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ABSTRACT: Amanita muscaria has a bright red or orange cap covered with small white plaques. It contains the isoxazole derivatives ibotenic acid, muscimol
and muscazone and other toxins such as muscarine. The duration of clinical manifestations after A. muscaria ingestion does not usually exceed 24 hours; we report on a 5-day paranoid psychosis after A. muscaria ingestion. A 48-year-old man, with no previous medical history, gathered and ate mushrooms he presumed to be A. caesarea. Half an hour later he started to vomit and fell asleep. He was found comatose having a seizure-like episode. On admission
four hours after ingestion he was comatose, but the remaining physical and neurological examinations were unremarkable. Creatine
kinase was 8.33 μkat/l. Other laboratory results and brain CT scan were normal. Toxicology analysis did not find any drugs
in his blood or urine. The mycologist identified A. muscaria among the remaining mushrooms. The patient was given activated charcoal. Ten hours after ingestion, he awoke and was completely
orientated; 18 hours after ingestion his condition deteriorated again and he became confused and uncooperative. Afterwards
paranoid psychosis with visual and auditory hallucinations appeared and persisted for five days. On the sixth day all symptoms
of psychosis gradually disappeared. One year later he is not undergoing any therapy and has no symptoms of psychiatric disease.
We conclude that paranoid psychosis with visual and auditory hallucinations can appear 18 hours after ingestion of A. muscaria and can last for up to five days.
Amanita muscaria ist ein Pilz mit einer leuchtend roten oder orangen Kappe mit kleinen weißen Flecken. Er enthält Isoxazol-Derivate, Ibotensäure,
Muskimol und Muscazon und andere Toxine, wie etwa Muskarin. Die Dauer der klinischen Symptome nach dem Verzehr von Amanita muscaria ist üblicherweise nicht länger als 24 Stunden. Wir berichten über eine über fünf Tage anhaltende paranoide Psychose nach
der Einnahme von Amanita muscaria. Ein 48-jähriger Mann mit völlig blander medizinischer Anamnese sammelte und aß Pilze, die er als Amanita caesarea agnostizierte. Eine halbe Stunde nach der Einnahme begann er zu erbrechen – anschließend schlief er ein. Er wurde komatös
mit krampfartigen Zustand aufgefunden. Bei Eintreffen im Spital war er komatös – seine sonstige klinisch physikalische und
neurologische Untersuchung ergab einen normalen Befund. Die Creatin-Kinase betrug 8,33 μkat/l. Die übrigen Laborbefunde und
das Schädel-CT waren normal. Das toxikologische Screening ergab keinen Hinweis auf Medikamente im Blut und im Harn. Unser
Pilzexperte identifizierte Amanita muscaria in den übrig gebliebenen Pilzen. Dem Patienten wurde aktivierte Tierkohle gegeben. 10 Stunden nach Einnahme des Pilzes erwachte
er. Zu diesem Zeitpunkt schien er völlig orientiert. 18 Stunden nach der Einnahme verschlechterte sich der Zustand wieder;
der Patient wurde verwirrt und zunehmend unkooperativ. Danach trat ein paranoid psychotisches Zustandsbild mit visuellen und
akustischen Halluzinationen ein, welches fünf Tage lang anhielt. Ab dem sechsten Tag nach Einnahme begannen die psychotischen
Symptome zu verschwinden. Ein Jahr später ist der Patient ohne jede Therapie und ohne Symptome psychiatrischer Erkrankung.
Wir folgern daraus, dass eine paranoide Psychose mit visuellen und akustischen Halluzinationen noch 18 Stunden nach Einnahme
von Amanita muscaria auftreten und bis zu fünf Tage lang anhalten kann.
