Intoxicación intencional por paracetamol en adolescentes: un problema de salud creciente: a propósito de un caso / Intentional paracetamol poisoning in adolescents: a growing health problem: clinical case study / Intoxicação intencional por paracetamol em adolescentes: um problema de saúde crescente: relato de caso

La intoxicación por paracetamol de causa no intencional en niños pequeños, e intencional en adolescentes es un motivo de consulta cada vez más frecuente en los servicios de urgencia. La gravedad y el pronóstico de esta intoxicación están dados por el riesgo de falla hepática. Ante la sospecha de ingesta de paracetamol, se debe conocer el tiempo transcurrido, la cantidad de ingesta del fármaco, estimar la toxicidad de la dosis ingerida para predecir hepatotoxicidad, determinar las medidas de contaminación necesarias, dosificar paracetamol en sangre y evaluar la necesidad de administración de antídoto. Se describe el caso de una adolescente que con intención suicida presentó una intoxicación aguda por paracetamol con riesgo de daño hepático requiriendo decontaminación digestiva, administración de antídoto y abordaje interdisciplinario de sus problemas psicoemocionales.

Paracetamol intoxication due to an unintentional cause in young children, and intentional in adolescents, is an increasingly frequent cause for consultation in emergency services. The severity and prognosis of this poisoning is due to the risk of liver failure. Given the suspicion of paracetamol ingestion, the time passed since the ingestion, the amount of paracetamol ingested, the estimate of the dose ingested to predict hepatotoxicity, we must determine the necessary decontamination measures and the paracetamol dose in blood and evaluate the need to administer a paracetamol antidote. We describe the case of an adolescent who presented acute paracetamol poisoning with risk of liver damage resulting from a suicide attempt and who required digestive decontamination, antidote administration and an interdisciplinary approach to her psychological and emotional problems.

A intoxicação não intencional por paracetamol em crianças pequenas e a intoxicação intencional em adolescentes é um motivo cada vez mais comum de consulta em serviços de emergência. A gravidade e o prognóstico desse envenenamento são dados pelo risco de insuficiência hepática. Quando há suspeita de ingestão de paracetamol, o tempo decorrido desde que é ingerido, a quantidade de paracetamol ingerida, a estimação da dose ingerida para predizer hepatotoxicidade, utilizamse para determinar as medidas de contaminação necessárias, dosar paracetamol no sangue e avaliar a ne- cessidade de administração de antídoto. Descrevemos o caso de uma adolescente com intenção suicida que apresentou intoxicação aguda por paracetamol com risco de lesão hepática com necessidade de descontaminação digestiva, administração de antídoto e abordagem interdisciplinar de seus problemas psicoemocionais.

Tratamiento de las intoxicaciones agudas por desinfectantes durante la COVID-19 / Treatment of acute poisoning by disinfectants during COVID-19

Introducción: El uso de productos de limpieza, a expensa de los desinfectantes se ha incrementado por la población mundial como consecuencia de la COVID-19. El manejo frecuente de estas sustancias químicas por las personas puede ocasionar cuadros de intoxicaciones agudas. Esta situación se evidencia en los reportes emitidos por los centros antitóxicos del orbe, donde consta el aumento en el número de consultas toxicológicas. Objetivo: Describir el tratamiento de las intoxicaciones agudas por desinfectantes durante la COVID-19. Métodos: Se realizó una revisión bibliográfica acerca del tratamiento de las intoxicaciones agudas por desinfectantes durante la COVID-19. Se incluyeron artículos escritos en español, inglés y portugués. Además, se abordaron aspectos relacionados con las intoxicaciones agudas por el uso de desinfectantes, el cuadro clínico, así como elementos del diagnóstico y tratamiento de las intoxicaciones agudas por estas sustancias químicas. Conclusiones: Las intoxicaciones agudas por hipoclorito de sodio y geles hidroalcohólicos son las más frecuentes en la población durante la COVID-19 en proporción con el uso de estos productos químicos. La atención médica precoz, eficaz y oportuna disminuirá la posibilidad de aparición de complicaciones. El tratamiento de estás intoxicaciones agudas está en relación con los síntomas y signos que presentan los pacientes al ser recibidos en los servicios de urgencia(AU)

