[Hyponatremia in toxicological practice].

Hyponatremia, defined as a serum sodium <135 mmol/l, is the most common clinical disorder of water and electrolyte balance. Hyponatremia occurs in approximately 15-20% of hospitalized patients and up to 20% of patients in critical condition. It can lead to a wide range of clinical symptoms, from mild to even life-threatening, and is associated with increased mortality and longer duration of hospitalization in patients affected by many different syndromes. The diagnosis and treatment of hyponatremia in patients' is still a major problem. Hyponatremia is a disorder observed commonly in toxicological practice. It most often occurs in people who abuse alcohol, narcotics - mainly ecstasy, drugs, as well as the so-called water intoxication in athletes and the people who are mentally ill. In view of the complex pathomechanisms and a variety of symptoms observed in poisoned patients, hyponatremia should be considered as one of the reasons and the exponent of the general condition of the patient.

[Morphine (obtained from poppy seeds) and dextrometorfan poisoning­ a case report].

Morphine is one of the many, and pharmacologically most important, opium poppy alkaloid (Papaver somniferum). A poppy plant consists of a lot of alkaloids. Most of them are morphine, codeine, narcotine, papaverine, thebaine, narceine and narcotoline. Most of the alkaloid is in the poppy milk - opium..It is a dried and properly processed juice with precut immature poppy-heads. It induces euphoria, somnolence, has an analgesic effect. In the study was presented a 24-yearold patient who was admitted to the Department of Toxicology and Cardiology because of suspicion of poisoning with unknown drugs. In retrospect, it turned out that he was poisoned brew with 5 kg of poppy and dextromethorphan. In the past, he drank alcohol heavily, used legal highs, amphetamine, methamphetamine, opiates, diazepam, cannabinoids. At the time of admission to the department, his general condition was severe, he was unconscious, with periodic breathing disorders, pinpoint pupils. In the laboratory: opiates>2000 ng/ml, other toxicological tests were negative. On the subsequent days of his stay he remained in a generally very severe condition; he was unconscious. Some electrolyte disorders were observed, as well as characteristics of developing rhabdomyolysis. With the applied intensive medical therapy, a gradual improvement of his general condition was achieved. Due to quadriplegia on the 30th day of the hospitalization, the patient was transferred to the Department of Neurology for further treatment.

[Nanopaticles cardiotoxity--review of the literature]. / Nanoczastki- toksycznosc 6 dla ukladu krazenia--przeglad pismiennictwa.

Nanoparticles are structures with at least one demension smaller than 100 nm. The rapid development of nanotechnology means that each day comes new nanostructures and also new opportunities for their use. However it should be remembered, that nanotechnology is not only benefits and progress, but the risk of side effects. Due to the unique properties of nanoparticles linked to their size and also large active surface, the nanoparticles interact virtually the entire human body, causing a variety of adverse effects also at the cellular level. The paper presents the general characteristics of the nanoparticles, their use, route of exposure and reports of their cardiotoxicity.

[Heart injury secondary to carbon monoxide poisoning--the use of imaging techniques]. / Uszkodzenie serca w przebiegu zatrucia tlenkiem wegla--zastosowanie badan obrazowych.

The heart muscle is particularly sensitive to the toxic effects of carbon monoxide. Cardiovascular complications are present in 30-40% poisoned patients. Currently, multiple ECG records and at least two-time determination of cardiac markers' concentration (mainly troponin I) are known as the gold standard practice in the diagnosis of cardiac injury especially with regard to medium and severe poisoning. So far there have not been any recommendations for further diagnostic steps in case of abnormalities in these examinations. This paper presents a review of cardiac imaging techniques as well as the analysis of their usefulness in carbon monoxide poisoning. According to the authors echocardiography is considered to be an extremely important examination which, thanks to its accessibility and non-invasive nature, should be performed on all patients with myocardium injury suspicion made on the basis of clinical image, ECG records and biochemical markers.

[Gamma-hydroxybutyrate (GHB) and its lactone (GBL) as psychoactive substances]. / Kwas gamma-hydroksymaslowy (GHB) i jego lakton (GBL) jako substancje psychoaktywne.

Gammabutyrolactone is included in the solvent such as wheel cleaners, pesticides, cosmetics, drugs. After ingestion GBL is converted to gamma-hydroxybutyrate. Both substances are classified as so called "club drugs" and their action is characterized by euphoria, sedation, and induction of retrograde amnesia of events. These activities were basis for the use of GHB and its lactone as rape pill. Acute poisoning with these compounds causes confusion, agitation, ataxia, nausea, vomiting, nystagmus, dyskinesia, hallucinations, coma, irregular breathing, hypothermia, bradycardia, hypotension, convulsions, respiratory paralysis and thus respiratory arrest. These substances carry a risk of development of physical addiction of the hard proceeding of abstinence syndrome. In the USA there is a ban on the sale and promotion of these compounds. In Poland despite the fact that GHB is a controlled substance, there is no regulation of GBL trading. The aim of this paper is to summarize current knowledge regarding the pharmacology, impact on the human body, toxicity, and the effects of chronic abuse of these substances.

[Myocardial infarction in the course of ethylene glycol poisoning--a case report]. / Zawal serca w przebiegu zatrucia glikolem etylenowym--opis przypadku.

The following paper describes the case of the 59-year-old patient moved from Clinical Cardiology to the Centre of Clinical Toxicology because of severe ethylene glycol poisoning, which occurred in the course of myocardial infarction of inferior wall. Ethylene glycol concentration was 85 mg/dl, the blood pH - 6.9, troponin >50 ng/ml, CK-MB 297.1 U/L. ECG current of injury was found at the bottom of the wall cuts reflective reductions in section ST in leads I, aVL and the precordial leads. In the coronarography was RCA occlusion, OM critical stenosis and suspected mouth of LAD stenosis. RCA urgent angioplasty was performed with implantation of bare metal stents 5. In addition, toxicological treatment consisted of mechanical ventilation, hemodialysis, ethanol, and intensive medical care. On 19 day of hospitalization the patient in good general condition was discharged home.