Avicenna's clinical toxicology approach and beneficial materia medica against oral poisoning.

Considering the rich background of Persian Medicine in the use of materia medica for the treatment of diseases, the huge burden of oral poisonings in the world, and the urgent need to find scientific solutions, the purpose of this study was to determine Avicenna's approach toward clinical toxicology and his proposed treatments for oral poisonings. In Al-Qanun Fi Al-Tibb, Avicenna addressed the materia medica for the treatments of oral poisonings after explaining the ingestion of different toxins and also elucidating the clinical toxicology approach toward poisoned patients. These materia medica were from different classes including emetics, purgatives, enemas, diaphoretics, antidiarrheals, inhaled drugs, sternutators, anticoagulants, antiepileptics, antitussives, diuretics, cooling drugs, stimulants, cardiotonic drugs, and heating oils. By applying different therapies, Avicenna endeavored to attain main goals in clinical toxicology that are comparable with modern medicine. They included removing the toxins from the body, decreasing the severity of the deleterious effects of toxins on the body, and counteracting the effects of toxins inside the body. Aside from introducing different therapeutic agents that played an important role in the treatment of oral poisonings, he emphasized the ameliorating effects of nutritive foods and beverages. Further research using other Persian medical resources is recommended to elucidate the applicable approaches and treatments for different poisonings.

A systematic review of clinical and laboratory findings of lead poisoning: lessons from case reports.

Lead is one of the most toxic heavy metals in the environment. The present review aimed to highlight hazardous pollution sources, management, and review symptoms of lead poisonings in various parts of the world. The present study summarized the information available from case reports and case series studies from 2009 to March 2020 on the lead pollution sources and clinical symptoms. All are along with detoxification methods in infants, children, and adults. Our literature compilation includes results from 126 studies on lead poisoning. We found that traditional medication, occupational exposure, and substance abuse are as common as previously reported sources of lead exposure for children and adults. Ayurvedic medications and gunshot wounds have been identified as the most common source of exposure in the United States. However, opium and occupational exposure to the batteries were primarily seen in Iran and India. Furthermore, neurological, gastrointestinal, and hematological disorders were the most frequently occurring symptoms in lead-poisoned patients. As for therapeutic strategies, our findings confirm the safety and efficacy of chelating agents, even for infants. Our results suggest that treatment with chelating agents combined with the prevention of environmental exposure may be an excellent strategy to reduce the rate of lead poisoning. Besides, more clinical studies and long-term follow-ups are necessary to address all questions about lead poisoning management.

Blood lead concentration among oral/inhaled opium users: systematic review and meta-analysis.

Lead is a poisonous heavy metal with various known side effects. The effect of opium on raising blood lead concentration (BLC) has been investigated with no general agreement. In Iran, the number of lead poisoning cases has raised among the opium-addicted population. This systematic review and meta-analysis aim to combine the results of previous studies with the Iranian population to investigate the effect of opium on BLC. In this systematic review, PubMed/Medline, Web of Sciences, Embase, and Scopus were searched for studies using the Iranian population to compare the BLC of opium-addicted cases and non-addicted controls till January 2020. A random-effects model was used to pool the results. I-square test was used to assess the heterogeneity of the studies. The effect sizes were standardized mean differences (proxied by Hedges' g) followed by a 95% confidence interval. Of 417 initial articles, 13 studies met the inclusion criteria to be considered in the meta-analysis. The sample size of eligible studies ranged from 40 to 131 (mean 81.83, SD 27.6). All studies were focused on adults with mean age ranged from 33.5 to 65.15 years old (overall mean 49.0, SD 7.66). There were 13 studies included with 18 Hedges' g effect sizes. Using a random effect model, the pooled effect size was gw = 2.48 (95% CI: 1.58-3.39) and statistically significant in favor of opium-addicted participants. Moreover, heterogeneity was 96.6% (I2=96.6, Q(17) = 504.95, p < 0.001). For studies with large Hedges' g effect sizes (> 4) identified as outliers and removed from meta-analysis. The pooled Hedges' g effect size reduced to 1.39 (95% CI: 0.94-1.85), still highly significant in favor of higher levels of lead in the opium-addicted group. The funnel plot appeared symmetrical confirmed by Egger's test (t = 1.87, p = 0.088), indicating no publication bias present.

