Cases Of Intentional Poisoning Research Articles

Sex differences among patients with intentional poisoning presenting to the emergency Department at a Tertiary Care Centre in Beirut, Lebanon.

Poisoning poses a worldwide public health challenge and recent data from Lebanon in 2020 revealed that over half patients presenting with acute toxicological exposure intentionally poisoned themselves, primarily with suspected suicidal intent. This study aims to assess sex disparities in intentional toxicological exposures among patients presenting to the Emergency Department, at a tertiary care centre in Lebanon. This was a secondary analysis of an existing toxicological database, including patients aged 6 years and older admitted due to acute overdose from March 2015 to August 2022. A total of 444 cases of intentional poisoning were analysed, with 302 (68.0%) women. The primary cause of intentional poisoning was suspected suicide in both sexes, significantly more common in women (85.1% versus 65.5%, P < 0.001). Specific agents exposed to patients varied by sex; sedatives/hypnotics/antipsychotics, antihistamines, and melitracen/flupentixol were significantly more prevalent in women (P < 0.001) while men showed higher prevalence for ethanol (P = 0.02), stimulants, street drugs and opioids (P < 0.001). Our study underscores substantial sex differences in intentional poisoning cases in Lebanon. Women exhibited a higher likelihood of exposures to sedatives/hypnotics/antipsychotics, antihistamines and melitracen/flupentixol, while stimulant drugs, ethanol, and opioids were prevalent in men. Developing proper and effective sex-specific measures may mitigate potential physical and psychological consequences.

Patterns and Emerging Trends in Acute Poisoning with Substances of Abuse Used for Recreational Purposes in Adolescents: A Six-Year Multicentre Study.

This six-year multicentre study investigated acute intentional poisoning with substances of abuse in adolescents to identify changes and patterns in substance use. Data from 562 adolescents were collected from three paediatric poison centres in Romania between January 2017 and December 2022. This study analysed the epidemiological and sociodemographic characteristics of the adolescents, including age, gender, place of residence, history of substance abuse, psychiatric history, and history of institutionalised care. The findings revealed that cannabis and new psychoactive substances (NPSs) are the most commonly implicated substances, each with distinct profiles among adolescents. Cannabis was involved in 46.1% of cases, with a significant association with urban residency. NPSs were identified as the second most prevalent substance, accounting for 39.3% of cases. These were more prevalent in rural areas and among patients with psychiatric disorders. Cannabis and NPSs were also the most commonly implicated substances in acute intentional poisoning cases with substances of abuse. These substances have distinct profiles among adolescents, including age, gender, residency area, history of substance abuse, psychiatric history, and institutional care. These findings underscore the necessity of targeted public health interventions and integrated care approaches to address substance use and related mental health issues in adolescents.

Deliberate self-poisoning in children and adolescents

IntroductionSuicide is a significant global public health issue that has a severe impact on children and adolescents.ObjectivesThis study examined the epidemiological features of self-poisoning events among these groups in Morocco.MethodsIn this retrospective study, data on intentional poisoning cases among children under 15 years of age and adolescents aged 15-19 years were analyzed. The Moroccan Poison Control Center has reported these cases over a period of 34 years.Results During the study period, 7,111 deliberate self-poisoning cases were documented among children and adolescents, representing 30% of all reported self-poisoning cases (out of a total of 23,711 cases with known ages). The vast majority of the cases (80.8%) involved females, indicating a significant female-to-male ratio of 4.2. The patients had a mean age of 16.05 ± 2.10 years. Notably, drugs were the predominant method of self-poisoning, comprising 51.7% of the cases, followed by pesticides at 31.3%. The symptoms of poisoning manifested with significant variation, contingent on the type of toxin involved, the amount ingested, and the time passed before medical care was administered. Of the 4,711 cases with known outcomes, 144 (3.06%) were fatal. Nonetheless, the outcomes were favorable for the remaining cases, with or without lasting sequelae.ConclusionsThe ongoing prevalence of suicide and suicide attempts among children and adolescents is a prominent issue in public health. Our research emphasizes the crucial necessity to address suicide, as it remains one of the primary causes of mortality in young individuals.Disclosure of InterestNone Declared

Comparison of pediatric poisoning patterns before and during the COVID-19 pandemic in South Korea.

