Florian Eyer

• MD
• Head of Department at Technical University of Munich

Over the past decade, quetiapine has become one of the most commonly used psychotropic drugs in acute intoxication events worldwide. A structured literature review and analysis were conducted to assess the relationship between the kinetic and dynamic profiles in acute quetiapine intoxication. The correlation between dose and peak serum concentratio...

Objective: To independently validate the negative predictive value of the Tanta University risk model for intensive care requirements in poison center telephone consultations with other physicians. Methods: This study included 400 consecutive patients with acute poisoning. Clinical and laboratory parameters were recorded during the initial consu...

Background A 53-year-old male with no pre-existing conditions and no permanent medication presented to our emergency department with an anticholinergic syndrome including confusion, anxiety, ataxia and dysarthria after ingestion of a homeopathic solution containing Atropa belladonna extract supposedly in a D4 dilution. Methods Atropine sulphate wa...

Organophosphorus (OP) nerve agents represent a class of highly toxic chemical warfare agents banned by the Chemical Weapons Convention. Nevertheless, in the past few years they have been used repeatedly for warfare, assassination and attempted murder. In addition, the chemically related OP pesticides were frequently used for suicide and may be depl...

Background A 22-year-old male with a known history of drug abuse presented to our department with prolonged agitated delirium, myocloni, tachycardia and subfebrile temperature after the deliberate ingestion of opium poppy tea ( Papaver somniferum L.) together with the methaqualone analog SL-164 (5-chloro-3-(4-chloro-2-methylphenyl)-2-methyl-4( 3H)-...

Objective To analyse the relative percentage of acute recreational drug toxicity emergency department (ED) presentations involving the main drug groups according to age and sex and investigate different patterns based on sex and age strata. Methods We analysed all patients with acute recreational drug toxicity included by the Euro-DEN Plus dataset...

Der vorliegende Fall zeigt die erfolgreiche Behandlung eines 31-jährigen Patienten nach Ingestionstrauma mit ABC-Löschpulver. Die Intoxikation wurde zunächst, auch nach Rücksprache mit verschiedenen Giftinformationszentralen, als harmlos eingestuft. Jedoch entwickelte sich durch die Aufnahme von großen Mengen von ammoniumsulfat- und ammoniumdihydro...

Ein Massenanfall von Verletzten (MANV) stellt eine besondere Herausforderung für alle Beteiligten dar. Während in der Präklinik Konzepte wie z. B. mSTaRT bereits fest etabliert sind, besteht im klinischen Bereich ein deutlicher Aufholbedarf. Besonders außergewöhnliche Schadenslagen wie Terrorangriffe oder Amokläufe mit zivilen Opfern erfordern gezi...

Life-threatening mushroom poisoning is rare in Germany. The diagnosis of mushroom poisoning is based on three criteria: identification of the mushroom ingested, the latency time between ingestion and onset of symptoms and finally, confirmation by clinical laboratory investigations. In the early stages a clinical differentiation between harmless and...

Background: Cardiac Index (CI) is a key-parameter of hemodynamic monitoring. Indicator-dilution is considered as gold standard and can be obtained by pulmonary arterial catheter or transpulmonary thermodilution (TPTD; CItd). Furthermore, CI can be estimated by Pulse-Contour-Analysis (PCA) using arterial wave-form analysis (CIpc). Obviously, adjust...

A 21 year old MSM patient with newly diagnosed HIV infection was hospitalized in our department after ingestion of an overdose of his antiretroviral therapy (ART) comprising dolutegravir (DTG - Tivicay®) and tenofovir disaproxil fumarate/emtricitabine (Truvada®) in suicidal intention. On admission, the patient did not show any clinical signs of int...

Therapiebedürftige Schlangenbisse (Vergiftungen mit Schlangengift) sind im europäischen Raum selten. Aufgrund privater Schlangenhaltung kommen jedoch auch Vergiftungen durch exotische Schlangen vor. Die Hauptgiftwirkung erklärt sich durch den jeweiligen Beißapparat des Tieres. Die heimischen Giftschlangen (Viperidae) zeichnen sich durch eine lokale...

Time savings and clinical accuracy of a new miniature ultrasound device was investigated utilizing comparison with conventional high-end ultrasound instruments. Our objective was to determine appropriate usage and limitations of this diagnostic tool in internal medicine. We investigated 28 patients from the internal-medicine department. Patients we...