Wiener klinische Wochenschrift 04/2012; 118(9):294-297. · 0.81 Impact Factor
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ABSTRACT: PURPOSE: Adverse drug reactions due to drug-drug interactions (DDIs) are important in drug safety. The aim of this study was
to check potential DDIs (pDDIs) on hospital admission and discharge and to evaluate admissions due to DDIs in medical departments
of a primary city and tertiary referral hospital. METHODS: Age, sex, presence of renal and liver failure, drug information,
diagnosis, and urgency and reason for admission were retrospectively recorded in 520 randomly selected patients in medical
departments of the University Medical Center Ljubljana. The screening program Drug-Reax was used to check for pDDIs in patients
with drug information on both admission and discharge home, and the proportion of patients admitted as the consequence of
a DDI was estimated. RESULTS: Overall, 14.6% (76/520) of patients had incomplete information on drug names in their medical
documentation on admission; at the end of treatment 12.5% (52/416) of patients were discharged home with incomplete information
on drug names in their discharge letters. A total of 323 patients had complete information on drug names on both admission
and discharge and were included in the analysis of pDDIs: 51% (166/323) of patients on admission and 63% (204/323) on discharge
had at least one pDDI (P = 0.001). Major pDDIs were found in 13% (41/323) of patients on admission and 18% (59/323) on discharge (P = 0.001). An ACE inhibitor combined with spironolactone was the most common major pDDI, representing 20.0% of all pDDIs on
admission and 25.6% on discharge. Among patients with pDDI on admission, 2.4% (4/166) of were admitted because of an ADR caused
by a DDI. Overall, 1.2% (4/323) of patients were admitted as the consequence of a DDI. CONCLUSIONS: The information on patient
medication on hospital admission and discharge is incomplete. Half of patients on admission and almost two-thirds on discharge
had pDDIs. ADRs due to DDIs caused 1.2% of admissions to medical departments in Ljubljana's primary city and tertiary referral
hospital.
ZIEL DER STUDIE: Unerwünschte Nebenwirkungen als Folge von Medikamenteninteraktionen spielen eine wichtige Rolle bei der Sicherheit
von Medikamenten. Ziel dieser Studie war es, mögliche Medikamenteninteraktionen bei der Spitalsaufnahme und -entlassung zu
erfassen, bzw. die Aufnahmen infolge solcher Interaktionen auf internen Abteilungen eines primären Stadtspitals und tertiären
Referenzspitals zu evaluieren. METHODEN: Bei 520 zufällig ausgesuchten Patienten des medizinischen Zentrums der Universität
Ljubljana wurden Alter, Geschlecht, Nieren- und Leberfunktion, Medikamente, Diagnosen sowie Dringlichkeit und Grund der Zuweisung
retrospektiv erhoben. Bei den Patienten, bei denen Information über die bei Aufnahme und Entlassung eingenommenen Medikamente
vorlag, wurde auf Medikamenteninteraktionen mittels des Interaktions-Screening Programms "Drug-Reax" geprüft. Basierend auf
den erhobenen Daten wurde der Anteil an Aufnahmen, deren Grund eine Medikamenteninteraktion war, geschätzt. ERGEBNISSE: Bei
14,6% (76/520) Patienten war die Information über die Medikamentennamen bei Aufnahme nicht vollständig. Nach der Behandlung
wurden 416 Patienten nach Hause entlassen, bei 52 von diesen (12,5%) war die Information über die Medikamentennamen im Entlassungsbrief
ebenfalls unvollständig. Die restlichen 323 Patienten mit kompletter Information wurden in die Studie inkludiert. Mindestens
eine Nebenwirkung wegen potentieller Medikamenteninteraktion hatten 51% (166/323) der Patienten bei Aufnahme und 63% (204/323)
bei Entlassung (p = 0,001). Schwere potentiell interaktionsbedingte Nebenwirkungen hatten 13% (41/323) der Patienten bei Aufnahme
und 18% (59/323) bei Entlassung (p = 0,001). Die gleichzeitige Gabe von ACE-Hemmern mit Spironolacton war die häufigste Interaktion.
(20% der Interaktionen bei Aufnahme bzw. 25,6% bei Entlassung). Nur 2,4% (4/166) der Patienten mit potentiell interaktionsbedingter
Nebenwirkungen wurden unter dieser Diagnose zugewiesen. 1,2% (2/323) aller Patienten wurden wegen Medikamenteninteraktion
aufgenommen. SCHLUSSFOLGERUNGEN: Die Information über die Medikation der Patienten bei Spitals-Aufnahme und -entlassung ist
nicht vollständig. Bei Aufnahme hatte die Hälfte und bei Entlassung zwei Drittel der Patienten potentiell interaktionsbedingte
Nebenwirkungen. Unerwünschte durch Interaktionen von Medikamenten bedingte Nebenwirkungen machten 1,2% der Zuweisungen zur
Aufnahme auf internen Abteilungen eines primären Stadtspitals und tertiären Referenzzentrums aus.
