Cases Of Poisoning Research Articles

Systematic Review of Fatal Sodium Nitrite Ingestion Cases: Toxicological and Forensic Implications.

Documented cases of sodium nitrite toxicity are almost exclusively caused by accidental ingestion; however, self-poisoning with sodium nitrite represents an increasing trend in nitrate-related deaths. This systematic review summarizes the most crucial evidence regarding the fatal toxicity of sodium nitrite. It identifies gaps and differences in the diagnostic forensic approaches and the detection methods of sodium nitrite intoxication. A total of eleven research articles were selected for qualitative and quantitative data. Most of the studies (6/11) were case reports. Fifty-three cases of fatal intoxication with sodium nitrite were chosen for the review. More research is required to develop cost-effective techniques and uniform cutoffs for blood nitrite and nitrate levels in the event of deadly sodium nitrite poisoning. There is still a lack of critical information on other matrices and the impact of time since death on toxicological results in such situations. The available evidence provides useful recommendations for forensic pathologists and health practitioners engaged in instances of sodium nitrite poisoning or death. The data should also set off alarm bells in the public health system, in prosecutor's offices, and for policymakers so that they may undertake preventative measures to stop and restrict the unregulated market for these substances.

Consumer experiences and perception with reclosable pharmaceutical child resistant closures in Ghana, West Africa

AbstractChild resistant closures (CRCs) are an effective deterrent in preventing inadvertent poisoning in young children. Nevertheless, investigations since their debut have shown that users in different parts of the world do not embrace this safety package due to their opening mechanism. In this study, consumers who have interacted with pharmaceutical CRCs in Ghana within the West African sub‐region were interrogated to assess their experiences and perception. The assessments centred on consumer attitudes towards using CRCs generally, as well as their understanding of and importance for CRCs, the types that are available, observed cases of unintended medicinal child poisoning, ease of opening and injuries/accidents caused by them. The two observed CRCs used in the region were push and turn and squeeze and turn closures, with the former being the most popular. Regardless of educational level, consumers within the region had little understanding of how CRCs worked and how important they were. Due to their imprecise instructions and unpleasant opening mechanisms, CRCs were generally assessed by consumers as being challenging to open. Consumers unable to open CRCs employed their teeth, knives and sharp objects, resulting in injuries and casualties such as cuts and scratches. To maintain safe containment and limit children's exposure to medications, consumers identified CRCs as their top choice for pharmaceutical packaging. In conclusion, consumers oppose changing the design of CRCs but advocate for better opening instructions and pharmacist education for correct use.

Study of clinical profile and outcome of children presented with poisoning in tertiary care hospital

Background: Poisoning is a common paediatric emergency. Worldwide estimate suggests that the rate of poisoning in under 20 years is 1.8 per one lakh population and for India it ranges between 0.6 to 11.6%. Methods: The study was conducted at B. J. Medical College Ahmedabad and Civil Hospital, Ahmedabad. A prospective analytical study consisting of total 110 patients, admitted in the intensive care unit during the period from June 2018 to November 2018 with inclusion criterion of children <12 years of age, presented with history of consumption of poisonous substances/insect bite irrespective of signs and symptoms excluding cases of food poisoning and idiosyncratic drug reactions. Detailed proforma was filled after taking necessary consent from the parents. Routine investigations and gastric samples for forensic analysis were sent in all irrespective of type or route of poisoning. Specific investigations done wherever required. Analysis of outcomes done using chi square. Results: The most common age group was 3-6 years with male to female ratio of 1.5:1. 99.1% poisoning were accidental with hydrocarbon poisoning being the most common of all (27.2%), followed by household substance poisoning in 20.9%. Snakebite was the most common insect bite (10.9%). The average duration of stay was 3.9 days, 8.1% children died with maximum mortality happened in children presented after 6 hours of intoxication. Conclusions: Management of poisoning requires immediate advice and first aid, followed by a directed treatment. Decontamination, enhanced elimination, antidotes, and supportive care are commonly used to manage poisoning cases.