Introduction: The use of cleaning products, at the expense of disinfectants, has increased by the world population as a consequence of COVID-19. Frequent handling of these chemical substances by people can cause acute poisoning. This situation is evidenced in the reports issued by the world's anti-toxic centers, where the increase in the number of toxicological consultations is recorded. Objective: To describe the treatment of acute poisoning by disinfectants during COVID-19. Methods: A literature review on the treatment of acute poisoning by disinfectants during COVID-19 was carried out. Articles written in Spanish, English and Portuguese were included. In addition, aspects related to acute poisoning due to the use of disinfectants, the clinical condition, as well as elements of the diagnosis and treatment of acute poisoning by these chemical substances were addressed. Conclusions: Acute poisoning by sodium hypochlorite and hydroalcoholic gels are the most frequent in the population during COVID-19 in proportion to the use of these chemical products. Early, effective and timely medical care will reduce the possibility of complications. The treatment of these acute intoxications is related to the symptoms and signs presented by patients when they are received in the emergency services(AU)

Progress in the management of acute colchicine poisoning in adults.

Colchicine is a tricyclic, lipid-soluble alkaloid which has long been used to treat gout and many immunological diseases. Due to its narrow therapeutic window and long half-life of elimination, colchicine overdose occurs occasionally. Unfortunately, some patients lost their lives because of colchicine overdose or suicide. Acute colchicine poisoning can lead to original gastrointestinal disorders, shock, progressive multiple organ failure, and myelosuppression. Although many researchers in the world performed lots of research, there are currently no specific antidotes for colchicine poisoning. Meanwhile, there are no management guidelines to treat patients with acute colchicine poisoning until now. Herein, we systematically elaborate on the clinical features and progress in the management of acute colchicine poisoning in adults according to the previous literature. This paper will provide some valuable and available information for clinicians.

[Unusual cause of a PCT-elevation]. / Ungewöhnliche Ursache einer PCT-Erhöhung.

INTRODUCTION: Procalcitonin (PCT) is an established marker for bacterial infection. Elevation of PCT can occur due to various reasons and is not specific, as we outline in the following case report. HISTORY: We report on a 29 year old patient, who was presented by the psychiatric department because of obscure abdominal pain, nausea and vomiting since two days. Taking the patients history did not result in conclusive findings at first. FINDINGS AND DIAGNOSIS: The clinical examination did not result in conclusive findings. The patient was afebrile. Blood work showed an elevation of transaminases and a massive elevation of PCT. In ultrasound no abnormalities were shown, serological investigations for viral hepatitis were negative. Blood cultures remained sterile, the search for an infectious focus remained unremarkable. THERAPY AND COURSE: In the course of the in-patient stay the patient reported the ingestion of approximately 40 g of acetaminophen in suicidal intention two days before. Therapy with N-acetylcysteine (NAC) was initiated. The transaminases and PCT were regressive the next day. Antibiotic therapy was foregone. CONCLUSIONS: This case illustrates that PCT-elevation is not specific for a bacterial infection and must be seen in correlation to patient's history and clinical findings.

A study of the effectiveness of naltrexone in preventing recurrence of methadone poisoning in opioid-naive children.

BACKGROUND: The prevalence of poisoning from methadone and prescription opioids is increasing in pediatric populations. Naloxone is the main antidote for treatment. Long-acting opioid toxicity may need close observation in the intensive care unit (ICU). In our previous study, naltrexone prevented re-narcotization in methadone-poisoned adults. Here, we aim to share our experience with the use of oral naltrexone for preventing recurrence of toxicity in opioid-naïve children. METHODS: In a single-center, retrospective case series, children (age ≤12 years) admitted to a poison center in Tehran (Iran) between March 2014-March 2016 were included if they presented with methadone poisoning and received naltrexone treatment in hospital. Naltrexone (1 mg/kg) was administrated orally after initial administration of 0.1 mg/kg naloxone intravenously. Children were monitored for level of consciousness, cyanosis, respiratory rate, VBG results, and O2 saturation for ≥48 h during their hospitalization. RESULTS: Eighty patients with methadone poisoning were enrolled, with median age of three years (range: 0.2-12.0). None involved polysubstance poisoning. Following naltrexone treatment, none experienced recurrent opioid toxicity during hospitalization, and hospital records indicated no readmission within 72-h post-discharge. CONCLUSION: Oral naltrexone could be a potential substitute for continuous naloxone infusion in methadone-poisoned children and reduce the need for ICU care.

Osteonecrosis of Femoral Head, An Overlooked Long-Term Complication after Paraquat Intoxication: A Retrospective Cohort Study.

