RESUMO
This work analyzes a massive intoxication that occurred in 1992 in Argentina as a result of the use of propolis syrup as a popular upper respiratory infection medicinal agent. The intoxicating agent was diethylene glycol (DEG), which caused metabolic acidosis, anuria, renal failure and death in 15 out of the 29 studied victims. DEG poisoning cases were classified in three groups according to survival time: Group 1-patients that survived up to 3 days; Group 2-patients that survived between 4 and 5 days; Group 3-patients that survived between 6 and 21 days. Patients from Group 1 showed the highest values of anion gap, the lowest measures of base excess (BE) and more severe clinical manifestations. Correlation between pH and BE was r(2) = 0.68, 0.99 and 0.55 for Groups 1, 2 and 3, respectively. A methanolic extraction was performed on the fatal victims' viscera and blood, with subsequent concentration and purification. The semi-crystalline fraction obtained retained DEG by means of co-dissolution and adsorption as demonstrated by thin lay chromatography/flame ionisation detection (TLC/FID). In 3 out of the 15 fatal cases (from Group 1), DEG was isolated from viscera and blood (femoral venous), between 48 and 72 h post ingestion. The concentration relation (DEG)viscera/(DEG)blood ranged from 1.45 to 1.55 with a coefficient correlation r(2)=0.96 (n=3). In the other victims, DEG could not be detected. The reason for this could be the long survival period of the victims after their ingestion of the syrup. Additionally, putrefying mechanisms could have been operating. Samples of the propolis syrup of each victim were studied by means of nuclear magnetic resonance (NMR) and quantified by gas chromatography/flame ionisation detection (GC/FID). Results showed that syrup samples contained 65.0% (w/v) of diethylene glycol (DEG) and 32.0% (w/v) of propylene glycol (PG). A good correlation between the amount of DEG ingested and the anion gap (r(2)=0.63) for the 15 victims studied could be observed. The lethal dose for human beings estimated in this work ranged from 0.014 to 0.170 mg DEG/kg body weight. This is a lower lethal dose than reported in a separate incident in Haiti. These results may contribute to the understanding of DEG's metabolic pathway and provides data from lethal doses in humans.
Assuntos
Etilenoglicóis/intoxicação , Mudanças Depois da Morte , Equilíbrio Ácido-Base , Injúria Renal Aguda/induzido quimicamente , Idoso , Idoso de 80 Anos ou mais , Alanina Transaminase/sangue , Anuria/induzido quimicamente , Arritmias Cardíacas/induzido quimicamente , Aspartato Aminotransferases/sangue , Creatina Quinase/sangue , Relação Dose-Resposta a Droga , Overdose de Drogas , Etilenoglicóis/análise , Feminino , Ionização de Chama , Humanos , Concentração de Íons de Hidrogênio , Rim/química , L-Lactato Desidrogenase/sangue , Contagem de Leucócitos , Fígado/química , Masculino , Pessoa de Meia-Idade , Própole/química , Insuficiência Respiratória/induzido quimicamente , Fatores de Tempo , gama-Glutamiltransferase/sangueRESUMO
El abuso de sustancias es un trastorno que tiene dimensiones llamtivas en la población que comete delitos y constituye un problema sanitario, criminológico y judicial. En el Departamento Judicial La Plata se implementó un programa piloto de evaluación psiquiátrica y de evaluación bioquímica de metabolitos de drogas en diversas matrices, con la meta de contribuir con las acciones destinadas a disminuir la recidiva de abuso de sustanciasy de las conductas delictivas asociadas, de aquellas personas que, habiendo sido institucionalizadas para el cumplimiento de condenas penales o medidas de seguridad, son liberadas bajo condiciones. Los resultados preliminares son promisorios pues permiten sostener que la efectivización de los análisis toxicológicos actua como factor de protección respecto al riesgo de recidiva delictiva...(AU)
Assuntos
Humanos , Transtornos Relacionados ao Uso de Substâncias , Projetos PilotoRESUMO
El abuso de sustancias es un trastorno que tiene dimensiones llamtivas en la población que comete delitos y constituye un problema sanitario, criminológico y judicial. En el Departamento Judicial La Plata se implementó un programa piloto de evaluación psiquiátrica y de evaluación bioquímica de metabolitos de drogas en diversas matrices, con la meta de contribuir con las acciones destinadas a disminuir la recidiva de abuso de sustanciasy de las conductas delictivas asociadas, de aquellas personas que, habiendo sido institucionalizadas para el cumplimiento de condenas penales o medidas de seguridad, son liberadas bajo condiciones. Los resultados preliminares son promisorios pues permiten sostener que la efectivización de los análisis toxicológicos actua como factor de protección respecto al riesgo de recidiva delictiva...
Assuntos
Humanos , Transtornos Relacionados ao Uso de Substâncias , Projetos PilotoRESUMO
Fifteen cases of fatal massive methanol intoxication have been investigated. Victims received either no treatment or ethanol therapeutic treatment. Methanol poisoning cases were classified in three groups according to survival time: more than 3 days (group 1), up to 3 days (group 2) and few hours (group 3). Body distribution of methanol and formic acid, as the main metabolite, was analyzed in blood and in different organs (brain, kidney, lung and liver). Relationships between formic acid concentration in the different tissues, survival time and type of treatment applied to victims were studied. Formic acid in blood and tissues was analyzed by head space gas chromatography (head space-GC) with FID detector, previous transformation in methyl formate, essentially as described by Abolin. Formic acid concentration was between 0.03 and 1.10g/l in the samples under study. A good correlation between blood and brain, but poor between blood and the remaining tissues was found. Obtained data suggested that the use of blood and brain could help to improve the analysis of formic acid intoxication. The best correlation among organs was found between lung and kidney for all groups (r(2)=0.91, 0.84 and 0.87, corresponding to groups 1, 2 and 3, respectively). Lethality index was defined as LI = (concentration of formic acid in blood in (g/l)/0.5) x 100, taking into account that 0.5g/l is the concentration reported by Mahieu in severe methanol poisoning. LI parameter was used to estimate formic acid incidence on the lethality of methanol poisoning cases. LI showed a good correlation with total formic acid concentration of the different tissues analyzed (r(2)=0.80). Furthermore, LI allowed us to discriminate between individuals that received therapeutic treatment and survived different periods. LI>100 indicated a severe intoxication and short survival time if the victim was assisted with ethanol therapy and hemodialysis was not applied. With regard to victims who received no therapeutic treatment and died in few hours, LI was in the range 40-100. LI was below 40 for individuals that survived more than 3 days and hemodialysis was not performed. Results showed the importance of performing formic acid analysis to diagnose severe methanol intoxication in post-mortem cases.