RESUMEN
Exposure to giant hogweed brings about the risk of serious skin damage, usually in the form of phytophotodermatitis. Initially, skin changes are signaled by a burning sensation, followed by a vesiculobullous rash and long-term hyperpigmentation. Usually, skin disorders improve after the application of topical and oral corticosteroids. In extremely rare instances, full skin thickness burns or epidermal necrosis occur. The study presents a case of occupational exposure to hogweed, which resulted in extensive skin lesions leading to the disablement of a 27-year-old man. The principles of procedure to be followed when contact with giant hogweed is an occupational hazard are also outlined.
Asunto(s)
Infecciones Bacterianas/complicaciones , Dermatitis Fototóxica/complicaciones , Dermatosis de la Mano/inducido químicamente , Heracleum/toxicidad , Dermatosis de la Pierna/inducido químicamente , Exposición Profesional/efectos adversos , Piel/patología , Adulto , Amputación Quirúrgica , Humanos , Dermatosis de la Pierna/etiología , Masculino , Necrosis/inducido químicamente , Necrosis/cirugíaRESUMEN
Poland is one of the European countries where serious problem of shortage of organ donors is observed. Organ donation from victims following fatal acute intoxications is extremely rare, and there's only several such case reports published in Poland. There's a need to establish guidelines of instrumental confirmatory tests of brain death determination according to acute poisonings. Authors present two cases of poisoned donors following acute poisonings with drugs. Current opinions concerning poisoned patients as a potential organ donors are also described. Case 1: A 36-years old male poisoned intentionally with insulin was admitted to Toxicology Department in Poznan. Patient was unconscious (GCS:3), hypoglycemic (glycaemia: 0). In 3rd day of treatment brain death was determined using clinical tests and instrumental confirmatory test (transcranial Doppler ultrasonography). Both kidneys were procured for transplantation. Case 2: A 23-years old male after prehospital sudden cardiac arrest in the course of suicidal carbamazepine intoxication was admitted to Toxicology Department. During whole hospitalization patient was unconscious, unresponsive to the pain (GCS:3), with circulatory and respiratory insufficiency. Despite intense treatment and decrease of carbamazepine level to therapeutic values there were no signs of patient recovery on the 9th day of treatment. After brain death determination patient was qualified as a kidneys and liver donor. Each patient diagnosed of brain death in the course of acute intoxication should be considered as a potential organ donor. Brain death determination in poisoned patients requires consultation by clinical toxicologist to exclude influence of neurotoxic xenobiotics on the central nervous system. Standards of instrumental confirmatory tests in victims following fatal poisonings should be established. Introduction of guidelines concerning donors intensive care procedures that allows successful organ procurement. All organ donations and transplantations from poisoned donors should be registered in national and/or international databases to provide an exchange of experiences and improve understanding of such cases.
Asunto(s)
Muerte Encefálica/diagnóstico , Carbamazepina/envenenamiento , Sobredosis de Droga , Insulina/envenenamiento , Obtención de Tejidos y Órganos , Adulto , Resultado Fatal , Humanos , Trasplante de Riñón , Trasplante de Hígado , Masculino , Suicidio , Recolección de Tejidos y Órganos , Ultrasonografía Doppler Transcraneal , Adulto JovenRESUMEN
Cases were corneas have been collected from poisoned patients are extremely rare. Globally, no more than a dozen or so such instances have been reported, with the decided majority concerning cyanide poisonings. The present study outlines a case of severe methanol poisoning, the course of which resulted in the brain death, and the female patient was duly qualified as a potential donor of corneas and kidneys. Due to the suspicion of a neoplastic process in the abdominal cavity, collection of the kidneys was desisted from. According to the knowledge of the authors of the work, this is the first case of transplantation of corneas collected from a person poisoned with methanol in Poland.