Case reports of tropane alkaloid contamination in spinach from Italy and its potential implications for consumer health

This study reports cases of intoxication that occurred in various regions of Italy in October 2022. These incidents were linked to the consumption of leafy vegetables contaminated with tropane alkaloids (TAs), likely due to suspected cross-contamination with toxic plants from the Datura genus. Although official controls were unable to identify the specific weed responsible for the contamination, chemical analysis of the remaining spinach and spinach-based foods consumed by the affected patients revealed concentrations of atropine and scopolamine up to 4642 μg/kg and 8158 μg/kg, respectively. While European regulations currently lack maximum limits for TAs in leafy vegetables, the concentrations detected in 4 out of 5 samples exceeded the maximum limits currently established for cereal-based foods, infant cereal-based foods, and herbal infusions.To assess the acute dietary exposure to atropine and scopolamine, estimated daily intakes of the Italian population were calculated using the TA concentrations measured in spinach samples or assuming the presence of 1 % of the weight of one Datura stramonium leaf in a 500 g spinach pouch. Both exposure scenarios resulted in concerning exposure levels, far exceeding the acute reference dose of 0.016 μg/kg bw by 2–1200 times. Toddlers exhibited the highest mean and 95th percentile acute dietary exposures compared to adults and the elderly. These findings emphasize the necessity of intensifying monitoring efforts and enacting regulatory measures to minimize exposure to TAs from dietary sources that are less commonly associated with contamination, especially for mitigating potential health risks for vulnerable population groups.

Association between Prescribing and Intoxication Rates for Selected Psychotropic Drugs: A Longitudinal Observational Study.

Psychotropic prescription drugs are commonly involved in intoxication events. The study's aim was to determine a comparative risk for intoxication in relation to prescribing rates for individual drugs. This was a nationwide observational study in Slovenian adults between 2015 and 2021. Intoxication events with psychotropic drugs were collected from the National Register of intoxications. Dispensing data, expressed in defined daily doses, were provided by the Health Insurance Institute of Slovenia. Intoxication/prescribing ratio values were calculated. The correlation between trends in prescribing and intoxication rates was assessed using the Pearson correlation coefficient. In total, 2640 intoxication cases with psychotropic prescription drugs were registered. Anxiolytics and antipsychotics were the predominant groups. Midazolam, chlormethiazole, clonazepam, sulpiride, and quetiapine demonstrated the highest risk of intoxication, while all antidepressants had a risk several times lower. The best trend correlation was found for the prescribing period of 2 years before the intoxication events. An increase of 1,000,000 defined daily doses prescribed resulted in an increase of fifty intoxication events for antipsychotics, twenty events for antiepileptics, and five events for antidepressants. Intoxication/prescribing ratio calculation allowed for a quantitative comparison of the risk for intoxication in relation to the prescribing rates for psychotropic drugs, providing additional understanding of their toxicoepidemiology.

Profile of Poisoning cases Attending in the Emergency Department of Khwaja Yunus Ali Medical College and Hospital (KYAMCH), Enayetpur, Sirajganj.

Background: Poisoning is a significant global public health problem. In many countries acute poisoning is one of the common scenarios in the emergency department of any general hospitals globally but it’s pattern may vary in different parts of the world and even may be different regional variation in the same country.Objective: In this study our main goal is to evaluate the Profile of Poisoning cases attending in the Emergency Department of Khwaja Yunus Ali Medical College & Hospital (KYAMCH), Enayetpur, Sirajganj.Materials and Methods: This cross-sectional study was carried out at the emergency department of Khwaja Yunus Ali Medical college and hospital (KYAMCH), Enayetpur, Sirajganj from January’21 to December’21. Total 80 poisoning cases were collected by using a pre-designed format from Emergency register book/ records, for the study, were those who had undergone exposure to poison either by household or agricultural pesticides, stings bite or snake bite, industrial toxins or toxic plants, drug or miscellaneous products.Results: During this study, the majority were belonging to 16-30 years age group (65%), (55%) were Female and (75%) were Muslims, most of the cases were Suicidal (70%) and no Homicidal case was recorded. Besides that, (20%) poisoning cases were due to Barbiturate, followed by (12.5%) were Organo-phosphorous compound poisoning as well as copper sulphate poisoning. (35%) victim came to hospital within 2 hours to 6 hours and (73.75%) cases were shifted to General bed, followed by (11.25%) cases were Admitted in ICU and (31.25%) cases were found during spring.Conclusion: From our study, we can say that suicidal cases and Barbiturate poisoning were commonly seen. Besides that, young and middle-aged female people are mostly vulnerable to poisonous cases. KYAMC Journal Volume: 14, No: 03, October 2023: 116-119.

