The right of a doctor to inform an employer of contraindications to perform a certain type of work by an employee / Prawo lekarza do informowania pracodawcy o przeciwwskazaniach do wykonywania okreslonego rodzaju pracy przez pracownika

BACKGROUND: The aim of this study is to analyze the legal regulations that pertain to the duty of doctor-patient privilege and the possibility of its repeal on the plane to provide information about the patient's health status to his employer. MATERIAL AND METHODS: The material constitutes the current Polish law regulations relating to the medical duty of doctor­patient privilege as well as provisions defining the scope of information on the patient's health status that may be transferred to a patient's employer. RESULTS: The doctor has no right to provide the employer with information on contraindications to perform a specific job, if the information was obtained in the mode of providing health services that are not eligible for the catalogue of preliminary/preventive/control examinations. The basis for the doctor providing information to the employer cannot be an exception to the obligation of medical confidentiality, which is governed by art. 40 § 2 pts 1­6 of the Act of Medical Profession, under which cases of admission of professional secrecy were listed, which makes it impossible to use the cited article in cases other than strictly specified in its content. CONCLUSIONS: Polish law specifies the circumstances in which it is possible to provide an employer with the medical information on the patient's health. However, there are regulations that provide for the information on contraindications to perform a certain type of work or job to be transmitted if the information has been obtained in a manner other than as provided in the ordinance on medical examinations of employees. Med Pr 2018;69(6):613­620

[Accidental severe poisoning with methemoglobinogenic substance: A case report]. / Zatrucie substancja methemoglobinotwórcza o ciezkim przebiegu ­ opis przypadku.

A 45-year-old male patient was admitted to the Regional Poison Center because of poisoning with dimethyloaniline contained in a toxic resin-curing dimethyl aniline-based formulation ingested inadvertently. Intoxication happened at workplace. The patient was then transferred to the Toxicology Clinic, where he stayed for 3 weeks. During the hospitalization, the primary method of treatment involved administration of methylene blue, which is the antidote of choice in such cases. During the intensive care and treatment of the patient massive intravascular hemolysis was seen. In that case treatment with blood products was required. He also showed signs of liver dysfunction due to cholestatic liver damage and jaundice. The reported case shows that severe organ damage may result from poisoning with even a small amount of the toxicant. Med Pr 2017;68(6):795-801.

High-mobility group box 1 protein levels in serum of subjects after exposure to fire smoke--short communication.

INTRODUCTION: Fire smoke inhalation a recognized etiologic factor of airway injuries. The objective of this study was evaluation of serum high-mobility group box 1 (HMGB1) protein concentration in subjects exposed to fire smoke (SEFS). MATERIAL AND METHODS: The study group consisted of 40 consecutive patients admitted to the Toxicology Unit, Lodz, Poland after exposure to fire smoke. Serum HMGB1 concentrations were measured upon admission to hospital and rechecked on the 2nd and on the day of discharge. Patients also underwent routine toxicological diagnostic procedures applied in case of those exposures, such as carboxyhaemoglobin (COHb) levels and urinary thiocyanate concentrations. The same diagnostic tests were performed in 10 healthy volunteers not exposed to smoke of the control group. RESULTS: The average serum SEFS concentration of HMGB1 protein was not significantly higher on admission in comparison with the respective values recorded on the 2nd day and on the day of discharge. The mean serum level of HMGB1 protein of exposed group was higher than that one in the control group, however the difference was not statistically significant. The highest concentration of HMGB1 protein was noted in serum of 28 subjects exposed to fire smoke reporting at least one symptom and the difference was statistically significant in a comparison with the control group. CONCLUSION: As indicated, an acute exposure to smoke may lead to transient increase of HMGB1 in serum in exposed subjects. Further studies are necessary in order to confirm the importance of this protein in pathogenesis of acute airway injury due to exposure to fire smoke.

Health effects and arsenic species in urine of copper smelter workers.