Therapiebedürftige Schlangenbisse (Vergiftungen mit Schlangengift) sind im europäischen Raum selten. Aufgrund privater Schlangenhaltungkommen jedoch auch Vergiftungen durch exotische Schlangen vor. Die Hauptgiftwirkung erklärt sich durch den jeweiligen Beißapparat des Tieres. Die heimischen Giftschlangen (Viperidae) zeichnen sich durch eine lokale...

Therapiebedürftige Schlangenbisse (Vergiftungen mit Schlangengift) sind im europäischen Raum selten. Aufgrund privater Schlangenhaltung kommen jedoch auch Vergiftungen durch exotische Schlangen vor. Die Hauptgiftwirkung erklärt sich durch den jeweiligen Beißapparat des Tieres. Die heimischen Giftschlangen (Viperidae) zeichnen sich durch eine lokale...

OriginalpublikationBateman DN, Thanacoody HK, Thomas SH et al (2014) Reduction of adverse effects from intravenous acetylcysteine treatment for paracetamol poisoning: a randomized controlled trial. Lancet 383:697–704HintergrundVergiftungen mit Paracetamol (Acetaminophen, AAP) sind häufig und die führende Ursache für ein akutes Leberversagen in Euro...

/st>Radial artery applanation tonometry technology can be used for continuous non-invasive measurement of arterial pressure (AP). The purpose of this study was to evaluate this AP monitoring technology in intensive care unit (ICU) patients in comparison with invasive AP monitoring using a radial arterial catheter. /st>In 24 ICU patients (German uni...

Ein Massenanfall von Verletzten stellt sowohl eine große materielle als auch personelle Herausforderung an den jeweilig betroffenen Rettungsdienstbereich dar. Durch eine mögliche vorherrschende ABC-Lage wird das ohnehin nicht alltägliche Einsatzgeschehen weiter erschwert. Umso wichtiger ist es somit, dass ein Triage-Algorithmus auch diesen Fall in...

Organophosphate (OP) poisoning is still associated with high morbidity and mortality rates, both in resource-poor settings and in well-developed countries. Despite numerous publications dealing with this particular poison, detailed clinical data on more severe overdoses with these agents are relatively sparsely reported. A retrospective study was c...

Background The T-Line TL-200pro (TL-200pro) device (Tensys Medical, Inc., San Diego, CA, USA), based on radial artery tonometry, provides an arterial pressure (AP) waveform and beat-to-beat values of systolic arterial pressure (SAP), mean arterial pressure (MAP), and diastolic arterial pressure (DAP). The aim of the study was to evaluate this non-i...

"Medically unexplained symptoms" in patients with suspected allergies: The role of psychiatric comorbidity and patient-doctor-interaction Background: We aimed to describe characteristics of the patient-doctor-interaction in patients with "medically unexplained symptoms (MUS)" attributed to allergies. Methods: 204 patients hospitalized for an allerg...

Hintergrund Alkohol- und Drogenvergiftungen sind häufige Alarmierungsgründe im Notarzt- und Rettungsdienst. Alkoholintoxikation Dabei führt der exzessive Konsum von Koffein und Alkohol enthaltenden Mischgetränken insbesondere in der Adoleszenz zunehmend zu Vorstellungen in Notaufnahmen. Vergiftungen mit toxischen Alkoholen wie Methanol oder Ethylen...

Lipocalins tailored with high affinity for prescribed ligands, so-called anticalins, constitute promising candidates as antidotes. Here, we present an animal study to investigate both pharmacokinetic and clinical effects of an anticalin specific for the digitalis compound digoxin. Intravenous digoxin (2.5-50 μg/kg/min) was administered to rats unti...

Purpose: The aim of this study was to evaluate continuous vancomycin infusion (contV) in intensive care unit patients. Materials and methods: A retrospective study in 164 patients treated with contV was conducted. They were compared with 75 patients treated with intermittent vancomycin infusion. Results: The median duration of vancomycin thera...

Purpose: The purpose of this study was to evaluate prediction factors for extubation failure (need for reintubation within 48 hours) in medical intensive care unit patients. Materials and methods: Sixty-one patients extubated after mechanical ventilation for more than 48 hours were included in the study. A retrospective analysis of medical recor...

The purpose of this study was to investigate characteristics of critically ill patients with Stenotrophomonas maltophilia (S. maltophilia) isolated from the respiratory tract, to identify risk factors for S. maltophilia-pneumonia and intensive care unit (ICU) mortality and to analyze antibiotic susceptibility of S. maltophilia. This was a retrospec...