Profile of paediatric medico legal cases admitted to a tertiary referral hospital over a period of one year

A retrospective study was conducted on the medico-legal cases admitted to the Department of Pediatrics over a period of one year (September 2022-August 2023). A majority of cases reported were accidental poisoning cases (46.47%) among which paint thinner poisoning was the most common. Other cases reported include burns, head trauma, road traffic accidents, fall from height, drowning, hanging and electrocution. A majority of cases reported were in the age group of less than five years. A mortality rate of 3.75% (n=57) was recorded.

Pharmaco-toxicological effects of the novel tryptamine hallucinogen 5-MeO-MiPT on motor, sensorimotor, physiological, and cardiorespiratory parameters in mice—from a human poisoning case to the preclinical evidence

RationaleThe 5-methoxy-N-methyl-N-isopropyltryptamine (5-MeO-MiPT, known online as “Moxy”) is a new psychedelic tryptamine first identified on Italian national territory in 2014. Its hallucinogen effects are broadly well-known; however, only few information is available regarding its pharmaco-toxicological effects.ObjectivesFollowing the seizure of this new psychoactive substances by the Arm of Carabinieri and the occurrence of a human intoxication case, in the current study we had the aim to characterize the in vivo acute effects of systemic administration of 5-MeO-MiPT (0.01–30 mg/kg i.p.) on sensorimotor (visual, acoustic, and overall tactile) responses, thermoregulation, and stimulated motor activity (drag and accelerod test) in CD-1 male mice. We also evaluated variation on sensory gating (PPI, prepulse inhibition; 0.01–10 mg/kg i.p.) and on cardiorespiratory parameters (MouseOx and BP-2000; 30 mg/kg i.p.). Lastly, we investigated the in silico ADMET (absorption, distribution, metabolism, excretion, toxicity) profile of 5-MeO-MiPT compared to 5-methoxy-N,N-diisopropyltryptamine (5-MeO-DIPT) and N,N-dimethyltryptamine (DMT).ResultsThis study demonstrates that 5-MeO-MiPT dose-dependently inhibits sensorimotor and PPI responses and, at high doses, induces impairment of the stimulated motor activity and cardiorespiratory changes in mice. In silico prediction shows that the 5-MeO-MiPT toxicokinetic profile shares similarities with 5-MeO-DIPT and DMT and highlights a cytochrome risk associated with this compound.ConclusionsConsumption of 5-MeO-MiPT can affect the ability to perform activities and pose a risk to human health status, as the correspondence between the effects induced in mice and the symptoms occurred in the intoxication case suggests. However, our findings suggest that 5-MeO-MiPT should not be excluded from research in the psychiatric therapy field.

Method development for the quantification of nine nitazene analogs and brorphine in Dried Blood Spots utilizing liquid chromatography – tandem mass spectrometry