The aim of this study was to compare indices of exposure in workers employed at different work posts in a copper smelter plant using neurophysiological tests and to evaluate the relationship between urinary arsenic species with the aid of sensitive respiratory and renal biomarkers. We have attempted to elucidate the impact of different arsenic speciation forms on the observed health effects. We focused on the workers (n = 45) exposed to atmospheres containing specific diverse mixtures of metals (such as those occurring in Departments of Furnaces, Lead and Electrolysis) compared to controls (n = 16). Subjective symptoms from the central (CNS) and the peripheral (PNS) nervous system were recorded and visual evoked potential (VEP), electroneurography (ENeG) and electroencephalography (EEG) curves were analysed. Levels of airborne lead (PbA), zinc (ZnA) and copper (CuA) and Pb levels in blood (PbB) and the relationships between airborne As concentrations (AsA) and the urinary levels of the inorganic (iAs); As(+3), As(+5) and the organic; methylarsonate (MMA(V)), dimethylarsinate (DMA(V)) and arsenobetaine (AsB) arsenic species were determined by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Effects of exposure were expressed in terms of biomarker levels: Clara cell protein (CC16) in serum as early pulmonary biomarker and ß2-microglobulin (ß2M) in urine and serum, retinol binding protein (RBP) as renal markers, measured by sensitive latex-immunoassay (LIA). Abnormal results of neurophysiological tests, VEP, EEG and ENeG showed dominant subclinical effects in CNS and PNS of workers from Departments of Lead and Furnace. In group of smelters from Departments of Furnace exposed to arsenic above current TLV, excreted arsenic species As(+3) and As(+5) seemed to reduce the level of Clara cell protein (CC16), thereby reducing anti-inflammatory potential of the lungs and increasing the levels of renal biomarker (ß2M) and copper in urine (CuU). The study confirmed deleterious arsenic effects to the kidney by increased levels of low-molecular weight protein in urine and the extent of the renal copper accumulation/excretion. The results of our work also support the usefulness of application of the sensitive neurophysiologic tests, such as VEP, EEG and ENeG, for the detection of early subclinical effects of the exposure of the nervous system in copper smelters.

[Metformin poisoning--clinical features, diagnostics and treatment--case presentations]. / Zatrucie metformina--symptomatologia, diagnostyka i leczenie--prezentacja przypadków klinicznych.

Metformin has been used for many years as oral anti-hyperglycaemic agent in the treatment of type 2 diabetes mellitus either in Poland or in the world. Metformin is the most commonly prescribed agent, but acute poisonings of this agent are rare. A review of our experience indicates, that poisoning with this agent may lead to life-threatening or fatal metformin toxicity. The authors of this publication postulate, that each patient with metformin exposure should be hospitalized. Physician must be vigilant to recognize anti-hyperglycaemic agent poisonings like biguanides when hypoglycaemia and acidosis are present in laboratory results. We present patients with metformin toxicity, some of them with fatal course.

[Intoxication or false-positive acetaminophen result of toxicological determinations? Two case reports]. / Zatrucie paracetamolem czy falszywie dodatni wynik analizy toksykologicznej? Opis 2 przypadków.

The aim of this study was to show the diagnostic procedure used in the two cases with false-positive serum acetaminophen results in suspected acetaminophen poisoning. The determination of serum acetaminophen were carried out using a UV/VIS spectrophotometer (Specord 40 Analytik Jena), coupled with an analytic computer station WinASPECT. The employed method of determination was based on the acetaminophen reaction with sodium nitrite, which yields yellow colour of solution in the presence of sodium hydrate. The intensity of the yellow colour depends on the concentration of acetaminophen in serum. The relationship between absorbance and concentration was linear at concentrations in the range 50-600 microg/mL, with relative standard deviation of +/- 2.1% and detection limit of 30 microg/mL. To confirm or reject the doubtful results of colorimetric assays, the serums of patients were measured with high performance liquid chromatography with mass spectrometry detection and gas chromatography with mass spectrometry detection. The analysis of presented cases leads to a conclusion that acetaminophen results should be confirmed either by scanning urine for p-aminophenol presence (which is a routine procedure in our laboratory) or by using a different method of measuring acetaminophen serum levels.

