[Preventive treatment of prolongation of the QT interval]. / Postepowanie profilaktyczne w przypadku wydluzonego odstepu QT.

Prolongation of QT interval is an indicator of bad prognosis in general population of people with heart disease, in patients after myocardial infarction and in people without recognized heart disease. Prolongation of QT interval occurs in many diseases and clinical states. It may be congenital or acquired ECG anomaly and it determines the basic symptom of long QT syndrome. In this paper we present clinical meaning of QT interval, measurement rules and problems with correct valuation of QT/QTc in electrocardiogram. We also discuss reasons of QT interval prolongation--congenital or acquired long QT syndrome, as well as the procedure in case of QT interval prolongation and possibilities of preventive treatment of iatrogenic long QT syndrome.

[The harmfulness of drugs and slimming substances--a toxicologist's point of view]. / Szkodliwosc leków i srodków wspomagajacych odchudzanie--punkt widzenia toksykologa.

Obesity in rapidly developing countries has recently become an epidemic. That is why the need to fight against this chronic disease is becoming more and more apparent. In order to lose weight it is necessary to achieve negative energy balance either by increasing physical activity or using a low calorie diet. When these methods are ineffective, pharmacotherapy is used. The criterion for the application of medical treatment is a BMI above 30 kg/m2 or above 27 along with the presence of other risk factors. Drugs for weight loss fall into three groups: appetite inhibitors, those increasing energy expenditure by enhancing thermogenesis and those inhibiting the absorption of food in the intestines. This paper presents an overview of these classes of drugs and dietary supplements with an emphasis on their adverse effects and the possibility of poisoning. Despite the fact that in Poland only one drug - orlistat has been registered for the treatment of obesity, the availability of other products is unlimited due to the Internet. This fact, and the tendency of patients to treat obesity by themselves using pharmacological substances, poses a major threat and a challenge to the toxicologist.

[Difficulties in interpreting the results of laboratory tests for methanol concentration in serum of patients with metabolic acidosis of various origins]. / Trudnosci w interpretacji wyników oznaczen metanolu u pacjentów z hiperglikemia i kwasica metaboliczna róznego pochodzenia.

Due to increasing availability of methyl alcohol, methanol poisoning becomes more common. Consumption of even relatively small amounts can lead to very serious consequences, including irreversible damage to the eye and death. Quickly implemented proper treatment can alleviate the course of poisoning. Since the victims of poisoning often come to medical facilities unconscious, unresponsive, with unknown or incomplete medical history, it is crucial, both for toxicologists and emergency physicians, to consider the possibility of methanol or ethylene glycol poisoning. It is important to be able to recognize the symptoms of such a poisoning and to order appropriate laboratory tests, especially arterial blood gas and if necessary serum concentrations of methanol and ethylene glycol. The article discusses the course of methanol poisoning, various diagnostic methods of detecting methyl alcohol and factors that affect the methanol concentration in serum. Two clinical cases of patients with non-respiratory acidosis and hyperglycemia, the presence of methanol determined by spectrophotometric method and no methanol intake in anamnesis were also presented. We are considering the possibility of false positive results of methanol determination in the course of diabetic ketoacidosis and significant hyperglycemia.

[Severe tricyclic antidepressants poisoning--a case study]. / Ciezkie zatrucie trójcyklicznymi antydepresantami--opis przypadku.

Long QT syndrome is a disease characterized by periodic or constant prolongation of QT interval and attacks of ventricular polymorphic tachycardia known as torsade de pointes. It may appear as a result of various medicines application, both anti-arrhythmic and non-cardiovascular. Currently, a list of medicines which may cause proarrhythmic action in consequence of QT prolongation is long and constantly updated. It contains tricyclic antidepressants, which are the most toxic antidepressants currently used and are often the cause of poisoning and hospitalization on toxicology wards. The paper presents the case of a 20-year-old man, treated in the clinical toxicology ward, after severe poisoning with tricyclic antidepressants. The patient, treated many times in our toxicology centre, had very high concentration of tricyclic antidepressants in the serum (2768 ng/ml). The concentration above 1000 ng/ml indicates serious life-threatening poisoning. Very severe symptoms of cardiotoxicity were observed: in ECG - wide QRS (160 ms) with heart rate 120-150 per minute, ventricular tachycardia, periodically polymorphic, prolongation of QT interval, hypotonia (80/60 mm Hg) and also recurrent attacks of seizures. Also metabolic/respiratory acidosis was stated (pH - 7.089; pCO2 - 56.9 mm Hg, HCO3 - 16.8 mmol/l). Gastric lavage, activated charcoal were administered, symptomatic and supportive treatment according to the intensive therapy rule was applied, including sodium bicarbonate, magnesium sulfate and vasopressors intravenous infusion. High concentration of the drug, unknown after ingestion and significantly developed symptoms of cardiotoxicity caused, that the treatment was ineffective. The case described shows that treatment of severe poisoning with tricyclic antidepressants and induced acquired long QT syndrome is still a challenge.

[Ergotamine poisoning: a case study]. / Zatrucie ergotamina: opis przypadku.

Ergotamine is a well known pharmacological remedy applied in neurology (treatment of vascular headache) and in obstetrics (abortive remedy, uterus atony). But today it is rarely used, because of new safer anti-migraine medicine (triptanes) which cause fewer side effects. According to obstetrical indications ergotamine is applied only in hospital treatment. For that reason, cases of intoxication by this class of drugs are rarely observed. Ergotamine causes constriction of the blood vessels through the blockade of alpha-receptors and stimulation of the serotonin-receptors on the walls of blood vessels both in the central nervous system and in peripheral circulation. Intoxication/overdose symptoms may appear on application of therapeutic dose by sensitive patients, mostly by patients with migraine headache using ergotamine preparation for relief of migraine attacks. In the Regional Centre of Clinical Toxicology, a 21-year-old patient was hospitalized. She took about 20 tablets of Cafergot (complex preparation containing 1mg ergotamine tartare and 100mg caffeine). During her stay on the ward, typical symptoms of severe poisoning were observed: nausea, severe vomiting, dizziness, decreased blood pressure without perceptible pulse, narrowing of the blood vessels in the extremities of the body (peripheral vasoconstriction) - paresthesia, digital cyanosis, refrigeration of legs, angina. Due to taking once of a great dose of the drug by the patient, violent process of intoxication, possibility of dangerous complication and also the unavailability of specific antidotes and lack of efficient methods of extracorporeal elimination of the drug, the patient was intensively controlled and symptomatic treatments according to the law of intensive therapy was applied.