Type Of Poisoning Research Articles

Lead and arsenic intoxications by traditional and alternative medicine: men are more sensitive than women.

Traditional and alternative medicines are widely used around the world and include for example herbal medicine, Ayurveda, traditional Chinese medicine, and indigenous therapies. Due to the long history and the mostly natural origin of traditional remedies, it is often assumed that they are harmless, but in recent decades more and more case reports have been published in which traditional medicine has caused metal poisoning. This paper provides an analysis of published cases in which patients have suffered metal poisoning due to traditional or alternative medicines. A systematic literature search was performed on PubMed, whereby 210 patient cases from a total of 102 case reports and 30 case series were identified and then analyzed about various aspects. Most of the traditional medicines involved come from Asia and are mainly contaminated with lead and arsenic. The analyzed patient cases show a high degree of heterogeneity with regard to age, sex, intake reason, symptoms, and severity of intoxication. The metal intoxication itself and the cause of the poisoning often remained unrecognized for a long time, which resulted in many patients undergoing unnecessary diagnostic methods and ineffective therapeutic approaches before the correct diagnosis was made. The evaluation of the available patient cases revealed a higher sensitivity to metal poisoning in children compared to adults and a higher sensitivity in men compared to women. Anemia and basophilic stippling were frequently observed and became more common as the metal content in the blood increased. Hopefully, this paper raises awareness of the potential dangers of traditional and alternative medicines, both from the patient's and the doctor's perspective, so that in case of intoxication, treatment can be initiated quickly using the correct diagnostic methods. As ingested metals do not only circulate in the blood but also accumulate in soft tissues and bones, long-term monitoring is necessary to ensure that patients make a full recovery. Doctors should be aware that, in contrast to common belief, men are more sensitive to this type of intoxication than women, necessitating particular attention for diagnosis and treatment.

#3073 Should we expand the indications for hemodialysis in lithium intoxications beyond the EXTRIP recommendations?

Abstract Background and Aims EXTRIP Workgroup (EW) recommends renal replacement therapy (RRT) in lithium poisoning when serum lithium levels >4 mmol/l in cases of impaired kidney function, decreased consciousness, seizures or dysrhythmias, and suggests RRT in cases of serum lithium >5 mmol/l or when there is confusion or the expected time to obtain lithium levels <1 mmol/l with optimal management exceeds 36 hours. The aim of this study was to assess the benefit of RRT in the conditions recommended and suggested by the EW, and evaluate the benefit from RRT in other conditions of lithium poisoning. Method We conducted a retrospective mutli-centre observational study that included patients with a diagnosis of lithium poisoning from January 2006 to December 2022. Demographic data, kidney function and comorbidities, clinical presentation including neurologic, cardiac and renal manifestations, type of intoxication, previous poisonings or concomitant intake of other toxic substances and treatments used were registered. In patients receiving RRT, the type of RRT, duration and number of sessions were registered. Lithium levels during hospitalization were recorded, and time for lithium levels <1 mmol/l was calculated. The primary outcomes were death from lithium poisoning and persistent neurologic deficits (syndrome of irreversible lithium-effectuated neurotoxicity, SILENT). Results The study included 179 cases of lithium poisoning (62.6% chronic lithium poisoning, 34.6% acute on chronic and 2.8% acute poisoning),with a mean age of 56.3 ± 15.4 years, and patients were predominantly females (57%). 130 patients (72.6%) presented neurological manifestations, out of which 33 patients (18.4%) presented a decreased conscious level or generalized convulsions, and 40 patients (22.3%) presented confusion. 98 patients (54.7%) presented acute kidney injury (AKI) and 21 patients (11.7%) presented life-threatening dysrhythmias. 68 patients (38%) were treated with RRT. 31 patients (17.3%) developed persistent neurological deficits (SILENT) and only 2 patients (1.1%) died of lithium poisoning during hospitalization. Concerning patients in whom hemodialysis was recommended according to EW guidelines, only 34 out of 53 patients (64.2%) received RRT. In this group of patients, those who received RRT developed less frequently SILENT (11.8% vs 36.8%, p = 0.031) Regarding patients in whom hemodialysis is suggested according to EW, only 34 out of 106 patients (32.1%) received RRT. Overall, combining patients in whom dialysis is recommended or suggested according to EW, SILENT developed less frequently in those who received RRT (13.2% vs 20.4%) Beyond the recommendations by the EW, we found that patients with lithium levels > 2 mEq/l with AKI and any neurological manifestations presented less frequently SILENT when receiving RRT (7% vs 26%, p = 0.033). We also observed that patients who received RRT had a shorter in-hospital stay (3.3 [IQR 2-7] days vs 9.4 [IQR 5-11] days, p = 0.01). Conclusion Patients presenting with lithium poisoning and impaired kidney function or any neurological manifestations who received RRT presented less frequently persistent neurologic deficits (SILENT) after discharge, regardless of lithium levels or type of poisoning. We suggest that EXTRIP should recommend RRT in any patient with lithium poisoning who presents with neurological symptoms or impaired kidney function, regardless of lithium levels.

