there are also problems related to these products, among these, exogenous intoxication, considered a world wide problem in the health sector, especially among women. The aim of the study was to analyze the data reported by exogenous drug intoxication among young adults of Rio Grande do Sul. Methods: it is an ecological descriptive study of cases of exogenous drug intoxication of individuals between 20-39 years of age, from Rio Grande do Sul, reported in the years 2011-2015, at Information System for Notifiable Diseases (SINAN. Results: 1,278 notifications of exogenous intoxication caused by drugs were found. Of these, 76.29% of the cases were female, 85.21% were white, 25.98% had incomplete primary education and 85.52% lived in urban areas. Of the reported cases, it highlights the 1,038 cases of attempted suicide (81.22%, followed by 68 cases of self-medication (5.32%. Conclusions: the exogenous drug intoxication among young adults in Rio Grande do Sul is serious and worrying, indicating the importance of educational measures of prevention and health promotion in this population.

  16. Effects of high-dose ethanol intoxication and hangover on cognitive flexibility.

    Wolff, Nicole; Gussek, Philipp; Stock, Ann-Kathrin; Beste, Christian


    The effects of high-dose ethanol intoxication on cognitive flexibility processes are not well understood, and processes related to hangover after intoxication have remained even more elusive. Similarly, it is unknown in how far the complexity of cognitive flexibility processes is affected by intoxication and hangover effects. We performed a neurophysiological study applying high density electroencephalography (EEG) recording to analyze event-related potentials (ERPs) and perform source localization in a task switching paradigm which varied the complexity of task switching by means of memory demands. The results show that high-dose ethanol intoxication only affects task switching (i.e. cognitive flexibility processes) when memory processes are required to control task switching mechanisms, suggesting that even high doses of ethanol compromise cognitive processes when they are highly demanding. The EEG and source localization data show that these effects unfold by modulating response selection processes in the anterior cingulate cortex. Perceptual and attentional selection processes as well as working memory processes were only unspecifically modulated. In all subprocesses examined, there were no differences between the sober and hangover states, thus suggesting a fast recovery of cognitive flexibility after high-dose ethanol intoxication. We assume that the gamma-aminobutyric acid (GABAergic) system accounts for the observed effects, while they can hardly be explained by the dopaminergic system. © 2016 Society for the Study of Addiction.

  17. Pathologic features of fatal shark attacks.

    Byard, R W; Gilbert, J D; Brown, K


    To examine the pattern of injuries in cases of fatal shark attack in South Australian waters, the authors examined the files of their institution for all cases of shark attack in which full autopsies had been performed over the past 25 years, from 1974 to 1998. Of the seven deaths attributed to shark attack during this period, full autopsies were performed in only two cases. In the remaining five cases, bodies either had not been found or were incomplete. Case 1 was a 27-year-old male surfer who had been attacked by a shark. At autopsy, the main areas of injury involved the right thigh, which displayed characteristic teeth marks, extensive soft tissue damage, and incision of the femoral artery. There were also incised wounds of the right wrist. Bony injury was minimal, and no shark teeth were recovered. Case 2 was a 26-year-old male diver who had been attacked by a shark. At autopsy, the main areas of injury involved the left thigh and lower leg, which displayed characteristic teeth marks, extensive soft tissue damage, and incised wounds of the femoral artery and vein. There was also soft tissue trauma to the left wrist, with transection of the radial artery and vein. Bony injury was minimal, and no shark teeth were recovered. In both cases, death resulted from exsanguination following a similar pattern of soft tissue and vascular damage to a leg and arm. This type of injury is in keeping with predator attack from underneath or behind, with the most severe injuries involving one leg. Less severe injuries to the arms may have occurred during the ensuing struggle. Reconstruction of the damaged limb in case 2 by sewing together skin, soft tissue, and muscle bundles not only revealed that no soft tissue was missing but also gave a clearer picture of the pattern of teeth marks, direction of the attack, and species of predator.

  18. Fatal fulminant hepatic failure related to the use of disulfiram.

    Watts, Thomas E; Pandey, Richa A; Vancil, Tobias J


    We report a case of fatal fulminant hepatic failure related to the use of disulfiram. This is a commonly used medication; however there are few reported cases in the medical literature of fatal liver failure related to its use. Patients using disulfiram for alcohol cessation typically have multiple risk factors for liver disease and are not acutely candidates for orthotopic liver transplant due to recent alcohol dependence. This case demonstrates a rare adverse reaction to a commonly used medication with a fatal outcome. Our patient was a sixty-six year old man who had recently started using disulfiram for the purpose of alcohol cessation. He developed hepatotoxicity that progressed to fulminant hepatic failure. Despite cessation of the medication and supportive care, the outcome was fatal.

  19. Children in Hot Cars Result in Fatal Consequences

    Full Text Available ... Share this! Home » Health Tips » Holiday and Seasonal Children in Hot Cars Result in Fatal Consequences Emergency ... the overwhelming dangers associated with leaving anyone, especially children in hot, unventilated vehicles during the summer. Children ...

  20. Children in Hot Cars Result in Fatal Consequences

    Full Text Available ... Tips » Holiday and Seasonal Children in Hot Cars Result in Fatal Consequences Emergency physicians are warning the ... the country die each year as a direct result of being left alone in a hot vehicle. “ ...

  1. Children in Hot Cars Result in Fatal Consequences

    Full Text Available ... for Disasters Communication With Your Family And Your Doctor About Your Wishes Visiting the ER Who Takes ... in Hot Cars Result in Fatal Consequences Emergency physicians are warning the public about the overwhelming dangers ...

  2. Children in Hot Cars Result in Fatal Consequences

    Full Text Available ... in Fatal Consequences Emergency physicians are warning the public about the overwhelming dangers associated with leaving anyone, ... Copyright © American College of Emergency Physicians 2017 Privacy Policy Terms of Use

  3. Where Medical Pot Is Legal, Fatal Car Crashes Often Decline

    ... 162675.html Where Medical Pot Is Legal, Fatal Car Crashes Often Decline It's possible that these state ... and Human Services. More Health News on: Marijuana Motor Vehicle Safety Recent Health News Related MedlinePlus Health ...

  4. Fatal poisoning in drug addicts in the Nordic countries

    Steentoft, Anni; Teige, Brita; Ceder, Gunnel


    . For all countries the distribution of deaths according to geographical regions showed a decreasing number of drug deaths in the metropolitan area and an increasing number in other cities. Heroin/ morphine dominated as the cause of death and was responsible for about 90% of the cases in Norway. In Sweden...... and Denmark, however, heroin/morphine caused only about 70% of the fatal poisonings. About 30% of the fatal poisonings in Denmark and Sweden were caused by other group I drugs, in Denmark mainly methadone and in Sweden mainly propoxyphene. Apart from two cases in Sweden methadone deaths were not seen...... in the other Nordic countries. In Finland heroin/morphine deaths have increased from about 10% in 1991 to about 40% in 1997. Forty-four percent of the fatal poisonings in Finland were caused by other group I drugs, mainly codeine and propoxyphene. The two fatal poisonings in Iceland were caused by carbon...

  5. Fatal Bacillus cereus bacteremia in a patient with diabetes.

    Orrett, F A


    This report describes a fatal case of Bacillus cereus septicemia in a patient with uncontrolled diabetes and re-emphasizes the potential seriousness of Bacillus infections in patients with compromised immune function.

  6. Fatality of salt stress to plants: Morphological, physiological and ...

    Fatality of salt stress to plants: Morphological, physiological and biochemical aspects. ... African Journal of Biotechnology ... Soil salinity affects various physiological and biochemical processes which result in reduced biomass production.

  7. Children in Hot Cars Result in Fatal Consequences

    Full Text Available ... Health Tips » Holiday and Seasonal Children in Hot Cars Result in Fatal Consequences Emergency physicians are warning ... it bluntly, leaving your child in a hot car is like leaving your child in a lit ...

  8. Fatal Acute Diclofenac-Induced Rhabdomyolysis in A Pediatric Patient

    Ahmet Güzel


    Full Text Available Diclofenac, a widely used nonsteroidal anti-inflammatory drug, has been reported to cause fatal drug-induced rhabdomyolysis very rarely . We report a case of a 13-month-old girl who developed fatal rhabdomyolysis after administration of intramuscular diclofenac for relief of pain caused by a scalding burn injury. Rhabdomyolysis due to diclofenac has not been reported in children. Here, we present the first case report to demonstrate rhabdomylysis secondary to diclofenac administration.

  9. Car Crash Fatalities Associated With Fire in Sweden

    Viklund, Åsa; Björnstig, Johanna; Larsson, Magnus; Björnstig, Ulf


    Objective: To study the epidemiology and causes of death in fatal car crashes on Swedish roads in which the victim's vehicle caught fire. Methods: The data set is from the Swedish Transport Administrations in-depth studies of fatal crashes 1998-2008. Autopsies from all cases provided data on injuries, toxicological analyses, and cause of death. Results: In total, 181 people died in 133 burning cars, accounting for 5 percent of all deaths in passenger cars, sport utility vehicles, vans, and mi...

  10. Benzodiazepine/GABA receptor complex during severe ethanol intoxication and withdrawal in the rat

    Hemmingsen, R.; Braestrup, C.; Nielsen, M.; Barry, D.I. (Dept. of Psychiatry, Rigshospitalet, Copenhagen, St. Hans Mental Hospital, Roskilde, and Ferrosan Research Laboratory, Soeborg, Denmark)


    The benzodiazepine/GABA (gammaaminobutyric acid) receptor complex was investigated during severe ethanol intoxication and withdrawal in the rat. The intragastric intubation technique was used to establish physical ethanol dependence in the animals. Cerebral cortex from male Wistar rats was studied 1) after 31/2 days of severe ethanol intoxication, 2) during the ethanol withdrawal reaction and 3) in a control group. The effect of GABA-ergic activation by muscimol and THIP (4,5,6,7-tetrahydroisoxazole(5,4-c)pyridin-3-01) on /sup 3/H-diazepam binding was unchanged during ethanol intoxication and withdrawal, as was the affinity constant (Ksub(D)) and the maximal number of binding sites (Bsub(max)) for /sup 3/H-flunitrazepam. In conclusion, the benzodiazepine/GABA receptor complex is unlikely to play any causual part in physical ethanol dependence.

  11. Acute atropine intoxication with psychiatric symptoms by herbal infusion of Pulmonaria officinalis (Lungwort

    Enrique Baca-García


    Full Text Available Background and objectives: Lungwort infusion is a preparation extracted from Pulmonaria officinalis which is occasionally used as a folk remedy for the common cold. The current report aims to describe acute atropine intoxications with delirium caused by Lungwort infusion in several members of the same family. Methods: Description of three case reports. Search of literature through Medline. Results: Three generations of a same family presented acute and moderately severe atropine intoxications after drinking an infusion prepared with Pulmonaria officinalis. Conclusions: Despite the lack of scientific evidence for its clinical use, medicinal plants continue being widely used. In spite of severe adverse effects reported, the general thought is that herbal remedies are harmless. To our knowledge, this is the first report of acute atropine intoxications with psychiatric symptoms secondary to Pulmonaria officinalis in several members of a family. We suspect that the lungwort infusion may have been contaminated with some other substance with atropinic properties.

  12. Ecstasy intoxication as an unusual cause of epileptic seizures in young children.

    Pauwels, Steven; Lemmens, Francis; Eerdekens, Kim; Penders, Joris; Poesen, Koen; Desmet, Koen; Vermeersch, Pieter


    In light of the widespread use of ecstasy, it is surprising that only few cases of intoxicated young children have been reported. Patients almost invariably present with convulsions accompanied by sympathetic signs and symptoms such as hyperthermia. Two new cases of toddlers intoxicated with ecstasy are described. The first patient, a 19-month-old boy, presented with convulsions but no sympathetic signs. The pediatrician's suspicion was raised because of the absence of a postictal state. The second patient, a 20-month-old girl, had a more typical presentation with convulsions and hyperthermia. Her story illustrates the fact that immunoassays for toxicological screening can easily miss traces of additional illicit drugs present in the urine such as cocaine. The presence of other illicit drugs provides clues to the child's risky environment and should lead to further investigation. Finally, we review the available literature on ecstasy intoxication to summarize the key presenting manifestations.