To investigate the epidemiological changes in emergency department (ED), including changes in toxic substances and ED outcomes in pediatric and adolescent patients who visited the EDs before and during the COVID-19 pandemic. This cross-sectional observational study used data from the ED-based Injury In-depth Surveillance from 2017 to 2021 in South Korea (SK). The study population comprised patients aged <19 years who visited 23 EDs because of poisoning before and during the COVID-19 outbreak. We divided the study period into pre-COVID-19 (January 2017 to February 2020) and COVID-19 periods (March 2020 to December 2021). In total, 5862 patients were included in the final analysis, with 3863 and 1999 in the pre-COVID-19 and COVID-19 periods, respectively. The patients' mean age increased from 8.3 ± 7.1 to 11.2 ± 6.9 years between the pre-COVID-19 and COVID-19 periods (P < 0.001), and the number of adolescents (aged 13-18 years) significantly increased during the COVID-19 period (1653 [42.8%] vs. 1252 [62.6%]; P < 0.001). The number of intentional poisoning cases increased from 1332 (34.5%) before COVID-19 to 1174 (58.7%) during COVID-19 (P < 0.001). Specifically, pharmaceutical poisoning significantly increased during the COVID-19 period (2242 [58.0%] vs. 1443 [72.2%]; P < 0.001), with central nervous system (CNS) drug poisoning being the most common type (780 [34.8%] vs. 747 [51.8%]; P < 0.001). Among the intentional poisoning cases, pharmaceutical substance use significantly increased during the COVID-19 period (1207 [90.6%] vs. 1102 [93.9%]; P = 0.007). We used Bayesian structural time series (BSTS) forecasting models to forecast the number of ED visits during COVID-19. The total number of pediatric patients with poisoning decreased during the COVID-19 pandemic. However, when using the BSTS forecasting model, the decrease in the number of patients was not significant. Furthermore, the forecasting models showed no statistically significant increase in the number of intentional pediatric poisoning cases. The previous studies suggested a decrease in the total number of patients with poisoning but an increase in intentional poisoning cases during the COVID-19 pandemic. By using similar methods to those of previous studies, our results also reached the same conclusion. However, the BSTS model, which predicts real-world time series patterns, seasonal effects, and cumulative effects, shows no significant change in pediatric poisoning patterns during the COVID-19 pandemic.

Profile of Acute Poisoning and Its Outcome in Children Admitted to a Tertiary Care Hospital in Northeast India: A Cohort Study

Introduction: Acute poisoning in children is an important public health problem. It is a significant paediatric emergency in both developing and developed countries, leading to preventable morbidity and mortality. While there is substantial research literature on acute childhood poisoning from developed countries, there is a lack of data from developing countries like India due to inadequate and poor surveillance of poisoning-related data. Aim: To investigate the clinical and epidemiological profile, as well as the outcome, of acute poisoning in children admitted to the paediatric emergency department of a tertiary care hospital in Northeast India. Materials and Methods: This prospective cohort study was conducted in the Paediatrics department of Assam Medical College and Hospital, Dibrugarh, Assam, India, from April 1, 2021, to March 31, 2022. All children under the age of 12 years who presented to the paediatric department with a history of exposure to toxic substances were included in the study. The admitted children were assessed in terms of demographic variables, type of poison, route of poisoning, time of presentation, circumstances of poisoning, storage place of poison, clinical presentation, and interventions provided. Data were presented as mean and frequency. Results: A total of 78 children under 12 years of age were enrolled in the study, with a mean age of three years and three months at presentation. The majority of cases (96.2%) involved accidental poisoning, while a small proportion (3.8%) was due to suicidal poisoning. Of the two reported cases of suicidal poisoning, one involved a male child and the other involved a female child. Both children were above six years of age. The most common causes of poisoning were kerosene (34.6%), organophosphorus compounds (10.3%), and liquid mosquito repellents (9.1%). Conclusion: This study revealed both unintentional and intentional poisoning cases, with a high prevalence of accidental poisoning observed in children below three years of age. Kerosene was identified as the most common cause of childhood poisoning.