Detailed data on severe overdoses with quetiapine are relatively sparsely reported in the literature. To describe a cohort of 20 acute quetiapine overdoses and provide additional data on the pharmacokinetics and clinical features of intoxication with this drug. A retrospective study was conducted on patients with quetiapine poisoning admitted to ou...

Although the importance of atropine in therapy of organophosphate (OP) poisoning is generally recognized, its dosing is a matter of debate. A retrospective analysis of atropine dosing was undertaken in 34 patients who had been enrolled in a clinical study assessing obidoxime effectiveness in OP-poisoning. All patients were severely intoxicated (sui...

To develop a prediction model for withdrawal seizures (WS) and delirium tremens (DT) during moderate to severe alcohol withdrawal syndrome (AWS) in a large cohort of inpatients treated for AWS (n = 827). Re-analysis of a cohort study population treated between 2000 and 2009. All patients received a score-guided and symptom-triggered therapy for AWS...

In approximately 20% of patients with suspected allergies, no organic symptom explanation can be found. Limited knowledge about patients with "medically unexplained symptoms (MUS)" contributes to them being perceived as "difficult" and being treated inadequately. This study examined the psychobehavioural characteristics of patients presenting for a...

To compare the clinical course, incidence of withdrawal seizures (WS) or delirium tremens (DT) and side effects during treatment of alcohol withdrawal in patients treated with either carbamazepine (CBZ) or valproate (VPA) as an adjunct to clomethiazole and clonidine therapy. Retrospective analysis of charts of two cohorts of inpatients treated duri...

S-hyoscyamine (S-hyo) is a toxic tropane alkaloid from plants of the solanacea family, which is extracted for pharmaceutical purposes thereby undergoing racemization (atropine). Merely the S-hyo enantiomer acts as an antagonist of muscarinic receptors (MR). Nevertheless, racemic atropine is clinically administered in e.g. ophthalmology and for symp...

Dysfunction of respiratory muscles is a life-threatening complication in poisoning by organophosphorus compounds (OPs). It is both of central and peripheral origin due to impaired cholinergic signalling upon inhibition of acetylcholinesterase (AChE). The dysfunction at neuromuscular synapses is not amenable to anticholinergics and remains a therape...

Reactivation of inhibited acetylcholinesterase (AChE) with oximes is a causal therapy of intoxication with organophosphorus compounds (OPs). Maximal oxime effects are expected when effective doses are administered as soon as possible and as long as reactivation can be anticipated. An obidoxime plasma level in the range of 10-20 microM was estimated...

Psychobehavioral characteristics of patients with somatoform disorders (SFDs), are increasingly discussed as possible positive criteria for this diagnostic group. However, little is known about psychobehavioral differences, or similarities, between the different SFD presentations, i.e., polysymptomatic [multisomatoform/somatization disorders (MSD)]...

This analysis aimed to study predictors of different treatment outcomes and associations between subjective symptoms, psychometric variables and mercury levels in patients who subjectively attributed their health problems to dental amalgam. A secondary and retrospective analysis of data of a recently published randomized clinical trial was performe...

Anamnese und klinischer Befund: 17 osteuropäische Arbeiter wurden mit Verdacht auf Bleivergiftungen in der toxikologischen Abteilung vorgestellt. Alle Arbeiter restaurierten an einer Baustelle die Masten von Hochspannungsleitungen. Hierfür wurde die bleihaltige Beschichtung mit Nadelpistolen entfernt. Bei den vorgestellten Patienten waren Bleikonze...

Seventeen East-European workers with a suspected lead-intoxication presented themselves to the Department of Toxicology. All of them had worked on the renovation of pylons of a high-tension line. The old paint, known to contain lead was removed with needle descalers. The patients had blood lead concentrations between 325 and 1124 microg/l, but no s...

A woman ingested 10 mg of methyldigoxin in a suicide attempt and presented 19 hours after ingestion with clinical signs of glycoside intoxication. Her serum level of digoxin was 7.4 ng/mL, and antidotal therapy with Fab antibody fragments was started. The manufacturer's recommended dosing scheme was modified, with 80 mg Fab administered intravenous...

The effects of obidoxime in the treatment of organophosphate poisoning were assessed by comparing the clinical course with its effects on laboratory parameters relevant to poisoning. In this article we report clinical findings and activity of cholinesterase in plasma and acetylcholinesterase (AChE) in red blood cells. In a linked paper we describe...