With increasing numbers of patients surviving acute intoxication phase, long-term complication after paraquat intoxication is a topic worth exploring, such as osteonecrosis (ON) of femoral head. We reviewed 86 paraquat-intoxicated survivors between 2000 and 2012 in Chang Gung Memorial Hospital, a 3700-bed tertiary hospital in Taiwan. With all the patients underwent same detoxification protocol in the acute stage, 17.4% of paraquat poisoning survivors developed ON of femoral head requiring surgery during follow up. Most of ON episodes occurred within 2 to 4 years after paraquat intoxication and then plateau after 6 years. ON patients exhibited higher SOFA scores than non-ON patients (2.80 ± 2.14 vs. 1.76 ± 1.52, p = 0.028). Furthermore, AKIN scores are also higher in the ON patients than non-ON patients (0.87 ± 1.13 vs. 0.38 ± 0.74, p = 0.040). Multivariate logistic regression showed higher AKIN score and higher partial pressure of carbon dioxide in the blood 48 hours after admission significantly predicted ON of femoral head after paraquat intoxication (p = 0.002 and p = 0.006 respectively). Larger studies with longer follow-up durations are warranted to confirm our finding.

Detoxification effects of long-chain versus a mixture of medium- and long-chain triglyceride-based fat emulsion on propafenone poisoning

In the present study, we aimed to compare the detoxifying effects of two fat emulsions containing either long-chain triglyceride or a mixture of medium-chain and long-chain triglycerides in the propafenone-poisoned rat model. Rats were randomly divided into 3 groups according to the fat emulsions used: long-chain triglyceride-based fat emulsion (LL) group; medium-chain and long-chain triglyceride-based fat emulsion (ML) group; normal saline (NS) group. Propafenone was continuously pumped (velocity=70 mg/kg per h) until the mean blood pressure dropped to 50% of basal level. Then, LL/ML fat emulsions or NS was intravenously infused instantly with a loading-dose (1.5 mL/kg) and a maintenance dose (0.25 mL/kg per min) for 1 h. Subsequently, the propafenone was added to plasma (3.5 μg/mL) in vitro, mixed with three doses of LL or ML (1, 2, or 4%). Finally, after centrifugation, the concentration of propafenone was measured. Rats treated with LL exhibited accelerated recovery, characterized by higher blood pressure and heart rate. Rats in both the LL and ML groups demonstrated decreased propafenone in plasma (time-points: 15, 25, and 60 min). However, rats that received LL showed lower propafenone in myocardial tissue at the end of detoxification treatment. Rats in the ML group had the lowest value of pH, the minimum content of HCO3-, and the highest production of lactic acid at the end. In the in vitro experiments, propafenone decreased more dramatically in the LL group compared to the ML group. Long-chain triglyceride fat emulsion had a better effect on treating propafenone poisoning in rats.

Tratamiento tardío de la intoxicación por paraquat en pacientes pediátricos: Reporte de dos casos / Late treatment of paraquat poisoning in pediatric patients: Report of two cases

El paraquat (PQ) pertenece al grupo de herbicidas de los bipiridilos. Su presentación es en forma líquida o en granulado, usándose con una concentración al 5 %, para uso en jardinería y al 20 % para uso agrícola. En la intoxicación en humanos el órgano blanco es el pulmón. Los pacientes desarrollan insuficiencia respiratoria que puede explicarse por una inicial actividad que involucra un gran estrés oxidativo, con presencia de radicales libres de oxígeno y peroxidación lipídica, con sus consecuentes daños, además de infiltración por polimorfonucleares que con su reacción de liberación empeoran la neumonitis. Puede haber mejoría de la neumonitis y el daño en algunos órganos, pero pronto la aparición de fibrosis pulmonar lleva a falta de respuesta a la administración de oxígeno y a la muerte por insuficiencia respiratoria en algunos días a semanas. De acuerdo con la cantidad ingerida varía la evolución de la severidad del cuadro clínico. Se presentan dos pacientes pediátricos con intoxicación por PQ, a quienes se les inició tratamiento inmunosupresor después de 48 horas de la exposición. Uno de los pacientes se intoxicó de manera no intencional y otro por suicidio. Los dos pacientes recibieron tratamiento similar, sin embargo, el paciente con intención suicida falleció días después de la exposición. Se hace una revisión de la literatura sobre el tratamiento administrado.