Clara Cell protein and myeloperoxidase levels in serum of subjects after exposure to fire smoke.

INTRODUCTION: Fire smoke inhalation is a well-recognized aetiological factor of airway injuries. The objective of this study was evaluation of Clara cell protein (CC16) and myeloperoxidase (MPO) concentrations in serum of patients after exposure to uncontrolled fire smoke. METHODS: The study group consisted of 40 consecutive patients admitted to the Toxicology Unit after exposure to fire smoke. CC16 and MPO concentrations in their serum samples was measured on the day of admission to hospital and rechecked at the 2nd day and on the day of discharge. Patients also underwent routine toxicological diagnostic procedures applied in case of exposures, such as carboxyhaemoglobin (COHb) levels and blood lactate and urinary thiocyanate concentrations. The same diagnostic tests were performed in the control group consisting of 10 healthy subjects not exposed to fire smoke. RESULTS: The average concentration of CC16 in the serum of subjects exposed to toxic factors was significantly higher at the day of admission in comparison with the respective values recorded on the 2nd day and on the day of discharge. The mean level of CC16 in the serum of the exposed group was also significantly higher than that in the control group. Tests for MPO concentrations in the serum did not reveal any significant changes in patients exposed to fire smoke. CONCLUSIONS: As indicated, acute exposure to smoke induces injury at the alveolar level, which results in a transient increase of CC16 in serum of exposed subjects.

[Acute ethylene glycol poisoning among patients of Nofer Institute of Occupational Medicine in Lódz, Toxicology Unit, hospitalized in the years 2000-2009]. / Ostre zatrucia glikolem etylenowym wsród pacjentów oddzialu Toksykologii Instytutu Medycyny Pracy im. Nofera w Lodzi, hospitalizowanych w latach 2000-2009.

Acute poisonings with ethylene glycol pose real challenge in the clinical toxicology. The main objective of this study is an analysis of clinical features and identification of prognostic factors in poisoning with ethylene glycol of patients hospitalized in the Toxicology Unit in the years 2000-2009. The medical records of the patients were identified and separated. In the years 2000-2009, 102 patients were hospitalized due to ethylene glycol poisoning, what accounted for 0.38% of total admissions to the unit (26.801 hospitalized people). The mean age of patients amounted 48.05 +/- 12.55 years, the history positive for chronic alcohol abuse was present in 63 (61.76%) cases. Mean values of ethylene glycol concentration were as: in serum 173.14 mg/dl, in urine 6576.46 mg/l. Patients condition on admission varied, with 63 (61.76%) cases described as the severe state. The most frequently noted pathologies were consciousness disturbances and tachycardia. 14 patients died within the analysed group and 63 (61.76%) developed single or multiorgan complications in the course of disease. The most commonly encountered complication were: acute renal failure, anaemia, pneumonia and central nervous system damage. Such parameters as: BE and HCO3 measured on admission should be considered as the prognostic factors, determining the course of the disease and the outcomes of treatment. Poor prognosis may be associated with such clinical features on admission, as: respiratory and circulatory disturbances and cerebral sequelae. The importance of acute poisoning of ethylene glycol is determined both by high frequency of immediate life threatening conditions and by the risk of complications leading to permanent organs damage.

[Medical analytical toxicology in Poland in year 2012]. / Kliniczna analityka toksykologiczna w Polsce w 2012 roku.

