False acute kidney injury alert due to model car fuel ingestion.

We report a case of accidental ingestion of model car fuel (Optifuel) resulting in an apparent elevation of serum creatinine of 274 µmol/L (3.1 mg/dL) as measured by the Jaffe (alkaline picrate) reaction, which resulted in an acute kidney injury (AKI) stage 3 alert being reported. Optifuel contains nitromethane, which has been reported to interfere in the Jaffe reaction causing falsely high creatinine measurements. The laboratory staff were vigilant about this potential interfering substance so repeated the analysis of the creatinine using an enzymatic method that showed a markedly lower result of 47 µmol/L (0.5 mg/dL). This report highlights the ability of nitromethane to potentially mimic AKI and the importance of being aware of the limitations of biochemical tests to avoid misinterpretation of results and instigating inappropriate treatment.

Poisonings Associated with Intubation: US National Poison Data System Exposures 2000-2013.

Patients may be intubated after exposure to a variety of substances because of respiratory failure, CNS sedation, pulmonary pathology, or cardiovascular instability. However, there is little data describing the types of substances that are associated with endotracheal intubation or the rates of intubation after these exposures. Evaluation of this association may inform future research on intubation after exposures to specific substances and guide poison prevention education. Our objective was to determine which exposures were commonly associated with intubation using the data from National Poison Data System (NPDS). The NPDS tracks data from potential exposures to substances reported to all American Association of Poison Control Centers. We performed a retrospective analysis of NPDS data from January 1st, 2000 to December 31st, 2013 to identify human exposures to substances that were associated with endotracheal intubation. Descriptive statistics were used to analyze the data. There were 93,474 single substance exposures and 228,507 multiple substance exposures that were associated with intubation. The most common exposures to substances that were associated with intubation were atypical antipsychotics (7.4 %) for single exposures and benzodiazepines (27.4 %) for multiple exposures. Within each age group, the most common known exposures to substances were for patients under 6 years, clonidine for single and multiple exposures; for patients aged 6-12 years, clonidine for single exposures and atypical antipsychotics for multiple exposures; for patients aged 13-19 years, atypical antipsychotics for single and multiple exposures; and for patients over 19 years, atypical antipsychotics for single exposures and benzodiazepines for multiple exposures. From 2000-2013, the exposures to substances most commonly associated with intubation varied by single versus multiple exposures and by age. This study helps clarify the exposures to substances that are associated with intubation reported to poison centers in the USA.

Follow-up study of genotoxic effects in individuals exposed to oil from the tanker Prestige, seven years after the accident.

The accident with the oil tanker Prestige in November 2002 resulted in a major spill of about 63,000 tons of heavy fuel oil. More than 300,000 people participated in the clean-up activities, which lasted for up to 10 months. Previous studies reported increases in genotoxicity endpoints in individuals exposed to Prestige oil, both at the moment of exposure [DNA breakage, micronuclei (MN), sister chromatid exchange] and two years later (chromosomal aberrations). In this work we carried out for the first time the follow-up of genotoxic effects in subjects exposed to an oil spill seven years after the exposure. The main objective was to determine the possible persistence of genotoxic damage in individuals exposed to Prestige oil seven years after the accident. The exposed group was composed of 54 residents of Galician villages in Spain that were heavily affected by the spill. This group was involved in clean-up labor for at least two months in the period November 2002-September 2003. They were compared with 50 matched controls. Primary DNA damage was evaluated by the comet assay, mutagenicity by the T-cell receptor (TCR) mutation assay, and MN frequency was determined both by the cytokinesis-block test and by flow cytometry. The results obtained showed no significant differences between the exposed and the controls in the comet assay, the TCR mutation assay and the cytokinesis-block MN test. An unexpected and significant decrease was observed in the exposed group for the results of the MN test evaluated by flow cytometry, probably influenced by modifying factors - other than age, sex and smoking - not considered in this study. Our results show no evidence of the persistence of genotoxic damage in individuals exposed to Prestige oil seven years later. Nevertheless, the need to plan biomonitoring studies on people participating in clean-up activities in case a new oil spill occurs should be established.