Paraquat (PQ) belongs to the bipyridyls herbicides. Its presentation is liquid or granulated, being used at concentrations of 5 %, in gardening and 20 % in agricultural use. In human poisoning, the target organ is the lung. The patients develop respiratory insufficiency that can be explained by an initial activity that involves a great oxidative stress, with the presence of oxygen free radicals and lipid peroxidation, with its consequent damages, in addition to polymorphonuclear infiltration that with its liberation reaction worsen pneumonitis. There may be improvement of pneumonitis, but the appearance of pulmonary fibrosis will lead to a lack of response to the administration of oxygen and death due to respiratory failure in a few days to a few weeks. According to the amount ingested, the evolution of the severity of the clinical picture varies. We present two pediatric patients with PQ poisoning, who were started on immunosuppressant treatment after 48 hours of exposure. One of the patients was poisoned incidentally and the other one by suicide. The two patients received similar treatment, however, the patient with suicidal intention died days after the exposure. A review of the literature on the treatment offered is made.

[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.

[Improved and harmonised laboratory analysis of paracetamol provides safer assessment of poisoning cases]. / Bättre labbanalys av paracetamol ger säkrare bedömning av förgiftningsfall - Bestämning av koncentrationen är grunden för rätt behandling.

Toxicological analysis is an important part of the acute treatment of various intoxications. Rapid laboratory responses are important for the patient to be assessed and treated correctly, and also to exclude poisoning and thus avoid unjustified and costly overtreatment. In Sweden, paracetamol (acetaminophen) is one of the most common pharmaceuticals in drug poisoning. Paracetamol overdose can cause severe liver damage unless treated early with the antidote acetylcysteine. A nation-wide initiative for improved laboratory measurement of paracetamol in plasma/serum samples has resulted in a marked reduction in the inter-laboratory coefficient of variation to generally below 10%. The introduction of a harmonized national reporting range for plasma/serum paracetamol covering at least 50-5 000 µmol/l was also recommended. This initiative will hopefully contribute to better healthcare from both a patient and health resource perspective in cases of paracetamol poisoning.

Psychotropics in Your Medicine Cabinet: A Case Study of Dimenhydrinate Use.

: Reporting of intoxication and withdrawal from aberrant use of over-the-counter medication has been sparse and inconsistent in literature. Attributed to their anticholinergic properties, medications such as dimenhydrinate (Gravol) taken in supratherapeutic doses have been associated with euphoria, anxiolysis, and hallucinations. We present a case of a woman in her forties, with a psychiatric history of bipolar disorder, and complex concurrent medical history including familial Mediterranean fever (FMF), and fibromyalgia, admitted for withdrawal management of her intravenous dimenhydrinate use. As a result of her FMF, there were numerous hospital admissions and treatment which required intravenous access. Hence, a physician-inserted intravenous access port was placed on her chest. The port was maintained monthly with the help of a community agency. In this port, she was injecting 100 to 200 mg of dimenhydrinate hourly for its euphoric and calming effects, consuming upwards of 2400 mg/d. Comprehensive laboratory work-up and urine drug screening were unremarkable. Vital signs were stable. Her mental status at time of admission was lethargic, unfocused, but calm. Her withdrawal symptoms included severe nausea, vomiting, sedation, headaches, dizziness, anxiety, and muscle stiffness. Her detoxification was managed with benztropine and lorazepam, and was well tolerated. The patient was discharged to a community inpatient rehabilitation center. Urine drug testing before discharge was negative. This case draws attention to the addictive potential of dimenhydrinate and offers a regime for its medical withdrawal management. Additionally, this case highlights that screening and management of over-the-counter medications warrants further clinical consideration and investigation.

Minimum ingested iron cut-off triggering serious iron toxicity in children.

BACKGROUND: Iron intoxication can occur accidentally in children or intentionally by adolescents as a suicide attempt. They usually present with various symptoms including vomiting and diarrhea. Clinical studies in this field has been reported different doses of ingested elemental iron that caused serious toxicity, but none of these studies determined the minimum cut-off of ingested iron that triggered the risk of severe toxicity. The aim of this study was therefore to investigate the demographic features of iron intoxication in Turkish children and to determine the lowest cut-off of ingested elemental iron triggering serious intoxication and the need for prompt management. METHODS: This retrospective study investigated 83 Turkish patients with accidental and intentional iron poisoning. RESULTS: Of the 83 cases of acute iron intoxication, accidental iron consumption was more common than intentional use. Fifty-three patients ingested a median toxic dose of elemental iron of 40.0 mg/kg (IQR, 33.5 mg/kg). The median serum iron concentration in the first 6 h of ingestion was 150 µg/dL (IQR, 282 µg/dL). Twenty patients were given deferoxamine, whereas 63 patients were given supportive treatment. CONCLUSION: The cut-off of ingested elemental iron that triggered serious toxicity and the need for deferoxamine in children <18 years of age was 28 mg/kg.