The effects of obidoxime in the treatment of organophosphate poisoning were assessed by biochemical and biological effect monitoring. In this article we report effects on neuromuscular function, oxime and atropine concentration, and relate them to acetylcholinesterase (AChE) activity. We measured the activity of cholinesterase in plasma and AChE in...

Thirty-four adult patients with severe organophosphorus compounds (OP) poisoning requiring artificial ventilation were enrolled in a clinical study and received atropine and obidoxime (250 mg i.v., followed by 750 mg/24 h) as antidotal treatment. Here, we re-analyzed the cholinesterase status (red blood cell acetylcholinesterase (RBC-AChE) activity...

Ingestion of toxic plant constituents still poses a challenge in clinical management. The amount of berries ingested is often unclear and in the case of Atropa belladonna may affect clinical outcome. Plasma levels of atropine may thus be useful in confirming the cause of intoxication. A 48-year-old man had ingested three handfuls of Atropa belladon...

To explore a combination of health-related psychobehavioral features as potential positive criteria for somatoform disorders (SFD). Currently, SFD can only be diagnosed in the absence of sufficient organic symptom explanation, resulting in low criterion validity and delay of appropriate therapy. Cross sectionally, we studied various psychobehaviora...

Prognostic factors for severe complications in tricyclic antidepressant (TCA) overdose remain unclear. We therefore evaluated the value of clinical characteristics and electrocardiograph (ECG) parameters to predict serious events (seizures, arrhythmia, death) in severe TCA overdose of 100 patients using logistic regression models for risk assessmen...

Caustic injuries of the eye usually occur accidentally and can result in minor eye irritations to total loss of vision. All chemical exposures to the eye require immediate decontamination by copious irrigation with an aqueous solution for at least 15-30 minutes up to two hours in single cases of massive exposure. Tap water is readily available, saf...

The widespread use of organophosphorus compounds (OPs) as pesticides and the frequent misuse of OP nerve agents in military conflicts or terrorist attacks emphasize the high clinical relevance of OP poisoning. The toxic symptomatology is caused by inhibition of acetylcholinesterase (AChE). A mainstay of standard antidotal treatment is atropine for...

Chlorpyrifos (CPF) is a pesticide that causes tens of thousands of deaths per year worldwide. Chlorpyrifos oxon (CPO) is the active metabolite of CPF that inhibits acetylcholinesterase. However, this presumed metabolite has escaped detection in human samples by conventional methods (HPLC, GC-MS, LC-MS) until now. A recently developed enzyme-based a...

Mushrooms of the Cortinarius species are nephrotoxic and can cause severe acute renal failure. The toxic effect is due to orellanine. It is suspected that the cytotoxic damage is caused by the production of oxygen-free radicals. Renal pathology shows tubular necrosis with interstitial nephritis. In addition to accidental intoxications as a conseque...

Sulfur mustard (SM) is a strong vesicant agent which has been used in several military conflicts. Large stockpiles still exist to the present day. SM is believed to be a major threat to civilian populations because of the persistent asymmetric threat by non-state actors, such as terrorist groups, its easy synthesis and handling and the risk of thef...

Caustic injuries of the eye usually occur accidentally and can result in minor eye irritations to total loss of vision. All chemical exposures to the eye require immediate decontamination by copious irrigation with an aqueous solution for at least 15 - 30 minutes up to two hours in single cases of massive exposure. Tap water is readily available, s...

Phenytoin is a widely used anticonvulsant agent responsible for a number of intentional and unintentional overdoses. However, besides supportive care, specific treatment recommendations to enhance elimination of the parent compound have been discussed controversially and effectiveness of hemoperfusion is under debate. A women with a prehistory of c...

Current treatment of amatoxin poisoning includes the administration of silibinin and penicillin in combination or silibinin alone. The aim of this study was to compare both therapeutic regimes. Of 604 patients with the suspected diagnosis of amatoxin poisoning 367 were retrospectively analysed: 118 patients had received silibinin alone and 249 pati...

Hintergrund und Fragestellung: Das aktuelle Konzept der Pharmakotherapie der Knollenblätterpilzvergiftung besteht in der Silibinin-Monotherapie oder in der Kombination von Silibinin und Penicillin. In der vorliegenden Studie wurden die beiden Schemata verglichen. Patienten und Methodik: Von 604 Patienten mit der Verdachtsdiagnose einer Knollenblätt...