Comparison of the Clinical Characteristics of Pediatric Poisoning Patients Who Visited Emergency Department Before and During the COVID-19 Pandemic.

We aimed to investigate changes in the clinical characteristics of pediatric poisoning patients who visited the emergency department (ED) before and during the coronavirus disease 2019 (COVID-19) pandemic. Poisoning cases below age 18 who visited the ED from January 2018 to December 2021 were retrospectively analysed. The study period was then divided into pre-COVID-19 and COVID-19 pandemic to compare poisoning patterns. During the study period, 86,153 visits to the pediatric ED had been recorded, with 625 patients being included the final analysis. During the COVID-19 period, the proportion of poisoned patients increased from 0.62% to 0.98%. The average age of the patients was higher in the COVID-19 period, with 53.4% of the cases being intentional (pre-COVID-19, 32.5%; P < 0.001). Moreover, 70.4% of poisoning cases during the COVID-19 period were caused by drugs (pre-COVID-19, 60.6%; P = 0.038). More patients underwent decontamination and laboratory investigation during the COVID-19 period than during the previous period (P = 0.007 and P < 0.001, respectively). The length of ED stay and the proportion of hospitalisation were significantly greater during the COVID-19 period. After analysing accidental poisoning cases, we found that antipyretics/nonsteroidal anti-inflammatory drugs and respiratory drugs were more common in the pre-COVID-19 group, whereas iron/vitamins, cardiovascular drugs and hormones were more common in the COVID-19 group. After analysing intentional poisoning cases, we found that 73.6% and 76.4% of the patients in the pre-COVID-19 and COVID-19 group had a history of psychiatric disease, respectively. Although no difference was observed in the frequency of previous first suicide attempts, 19.0% of the patients in the COVID-19 group attempted suicide more than three times. During the COVID-19 pandemic, intentional poisoning cases, especially in adolescence, increased and were treated more. Many of the patients with intentional poisoning had a history of mental illness or suicide in the past. Therefore, it seems that policy consideration for mentally vulnerable adolescents during this new pandemic period is necessary.

Patterns and Clinical Outcomes of Poisoning among Poisoning Cases Presented in a Hospital: Retrospective study

Introduction: Poisoning is one of the major health and health-related problems of our nations. It causes significant disease and death in many countries. In developing countries, the incidence of poisoning is increasing resulting in significant threats including hospitalization and huge financial crisis. This study aimed to assess the pattern of acute poisoning cases and their management at the emergency department of the hospital. Methods: Study design was institution based retrospective cross sectional. All patients who presented with poisoning conditions between September 2016 and August 2020 were included in the study. Data was collected using a data extraction form from the case records. Data were analyzed using SPSS 20. Results: In this study, most cases were among females, young age groups, and rural residents. The prevalence of acute poisoning per number of people presenting to the emergency departments in the hospitals was 0.52%. More than half (63.06%) of the patients were poisoned intentionally (deliberately), and the mortality rate due to poisoning was 2.5%. Discussion and Conclusion: Among 360 acute poisoning cases, two third (63.06%) were intentional poisoning cases. Organophosphate poisoning accounts greater than one third (40.56%) of the total poisoning cases; the three major reasons for intentional poisoning were unemployment, marital disharmony, and quarrel with family.

Intentional Carbofuran poisoning in 7 dogs

BackgroundCarbofuran is a widely used broad-spectrum pesticide that, despite strict regulation and being banned for more than a decade, is still encountered in cases of intentional poisoning in dogs and wildlife. The objective of the study was to provide a complete and detailed description of the pathological, histological and toxicological findings of 7 cases of intentional carbofuran poisoning in dogs.ResultsIn this retrospective study, 7 cases of carbofuran intoxication recorded from July 2015 to June 2017 were analyzed. Following complete history recording, all cases were examined by complete necropsy and histopathology. Carbofuran intoxication was confirmed in all cases by gas chromatography. The postmortem examination revealed extensive hemorrhaging and congestion located mainly within the respiratory, nervous and cardiovascular systems, accompanied by degeneration and necrosis within the lungs, heart, and kidneys.ConclusionsAlthough carbamates have been banned in the European Union, carbamate poisoning is still frequently encountered, especially in wild animals. This paper will contribute to a better understanding of the occurrence and pathogenesis of acute carbofuran exposure in dogs and contribute some peculiar pathological features of this type of poisoning to the current literature.