There are 12 centers of acute poisoning treatment and 9 round the clock toxicological laboratories. Most of the laboratories access evidence of activity run by National Clinical Toxicology Consultant. The paper presents actual status of medical toxicology laboratories in Poland and summarizes activity of the laboratories in the year 2012. In 2012 toxicological laboratories reported 113,719 assays. There were diagnosed 63.8% men and 34.8% women. The toxicological laboratories determine most substances and markers of exposition to chemical compounds important for diagnosis and treatment of acute poisonings (i.e. ethanol, methanol, ethylene glycol, acetaminophen, salicylates, anticonvulsants, carboxyhemoglobin, methemoglobin). There is not possible to determine heavy metals, all medicines and "designed" drugs of abuse in all laboratories. Limited access to reference methods, that enable to confirm results obtained by screening methods (immunological cassette and strip tests) is also a problem.

[Kidney transplants from donors burdened metabolic acidosis in the course of poisoning with methanol and carbon monoxide]. / Transplantacje nerek od dawców obciazonych kwasica metaboliczna w przebiegu zatruc metanolem i tlenkiem wegla.

The question of obtaining organs from donors who died of methanol poisoning has been discussed in the medical literature for many years. The results of such transplants published so far are very optimistic. However, the possibility of permanent and significant injury to transplanted organs caused by poisons or its metabolites raises serious concerns regarding the procedure. The long-term effects of intensive treatment of poisoning need to be considered as well. Metabolic acidosis and high blood osmolality are agents with recognized damaging potential impairing organ function at cellular level. The study traced the fate of kidney transplants from 13 donors who died of methanol poisoning and one isoned with carbon monoxide. The donors group consisted of 12 men and 2 women, of mean age 49 years (SD +/- 7.93). The kidneys were transplanted 20 men and 8 women. The mean age of recipients was 50.29 years (SD +/- 12.9). At the time of admission to the Department of Toxicology all donors presented with profound metabolic acidosis and high plasma osmolality (mean 434.71 mOsm/kg H2O (SD +/- 73.29). Metabolic acidosis was treated high doses of sodium bicarbonate (mean infusion volume of was 409 ml) before the HD procedure. Blood methanol levels were between 125 and 470 mg% (mean 317.23 SD +/- 136.83). The carboxyhaemoglobin concentration of in the donor poisoned with carbon monoxide was 47.2%. Transplantation was performed after confirmation of the brain death, the period of cold ischemia (CIT) ranged from 6 to 22 hours (mean 16.06 hours; SD +/- 3.99). Kidneys have taken function immediately after transplantation in 21 recipients. In seven cases, patients required two or three HD procedures. A total of 16 dialysis were performed post-transplants. In the group of patients, the mean glomerular filtration rate (GFR) at 3 months after transplantation was 46.71 ml/min/1.73m2 (SD +/- 10.89). During the 18 months follow-up a constant upward trend to the mean GFR 50.55 was noticed. In the group of donors, the mean blood urea concentration (BUN) 3 months after transplantation was 61.43 mg/dL, including 7 patients with BUN within the range of 80-100 mg/dL. At 18 months post transplant, the average concentration was 42.36 mg/dL, with no cases exceeding 55 mg/dL. Similarly, serum creatinine level normalized with the mean value of 3.01 mg/dL at 3 months and 1.68 mg/dL at 18 months post the procedure. There was no case exceeding 2 mg/dL. One recipient died of a heart attack after a period of more than 18 months after transplantation. However, the transplant was efficiently active at all times (GFR 56-60 ml).

[Acute novel drugs poisoning among patients of Nofer Institute of Occupational Medicine in Lodz, Toxicology Unit, hospitalized in the years 2008-2012--epidemiology, clinical state]. / Ostre zatrucia nowymi srodkami psychoaktywnymi wsród pacjentów oddzialu Toksykologii Instytutu Medycyny Pracy w Lodzi w latach 2008-2012-- rozpowszechnienie, obraz kliniczny zatrucia.