#1256 Comparison of clinical characteristics of acute kidney injury between glufosinate and glyphosate poisoning

Abstract Background and Aims There are few studies comparing the clinical characteristics of acute kidney injury (AKI) between glufosinate and glyphosate poisoning. In this study, we investigated the clinical characteristics of AKI in patients with glufosinate and glyphosate poisoning, and compared the clinical features of AKI between two groups. Method This study performed between 2008 and 2021 included 76 patients with glufosinate poisoning and 184 patients with glyphosate poisoning. This study included 76 patients with glufosinate poisoning and 184 patients with glyphosate poisoning in the period from 2008 to 2021. Based on Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease classification, we investigated the incidence, clinical characteristics, and severity of AKI between two groups [(glufosinate-induced AKI (Glu-AKI, n=54) and glyphosate-induced AKI (Gly-AKI, n=82)]. Results The incidence of AKI in patients with glufosinate poisoning is higher than that of glyphosate poisoning (57.5% vs 44.5%, P<0.05). However, there is no difference of AKI severity between two groups (Glu-AKI; Risk 56.2%, Injury 36.9%, Failure 6.9% vs Gly-AKI; Risk 56.2%, Injury 14.6%, Failure 29.2%, P=NS). Comparing two groups, there is also no difference in age (62.6 ± 14.2 years vs. 63.3 ± 16.2 years, P=NS) and renal function on admission (63.9 ± 25.2 mL/min/1.73 m2 vs. 62.2 ± 22.9 mL/min/1.73 m2, P=NS). The length of hospitalization was longer (17.2 ± 17.2 days vs. 10.7 ± 12.1 days, P<0.05) in Glu-AKI group than that of Gly-AKI group. The mortality rate was higher in the Gly-AKI group than Glu-AKI (11.1% vs. 18.3%, P=NS). Multivariate logistic regression analysis showed that serum bicarbonate concentration on admission was a significant predictors of AKI in patients with AKI after glyphosate and glufosinate intoxication. Conclusion Although there is a higher incidence of AKI in glufosinate poisoning, there is no difference in clinical characteristics between the two types of intoxication.

Prehospital Care of Severely Intoxicated Patients by a Dutch Physician-Staffed Helicopter Emergency Medical Services: A Retrospective Study