Intentional Poisoning in Pediatric Patients: Examining the Risk Factors.

Poisonings in children are common reasons for presentation to the emergency department and can potentially have serious complications. Our research aims to review risk factors leading to intentional self-poisoning. A retrospective medical record review of all intentional pediatric poisoning cases presenting to the Children's Emergency at National University Hospital, Singapore between January 2014 and December 2015 was performed. Eighty-seven cases of intentional poisonings were identified, 31 (36.5%) of which were with suicidal intent. The majority of cases were female (85.1%) and adolescents older than 16 years (93.1%). A known psychiatric history was present in 57.5% and 62 (71.3%) had a history of deliberate self-harm. Being diagnosed with a new psychiatric illness during that presentation was associated with a history of self-harm (adjusted odds ratio [Adj OR], 6.74; 95% confidence interval [CI]; 1.04-43.62; P = 0.045). Twenty-seven (31.0%) patients had a history of intentional poisoning, and 15 (17.2%) went on to have subsequent presentations for poisoning. Recurrent poisoning attempts were strongly associated with a known psychiatric history (Adj OR, 5.91; 95% CI, 1.62-21.58; P = 0.007) and a history of deliberate self-harm (Adj OR, 7.49; 95% CI, 1.38-40.66; P = 0.02). Deliberate overdosing on personal long-term medication was seen in 15 (35.7%) of 42, of which 12 (80%) of 15 were psychiatric medications. Known psychiatric history or a history of deliberate self-harm are risk factors for intentional poisoning. Appropriate risk stratification and preemptive interventions involving closer surveillance or cognitive behavioral programs are possible measures to prevent intentional self-poisoning, especially in these at-risk groups.

Assessment of the Sociodemographic Profile, Pattern, and Outcomes of Intentional Poisoning Cases in an Emergency Department of a Tertiary Care Teaching Hospital.

Background: Intentional self-poisoning has become a major health problem in low- and middle-income countries. Aims: We aimed to assess the sociodemographic profile, pattern, and outcomes of intentional poisoning cases in the emergency department of a tertiary care teaching hospital. Method: A prospective observational study was conducted at the department of emergency medicine of a South Indian tertiary care hospital for 1 year to study the sociodemographic profile, pattern, and outcomes of intentional poisoning cases. Results: The majority of poisonings were observed in the male population (64.5%) and among the age group of 19-40 years (65.2%). Poisoning was prevalent in rural/semi-urban populations (77.5%) and in people engaged in agriculture (28.4%) for their livelihood. Pesticides were the most common agents implicated (65.9%) in poisonings. Based on the Glasgow Coma Scale (GCS) and Poison Severity Scale (PSS), the majority of people with poisoning presented with mild (53.9%) and minor symptoms (36.3%). In 78.5% of the cases, patients recovered while mortality was observed in 5.4% of cases. Conclusion: There was a strong association between outcomes of poisoning and age. Organophosphate pesticides were the most commonly implicated substances in poisonings. Regulation policies should be made by the government to regulate the transport, distribution, and use of insecticides and pesticides.

A Retrospective Study of Acute Poisoning Cases and Their Management at Emergency Department of Dessie Referral Hospital, Northeast Ethiopia.

