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ABSTRACT: We investigated two cases of hydrogen sulfide poisoning in which the patients showed lethal myocardial injury. Both patients had planned to commit suicide by inhaling hydrogen sulfide. In case 1, a 17-year-old man was confused and was brought to our hospital by ambulance. An electrocardiogram (ECG) revealed diffuse elevation of the ST segment on the second hospital day. The patient recovered and was discharged from the hospital on the 15th day. However, he died suddenly on the 18th day. In case 2, a 21-year-old man was found lying on the floor and was admitted to our hospital. ECG showed tall T waves after 5 hr. Tachycardia and tachypnea occurred after 12 hr. After 16 hr, the ECG showed a marked elevation of the ST segment, and the patient developed cardiac arrest. Even though percutaneous cardiopulmonary support was used, he died on the 4th day. It is highly probable that myocardial injury asscociated with hydrogen sulfide poisoning was not caused by systemic hypoxia but by selective myocardial toxicity. These cases demonstrate that delayed presentation of a lethal myocardial injury should be considered while treating cases of hydrogen sulfide poisoning.
Chūdoku kenkyū: Chūdoku Kenkyūkai jun kikanshi = The Japanese journal of toxicology 09/2011; 24(3):231-5.
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ABSTRACT: Blunt gastric injury (BGI) is a rare condition that accounts for 0.02%-1.7% of all blunt abdominal trauma cases. Blunt gastric rupture, which occurs in less than 40% of all BGI cases, presents unstable vital signs and symptoms of peritonitis due to massive peritoneal contamination. This article presents the case of a patient with BGI who did not present with symptoms of peritonitis in spite of presenting with persistent hypovolemic shock.
Surgery Today 10/2010; 40(10):963-6. · 1.22 Impact Factor
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ABSTRACT: We report two cases of methanol poisoning and evaluate the kinetics of methanol, ethanol, and formate. The first case was a 48-year-old man (case 1). His initial methanol level was 56.4 mg/dL and serum ethanol level was 2.4 mg/dL. Serum formate was not detected, and ethanol administration was initiated. However, methanol was eliminated slowly, and serum formate increased. His methanol and formate levels decreased rapidly following hemodialysis. He was discharged without any sequelae. The second case was a 35-year-old man (case 2). His serum methanol level was 400 mg/dL, and serum ethanol was not detected. His serum formate level was 13.4 mg/dL, and ethanol and activated folate were administered. He underwent hemodialysis immediately after diagnosis. Methanol and formate decreased rapidly, and he was discharged without any sequelae. Methanol and formate are eliminated slowly if ethanol is administered alone. We suggest that hemodialysis should be considered immediately after ethanol administration.
Chūdoku kenkyū: Chūdoku Kenkyūkai jun kikanshi = The Japanese journal of toxicology 09/2010; 23(3):232-7.
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ABSTRACT: The symptoms of acute poisoning caused by ingestion of bialaphos (BIAL), an ingredient of herbicide, are supposed to be due to the L-glufosinate (L-GLUF), which is formed by the degradation of bialaphos. To elucidate the pharmacokinetics of BIAL and L-GLUF, we attempted a simultaneous analysis of BIAL and L-GLUF in biological samples by exploiting a reversed phase HPLC method. The derivatization reaction of BIAL and L-GLUF using (+) -1- (9-fluorenyl) ethyl chloroformate was completed in 30 min at 40 degrees C and both derivatives were stable for 48 hr at 25 degrees C. A fluorescence detector were used for HPLC; the exicitation wavelength was set at 265 nm and the emission wavelength at 315 nm. Respective calibration curves prepared by adding BIAL and L-GLUF to serum were linear within ranges of 0.01-10.0 and 0.005-10.0 microg/mL in derivatived liquid samples for introducing into HPLC. The lower limits of detection for BIAL and L-GLUF were 0.005 and 0.001 microg/mL, respectively. An 83-year old male who ingested approximately 350 mL of Herby Liquid, a herbicide containing 18% BIAL and 82% surfactant, in an attempt to commit suicide developed delayed respiratory depression and seizures. L-GLUF was detected in the serum of the patient 2.7 hr after ingestion, but BIAL was not. The change in serum L-GLUF concentration measured over time was consistent with a 2-compartment model, with a distribution half-life of 1.70 hr and an elimination half-life of 6.03 hr.
Chūdoku kenkyū: Chūdoku Kenkyūkai jun kikanshi = The Japanese journal of toxicology 07/2009; 22(2):113-20.
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ABSTRACT: We report two cases of a rapidly progressive fatal overwhelming pneumococcal infection. Patient 1 was a 67-year-old man with a 24-h history of fever and malaise and was transferred to our department. He was severely ill, tachypneic, and felt a chill. A purpuric discoloration with ecchymosis of the skin was noted over the body. The chest X-ray findings demonstrated thickening of the bronchovascular bundle in the right lower lung field, which later revealed the presence of bronchopneumonia. Laboratory studies revealed the presence of metabolic acidosis and disseminated intravascular coagulation. After presentation, rapid deterioration occurred followed by cardiopulmonary arrest. Despite cardiopulmonary resuscitation, the patient died only 3 h after presentation. The isolates from the patient's blood revealed penicillin-susceptible Streptococcus pneumoniae, serotype 4. Patient 2 was a 30-year-old woman with a prior history of uneventful pregnancies was transferred to our department with a 2-day history of fever, nausea, headache, and malaise. Although she was in the 19th week of pregnancy at the time, she suffered a miscarriage just prior to admission. Upon presentation to our department, she demonstrated unstable vital signs, diminished consciousness, anuria, and icterus. Purpuric discoloration with ecchymosis of the skin was noted in over most of her body, including the distal extremities. The chest X-ray findings were close to normal. Initial laboratory studies revealed the presence of severe metabolic acidosis and disseminated intravascular coagulation with multiple organ failure. Despite aggressive cardiopulmonary support, normal neurological responses disappeared on the 2nd day following admission and the patient died on the 16th day after admission. The patient's isolates from blood and vaginal swabs both later revealed penicillin-susceptible Streptococcus pneumoniae, serotype 12F. The presentation of rapidly progressive septic shock should raise the treating physician's suspicion of overwhelming pneumococcal infection, which has limited management options.
Journal of Infection and Chemotherapy 11/2007; 13(5):346-9. · 1.80 Impact Factor