The detection of nitazenes in biological fluids is increasingly needed as they are repeatedly reported in intoxication and overdose cases. A simple method for the quantification of low levels of nine nitazene analogs and brorphine in Dried Blood Spots (DBS) was developed and validated. 10 μL of spiked whole blood is deposited on a Capitainer®B card and allowed to dry. The spot is punched out, and extracted with 500 μL methanol:acetonitrile (3:1 v/v) added with 1.5 μL of fentanyl-D5 as the internal standard. After stirring, sonication, and centrifugation of the vial, the solvent is dried under nitrogen, the extract is reconstituted in 30 μL methanol, and 1 μL is injected into a UHPLC-MS/MS instrument. The method validation showed linear calibration in the 1–50 ng/mL range, LOD values ranging between 0.3 ng/mL (isotonitazene) and 0.5 ng/mL (brorphine), average CV% and bias% within 15 % and 10 % for all compounds, respectively. The matrix effect due to blood and filter paper components was within 85–115 % while recovery was between 15–20 %. Stability tests against time and temperature showed no significant variations for storage periods up to 28 days. Room temperature proved to represent the best samples storage conditions. UHPLC-MS/MS proved capable to reliably identify all target analytes at low concentration even in small specimen volumes, as those obtained from DBS cards, which in turn confirmed to be effective and sustainable micro-sampling devices. This procedure improves the efficiency of toxicological testing and provides an innovative approach for the identification of the nitazene class of illicit compounds.

Clinical manifestations and analytical reports for MDPHP acute intoxication cases

MDPHP is a synthetic cathinone (SC) belonging to α-pyrrolidinophenone derivatives. It is a central nervous system stimulant and may induce hallucinations, paranoia, tachycardia, hypertension, chest pain, and rhabdomyolysis. In literature, a few cases of intoxication have been reported. In the present study, 17 cases of MDPHP intake were described including the analytical findings and clinical manifestations. MDPHP was quantified by liquid chromatography–tandem mass spectrometry in blood (range 1.26–73.30 ng/mL) and urine (range 19.31–8769.64 ng/mL) samples. In three cases the presence of α-PHP was observed. In one case, MDPHP was the only detected substance. Concomitant use of MDPHP with other substances, particularly psychostimulants, was common and it was difficult to describe the peculiar clinical characteristics of this SC. Most of the symptoms overlapped those expected, some of them were unusual and all of them particularly severe thus inducing the research of NPS in laboratory tests. We demonstrated the presence of psychiatric, neurological, and respiratory symptoms, as well as the possible presence of rhabdomyolysis and cardiotoxicity associated with the use of MDPHP. ED admissions were also more frequent in patients with addiction problems. In some cases, MDPHP intake required intensive supportive care. A multidisciplinary approach, including specialist consultation, is recommended for patients showing challenging features. Moreover, we demonstrated that the adoption of advanced analytical techniques, i.e., liquid chromatography–tandem mass spectrometry, is necessary to detect these molecules. Further studies are needed to understand MDPHP intake patterns and associated symptoms. It is essential to raise awareness in addiction treatment centers and among potential users, especially young people, and chemsex addicted.

Profile of poisoning cases in a tertiary care centre in rural South India

BACKGROUND: Poisoning is the fourth most common cause of mortality in rural India. The commonest agents in India appear to be pesticides, sedatives, chemicals, alcohol, animal plant toxins and household toxins. Our hospital receives an average of 20 to 25 poisoning cases every month.
 AIMS: To profile all cases of poisoning those are reported to casualty department at Dr. Chandramma Dayananda Sagar Institute of Medical Education and Research (CDSIMER); to study the types and frequency of poisoning cases admitted to the centre; to study the socio demographic associations of the poisoning cases.
 MATERIALS AND METHODS: Present study is a hospital record-based retrospective observational study of acute poisoning cases registered in the medicolegal register in the casualty of CDSIMER, which is a tertiary care centre situated in rural area near Harohalli, Ramanagara District, India.
 RESULTS: Males constituted 58% of the cases and 33.52% of the cases were in the age group of 21–30 years. 81.4% of the cases were able to reach hospital between 1 to 8 hours. 56% of the cases recovered and were discharged within 3 days. In 22 cases the duration of admission was more than 2 weeks as they went into complications. Organo phosphorus group of insecticide was the most common type of poison consumed constituting to 40.8% of the cases followed by Snake bite. Attempt to suicide (60.35%) was more common than accidental poisoning.
 CONCLUSION: Insecticides mainly Organophosphorus compound are the most common group of poisons which causes morbidity and mortality in rural Indian population especially in young adults between 21 to 40 years. Owing to the presence of forests in the region, Snake bite becomes the second largest type of poisoning. Suicide frequently prevails in the rural areas; financial problem is the leading cause for farmers to commit suicide.

