[Poisonings by selected drugs: analysis of 1995-1999 data files of the Clinic of Acute Poisonings Institute of Occupational Medicine in Lódz]. / Zatrucia wybranymi narkotykami w latach 1995-1999 w materiale Kliniki Ostrych Zatruc Instytutu Medycyny Pracy w Lodzi.

Over the period of 1995-1999 a total number of 439 cases were admitted to the Clinic of Acute Poisonings, Lódz, Poland, due to poisoning with opiates, opioids, amphetamine, cannabis products, LSD and cocaine. Most of the patients were males, the male to female ratio was 1:1.5 (266 to 173). The distribution by age indicated the persons aged 21-30 yr as the highest risk group, then those aged 14-21 yr. Over the period under study the structure of poisonings changed significantly. Since 1997 the number of poisonings with amphetamine and cannabis products increased dramatically, while that of opiate poisonings declined. Approximately 84% of cases were found to be addicted to a combination of drugs and psychotropic agents, mostly benzodiazepine and ethyl alcohol. Drug addiction was reported by over 80% patients with opiate poisoning, 44.8% with tetrahydrocannabinole poisoning and only 9.5% with amphetamine poisoning. The efficacy of treatment in cases of drug addiction is very low. Repeated treatment was reported by almost 100% of patients who had attempted to quit drug abuse. Among opiate poisoning cases, only 8 out of 45 patients did not question the effectiveness of the withdrawal treatment.

Acute potassium dichromate poisoning: a toxicokinetic case study.

CASE REPORT: A 48-year-old man drank 150 mL of an aqueous solution containing potassium dichromate 22.5 g in a suicidal attempt and was admitted 7 hours after the ingestion. Hemodialysis was promptly undertaken and chromium concentrations in serum, erythrocytes, and dialysate were determined during the treatment. Chromium elimination in urine was monitored during hemodialysis and the subsequent 400 hours. The total chromium eliminated via hemodialysis and urine was calculated as 36.7 mg or 0.16% of the ingested dose. Spontaneous urinary elimination proceeded according to an open one-compartment model. The elimination half-life was 71.37 hours +/- 17.13 hours (95% CI). Chromium elimination from serum followed an open two-compartment model, with the half-lives of 3.16 hours +/- 2.63 hours for phase 1 and 50 hours +/- 27 hours (95% CI) for phase 2. Calcium-EDTA therapy had no influence on erythrocyte, serum, or urine chromium level. It contributed, however, to a significant increase in chromium elimination rate in the dialysate. Serum zinc was very low at admission and serum zinc, copper, and magnesium were controlled during the initial 30 hours.

[Clinical symptomatology and laboratory diagnosis of 75 cases of ethylene glycol poisonings]. / Symptomatyka kliniczna i diagnostyka laboratoryjna 75 przypadków zatrucia glikolem etylenowym.

Between 1991 and 1995 there were 75 cases of ethylene glycol poisoning (GE) hospitalised in the Clinic of Acute Poisoning of Institute of Occupational Medicine in Lódz, which comprised 0.9% of the total number of patients. The most common were cases of accidental antifreeze liquids consumption. On admittance to the clinic the state of 59% of the patients was diagnosed as severe and very severe. The main symptoms were: metabolic acidosis, which developed in 77% cases of poisoning, and its consequences--the central nervous damage and the cardiovascular system distributions. The average pH amounted to 7.06 while the base deficit to 22.42 mmol/l. Among complications the most commonly observed was the acute renal failure (84%) which developed during the first 24 hrs in all the 25 cases ending in deaths. Only in 16 out of 63 cases, in which the acute renal failure occurred, multiple hemodialyses proved necessary. Other complications accompanying the poisoning were as follows: anaemia, pneumonia, the irreversible central nervous system damage, the disseminated intravascular coagulation syndrome, and the hepatic damage. The comparative analysis (base on the chi2 and median test) of the deceased and cured patients has shown a significant difference (p < 0.05), among others, concerning the plasma osmolality, the frequency of the acute renal failure and the central nervous system damage occurrence.

Sources of poisoning exposures in children during 1990-1995. An analysis of the National Poison Information Centre files.