Asunto(s)
Muerte Encefálica/diagnóstico , Trasplante de Córnea , Metanol/envenenamiento , Donantes de Tejidos , Obtención de Tejidos y Órganos , Córnea , Resultado Fatal , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Hematological disturbances are rare, but potentially serious complication of chronic valproate therapy. Transient asymptomatic thrombocytopenia is most frequently described. Less common toxicities include neutropenia and anemia. 58 years old female with pancytopenia in the course of acute valproic acid intoxication was described. She had been treated with unknown dose of valproic acid for eight years. At admission leucocytes and erythrocytes counts were normal, but platelets were diminished (36 x 10(9)/ L). Maximum serum concentration of valproic acid reached 668 microg/mL in first 24 hours of treatment, and had dropped into the therapeutic range during following 12 hours. Thrombocytopenia, leucopenia and anemia with minimal values that reached 10x10(9)/L, 1,97 x 10(9)/L and 1,71 x 10(9)/L were observed. These disturbances were accompanied by spontaneous nasal bleeding that required tamponade. Symptomatic treatment with platelets (25 units) and red blood cells (2 units) transfusions were effectively applied. After 197 hours of treatment trend in blood parameters improvement was seen.
Asunto(s)
Pancitopenia/inducido químicamente , Ácido Valproico/sangre , Ácido Valproico/envenenamiento , Epistaxis/inducido químicamente , Femenino , Humanos , Persona de Mediana Edad , Trastornos del Humor/tratamiento farmacológicoRESUMEN
Case of suicidal intoxication following ingestion of approximately 120 leaves is presented. Cardiogenic shock, severe cardiac arrhythmias and conduction defects were observed in the course of intoxication. Authors believe that application of transient intracavitary pacemaking significantly contributed to patient recovery.
Asunto(s)
Arritmias Cardíacas/inducido químicamente , Arritmias Cardíacas/terapia , Estimulación Cardíaca Artificial , Bloqueo Cardíaco/inducido químicamente , Bloqueo Cardíaco/terapia , Intoxicación por Plantas/terapia , Taxus/envenenamiento , Adulto , Arritmias Cardíacas/diagnóstico , Bradicardia/inducido químicamente , Electrocardiografía , Femenino , Sistema de Conducción Cardíaco/efectos de los fármacos , Sistema de Conducción Cardíaco/fisiopatología , Humanos , Intento de Suicidio , Taxus/química , Resultado del TratamientoRESUMEN
Selected clinical aspects of suicidal attempts during pregnancy were presented. Nineteen pregnant females, in the age range 17-27 (mean 22 +/- 2.58), were admitted to the Clinic of Acute Poisonings in Gdansk and Toxicological Ward in Poznan between 2001 and 2004 because of acute suicidal intoxication. The main attention was put on reasons of self-intoxication, the timing of attempted suicide as well as the influence of intoxication on the mother and the child. For most admitted women it was their first pregnancy (12 cases, 63.2%). The week of pregnancy varied from 4 to 37 (mean 19 +/- 9.3) weeks. The most popular drugs for attempting suicide among pregnant females were benzodiazepines (7 cases, 36.8%). The most often reason of suicidal attempts was unplanned pregnancy (9 cases, 47.4%). There were two miscarriages and one premature birth observed in our cases. Acute self-poisonings during pregnancy appeared to be a relatively marginal problem in the analyzed toxicology clinics and occurred in merely 0.38% of all women hospitalized between 2001 and 2004 in both clinics. The main reason of suicidal attempts in pregnant women was unplanned pregnancy (9 cases, 47.4%). None of the studied females admitted that the main reason of suicidal attempt was an abortion induction.