ObjectiveIntoxicated patients are often encountered by emergency medical services (eg, in cases of recreational drug use, accidental ingestion, or inhalation of toxic substances or [attempted] suicide). Earlier research showed that a physician-staffed helicopter emergency medical service (P-HEMS) is regularly dispatched for intoxicated patients. However, it is still unclear if there is added value of P-HEMS compared with standard care provided by an ambulance crew. The aim of this study was to analyze the contribution of additional expertise and equipment that P-HEMS brings to the prehospital scene. MethodsIn this retrospective study, we searched the database of the helicopter emergency medical service Lifeliner 1 serving the northwestern quadrant of the Netherlands for cases that involved intoxications from January 2013 to July 2020. Patients were included in this study if the primary reason for P-HEMS dispatch was intoxication. The types of intoxication were categorized as (illicit/recreational) drug related, suicide attempt, or accidental. The agents were categorized as stimulants, depressants, hallucinogenic, cannabinoids, and other substances such as bleach or insulin. Patient characteristics, vital signs, and the therapeutic interventions performed were recorded for analysis. ResultsIn our study period, P-HEMS was dispatched 23,878 times. Of these dispatches, a total of 259 cases were included for further analysis. The majority of patients were male (64.5%). Sixty-six patients (25.5%) had an intoxication of depressant agents alone, whereas 60 patients (23.2%) had an intoxication with a combination of agents. With 159 (61.4%) patients, the majority of cases involved recreational drug intoxications. Unintentional intoxications were treated in 27 (10.4%) patients, whereas 73 (28.2%) cases involved suicide attempts. In 159 patients (61.4%), prehospital endotracheal intubation was required; the vast majority was performed by the helicopter emergency medical service physician. Specific antidotes were administered in 56 (21.6%) of the cases. ConclusionIn this study, we found that P-HEMS crews might complement usual prehospital care by ambulance crews for patients with severe intoxications by bringing advanced skills (eg, airway management and specific antidotes) to the scene.

The challenge of understanding and predicting phenotypic diversity in urea cycle disorders.

The Urea Cycle Disorders Consortium (UCDC) and the European registry and network for Intoxication type Metabolic Diseases (E-IMD) are the worldwide largest databases for individuals with urea cycle disorders (UCDs) comprising longitudinal data from more than 1100 individuals with an overall long-term follow-up of approximately 25 years. However, heterogeneity of the clinical phenotype as well as different diagnostic and therapeutic strategies hamper our understanding on the predictors of phenotypic diversity and the impact of disease-immanent and interventional variables (e.g., diagnostic and therapeutic interventions) on the long-term outcome. A new strategy using combined and comparative data analyses helped overcome this challenge. This review presents the mechanisms and relevant principles that are necessary for the identification of meaningful clinical associations by combining data from different data sources, and serves as a blueprint for future analyses of rare disease registries.

Comparison of rhabdomyolysis in acutely intoxicated patients with psychotropic and chemical substances.

Rhabdomyolysis is characterized by a muscle injury that leads to the release of intracellular muscle contents/constituents into the systemic circulation.

Analysis of the raw material base for pectin production

The addition of pectin to food products is important because this natural polysaccharide plays a key role in improving the quality and stability of the product, it allows for high-quality preservation of products that have a long shelf life, which is important for the health and wellbeing of consumers. The purpose of the study is to investigate the main raw materials of plant origin for the synthesis of pectin, which can be used as a promising raw material for food industry enterprises in Ukraine. The study was carried out using various methods of analysis, a thorough comparative analysis of papers by Ukrainian and foreign researchers, which are published in the scientometric databases Scopus, Web of Science, Journal Citation Reports, Scimago Journal & Country Rank, and Google Scholar. Based on the results of analytical studies, the main raw materials used for the production of pectin and pectin-containing pastes were analysed, and the main problems of the production process were identified. It has been found that adding pectin to food products can have a significant number of benefits: increasing the viscosity of the product, which is useful for creating a thick texture of the product; increasing the resistance of the product to heat treatment, reducing the risk of product separation or quality degradation; increasing functionality; introducing it into products can help improve the consistency and appearance of the product, add taste and color properties, and reduce the amount of sugar that must be added to the product to ensure viscosity and taste. It is established that the main raw material for the production of pectin in Ukraine is apple fruits. It is proven that pectin can be obtained from other fruits, berries, and vegetables, such as gooseberries, currants, cherries, pumpkins, etc. The intensification of the pectin production process should provide the population with a high-quality product that will prevent various types of intoxication by removing radionuclides from the body and contribute to the recovery of people in the post-war period. The practical significance of this study lies in the ability to help manufacturers find optimal sources of raw materials with a high pectin content to ensure the quality of the final product. In addition, this study will also facilitate the development of appropriate technological solutions for the optimal process of producing pectin from the selected raw materials