  13. Life-threatening intoxication with methylene bis(thiocyanate: clinical picture and pitfalls. A case report

    Schnuelle Peter


    Full Text Available Abstract Background Methylene bis(thiocyanate (MBT is a microbiocidal agent mainly used in industrial water cooling systems and paper mills as an inhibitor of algae, fungi, and bacteria. Case presentation We describe the first case of severe intoxication following inhalation of powder in an industrial worker. Profound cyanosis and respiratory failure caused by severe methemoglobinemia developed within several minutes. Despite immediate admission to the intensive care unit, where mechanical ventilation and hemodialysis for toxin elimination were initiated, multi-organ failure involving liver, kidneys, and lungs developed. While liver failure was leading, the patient was successfully treated with the MARS (molecular adsorbent recirculating system procedure. Conclusion Intoxication with MBT is a potentially life-threatening intoxication causing severe methemoglobinemia and multi-organ failure. Extracorporeal liver albumin dialysis (MARS appears to be an effective treatment to allow recovery of hepatic function.

  14. Intoxication after Extreme Oral Overdose of Quetiapine to Attempt Suicide: Pharmacological Concerns of Side Effects

    C. Müller


    Full Text Available Quetiapine is an atypical antipsychotic approved for the treatment of patients with psychotic disorders. Since approvement several case reports about intoxication with quetiapine were linked mainly with tachycardia, QTc-prolongation, somnolence, and hyperglycemia. Here, we present the first case report of an intoxication with an extreme overdose of quetiapine (36 g, ingested by a 32-year-old female (62 kg bodyweight to attempt suicide. Symptoms associated with intoxication were coma without arterial hypotension, persistent tachycardia, hyperglycemia, and transient hypothyreoidism. QTc-interval was moderately extended. Management consisted of intubation for airway protection, gastric lavage, the use of activated charcoal, i.v. saline, and observation for 17 hours on an intensive care unit. Despite the extremely high dose of quetiapine, the patient recovered completely without residual symptoms.

  15. Injury patterns and features of cycling fatalities in South Australia.

    Olds, Kelly; Byard, Roger W; Langlois, Neil E I


    There has been an increase in cycling in Australia. This means that more cyclists are at risk of injuries, which account for a proportion of transport-related fatalities. In this study, all cyclist fatalities from 2002 to 2013 in South Australia where post-mortem examinations were performed were investigated. There were 42 deaths representing 3% of the total road fatalities over the same time. Of this total number of cases, 13 deaths (31%) involved collapse (mostly natural causes from an underlying medical condition) and 29 (69%) resulted from trauma. There were no cases of hyperthermia. Of the decedents 95% were male, and the mean age at death was 47 years. Fatal incidents were more likely to occur during April and November, and on a Monday. However, statistical analysis was not possible due to the small number of cases. Fatalities (traumatic and collapse) predominantly occurred whilst the cyclist was riding (86%). The majority of riding fatalities were as a result of collision with vehicles (81%). Drugs (including alcohol) were detected in two (15%) of the 13 cases of the collapses, and in seven (26%) of the 27 trauma cases tested. In trauma cases, death was most often due to multiple injuries. The most frequent area for injury was the head (found in 90% of traumatic deaths). Despite the increasing numbers of cyclists on South Australian roads over the last decade, death rates have trended downwards suggesting that road safety campaigns and the provision of more dedicated bicycle lanes have had a positive outcome.

  16. Age of onset of first alcohol intoxication and subsequent alcohol use among urban American Indian adolescents.

    Henry, Kimberly L; McDonald, James N; Oetting, Eugene R; Walker, Patricia Silk; Walker, R Dale; Beauvais, Fred


    The objective was to assess the effect of early onset intoxication on subsequent alcohol involvement among urban American Indian youth. The data come from the American Indian Research (AIR) project, a panel study of urban Indian youth residing in King County, Washington. Data were collected annually from the adolescent and his/her primary caregiver from the 1988-89 school year to the 1996-97 school year, providing a total of nine waves of data. Early intoxication (by age 14) was related to delinquency, family history of alcohol abuse or dependence, poverty, broken family structure, less family cohesiveness, and more family conflict. The effects of these characteristics were, therefore, partialed out in testing effects of early intoxication on later alcohol involvement. Two-part latent growth models of alcohol use and alcohol problems were specified. Effects of early onset intoxication on these trajectories, as well as lifetime alcohol abuse or dependence by the transition to young adulthood, were examined. Findings indicate that adolescents who experienced their first intoxication early (by age 14), used alcohol more heavily from the ages of 16 to 18, experienced more problems related to the alcohol's use from the ages of 16 to 18, and were more likely to have a diagnosed alcohol disorder by the final wave of data collection. Congruent with similar studies in the general population, early intoxication appears to be associated with a deleterious course of alcohol involvement during adolescence and into the transition to young adulthood among urban American Indian youth. Implications for prevention are discussed.

  17. Patient characteristics and patterns of intoxication: one-time and repeated use of emergency ambulance services.

    Holzer, Barbara M; Minder, Christoph E; Rosset, Nina; Schaetti, Gabriela; Battegay, Edouard; Mueller, Stefan; Zimmerli, Lukas


    The aim of this study was to investigate the utilization of ambulance services that resulted from alcohol and drug intoxication over a period of 1 year in a metropolitan area, with an emphasis on characteristic differences between patients with one-time versus repeated use. All ambulance-service report forms filed in 2010 were systematically screened for utilizations in which alcohol intoxication or intoxication resulting from consumption of illicit or legal drugs other than alcohol was the chief complaint (N = 2,341 patients; 65% male). Repeat users differed from persons with one-time use in their characteristics and patterns of intoxication. On average, patients with repeated ambulance use were almost 8 years older and had a different pattern of ambulance use over the course of the week with no clear peak on any specific day. The mean number of ambulance services in patients with repeated use was 2.8 (SD = 1.517) in the 1-year study period. Repeat users were less likely to be injured than patients with one-time ambulance-service use and more often showed aggression or uncooperative behavior toward paramedics. All cases of death associated with intoxication involved patients with one-time ambulance use. The ambulance-service users' generally slight impairment of consciousness and the high proportion of intoxicated patients without any injuries raise the question of how many of these patients could be adequately cared for in a sobering center. Sobering centers might relieve hospital emergency departments of patients not requiring acute emergency care and, in addition, could provide intervention services to prevent relapses.

  18. Evaluation of Suicide and Intoxication Cases Admitted to our Newly Opened Intensive Care Unit

    Nalan Muhammedoğlu


    Full Text Available Aim: The aim of this study was to evaluate the suicide and intoxication cases between April 2011 and April 2013. Methods: We retrospectively analyzed hospital records of patients who were admitted to our intensive care unit due to suicide and intoxication. The age, sex, intoxication causes, laboratory analyses, treatment refusal rates, and the prognosis were evaluated. Results: A total of 308 patients (105 males, 203 females were admitted to the intensive care unit. The mean age of the patients was 27.45±10.26 years (males: 28.70±9.86 years, females: 26.80±10.43 years. There were only 4 patients over 65 years of age. 275 patients had drug intoxication (antidepressant drug, pain killer, antibiotic, etc. and 33 patients had other causes of intoxication. When analyzing the prognosis; a total of 234 patients were discharged after initial treatment and 57 patients were discharged due to treatment refusal. 15 patients were referred for inpatient psychiatric treatment, 1 patient to the Alcohol and Drug Addiction Treatment Center (AMATEM and 1 patient was referred to İstanbul University Medical Faculty due to acute hepatic failure. Conclusion: The patients admitted to our intensive care unit due to suicide and intoxications were mainly females (65.9% and individuals of young age (median age: 27.45 years. Female patients had used antidepressants for suicide attempts and males had used antiflu-acetaminophen combinations. No mortality was observed. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52:153-7

  19. A fatal pseudo-tumour: disseminated basidiobolomycosis

    Bemelman Willem A


    with amphotericin B (Itraconazol contra-indicated because of renal insufficiency. A few days later the patient died of a septic shock. After autopsy Basidiobolus ranarum was cultured from liver, gallbladder and colon. Conclusion Our patient died of gastrointestinal basidiobolomycosis with an obstructing colon tumour and a large hepatic mass. This was a rare presentation of basidiobolomycosis and the second fatal case described worldwide.

  20. Effects of mixing alcohol with caffeinated beverages on subjective intoxication : A systematic review and meta-analysis

    Benson, Sarah; Verster, Joris C; Alford, Chris; Scholey, Andrew


    It has been suggested that mixing alcohol with energy drinks or other caffeinated beverages may alter the awareness of (or 'mask') intoxication. The proposed reduction in subjective intoxication may have serious consequences by increasing the likelihood of engaging in potentially dangerous activitie

  1. Effects of mixing alcohol with caffeinated beverages on subjective intoxication : A systematic review and meta-analysis

    Benson, Sarah; Verster, Joris C|info:eu-repo/dai/nl/241442702; Alford, Chris; Scholey, Andrew


    It has been suggested that mixing alcohol with energy drinks or other caffeinated beverages may alter the awareness of (or 'mask') intoxication. The proposed reduction in subjective intoxication may have serious consequences by increasing the likelihood of engaging in potentially dangerous

  2. Can Urtica dioica supplementation attenuate mercury intoxication in Wistar rats?

    Wafa Siouda


    supplemented rats. Conclusion: Nettle leaves have not only played a clear protective role during Hg intoxication, but it also enhanced hepatic, renal and testicular GSH level of Wistar rats.

  3. [Myocardial damage and paroxysmal ventricular tachycardia in a dog after Albuterol intoxication].

    Matos, J; Jenni, S; Fischer, N; Bienz, H; Glaus, T


    Intoxication with the beta2-agonist Albuterol may lead to immediate signs of beta-adrenergic stimulation like excitation, tachypnea and tachycardia. Furthermore, it typically causes severe hypokalemia, which then leads to muscle weakness and which predisposes to ventricular arrhythmias. We describe a dog where albuterol intoxication caused runs of fast paroxysmal ventricular tachycardia that persisted after normalization of the hypokalemia. Based on a markedly elevated serum troponin I level acute myocardial damage was identified as cause of the tachyarrhythmia. Repeated Troponin I measurements and Holter-ECGs were the means to document complete cure.

  4. 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.

  5. Reporting of drug induced depression and fatal and non-fatal suicidal behaviour in the UK from 1998 to 2011

    Thomas, Kyla H.; Richard M. Martin; Potokar, John; Pirmohamed, Munir; Gunnell, David


    Background Psychiatric adverse drug reactions (ADRs) are distressing for patients and have important public health implications. We identified the drugs with the most frequent spontaneous reports of depression, and fatal and non-fatal suicidal behaviour to the UK’s Yellow Card Scheme from 1998 to 2011. Methods We obtained Yellow Card data from the Medicines and Healthcare products Regulatory Agency for the drugs with the most frequent spontaneous reports of depression and suicidal behaviour f...

  6. Brain marker protein changes after short- and long-term ethanol intoxication and withdrawal in the rat

    Clemmesen, L; Jørgensen, Ole Steen; Hemmingsen, R


    for D3, possibly indicating degradation of mature synapses; increased concentration of proteins D2 and MM during withdrawal, the D2 changes possibly indicating formation of new synapses; increased concentration of D1 protein and MM during long-term intoxication. We suggest that the changes in brain......The brain marker proteins, D1, D2, and D3, localised to neuronal membranes, and mitochondrial and cytoplasmic marker proteins (MM and CM), were studied during 1-6 days (short term) intragastrically-induced severe ethanol intoxication and during 1 month (long-term) ethanol intoxication established...... by a liquid diet regimen. The concentrations of the same brain proteins were also measured during withdrawal from the ethanol intoxication periods. Three categories of effect were encountered: decreased concentration of brain marker proteins during severe short-term intoxication the effect being most marked...