KeywordsInteraction-screening program-Drug-drug interactions-Adverse drug reactions-Admissions-Medical departments
Wiener klinische Wochenschrift 04/2012; 122(3):81-88. · 0.81 Impact Factor
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ABSTRACT: The progressive clinical course with delayed neurological damage in carbon monoxide (CO) poisoning may be due to neuron apoptosis. The usefulness of hyperbaric oxygen (HBO) in different time periods after CO exposure in neuronal cell apoptosis reduction has not been evaluated thus far. The aim was to evaluate HBO efficacy in reducing neuronal apoptosis in different time periods after CO exposure.
Wistar rats were exposed to 3000 ppm CO in air for 60 min and 100% oxygen at a pressure of three bar for 30 min 0-12 h after CO exposure. The apoptosis was evaluated by immunohistochemical analysis with antibodies against activated caspase-3 and the percentage of caspase-3 positive hippocampal ganglionic cells was reported.
It was shown that CO poisoning results in ganglionic cell apoptosis. The percentage of apoptotic cells in rats exposed to CO was the highest (32%), whereas the percentage of apoptotic cells in rats exposed to HBO 0 and 1 h after CO was similar with a lower percentage than rats exposed to CO. The percentage of apoptotic cells in rats exposed to HBO 3 and 5 h after CO was similar with a lower percentage than rats exposed to HBO 0 and 1 h after CO. The percentage of apoptotic cells in rats exposed to HBO 7-12 h after CO was similar with a higher percentage than rats exposed to HBO 5 h after CO.
HBO has a time-dependent protective effect on CO-induced neuron apoptosis with the highest efficiency at 3 and 5 h after CO poisoning.
Inhalation Toxicology 10/2010; 22(12):1026-31. · 1.92 Impact Factor
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ABSTRACT: Adverse drug reactions due to drug-drug interactions (DDIs) are important in drug safety. The aim of this study was to check potential DDIs (pDDIs) on hospital admission and discharge and to evaluate admissions due to DDIs in medical departments of a primary city and tertiary referral hospital.
Age, sex, presence of renal and liver failure, drug information, diagnosis, and urgency and reason for admission were retrospectively recorded in 520 randomly selected patients in medical departments of the University Medical Center Ljubljana. The screening program Drug-Reax was used to check for pDDIs in patients with drug information on both admission and discharge home, and the proportion of patients admitted as the consequence of a DDI was estimated.
Overall, 14.6% (76/520) of patients had incomplete information on drug names in their medical documentation on admission; at the end of treatment 12.5% (52/416) of patients were discharged home with incomplete information on drug names in their discharge letters. A total of 323 patients had complete information on drug names on both admission and discharge and were included in the analysis of pDDIs: 51% (166/323) of patients on admission and 63% (204/323) on discharge had at least one pDDI (P = 0.001). Major pDDIs were found in 13% (41/323) of patients on admission and 18% (59/323) on discharge (P = 0.001). An ACE inhibitor combined with spironolactone was the most common major pDDI, representing 20.0% of all pDDIs on admission and 25.6% on discharge. Among patients with pDDI on admission, 2.4% (4/166) of were admitted because of an ADR caused by a DDI. Overall, 1.2% (4/323) of patients were admitted as the consequence of a DDI.
The information on patient medication on hospital admission and discharge is incomplete. Half of patients on admission and almost two-thirds on discharge had pDDIs. ADRs due to DDIs caused 1.2% of admissions to medical departments in Ljubljana's primary city and tertiary referral hospital.
Wiener klinische Wochenschrift 02/2010; 122(3-4):81-8. · 0.81 Impact Factor
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ABSTRACT: Adverse Drug Reactions (ADRs) have been regarded as a major public health problem since they represent a sizable percentage of admissions. Unfortunately, there is a wide variation of ADR related admissions among different studies. The aim of this study was to evaluate the frequency of ADR related admissions and its dependency on reporting and method of detection, urgency of admissions and included medical departments reflecting department/hospital type within one study.
The study team of internal medicine specialists retrospectively reviewed 520 randomly selected medical records (3%) of patients treated in the medical departments of the primary city and tertiary referral governmental hospital for certain ADRs causing admissions regarding WHO causality criteria. All medical records were checked for whether the treating physicians recognised and documented ADRs causing admissions. The hospital information system was checked to ensure ADR related diagnoses were properly coded and the database of a national spontaneous reporting system was searched for patients with ADRs included in this study.