Overview of infectious and non-infectious diseases in French Guiana in 2022

Source of many myths, French Guiana represents an exceptional territory due to the richness of its biodiversity and the variety of its communities. The only European territory in Amazonia, surrounded by the Brazilian giant and the little-known Suriname, Ariane 6 rockets are launched from Kourou while 50% of the population lives below the poverty line. This paradoxical situation is a source of health problems specific to this territory, whether they be infectious diseases with unknown germs, intoxications or chronic pathologies.Some infectious diseases such as Q fever, toxoplasmosis, cryptococcosis or HIV infection are in common with temperate countries, but present specificities leading to sometimes different management and medical reasoning. In addition to these pathologies, many tropical diseases are present in an endemic and / or epidemic mode such as malaria, leishmaniasis, Chagas disease, histoplasmosis or dengue. Besides, Amazonian dermatology is extremely varied, ranging from rare but serious pathologies (Buruli ulcer, leprosy) to others which are frequent and benign such as agouti lice (mites of the family Trombiculidae) or papillonitis. Envenomations by wild fauna are not rare, and deserve an appropriate management of the incriminated taxon. Obstetrical, cardiovascular and metabolic cosmopolitan pathologies sometimes take on a particular dimension in French Guiana that must be taken into account in the management of patients. Finally, different types of intoxication are to be known by practitioners, especially due to heavy metals.European-level resources offer diagnostic and therapeutic possibilities that do not exist in the surrounding countries and regions, thus allowing the management of diseases that are not well known elsewhere.Thanks to these same European-level resources, research in Guyana occupies a key place within the Amazon region, despite a smaller population than in the surrounding countries. Thus, certain pathologies such as histoplasmosis of the immunocompromised patient, Amazonian toxoplasmosis or Q fever are hardly described in neighboring countries, probably due to under-diagnosis linked to more limited resources. French Guiana plays a leading role in the study of these diseases.The objective of this overview is to guide health care providers coming to or practicing in French Guiana in their daily practice, but also practitioners taking care of people returning from French Guiana.

Pediatric Emergency Department Management in Acute Poisoning-A 2-Year Retrospective Study.

(1) Background: Poisonings in children are common reasons for addressing ED and can potentially have serious complications. Our research aims to review risk factors leading to poisoning in children. (2) Methods: A retrospective review of all pediatric poisoning cases addressing the Children's emergency department of St Mary Hospital over a two-year period was performed. (3) Results: We collected data on 797 children admitted for acute poisoning. The highest incidence identified was in the 12-18 and 1-3-year-old age groups. The distribution of voluntary versus unintentional poisonings was relatively balanced: 50.19% versus 47.43% (for some cases the type of intoxication remained unknown). Exposure to the toxic substance by ingestion was significant compared to the other routes, with an incidence of 87.1%. Acute poisoning happened at home in 70.4% of cases. A known risk factor before reaching the ED was present in 13.04%. (4) Conclusions: Our study showed a greater risk for acute poisoning in children between 1-3 years of age, and adolescents over 12 years. Identifying and documenting epidemiological aspects and other variables is important for establishing preventive measures and for therapeutic conduct. Adequate risk stratification and preventive measures involving closer supervision of minors or cognitive-behavioral programs can prevent voluntary intoxication.

Outcome in intoxicated patients transported by a physician-staffed helicopter in Japan from 2015 to 2020.