  7. The effect of chronic alcohol intoxication and smoking on the activity of oral peroxidase The effect of chronic alcohol intoxication and smoking on the activity of oral peroxidase

    Napoleon Waszkiewicz


    Full Text Available Peroxidase is the most important antioxidant enzyme in saliva. Through peroxidation of thiocyanate in
    the presence of H2O2, peroxidase catalyses the formation of bacteriocidic compounds such as hypothiocyanate.
    The purpose of this study was to evaluate the effect of chronic alcohol intoxication and smoking on the activity
    of oral peroxidase (OPO. A total of 37 volunteers participated in the study. This cohort consisted of 17 male
    alcohol-dependent smoking patients after chronic alcohol intoxication (AS group, alcohol + smoking (mean
    age: 42 years; range: 26–55 (100–700 g/day of alcohol; 10–20 cigarettes/day and 20 control male social drinkers
    (CNS group, control non-smokers with no history of alcohol abuse or smoking (mean age: 42 years; range:
    30–53. Salivary peroxidase activity was measured by the colorimetric method. The differences between groups
    were evaluated using the Mann–Whitney U test. There was significantly higher activity of OPO (p = 0.00001
    and significantly lower salivary flow (SF (p = 0.007 in alcohol-dependent smokers after chronic alcohol intoxication
    compared to the control group. OPO activity significantly correlated with the number of days of alcohol
    intoxication, but not with smoking. Gingival index (GI was significantly higher in smoking alcohol-dependent
    persons than in the control group, and correlated with OPO activity. The sensitivity of the OPO test was 70% in
    smoking alcoholics, while specificity was 95%. The increased activity of OPO suggests chronic oxidative stress is
    more likely due to ethanol action than to smoking. Smoking alcohol-dependent persons have a worse periodontal
    status than controls. OPO activity as a marker of chronic alcohol abuse may help in the diagnosis of alcoholism.Peroxidase is the most important antioxidant enzyme in saliva. Through peroxidation of thiocyanate in
    the presence of H2O2, peroxidase

  8. Accidental intoxication with hydrochloric acid and hydrofluoric acid mixture

    Anna Smędra-Kaźmirska


    Full Text Available The paper describes a fatal case of accidental ingestion of a mixture of hydrochloric acid and hydrofluoric acid. The man was admitted to hospital, where appropriate treatment, adequate to his condition, was instituted. Numerous ventricular fibrillation episodes, for which the patient was defibrillated repeatedly, were observed during the period of hospitalization. The patient was in a critical condition, with progressive symptoms of hypovolemic shock and multiorgan failure. On the next day after admission, signs of electromechanical dissociation progressing to asystole were noted. The instituted resuscitation procedure proved ineffective and the patient died. Autopsy revealed brownish discoloration of the esophageal, gastric, and small intestinal mucous membranes. Numerous ulcerations without signs of perforation were found both in the esophagus and in the stomach. The mucous membrane of the small intestine demonstrated focal rubefactions, whereas no focal lesions of the large intestinal mucosa were seen. Microscopic investigation of the biopsy specimens collected from the stomach, duodenum and small intestine revealed mucous membrane necrosis foci, reaching the deeper layers of the wall of these organs. The mucous membrane of the large intestine was congested. Bioptates obtained from the lungs indicated the presence of hemorrhagic infarcts and focal extravasations. Poisoning with the aforementioned acids with consequent necrosis of the esophageal, gastric, duodenal and small intestinal walls with hemorrhages to the gastrointestinal tract, as well as extravasations and hemorrhagic infarcts in the lungs was considered to be the cause of death.

  9. Accidental intoxication with hydrochloric acid and hydrofluoric acid mixture.

    Smędra-Kaźmirska, A; Kędzierski, M; Barzdo, M; Jurczyk, Ap; Szram, S; Berent, J


    The paper describes a fatal case of accidental ingestion of a mixture of hydrochloric acid and hydrofluoric acid. The man was admitted to hospital, where appropriate treatment, adequate to his condition, was instituted. Numerous ventricular fibrillation episodes, for which the patient was defibrillated repeatedly, were observed during the period of hospitalization. The patient was in a critical condition, with progressive symptoms of hypovolemic shock and multiorgan failure. On the next day after admission, signs of electromechanical dissociation progressing to asystole were noted. The instituted resuscitation procedure proved ineffective and the patient died. Autopsy revealed brownish discoloration of the esophageal, gastric, and small intestinal mucous membranes. Numerous ulcerations without signs of perforation were found both in the esophagus and in the stomach. The mucous membrane of the small intestine demonstrated focal rubefactions, whereas no focal lesions of the large intestinal mucosa were seen. Microscopic investigation of the biopsy specimens collected from the stomach, duodenum and small intestine revealed mucous membrane necrosis foci, reaching the deeper layers of the wall of these organs. The mucous membrane of the large intestine was congested. Bioptates obtained from the lungs indicated the presence of hemorrhagic infarcts and focal extravasations. Poisoning with the aforementioned acids with consequent necrosis of the esophageal, gastric, duodenal and small intestinal walls with hemorrhages to the gastrointestinal tract, as well as extravasations and hemorrhagic infarcts in the lungs was considered to be the cause of death.

  10. Acute cyanide Intoxication: A rare case of survival

    Durga Jethava


    Full Text Available A 30-year-old male jewellery factory worker accidentally ingested silver potassium cyanide and was brought to the emergency department in a state of shock and profound metabolic acidosis. This patient was managed hypothetically with use of injection thiopentone sodium intravenously until the antidote was received. Cyanide is a highly cytotoxic poison and it rapidly reacts with the trivalent iron of cytochrome oxidase thus paralysing the aerobic respiration. The result is severe lactic acidosis, profound shock, and its fatal outcome. The patient dies of cardio-respiratory arrest secondary to dysfunction of the medullary centres. It is rapidly absorbed, symptoms begin few seconds after exposure and death usually occurs in <30 min. The average lethal dose for potassium cyanide is about 250 mg. We used repeated doses of thiopentone sodium till the antidote kit was finally in our hands, hypothesising that it contains thiol group similar to the antidote thiosulphate. Moreover, it is an anticonvulsant. We were successful in our attempts and the patient survived though the specific antidotes could be administered after about an hour.

  11. What makes a feline fatal in Toxoplasma gondii's fatal feline attraction? Infected rats choose wild cats.

    Kaushik, M; Knowles, S C L; Webster, J P


    Toxoplasma gondii is an indirectly transmitted protozoan parasite, of which members of the cat family (Felidae) are the only definitive hosts and small mammals such as rats serve as intermediate hosts. The innate aversion of rodents to cat odor provides an obstacle for the parasite against successful predation by the feline definitive host. Previous research has demonstrated that T. gondii appears to alter a rat's perception of the risk of being preyed upon by cats. Although uninfected rats display normal aversion to cat odor, infected rats show no avoidance and in some cases even show attraction to cat odor, which we originally termed the "Fatal Feline Attraction." In this study, we tested for the first time whether the "Fatal Feline Attraction" of T. gondii-infected rats differed according to the type of feline odor used, specifically whether it came from domestic cats (Felis silvestris catus) or wild cats-cheetahs (Acinonyx jubatus) or pumas (Felis concolor). In two-choice odor trials, where wild and domestic cat odors were competed against one another, consistent with previous findings we demonstrated that infected rats spent more time in feline odor zones compared with uninfected rats. However, we further demonstrated that all cat odors are not equal: infected rats had a stronger preference for wild cat odor over that of domestic cats, an effect that did not differ significantly according to the type of wild cat odor used (cheetah or puma). We discuss these results in terms of the potential mechanism of action and their implications for the current and evolutionary role of wild, in addition to domestic, cats in transmission of T. gondii.

  12. Fatal and non-fatal suicidal behavior in Israeli adolescent males.

    Apter, Alan; King, Robert A; Bleich, Avi; Fluck, Avi; Kotler, Moshe; Kron, Shmuel


    The objective of this study is examine the similarities and differences between adolescent suicide completers, adolescents with non-fatal suicidal symptoms, and non-suicidal psychiatric controls in an epidemiologic sample. Using the central Israeli military medical registry, 214 18-21 year old males from the same national service cohort were identified, consisting of 43 consecutive completed suicides and 171 consecutive central psychiatric clinic outpatients presenting with near-fatal suicide attempts, serious suicide attempts, para-suicidal gestures, threats, ideation, or other non-suicidal complaints. Systematic pre-induction and service data were available for all subjects, with detailed postmortem inquest data for suicides. Systematic clinical data, including the Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS), Hamilton Depression Scale, and Eysenck Personality Inventory were obtained on all clinic subjects. Major depression was present in half of completers, near-lethal attempters, and ideators, but absent in the other clinic groups, whose commonest diagnosis was adjustment disorder. Depression scores increased across groups with increasing intent; ideators also had high scores. Completers and near-lethal attempters had higher I.Q. and medical fitness ratings and were in more demanding assignments than other groups. Prior attempts were commonest in completers, near-lethal attempters, and gesturers. Disciplinary history, ethnicity, family intactness, immigrant status, and Eysenck Personality Inventory scores did not differentiate the groups. The findings may not be generalizable to female adolescents or to other countries or time periods. The findings thus point to contrasts, as well as similarities, between groups of adolescents with different types of suicidal symptoms.

  13. Circumstances and witness characteristics associated with overdose fatality.

    Bohnert, Amy S B; Tracy, Melissa; Galea, Sandro


    Emergency physicians have an opportunity to provide overdose fatality prevention interventions to individuals at risk for experiencing or witnessing an overdose to reduce fatality. The present study uses data about the most recent overdose observed by a sample of inner-city drug users to determine the circumstances of overdose that are associated with overdose fatality. Participants (n=690) aged 18 years or older were recruited with targeted street outreach. All participants had used heroin or cocaine in the previous 2 months and had witnessed at least 1 overdose. Survey data included the circumstances of the last overdose witnessed, including actions taken, drug use behavior, the location of the event, and whether or not the overdose was fatal (the outcome measure). One hundred fifty-two (21.7%) of the witnessed overdoses were fatal. Witness powdered cocaine use (adjusted odds ratio=1.6; 95% confidence interval [CI] 1.0 to 2.6) and injection drug history (adjusted odds ratio=0.5; 95% CI 0.3 to 0.9) were associated with the last witnessed overdose being fatal. Witnessed overdoses that occurred in public or abandoned buildings compared with homes were more likely to be fatal (adjusted odds ratio=1.9; 95% CI 1.0 to 3.5), as were overdoses in which witnesses sought outside medical help (adjusted odds ratio=1.5; 95% CI 1.0 to 2.1). Future prevention interventions may fruitfully target users of powdered cocaine, drug users without a history of injecting, and individuals who use drugs in public or abandoned buildings for brief interventions on responding when witnessing an overdose to reduce mortality.

  14. Clinical diagnosis versus autopsy findings in polytrauma fatalities

    Fakler Johannes K


    Full Text Available Abstract Objectives The aim of the study was to determine if differences in clinical diagnosis versus autopsy findings concerning the cause of death in polytrauma fatalities would be detected in 19 cases of fatal polytrauma from a Level 1 trauma centre. Methods Clinical diagnoses determining the cause of death in 19 cases of fatal polytrauma (2007 - 2008 from a Level 1 trauma centre were correlated with autopsy findings. Results In 13 cases (68%, the clinical cause of death and the cause of death as determined by autopsy were congruent. Marginal differences occurred in three (16% patients while obvious differences in interpreting the cause of death were found in another three (16% cases. Five fatalities (three with obvious differences and two with marginal differences were remarked as early death (1-4 h after trauma and one fatality with marginal differences as late death (>1 week after trauma. Obvious and marginal discrepancies mostly occurred in the early phase of treatment, especially when severely injured patients were admitted to the emergency room undergoing continued cardiopulmonary resuscitation, i. e. limiting diagnostic procedures, and thus the clinical cause of death was essentially determined by basic emergency diagnostics. Conclusions Autopsy as golden standard to define the cause of death in fatal polytrauma varies from the clinical point of view, depending on the patient's pre-existing condition, mechanism of polytrauma, necessity of traumatic cardiopulmonary resuscitation, survival time, and thus the possibility to perform emergency diagnostics. An autopsy should be performed at least in cases of early fatal polytrauma to help establishing the definite cause of death. Moreover, autopsy data should be included in trauma registries as a quality assessment tool.

