[Simplified N-acetylcystein treatment after paracetamol overdose - new recommendations from Swedish Poisons Information Centre]. / Ny förenklad motgiftsbehandling vid förgiftning med paracetamol - Giftinformationscentralen ändrar sin doseringsanvisning för N-acetylcystein.

Since the late 1970s N-acetylcystein has been used as an antidote after paracetamol intoxication. The treatment is traditionally given as three consecutive infusions for 20 hours and 15 minutes. The total dose given is 300 mg/kg. Half of this amount is given as a bolus during the first 15 minutes of treatment.  This regime has proven very efficient in avoiding liver injury. However, side effects, caused by histamine release, are common (10-15%). Symptoms as flush, urticaria and, in rare cases, bronchospasm, angioedema and circulatory shock typically appear during the bolus dose and may lead to interrupted and inadequate treatment. In addition, the regime is complicated leading to a risk of administration errors. During the last years several publications have described the use of a model with two infusions instead of three. The first and the second infusions are merged and given over four hours. The third infusion and the total dose are left unchanged. This modified regime has been shown to reduce side effects and seems not to increase the risk of liver injury. As of November 1, 2019, the Swedish Poisons Information Centre will change its recommendations to the new two-infusion protocol.

["Spice"--synthetic cannabinoids with dangerous effects]. / ¼Spice« - syntetiska kannabinoider med riskabla effekter - Fall av akut njursvikt och cerebral ischemi med stroke har rapporterats.

Synthetic cannabinoids are a large group of chemicals functionally related to delta-9-tetrahydrocannabinol (THC) found in Cannabis sativa. These compounds are full agonists on cannabinoid receptors, therefore more potent than THC. Products marketed over the Internet intended for abuse usually consist of dried inert plant material sprayed with different kinds of cannabinoids. Smoking is the most common route of administration. In Sweden commercially available products are usually labeled ¼spice«. A case concerning a young male with convulsions and acute kidney failure requiring temporary dialysis is presented. Other reported serious effects of this group of substances are acute psychosis, unconsciousness, cardiac ischemia, seizures and stroke. The vendors are very aware of the legal situation in each country and adjust their supply according to current narcotics classifications. New, previously unknown cannabinoids are constantly appearing on the market.

Endoscopic removal of slow release clomipramine bezoars in two cases of acute poisoning.

INTRODUCTION: Acute gastroscopy is seldom advocated in cases of drug overdose. However, this intervention is sometimes recommended in cases where a pharmacobezoar of toxic tablets has formed. CASE REPORTS: We describe two patients who were admitted after major ingestion of slow release clomipramine. In one case an abdominal x-ray was highly suspicious of a large pharmacobezoar in the stomach and in the other case a tablet conglomerate totally obstructed the oesophagus. Both conditions were successfully managed by acute gastroscopy. DISCUSSION: There are limited and inconclusive recommendations in the literature concerning the optimal treatment of pharmacobezoars. CONCLUSION: This article provides further evidence that slow release clomipramine may be capable of forming a radio-opaque pharmacobezoar. The clinical courses in these two cases suggest that tablet removal by gastroscopy should be considered in selected cases of drug poisoning. Suspicion of a pharmacobezoar may warrant diagnostic investigations such as imaging studies and endoscopy.