The analysis of the cases of aspired fuel oil and gasoline through siphonage method.

Accidental aspiration of petroleum products in children can also be witnessed in adults working with petroleum products by siphonage or swallowing fire for demonstration purposes. Ten cases admitted to Yuzuncu Yil University Emergency Service due to fuel oil and gasoline aspiration in a three-year period were retrospectively analysed. All cases were males and their average age was determined as 32,4 +/- 7.83 years. Three of the patients aspirated gasoline and 7 fuel oil. Blood gas values in all patients were at normal levels and their average white blood cell values were 16,590. The most frequent symptom for referral to our service was shortness of breath. Infiltration was confirmed in the chest X-ray of 2 patients with aspirated fuel oil and all cases of gasoline aspiration. All patients received methylprednisolone and IV proton-pump inhibitors for treatment. Eight patients were given antibiotics. All victims were discharged from the hospital after recovery. Aspiration of petroleum products which is normally rarely seen is witnessed more frequently in under developed countries. Since the findings determined by screening methods are often nonspecific, history is important for making a diagnosis.

[Extracorporeal membrane oxygenation of a child with severe chemical pneumonia]. / Ekstrakorporal membranoxygenering af et barn med svær kemisk pneumoni.

This case presents a thirteen months old child with severe acute respiratory distress syndrome after ingestion of lamp oil (hydrocarbon). Mechanical ventilation including high-frequency oscillation could not stabilise the course, and the child developed pneumothorax and emphysema. Treatment was changed to veno-arterial extracorporeal membrane oxygenation (ECMO) on the third day. After nine days of ECMO and further two days of conventional ventilatory treatment he was extubated, and four months later the child presented with normal X-ray of the lungs and without any signs of disease.

Apparent elevated creatinine after ingestion of nitromethane: interference with the Jaffe reaction.

We assessed a 2-year 4-month-old boy found to have a persistently elevated serum creatinine (peak 926 µmol/L) as measured by the Jaffe reaction after ingesting an unknown quantity of fuel for a model car, which commonly contains nitromethane. The patient was otherwise clinically well and the remaining investigations were unremarkable. When creatinine concentrations were measured with specific enzymatic testing on these same blood samples, all values were within normal limits. Nitromethane has been shown to interfere with the determination of serum creatinine through the Jaffe reaction. Because many ingestions present only rarely, it is not possible for the emergency department clinician to be aware of all toxin factors affecting patient management. This case illustrates the importance of analysis of laboratory results in the context of the patient's clinical status.

Lamp oil poisoning: did the European guideline reduce the number and severity of intoxications?

INTRODUCTION: In 1997, a European guideline concerning the viscosity and surface tension of lamp oil was adopted to reduce instances and severity of lamp oil intoxications. In 2005, the Dutch National Poisons Information Centre investigated lamp oil intoxications to determine whether they differed in severity from the intoxications reported before the guideline was adopted. METHODS: We compared the data prospectively collected on lamp oil intoxications reported to our center in 2005 and in 1996. RESULTS: In 2005 and 1996, respectively 152 and 165 cases were included. The frequency of the symptoms and diagnosed pneumonitis did not differ significantly between those years. In 2005, ingestion of a transparent lamp oil seemed to be associated with a greater risk of serious respiratory symptoms than ingestion of colored oil. CONCLUSION: Despite the directive, frequency and severity of symptoms of lamp oil ingestions remain disturbing. Consequently, further actions concerning packaging and labeling of lamp oil, design of oil lamps, education of parents, and additions to the current guideline should be considered.

Estimation of potential impacts and natural resource damages of oil.