Opium-Related Lead Toxicity: An Integrative Review and Case Series.

BACKGROUND: Restrictive regulations and the increased price of opioids have resulted in the addition of impurities to illicit opioids by drug dealers. Among the adulterants, lead salts are optimal agents to make packages heavier. Consequently, lead toxicity has emerged in the opioid-user population. OBJECTIVES: Our goal was to review the related literature and describe patients with common presentations of opioid-related lead poisoning to provide a basis to prepare optimal management. METHODS: A narrative review was performed aiming to study opioid lead poisoning. PubMed and Google Scholar databases were explored with two Medical Subject Heading terms, lead poisoning and substance-related disorders to find a broad but relevant spectrum of articles. Then, the reference lists within those articles were checked to upgrade our literature pool on this issue. RESULTS: Ultimately, among English-language articles, 16 were case series and case reports of patients with lead intoxication after opioid consumption. Data pertaining to disease characteristics, diagnosis, and treatment protocols were extracted. CONCLUSIONS: The clinical presentation of opioid lead intoxication can vary from rather asymptomatic to severely debilitating gastrointestinal or neurologic symptoms. The diagnosis is made by checking lead blood levels after obviating other critical diagnoses and should be considered in each drug user in endemic regions of opioid addiction, such as the Middle East. Management protocols are suggested to cover both features of opioid-related complications and lead toxicity.

Neuromuscular manifestations of lead poisoning in opium and herbal users in Iran.

Opium sale is prohibited in Iran, and sellers mix it with lead to increase the weight. Herein, we describe neuromuscular findings in nine patients who developed lead poisoning due to opium/drug consumption. The mean age of patients was 53±3.5 years and their mean blood lead level was 122.6±20.8µg/dL. Most of the patients had an acute/subacute course presenting as axonal or demyelinating sensorimotor polyneuropathy, motor neuron disease, and multiple mononeuropathies with favorable response to the chelation therapy. Lead poisoning should be considered in patients with a history of opium use and neuromuscular symptoms.

A Case of Strychnine Poisoning from a Southeast Asian Herbal Remedy.

BACKGROUND: Strychnine is a highly toxic alkaloid found in both naturally occurring compounds and commercial products. Extracts of fruits from the strychnine plant have been used in Southeast Asia as remedies for various illnesses. We describe strychnine poisoning from ingestion of a Southeast Asian herbal supplement quantitatively confirmed by serum and urine analysis. CASE REPORT: A 40-year-old Cambodian woman presented to the emergency department with a complaint of jaw pain and spasms. The patient was staying with a relative and drank 2 oz from an unmarked bottle that she thought contained vodka. She then developed trismus and abdominal cramping, after which a family member said the bottle contained a compound called "slang nut." Her vital signs were as follows: heart rate 102 beats/min, blood pressure 142/72 mm Hg, respiratory rate 20 breaths/min, and oxygen level 100%. The physical examination revealed no significant abnormalities. Serum toxicologic screens were negative except for strychnine levels that revealed a serum concentration of 350 ng/mL and a urine concentration >200 ng/mL. The patient was observed for 2.5 h and discharged with no long-term complications. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Strychnine is a well-known compound that has been used in poisons, rodenticides, and performance enhancing drugs for years. In the Western world, strychnine is a much less common poisoning given that its use has been restricted because of the potential for severe toxicity; however, given its potentially high mortality, it is important to be aware of other sources of exposure, including those from herbal and homeopathic remedies.

Patient's death as a result of mistakenly injection of pancuronium.

Pancuronium is a typical non-depolarizing, curare-mimetic, very potent muscle relaxant. Besides application in anesthesiology and intensive care, it is used in execution as a part of lethal injection. In medico-legal practice, there are cases of using this substance in order to commit suicide or to deprive other people of their lives. Accidental pancuronium intoxications are very rare. The authors present such case ended in sudden death of hospitalized woman after mistakenly injection of the drug. 57-year-old female alcoholic was admitted to the Acute Poisoning Centre after ethylene glycol ingestion. During the fifth day of treatment the nurse by mistake, instead of furosemide, intravenously administered her pancuronium. Sudden respiratory and circulatory arrest occurred, so she was intubated and resuscitation with artificial ventilation were undertaken, however within 1 hour and 45 minutes the patient died. Due to the vague background of a sudden deterioration in the patient's condition, the case was brought for prosecution. The autopsy and histopathological studies did not reveal the cause of death, but undertaken chemico-toxicological examinations identified the presence of pancuronium in blood, liver and kidney (190 ng/ml, 70 ng/g and 125 ng/g, respectively). Chemico-toxicological analysis proved that the cause of death of the 57-year-old hospitalized woman was pancuronium intoxication due to evident medical error during drug administration. In our case the concentration of pancuronium in blood was in therapeutic range (200-600 ng/ml). However, even a therapeutic pancuronium dose administered to patient the breath of whom is not supported and monitored can be a threat to his life.