  15. Brazilian road traffic fatalities: a spatial and environmental analysis.

    Luciano de Andrade

    Full Text Available BACKGROUND: Road traffic injuries (RTI are a major public health epidemic killing thousands of people daily. Low and middle-income countries, such as Brazil, have the highest annual rates of road traffic fatalities. In order to improve road safety, this study mapped road traffic fatalities on a Brazilian highway to determine the main environmental factors affecting road traffic fatalities. METHODS AND FINDINGS: Four techniques were utilized to identify and analyze RTI hotspots. We used spatial analysis by points by applying kernel density estimator, and wavelet analysis to identify the main hot regions. Additionally, built environment analysis, and principal component analysis were conducted to verify patterns contributing to crash occurrence in the hotspots. Between 2007 and 2009, 379 crashes were notified, with 466 fatalities on BR277. Higher incidence of crashes occurred on sections of highway with double lanes (ratio 2∶1. The hotspot analysis demonstrated that both the eastern and western regions had higher incidences of crashes when compared to the central region. Through the built environment analysis, we have identified five different patterns, demonstrating that specific environmental characteristics are associated with different types of fatal crashes. Patterns 2 and 4 are constituted mainly by predominantly urban characteristics and have frequent fatal pedestrian crashes. Patterns 1, 3 and 5 display mainly rural characteristics and have higher prevalence of vehicular collisions. In the built environment analysis, the variables length of road in urban area, limited lighting, double lanes roadways, and less auxiliary lanes were associated with a higher incidence of fatal crashes. CONCLUSIONS: By combining different techniques of analyses, we have identified numerous hotspots and environmental characteristics, which governmental or regulatory agencies could make use to plan strategies to reduce RTI and support life-saving policies.

  16. A case of acute intoxication due to combined use of fentanyl and 3,4-dichloro-N-[2-(dimethylamino)cyclohexyl]-N-methylbenzamide (U-47700).

    Coopman, Vera; Blanckaert, Peter; Van Parys, Geert; Van Calenbergh, Serge; Cordonnier, Jan


    A 30-year old man was found dead in his home after inhaling fumes of a powder burned on aluminum foil. Blood and urine were taken by the medical examiner during the external body examination and submitted to the laboratory for a comprehensive systematic toxicological analysis. A toxic fentanyl level of 10.9μg/L was measured in the subclavian blood. Police investigation revealed that the man searched the internet for information on new psychotropic substances, among others including U-47700. A powder found in the victims' home was transferred to the laboratory for analysis, in which trace amounts of fentanyl (0.0035%, m/m) and U-47700 (0.0012%, m/m) were identified by gas chromatography mass spectrometry. U-47700 is an opioid analgesic drug, considered to have a potency of approximately 7.5 times that of morphine. A target analysis on U-47700 was performed using liquid-liquid extraction and ultra performance liquid chromatography tandem mass spectrometry operating in multiple reaction monitoring mode. The method validation was based on the Scientific Working Group of Forensic Toxicology document 'Standard Practices of Method Validation in Forensic Toxicology'. In blood and urine the U-47700 concentration was 13.8 and 71.0μg/L, respectively. To the author's knowledge, this is the first case report of a fatal intoxication involving U-47700 abused as a new psychotropic substance.

  17. Natural hazard fatalities in Switzerland from 1946 to 2015

    Badoux, Alexandre; Andres, Norina; Techel, Frank; Hegg, Christoph


    A database of fatalities caused by natural hazard processes in Switzerland was compiled for the period between 1946 and 2015. Using information from the Swiss flood and landslide damage database and the Swiss destructive avalanche database, the data set was extended back in time and more hazard processes were added by conducting an in-depth search of newspaper reports. The new database now covers all natural hazards common in Switzerland, categorised into seven process types: flood, landslide, rockfall, lightning, windstorm, avalanche and other processes (e.g. ice avalanches, earthquakes). Included were all fatal accidents associated with natural hazard processes in which victims did not expose themselves to an important danger on purpose. The database contains information on 635 natural hazard events causing 1023 fatalities, which corresponds to a mean of 14.6 victims per year. The most common causes of death were snow avalanches (37 %), followed by lightning (16 %), floods (12 %), windstorms (10 %), rockfall (8 %), landslides (7 %) and other processes (9 %). About 50 % of all victims died in one of the 507 single-fatality events; the other half were killed in the 128 multi-fatality events. The number of natural hazard fatalities that occurred annually during our 70-year study period ranged from 2 to 112 and exhibited a distinct decrease over time. While the number of victims in the first three decades (until 1975) ranged from 191 to 269 per decade, it ranged from 47 to 109 in the four following decades. This overall decrease was mainly driven by a considerable decline in the number of avalanche and lightning fatalities. About 75 % of victims were males in all natural hazard events considered together, and this ratio was roughly maintained in all individual process categories except landslides (lower) and other processes (higher). The ratio of male to female victims was most likely to be balanced when deaths occurred at home (in or near a building), a situation

  18. Denominator effects on traumatic occupational fatality incidence rates.

    Biddle, E A; Kisner, S M


    Each year over 6,000 workers are killed while earning a living in the United States. From these deaths, how can researchers determine if employees in the manufacturing industry are at greater risk of a traumatic occupational fatality than those employed in agriculture or any other industry? Similarly, does the risk of traumatic occupational fatality differ among states? To answer such questions, two measurements are normally used: frequency of occurrence and incidence rate. These measures are used to identify worker groups at greatest risk of fatal injury, target research and prevention activities, and evaluate the impact of these activities. Developing the best methods to accurately identify worker groups at greatest risk of losing their life while at work is always important, but even more so in times of limited government resources. The accuracy of a traumatic occupational fatality incidence rate depends on how closely the denominator and numerator represent the same population. Selecting data from different employment programs for the denominator when calculating incidence rates using the National Traumatic Occupational Fatalities surveillance system for the numerator has shown dramatically different results. This analysis points out that researchers must carefully: choose the data they employ; evaluate the meaning of calculated incidence rates; and document the data sources to ensure proper interpretation by others. Additional research and evaluation are necessary to improve data sources, analytical methods and tools to ensure effective resource allocations for the occupational safety and health field.

  19. Fatal diving accidents in western Norway 1983-2007.

    Ramnefjell, M P; Morild, I; Mørk, S J; Lilleng, P K


    Despite efforts to reduce their number, fatal diving accidents still occur. The circumstances and post-mortem findings in 40 fatal diving accidents in western Norway from 1983 through 2007 were investigated. Diving experience, medical history and toxicology reports were retrieved. The material consisted of recreational divers, professional saturation divers and professional divers without experience with saturation. In 33 cases the diving equipment was examined as part of the forensic investigation. In 27 cases defects in the diving equipment were found. For six divers such defects were responsible for the fatal accidents. Eighteen divers died on the surface or less than 10 m below surface. Five divers reached below 100 msw, and two of them died at this depth. The fatalities were not season-dependent. However, wave-height and strength of currents were influential factors in some cases. Twelve divers were diving alone. Twenty divers had one buddy, 9 of these divers were alone at the time of death. The cause of death was drowning in 31 out of 40 divers; one of them had a high blood-ethanol concentration, in two other divers ethanol was found in the urine, indicating previous ethanol consumption. Nine divers died from sudden decompression, pulmonary barotraumas, underwater trauma and natural causes. The study shows that most of the fatal diving accidents could be avoided if adequate diving safety procedures had been followed.

  20. CREBH determines the severity of sulpyrine-induced fatal shock.

    Naganori Kamiyama

    Full Text Available Although the pyrazolone derivative sulpyrine is widely used as an antipyretic analgesic drug, side effects, including fatal shock, have been reported. However, the molecular mechanism underlying such a severe side effect is largely unclear. Here, we report that the transcription factor CREBH that is highly expressed in the liver plays an important role in fatal shock induced by sulpyrine in mice. CREBH-deficient mice were resistant to experimental fatal sulpyrine shock. We found that sulpyrine-induced expression of cytochrome P450 2B (CYP2B family genes, which are involved in sulpyrine metabolism, in the liver was severely impaired in CREBH-deficient mice. Moreover, introduction of CYP2B in CREBH-deficient liver restored susceptibility to sulpyrine. Furthermore, ectopic expression of CREBH up-regulated CYP2B10 promoter activity, and in vivo knockdown of CREBH in wild-type mice conferred a significant resistance to fatal sulpyrine shock. These data demonstrate that CREBH is a positive regulator of CYP2B in response to sulpyrine administration, which possibly results in fatal shock.

  1. Forensic intoxication with clobazam: HPLC/DAD/MSD analysis.

    Proença, Paula; Teixeira, Helena; Pinheiro, João; Marques, Estela P; Vieira, Duarte Nuno


    Clobazam (Castillium, Urbanil), a benzodiazepine often used as an anxiolytic and in the treatment of epilepsy, is considered a relatively safe drug. The authors present a fatal case with a 49-year-old female, found dead at home. She had been undergoing psychiatric treatment and was a chronic alcoholic. The autopsy findings were unremarkable, except for multivisceral congestion, steatosis and a small piece of a plastic blister pack in the stomach. Bronchopneumonia, bronchitis and bronchiolitis were also diagnosed. Anhigh-performance liquid chromatography (HPLC)/diode array detector (DAD)/mass spectrometry detection (MSD) with electrospray method was developed in order to detect, confirm and quantify clobazam in the post-mortem samples. In the chromatographic separation, a reversed-phase column C18 (2.1 x 150 mm, 3.5 microm) was used with a mobile phase of methanol and water, at a 0.25 ml/min flow rate. Carbonate buffer (pH 10.5) and 20 microl of prazepam (100 microg/ml) as internal standard were added to the samples. A simple and reliable liquid-liquid extraction method for the determination of clobazam in post-mortem samples was described. Calibration curves for clobazam were performed in blood, achieving linearity between 0.01 and 10 microg/ml and a detection limit of 1.0 ng/ml. The clobazam concentration found in post-mortem blood was 3.9 microg/ml, higher than the reported therapeutic concentration (0.1-0.4 microg/ml). The simultaneous acquisition by photodiode array detection and mass spectrometry detection results allowed benzodiazepines to be identified with sufficient certainty. An examination of all the available information suggested that death resulted from respiratory depression due to clobazam toxicity.

  2. Beneficial effects of TCP on soman intoxication in guinea pigs : seizures, brain damage and learning behaviour

    Groot, D.M.G. de; Bierman, E.P.B.; Bruijnzeel, P.L.B.; Carpentier, P.; Kulig, B.M.; Lallement, G.; Melchers, B.P.C.; Philippens, I.H.C.H.M.; Huygevoort, A.H.B.M. van


    Poisoning with the potent nerve agent soman produces a cascade of central nervous system (CNS) effects characterized by severe convulsions and eventually death. In animals that survive a soman intoxication, lesions in the amygdala, piriform cortex, hippocampus and thalamus can be observed. In order

  3. Heavy Ethanol Intoxication Increases Proinflammatory Cytokines and Aggravates Hemorrhagic Shock-Induced Organ Damage in Rats

    Tsung-Ming Hu


    Full Text Available Hemorrhagic shock (HS following acute alcohol intoxication can increase proinflammatory cytokine production and induce marked immunosuppression. We investigated the effects of ethanol on physiopathology and cytokine levels following HS in acutely alcohol-intoxicated rats. Rats received an intravenous injection of 5 g/kg ethanol over 3 h followed by HS induced by withdrawal of 40% of total blood volume from a femoral arterial catheter over 30 min. Mean arterial pressure (MAP and heart rate (HR were monitored continuously for 48 h after the start of blood withdrawal. Biochemical parameters, including hemoglobin, ethanol, glutamic oxaloacetic transaminase (GOT, glutamic pyruvic transaminase (GPT, blood urea nitrogen (BUN, creatinine (Cre, lactic dehydrogenase (LDH, and creatine phosphokinase (CPK, were measured at 30 min before induction of HS and 0, 1, 3, 6, 9, 12, 18, 24, and 48 h after HS. Serum tumor necrosis factor-α (TNF-α and interleukin-6 (IL-6 levels were measured at 1 and 12 h after HS. The liver, kidneys, and lungs were removed for pathology at 48 h later. HS significantly increased HR, blood GOT, GPT, BUN, Cre, LDH, CPK, TNF-α, and IL-6 levels and decreased hemoglobin and MAP in rats. Acute ethanol intoxication further increased serum levels of GOT, GPT, BUN, Cre, LDH, CPK, TNF-α and IL-6 elevation following HS. Acutely intoxicated rats exacerbated the histopathologic changes in the liver, kidneys, and lungs following HS.