Methods were developed to estimate the potential impacts and natural resource damages resulting from oil spills using probabilistic modeling techniques. The oil fates model uses wind data, current data, and transport and weathering algorithms to calculate mass balance of fuel components in various environmental compartments (water surface, shoreline, water column, atmosphere, sediments, etc.), oil pathway over time (trajectory), surface distribution, shoreline oiling, and concentrations of the fuel components in water and sediments. Exposure of aquatic habitats and organisms to whole oil and toxic components is estimated in the biological model, followed by estimation of resulting acute mortality and ecological losses. Natural resource damages are based on estimated costs to restore equivalent resources and/or ecological services, using Habitat Equivalency Analysis (HEA) and Resource Equivalency Analysis (REA) methods. Oil spill modeling was performed for two spill sites in central San Francisco Bay, three spill sizes (20th, 50th, and 95th percentile volumes from tankers and larger freight vessels, based on an analysis of likely spill volumes given a spill has occurred) and four oil types (gasoline, diesel, heavy fuel oil, and crude oil). The scenarios were run in stochastic mode to determine the frequency distribution, mean and standard deviation of fates, impacts, and damages. This work is significant as it demonstrates a statistically quantifiable method for estimating potential impacts and financial consequences that may be used in ecological risk assessment and cost-benefit analyses. The statistically-defined spill volumes and consequences provide an objective measure of the magnitude, range and variability of impacts to wildlife, aquatic organisms and shorelines for potential spills of four oil/fuel types, each having distinct environmental fates and effects.

Restoration of oiled mussel beds in Prince William Sound, Alaska.

Natural loss of hydrocarbons was often low from mussel (Mytilus trossulus) beds (which were typically not cleaned after the Exxon Valdez oil spill), thus this habitat remained a long-term source of oil. Consequently, experimental restoration of nine contaminated beds was attempted in 1994; mussels were removed, contaminated surface sediment was replaced (33 metric tons), and original mussels were returned. Hydrocarbon concentrations and mussel populations were monitored for 5 years thereafter. Post-restoration mussel population fluctuations were indistinguishable from regional changes. Increased short-term oil loss was apparent, but long-term (5 year) improvement was equivocal and difficult to distinguish from natural losses. By 1999, oil concentrations in mussels were typically at baseline levels in restored and oiled reference beds; concentrations in replaced sediment were elevated in one third of restored beds, indicating recontamination from underlying or surrounding sediment. Our results suggest mussel relocation is feasible but suggest oil might more effectively be removed from sediment mechanically or chemically than manually.

Patterns and problems of deliberate self-poisoning in the developing world.

Deliberate self-harm is a major problem in the developing world, responsible for around 600 000 deaths in 1990. The toxicity of available poisons and paucity of medical services ensure that mortality from self-poisoning is far greater in the tropics than in the industrialized world. Few data are available on the poisons most commonly used for self-harm in different parts of the world. This paper reviews the literature on poisoning, to identify the important poisons used for self-harm in these regions. Pesticides are the most important poison throughout the tropics, being both common and associated with a high mortality rate. In some regions, particular pesticides have become the most popular method of self-harm, gaining a notoriety amongst both health-care workers and public. Self-poisoning with medicines such as benzodiazepines and antidepressants is common in urban areas, but associated with few deaths. The antimalarial chloroquine appears the most significant medicine, self-poisoning being common in both Africa and the Pacific region, and often fatal. Paracetamol (acetaminophen) is used in many countries but in few has it reached the popularity typical of the UK. Domestic and industrial chemicals are responsible for significant numbers of deaths and long-term disabilities world-wide. Self-poisoning with plant parts, although uncommon globally, is locally popular in some regions. Few of these poisons have specific antidotes. This emphasizes the importance of determining whether interventions aimed at reducing poison absorption actually produce a clinical benefit, reducing death and complication rates. Future research to improve medical management and find effective ways of reducing the incidence of self-harm, together with more widespread provision of interventions proven to be effective, could rapidly reduce the number of deaths from self-poisoning in the developing world.

[When necrosis smells of heating oil... what damage fuels can do]. / Wenn die Nekrose nach Heizöl riecht ... Was der Brennstoff alles anrichten kann.

