RESUMEN
In the last ten years advances in analytical methods have enabled the determination of xenobiotics in alternative material such as sweat, saliva, and hair. The aim of this study was to develop an analytical method and measure the concentration of the main opiates in serum saliva and hair of subjects from a detoxification and methadone treatment programme. The analytical strategy in the presented study, based on enzymoimmunoassay screening of opiates in urine and GC/MS confirmation, meets the needs of forensic and clinical toxicology. Blood and saliva samples from thirty seven patients and hair from twenty three with a history of intravenous opiate use were collected for analysis. The ranges of morphine in serum and saliva were 0-2081 and 0-208 ng/ml respectively; corresponding concentrations of codeine were 0-580 and 0-428 ng/ml respectively. The concentration of morphine, codeine and 6-MAM in hair of addicts ranged respectively from 0-32.4, 0-12.5 and 0-2.8 ng/mg. From the clinical toxicology point of view, hair analysis is supplementary to urine, serum or saliva determination, but in drug testing at the workplace it can play a crucial role.
Asunto(s)
Cabello/química , Narcóticos/análisis , Trastornos Relacionados con Opioides/diagnóstico , Saliva/química , Adulto , Codeína/análisis , Femenino , Cromatografía de Gases y Espectrometría de Masas , Humanos , Concentración de Iones de Hidrógeno , Masculino , Metadona/uso terapéutico , Morfina/análisis , Derivados de la Morfina/análisis , Narcóticos/sangre , Narcóticos/orina , Trastornos Relacionados con Opioides/tratamiento farmacológico , Trastornos Relacionados con Opioides/metabolismoRESUMEN
Guillain-Barré Syndrome is the most common form of polineuropathy. It is suggested that some infectious, immune and allergic factors are involved in developing the syndrome. "Kompot" or "Polish heroine", a domestic product, is produced from poppy straw or juice of poppy head (Papaver somniferum) and it is administered intravenously. "Kompot" shows variable contents of heroine, 6-MAM, 3-MAM, morphine, acetylo-codeine and codeine as well as papaverine, thebaine and narcotine. The case history of a young man dependent on "Polish heroine" who developed the Guillain-Barré Syndrome due to severe intoxication induced by home made heroine, barbiturates and benzodiazepines is described.
Asunto(s)
Síndrome de Guillain-Barré/inducido químicamente , Heroína/envenenamiento , Drogas Ilícitas/envenenamiento , Trastornos Relacionados con Sustancias/complicaciones , Adulto , Barbitúricos/envenenamiento , Benzodiazepinas/envenenamiento , Codeína/envenenamiento , Humanos , Inyecciones Intravenosas , Masculino , Morfina/envenenamiento , Derivados de la Morfina/envenenamientoRESUMEN
Although it is known that drug addicts are a high-risk group for disruption of many homeostatic processes, little is know about changes in serum trace elements concentrations after taking the psychoactive substances. The aim of the study was to check the influence of the taking homemade heroin on serum level of copper. Blood samples were taken from 30 opiate addicts, and copper concentrations were measured by the means of atomic absorption spectrophotometry. The result of the study show that in the examined group, copper serum concentrations (1.35 mg/L) upon admission to the clinic were higher than in the control group (1.11 mg/L) but decreased during hospitalization (1.18 mg/L). There was no correlation between duration of stay at the hospital and changes in serum copper concentration.
Asunto(s)
Cobre/sangre , Dependencia de Heroína/sangre , Dependencia de Heroína/terapia , Adolescente , Adulto , Alanina Transaminasa/metabolismo , Aspartato Aminotransferasas/metabolismo , Estudios de Casos y Controles , Humanos , Hígado/efectos de los fármacos , Hígado/metabolismo , Masculino , Persona de Mediana Edad , IntoxicaciónRESUMEN
The aim of this study was to determine the concentration of zinc, copper and magnesium in the blood serum of drug addicts in order to ascertain whether drug abuse has an effect on the concentration of these metals. The study was carried out on a group of 33 addicts undergoing treatment at the Department of Clinical Toxicology, Collegium Medicum, Jagiellonian University in Kraków. The control group consisted of 22 young, healthy, drug free, male volunteers. Analyses were performed using flame atomic absorption spectrometry. The results demonstrate that zinc serum concentrations in the examined group of addicts before therapy (mean 0.82 mg/l) were reduced in relation to the control group (mean 1.12 mg/l), and was slightly enhanced after the detoxification process (mean 0.86 mg/l). The opposite effect was observed in the case copper serum concentration. The copper level in the group of addicts on admission to hospital (mean 1.35 mg/l) increased in relation to the control group (mean 1.11 mg/l) and was lower during hospitalisation (mean 1.18 mg/l). The concentration of magnesium in the serum of drug addicts did not change during therapy and was in the same range as in the control group (mean concentrations were 20.3 mg/l, 20.2 mg/l and 20.6 mg/l respectively).