A cluster of acute thebaine poisonings from non-food grade poppy seeds in the Australian food supply.

INTRODUCTION: Poppy seed tea is used for its opioid effects and contains multiple opium alkaloids, including morphine, codeine, papaverine, and thebaine. Animal studies indicate thebaine has strychnine-like properties, but there is limited literature describing human thebaine poisoning. We describe a cluster of acute thebaine poisoning in people ingesting tea made using poppy seeds with high thebaine content that entered the Australian food supply chain. METHODS: This is an observational study of patients poisoned after drinking poppy seed tea. Cases were identified by three prospective toxicovigilance systems: the Emerging Drug Network of Australia collaboration, the New South Wales Prescription, Recreational and Illicit Substance Evaluation program, and the Emerging Drugs Network of Australia Victoria study. We report characteristics of clinical toxicity in cases with reported ingestion of poppy seed tea and analytical confirmation of thebaine exposure. RESULTS: Forty cases presenting with multi-system toxicity following poppy seed tea ingestion were identified across seven Australian states/territories from November 2022 to January 2023. Blood testing in 23 cases confirmed high thebaine concentrations. All 23 were male (median age 35, range 16-71 years). All patients experienced muscle spasms. Rigidity was described in nine, convulsions in six, while rhabdomyolysis, acute kidney injury, and metabolic acidosis occurred in five patients. There were two cardiac arrests. The thebaine median admission blood concentration was 1.6 mg/L, with a range of 0.1-5.6 mg/L, and was the dominant opium alkaloid in all samples. Convulsions, acute kidney injury, metabolic acidosis, and cardiac arrest were associated with increasing median thebaine concentrations. Four patients were managed in the Intensive Care Unit, with two receiving continuous kidney replacement therapy (one also received intermittent haemodialysis) for kidney injury. There was one death. CONCLUSIONS: Thebaine toxicity, like strychnine poisoning, resulted in neuromuscular excitation characterized by muscle spasm, rigidity, and convulsions. Severe toxicity, including acute kidney injury, metabolic acidosis, and cardiac arrest, appears dose-dependent.

A Study on the Profile of Poisoning in the Paediatric Population in a Tertiary Care Teaching Hospital of Chitradurga Region.

Background Most poisoning events among children are preventable and the major reason is lack of supervision by adults, including poor knowledge and attitude toward storage of such items. So, the prevention policy on children's poisoning shall take into account the age group, gender, socioeconomic status, residence, and other aspects such as the knowledge and attitude of adults. The present study was conducted to describe the profile of poisoning in the paediatric population in a tertiary care teaching hospital. Methods Our observational study was retrospective and was conducted at Basaveshwara Medical College and Hospital (BMCH), Chitradurga, Karnataka, under the Department of Forensic Medicine for a duration of three months (February 2021 to April 2021). Institutional ethical approval was obtained prior to the start of the study. As our study participants were paediatric patients (0-17 years) with acute poisoning (excluding homeopathic drug ingestion), a total of 81 paediatric patients' case sheets were finally reviewed and analysed. The data of paediatric poisoning cases were collected in a predesigned study proforma and included details about children's age (in years), gender (male, female), residence (rural, urban), outcome (death, discharge), nature of poisoning (accidental, suicidal), and toxic agents in poisoning. The collected data were entered and analysed in the Microsoft Excel spreadsheet (Microsoft Corporation, Redmond, WA). Results The incidence of acute poisoning among the paediatric population in our teaching hospital was 1.4%. The most common age group with acute poisoning was 13-17 years (30.9%). The prevalence of acute poisoning was higher in male children (56.8%) when compared to female children (43.2%). Around three-fourths of paediatric cases (71.6%) with acute poisoning were having a rural residence. The overall mortality rate among children due to acute poisoning was 9.9%. The most common toxic agents involved in acute poisoning among children were organophosphate compounds (35.8%), followed by organochlorine compounds (30.9%) and pyrethrum compounds (11.1%). Conclusion From this study, we concluded that acute poisoning among children is mainly accidental, and the most common toxic agent responsible for the poisoning is pesticide or insecticide. Most poisoning events among children are preventable, and the major reason is a lack of supervision by adults, including poor knowledge and attitude toward storage of such items.