The subcutaneous injection of heating oil or other crude oil distillates are rare injuries. In the present case, a 26-year-old man injected heating oil subcutaneously into the left cubital region. He then developed massive swelling, pain, local necrosis and abscess, accompanied by fever and leukocytosis. Radical surgical debridement and open wound treatment successfully stopped the necrotic process. Subsequently, a mesh-graft was applied to the wound, which healed with no residual defects. The course of the present case, and the results of a review of the literature on similar occurrences involving mineral oil suggest early extensive debridement of such injuries.

Acute renal failure after immersion in seawater polluted by diesel oil.

Acute renal failure after exposure to toxic doses of hydrocarbon has been uniformly associated with multiorgan failure. We report a case of isolated acute renal failure in a patient after immersion in seawater polluted by diesel oil. The sites of absorption were likely to be skin, gastrointestinal tract, and lung. Investigations showed renal impairment as the only consequence from the exposure. The patient recovered uneventfully and did not require dialysis. This case highlighted the unusual consequence of isolated renal involvement resulting from hydrocarbon toxicity.

Elevated creatinine after ingestion of model aviation fuel: interference with the Jaffe reaction by nitromethane.

A 2 years 9 month-old-boy who ingested model aviation fuel was found to have an elevated serum creatinine concentration of 0.53 mmol/L (normal range 0.02-0.05 mmol/L) by the Jaffe (alkaline picrate) reaction. However, when the creatinine concentration was measured using a specific enzymatic assay, it was within the normal range. It was shown that nitromethane, a constituent of aviation fuel, interferes with the Jaffe reaction, leading to a falsely elevated creatinine reading. This phenomenon has been reported only once previously and, despite its potential clinical importance, nitromethane does not appear in published lists of substances that interfere with the Jaffe reaction.

Near fatal ingestion of household lamp oil--Ohio, August 1997.

Unintentional poisoning from liquid fuels accounts for approximately 2.5% of all unintentional poisoning exposures among children aged <6 years. The risk for unintentional poisoning increases when fuel is transferred from its original container, often with required child-resistant packaging, to other containers (e.g., fuel lamps) without special packaging requirements. This report describes the poisonings of four children who were admitted to a regional referral medical center in Columbus, Ohio, during a 2-week period in August 1997; these children developed serious pulmonary complications after ingesting household lamp oil.

Health hazards among workers in power stations. Comparative study between natural gas and mazout stations.

This study was done on 65 workers working in power station I (Shoubra El-Kheima) where they are exposed to natural gas and mazout, 74 workers in power station II (El-Gharb) where there is mazout exposure only and 74 individuals acting as controls. All these individuals were admitted to a questionnaire, examined clinically and they were investigated to assess their respiratory, liver and kidney function tests. This is in addition to a complete blood picture. Air pollution inside these stations was assessed. The study aimed at determining the pollutants inside and outside the stations and to investigate the health hazards of the workers exposed to these pollutants. It aimed also to see if it is important and urgent to replace the mazout by natural gas as a fuel in these power stations. The results showed that by-products of mazout have bad effect on the environment. When mazout is used alone as a fuel, it has an adverse effect on the respiratory system and the liver. There is a need for a prospective study to assess the causal relationship between mazout by-products and health hazards before taking the decision of replacing mazout by natural gas.

Audiological and vestibulo-oculomotor findings in workers exposed to solvents and jet fuel.

Three groups of subjects with long-term (5-41 years) occupational exposure to industrial solvents have been evaluated with extensive audiological and vestibular test batteries. Group A comprised 16 subjects with a confirmed diagnosis of psycho-organic syndrome (POS), while group B consisted of 7 subjects with suspected POS. Both groups had been exposed to mixtures of aliphatic and aromatic solvents. Eight subjects with long-term exposure to jet fuel constituted group C. In the audiological test battery, discrimination of interrupted speech and evoked cortical potentials in response to frequency glides were the tests that yielded significantly abnormal results. In the vestibular test battery, considerable pathology was seen in electronystagmography, and in addition, visual suppression test and saccade test indicated CNS disturbance. In general, when a test yielded pathological results, the incidence of pathology was highest in group A and lowest in group C.