UNLABELLED: Intoxication with novel recreational drugs poses significant challenge for medical staff due to diagnostic difficulties, complex clinical pattern, resulting from polyethiology of poisoning and potential risk of life threatening complications. OBJECTIVES: Description of clinical pattern novel drug intoxication. METHODS: retrospective review of medical records patients hospitalized in the Toxicology Unit (TU) with diagnosis of intoxication with novel recreational drugs. RESULTS: During the period from 2008-2010--431 patients were admitted to TU with mentioned above diagnosis. 159 (36.9%) patients were positive for ethanol with its average concentration in blood 150 mg%. Presence of other substances like amphetamine, cannabinoids, atropine, ephedrine, carbamazepine, benzodiazepines and dextrometorphan was confirmed. The most frequent clinical symptoms observed on admission were: anxiety, agitation, complaints associated with circulatory system and vertigo Average pulse rate and both: diastolic and systolic pressure were within normal limits, however authors noted slight tendency toward tachycardia. One patients died due to multiorgan failure. Average period of hospitalization amounted 2.24 days. Co-poisoning with ethanol was associated with higher frequency of circulatory system disturbances. RESULTS: Clinical pattern of poisoning with novel drugs could partially correspond with mild sympathomime. tic syndrome.

[Acute poisonings with carbon monoxide among the patients hospitalized in the Toxicology Unit during the period of 2006-2010]. / Zatrucia tlenkiem wegla w materiale Oddzialu Toksykologii Instytutu Medycyny Pracy w Lodzi w latach 2006-2010.

Acute poisonings with carbon monoxide pose real challenge in the clinical toxicology. Its importance is determined both by high frequency of immediate life threatening conditions and by the risk of complications leading to permanent organs damage. The main objective of this study is an identification of prognostic factors on the base of analysis the cohort of patients hospitalized due to intoxication with these agents in the Toxicology Unit during the period 2006-2010. During the search process 571 patients hospitalized due to carbon monoxide poisoning during the period 2006-2010 were identified within total number of 21 400 subjects hospitalized during studied period. Therefore intoxications with carbon monoxide accounted for 2.66% of total admissions to the unit. The main sources of exposure were faulty gas heaters. Patients condition on admission varied, with most cases described as the moderate and severe state. At the moment of admission to hospital, the most frequently noted pathologies were: vertigo, headeache and complains from the respiratory tract. The most commonly encountered complication were labyrinths' injuries, neurological abnormalities and pneumonia. Mean concentration of COHb measured on admission in this group was in the blood 21.50 +/- 10.96%. Poor prognosis may be associated with such clinical features on admission, as: respiratory and circulatory disturbances, cerebral sequelae and reported sequelae from labyrinths. Such parameters as: COHb level, lactate and troponine concentrations and BE values measured on admission should be considered as the prognostic factors, determining the course of the disease and the outcomes of treatment.

[Acute methanol poisoning among patients of Toxicology Unit, Nofer Institute of Occupational Medicine in Lódz, during the period 2000-2009]. / Ostre zatrucia alkoholem metylowym wsród pacjentów Oddzialu Toksykologii Instytutu Medycyny Pracy im. Nofera w Lodzi, hospitalizowanych w latach 2000-2009.

The main objective of this study was an analysis of the cohort of patients hospitalized due to intoxication with this agent during the period 2000-2009 and investigate factors, which determined the course of poisoning. During the search process, 288 (1.07%) patients were identified within total number of 26801 patients hospitalized. Within analysed cohort male patients formed majority with 227 males, whereas only 61 females were found within this group. The mean methanol blood concentration was 50.09 mg/dl and ethanol - 292.90 mg/dl. Patients condition on admission varied, the most frequently noted pathologies were consciousseness disturbances and tachycardia, namely the former was recorded in 171 cases (59.4%) whereas the latter in 89 patients (30.90%). 11 patients died within the analysed group and 72 developed single or multiorgan complications in the course of poisoning. The most commonly encountered complication was pneumonia. Features of central nervous system (CNS) damage were found in 20 cases (6.94%). Average concentrations of methanol in the group of the 11 deceased patients were: 158.73 mg/ dl, 20.91 mg/dl for ethanol. The average values of arterial blood gases parameters in this group were pH= 6.98; BE=(-) 22.482; HCO3=9.67 mmol/l. Within the non survivors group such complications as CNS damage, seizures, pneumonia, liver injury and pancreatitis were noted more frequently, with statistical significance. The concentrations of methanol and ethanol in the blood on admission and such ABG parameters as pH, BE, HCO3, pCO2 i pO2 also measured on admission should be considered as the prognostic factors, determining the course of the disease and the outcomes of treatment. Poor prognosis may be associated with such clinical features on admission, as: respiratory and circulatory disturbances and cerebral sequelae.