Chlorpyrifos oxon (CPO) is the active metabolite of the pesticide chlorpyrifos that inhibits cholinesterases at high reaction rates. Chlorpyrifos is of major concern because it causes some ten thousand fatalities each year, mostly due to suicidal attempts. Notwithstanding, toxicokinetic studies on chlorpyrifos in humans are scarce and CPO has not b...

Unusual suicide attempts often remain undetected, and bizarre methods can be a clue to psychotic origin. We report a suicide attempt by proxy--the bite of a puff adder--and provide a brief literature survey about further archaic self-injurious behaviour. Due to the easy availability of venomous snakes and the close networking of suicidal patients v...

Ungewöhnliche Suizidversuche bleiben häufig unentdeckt und bizarre Methoden können als Hinweis auf eine psychotische Genese gewertet werden. Wir berichten über den Versuch einer Selbsttötung durch den Biss einer Puffotter und geben eine kurze Literaturübersicht über weitere archaische Selbstverletzungen. Aufgrund der zunehmend einfachen Verfügbarke...

A 34-year-old man with a history of multiple substance abuse (now abstinent for six years) became addicted to tranylcypromine, consuming up to 240 mg/day. After discontinuing the drug, he developed thrombocytopenia (52,000/ul) and delirium; there were no other anticholinergic signs. The delirium was unresponsive to haloperidol and diazepam. Intrave...

The fate of carbamazepine after intravenous injection in rats (n = 24) and the influence of activated charcoal on the kinetics was investigated. After randomization to four groups (n = 6, each), plasma concentration and the quantities of carbamazepine and metabolites excreted into bile, urine and intestine were determined using an in situ perfusion...

The fate of acetaminophen after intravenous injection in whole bowel-irrigated rats (n = 40) and the influence of activated charcoal on the kinetics were investigated. After randomization to four groups (n = 10, each group), plasma concentration and the quantities of acetaminophen and metabolites excreted into bile, urine and intestine were determi...

Body temperature can be severely disturbed by drugs capable of altering the balance between heat production and dissipation. If not treated aggressively, these events may become rapidly fatal. Several toxins can induce such non-infection-based temperature disturbances through different underlying mechanisms. The drugs involved in the eruption of th...

The clinical features and pharmacokinetics of 22 lithium overdoses are described. Effectiveness of different treatment regimens regarding elimination of lithium is discussed. Origin of overdose was due to deliberate poisoning or precipitated by concomitant diseases, coadministration of drugs, or combination of both. Treatment included supportive ca...

Intravenous injection of elemental mercury (Hg) is rare and considered relatively harmless. Treatment recommendations vary and the effectiveness of chelation therapy is controversial. A 27-year-old man intravenously injected 1.5 mL of elemental Hg. Within 12 hours he became febrile, tachycardic and dyspneic. Physical examination was unremarkable. X...

Drug overdose (OD) is a frequent incident among opiate addicts. Survivors of ODs are at risk for additional and eventually fatal ODs. ODs may be classified as accidental (aOD) or deliberate (dOD). Investigations into the connection between OD and suicide attempts have led to insconsistent results. (1) to determine how many non-fatal ODs were dODs a...

The clinical features, complications, and pharmacokinetics of intentional acute valproic acid (VPA) overdoses are described. Alteration in fatty acid metabolism is evaluated and therapy-induced changes are discussed. Central nervous system features were the predominant clinical manifestations (6/6), followed by respiratory failure (5/6) and multior...

The clinical features, complications, and pharmacokinetics of intentional acute valproic acid (VPA) overdoses are described. Alteration in fatty acid metabolism is evaluated and therapy-induced changes are discussed. Central nervous system features were the predominant clinical manifestations (6/6), followed by respiratory failure (5/6) and multior...

A 33-year-old drug addict injected accidentally into the femoral vein 5 ml urine (kept in the refrigerator for 1 week for unanticipated drug-screening) which she mis-took for methadone. Soon after injection she was found confused with shivering. On admission she had a blood pressure of 90/60 mmHg, heart rate of 120/min and fever of 40 degrees C. La...

Die Inzidenz vergiftungsbedingter, lebensbedrohlicher Hypernatrimien bei Erwachsenen ist gering. Abhngig von der Geschwindigkeit der Entwicklung kommt es zur zellulren Dehydrierung durch Flssigkeitsverschiebungen nach extrazellulr. Neurologische Strungen wie cerebrale Krampfanflle, Lethargie und komatse Verlaufsformen gehren zu den hufigsten Sympto...