The established frequency of admissions due to certain ADRs recognised by the study team and documented in medical records by the treating physicians was the same and represented 5.8% of all patients (30/520). The frequency of ADR causing admissions detected by employing a computer-assisted approach using an ICD-10 coding system was 0.2% (1/520), and no patient admitted due to ADRs was reported to the national reporting system (0/520). The recognized frequency of ADR related admissions also depends on the department's specialty (p = 0.001) and acceptance of urgently admitted patients (p = 0.001). Patients admitted due to ADRs were significantly older compared to patients without ADRs (p = 0.025). Gastrointestinal bleeding due to NSAID, acetylsalicylic acid and warfarin was the most common ADR that resulted in admission and represented 40% of all certain ADRs (12/30) according to WHO causality criteria.
ADRs cause 5.8% of admissions in medical departments in the primary city and tertiary referral hospital. The physicians recognise certain ADR related admissions according to WHO causality criteria and note them in medical records, but they rarely code and report ADRs. The established frequency of ADR related admissions depends on the detection method, department specialty and frequency of urgently admitted patients.
BMC Clinical Pharmacology 02/2009; 9:8. · 1.36 Impact Factor
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ABSTRACT: Acute ethanol ingestion can prolong the PR interval, but searching Medline, we have found only one report of Wenckebach-type atrioventricular block in ethanol poisoning. We present a high-degree atrioventricular block in an ethanol-poisoned patient.
A 17-year-old woman with a non-contributory medical history ingested 3dcl of vodka and was found comatose. On arrival she was somnolent with nausea, tympanic temperature 36.0 degrees C, pulse 70 counts/min, blood pressure 90/60 mmHg, respiratory rate 12 counts/min and SpO(2) 96% on room air. Her blood ethanol level was 130 mg/dL; other blood laboratory test results were normal. ECG revealed sinus rhythm, first-degree atrioventricular block with a PR interval of 0.32 seconds and intermittent second- and third-degree atrioventricular blocks with up to 4-second-long pauses that appeared 15-30 seconds after each vomiting. She was given thiethylperazine and vomiting resolved within an hour. ECG 12 hours after admission revealed a first-degree atrioventricular block with a PR interval of 0.24 seconds. One month later Holter monitor showed a sinus rhythm and first-degree atrioventricular block with a PR interval of 0.21 seconds. Vagal maneuvers did not provoke high-degree atrioventricular block. The echocardiogram was normal.
Acute ethanol poisoning has the potential to prolong the PR interval in adults with first-degree atrioventricular block and provoke intermittent second- and third-degree atrioventricular blocks, possibly by its direct inhibitory action on the conduction system and increasing parasympathetic tone due to nausea and vomiting.
Cases Journal 01/2009; 2:8559.
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ABSTRACT: Prometryn is a triazine herbicide, which is one of the most extensively used groups of herbicides. The mechanism of acute triazine herbicide toxicity in humans is not known. We report a first case of acute prometryn poisoning.
A 62-year-old male ingested 50 g of prometryn and ethanol in a suicide attempt. On arrival two hours after ingestion, he was somnolent and vomited. Seven hours after ingestion laboratory tests showed metabolic acidosis with a calculated anion gap of 47.5 mmol/L and lactate of 23.4 mmol/L. Gas chromatography/mass spectrometry revealed serum prometryn concentrations of 48.1 mg/L. Hemodialysis corrected metabolic acidosis, but the serum prometryn concentration increased to 67.7 mg/L. The lactate level after hemodialysis was 11.7 mmol/L and returned within normal limits 47 hours after ingestion. The patient was discharged without any sequelae after psychiatric evaluation.
In high anion gap metabolic acidosis we should consider poisoning with prometryn and other triazine herbicides. Hemodialysis corrects metabolic derangements, but it does not lower serum prometryn concentration.
Clinical Toxicology 04/2008; 46(3):270-3. · 2.22 Impact Factor
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ABSTRACT: Baclofen is a centrally acting gamma-aminobutyric acid agonist used for spasticity of spinal origin and mainly excreted unchanged by the kidneys. We report haemodialysis clearance and the haemodialysis removal rate constant of baclofen in a comatose patient with baclofen overdose due to acute renal failure.
A 60-year-old man with spastic tetraplegia on chronic baclofen therapy was admitted due to pneumonia and acute renal failure. The patient became comatose and, as a result of the baclofen dosage being left unchanged despite a deterioration leading to renal failure due to hypotension, the concentration of baclofen was determined to be in the toxic range (0.70 mg/L). During a 4-hour-long bicarbonate haemodialysis the patient woke up and became completely orientated and cooperative. Baclofen therapy was subsequently stopped, and the patient remained conscious. The pharmacokinetics calculations revealed a baclofen haemodialysis removal rate constant of 0.152 h(-1) and a haemodialysis clearance of 2.14 mL/s.