BackgroundPoisoning causes significant patient morbidity and mortality worldwide. It is a common reason for emergency department visits and hospitalizations. Acute poisoning needs immediate effective management to prevent patient mortality or sequela. This study was carried out to determine the pattern of acute poisoning cases and their management at the emergency department of Dessie referral hospital, northeast Ethiopia.MethodsA retrospective cross-sectional study of all registered poisoning cases managed at the emergency department of Dessie referral hospital was conducted from March 10 to May 2, 2018.ResultsThere were a total of 147 registered poisoning cases listed in the registry during the study period, of which 120 cases (81.6%) had complete data and were included in the study. Among the total of 120 studied poisoning cases, 66 (55%) were females, and 53 (44.2%) were in the age group of 21–30 years. The causative poison was documented for 118 cases. Organophosphates were the most common poisoning agents involved in 54 (45%) of the cases followed by sodium hypochlorite, 27 (22.5%), and food poisoning, 19 (15.8%). Among the total patients, 77 (64.2%) were self-poisoned intentionally, 31 (25.8%) were poisoned in an unintentional manner and the rest, 12 (10%), had an unknown manner of poisoning. Mental disorder, 25 (20.8%); family disharmony, 23 (19.2%); and marital disharmony, 19 (15.8%) were the three most common causes of intentional poisoning. In all cases of acute poisoning, both pharmacological and non-pharmacological treatment approaches were used. Cimetidine was the most commonly used pharmacologic treatment, 118 (98.3%), followed by antiemetic, 107 (89.2%); proton pump inhibitor, 87 (72.5%), and atropine, 67 (55.8%). ANOVA did not show a statistically significant difference (P>0.05) in the frequency of poisoning cases across seasons.ConclusionAmong 120 acute poisoning cases, 77 (64.2%) were intentional poisoning cases. Organophosphate poisoning accounts for 45% of the total poisoning cases. The three major reasons for intentional poisoning were mental disorders (20.8%), family disharmony (19.2%) and marital disharmony (15.8%). Cimetidine (98.3%) was the most commonly used pharmacologic treatment of the poisoning cases.

SOCIODEMOGRAPHIC PROFILE OF PATIENTS WITH ACUTE POISONING IN THE EMERGENCY WARDS OF A TERTIARY CARE HOSPITAL

Objective: To assess the socio-demographic profile and outcomes in the patients with poisoning admitted to the emergency wards of a tertiary care hospital.Methods: The prospective observational study was conducted for a period of six months in the emergency wards of a tertiary care hospital. The demographic data, hospital admission variables and outcomes were collected from various sources and documented. Cluster analysis was used to find the interaction between the socio-demographic and hospital admission variables in association with outcomes of poisoning.Results: A total of 133 patients were admitted with acute poisoning. The mean age was 27.76±15.5%. Females (51.1%) were dominant over males (48.8%). Incidents of poisoning were predominant in married (49.6%), literates (41.35%), abiding in urban region (86.4%) and belonging to upper lower class (37.6%). The poisonings were intentional (69.17%) occurring through oral route (81.2%) at home (82%). Reason for poisoning was the most significant (1.00*) predictor followed by route of poisoning. Patients with mild symptoms were 85.71% 10.5% moderate and severe symptoms 3.75%. Majority of the victims recovered (82.71%) whilst 4.51% died.Conclusion: Poisoning patterns vary with socio-demographic and socio-economic status, which is a prevalent social and economic issue in developing countries. Depression acts as a slow poison and is common among younger age groups leading to increased cases of intentional poisoning, thereby indicating a necessity for appropriate psychiatric counselling, medical and peer management strategies to identify the individuals in need that can reduce the risk of next attempt.

Prevention of phosphine-induced cytotoxicity by nutrients in HepG2 cells.