We retrospectively investigated the current status of poisoned patients who had been transported by a physician-staffed helicopter emergency medical service and their final outcomes using data from the JAPAN DOCTOR HELICOPTER REGISTRY SYSTEM. The following details of dispatch activity were collected from the database of the JAPAN DOCTOR HELICOPTER REGISTRY SYSTEM: patient age and sex, timing of dispatch request, presence of cardiac arrest, vital signs, medical intervention, main etiology of intoxication, and final outcome. The patients were divided into two groups: those with a good outcome and those with a poor outcome. The variables were compared between the two groups. A total of 336 patients were intoxicated. Psychotropic drug overdose was the dominant cause, followed by carbon monoxide and ethanol. The median Glasgow Coma Scale score was significantly higher in the good outcome group than in the poor outcome group. The rates of cardiac arrest, interventions to secure an airway and/or assist with ventilation, and drug administration were significantly lower in the good outcome group than in the poor outcome group. There were no records concerning the decontamination of the intoxicating substance at the scene or during air evacuation. The study suggests that various factors may influence the outcomes of patients with different types of intoxication. These findings offer valuable insights that could help to establish effective treatment strategies and the operation of doctor helicopters for intoxicated patients.

Impact of the SARS-CoV-2 pandemic on the health of individuals with intoxication-type metabolic diseases-Data from the E-IMD consortium.

The SARS-CoV-2 pandemic challenges healthcare systems worldwide. Within inherited metabolic disorders (IMDs) the vulnerable subgroup of intoxication-type IMDs such as organic acidurias (OA) and urea cycle disorders (UCD) show risk for infection-induced morbidity and mortality. This study (observation period February 2020 to December 2021) evaluates impact on medical health care as well as disease course and outcome of SARS-CoV-2 infections in patients with intoxication-type IMDs managed by participants of the European Registry and Network for intoxication type metabolic diseases Consortium (E-IMD). Survey's respondents managing 792 patients (n=479 pediatric; n=313 adult) with intoxication-type IMDs (n=454 OA; n=338 UCD) in 14 countries reported on 59 (OA: n=36; UCD: n=23), SARS-CoV-2 infections (7.4%). Medical services were increasingly requested (95%), mostly alleviated by remote technologies (86%). Problems with medical supply were scarce (5%). Regular follow-up visits were reduced in 41% (range 10%-50%). Most infected individuals (49/59; 83%) showed mild clinical symptoms, while 10 patients (17%; n=6 OA including four transplanted MMA patients; n=4 UCD) were hospitalized (metabolic decompensation in 30%). ICU treatment was not reported. Hospitalization rate did not differ for diagnosis or age group (p=0.778). Survival rate was 100%. Full recovery was reported for 100% in outpatient care and 90% of hospitalized individuals. SARS-CoV-2 impacts health care of individuals with intoxication-type IMDs worldwide. Most infected individuals, however, showed mild symptoms and did not require hospitalization. SARS-CoV-2-induced metabolic decompensations were usually mild without increased risk for ICU treatment. Overall prognosis of infected individuals is very promising and IMD-specific or COVID-19-related complications have not been observed.

Copper Poisoning, a Deadly Hazard for Sheep.

Simple SummarySheep are very susceptible to copper intoxication, a deadly disease that causes significant economic losses worldwide. Two types of copper poisoning can occur depending on the chronic or acute exposure to copper. Chronic toxicosis is the most common form and is developed after a long subclinical period of copper accumulation in the liver. When the capacity of the liver for copper storage is exceeded, a sudden release of copper into the blood causes severe haemolysis and the death of the animals. Acute copper poisoning is much less frequent and appears following the accidental administration or ingestion of toxic amounts of copper. Collapse and death occur shortly after parenteral administration, whereas acute oral exposure to copper causes severe gastroenteritis followed by shock and death. In this review, we summarise the available information on the aetiology, epidemiology, pathogenesis, clinical features, diagnosis, treatment and prevention of sheep copper poisoning.Copper (Cu) is an essential microelement for animals. However, sheep are particularly susceptible to Cu intoxication, a deadly disease reported worldwide. The risk of developing this poisoning is higher in vulnerable breeds and in intensively managed lambs or milk sheep. Two types of Cu intoxication can occur depending on the chronic or acute exposure to Cu. In chronic Cu poisoning (CCP), the most common form, Cu is accumulated in the liver during a subclinical period. A low intake of Cu antagonists (molybdenum, sulphur, iron, or zinc) favours Cu accumulation. The sudden release of Cu into the blood causes acute haemolysis with anaemia, haemoglobinuria, jaundice and death within 1–2 days. Acute Cu poisoning is related to the accidental administration or ingestion of toxic amounts of Cu. Acute oral exposure to Cu causes severe gastroenteritis, shock and death. Collapse and death occur shortly after parenteral administration. The diagnosis is based on history, clinical, gross pathological, histological and toxicological findings. Treatment of sheep with severe clinical signs often has poor success but is very effective during the Cu accumulation phase. Different therapies, based on either chelating agents or Cu antagonists, have been used to treat and prevent CCP.