  4. Is gender a risk factor for pesticide intoxications among farmers in Bolivia?

    Jørs, Erik; Hay-Younes, Jasmin; Condarco, Madelaine A


    This study compares gender differences regarding knowledge, practice, and symptoms of intoxication when handling pesticides in farming. Data were gathered in La Paz County, Bolivia, in 2008 and 2009. Poor knowledge on safe handling, hazardous working practices, and use of very toxic pesticides were...... symptoms. To minimize this gap, education and agricultural services should be made more accessible to female farmers in Bolivia....

  5. Women's condom use assertiveness and sexual risk-taking: effects of alcohol intoxication and adult victimization.

    Stoner, Susan A; Norris, Jeanette; George, William H; Morrison, Diane M; Zawacki, Tina; Davis, Kelly Cue; Hessler, Danielle M


    This experiment examined relationships among adulthood victimization, sexual assertiveness, alcohol intoxication, and sexual risk-taking in female social drinkers (N=161). Women completed measures of sexual assault and intimate partner violence history and sexual assertiveness before random assignment to 1 of 4 beverage conditions: control, placebo, low dose (.04%), or high dose (.08%). After drinking, women read a second-person story involving a sexual encounter with a new partner. As protagonist of the story, each woman rated her likelihood of condom insistence and unprotected sex. Victimization history and self-reported sexual assertiveness were negatively related. The less sexually assertive a woman was, the less she intended to insist on condom use, regardless of intoxication. By reducing the perceived health consequences of unprotected sex, intoxication indirectly decreased condom insistence and increased unprotected sex. Findings extend previous work by elucidating possible mechanisms of the relationship between alcohol and unprotected sex - perceived health consequences and situational condom insistence - and support the value of sexual assertiveness training to enhance condom insistence, especially since the latter relationship was robust to intoxication.

  6. Compliance with the Legislation on Alcohol Serving and Selling and Alcohol Intoxications in Adolescents

    van Hoof, Joris Jasper; Boeynaems, Gerben; van der Lely, Nicolaas


    Purpose: study the relation between compliance to the legal age limits for alcohol sales and alcohol intoxication in adolescents. Methods: from 2007 till 2012 we collected data on adolescents, with a positive BAC, treated in a hospital. Within the Dutch Pediatric Surveillance System (NSCK),

  7. Are restrained eaters accurate monitors of their intoxication? Results from a field experiment.

    Buchholz, Laura J; Crowther, Janis H; Olds, R Scott; Smith, Kathryn E; Ridolfi, Danielle R


    Brief interventions encourage college students to eat more before drinking to prevent harm (Dimeff et al., 1999), although many women decrease their caloric intake (Giles et al., 2009) and the number of eating episodes (Luce et al., 2012) prior to drinking alcohol. Participants were 37 undergraduate women (24.3% Caucasian) who were recruited from a local bar district in the Midwest. This study examined whether changes in eating after intending to drink interacted with dietary restraint to predict accuracy of one's intoxication. Results indicated that changes in eating significantly moderated the relationship between dietary restraint and accuracy of one's intoxication level. After eating more food before intending to drink, women higher in restraint were more likely to overestimate their intoxication than women lower in restraint. There were no differences between women with high levels and low levels of dietary restraint in the accuracy of their intoxication after eating less food before intending to drink. Future research would benefit from examining interoceptive awareness as a possible mechanism involved in this relationship.

  8. A Cost Analysis of Web-Enhanced Training to Reduce Alcohol Sales to Intoxicated Bar Patrons

    Page, Timothy F.; Nederhoff, Dawn M.; Ecklund, Alexandra M.; Horvath, Keith J.; Nelson, Toben F.; Erickson, Darin J.; Toomey, Traci L.


    Objective: The purpose of this study was to document the development and testing costs of the Enhanced Alcohol Risk Management (eARM) intervention, a web enhanced training program to prevent alcohol sales to intoxicated bar patrons and to estimate its implementation costs in a "real world", non-research setting. Methods: Data for this…

  9. Corrections by melatonin of liver mitochondrial disorders under diabetes and acute intoxication in rats.

    Cheshchevik, Vitali T; Dremza, Iosif K; Lapshina, Elena A; Zabrodskaya, Svetlana V; Kujawa, Jolanta; Zavodnik, Ilya B


    The aim of the present work was to investigate the mechanisms of oxidative damage of the liver mitochondria under diabetes and intoxication in rats as well as to evaluate the possibility of corrections of mitochondrial disorders by pharmacological doses of melatonin. The experimental (30 days) streptozotocin-induced diabetes mellitus caused a significant damage of the respiratory activity in rat liver mitochondria. In the case of succinate as a respiratory substrate, the ADP-stimulated respiration rate V₃ considerably decreased (by 25%, p diabetic liver damage. Acute rat carbon tetrachloride-induced intoxication resulted in considerable decrease of the phosphorylation coefficient because of uncoupling of the oxidation and phosphorylation processes in the liver mitochondria. The melatonin administration during diabetes (10 mg·kg⁻¹ body weight, 30 days, daily) showed a considerable protective effect on the liver mitochondrial function, reversing the decreased respiration rate V₃ and the diminished ACR to the control values both for succinate-dependent respiration and for glutamate-dependent respiration. The melatonin administration to intoxicated animals (10 mg·kg⁻¹ body weight, three times) partially increased the rate of succinate-dependent respiration coupled with phosphorylation. The impairment of mitochondrial respiratory plays a key role in the development of liver injury under diabetes and intoxication. Melatonin might be considered as an effector that regulates the mitochondrial function under diabetes.

  10. Ricinus communis Intoxications in Human and Veterinary Medicine—A Summary of Real Cases

    Martin Schaer


    Full Text Available Accidental and intended Ricinus communis intoxications in humans and animals have been known for centuries but the causative agent remained elusive until 1888 when Stillmark attributed the toxicity to the lectin ricin. Ricinus communis is grown worldwide on an industrial scale for the production of castor oil. As by-product in castor oil production ricin is mass produced above 1 million tons per year. On the basis of its availability, toxicity, ease of preparation and the current lack of medical countermeasures, ricin has gained attention as potential biological warfare agent. The seeds also contain the less toxic, but highly homologous Ricinus communis agglutinin and the alkaloid ricinine, and especially the latter can be used to track intoxications. After oil extraction and detoxification, the defatted press cake is used as organic fertilizer and as low-value feed. In this context there have been sporadic reports from different countries describing animal intoxications after uptake of obviously insufficiently detoxified fertilizer. Observations in Germany over several years, however, have led us to speculate that the detoxification process is not always performed thoroughly and controlled, calling for international regulations which clearly state a ricin threshold in fertilizer. In this review we summarize knowledge on intended and unintended poisoning with ricin or castor seeds both in humans and animals, with a particular emphasis on intoxications due to improperly detoxified castor bean meal and forensic analysis.

  11. Hazards of Secondary Bromadiolone Intoxications Evaluated using High-performance Liquid Chromatography with Electrochemical Detection

    René Kizek


    Full Text Available This study reported on the possibility of intoxications of non-target wild animalsassociated with use of bromadiolone as the active component of rodenticides withanticoagulation effects. A laboratory test was done with earthworms were exposed tobromadiolone-containing granules under the conditions specified in the modified OECD207 guideline. No mortality of earthworms was observed during the fourteen days longexposure. When the earthworms from the above test became a part of the diet of commonvoles in the following experiment, no mortality of consumers was observed too. However,electrochemical analysis revealed higher levels of bromadiolone in tissues fromearthworms as well as common voles compared to control animals. There were determinedcomparable levels of bromadiolone in the liver tissue of common voles after primary(2.34±0.10 μg/g and secondary (2.20±0.53 μg/g intoxication. Therefore, the risk ofsecondary intoxication of small mammalian species feeding on bromadiolone-containing earthworms is the same as of primary intoxication through baited granules. Bromadiolone bio-accumulation in the food chain was monitored using the newly developed analytical procedure based on the use of a liquid chromatography coupled with electrochemical detector (HPLC-ED. The HPLC-ED method allowed to determine the levels of bromadiolone in biological samples and is therefore suitable for examining the environmental hazards of this substance.

  12. Synthetic legal intoxicating drugs: the emerging 'incense' and 'bath salt' phenomenon.

    Jerry, Jason; Collins, Gregory; Streem, David


    Synthetic legal intoxicating drugs (SLIDs), such as those commonly contained in products sold over the counter as "bath salts" and "incense," have risen tremendously in popularity in the past few years. These drugs can have powerful adverse effects, including acute psychosis with delusions, hallucinations, and potentially dangerous, bizarre behavior.

  13. Fasting ameliorates metabolism, immunity, and oxidative stress in carbon tetrachloride-intoxicated rats.

    Sadek, Km; Saleh, Ea


    Fasting has been recently discovered to improve overall health, but its beneficial effects in the presence of hepatic insufficiency have not been proven. The influence of fasting on the metabolism, immunological aspects, and oxidative stress of 40 male carbon tetrachloride (CCl4)-intoxicated Wistar rats was investigated in the present study. The rats were divided into four groups, including a placebo group, CCl4-intoxicated rats, which were injected subcutaneously with 1.0 ml/kg of CCl4 solution, a fasting group, which was fasted 12 h/day for 30 days, and a fourth group, which was injected with CCl4 and fasted. The metabolism, immunity, and oxidative stress improved in CCl4-intoxicated rats fasted for 12 h/day for 30 days, as evidenced in significant increase (p fasting improved metabolism, immunity, and oxidative stress in CCl4-intoxicated rats. Thus, fasting during Ramadan is safe for patients with hepatic disorders, as the prophet Mohammed (S) said "Keep the fast, keep your health". © The Author(s) 2014.

  14. Effects of Alcohol Intoxication on Anger Experience and Expression among Partner Assaultive Men

    Eckhardt, Christopher I.


    The author investigated the acute effects of alcohol intoxication on anger experience and expression among 46 maritally violent (MV) and 56 maritally nonviolent (NV) men randomly assigned to receive alcohol, placebo, or no alcohol. Participants completed an anger-arousing articulated thoughts in simulated situations (ATSS) paradigm and imagined…

  15. Mercury Intoxication in Rats: Iron and Vitamin B6 as A Potential Therapy

    Mohammad Taimur Islam*


    Full Text Available Background: Mercury in any form is poisonous and mercury toxicity most commonly affects the nervous, gastrointestinal (GI and urinary systems. The aim of this study was to investigate the specific effect associated with mercury toxicity and to evaluate the effectiveness of iron and vitamin B6 supplement on mercury-induced toxicities in rats. Methods: This experiment was performed on 25 rats. All rats were randomly divided into five equal groups (5×5. Toxic signs and body weight change, hematological parameters like total erythrocyte count (TEC, total leukocyte count (TLC, hemoglobin content (Hb% and packed cell volume (PCV and postmortem changes in rats were investigated. Results: Rats treated with mercury intoxication showed severe toxic signs and significantly (P<0.01 reduced TEC, TLC, Hb content and PCV. However, rats treated with mercury intoxication in combination with iron and vitamin B6 showed physiological levels of hematological parameters. Mercury intoxication induced the congestion and necrosis in lung, liver, heart and kidney, whereas combined use of mercury intoxication, iron and vitamin B6 recovered the condition. Conclusion: Combined use of iron and vitamin B6 is highly protective against mercury toxicity.

  16. Assessing Driving while Intoxicated (DWI) Offender Characteristics and Drinking Problems Utilizing the Numerical Drinking Profile (NDP)

    Barry, Adam E.; Misra, Ranjita; Dennis, Maurice


    Driving a vehicle under the influence of alcohol is a major public health concern. By distinguishing the type of individuals violating driving while intoxicated (DWI) sanctions, intervention programs will be better suited to reduce drinking and driving. The purpose of this study was to examine the personal characteristics of DWI offenders and…

  17. Statistical parametric mapping in brain single photon computed emission tomography after carbon monoxide intoxication.