Concepción teórica de la recepción masiva de intoxicados en los hospitales durante emergencias químicas / Theoretical conception of mass reception of intoxicated people in hospitals during chemical emergencies

Introducción: La recepción masiva de intoxicados en los hospitales, derivados de emergencias químicas, se sustenta en postulados teóricos generales de estas emergencias, los siniestros con víctimas en masa y la teoría de los sistemas. Debe tributar al ciclo de reducción de riesgos de desastres. Objetivo: Diseñar una concepción teórica de la recepción masiva de intoxicados derivados de emergencias químicas, para los hospitales, que tribute a las fases de la etapa de respuesta del ciclo de reducción de riesgos de desastres. Métodos: Se realizó una investigación en sistemas y servicios de salud, entre los años 2005 y 2017. Se revisaron y analizaron fuentes bibliométricas e infométricas y se consultaron expertos en el proceso de concreción del resultado, por método de consenso para determinar la pertinencia. Resultados: Se concibió la recepción masiva de intoxicados en los hospitales como un sistema, que asumió cuatro subsistemas: el preparativo, ejecutivo y recuperativo como fundamentales, y el de aseguramiento, para garantizar el funcionamiento de estos. Todos están relacionados entre sí, con dependencia significativa entre ellos. Se caracteriza por ser: flexible, objetivo, participativo, oportuno, aceptable, adecuado y selectivo. Conclusiones: El enfoque sistémico de la recepción masiva de intoxicados en los hospitales como consecuencia de las emergencias químicas, constituye un referente de gran valor teórico para su comprensión integral como fenómeno complejo, su estructura está conformada por cuatro subsistemas: el preparativo, ejecutivo, recuperativo y el de aseguramiento, y tributa a las fases de la etapa de respuesta del ciclo de reducción de riesgos de desastres(AU)

ABSTRACT Introduction: The mass reception of intoxicated people in hospitals, resulting from chemical emergencies, is based on general theoretical postulates of chemical emergencies, mass casualty events and systems theory, which must contribute to the disaster risk reduction. Objective: To design a hospital theoretical conception for mass reception of intoxicated people resulting from chemical emergencies. This conception should contribute to the response phases of the disaster risk reduction. Methods: This is a research on health systems and services conducted from 2005 to 2017. We reviewed and analyzed bibliometric and infometric sources and we consulted experts. To determine the relevance, we focused on the process of result concretion and consensus method. Results: The mass reception of intoxicated patients in hospitals was conceived as a system of four subsystems. The basic are preparatory, executive and recuperative subsystems. The assurance subsystem guarantees the operation. All subsystems relate to each other with significant dependence between them. This system is flexible, objective, participatory, timely, acceptable, adequate and selective. Conclusions: The systemic approach of the mass reception of intoxicated patients in hospitals resulting from chemical emergencies constitutes a valuable theoretical reference for its basic comprehension as a complex phenomenon. Four subsystems structures it: preparatory, executive, recuperative and assurance. It contributes to the response phases of the cycle for disaster risk reduction(AU)

Intoxicação crônica por Pteridium arachnoideum em bovinos no nordeste do estado do Rio Grande do Sul, Brasil / Chronic poisoning by bracken fern (Pteridium arachnoideum) in cattle in the northeast region of the state of Rio Grande do Sul, Brazil

Pteridium spp., popularmente conhecida como samambaia, comumente encontrada em solos ácidos, arenosos e de baixa fertilidade. A intoxicação ocorre quando os animais passam por privação alimentar ou ingestão acidental. O objetivo deste estudo é relatar a ocorrência de dois casos de intoxicação crônica por samambaia em bovinos na região nordeste do estado do Rio Grande do Sul, Brasil. Ambos os casos cursaram com sinais clínicos de disfagia, halitose, salivação e presença de tumores na orofaringe. A baixa oferta e qualidade de forragem, superlotação das áreas de pasto, manejo inadequado das pastagens, a presença de Pteridium arachnoideum, os sinais clínicos em conjunto com os achados de necropsia e o exame histopatológico confirmaram o diagnóstico de intoxicação crônica.