Lead poisoning among asymptomatic individuals with a long-term history of opiate use in Golestan Cohort Study.

BACKGROUND: Recent reports of lead poisoning suggest that people who use opium may be exposed to high amounts of lead. Here, we investigate the association between opium use and blood lead levels (BLL) in a population-based cohort study. METHODS: In 2017, we studied a random sample of 410 people who currently (both within the past year and the past month) used opium and 104 who did not from participants of the Golestan Cohort Study in northeast Iran. Participants were stratified by sex and tobacco use history, completed a comprehensive opiate and tobacco use questionnaire and provided blood. BLL was measured by Lead Care® II Blood Lead Test Kit, validated by inductively coupled plasma triple quadrupole mass spectrometry. BLL was categorized as "<5 µg/dL", "elevated" (5-10 µg/dL), "high" (10-50 µg/dL), and "very high" (above 50 µg/dL). To assess the association between BLL categories and opiate use, route of consumption and weekly use, we used ordered logistic regression models, and report OR (odds ratio) and 95% CI (confidence interval) adjusted for age, sex, place of residence, education, occupation, household fuel type, and tobacco use. RESULTS: In the cohort, participants used only raw (teriak) or refined (shireh) opium, which were smoked (45%, n = 184), taken orally (46%, n = 189), or both (9%, n = 37), for a mean duration of 24.2 (standard deviation: 11.6) years. The median BLL was significantly higher in people who currently used opium (11.4 µg/dL; IQR: 5.2-23.4) compared with those who did not (2.3 µg/dL; IQR: 2.3-4.2), and the highest median BLL was seen in oral use (21.7 µg/dL; IQR: 12.1-34.1). The BLL was <5 µg/dL among 79.8% of people with no opiate use, compared with only 22.7% in those using opium. BLL was elevated in 21.7%, high in 50.5% and very high in 5.1% of people using opium. About 95% of those with oral (180/189) or dual use (35/37) and 55% (102/184) of those who smoked opium had levels of blood lead above 5 µg/dL. The OR for the association between any opium use and each unit of increase in BLL category was 10.5 (95%CI: 5.8-19.1), and oral use of opium was a very strong predictor of increasing BLL category (OR=74.1; 95%CI: 35.1-156.3). This odds ratio was 38.8 (95%CI: 15.9-95.1) for dual use and 4.9 (95%CI: 2.6-9.1) for opium smoking. There was an independent dose-response association between average weekly dose and BLL among people using opium, overall and when stratified by route of use. CONCLUSION: Our results indicate that regular use of lead-adulterated opium can expose individuals to high levels of lead, which may contribute to mortality and cancer risks associated with long-term opium use.

Opium poisoning in modern times. An overview.

Opium is a substance extracted from Papaver somniferum L that is chronically abused specially in the traditional production regions. Reports on opium poisoning has largely disappeared from the occidental literature on drug problems but recent scientific articles show cases of death related to opium in industrialized countries. This fact led us to consider the interest of knowing the state of the art of acute opium intoxication in modern times. This work shows a compilation of these uncommon cases occurred in different settings and circumstances. Data were obtained by a computer assisted search of the literature using the key words "opium poisoning", "poppy", "poppy seeds", and "papaver somniferum" in PubMed, accompanied by a hand search of the reference lists of all articles for any relevant studies not included in the database. In addition, Google Scholar, government reports, and cases adequately documented on websites were reviewed. Type 1 cases, Accidental opium intoxications when it is used as a recreational drug: Reported cases came mainly from industrialized countries. They were mostly male with a range age of 17-64 years. Many had antecedents of alcoholism or drug abuse and opium tea was used as a substitute of heroin. Rachacha has caused poisonings in France and has been detected in a stash in Spain. Toxicological analysis was documented in forensic cases. The danger of this renewed interest in opium is exemplified in that many of the poisoning cases resulted in fatalities. Type 2 cases, Accidental opium intoxications in children or adults when it used as folk remedy: Pediatric intoxication after the use of opium as folk remedy are mainly published in traditional opium-producing areas with a long history of use or ethnic communities in England or USA. Addiction to opium was common among relatives. Type 3 cases, Opium intoxications with poppy seeds consumed as food: Due to excessive consumption of opium seeds as food, sporadic cases of mild toxicity had been reported and morphine contents were documented. Type 4 cases: Accidental opium intoxications when using the abdominal or pelvic cavity for concealing the drug: Accidental opium body packer intoxications are seen in patients who traveled from illegal opium areas of production. Type 5 cases: Suicides by opium: Opium was a prevalent agent among cases of suicides in Iran but data are scarce.