C2 Product Formation over the C1 Product and HER on the 111 Plane of Specific Cu Alloy Nanoparticles Identified through Multiparameter Optimization.

C2 products are more desirable than C1 products during CO2 electroreduction (CO2ER) because the former possess higher energy density and greater industrial value. For CO2ER, Cu is a well-known catalyst, but the selectivity toward C2 products is still a big challenge for researchers due to complex intermediates, different final products, and large space of the catalyst due to its morphology, plane, size, host surface etc. Using density functional theory (DFT) calculations, we find that alloying of Cu nanoparticles can help to enhance the selectivity toward C2 products during CO2ER with a low overpotential. By a systematic investigation of 111 planes (which prefer the C1 product in the case of bulk Cu), the alloys show the generation of C2 products via *CO-*CO dimerization (* indicates adsorbed state). It also suppresses the counter-pathway of hydrogenation of *CO to *CHO, which leads to C1 products. Further, we find that *CH2CHO is the bifurcating intermediate to distinguish between ethanol and ethylene as the final product. We have used simple graphical construction to identify the catalyst for CO2ER over HER, and vice versa. We have also defined the case of hydrogen poisoning and projected a parity plot to recognize the catalyst for C2 product evolution over the C1 product. Our study reveals that Cu-Ag and Cu-Zn catalysts selectively promote ethanol production on 111 planes. Moreover, an edge-doped 2SO2 graphene nanoribbon as the host layer further lowers the barrier and selectively promotes ethanol on Cu38- and Cu79-based alloys. This work provides new theoretical insights into designing Cu-based nanoalloy catalysts for C2 product formation on the 111 plane.

Lessons From the Household Humidifier Disinfectant Tragedy (HHDT) With Focus on the Chemical Poisoning Surveillance System: Review and Recommendation.

Lessons learned from the Household Humidifier Disinfectant Tragedy (HHDT) in Korea, which poisoned thousands of citizens over a period of years, necessitated an examination of national poison prevention and surveillance systems. The objectives of this study are to identify essential changes needed in chemical poisoning prevention regulations and surveillance systems for effective poison control by comparing recent trends in international poison control center (PCC) operations, and to delineate the critical elements for establishing a state-of-the-art poison control surveillance system in Korea based on recent advances in PCCs with toxicovigilance. A comprehensive review of Korea's regulatory and surveillance systems for chemical health hazards, with a focus on household products under the HHDT, was conducted. A review of toxicovigilance systems in major countries shows that creating an effective national PCC requires key elements: a centralized database of toxic substances and poisoning cases, mandatory or voluntary reporting of poisoning cases, real-time alerts, collaboration among health organizations, and targeted follow-up of poisoned individuals. Significant deficiencies in Korea's legislation, toxicological data management, and poisoning surveillance systems, explained the inadequate response of the Korean government to the HHDT for nearly 17 years until the end of 2011. Based on a review of PCC toxicovigilance systems in major countries, a national framework with five core components is recommended for establishing a modern comprehensive Korea PCC system with toxicovigilance capacity. The core components include establishment of a centralized database of toxic substances information and clinical poisoning cases, implementation of mandatory or permissive reporting of poisoning cases, real-time alert mechanisms, collaborative systems among health-related organizations, and clinical follow-up of poisoned sub-groups. A rationale and framework for a state-of-the-art national Korean PCC with toxicovigilance is justified and offered. This proposed system could assist neighboring countries in establishing their own sophisticated, globally integrated PCC networks.