Pteridium spp., commonly known as fern, is commonly found in acidic, sandy and low fertility soils. Poisoning occurs when animals go through food deprivation or accidental ingestion. The objective of this study is to report the occurrence of two cases of chronic intoxication in cattle in the northeast region of the state of Rio Grande do Sul, Brazil. Both cases had clinical signs of dysphagia, halitosis, salivation and the presence of tumors in the oropharynx. Low supply and quality of forage, overcrowding of pasture areas, inadequate pasture management, presence of Pteridium arachnoideum, clinical signs, necropsy and histopathological of lesions confirmed the diagnosis of chronic intoxication.

Paracetamol metabolite concentrations following low risk overdose treated with an abbreviated 12-h versus 20-h acetylcysteine infusion.

CONTEXT: To compare degree of liver injury and paracetamol metabolite concentrations after treatment with standard of care (20-h) vs. abbreviated (12-h) acetylcysteine regimens used in paracetamol overdose (NACSTOP trial). METHODS: Timed blood samples from a cohort of subjects enrolled in the cluster-controlled NACSTOP trial evaluating a 12-h acetylcysteine regimen (200 mg/kg over 4 h, 50 mg/kg over 8 h) were assayed for paracetamol metabolites as a pilot study, using liquid chromatography/mass spectrometry. Control group subjects received a 20-h course of acetylcysteine (200 mg/kg over 4 h, 100 mg/kg over 16 h). The intervention group received a 12-h acetylcysteine regimen (stopped after at least 12 h of treatment). Positive control groups not in the trial with acute liver injury (ALI) or hepatotoxicity were also studied. RESULTS: One hundred and forty-one blood samples were collected from 40 patients receiving acetylcysteine after paracetamol overdose. Median ALT after 20 h of acetylcysteine was 12 U/L (IQR 8.14) in the abbreviated regimen group, compared to the control group 16 U/L (IQR 11.21) (p = .46). There was no significant difference in median metabolite concentrations on presentation and after 20 h of acetylcysteine between these two groups (p > .05). Presentation median sum CYP-metabolite/total metabolite percentages were 2.5 and 3.0 in the abbreviated and control NACSTOP groups, respectively. CONCLUSIONS: An abbreviated 12-h acetylcysteine regimen for paracetamol overdose used in the NACSTOP trial had similar circulating metabolite concentrations compared to a 20-h regimen in selected subjects with low risk of hepatotoxicity. This suggests that further acetylcysteine may not be needed in the abbreviated group at time of cessation.

Acetaminophen and Acetylsalicylic Acid Exposure in a Preterm Infant after Maternal Overdose.

Here, we review the case of a 26 1/7 weeks' gestation premature female infant born to a mother who intentionally ingested a large quantity of Tylenol, aspirin, quetiapine, and prenatal vitamins. The neonate subsequently had markedly elevated levels of both Tylenol and aspirin when checked on the first day of life. While overall clinically stable, the neonate did demonstrate coagulopathy as evidenced by abnormal coagulation studies. Both poison control and a pediatric gastroenterologist/hepatologist were consulted. She successfully tolerated a course of N-acetylcysteine; her subsequent Tylenol level was markedly decreased and the neonate exhibited no further effects of toxicity. The salicylate level decreased on its own accord. To our knowledge, this is the first report of a neonate at 26 weeks' gestation that has been successfully managed for supratherapeutic concentrations of acetaminophen and acetylsalicylic acid secondary to maternal ingestion. While rare, this case may serve as a reference for the effectiveness of N-acetylcysteine in premature infants in such instances.

[Xuebijing improves clinical prognosis and reduces mortality in patients with acute paraquat poisoning: a Meta-analysis included 1 429 patients].