[Suicidal intoxication with digoxin--still actual problem in clinical toxicology--case report]. / Samobójcze zatrucie digoksyna--nadal aktualny problem toksykologii klinicznej --opis przypadku.

We present case a male patient who attempted suicide by ingestion of 90 tablets of digoxin in total dose of 22.5 mg. A measured peak level of digoxin was 6,75 ng/ml. Temporary invasive cardiac pacing with single chamber ventricular pacer was performed for treatment of the life-threatening rhythm and conduction disturbances that revealed within few hours after admission. According to the authors, presented method of therapy should always be taken into consideration in case development of cardiovascular disturbances in acute poisoning with digoxin.

[Sodium azide--clinical course of the poisoning and treatment]. / Azydek sodu--przebieg kliniczny zatrucia i leczenie.

Sodium azide poisonings occur very rarely. The mechanism of sodium azide toxic effect has not yet been fully explained. Despite the lack of an explicit procedure for the cases of sodium azide poisonings, in vitro tests and rare case reports suggest that treatment with antidotes for cyanide poisoning victims can be effective. This study describes two cases of suicidal sodium azide ingestion. Case 1. 30-year-old male ingested ca. 180 mg of sodium azide. On admission to hospital, within 4 hours from poisoning, the man complained of dizziness and anxiety. Physical examination revealed horizontal nystagmus, flapping tremor, HR 135/min. In laboratory tests, higher blood concentration of lactates (3 mmol/l) was detected, as well as lower potassium concentration (3.4 mmol/L) and increased transaminase activity (ALT 74 U/l, AST 90 U/l). Electrocardiographic tests showed a negative T wave in limb lead III. Other results were within normal. As the patient ingested a toxic dose of sodium azide, he was treated according to the therapy prescription for cyanide poisoning (amyl nitrite inhalation followed by intravenous administration of sodium nitrite and sodium thiosulphate). ECG record of the last day of hospitalization (7th day of treatment) showed negative T waves in lead III, V4-V6. He was discharged from hospital in good condition. Case 2.23-year-old male ingested 10 g of sodium azide 1.5 hours prior to admission to hospital. At the beginning, the patient's condition was good, but it changed to critical state within the first hours of hospitalization. He developed a deep coma, respiratory and circulatory insufficiency, metabolic acidosis, cardiac dysrrhythmias and anuria. Cardiac activity monitoring showed alternating tachycardia (140 beats per minute) and bradycardia (48 beats per minute), numerous additional supraventricular and ventricular extrasystoles and sinus dysrrhythmia. Cardiac arrest (asystolia) occurred twice, the second incident with fatal outcome. The patient received supportive therapy, he was also treated according to the therapy prescription for cyanide poisoning. Circulatory disturbances observed in both cases have been described in literature as symptoms of sodium azide poisoning. However, available literature data are scarce and lack systematization, most of them coming from several decades ago. The lack of patient's consent for detailed examination of circulatory system and liver made it impossible to gather further knowledge on the subject. The efficacy of treatment with antidotes for cyanide poisoning has not been unequivocally determined for this kind of intoxication.

[Carbamazepine "CR"--clinical picture of intoxication: the kinetics of extracorporeal elimination]. / Karbamazepina "CR"--obraz kliniczny zatrucia: kinetyka eliminacji pozaustrojowej.