Lead poisoning due to ingestion of lead-contaminated opium: A diagnostic study on patients' imaging findings.

OBJECTIVES: Our study attempts to determine if for patients following ingestion of lead-contaminated opium, radiographs [plain X-ray (KUB)] or unenhanced computed tomography (CT scan) of the abdomen may be predictive of lead poisoning. METHODS: Our study is concerned with patients of >21 years with elevated lead concentrations, who had undergone KUB or CT. Patients with other toxicities who had undergone similar imaging profiles but who had low blood lead level (BLL) were enrolled as controls. RESULTS: We evaluated a total of 79 cases and 79 controls with median [IQR] BLLs of 126 [97.4, 160] µg/dL and 8.7 [5.5, 15] µg/dL. All cases and eleven controls (13.9%) were addicted to oral opium, and of these cases, anemia (94.9%) and abdominal pain (92.4%) were the two most common clinical manifestations. Two radiologists reviewed the X-ray and non-contrast CTs. Fifty (63.3%) and 53 (67.1%) cases and controls underwent CT scanning with 34 (68%) vs. 6 (11.3%) positive CTs (P < 0.001) while 43 (54.4%) and 39 (43.3%) underwent X-rays with 21 (48.8%) vs. 4 (11.8%) positive X-rays, respectively (P < 0.001). Positive CT is associated with BLL between 10 and 45 µg/dL with a specificity of 96.9%, 88.7% and positive predictive value of 97.5% and 85% respectively. CONCLUSIONS: In suspected cases of lead exposure due to ingested opium, and if BLL is not readily available, a positive imaging result may guide radiologists and physicians to consider lead poisoning.

Lead Toxicity due to Ingestion of Lead-Contaminated Opium in a Patient Presenting with Motor Neuropathy and Upper Limb Paresis: A case report.

Opium users may present with central or peripheral nervous system-related symptoms, gastrointestinal complications and anaemia; in such cases, lead poisoning should be suspected and chelation therapy initiated as soon as possible. We report a 64-year-old male patient with a 20-year history of opium addiction who was referred to the Imam Reza Hospital, Birjand, Iran, in 2017 with severe motor neuropathy and paresis in both upper limbs. His primary symptoms were generalised weakness, abdominal and bone pain, constipation and lower limb paraesthesia that had started several months prior. In addition, he reported severe progressive bilateral paresis of the upper limbs of one month's duration. A diagnosis of lead poisoning was confirmed by a blood lead level of 140 µg/dL. The patient underwent chelation therapy after which he improved significantly. At a one-year follow-up visit, he was neurologically intact and symptom-free.

Oxidative stress in opium users after using lead-adulterated opium: The role of genetic polymorphism.

Use of lead-adulterated opium has become one of the major sources of lead poisoning in Iran. This study was designed to assess clinical effects and oxidative stress and its association with GSTM1, GSTT1, NQO1, and ALAD genes polymorphisms and blood lead level (BLL) in lead-adulterated opium users. The oxidative stress status in 192 opium users with lead poisoning symptoms measured and compared with 102 healthy individuals. Gluthatione S-transferase (GST)-M1 and -T1 genes deletion, NQO1 rs1800566, and δ-aminolevulinic acid dehydratase (ALAD) rs1800435 polymorphisms were determined using PCR and PCR-RFLP. The relation between the polymorphisms, BLL, and oxidative stress parameters were analysed using multivariate linear regressions. The common symptoms of lead toxicity were gastrointestinal and neurologic complications. Oxidative stress was significantly higher in opium addicts and lipid peroxidation significantly correlated with BLL. There was significant association between ALAD rs1800435 and BLL, and the BLL was significantly lower in the patients with ALAD 1-2 genotype. Use of lead-adulterated opium causes high frequency of lead toxicity symptoms, hematological and biochemical abnormalities, and oxidative stress which are associated with BLL. Route of opioid use and the polymorphism of rs1800435 in ALAD gene are the major determinants of BLL in lead-adulterated opium users.