Epidemiological Study of Acute Unintentional Poisoning Among Children in Iran.

The occurrence of different types of poisoning and early diagnosis is important for therapeutic measures. In this study, we investigate the epidemiological causes of acute poisoning in children.In this retrospective descriptive study, children presented with acute poisoning during 2010-2019 to Shahid Madani Hospital were included. The Electronic Medical Record system of the hospital was accessed to obtain the data of the patients. The data included was demographic information, type of poisoning, clinical findings, complications, duration of hospitalization, parents' education status, and mortality status.Of 336 patients included in the study, the mean age of patients was 4.90±3.27 years (range: 1-12 years). There was a significant correlation between the age of the child and the type of poisoning, p=0.001. The most frequent age group was 5 years and less (69.6%). The most frequent sex group was male (58.6%). However, there was no significant correlation between the sex of the child and the type of poisoning. Parents' education and ICU admission were also associated significantly with the type of poisoning, p=0.001, respectively. The most common type of poisoning in children was medication (60.6%) which was mainly due to methadone. The mortality rate in the study was 1.2%.Our study showed that pharmacological drugs are the main cause of poisoning in our population. Age of the children is likely to be associated with the type of poisoning however, no gender difference was found in this regard was found in our study.

The importance of plasma amino acid profiling in the diagnosis of inborn errors of metabolism: analytical – prospective study

Introduction. Inborn errors of metabolism (IEM) make up a large group of disorders caused by an inherited defect of proteins that have enzymatic, carrier, receptor or structural roles. The cumulative prevalence of IEM in different populations is around 1:500 – 800 newborns, despite the fact that some of these disorders are extremely rare when taken individually. Early recognition and intervention are essential to avoiding disastrous consequences associated with IEM. The phenotype of IEM patients is very heterogeneous and only in combination with specialized metabolic test it can lead to a correct diagnosis. The aim of the study was defined as evaluation of importance of plasma amino acid profile in the diagnosis of IEM. Material and methods. Plasma amino acids quantification have been performed by high performance liquid chromatography on Shimadzu LC-20 with post column derivatization with OPA in 15 patients aged from 0 to 13 years old, selected through medical genetic counseling, based on inclusion and exclusion criteria. Inform consent has been signed by parents after receiving all necessary information regarding the study. Additionally, liquid chromatography-tandem mass spectrometry (LC-MS/MS) on dried blood spots and Nuclear Magnetic Resonance Spectroscopy (H1-NMR) on urine has been done as complementary tests. Results. The first line investigations showed acid-base imbalance (33,3%), hypoglycemia (46,6%), high lactate level (46,6%) and high ammonia level (20%). Plasma amino acid concentrations were abnormal in 4 patients (27%). Increased glycine (544 μmol/L, reference values 70,72 – 256,36 μmol/L), along with elevated glycine in cerebrospinal fluid (CSF) / plasma ratio (0,147, normal < 0.02) was detected in a patient with seizures, coma, and respiratory arrest indicating non-ketotic hyperglycinemia. High level of phenylalanine (Phe 1568µmol/L, reference values 26.52 – 221 µmol/L) has been identified in a patient suspected for Phenylketonuria after neonatal screening results (Phe > 3mg/dL). Also the ratio Phe / Tyr around 17 was specifically appreciated as for classical form of PKU. High alanine concentration (> 450 µmol/L) has been observed in two patients presenting severe metabolic acidosis and high lactate level, suggesting for a metabolic error with mitochondrial involvement. The results from extended newborn screening and NMR spectroscopy narrowed the spectrum of suspected diseases, facilitating the diagnosis. Molecular genetic tests are required for the confirmation of disease in all cases. Conclusions. Quantitative amino acids analysis is an important tool for the diagnosis of “intoxication type” of IEMs and nutritional monitoring of individuals with already established diagnosis.