Information protocols on the causes of acute poisoning exposures with chemicals in children up to 14 years old collected during 1990-95 at the National Poison Information Centre have been analyzed. Approximately 96% of intoxication were accidental, 44% of patients were poisoned with drugs, 22% with household products and 14% with pesticides. Almost 25% of drug poisonings were due to sedative and to psychotropic drugs, and 17% to drug mixtures. The frequency of mushrooms and plants poisonings were low - 6%. In Poland there are practically no acute poisoning departments which treat children (actually, there is only one Poison Unit in Kraków at Polish-American Children's Hospital), and thus these patients are treated in paediatric wards and paediatric hospitals, so complete data on the poisonings in children from over the whole territory of Poland are not available. However, we believe that the frequency of causes of children's intoxication in our country is properly reflected in our material. This allows us to draw conclusions of the prevention of poisoning in this age group.

[Poisoning with narcotics and hallucinogens in material from the Clinic of Acute Poisoning in Lodz (1993-1996)]. / Zatrucia srodkami narkotycznymi i halucynogennymi w materiale Kliniki Ostrych Zatruc Instytutu Medycyny Pracy w Lodzi (lata 1993-1996).

Our material consists of the patients treated for poisonings with street-drugs in Clinic of Acute Poisonings, Lódz, Poland during the period 1993-1996. During the time of 4 years, the number of hospitalised patients have grown up 4.5 times. The structure of used drugs has also changed. Up to 1993 the most popular were opiates derivatives and narcotic analgetics-morphine derivatives. In 1996 almost all narcotics are common, opiates (both natural and synthetic), cocaine, LSD, amphetamine and commonly used (by youngsters especially) Cannabis sativa (marihuana etc). The most common sources of poisoning in our material were opiates and amphetamine, followed by tetrahydrocannabinol derivatives-marijuana.

[Alcohol and suicide attempts]. / Alkohol a próby samobójcze.

A large number of patients (30%) admitted to the Clinic of Acute Poisonings, Lódz, Poland, with suicidal drug poisoning have been found to act under the influence of alcohol. Sociological interview revealed that 6% of them were alcoholics and 3.8% reported to have repeated the suicidal attempt because of alcohol addiction. From the sociological point of view the female and adolescent (15-18 years old) family members are most vulnerable as they are frequently exposed to highly stressful conditions which may eventually result in their becoming addicted to alcohol as well.

Telephone toxicological information service on pesticide poisonings.

The problem of pesticide poisonings has been discussed with reference to the records of the toxicological information provided in 1993-1995 by the staff of the National Poison Information Centre and the physicians of the Clinic of Acute Poisonings in Lódz. Based on those data, pesticide poisonings occupy second place among the categories of chemical most frequently responsible for acute poisonings, while the first place is occupied by drugs. In the pesticide category, most of the information related to poisonings with pyrethroids, followed by organophosphorous compounds, coumarine derivatives, carbamates. Pesticide poisonings in children continue to be a serious problem. Coumarine derivatives and zinc phosphide found in rodenticides constitute the most frequent source of pesticide poisoning among children. Considering the circumstances of pesticide poisoning, accidental poisonings are the most frequent. The high incidence of pesticide poisoning shows that it is a serious problem and the steps should be taken to prevent poisonings with pesticides.

Acute poisoning with Diffenbachia picta.

Plants from the Araceae family contain unidentified volatile compounds that are highly irritative or corrosive. Patient aged 38 was admitted with acute poisoning with Diffenbachia picta exhibited as severe salivation, burning and pain of the oral cavity, mucosal edema and blistering. Treatment was conservative similar to that in corrosive poisonings. Patient was discharged after 14 d hospitalization without postburning complications.

[Clinical course and treatment of acute poisoning caused by some mushrooms]. / Obraz kliniczny i leczenie ostrych zatruc spowodowanych niektórymi grzybami.

Mushroom poisonings are discussed in the paper. Clinical picture and applied treatment are presented with characterisation of the most toxically species for human being.

The use of haemodialysis and 2,3 propanesulphonate (DMPS) to manage acute oral poisoning by lethal dose of arsenic trioxide.

The paper discusses a case of oral acute poisoning by dental paste containing arsenic trioxide. A 33-year-old woman ingested 1/3 of the dental paste package, which corresponds to 1850 mg pure arsenic trioxide. Acute gastroenteritis and oral mucosa burn developed within 3 hours since the poisoning. Considering the amount of the ingested poison, highly exceeding the lethal dose, haemodialysis was undertaken. During the treatment, DMPS (Unithiol) was administered, with the patient's consent. The patient recovered completely, with no complications or side-effects of the therapy.

[An attempt to use simplified mathematical analysis for evaluation of elimination of cyclobarbital from blood of acutely poisoned patients]. / Próba zastosowania uproszczonej analizy matematycznej do oceny zaniku cyklobarbitalu z krwi ostro zatrutych chorych.