Asunto(s)
Cobre/sangre , Magnesio/sangre , Trastornos Relacionados con Sustancias/sangre , Zinc/sangre , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The aim of this study was to evaluate a morphological and functional status of the CNS in acute cholinesterase inhibitors (ChI) poisonings using the brain computer tomography (CT) and complex psychiatric examination. Under examination there were 59 cholinesterase inhibitors orally poisoned patients, treated at the Department of Clinical Toxicology in years 1984-1997, aged from 14 to 68 (mean 34.7 +/- 12.8) years. The examined group comprised 9 women (15.3%) and 50 men (84.7%). Between the 3rd and 7th day of hospitalisation a complex psychiatric examination was performed. The CNS damage was diagnosed when the point score from complex psychiatric examination was minimum 5 points. CT was performed between the 3rd and 10th day after the intoxication. Incorrect CT scans were found in 78% of poisoned patients. The most common lesion was generalised cortex atrophy and subcortex atrophy of the brain (73.9%), followed by isolated cortex (17.4%) and subcortex atrophy with simultaneous areas of low density in the subcortical nuclei (8.7%). The frequency of incorrect CT scans was statistically higher (p < 0.01) in the group of organophosphorous compounds poisoned patients compared to those poisoned with carbamates. The complex psychiatric examination revealed in 24 patients (40.7%) the differently intensified alterations, but the point score was not higher than 4. Unquestionable damage of the CNS was recognised in 34 patients (57.6%) of the ChI poisoned patients. The frequency of CNS changes detected in complex psychiatric examination was statistically higher (p < 0.01) in the group of the severely poisoned patients. The significantly higher frequency of pathological changes revealed by the brain CT was found in the group of patients with higher than 5 point score obtained from the complex psychiatric evaluation compared to those with score lower than 5 (p < 0.001).
Asunto(s)
Encefalopatías/inducido químicamente , Encéfalo/diagnóstico por imagen , Inhibidores de la Colinesterasa/envenenamiento , Tomografía Computarizada por Rayos X , Acetilcolinesterasa/sangre , Adolescente , Adulto , Anciano , Atrofia , Encéfalo/efectos de los fármacos , Encéfalo/patología , Encefalopatías/diagnóstico , Eritrocitos/enzimología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Examen Neurológico , Intento de Suicidio/estadística & datos numéricosRESUMEN
The aim of the study was to evaluate the frequency and the kind of multiorgan damage in acute oral carbamates poisonings. Under analysis there were 36 carbamates orally poisoned patients treated at the Department of Clinical Toxicology in the years 1987-1997. Patients with the liver or biliary tract diseases, chronic circulatory insufficiency symptoms, HBs antigen carriers, who suffered head traumas, CNS illness and heavy drinkers were excluded from the study. The organs damage was noted in 91.7% of the poisoned patients. The respiratory system followed by the CNS and the liver were mostly affected by carbamates toxicity. The frequency of pathological changes in the kidney and circulatory system was relatively lower. Only in a few persons peripheral nervous system injuries were noted. In 15% of the examined group the injuries of one organ only was stated. In 48.5% of the patients simultaneous injury of two and three organs or systems were noted. 36.3% of the patients suffered from multiorgan (four or more) damage. In all the severely poisoned patients (III degree) the organs damage was noted. In 53% of them the simultaneous damage of four or more organs/systems was noted. In the group of patients stated as moderately poisoned on admission to the clinic, the multiorgan damage (2-3 organs/systems) was found in 77% of the patients. The lowest number of organ damage was observed in the group of slightly poisoned patients.
Asunto(s)
Carbamatos/envenenamiento , Insuficiencia Multiorgánica/inducido químicamente , Acetilcolinesterasa/sangre , Adolescente , Adulto , Anciano , Carbamatos/análisis , Distribución de Chi-Cuadrado , Eritrocitos/enzimología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/diagnóstico , Insuficiencia Multiorgánica/epidemiología , Intoxicación/clasificaciónRESUMEN
An analysis of ethylene glycol acute intoxication treatment results was performed in a group of 36 patients hospitalized within a five year period. Mean serum and urine glycol concentrations in the analyzed population ranged from 0-851 mg/dl (mean = 130 mg/dl) and from 12.4 to 930.0 mg/dl (mean 333 mg/dl), respectively. At the time of admission to the clinic 15 of 36 patients were deeply unconscious and mean acid-base balance values were as follows: pH 6.99, pCO2 16.7 mmHg, pO2 140.1 mmHg, HCO3 6.36 mmol/l, BE -29.6 mmol/l. Because of respiratory failure 21/36 patients (58.3%) required controlled ventilation and 24/36 (66.7%) underwent dialysis. Sixteen patients (44.4%) developed acute renal failure. Mean hospitalization period was 16 days (1-53). Eighteen patients (50%) died. The direct death mechanism in 15 patients (83.3%) was asystolia and in the remaining individuals other circulatory disturbances. The main reasons of high mortality rate were multiple organ damages secondary to severe metabolic acidosis.