OBJECTIVE: To explore the therapeutic effect of Xuebijing on patients with acute paraquat poisoning (APP) by using systematic evaluation method. METHODS: PubMed, Cochrane Library, Embase, Wanfang database, China National Knowledge Infrastructure (CNKI), VIP database (VIP) and China Biology Medicine (CBM) were searched using the computers to find the literatures published about the Xuebijing injection for the treatment of APP. Randomized controlled trials (RCT) were retrieved from the establishment of the database to August 2019. Patients in experimental group were treated with Xuebijing injection combined with conventional treatment, while the patients in control group were only given conventional treatment. The patients' outcome included the 14-day mortality, arterial oxygen saturation (SaO2) and incidence of pulmonary fibrosis. In addition, the 6-month survival rate, alanine aminotransferase (ALT), serum creatinine (SCr), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), malondialdehyde (MDA) and superoxide dismutase (SOD) between the two groups were compared. The literature data were extracted by two researchers independently, and the quality of the literatures was evaluated according to the Cochrane 5.1 handbook. The Meta-analysis was performed by using RevMan 5.3 software. The results stability of Meta-analysis was tested by sensitivity analysis. The publication bias was analyzed through drawing of funnel diagram. RESULTS: Twenty-seven RCT studies in total were enrolled, of which 26 were in Chinese and 1 was in English. A total of 1 429 patients were enrolled, among whom 726 were in experimental group and another 703 were in control group. Meta-analysis showed that compared with the control group, the 14-day mortality [relative risk (RR) = 0.62, 95% confidence interval (95%CI) was 0.54 to 0.72, P < 0.000 01] and incidence of pulmonary fibrosis (RR = 0.67, 95%CI was 0.53 to 0.85, P = 0.000 9) of patients in the experimental group were significantly lowered, while SaO2 at 7 days and 14 days were significantly increased [7 days: mean difference (MD) = 16.86, 95%CI was 9.89 to 23.83, P < 0.000 01; 14 days: MD = 16.51, 95%CI was 10.22 to 22.80, P < 0.000 01]. Compared with the control group, the survival rate within 6 months (RR = 1.55, 95%CI was 1.41 to 1.71, P < 0.000 01) and SOD (MD = 13.88, 95%CI was 7.43 to 20.33, P < 0.000 1) of patients in the experimental group were significantly increased, ALT at 14 days (MD = -78.35, 95%CI was -127.35 to -29.34, P = 0.000 5), SCr at 7 days and 14 days (7 days: MD = -135.13, 95%CI was -219.09 to -51.17, P = 0.002; 14 days: MD = -206.05, 95%CI = -290.13 to -121.96, P < 0.000 01), CRP (MD = -11.55, 95%CI was -17.77 to -5.33, P = 0.000 3), TNF-α (MD = -9.27, 95%CI was -15.48 to -3.96, P = 0.000 9) and MDA (MD = -1.27, 95%CI was -1.57 to -0.96, P < 0.000 01) were significantly lowered. The overall effect value of the parameters with high heterogeneity was not significantly changed after further Meta-analysis excluding any one of the studies, suggesting that the result was relatively stable. Funnel chart analysis was used to analyze the parameters from more than 10 articles enrolled, and it showed that there was publication bias. CONCLUSIONS: Xuebijing injection can reduce the mortality of patients with APP, which may because that it can improve liver and kidney function, reduce inflammation and oxidative stress damage, inhibit pulmonary fibrosis and increase oxygenation level.

Dihydroxyacetone as a definitive treatment for aluminium phosphide poisoning in rats.

Aluminium phosphide (AlP), a very toxic pesticide also known as the rice tablet, releases phosphine gas upon contact with water, moisture, or gastric acid. Its mortality rate in humans is 70-100 % due to cardiogenic shock and refractory hypotension. Dihydroxyacetone (DHA) is a simple ketonic carbohydrate, mainly used for sunless skin tanning. It also plays a beneficial role in the treatment of hypotension and cardiogenic shock by restoring blood volume and cellular respiration. The aim of this study was to investigate the its effect on the haemodynamics and electrocardiogram (ECG) in male rats poisoned with AlP. The animals were divided into the following groups: control (received 1 mL corn oil, orally), AlP (received 15 mg kg-1 AlP solved in corn oil, orally), AlP plus DHA (treated with 50 mg kg-1 of DHA 30 min after receiving AlP), and AlP plus N-acetyl cysteine (NAC) (treated with 200 mg kg-1 of NAC 30 min after receiving AlP). The animals were then anaesthetised and ECG, blood pressure, and heart rate were recorded for 120 min. Treatment with AlP alone and in combination with NAC was associated with progressive hypotension, tachycardia, and ECG disturbances in rats, resulting in 100 % mortality 3 h after poisoning. However, DHA achieved 100 % survival in the poisoned rats and prevented AlP-induced ECG and haemodynamic abnormalities. The main mechanism of DHA in the treatment of AlP poisoning is unclear, but the findings suggest the promising therapeutic potential of DHA against AlP poisoning.