Opšti principi hitnog zbrinjavanja trovanja u ambulanti lekara opšte medicine - izazovi i prepreke

Introduction. Timely recognition of acute or chronic poisoning, as well as the pharmacodynamic mechanisms and pathophysiology of poisoning, is of the utmost importance in the general practice office. Objective. We aimed to find out the rate of awareness and education of primary healthcare physicians on necessary measures in the case of poisoning treatment. Method. Physicans working in general practice in the Republic of Serbia were sent an electronic questionnaire ''Urgent poisoning treatment in the general practice office''. The questionnaire had 13 questions referring to the physician's practical experience. Results. The rise of medication, product, and biological substance poisoning rate was registered at the primary healthcare level in the last five years and it went from 0,14 to 0,21. Poisoning with non-medical substances is on the steep decline, from 0,30 to 0,19 per 1000 inhabitants. We followed the experience of general physicians (GPs) from outpatient clinics, concerning the cases of acute and chronic poisoning, by examining the questionnaire which showed 71,43% of GPs met with this condition. Physicans were more likely to be met with accidental poisoning (41,07%), while (21,43%) were met with multiple intentional poisonings. A larger percentage of these cases (44,65%) were treated on-site. About the existence of the National Poisoning Control Center knew 53,57% of physicans and 58,93% were familiar with detoxication measures. Additional expertise in the area of poisoning is necessary in the opinion of 75% of physicians. Discussion. Poison intake, in different ways, into a body, may cause a patient's death if not recognized on time, at the initial encounter in the general physician's office. Conclusion. Awareness and education of the GPs in the outpatient clinics, as well as, readiness to learn additional skills proved to be an important factor in taking care of poisoned patients who call on their GPs first. Continuous education is a necessary measure for the improvement of healthcare quality in the treatment of acute and chronic poisoning.

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.

Development of antibodies against recombinant staphylococcal enterotoxin B from food poisoning cases.

Staphylococcal enterotoxin B (SEB) is the most common serotype involved in food poisoning. The aim of this study was to develop immunoassay detection methods using a recombinant enterotoxin B antigen protein to produce recombinant polyclonal antibodies in vivo. Staphylococcus aureus isolated from a food poisoning case (strain JH5800) was analyzed by polymerase chain reaction (PCR) and confirmed to contain a seb gene of 477 bp. A SEB segment was amplified, cloned, sequenced, and aligned. The PCR product corresponding to the predicted mature SEB peptide was inserted into Escherichia coli BL21 (DE-3) expression vector and expressed as a hexahistidine-SEB fusion protein. Antiserum against recombinant SEB protein was produced by immunization of Balb/c mice. In the indirect enzyme-linked immunosorbent assay (ELISA), the polyclonal antibodies produced had a titer of 1:3200. The seb gene of Staphylococcus aureus isolated from a poisoning case (JH5800) had a molecular size of about 477 bp and a band of recombinant SEB toxin was observed at approximately 30 kDa on SDS-PAGE gel. The polyclonal anti-SEB antibody titer, as revealed by indirect ELISA, was 1:3200 at 59 days. SEB recombinant protein could be used to produce polyclonal antibodies. ELISA and Western blotting were used to analyze the specificity and sensitivity of the recombinant polyclonal antibodies. Polyclonal antibodies produced could be used to detect SEB on a large-scale.

Children&amp;apos;s Ingestion of Blister Beetles Causing Cantharidin Poisoning : Two pediatric cases in Saudi Arabia

Background: Cantharidin, a toxic substance produced by Meloidae (Coleoptera family) beetles, poses serious health risks upon ingestion, including renal impairment, hematemesis, altered consciousness, electrolyte imbalances, and hematuria. Case Report: This study presents two pediatric cases of cantharidin poisoning resulting from biting of Meloid beetles. Case 1 involved a 2-year-old exhibiting hematuria and vomiting, while case 2, a 9-month-old, presented with agitation, lethargy, and hematuria. Both cases required intensive care and supportive management. Conclusion: These cases highlight the clinical manifestations of cantharidin intoxication in children following exposure to Meloid beetles. Early recognition of symptoms, prompt medical intervention, and close monitoring are crucial in managing cantharidin poisoning, for which no specific antidote currently exists.