Asunto(s)
Desequilibrio Ácido-Base/terapia , Lesión Renal Aguda/terapia , Glicoles de Etileno/envenenamiento , Insuficiencia Respiratoria/terapia , Desequilibrio Ácido-Base/etiología , Acidosis/etiología , Acidosis/mortalidad , Acidosis/prevención & control , Lesión Renal Aguda/etiología , Adolescente , Adulto , Causas de Muerte , Sobredosis de Droga , Glicol de Etileno , Glicoles de Etileno/sangre , Glicoles de Etileno/orina , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Polonia , Insuficiencia Respiratoria/etiología , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
The aim of this study is to compare the frequency, kind and structure of acute poisonings of the Kraków residents in years 1983 and 1993. The group of 2132 people treated for acute poisonings in the year of 1983 consisted of 50.6% men and 49.4% women, in 1993 the group of 2311 patients consisted of 60.7% men and 39.3% women. The group of 154 poisoned who died at the place of accident in 1983 consisted of 89.6% men and 10.4% women, whereas in 1993 the group of 220 such cases included 83% men and 17% women. The overall coefficient of poisonings during the years compared was 36.2 for 1983 and 42.0 for 1993. The coefficient of poisonings in the years examined of 1983, 1993 were 39.4 and 50.4 for men, and respectively 33.4 and 28.0 for women. In 1983 the poisonings with drugs (40.6%) were most numerous, ethanol came second (25%). In 1993 the first place took ethanol (31.8%), the second drugs (31.3%). The number of poisonings with carbon monoxide increased from 9.87% in 1983 to 13.6% in 1993. The comparison of numbers concerning the mortality rate of the treated patients and of those who died at the place of accident prior to any treatment, shows a considerable growth in mortality rate in 1983 from 1.1% up to 7.8% and in 1993 from 0.8% to 9.4%. Such a significant growth in this mortality rate is influenced by poisoning with ethanol and carbon monoxide at the place of accident.
Asunto(s)
Intoxicación/epidemiología , Enfermedad Aguda , Adolescente , Adulto , Distribución por Edad , Femenino , Humanos , Drogas Ilícitas/envenenamiento , Incidencia , Masculino , Persona de Mediana Edad , Plaguicidas/envenenamiento , Intoxicación/mortalidad , Polonia/epidemiología , Estaciones del Año , Distribución por Sexo , Solventes/envenenamiento , Tasa de Supervivencia , Factores de TiempoRESUMEN
Problems with the assessment of organ damage caused by toxic substances in places of residence have recently appeared with increasing frequency. In spite of this there have been so far no uniform, objective research methods which could allow their accurate evaluation. This is why the attempt has been made to assess morphological and functional condition of the liver in patients chronically exposed to mercury compounds in the place of settlement. The research group consisted of 62 patients exposed to metallic mercury at a yearly rate exceeding 24 kg for average duration of 16 years. Patients with the liver or biliary tract diseases, symptoms of chronic circulatory insufficiency, Australia (HBs+) antigen carriers and alcoholics were excluded from the research group. The control group consisted of 29 males. AST and ALT activity, prothrombin level, bilirubin and protein concentration in blood serum were measured and scintigraphic and USG examinations of the liver were performed. Mercury concentrations were also established. Scintigraphic examination yielded an abnormal image of the liver in 52% of the exposed patients. The differences in frequency and intensity of scintigraphic changes in comparison with the control group were of statistical significance. No pathological changes were found in USG examination. Significantly higher ALT activity and bilirubin concentration and significantly lower total protein concentration were found in the exposed group. The correlation between the intensity of scintigraphic changes and mercury concentration were noted. Liver scintigraphic examination combined with biochemical analysis allows an assessment of the liver condition in chronic exposure to mercury compounds in the place of settlement.
Asunto(s)
Contaminantes Atmosféricos/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas , Intoxicación por Mercurio/etiología , Mercurio/efectos adversos , Adolescente , Adulto , Anciano , Distribución de Chi-Cuadrado , Exposición a Riesgos Ambientales/efectos adversos , Monitoreo del Ambiente/métodos , Humanos , Hígado/diagnóstico por imagen , Hepatopatías/diagnóstico , Hepatopatías/metabolismo , Pruebas de Función Hepática , Masculino , Mercurio/sangre , Intoxicación por Mercurio/diagnóstico , Persona de Mediana Edad , CintigrafíaRESUMEN
The drug overdose resulting in acute intoxication diagnosed in the 106 drug abusers in period form June to December 1994. The screening drugs identification was performed using immunoassays Triage and Vitalab Eclair manufactured by MERCK. Benzodiazepines followed by barbiturates and opiods were most often the cause of acute poisonings among the adult Kraków inhabitants. The results presented indicate that only adequate clinical observation, laboratory tests performance and establishing of intoxication state (acute poisoning, chronic intoxication or withdrawal) allows a complete patient evaluation.