Committing a Crime while Intoxicated: The Basis of Liability and Legal Regulation

Alcohol and drugs have been known for a long time, and their purpose has changed in the course of history. Being part of the global culture, they have come down to us. With the development of mankind, drugs were limited. This article attempts to analyzes the concept and types of intoxication. The authors also take into consideration the basis of criminal liability for committing a crime while intoxicated, as well as the role of intoxication in criminal law. This research was based on a dialectical approach to the disclosure of legal phenomena and processes using general scientific (systematic and logical methods, analysis and synthesis) and specific scientific methods. In the end, It can be concluded that the state of intoxication can be included in the main corpus delict, used as a qualifying attribute, as well as circumstances aggravating liability. It is indicated that considering intoxication as an aggravating circumstance requires a connection between crime and intoxication.

Veno-arterial extracorporeal membrane oxygenation for drug intoxications: A single center, 14-year experience.

Acute cardiovascular failure remains a leading cause of death in severe poisonings. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used as a rescue therapeutic option for those cases refractory to optimal conventional treatment. We sought to evaluate the outcomes after VA-ECMO used for drug intoxications in a single-center experience. We performed an observational analysis of our prospective institutional database. The primary endpoint was survival to hospital discharge. Between January 2007 and December 2020, 32 patients (mean age: 45.4 ± 15.8 years; 62.5% female) received VA-ECMO for drug intoxication-induced refractory cardiogenic shock (n = 25) or cardiac arrest (n = 7). Seven (21.8%) patients developed lower limb ischemia during VA-ECMO support. Twenty-six (81.2%) patients were successfully weaned after a mean VA-ECMO support of 2.9 ± 1.3 days. One (3.1%) patient died after VA-ECMO weaning for multiorgan failure and survival to hospital discharge was 78.1% (n = 25). In-hospital survivors were discharged from hospital with a good neurological status. Survival to hospital discharge was not statistically different according to sex (male = 75.0% vs. female = 80.0%; p = .535), type of intoxication (single drug = 81.8% vs. multiple drugs = 76.1%; p = .544) and location of VA-ECMO implantation (within our center = 75% vs. peripheral hospital using our Mobile Unit of Mechanical Circulatory Support = 100%; p = .352). Survival to hospital discharge was significantly lower in patients receiving VA-ECMO during on-going cardiopulmonary resuscitation (42.8% vs. 88.0%; p = .026). VA-ECMO appears to be a feasible therapeutic option with a satisfactory survival rate and acceptable complicationsrate in poisonings complicated by refractory cardiogenic shock or cardiac arrest.

Foodborne botulism in southeast Turkey in over a five-year period

Aim: The purpose of this study was to evaluate food-borne botulism cases (especially purslane) observed in Adıyaman, a southeastern province of Turkey. Material and Methods: This retrospective study covers food-borne botulism cases, especially due to purslane, which were detected in 9 out of 796 people admitted to the emergency department due to food poisoning in Adıyaman between 2015-2020. The demographic characteristics of the cases, nutritional sources, and prognosis of the disease, its clinical signs and symptoms, duration of hospital stay, and treatment and death rates were analyzed. Results: A total of 9 patients from the same family (5 females and 4 males) were included in the study. The time elapsed since the onset of the disease was between 8-12 hours. The outbreaks occurred due to purslane prepared in the autumn season and consumed in the spring season. At the end of follow-up and treatment, all the patients were discharged with full recovery. Conclusion: When looking at the data of our hospital, patients were frequently diagnosed with food poisoning, but the cause was not specified. The main source of toxin seen in food poisoning in our city was due to canned purslane, which was stored in unsuitable conditions at home. Therefore, emergency physicians need to know how to diagnose and treat this rare but potentially fatal condition, as they may be the first to treat a patient with any type of botulinum intoxication.