    Watanabe, N; Nohara, S; Matsuda, H; Sumiya, H; Noguchi, K; Shimizu, M; Tsuji, S; Kinuya, S; Shuke, N; Yokoyama, K; Seto, H


    The purpose of this retrospective study was to assess regional cerebral blood flow in patients after carbon monoxide intoxication by using brain single photon emission computed tomography and statistical parametric mapping. Eight patients with delayed neuropsychiatric sequelae and ten patients with no neuropsychiatric symptoms after carbon monoxide intoxication were studied with brain single photon emission tomography imaging with 99mTc-hexamethyl-propyleneamine oxime. Forty-four control subjects were also studied. We used the adjusted regional cerebral blood flow images in relative flow distribution (normalization of global cerebral blood flow for each subject to 50 ml x 100 g(-1) x min(-1) with proportional scaling) to compare these groups with statistical parametric mapping. Using this technique, significantly decreased regional cerebral blood flow was noted extensively in the bilateral frontal lobes as well as the bilateral insula and a part of the right temporal lobe in the patients with delayed neuropsychiatric sequelae as compared with normal volunteers (Pparametric mapping is a useful technique for highlighting differences in regional cerebral blood flow in patients following carbon monoxide intoxication as compared with normal volunteers. The selectively reduced blood flow noted in this investigation supports the contention that the decrease following carbon monoxide intoxication may be prolonged and further worsen in the frontal lobe. In addition, the present study may help to clarify the characteristics of the pathophysiological alteration underlying delayed neuropsychiatric sequelae.

  18. Gender, male-typicality, and social norms predicting adolescent alcohol intoxication and marijuana use.

    Mahalik, James R; Lombardi, Caitlin McPherran; Sims, Jacqueline; Coley, Rebekah Levine; Lynch, Alicia Doyle


    This study examined the direct and interactive effects of gender, male-typicality, and social norms in predicting the initiation and longitudinal patterns of alcohol intoxication and marijuana use in U.S. youth. Data were drawn from a longitudinal survey of 10,588 youth who participated in the in-home survey of the National Longitudinal Study of Adolescent Health (Add Health). Multilevel growth modeling used data from three time points to assess trajectories of substance use from adolescence to young adulthood. Analyses indicated that gender, male-typicality, as well as home availability, friend social norms, and schoolmate social norms predicted initial levels of intoxication and marijuana use, with gender, friend norms, and schoolmate norms also predicting differential rates of growth over time in intoxication and marijuana use. Interaction results indicated that gender moderated male-typicality's relationship to both substance use variables, and home availability's relationship to alcohol intoxication. These findings extend the literatures regarding interrelations among gender, gender roles, social norms, and health risk behaviors by (a) locating the genesis of those effects in adolescence, (b) identifying gender and social norms to be salient in terms of both initiation and growth of substance use over time, (c) suggesting that gender differences should be understood as moderated by other social-contextual variables, and (d) arguing that prevention efforts should address gender and gender roles more explicitly in programming. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Catechol-Bisphosphonate Conjugates:New Potential Chelating Agents for Metal Intoxication Therapy

    Guang Yu XU; Chun Hao YANG; Bo LIU; Xi Han WU; Yu Yuan XIE


    In a quest for better chelating therapy drugs for the treatment of intoxication by Fe, Al, or actinides, two new series of mixed catechol-bisphosphonate through amide linkage were synthesized.Benzyl group was used as protecting group to avoid the breakage of amide by acid hydrolysis or imcomplete reaction in silylation-dealkylation using bromotrimethylsilane.

  20. Acute toluene intoxication--clinical presentation, management and prognosis: a prospective observational study.

    Camara-Lemarroy, Carlos Rodrigo; Rodríguez-Gutiérrez, René; Monreal-Robles, Roberto; González-González, José Gerardo


    Toluene is one of the most widely abused inhaled drugs due to its acute neurologic effects including euphoria and subsequent depression. However, dangerous metabolic abnormalities are associated to acute toluene intoxication. It has been previously reported that rhabdomyolysis and acute hepatorenal injury could be hallmarks of the condition, and could constitute risk factors for poor outcomes. The objective was to describe the clinical presentation, to characterize the renal and liver abnormalities, the management and prognosis associated to acute toluene intoxication. We prospectively assessed 20 patients that were admitted to a single center's emergency department from September 2012 to June 2014 with clinical and metabolic alterations due to acute toluene intoxication. The main clinical presentation consisted of weakness associated to severe hypokalemia and acidosis. Renal glomerular injury (proteinuria) is ubiquitous. Biliary tract injury (alkaline phosphatase and gamma-glutamyl transpeptidase elevations) disproportional to hepatocellular injury is common. Rhabdomyolysis occurred in 80% of patients, probably due to hypokalemia and hypophosphatemia. There were three deaths, all female, and all associated with altered mental status, severe acidosis, hypokalemia and acute oliguric renal failure. The cause of death was in all cases due to cardiac rhythm abnormalities. The hallmarks of acute toluene intoxication are hypokalemic paralysis and metabolic acidosis. Liver injury and rhabdomyolysis are common. On admission, altered mental status, renal failure, severe acidemia and female gender (not significant in our study, but present in all three deaths) could be associated with a poor outcome, and patients with these characteristics should be considered to be treated in an intensive care unit.

  1. The need for ICU admission in intoxicated patients : a prediction model

    Brandenburg, Raya; Brinkman, Sylvia; de Keizer, Nicolette F; Kesecioglu, Jozef; Meulenbelt, Jan; de Lange, Dylan W

    CONTEXT: Intoxicated patients are frequently admitted from the emergency room to the ICU for observational reasons. The question is whether these admissions are indeed necessary. OBJECTIVE: The aim of this study was to develop a model that predicts the need of ICU treatment (receiving mechanical

  2. Brain MR finding of {beta}-fluoroethyl acetate rodenticide intoxication: a case report

    Kim, Ji Young; Jung, Cheol Kyu; Lee, Seung Ro; Park, Dong Woo [College of Medicine, Hanyang University, Seoul (Korea, Republic of)


    {beta}-fluoroethyl acetate rodenticide intoxication can manifest as several different clinical abnormalities such as respiratory, neurologic, cardiologic and fluid-electrolyte problems. We report here on the MR findings of a case that showed symmetric cytotoxic edema in the while matter of the cerebral hemispheres after the ingestion of {beta} - fluoroethyl acetate rodenticide by a woman who was attempting suicide.

  3. Ricinus communis intoxications in human and veterinary medicine-a summary of real cases.

    Worbs, Sylvia; Köhler, Kernt; Pauly, Diana; Avondet, Marc-André; Schaer, Martin; Dorner, Martin B; Dorner, Brigitte G


    Accidental and intended Ricinus communis intoxications in humans and animals have been known for centuries but the causative agent remained elusive until 1888 when Stillmark attributed the toxicity to the lectin ricin. Ricinus communis is grown worldwide on an industrial scale for the production of castor oil. As by-product in castor oil production ricin is mass produced above 1 million tons per year. On the basis of its availability, toxicity, ease of preparation and the current lack of medical countermeasures, ricin has gained attention as potential biological warfare agent. The seeds also contain the less toxic, but highly homologous Ricinus communis agglutinin and the alkaloid ricinine, and especially the latter can be used to track intoxications. After oil extraction and detoxification, the defatted press cake is used as organic fertilizer and as low-value feed. In this context there have been sporadic reports from different countries describing animal intoxications after uptake of obviously insufficiently detoxified fertilizer. Observations in Germany over several years, however, have led us to speculate that the detoxification process is not always performed thoroughly and controlled, calling for international regulations which clearly state a ricin threshold in fertilizer. In this review we summarize knowledge on intended and unintended poisoning with ricin or castor seeds both in humans and animals, with a particular emphasis on intoxications due to improperly detoxified castor bean meal and forensic analysis.

  4. Compliance with the Legislation on Alcohol Serving and Selling and Alcohol Intoxications in Adolescents

    Hoof, van Joris J.; Boeynaems, Gerben; Vanderlely, Nicolaas


    Purpose: study the relation between compliance to the legal age limits for alcohol sales and alcohol intoxication in adolescents. Methods: from 2007 till 2012 we collected data on adolescents, with a positive BAC, treated in a hospital. Within the Dutch Pediatric Surveillance System (NSCK), pediatr

  5. Oral administration of piperine for the control of aflatoxin intoxication in rats

    Thalita B. Gagini


    Full Text Available Aflatoxins are mycotoxins that have important toxic effects on human and animal health, even if consumed at low doses. The oral administration of piperine (1.12 mg/kg during 23 days in rats seemingly interfered with the toxicity of aflatoxins, decreasing hepatic injuries and the leukocyte depletion in experimentally intoxicated animals.

  6. The Effect of Vitamin C on the Erythrocyte Antioxidant Enzymes in Intoxicated-Lead Rat Offsprings

    Eshginia, Samira; Marjani, Abdoljalal


    Objective: Lead exposure or lead poisoning is known to cause a large spectrum of physiological, biochemical, and behavioural disorders in animals. This study was aimed at assessing the effect of vitamin C on the erythrocyte superoxide dismutase, glutathione peroxidase and the glutathione reductase activities in intoxicated- lead rat offsprings.

  7. Acute isoniazid intoxication: an uncommon cause of convulsion, coma and acidosis.

    Uzman, Sinan; Uludağ Yanaral, Tümay; Toptaş, Mehmet; Koç, Alparslan; Taş, Aytül; Bican, Gülşen


    Despite the widespread use, suicidal ingestion of isoniazid is a rare condition in Turkey. We reported a case of acute isoniazid intoxication associated with alcohol intake presenting with convulsion, coma and metabolic acidosis. The patient was treated successfully with intravenous pyridoxine administration. Early recognation and appropriate treatment in the intensive care unit is very important to prevent mortality in patients with acute isoniazid toxicity.

  8. Fatal injuries while under the influence of psychoactive drugs: a cross-sectional exploratory study in England

    Dryden Ruth


    Full Text Available Abstract Background Studies of drug-related mortality rarely describe fatal injuries due to psychoactive drug intoxication (FIUI. The main aim of this study was to determine the nature, extent and pattern of FIUI. Methods This observational study covered the period January 1999 to December 2001. Data were provided by members of a study panel of coroners in England using a standard protocol. Sources of data for this study included autopsy protocols, death certificates, hospital records, police reports, toxicology reports and inquest transcripts. Inclusion criteria for this were (i the mention of one or more psychoactive substances as contributing to fatality; and (ii the presence of a Controlled Drug at post mortem. Results A total of 3,803 drug-related deaths of persons aged 16–64 years were reported by the study panel during the three-year period. The study panel accounted for 86% of drug-related deaths in England in this period. There were 147 FIUI cases (119 males, 28 females, giving a proportionate mortality ratio of approximately 4%. The majority of FIUI cases (84% were aged 16–44 years, with a median age at death of 33 years (Quartile deviation = 7. Fifty-six percent of FIUI occurred in urban areas of England. The population of the study jurisdictions aged 16–64 years contributed 49,545,766 person-years (py to the study, giving an annual crude rate of 3/1,000,000 person-years (py. Rates for male and females were 4.9 and 1.1/1,000,000 py respectively, giving a male/female rate ratio of 4.5 (95%CI = 2.9–6.8. The rates of intentional and unintentional FIUI were 2 and 1/1,000,000 py respectively. The leading mechanism for intentional FIUI was suffocation while the predominant mechanisms in unintentional FIUI were road traffic accidents and falls. There is a significant difference in the pattern of drug-specific risk between FIUI and fatal poisoning. Risks of intentional FIUI are elevated among Black and Minority Ethnic groups

  9. Blast overpressure after tire explosion: a fatal case.

    Pomara, Cristoforo; D'Errico, Stefano; Riezzo, Irene; Perilli, Gabriela; Volpe, Umberto; Fineschi, Vittorio


    Fatal blast injuries are generally reported in literature as a consequence of the detonation of explosives in war settings. The pattern of lesion depends on the position of the victim in relation to the explosion, on whether the blast tracks through air or water, and whether it happens in the open air or within an enclosed space and the distance from the explosion. Tire explosion-related injuries are rarely reported in literature. This study presents a fatal case of blast overpressure due to the accidental explosion of a truck tire occurring in a tire repair shop. A multidisciplinary approach to the fatality involving forensic pathologists and engineers revealed that the accidental explosion, which caused a series of primary and tertiary blast wave injuries, was due to tire deterioration.