Asunto(s)
Intoxicación/epidemiología , Complicaciones del Embarazo , Mujeres Embarazadas/psicología , Trastornos Relacionados con Sustancias/epidemiología , Intento de Suicidio , Enfermedad Aguda , Adolescente , Adulto , Síntomas Afectivos/epidemiología , Actitud Frente a la Salud , Depresión/epidemiología , Femenino , Humanos , Intoxicación/psicología , Polonia/epidemiología , Embarazo , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/psicología , Embarazo no Planeado/psicología , Estudios Retrospectivos , Medición de Riesgo , Trastornos Relacionados con Sustancias/psicología , Intento de Suicidio/psicología , Intento de Suicidio/estadística & datos numéricos , Encuestas y Cuestionarios , Salud de la MujerRESUMEN
Intoxication with carbamazepine (Amizepine, Tegretol) represents a significant problem of clinical and forensic toxicology which frequently develops independently of the commonly used monitored therapy. In the study a technique of qualitative and quantitative analysis applied to carbamazepine (CBZ) as well as its metabolites carbamazepine 10, 11-epoxide (CBZ-E) and 10, 11-dihydroxycarbamazepine (CBZ-DH) in biological material using high-performance liquid chromatography (HPLC) was presented. The studies also involve isolation of studied compounds using solid phase extraction, SPE-Abselut NEXUS (Varian), establishment of calibration range and validation of analytical parameters. This was followed by a discussion of results obtained in routine diagnostic investigations in cases of intoxications, corroborating practical suitability of the designed technique.
Asunto(s)
Carbamazepina/análogos & derivados , Carbamazepina/efectos adversos , Cromatografía Líquida de Alta Presión/métodos , Detección de Abuso de Sustancias/métodos , Anticonvulsivantes/efectos adversos , Anticonvulsivantes/metabolismo , Antimaníacos/efectos adversos , Antimaníacos/metabolismo , Carbamazepina/administración & dosificación , Carbamazepina/sangre , Carbamazepina/metabolismo , Medicina Legal/métodos , Humanos , Intoxicación/diagnóstico , Intoxicación/etiología , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Toxicología/legislación & jurisprudenciaRESUMEN
So far 5 cases of severe acute liver failure in the course of Amanita phalloides poisoning, treated in Department of Toxicology in Poznan were regarded for need of liver transplantation. In September 2001, 4 patients were directed to transplantology center: 3 adult persons were treated in Department of General Surgery and Liver Diseases, Medical University of Warsaw, and one 15-year-old boy in Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute in Warsaw. According to King's College Hospital criteria a family of three qualified for liver transplantation. 40-year-old mother died during transplantation, 41-year old father and his 15-year old son underwent operation successfully. Two years after liver transplantation these two men were admitted to Department of Toxicology in Poznan for their clinical status assessment. Based on observations made in Department of Toxicology we conclude the management of patients who meet the clinical indicators of poor prognosis should be discussed with a transplantology center in the early stage of severe acute liver failure.
Asunto(s)
Amanita , Fallo Hepático Agudo/inducido químicamente , Fallo Hepático Agudo/cirugía , Trasplante de Hígado , Intoxicación por Setas/complicaciones , Adolescente , Adulto , Femenino , Humanos , Masculino , Resultado del TratamientoRESUMEN
Intoxication with carbamazepine (Amizepine, Tegretol) represents a significant problem of clinical and forensic toxicology, which frequently develops independently of the commonly used monitored therapy. In the study a technique of qualitative and quantitative analysis applied to carbamazepine (CBZ) as well as its metabolites carbamazepine 10,11-epoxide (CBZ-E) and 10,11-dihydroxycarbamazepine (CBZ-DH) in biological material using high-performance liquid chromatography (HPLC) was presented. The studies also involve isolation of studied compounds using solid phase extraction, SPE-Abselut NEXUS (Varian), establishment of calibration range and validation of analytical parameters. This was followed by a discussion of results obtained in routine diagnostic investigations in cases of intoxications, corroborating practical suitability of the designed technique.
