[Poisonings in Germany : Poisons Centres, Medical Management and National Monitoring]. / Vergiftungen in Deutschland : Giftinformationszentren, medizinische Versorgung und nationales Monitoring.

BACKGROUND: Illnesses caused by exposure to extracorporeal artificial substances play a major role in emergency medicine, family medicine, and environmental medicine. OBJECTIVE: The current situation of medical poisoning management and national reporting of poisonings in Germany are described. MATERIALS UND METHODS: The information and data presented here are derived from a literature review and from stakeholder interviews. RESULTS AND CONCLUSION: Eight poison centres (PCs) offer consultation supporting the diagnosis and treatment of poisoning cases in Germany today. Furthermore, those affected, their relatives and first aiders contact these German PCs, mainly because of a suspected poisoning. German PCs are also contacted by those affected and by institutions in other situations when expert toxicological judgement is needed, especially in cases with an environmental background. Often, interpretation of analytical laboratory results of body fluid samples or environmental samples are requested, or reference to environmental medicine treatment facilities is made. The PCs and the German Federal Institute for Risk Assessment (BfR) cooperate on the national reporting of the risks of poisoning for the population. In addition, the BfR collects and evaluates poisoning reports from German medical doctors that have been directly submitted. A pilot project on a national monitoring of poisonings should collate future case reports. An extensive and current overview of poisonings in Germany is a prerequisite for the identification of unsafe products and to fully comply with the international reporting needs of the German Federal Government in the case of chemical outbreaks and the resulting suspected cases.

Acute selenium poisoning by paradise nuts (Lecythis ollaria).

Two previously healthy women developed nausea, vomiting, headache and dizziness for several days, a massive hair loss about 2 weeks later and a discoloration of the fingernails. Detailed diagnostic procedures did not reveal any pathological results. Therapeutic measures did not show any effect. Thallium and arsenic were within normal range in plasma. Delayed quantitative determination of selenium in blood, however revealed toxic values (in case I: 479 microg/L of serum, 8 weeks after ingestion, and in case II 300 microg/L of serum, 9 weeks after ingestion). In retrospect, a relation to the ingestion of paradise nuts could be established.