MANAGEMENT OF A PATIENT PRESENTED WITH AMITRIPTILINE POISONING- A RARE CASE REPORT

Abstract Tricyclic Antidepressant overdose for suicidal poisoning purpose is not frequent but still possible in patient and his near relative due to its availability at home. On susception laboratory testing is required for many poisons but availability is limited and any delay in diagnosis and starting management may worsen the patient&amp;apos;s condition. Amongst all TCAs, Amitriptyline is classic having sedative and anticholinergic properties. Its self-poisoning is not that much common in general population. Here we are reporting a case of Amitriptyline poisoning in a healthy women aged 30 years brought by relatives with drowsiness and giddiness to our Emergency Medicine Department, LG Hospital, Narendra Modi Medical College, Ahmedabad. Her relatives had given history of self-ingestion of 30 Tab of Amitriptyline Hydrochloride. Each Tablet contained 25 mg of drug molecule. On examination in ED, patient was in drowsy but arousable state. Patient had tachycardia (130/min), high blood pressure (140/90 mm of Hg) and tachypnoea (RR 24/min). Except tachycardia her ECG did not show any significant findings. She was taking Tab. Amitriptyline for her psychiatric problems. Urine sample for toxicology was sent and the reports were normal. Other blood investigations were normal. In emergency room, Ryle&amp;apos;s tube inserted, gastric sample was collected and she was given activated charcoal lavage and force alkaline diuresis with Inj. Furosemide with saline. She was shifted to emergency ICU for further management. After 12 hours patient was conscious and oriented with stable hemodynamic. She was referred to psychiatry department and then transferred to Medicine department for further care. She remained stable there and discharged after 2 days.

Fenthion flea-killer: Unpredictable and dangerous

Introduction This case of fenthion poisoning demonstrates the delayed, protracted and yet unpredictable nature of cholinergic effects which are unique to fenthion toxicity. Case Presentation A 36-year-old female presented to the emergency department with drowsiness and vomiting, 8 hours after an unknown pesticide ingestion. She had some cholinergic symptoms (miosis, incontinence, emesis) suspicious of organophosphate toxicity but was initially well with no bronchorrhea or bradycardia. During her admission, she developed increasing salivation and bronchorrhea resulting in respiratory failure requiring intubation 27 h’ post-ingestion. Possible aspiration pneumonitis was initially considered given the delayed nature of deterioration. However, blood toxicology results confirmed fenthion poisoning. Atropine and pralidoxime boluses were administered followed by continuous infusion. She was extubated after initial improvement and stabilization – only to require reintubation for recurring respiratory failure and seizures on Days 4 and 5, each time following apparent recovery. She was eventually weaned off mechanical ventilation only on Day 31. Discussion and Conclusion This case illustrates the importance of physician awareness to potentially innocuous presentations of fenthion poisoning as symptoms at the onset may appear benign and falsely reassuring. Serious toxic manifestations may be significantly delayed over a prolonged, waxing-and-waning clinical course because of the compound’s high lipid solubility and metabolism into potent secondary compounds.

Случай хронического отравления ртутью у кота при кормлении морской рыбой

Mercury is an element that exhibits high toxicity even in small concentrations, and therefore its content in the environment, feed and food products is strictly specified by sanitary and hygienic standards. In long-lived predatory fish, the accumulated mercury content can exceed its content in the habitat by hundreds of thousands and even millions of times. Therefore, from the point of view of the impact on animal health, it poses the greatest danger. Pets, which are traditionally fed fresh or thermally processed sea fish, are at especially high risk. According to some studies in animals, mercury poisoning is manifested by damage to the liver, kidneys and pathology of the central and peripheral nervous system. Morphological and biochemical blood tests for this poisoning remain uninformative, so toxicological studies are required. In a veterinary clinic, in order to establish a diagnosis and treat an animal, a case of chronic mercury poisoning of a cat when feeding sea fish was laboratory confirmed. The article presents the results of a clinical examination of the animal, the results of laboratory tests, the method of treatment and recommendations for the prevention of mercury poisoning.