Asunto(s)
Carbamazepina/análogos & derivados , Carbamazepina/efectos adversos , Cromatografía Líquida de Alta Presión/métodos , Detección de Abuso de Sustancias/métodos , Anticonvulsivantes/efectos adversos , Anticonvulsivantes/metabolismo , Antimaníacos/efectos adversos , Antimaníacos/metabolismo , Carbamazepina/administración & dosificación , Carbamazepina/sangre , Carbamazepina/metabolismo , Medicina Legal/métodos , Humanos , Intoxicación/diagnóstico , Intoxicación/etiología , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Toxicología/legislación & jurisprudenciaRESUMEN
In this study we present 11 cases of severe drug's intoxications connected with serious rhythm disorders, in which establishment an endocavital electrode and artificial pacemaking were saving-life interventions. Among them Ca-antagonists, digoxin, beta-blockers, angiotensin convertase inhibitors intoxications were observed. 9 cases were treated successfully, 2 patients died. In 2 cases we established electrode, but it wasn't useful. Previous conventional treatment of intoxicated patients with disorders of atrioventricular conductance and impulse creation requires complementation with more aggressive procedures of using artificial pacemaking in properly quick time.
Asunto(s)
Cardiotónicos/envenenamiento , Bloqueo Cardíaco/inducido químicamente , Bloqueo Cardíaco/terapia , Marcapaso Artificial , Intento de Suicidio/psicología , Adolescente , Adulto , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la EnfermedadRESUMEN
For many years ECG disturbances caused by cardiologic drugs are in the spot of our interests. In the Poisoning Centers patients who ingested large amounts of these drugs are treated so there are possibilities to investigate such kind of ECG changes. For the demonstration we present ECG-s illustrating disturbances in the course of intoxication with calcium channel blockers, beta antagonists and digoxin.
Asunto(s)
Bradicardia/inducido químicamente , Bradicardia/diagnóstico , Cardiotónicos/envenenamiento , Vasodilatadores/envenenamiento , Verapamilo/envenenamiento , Adulto , Anciano , Sobredosis de Droga , Electrocardiografía , Femenino , Humanos , Masculino , Índice de Severidad de la EnfermedadRESUMEN
Risk of hepatotoxicity from acetaminophen taken in therapeutic or modestly excessive doses is high in alcoholics and long-term alcohol users, cachexic patients and people taking drugs inducing acetaminophen metabolism on microsomal cytochromes P450. Interaction between alcohol and acetaminophen increases production of NAPQI--highly reactive and toxic metabolite of paracetamol. Elevation of transaminases activity (especially AST) and other evidence of hepatic injury in patient with history of both alcohol and paracetamol intake should be suspicied of alcohol--acetaminophen syndrome; in such cases treatment with intravenous acetylcysteine should be maintained as soon as possible. In study case of 23-year old alcoholic man admitted to Department of Toxicology in Poznan with symptoms of acute hepatic failure after accidental paracetamol overdose is presented. After 5 days long ACC infusions patient's state improved and 2 weeks later he left hospital in full recovery.
Asunto(s)
Acetaminofén/efectos adversos , Acetaminofén/metabolismo , Alcoholismo/metabolismo , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Enfermedad Aguda , Adulto , Alcoholismo/complicaciones , Enfermedad Hepática Inducida por Sustancias y Drogas/complicaciones , Enfermedad Hepática Inducida por Sustancias y Drogas/terapia , Humanos , Masculino , SíndromeRESUMEN
Carbamazepine toxicity on cardiovascular system in the course of acute poisonings and long term therapy are observed rarely. It's toxic influence on action potential in Purkinje fibres and 4 depolarization phase expresses clinically as the His bundle and atrioventricular blocks especially in patients with cardiologic disturbances. We present case of 64-year old woman with ischaemic heart disease poisoned with carbamazepine who died because of severe arrhythmias in the course of myocardial infarction during first 24 hours of intoxication. Heightened awareness of high risk lethal cardiovascular complications in patients intoxicated with carbamazepine with history of heart diseases is needed.