An interesting case of opium tea toxicity.

We present an unusual cause of respiratory arrest resulting from sole ingestion of home-brewed opium tea. A 64-year-old woman was found unresponsive and in respiratory arrest by a first responder. There were no obvious signs of regular recreational drug use. On presentation to the local district general hospital, the patient was in extremis, with severe physiological and biochemical derangements. A naloxone infusion was commenced and she later made a good recovery. It was subsequently discovered that she had brewed opium tea from opium buds she had picked from a nearby commercial poppy farm, a practice she had learnt while in Afghanistan.

Dióxido de cloro: la verdad toxicológica y el riesgo de las noticias falsas / Chlorine dioxide: the toxicological truth and the risk of fake news

El dióxido de cloro es una sustancia que se ha usado como desinfectante para tratar el agua de consumo humano. A las dosis usadas en este escenario no se han asociado compromisos toxicológicos para el ser humano. Químicamente, el dióxido de cloro se caracteriza por reaccionar con diversas moléculas y generar estrés oxidativo en los microorganismos y en las células. A pesar de no ser un medicamento ni estar aprobado por las agencias reguladoras, se ha promovido su uso como una solución milagrosa; sin embargo, no hay ninguna evidencia científica que lo respalde. De otro lado, sí hay evidencia de que puede generar toxicidad aguda, y posiblemente crónica, para el ser humano.

Summary Chlorine dioxide has been used as a disinfectant to treat water for human consumption, at the doses used in this scenario, human poisoning has not been described. Chemically, chlorine dioxide is characterized by reacting with various molecules, and generating oxidative stress in microorganisms, and in human cells. Chlorine dioxide is not a medicine, and it is not approved by regulatory agencies. Chlorine dioxide has been promoted as a miracle solution, yet there is no scientific evidence to back it up. On the other hand, there is evidence, that it can generate acute poisoning and possibly chronic poisoning in humans.

Death in a legal poppy field in Spain.

Opium is a substance extracted from Papaver somniferum L. Opium latex contains morphine, codeine, and thebaine and non-analgesic alkaloids such as papaverine and noscapine. In Spain opium growing is allowed only for scientific or pharmaceutical purposes and harvest is supervised by the Spanish Health Ministry. This work describes a sudden fatality involving opium consumption in a legal poppy field. The toxicological and autopsy findings, previous disease, paraphernalia, and scenario are discussed in order to clarify cause and manner of death. A 32-year-old white caucasian male was found unresponsive in a legal poppy field in the South of Spain. The emergency medical services responded to the scene where he was pronounced dead. The friends explained that the deceased had presented with about 30min of convulsions; in spite of trying to keep his airway tract open they noted that "he stayed airless". According to them the victim suffered from epilepsy. Tools found beside his body consisted of plain wood sticks with a blade razor, a fabric handle, and paper. A comprehensive toxicological screening for abuse and psychoactive drugs was performed in the deceased samples. This included ethanol and volatile analysis by HS-GC-FID in peripheral blood and urine, enzyme immunoassay in urine by CEDIA, and a basic drug screening in all samples (including paraphernalia) by GC-MS using modes full scan for screening/confirmation and selected ion monitoring for quantitation. The peripheral blood, urine, vitreous, and gastric content contained the following concentrations of opiates expressed in mg/L (gastric content additionally also expressed in mg total): 0.10, 7.12, 0.23, and 14.80 (2.81mg total) of thebaine, 0.13, 4.50, 0.13, and 6.60 (1.25mg total) of morphine (free), 0.48, 0.88, 0.17, and 1.50 (0.28mg total) of codeine. These tree opiates were also detected in the tools (paraphernalia) used by the deceased for opium consumption. Other toxicological findings were metabolites of cocaine and cannabis. Apparently the victim stole poppy capsules and ingested an unknown quantity of the latex with the goal to obtain euphoric effects. The cause of death was considered poly-drug toxicity with a preponderant role of thebaine and morphine. In addition, the epileptic condition of the deceased could have played a role. As far as we know, there are no previous reports of fatalities occurring in legal poppy fields.