  10. Morphine protects against methylmercury intoxication: a role for opioid receptors in oxidative stress?

    Allan Costa-Malaquias

    Full Text Available Mercury is an extremely dangerous environmental contaminant responsible for episodes of human intoxication throughout the world. Methylmercury, the most toxic compound of this metal, mainly targets the central nervous system, accumulating preferentially in cells of glial origin and causing oxidative stress. Despite studies demonstrating the current exposure of human populations, the consequences of mercury intoxication and concomitant use of drugs targeting the central nervous system (especially drugs used in long-term treatments, such as analgesics are completely unknown. Morphine is a major option for pain management; its global consumption more than quadrupled in the last decade. Controversially, morphine has been proposed to function in oxidative stress independent of the activation of the opioid receptors. In this work, a therapeutic concentration of morphine partially protected the cellular viability of cells from a C6 glioma cell line exposed to methylmercury. Morphine treatment also reduced lipid peroxidation and totally prevented increases in nitrite levels in those cells. A mechanistic study revealed no alteration in sulfhydryl groups or direct scavenging at this opioid concentration. Interestingly, the opioid antagonist naloxone completely eliminated the protective effect of morphine against methylmercury intoxication, pointing to opioid receptors as the major contributor to this action. Taken together, the experiments in the current study provide the first demonstration that a therapeutic concentration of morphine is able to reduce methylmercury-induced oxidative damage and cell death by activating the opioid receptors. Thus, these receptors may be a promising pharmacological target for modulating the deleterious effects of mercury intoxication. Although additional studies are necessary, our results support the clinical safety of using this opioid in methylmercury-intoxicated patients, suggesting that normal analgesic doses could

  11. The effects of acute alcohol intoxication on the cognitive mechanisms underlying false facial recognition.

    Colloff, Melissa F; Flowe, Heather D


    False face recognition rates are sometimes higher when faces are learned while under the influence of alcohol. Alcohol myopia theory (AMT) proposes that acute alcohol intoxication during face learning causes people to attend to only the most salient features of a face, impairing the encoding of less salient facial features. Yet, there is currently no direct evidence to support this claim. Our objective was to test whether acute alcohol intoxication impairs face learning by causing subjects to attend to a salient (i.e., distinctive) facial feature over other facial features, as per AMT. We employed a balanced placebo design (N = 100). Subjects in the alcohol group were dosed to achieve a blood alcohol concentration (BAC) of 0.06 %, whereas the no alcohol group consumed tonic water. Alcohol expectancy was controlled. Subjects studied faces with or without a distinctive feature (e.g., scar, piercing). An old-new recognition test followed. Some of the test faces were "old" (i.e., previously studied), and some were "new" (i.e., not previously studied). We varied whether the new test faces had a previously studied distinctive feature versus other familiar characteristics. Intoxicated and sober recognition accuracy was comparable, but subjects in the alcohol group made more positive identifications overall compared to the no alcohol group. The results are not in keeping with AMT. Rather, a more general cognitive mechanism appears to underlie false face recognition in intoxicated subjects. Specifically, acute alcohol intoxication during face learning results in more liberal choosing, perhaps because of an increased reliance on familiarity.

  12. [Case report: kleptomania and other psychiatric symptoms after carbon monoxide intoxication].

    Gürlek Yüksel, Ebru; Taşkin, E Oryal; Yilmaz Ovali, Gülgün; Karaçam, Melek; Esen Danaci, Ayşen


    Carbon monoxide (CO) intoxication is usually a serious condition, which can result in neurological disturbances or death. In some patients with CO intoxication, but not usually, a biphasic pattern can be seen. In this condition, after antitoxic treatment, patients may completely recover and after a short recovery period, neurological and/or psychiatric symptoms appear again. This condition is known as delayed encephalopathy and its occurrence rate is between 0.06% and 11.8%. Herein, we report a case with delayed encephalopathy after CO intoxication, which began with neurological symptoms and continued with obsessive-compulsive disorder, depression, kleptomania, and psychotic disorder. The 41-year-old female patient had no psychiatric or neurological symptoms or disorders prior to CO intoxication. Increased signal intensity changes in the basal region of the left temporal lobe (including the cortex and subcortical white matter), globus pallidus (bilateral), and cerebellar cortical and subcortical white matter (bilaterally symmetrical) was detected on axial T2-weighted magnetic resonance imaging (MRI). In addition, there were atrophic changes in both cerebellar hemispheres. To the best of our knowledge, this is the first case of kleptomania described after CO intoxication in the literature. We discuss the organic etiology of kleptomania and the other psychiatric symptoms of this patient in the light of recent research. We concluded that the kleptomania seen in this patient was related to concurrent lesions in the temporal lobe and globus pallidus; in other words, her kleptomania may have been related to dysfunction simultaneously seen in both the temporolimbic and frontal-subcortical circuits.

  13. The influence of ultraviolet blood irradiation and oxygenation on oxygen free radicals metabolism in rabbits with soman intoxication


    Objective: To investigate the effect of ultraviolet blood irradiation and oxygenation (UBIO) on the metabolism of oxygen free radicals in rabbits with acute soman intoxication. Methods: One hundred rabbits were randomly divided into 5 groups: normal control group, intoxication group, routine therapy group, UBIO therapy group and combined therapy group. After 14 d, the concentration of malondiadehyde (MDA) and activity of superoxide dismutase (SOD), glutathionperoxidase (GSH-Px), catalase (CAT)and total antioxidative capacity (T-AOC) in serum were determined respectively. Results: Compared with the normal control group, the concentration of MDA and activity of CAT in the intoxication group were significantly higher (P < 0. 05 ), but SOD, GSH-Px activity and T-AOC were significantly lower (P<0.05). After UBIO or combined therapy, serum MDA level was significantly lower in comparison with intoxication group (P<0.05), but the activity of SOD, GSH-Px, CAT and T AOC were higher than intoxication group(P<0.05). Conclusion: There is an obvious oxygen free radical injury in rabbits with acute soman intoxication. UBIO can improve the antioxidation ability of rabbits and may be applied to treat acute soman intoxication as adjunctive therapy.

  14. Rising gasoline prices increase new motorcycle sales and fatalities.

    Zhu, He; Wilson, Fernando A; Stimpson, Jim P; Hilsenrath, Peter E


    We examined whether sales of new motorcycles was a mechanism to explain the relationship between motorcycle fatalities and gasoline prices. The data came from the Motorcycle Industry Council, Energy Information Administration and Fatality Analysis Reporting System for 1984-2009. Autoregressive integrated moving average (ARIMA) regressions estimated the effect of inflation-adjusted gasoline price on motorcycle sales and logistic regressions estimated odds ratios (ORs) between new and old motorcycle fatalities when gasoline prices increase. New motorcycle sales were positively correlated with gasoline prices (r = 0.78) and new motorcycle fatalities (r = 0.92). ARIMA analysis estimated that a US$1 increase in gasoline prices would result in 295,000 new motorcycle sales and, consequently, 233 new motorcycle fatalities. Compared to crashes on older motorcycle models, those on new motorcycles were more likely to be young riders, occur in the afternoon, in clear weather, with a large engine displacement, and without alcohol involvement. Riders on new motorcycles were more likely to be in fatal crashes relative to older motorcycles (OR 1.14, 95 % confidence interval (CI) 1.02-1.28) when gasoline prices increase. Our findings suggest that, in response to increasing gasoline prices, people tend to purchase new motorcycles, and this is accompanied with significantly increased crash risk. There are several policy mechanisms that can be used to lower the risk of motorcycle crash injuries through the mechanism of gas prices and motorcycle sales such as raising awareness of motorcycling risks, enhancing licensing and testing requirements, limiting motorcycle power-to-weight ratios for inexperienced riders, and developing mandatory training programs for new riders.

  15. Epidemiology of Child Motor Vehicle Crash Injuries and Fatalities

    Arbogast, Kristy B.; Durbin, Dennis R.

    Although children represent only 10-15 % of the overall traffic fatality burden in the United States, motor vehicle crashes (MVCs) remain the leading cause of death and disability for children and young adults; and, close to half of all unintentional injury deaths to children and adolescents (Centers for Disease Control and Prevention National Center for Injury Prevention and Control, Web-based Injury Statistics Query and Reporting System [CDC NCIPC WISQARS] 2010). Moreover, their exposure to motor vehicle risk is significant because they travel by motor vehicles nearly as much as adults. Prevention of the fatalities, injuries and disability associated with MVC must be a priority for ensuring our children's overall health.

  16. Projecting Fatalities in Crashes Involving Older Drivers, 2000-2025

    Hu, P.S.


    As part of this research effort, we developed a new methodology for projecting elderly traffic crash fatalities. This methodology separates exposure to crashes from crash risk per se, and further divides exposure into two components, the number of miles driven and the likelihood of being a driver. This component structure permits conceptually different determinants of traffic fatalities to be projected separately and has thorough motivation in behavioral theory. It also permits finer targeting of particular aspects of projections that need improvement and closer linking of projections to possible policy instruments for influencing them.

  17. Pharyngitis – fatal infectious disease or medical error?

    Marta Rorat


    Full Text Available Reporting on adverse events is essential to create a culture of safety, which focuses on protecting doctors and patients from medical errors. We present a fatal case of Streptococcus C pharyngitis in a 56-year-old man. The clinical course and the results of additional diagnostics and autopsy showed that sepsis followed by multiple organ failure was the ultimate cause of death. The clinical course appeared fatal due to a chain of adverse events, including errors made by the physicians caring for the patient for 10 days.

  18. Rare and fatal complication of Gianturco tracheobronchial stent.

    Asopa, Sanjay; Moorjani, Narain; Saad, Rasheed A; Turner, Jonathan T; Amer, Khalid M


    Tracheobronchial stents are increasingly being used for the management of compromised large airways. Traditionally they have been used to palliate malignant conditions; however, they are now being used more frequently for nonmalignant conditions. The use of Gianturco self-expanding metal stent (William Cook, Bjaeverskov, Denmark) has been challenged for treatment of tracheobroncheomalacia, as fracture of the metal work could prove fatal. In this report we describe a case of fracture in the metal framework of a Gianturco stent resulting in recurrent pneumothoraces; heralding fatal haemoptysis as a result of perforation of the left subclavian artery.

  19. Fatal occupational accidents in Danish fishing vessels 1989-2005

    Laursen, Lise Hedegaard; Hansen, Henrik L; Jensen, Olaf


    training for all fishermen and improved safety measures are needed, especially in the underscored areas of sea disasters concerning small vessels and occupational accidents on big vessels. Better registration of time at risk for fishermen is needed to validate the effect of the safety measures.......The purpose of the study was to study the circumstances and incidence rates of fatal accidents in inspection obligated and non-inspection obligated Danish fishing vessels to identify areas for prevention. Information about the fatalities came from maritime authority reports, including vessel...

  20. Causes and Severity of Fatal Injuries in Autopsies of Victims of Fatal Traffic Accidents

    F Panahi


    Full Text Available Introduction: In this retrospective study, we decided to determine the death causes and severity of injuries in traffic accidents according to reports of the forensic medical center of Yazd. Methods: A total of 251 fatalities due to traffic accidents that had undergone autopsy examinations at the Yazd forensic medicine center from2006 till 2008 were included in the study by census method. Data regarding gender, road user type, type of vehicle (car, motorcycle, autobus or minibus, consciousness level, and intensive care unit (ICU admission was gathered. For evaluation of injury severity, we used Injury Severity Score (ISS. Results: The population under study consisted of 202 men (80.5% and 49 women (19.5% with an average age of 34.1 years (range: 1-89 years. Motorcycle-pedestrian accidents were the most common type of injury (100, 39.8%. Head (220, 87.6% and face (169, 67.3% were the two most common sites of injuries. Mean (±SD of ISS was 23.2 (±10.4. According to autopsy records, the main cause of death was head trauma (146, 58.1%. Conclusion: Public awareness in terms of primary prevention of road accidents should be considered important. Also, regarding the high prevalence of brain injuries and complications associated with skull fractures, accessibility to neurosurgeons and availability of imaging devices have an important role in decreasing the mortality rate of traffic accidents.