Management of lithium intoxication

SUMMARYLithium is a gold standard maintenance treatment in bipolar affective disorder. It has a narrow therapeutic range, and at higher serum lithium levels there is a risk of adverse effects and toxicity. There are three patterns of lithium intoxication: acute, acute-on-chronic and chronic. We describe risk factors for lithium intoxication, mechanisms of toxicity and clinical symptoms seen in lithium intoxication. We describe both the acute and chronic effects of lithium toxicity. Lithium intoxication may be life-threatening and associated with longer-term sequelae. The management of lithium intoxication involves determining the type of intoxication. We discuss treatment strategies aimed at reducing absorption and increasing elimination of lithium. We discuss clinical indications for extracorporeal methods such as dialysis, which are used to limit the time and degree of exposure of the central nervous system to toxic lithium concentrations. Haemodialysis is the most rapid method of eliminating lithium from the body, but careful monitoring is required. Preventive strategies to mitigate the risk for lithium intoxication are discussed.

A unique case of death by MDPHP with no other co-ingestion: a forensic toxicology case

Synthetic cathinones are a class of psychoactive drugs that have become, in recent years, of quite common observation in medical and toxicological forensic field. MDPHP (3,4-methylenedioxy-α-pyrrolidinohexanophenone) belongs to this class of substances but lethal acute intoxication caused by this specific substance without other co-ingestions has never been described in literature. We are presenting the unique case of a fatal acute intoxication caused by MDPHP in a 48-year-old man carried to the A&E department of a big Milanese hospital where he suddenly deceased after brief time. Clinical records, autopsy examination, histological findings, and toxicological analysis, assessed via a Q-Exactive Orbitrap with a HPLC system and LC/MS–MS system, are discussed. This case report may represent the first case of this type of intoxication and might help in improving recognition and treatment of these particular cases.

Inborn errors of metabolism and coronavirus disease 2019: Evaluation of the metabolic outcome.

BackgroundInfectious diseases can result in a catabolic state and possibly trigger an acute metabolic decompensation in inborn errors of metabolism (IEM), which could be life threatening. Studies regarding the course of severe acute respiratory syndrome coronavirus 2 infections in patients with IEM are generally limited to case reports. Here, we aimed to evaluate the clinical findings of coronavirus disease 2019 (COVID‐19) and describe the impact of severe acute respiratory syndrome coronavirus 2 infections on metabolic outcomes in IEM patients.MethodsPatients who were diagnosed with different types of IEM and developed microbiologically confirmed COVID‐19 infection were included. Clinical findings and laboratory results were recorded retrospectively in terms of both IEM and COVID‐19.ResultsEleven patients with diagnosis of intoxication type metabolic disorders, five patients with energy metabolism disorders, and six patients with complex molecular disorders were enrolled. The most frequent clinical finding was fever (52.1%) followed by fatigue/myalgia (47.8%). None of the patients was younger than 1 year. None of the patients presented severe or critical disease. In terms of metabolic decompensation, two patients diagnosed with propionic acidemia, one patient with methylmalonic acidemia and one patient with 3‐hydroxy‐3‐methylglutaryl‐CoA lyase deficiency presented clinical and biochemical findings of an acute metabolic attack.ConclusionsBased on our results, IEM are not found to be an additional risk factor for severe COVID‐19 infection. However, patients with intoxication type and energy metabolism disorders should be considered as a vulnerable population for COVID‐19 and have a major risk of developing acute metabolic decompensation that can lead to life‐threatening complications.