Intoxicação natural e experimental por Nerium oleander (Apocynaceae) em bovinos no Rio Grande do Sul / Natural and experimental poisoning by Nerium oleander (Apocynaceae) in cattle in Rio Grande do Sul

Descreve-se a intoxicação natural e experimental por Nerium oleander em bovinos no Rio Grande do Sul, Brasil. Dois de oito bovinos morreram subitamente após consumirem folhas de galhos de N. oleander que haviam sido podados e jogados no piquete onde os animais eram mantidos. Não foram observados sinais clínicos em uma vaca, mas um terneiro de 4 meses de idade apresentou decúbito lateral, movimentos de pedalagem, vocalização e morte. As alterações macroscópicas mais importantes observadas na vaca morta naturalmente e em duas novilhas intoxicadas experimentalmente ocorreram no coração que apresentava petéquias e equimoses no átrio esquerdo, coágulos e hemorragias no endocárdio do ventrículo esquerdo e áreas levemente pálidas no septo interventricular e em porções do miocárdio dos ventrículos. Na histologia, havia necrose de coagulação de fibras cardíacas individuais e de pequenos agrupamentos, caracterizada por aumento de eosinofilia citoplasmática e núcleos picnóticos. Essas lesões eram mais acentuadas no músculo papilar. O diagnóstico foi fundamentado na presença da planta no potreiro onde estavam os animais, quadro clínico-patológico compatível e reprodução experimental em dois bovinos nas doses de 0,5 e 1,0g/kg de folhas frescas da planta.

This paper describes natural and experimental poisoning of cattle by Nerium oleander in Rio Grande do Sul. Two out of eight cattle died acutely after consumption of leaves of Nerium oleander, branches of which had been cut and placed into a paddock where the animals were kept. An affected cow did not show clinical signs, but a 4-month-old calf presented lateral recumbence, paddling, vocalization and death. Main gross findings in the cow naturally poisoned and in two experimentally intoxicated heifers were observed in the heart and included hemorrhages in the left atrium, clots and hemorrhages in the left ventricular endocardium, and pale areas in the interventricular septum and ventricular myocardium. Histologically, there was coagulation necrosis of individual cardiac fibers or small groups of fibers, characterized by enhanced cytoplasmic eosinophily and picnotic nuclei. These lesions were most severe in the papillary muscle. The diagnosis was based on presence of the trimmed N. oleander in the paddock where the animals stayed, evidence of consumption of the plant, consistent clinical and pathological findings, and experimental reproduction of the disease through oral administration of 0.5 and 1.0g/kg of its green leaves to two cattle.

Tratamiento de intoxicaciones por compuestos hepatotóxicos: uso de la N-acetilcisteína y las carboximetilcisteína: [revisión] / Treatment of intoxications by hepatotoxic compounds: use of N-acetylcystein and S-carboxymetylcystein: [review]

La N-acetilcisteina (NAC) es un fármaco con propiedades antidóticas útiles en la intoxicación por compuestos hepatotóxicos, como paraquat, acetaminofen y fósforo inorgánico. No se encuentra fácilmente disponible en Venezuela a pesar que la frecuencia y severidad de este tipo de intoxicación son significativas. Se discuten ciertas características fármacocinéticas y fármacodinámicas de la NAC y de la S-carboximetilcisteina (SCMC), presente en el mercado farmacéutico venezolano. Además se presenta una revisión de las experiencias clínicas y experimentales con la SCMC en intoxicaciones por compuestos hepatototóxicos.

N-acetylcysteine (NAC) is a drug with antidotal properties useful in poisoning by hepatotoxic compounds such as paraquat, acetaminophen and inorganic phosphorus. Although the frequency and severity of this type of poisoning are significant, NAC is not readily available in Venezuela. Certain pharmacokinetic and pharmacodynamic characteristics of NAC and S-carboxymetylcisteine (SCMC), available in venezuelan pharmaceutical market are discussed. In addition, a review of the clinical and experimental experiences with SCMC in poisoning for hepatotoxic compounds is presented.