Background & objectives:Phosphides used as an insecticide and rodenticide, produce phosphine (PH3) which causes accidental and intentional poisoning cases and deaths. There is no specific treatment or antidote available for PH3 poisoning. It is suggested that PH3-induced toxicity is associated with adenosine triphosphate (ATP) depletion; therefore, in this study the effect of some nutrients was evaluated on PH3 cytotoxicity in a cell culture model.Methods:PH3 was generated from reaction of zinc phosphide (10 mM) with water in the closed culture medium of HepG2 cells, and cytotoxicity was measured after one and three hours of incubation. ATP, glutathione (GSH) and lipid peroxidation were also assessed at one or three hours post-incubation. ATP suppliers including dihydroxyacetone, glyceraldehyde and fructose were added to the culture medium 10 min before PH3 generation to prevent or reduce phosphine-induced cytotoxicity.Results:Phosphine caused about 30 and 66 per cent cell death at one and three hours of incubation, respectively. ATP content of the cells was depleted to 14.7 per cent of control at one hour of incubation. ATP suppliers were able to prevent cytotoxicity and ATP depletion induced by PH3. Dihydroxyacetone, α-ketoglutarate, fructose and mannitol restored the ATP content of the cells from 14.7 per cent to about 40, 34, 32 and 30 per cent, respectively. Lipid peroxidation and GSH depletion were not significantly induced by zinc phosphide in this study.Interpretation & conclusions:The results supported the hypothesis that phosphine-induced cytotoxicity was due to decrease of ATP levels. ATP suppliers could prevent its toxicity by generating ATP through glycolysis. α-keto compounds such as dihydroxyacetone and α-ketoglutarate may bind to phosphine and restore mitochondrial respiration.

Pesticide exposure and health risks in Morocco

Introduction: The pesticide self-poisoning is one of the most commonly used methods of suicide in the World and this problem is particularly worrying in African region. To contribute to the reduction of morbidity and mortality caused by suicidal poisoning, the aim of this work is to describe and analyze the epidemiological characteristics of suicide with pesticides in Morocco. Methods: This is a retrospective analysis of the last decade (2004 to 2013), covering all cases of intentional poisoning – to suicidal character – with pesticides occurred in Morocco and reported to the Moroccan Poison Control Centre. Results: A total of 3428 suicidal cases by intentional ingestion of pesticides were recorded. More than 65% of the cases were females with a female-male ratio of 2.0. The average age of the patients was 25 ± 10 years. Three-quarters of the cases were under 30 years; only the most likely to die were the cases aged 30 years or over. Over 97% of cases are poisoned at home. The median delay in presentation to hospital was 2 hours. Almost all cases were addressed to the emergency. The risk was mainly related to the use of organophosphates. The poisoning symptoms were dominated by vomiting (19.2%), abdominal pain (18.0%), nauseas (13.5%), dyspnoea (4.4%) and dizziness (4.0%). On admission to hospital, most of the patients received gastric lavage (75.3%). The number of suicide attempts was 9 times higher than that for successful suicide. Among the 2360 patients for whom the outcome is known, 241 of them died. And, men are 2.1 times more likely to die by suicide than women. According to the test Cramer's V, only age and gender are strongly associated with the evolution of vital prognosis of the patient. Conclusions: Morocco is widely known by the expansion of this toxicological pathology, however, the exact dimensions remain misidentified; the taboo and the stigmatization associated with it continue. The best way to prevent suicide is the communication.

Intentional and accidental paracetamol poisoning in childhood - a retrospective analysis.

Paracetamol is one of the most commonly used analgesics and antipyretics available without limits as preparations of the OTC group (over the counter drugs). Overdose and poisoning with this drug always brings about the risk of acute hepatic failure. The objective of the study was a retrospective evaluation of patients hospitalized in the Paediatric Clinic during the period 2004-2012 due to poisoning with paracetamol. The analysis covered 44 patients hospitalized in the Paediatric Clinic during 2004-2012 due to poisoning with paracetamol. Patients were divided into three groups: intentional poisonings, accidental poisonings, and drug overdose. During the period of the study, 44 patients aged 2.1-17.1, poisoned with paracetamol, were hospitalized. Among these patients there were 30 (68.2%) cases of intentional poisonings, 10 (22.7%) of accidental poisonings, and only 4 patients (9.1%) were children hospitalized after a paracetamol overdose. The majority of patients in all groups were females (93.3%). Paracetamol intoxication may occur after exceeding a single allowable dose, in the case of intentional poisoning, more rarely after exceeding the daily dose, in the case of intense pain complaints, or in the treatment of persistent fever. Based on the analysis performed, an increase was observed in the frequency of poisoning with paracetamol, especially intentional poisoning. Unlimited access to paracetamol as an OTC drug should be reconsidered.