Patients on a stable baclofen regime can develop baclofen toxicity due to acute renal failure. Haemodialysis removes baclofen as effectively as normal kidneys, and it would appear that haemodialysis is a reasonable treatment modality in patients with accidental baclofen overdose due to acute renal failure.
European Journal of Clinical Pharmacology 01/2008; 63(12):1143-6. · 2.85 Impact Factor
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ABSTRACT: Intraarticular injection of metallic mercury (Hg) such as those found in thermometers is very rare. According to available data in literature, an arthroscopic presentation and treatment of knee injury that had intraarticular elementary mercury seems not to have been published yet.
We report a first case of arthroscopically treated chronic right knee synovitis after accidental intraarticular mercury infusion by a broken thermometer in an 11-year-old boy.
Mercury levels in blood and urine were slightly increased, but no systemic mercury intoxication developed. Inflamed synovia as well as synovia with incorporated metal particles was excised. A histological analysis of macroscopically inflamed synovia revealed an unspecific inflammation reaction. The symptoms gradually subsided and the knee regained full function. However, all the metal particles were not successfully removed from the injured knee; therefore a careful follow-up of the patient was provided.
It seems that arthroscopic excision and lavage could be suitable treatments for knee injury, infused with elementary mercury, and toxic knee synovitis.
Archives of Orthopaedic and Trauma Surgery 12/2007; 128(9):979-83. · 1.37 Impact Factor
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Critical care (London, England) 02/2007; 11(3):415. · 4.61 Impact Factor
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ABSTRACT: To evaluate S100B, an astroglial structural protein, during normobaric and hyperbaric oxygen therapy of conscious carbon monoxide (CO)-poisoned rats. So far, the usefulness of hyperbaric oxygen therapy in conscious CO-poisoned patients has been shown with neuropsychological testing. The S100B protein has been demonstrated as a possible biochemical marker and prognostic parameter in CO-poisoned rats.
Randomized, controlled interventional trial.
University laboratory.
: Male Wistar rats weighing 254 +/- 14 g.
The rats were exposed to a mixture of 3,000 ppm CO in air for 60 mins. After CO exposure, the first group of eight conscious rats was exposed to ambient air for 30 mins, the second group of six conscious rats was exposed to 100% normobaric oxygen for 30 mins, and the third group of six conscious rats was exposed to 100% hyperbaric oxygen at 3 bars for 30 mins. Blood samples were taken from the jugular vein just before CO exposure and immediately after oxygen therapy. The level of consciousness was evaluated at the end of exposure, and the survival rate was monitored for 14 days. The S100B concentrations were measured with a commercial immunoluminometric assay.
Analyses of differences in S100B levels between different kinds of therapy before and after treatment showed a global significant difference (p = .002). The post hoc test results showed that S100B levels after therapy of the first group treated with ambient air (0.16 +/- 0.07 microg/L) and the second group treated with normobaric oxygen (0.19 +/- 0.05 microg/L) were similar (p = .741), and both of them were significantly different, with much higher values of S100B levels after therapy, from the third group treated with hyperbaric oxygen (0.06 +/- 0.03 microg/L; p = .018 and p = .002, respectively). All the rats survived.
S100B is elevated in conscious CO-poisoned rats left on ambient air or treated with normobaric oxygen, but not in conscious CO-poisoned rats treated with hyperbaric oxygen.
Critical Care Medicine 09/2006; 34(8):2228-30. · 6.33 Impact Factor
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ABSTRACT: In CO-poisoned patients without loss of consciousness no significant long-term functional differences in outcome have been shown in any hyperbaric versus normobaric oxygen studies. Since brain histology changes cannot be studied in CO-poisoned patients we evaluated the efficacy of normobaric and hyperbaric oxygen therapy in preventing brain cell injury in CO-poisoned animals without loss of consciousness. Wistar rats without loss of consciousness after exposure to 3000ppm of CO for 60min were exposed to ambient air (group 1), 100% oxygen at a pressure of 1bar (group 2) and 100% oxygen at a pressure of 3bar (group 3). The rats were sacrificed after two weeks, brain samples were stained with hematoxylin-eosin and a percentage of pyknotic cells in hippocampus was reported. Analyses of differences in percentage of pyknotic cells between different kinds of therapy showed that the percentage of pyknotic cells of the second group (2.3+/-1.2%) treated with normobaric oxygen and the third group (4.5+/-4.0%) treated with hyperbaric oxygen were similar, and both of them were significantly different, with a much lower percentage of pyknotic cells, from the first group left on ambient air (47.7+/-10.0%). In conclusion, immediate normobaric and hyperbaric oxygen therapy equally prevents hippocampal cell injury in CO-poisoned rats without loss of consciousness.