Carbamazepine (CBZ) intoxication is an important issue in acute poisonings practice. Pathological reflexes, central breathing depression and cardiac disturbances are the characteristic features of carbamazepine poisoning. The clinical picture is variable and does not always correlate with CBZ serum concentration. Controlled-release formulations of CBZ have a delay of over 48h between the time of ingestion and peak serum CBZ concentrations. Peristalsis paralysis makes the extracorporeal elimination a treatment of choice in this case. Unfortunately, the effectiveness of this procedure is not clearly established -the results are often contradictory which makes it difficult to set standards for elimination treatment. In this research we report 2 cases of controlled-release CBZ poisonings. Deterioration in the clinical state characterized mainly by central breathing depression appeared after 51 hrs (patient I) and 74 hrs (patient II) from CBZ ingestion. Charcoal hemoperfusion (HP) improved patients clinical state. During the HP procedure the mean CBZ plasma half-life (T(1/2)) was 6.67 h and 12.66 h. Those values were a few times lower then those measured after the cessation of HP. The mean charcoal column clearances (with blood flow 180 ml/min) were 77.2 and 108.9 ml/min. CBZ pharmacokinetics makes the drug move rapidly between the compartments during the HP. This movement may cause a reduction in CBZ concentrations in receptors' vicinity. Probably this mechanism accounts for the improvement of the patients' clinical state despite low kinetic values of the procedure.

Cardiotoxic effect due to accidental ingestion of an organic solvent.

Toxic myocardial injury can be misdiagnosed as a myocardial infarction, resulting in the patient undergoing standard treatment for cardiac rehabilitation. However, such inadequate therapeutic strategies can lead to cardiovascular complications including dilated cardiomyopathy. This study presents a case of a 65-year-old man after accidental ingestion of organic solvents (toluene and xylene), whose condition demonstrated all the criteria for diagnosis of myocardial infarction. The qualitative determinations of the above mentioned volatile organic compounds (VOCs) in whole blood were carried out using a headspace sampling by means of gas chromatography. Cardiac catheterization revealed no specific coronary lesions, only a muscular bridge causing a 30-50% stenosis in the middle of the circumflex branch of the left coronary artery.

Carbamazepine poisoning: elimination kinetics and quantitative relationship with carbamazepine 10,11-epoxide.

Carbamazepine (amizepine) is a widely used psychotropic agent. A much easier accessibility of this drug, observed during the recent years, may account for an increasing number of acute intoxications with carbamazepine. The aim of this study was to determine the elimination kinetics of carbamazepine and its metabolite carbamazepine 10,11-epoxide, and to identify the quantitative relationship between concentrations of these compounds, in serum. The subjects were 41 patients with acute carbamazepine intoxication. Serum carbamazepine and carbamazepine 10,11-epoxide concentrations were determined every 6 hours during thefirst 24 hours of hospitalization, and then every 12 hours. At the same time, urinalyses were performed for each patient to confirm or exclude homogeneity of poisoning. Depending on the type of intoxication (homogenous or combined), three groups of patients, and on the method of treatment (symptomatic, charcoal administration), two groups of patients were distinguished. The statistical analysis of the results revealed that among the investigated parameters (time-integrated concentrations of carbamazepine and carbamazepine 10,11-epoxide in serum, the presence of drugs, and/or ethanol, charcoal treatment) only carbamazepine concentrations had statistically significant effect on the duration of coma regarded as a critical effect. The kinetics of carbamazepine elimination was determined on the basis of the mean carbamazepine concentrations at the same timing of sampling for each patient in all the three groups; the mean carbamazepine elimination in serum followed zero-order kinetics. In individual groups, the decrease in serum carbamazepine concentrations ranged from 0.5 to 0.8 mg L(-1) hour(-1). Contrary to the suggestions found in the literature, carbamazepine 10,11-epoxide determination does not seem to enhance the possibility of anticipating the course of intoxication or the time of recovery.