  1. Long-term trends in flood fatalities in the United State

    Sharif, Hatim; Chaturvedi, Smita


    This presentation reviews flood-related fatalities in the United States between 1959 and 2013. Information on flood fatality victims and the flood-causing events was obtained from the National Climatic Data Center. The data collected included the date, time, location, and weather conditions and the gender and age of the flood victims. Long term trends in the numbers of fatalities and fatality rates were analyzed. For most of the states fatalities were largely caused by single catastrophic events. The analysis indicates that the standardized annual flood fatality rates are decreasing significantly for all states. Vehicle related fatalities represent more than 50% of flood fatalities for most of the states and can be as high as 77%. A combination of improved hydrometeorological forecasting, educational programs aimed at enhancing public awareness of flood risk and the seriousness of flood warnings, and timely and appropriate action by local emergency and safety authorities will help further reduce flood fatalities in Texas.

  2. Second Fatal Case of Infective Endocarditis caused by Gemella bergeriae

    Aijan Ukudeeva


    Full Text Available Our case illustrates a fatal course of infection with Gemella bergeriae endocarditis that was complicated by cardiogenic shock due to perforation of the mitral valve with severe mitral regurgitation, extension of infection into the myocardium adjacent to the mitral valve, and coronary sinus thrombosis.

  3. Critical factors in fatal collisions of adult cyclists with automobiles.

    Bíl, Michal; Bílová, Martina; Müller, Ivo


    This article evaluates, by means of multivariate regression, critical factors influencing the collisions of motor vehicles with adult (over 17 years) cyclists that result in fatal injury of cyclists. The analysis is based on the database of the Traffic Police of Czech Republic from the time period 1995-2007. The results suggest that the most consequential categories of factors under study are: inappropriate driving speed of automobile; the head-on crash; and night-time traffic in places without streetlights. The cyclists' faults are of most serious consequence on crossroads when cyclists deny the right of way. Males are more likely to suffer a fatal injury due to a collision with a car than females. The most vulnerable age group are cyclists above 65 years. A fatal injury of a cyclist is more often driver's fault than cyclist's (598 vs. 370). In order to reduce the fatal risk, it is recommended to separate the road traffic of motor vehicles from bicyclists in critical road-sections; or, at least, to reduce speed limits there.

  4. Fatalism in Thomas Hardy’s Jude the Obscure

    Sun; Gengmei; Zhou; Juntao


    Hardy is distinguished for his deep understanding of human nature and his insight of human life and experience.This paper will make an exploration about the theme of Jude the Obscure,which conveys the strong sense of fatalism,to show Hardy’s life outlook and reveal his pessimistic views towards society and human nature.

  5. Fatalism in Thomas Hardy’s Jude the Obscure

    Sun Gengmei; Zhou Juntao


    Hardy is distinguished for his deep understanding of human nature and his insight of human life and experience. This paper will make an exploration about the theme of Jude the Obscure, which conveys the strong sense of fatalism, to show Hardy’s life outlook and reveal his pessimistic views towards society and human nature.

  6. [Fatal electric arc accidents due to high voltage].

    Strauch, Hansjürg; Wirth, Ingo


    The frequency of electric arc accidents has been successfully reduced owing to preventive measures taken by the professional association. However, the risk of accidents has continued to exist in private setting. Three fatal electric arc accidents caused by high voltage are reported with reference to the autopsy findings.

  7. Fatal pericardial tamponade after superior vena cava stenting.

    Ploegmakers, M.J.M.; Rutten, M.J.C.M.


    We discuss a fatal complication of percutaneous superior vena cava (SVC) self-expandable stent placement in a patient with superior vena cava syndrome (SVCS). The SVCS was caused by a malignant mediastinal mass with total occlusion of the SVC. Twenty-four hours after the procedure, the patient died

  8. Femme fatale'i kütkes / Kadri Kõusaar

    Kõusaar, Kadri, 1980-


    15.-21. maini on kinos Sõprus Manifesti filminädal "Femme fatale", mis pühendatud prantsuse mängufilmidele 1960.-1970. aastate tipprežissööridelt, kus keskne karakter on saatuslik naine. Lähemalt festivali filmidest, kus peaosades Brigitte Bardot, Catherine Deneuve, Jeanne Moreau

  9. Fatal poisoning in drug addicts in the Nordic countries

    Steentoft, Anni; Teige, Brita; Ceder, Gunnel


    The study includes medicolegally examined fatal poisonings among drug addicts in 1997 in the five Nordic countries: Denmark, Finland, Iceland, Norway and Sweden, and the results are compared to a similar investigation from 1991. A common definition of ‘‘drug addict’’ was applied by the participat......The study includes medicolegally examined fatal poisonings among drug addicts in 1997 in the five Nordic countries: Denmark, Finland, Iceland, Norway and Sweden, and the results are compared to a similar investigation from 1991. A common definition of ‘‘drug addict’’ was applied...... by the participating countries. The highest death rate by poisoning in drug addicts was observed in Denmark, where it was 6.54 per 105 inhabitants, followed by Norway with 6.35, Sweden with 2.21, Finland with 1.63 and Iceland with 1.20 per 105 inhabitants. All countries showed a higher death rate in 1997 than in 1991...... and Denmark, however, heroin/morphine caused only about 70% of the fatal poisonings. About 30% of the fatal poisonings in Denmark and Sweden were caused by other group I drugs, in Denmark mainly methadone and in Sweden mainly propoxyphene. Apart from two cases in Sweden methadone deaths were not seen...

  10. Femme fatale'i kütkes / Kadri Kõusaar

    Kõusaar, Kadri, 1980-


    15.-21. maini on kinos Sõprus Manifesti filminädal "Femme fatale", mis pühendatud prantsuse mängufilmidele 1960.-1970. aastate tipprežissööridelt, kus keskne karakter on saatuslik naine. Lähemalt festivali filmidest, kus peaosades Brigitte Bardot, Catherine Deneuve, Jeanne Moreau

  11. Fatal angioedema induced by angiotensin conversion enzyme (ACE ...


    Feb 9, 2009 ... on the Essential Drugs List, and are therefore used at primary to tertiary health care ... is considered a rare, but potentially fatal side-effect of this agent, with a reported ... Co-pathology often exists in these patients (e.g. heart.

  12. Children in Hot Cars Result in Fatal Consequences

    Full Text Available ... this! Home » Health Tips » Holiday and Seasonal Children in Hot Cars Result in Fatal Consequences Emergency physicians are warning the public ... throbbing headache, dizziness, nausea, confusion and disorientation. READ IN SUMMER Summer Safety: Alcohol And Boating Don’t ...

  13. Ethylene Glycol and Metabolite Concentrations in Fatal Ethylene Glycol Poisonings.

    Viinamäki, Jenni; Sajantila, Antti; Ojanperä, Ilkka


    Ethylene glycol (EG) is used in antifreeze and other industrial products. It metabolizes to glycolic acid (GA) and oxalic acid (OX) that cause metabolic acidosis and are mainly responsible for the toxicity of EG. During 2010-2014, EG or GA was found in 25 postmortem cases in Finland. Of these cases, 21 were classified as fatal EG poisonings and 3 were classified as methanol (MeOH) poisonings. In this study, we report the concentrations of EG and GA in postmortem blood and urine samples of fatal EG or mixed MeOH/EG poisonings. In the fatal EG poisonings, the median EG and GA concentrations were 0.87 and 1.6 g/L in blood and 4.3 and 5.3 g/L in urine. The median urine-blood ratios were 3.8 and 3.1 for EG and GA. These results warrant the use of urine as a primary matrix for screening. In EG positive cases, the quantification of both EG and GA in blood is crucial as GA concentration appears to best indicate a fatal poisoning with an approximate threshold of 1.5 g/L. The measurement of urinary OX does not offer much additional value to toxic alcohol screening as it may originate from varying dietary conditions. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email:

  14. Fatal hypothermia: an analysis from a sub-arctic region

    Helge Brändström


    Full Text Available Objectives. To determine the incidence as well as contributing factors to fatal hypothermia. Study design. Retrospective, registry-based analysis. Methods. Cases of fatal hypothermia were identified in the database of the National Board of Forensic Medicine for the 4 northernmost counties of Sweden and for the study period 1992–2008. Police reports, medical records and autopsy protocols were studied. Results. A total of 207 cases of fatal hypothermia were noted during the study period, giving an annual incidence of 1.35 per 100,000 inhabitants. Seventy-two percent occurred in rural areas, and 93% outdoors. Many (40% were found within approximately 100 meters of a building. The majority (75% occurred during the colder season (October to March. Some degree of paradoxical undressing was documented in 30%. Ethanol was detected in femoral vein blood in 43% of the victims. Contributing co-morbidity was common and included heart disease, earlier stroke, dementia, psychiatric disease, alcoholism, and recent trauma. Conclusions. With the identification of groups at high risk for fatal hypothermia, it should be possible to reduce risk through thoughtful interventions, particularly related to the highest risk subjects (rural, living alone, alcohol-imbibing, and psychiatric diagnosis-carrying citizens.

  15. Fatal hypertensive crisis as presentation of mitochondrial complex I deficiency.

    Lohmeier, K.; Distelmaier, F.; Heuvel, L.P.W.J. van den; Rodenburg, R.J.T.; Smeitink, J.A.M.; Mayatepek, E.; Hoehn, T.


    Complex I deficiency is a frequent defect of the mitochondrial electron transport chain. We report on a 3-year-old boy, who rapidly deteriorated after sudden flushing and collapse. This fatal and unusual case was characterized by widely uncontrollable arterial hypertension. It might indicate that hy

  16. Children in Hot Cars Result in Fatal Consequences

    Full Text Available ... this! Home » Health Tips » Holiday and Seasonal Children in Hot Cars Result in Fatal Consequences Emergency physicians are warning the public ... throbbing headache, dizziness, nausea, confusion and disorientation. READ IN SUMMER Top Tips to a Safe Memorial Day ...

  17. Prevalence, circumstances and consequences of non-fatal road ...


    or other treatment for depression in the past 12 months and having a ... homes and communities, are needed in order to enhance their quality of life (WHO, 2015c, p. 4). ... Studies on the association with non-fatal road traffic injury in older adult ...

  18. A case of fatal necrotizing fasciitis arising from chronic lymphedema.

    Jun, Young Joon; Kang, In Sook; Lee, Jung Ho; Kim, Sue Min; Kim, Young Jin


    Chronic lymphedema and lymphangitis are common adverse effects following treatment for gynecological cancer. Because the early symptoms of necrotizing fasciitis are similar to those of lymphangitis, fatal outcome can occur if patients or physicians underestimate this condition. Here, we present a case of necrotizing fasciitis in a patient with chronic lymphedema.

  19. Hormone replacement therapy and risk of non-fatal stroke

    Pedersen, A T; Lidegaard, O; Kreiner, S;


    BACKGROUND: The effect of postmenopausal hormone replacement therapy (HRT) on the risk of subtypes of stroke is as yet unclear. To investigate the effect of oestrogen and combined oestrogen-progestagen therapy on the risk of non-fatal haemorrhagic and thromboembolic stroke, we carried out a case-...

  20. Blastomyces gilchristii as Cause of Fatal Acute Respiratory Distress Syndrome.

    Dalcin, Daniel; Rothstein, Aaron; Spinato, Joanna; Escott, Nicholas; Kus, Julianne V


    Since the 2013 description of Blastomyces gilchristii, research describing the virulence or clinical outcome of B. gilchristii infection has been lacking. We report molecular evidence of B. gilchristii as an etiologic agent of fatal acute respiratory distress syndrome. B. gilchristii infection was confirmed by PCR and sequence analysis.