Toxicology 09/2006; 225(2-3):138-41. · 3.68 Impact Factor
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ABSTRACT: Amanita muscaria has a bright red or orange cap covered with small white plaques. It contains the isoxazole derivatives ibotenic acid, muscimol and muscazone and other toxins such as muscarine. The duration of clinical manifestations after A. muscaria ingestion does not usually exceed 24 hours; we report on a 5-day paranoid psychosis after A. muscaria ingestion. A 48-year-old man, with no previous medical history, gathered and ate mushrooms he presumed to be A. caesarea. Half an hour later he started to vomit and fell asleep. He was found comatose having a seizure-like episode. On admission four hours after ingestion he was comatose, but the remaining physical and neurological examinations were unremarkable. Creatine kinase was 8.33 microkat/l. Other laboratory results and brain CT scan were normal. Toxicology analysis did not find any drugs in his blood or urine. The mycologist identified A. muscaria among the remaining mushrooms. The patient was given activated charcoal. Ten hours after ingestion, he awoke and was completely orientated; 18 hours after ingestion his condition deteriorated again and he became confused and uncooperative. Afterwards paranoid psychosis with visual and auditory hallucinations appeared and persisted for five days. On the sixth day all symptoms of psychosis gradually disappeared. One year later he is not undergoing any therapy and has no symptoms of psychiatric disease. We conclude that paranoid psychosis with visual and auditory hallucinations can appear 18 hours after ingestion of A. muscaria and can last for up to five days.
Wiener klinische Wochenschrift 06/2006; 118(9-10):294-7. · 0.81 Impact Factor
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ABSTRACT: Insulin lispro has a more rapid onset and a shorter duration of hypoglycaemic action than regular insulin. We report a 39-year-old woman, with no previous medical history, who injected 300 U of the insulin lispro (Humalog) in an attempted suicide. Half an hour later, she was found comatose and brought to our emergency department. On arrival, she was comatose, with capillary glucose of 0.4 mmol/L. She awoke after a 50 ml intravenous bolus of 50% glucose. A continuous infusion of 10% glucose was started. Intermittent hypoglycaemia with neurological signs requiring treatment with 50% glucose was recorded three times during subsequent hospitalization, the last episode being 11 h after insulin injection. The plasma insulin level 4 h after injection was 1465 mU/L, and 18 h after injection was 11 mU/L. Hypoglycaemia after an insulin lispro overdose may last for more than 11 h. Repeated hypoglycaemia after an insulin overdose could be avoided with a glucose infusion rate equivalent to the maximal glucose disposal rate.
European Journal of Emergency Medicine 11/2005; 12(5):234-5. · 0.90 Impact Factor
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Clinical Toxicology 02/2005; 43(7):891-2. · 2.22 Impact Factor
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Clinical Toxicology 02/2005; 43(3):219-20. · 2.22 Impact Factor
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ABSTRACT: To assess the possible role of S100B, a structural protein of astroglial cells, as a biochemical marker in acute carbon monoxide-poisoned rats and to compare its prognostic value with consciousness level, which is one of the major parameters for treatment decision in acute carbon monoxide poisoning.
Nonrandomized, controlled interventional trial.
University laboratory.
Male Wistar rats weighing 263 +/- 18 g.
The rats were exposed to a mixture of 3000 ppm carbon monoxide in air for 60 mins (group 1) and a mixture of 5000 ppm carbon monoxide in air for 30 mins (group 2). Blood samples were taken from the jugular vein just before and immediately after the carbon monoxide poisoning. The level of consciousness was evaluated at the end of the exposure, and the survival rate was monitored for 7 days. The S100B concentrations were measured with a commercial immunoluminometric assay.