Two different mathematical methods were used to calculate the rate of poison elimination in 52 unconscious patients due to barbiturate poisoning. The process of poison elimination is reflected by an exponential curve. Its rate can be determined with the use of a logarithmic function formula. In the study, an attempt was made to find out whether a linear function formula could also be applied to calculate this parameter. The hypothesis was based on the observation that, when considered for short periods of time parts on an elimination curve resemble straight line. The barbiturate elimination was checked every four hours to ensure that the exponential curve be as close as possible to a straight line. Then, correlations between the rate of poison elimination calculated from both formulas and seven biochemical and clinical parameters of forced diuresis were examined. The findings revealed qualitative concordance of the results, i.e. correlations were found for the same parameters when the elimination rate was calculated either from the logarithmic or linear formula. For further verification of the hypothesis apart from a simple correlation analysis a normalized standard error (NSE) method was used to investigate these correlations. Also in this analysis a similar concordance of results was obtained: when there was a correlation between the elimination rate as a logarithmic function and particular parameter of forced diuresis, it was also found the same for the rate calculated from the linear function formula. Conversely the absence of correlation in the former case corresponded to similar absence in the latter.(ABSTRACT TRUNCATED AT 250 WORDS)

Early parenteral nutrition in patients unconscious because of acute drug poisoning.

The author studied the clinical and laboratory effects of early parenteral nutrition (EPN) in patients who were comatose as a result of acute drug poisoning. All patients were unconscious at the time of admission and entry into the study and received our usual conservative therapy for the first 24 hours. Alternate patients received an EPN solution containing amino acids and glucose. Volume, composition, and caloric content of the EPN solution were calculated separately for each patient according to weight and height nomograms. It was found that the group receiving EPN (n = 46) normalized their nitrogen balance sooner and demonstrated a consistent decrease in their creatine phosphokinase level. Serum amino acid values in patients treated with EPN did not change significantly during the treatment trial. The control group (n = 40) demonstrated a significantly lower serum amino acid concentration on the third day of treatment (p < .001), had significantly more pneumonias (p < .05), and their hospitalization time was significantly longer (.01 < p < .05) than the EPN group. There were significantly fewer instances of disseminated intravascular coagulation in the group receiving EPN (p < .05).

Kinetics of trichloroethylene elimination from venous blood after acute inhalation poisoning.

The kinetics of trichloroethylene were examined in three men, 28-36 years old, hospitalized after an acute occupational exposure. The trichloroethylene concentration of venous blood was determined by gas chromatography with headspace analysis; urinary trichloroacetic acid was assayed by the colorimetric method of Fujiwara. The kinetics of blood trichlorethylene (t1/2 21.7 h) and the urinary elimination of trichloracetic acid over six days were used to calculate the total inhalation exposures. Blood trichlorethylene was diagnostically more relevant than urinary trichloracetic acid.

[Acute suicidal poisoning with lithium carbonate]. / Ostre samobójcze zatrucie weglanem litu.

A case of the acute poisoning with lithium carbonate is presented. Single hemodialysis did not decrease lithium blood levels significantly. Lithium blood concentration has been slowly decreasing with persisting severe neurological symptoms. Hemodialysis should be repeated until lithium has been released from various tissue compartments.

[Evaluation of the usefulness of forced diuresis in patients with calcium cyclobarbital or reladorm poisoning]. / Ocena zasadnosci stosowania forsownej diurezy u chorych zatrutych Cyclobarbitalum calcium lub preparatem reladorm.

An attempt was made at evaluating the usefulness of forced diuresis for the treatment of Phanodorm poisoning. Fifty two patients were examined, 40 of them with Reladorm (Polish trade name. Reladorm contains 100 mg of cyclobarbital and 10 mg of diazepam) poisoning and 12 with Cyclobarbitalum Calcium (Phanodorm) poisoning. The test group was selected out of those poisoned with barbiturates so that a homogeneous toxic agent would be involved and the impact that other toxins may have on the rate of metabolism and excretion eliminated. The elimination of drug from blood was compared with the elements determining ED intensity, such as i.v. fluid administration, primary infiltrate (clearance of endogenous creatinine), reabsorption in renal tubules and diuresis rate. No correlation was found which is an evidence that ED proves to be useless in the treatment of Phanodorm poisoning. The author suggests that in this type of poisoning supportive treatment should be undertaken according to daily fluid demand in relation to such factors as sex, age, body temperature, health conditions and contraindications due to the patient's general condition.