Pesticide poisonings in South Korea

Pesticide poisoning stands as a major public health issue worldwide. The objective of this study was to examine the epidemiologic characteristics of pesticide-related hospitalizations in South Korea. Data from the Korea National Hospital Discharge Survey were analyzed to describe the epidemiologic characteristics of pesticide poisoning among hospitalized patients from 2004 through 2006. Pesticide-related hospitalizations were identified using the International Classification of Diseases, Tenth Revision codes. National estimates of pesticide-related hospitalizations were calculated using sampling weights for number of hospitalizations. A total of 25,982 pesticide-related hospitalizations were estimated during the years 2004-2006, yielding an average annual pesticide-related hospitalization rate of 17.8 per 100,000 population in South Korea. Age-specific rates for pesticide-related hospitalization increased with age, with the highest rate noted among those aged 70 or above. The majority of pesticide-related hospitalization was cases of intentional poisoning in rural areas. Seasonal variation in the rate was observed, with summer being the highest among both men and women. Pesticide-related hospitalization is prevalent and demonstrates demographic and seasonal and regional variations. More effective strategies to reduce pesticide-related hospitalizations are required in South Korea.

Intentional poisoning cases of animals with anticholinesterase pesticide-carbofuran in Sri Lanka

Carbofuran is a broad spectrum insecticide and nematicide which inhibits acetyl cholinesterase. Several intentional poisoning cases of animals and birds including crows, dogs, cow, and elephant, using carbofuran were reported in Sri Lanka. Qualitative analysis of carbofuran in biological specimens was carried out using T.L.C and GC–MS. The quantitative analysis was carried out by HPLC using Zorbax Eclips XDB-C18 (150 × 4.6 mm I.D × 5 μm particle size) column with acetonitrile: water 25:75 v/v mobile phase and UV detection at 210 nm [1]. The liquid–liquid extraction with chloroform was reproducible and sensitive. The procedure was validated in terms of linearity (0.996 < r < 0.999) for concentrations ranging from 1 to 200 μg/ml, repeatability (RSD 4.4% at 100 μg/ml, n = 10) extraction recovery (91.7% at 100 μg/g, 77.3% at 20 μg/g), limit of detection (S/N ratio = 3, 0.7 μg/ml) and limit of quantification (S/N ratio = 10, 2.4 μg/ml). The method was found satisfactory and successfully applied in fatal cases of animals and birds due to carbofuran poisoning. The fatal carbofuran levels detected were in the range of 42–910 μg/g in crow’s gizzard and contents, 50–800 μg/g in dog’s stomach contents, 13–20 μg/g in dog’s liver, 0.9 μg/g in cow’s stomach and contents, 35 μg/g in elephant’s stomach and contents.

Carbon Monoxide Poisoning at Motels, Hotels, and Resorts

Each year, more than 200 people in the United States die from carbon monoxide (CO) poisoning. Poisoning has occurred at motels, hotels, and resorts. Congressional mandate requires smoke alarms in all guest rooms; however, smoke alarms do not detect CO. Data on patients poisoned at hotels, motels, and resorts were evaluated at a hyperbaric medicine service. In 2005, legal databases and online news databanks were searched to discover additional incidents. Only victims evaluated in hospitals or declared dead at the scene were included. Cases of intentional poisoning and poisoning from fires were excluded. Between 1989 and 2004, 68 incidents of CO poisoning occurring at hotels, motels, and resorts were identified, resulting in 772 accidentally poisoned: 711 guests, 41 employees or owners, and 20 rescue personnel. Of those poisoned, 27 died, 66 had confirmed sequelae, and 6 had sequelae resulting in a jury verdict. Lodging-operated, faulty room heating caused 45 incidents, pool/spa boilers 16, CO entrained from outdoors 5, and unreported sources caused 2 incidents. Public verdicts have averaged $4.8 million per incident (range, $1 million to $17.5 million). Poisoning occurred at hotels of all classes. Despite these incidents, most properties did not install CO alarms, and requirements for CO alarms at hotels, motels, and resorts are rare. Guests of motels, hotels, and resorts remain at risk for injury or death from CO poisoning. Measures to prevent CO poisoning of guests and employees of the lodging industry should be evaluated.