In the first group, the unconscious rats after carbon monoxide exposure had significantly higher S100B levels compared with the rats without loss of consciousness. In the second group, the unconscious rats that later died had significantly higher S100B levels compared with the unconscious rats that survived. The S100B levels of all conscious and unconscious surviving rats were not significantly different. The serum level of S100B below 0.44 microg/L predicted survival of carbon monoxide-poisoned rats, with a sensitivity of 100% and a specificity of 86%.
Acute carbon monoxide poisoning is associated with elevated S100B levels. S100B is a better predictor of final outcome than the consciousness level, so it could be used as a prognostic parameter for acute carbon monoxide poisoning in rats.
Critical Care Medicine 11/2004; 32(10):2128-30. · 6.33 Impact Factor
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ABSTRACT: Acute symptomatic hyponatremia after ecstasy (3,4 methyldioxymethamphetamine; MDMA) ingestion is well documented and has been attributed to the syndrome of inappropriate antidiuretic hormone (SIADH). We report the case of an 18-year-old woman who took five tablets of ecstasy in a suicide attempt and drank 1700 ml water at the Emergency Department (ED). The laboratory findings obtained 5 h after ingestion showed a serum sodium concentration of 130 mmol/l, plasma osmolality of 264 mOsm/kg, urinary osmolality of 335 mOsm/kg and natriuresis of 101 mmol/l. The plasma arginine vasopressin level by radioimmunoassay was 33.7 pmol/l 5 h after ingestion. A gas chromatography-mass spectrometry assay confirmed MDMA in blood samples, with serum concentrations of 0.87 mg/l on arrival. This case report strongly suggests that MDMA reduces serum sodium levels through the dual pathways of SIADH and polydipsia. Accordingly, we believe that hyponatremia may be prevented in ED patients after MDMA ingestion by the early restriction of water intake.
European Journal of Emergency Medicine 11/2004; 11(5):302-4. · 0.90 Impact Factor
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ABSTRACT: Carbon monoxide (CO) poisoning is the most common form of lethal poisoning. The aim of this prospective clinical study was to assess the possible role of S100B, the structural protein in the astroglia, as a biochemical marker of brain injury in carbon monoxide poisoning. Serum S100B determination was performed in 38 consecutive patients poisoned by carbon monoxide who were admitted to the Emergency Department (ED) in Ljubljana. All three unconscious patients had elevated S100B levels. The patient with the highest S100B died. S100B was elevated in two of the six patients with initial transitory unconsciousness at the scene. All 29 patients without loss of consciousness had normal S100B levels. Carbon monoxide poisoning appears to be associated with elevated S100B levels.
Resuscitation 07/2004; 61(3):357-60. · 3.60 Impact Factor
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ABSTRACT: Colchicum autumnale, commonly known as the autumn crocus or meadow saffron, contains the antimitotic colchicine, which binds to tubulin and prevents it forming microtubules that are part of the cytoskeleton in all cells.
A 71-year-old woman ate a plant she thought to be wild garlic (Allium ursinum). Ten hours later she arrived at the emergency department complaining of nausea, vomiting and watery diarrhea. Ingestion of a poisonous plant was suspected and she was treated with gastric lavage, oral activated charcoal and an infusion of normal saline. Toxicology analysis with gas chromatography and mass spectrometry revealed colchicine in the patient's gastric lavage, blood (5 microg/l) and urine (30 microg/l). She developed arrhythmias, liver failure, pancreatitis, ileus, and bone marrow suppression with pancytopenia. Alopecia began in the third week. Treatment was supportive only. Five months later she had no clinical or laboratory signs of poisoning.
The patient mistakenly ingested autumn crocus instead of wild garlic because of their great similarity. Colchicine primarily blocks mitosis in tissues with rapid cell turnover; this results in gastroenterocolitis in the first phase of colchicine poisoning, bone marrow hypoplasia with pancytopenia in the second and alopecia in the third, all of which were present in our patient. Colchicine toxicity in tissues without rapid cell turnover caused arrhythmias, acute liver failure and pancreatitis.
Colchicine poisoning can result in gastroenterocolitis followed by multi-organ dysfunction syndrome. In unexplained gastroenterocolitis after ingestion of wild plants as a salad or spice, especially when wild garlic is mentioned, we should always consider autumn crocus. Diagnosis could be confirmed only by toxicology analyses. Management of colchicine poisoning is restricted to supportive therapy.
Wiener klinische Wochenschrift 04/2004; 116(5-6):205-8. · 0.81 Impact Factor
