Clinical and analytical problems of sodium azide poisonings as exemplified by a case of fatal suicidal poisoning.

AIM OF THE STUDY: To present clinical and analytical aspects associated with sodium azide poisoning. The problems were verified on the basis of a case of sodium azide poisoning which was unique due to its circumstances and the development of an analytical method applied for medico-legal practice. MATERIAL AND METHODS: The object of the study was a toxicological analysis of biological specimens collected from a woman who ingested two doses of sodium azide purchased over the Internet, in a suicide attempt. After the ingestion of the first dose, the clinical management in the form of symptomatic treatment indicated a possibility of recovery. However, the ingestion of a second dose of the xenobiotic, already in the hospital, caused death. Toxicological findings were obtained with the dedicated technique of gas chromatography-mass spectrometry (GC-EI-MS-MS) after extraction combined with derivatization using pentafluorobenzyl bromide (PFBBr). RESULTS: Post-mortem toxicological studies demonstrated sodium azide in the blood (0.18 mg/l) and urine (6.50 mg/l) samples collected from the woman. CONCLUSIONS: Cases of sodium azide poisoning are rare and difficult to treat, but a review of the literature over a longer interval of time shows that they continue to occur. Therefore, case studies of sodium azide poisoning, together with descriptions of research methodology, can be useful both in clinical terms and in the preparation of toxicological expert opinions for medico-legal purposes.

Outcome of emergency liver transplantation including mortality on the waiting list: a single-center experience.

Patients with irreversible fulminant hepatic failure (FHF) as well as recipients with primary graft nonfunction (PNF) and early hepatic artery thrombosis (HAT) die unless they undergo emergent liver transplantation (OLT). Therefore, they have the highest priority in organ allocation systems. Herein we describe our initial experience with 18 emergency among 103 OLT procedures performed in 99 adults from February 2002 through February 2007. Their diagnoses were FHF (n = 16), PNF (n = 1), and early HAT (n = 1). Ten subjects (56%) underwent emergency OLT after a mean 1.6 (range, 1 to 4) days after listing, whereas 8 (44%) patients died while awaiting a graft for a mean of 5.9 days (range, 2 to 17). All the transplants were performed according to the piggyback technique with routine preoperative use of intravenous recombinant factor VIIa (rVIIa) to control the coagulopathy, which resulted in significant (P < .0001), prompt correction of prothrombin time from a mean of 61 (range, 22 to 300) to 14 (range, 11 to 22) seconds at 15 minutes after drug administration. A mean of 4 (range, 0 to 14) units of RBC and 9 (range, 3 to 18) units of fresh frozen plasma were transfused during the procedure. Eight (80%) transplanted patients are alive in good condition with normal liver function at a mean of 18 (range, 4 to 36) months follow-up. Two patients died in the early postoperative period after massive aortic bleeding and biliary sepsis. In summary, only 56% of patients requiring emergency OLT received grafts achieving good medium and long-term survivals, which was significantly lower compared with Western European centers where this proportion reaches 90%. This outcome could be improved by international organ-sharing arrangements for emergency transplantation or living donation alternatives.

[Macroscopic and microscopic picture of the gastric mucosa in alcoholics]. / Obraz makroskopowy i mikroskopowy blony sluzowej zoladka u osób uzaleznionych od alkoholu.

The aim of the study was to compare a macroscopic and microscopic picture of the gastric mucosa of ethanol dependent patients admitted to the Kraków Department of Clinical Toxicology because of acute ethanol intoxications (n = 28) with those admitted because of ethanol withdrawal syndrome (n = 38). All the 66 study patients suffered from gastrointestinal tract symptoms. The mean age was 41.5 and mean duration of ethanol dependence was 10 years. The mean blood ethanol concentration in acutely intoxicated group was higher then 1 g/L, intensification of withdrawal syndrome in the group of non-acutely intoxicated patients was higher than 15 points according to CIWA scale. In the first day of hospitalization gastrointestinal endoscopy was performed and specimens from gastric corpus, antrial, and pyloric region mucosa were taken to histopathological examination. In 46 of still symptomatic patients a control gastroscopy and histopathological examination were performed after 10 days of controlled abstinence. A normal macroscopic picture of gastric mucosa was stated in 25% of acutely ethanol intoxicated patients and in 26% of those ethanol abusers who were admitted because of withdrawal syndrome. In 76% of all the examined patients a mild, superficial inflammatory changes localized mostly in distal part of the stomach were revealed by endoscopy. The symptoms of chronic inflammation and also the sings of inflammation's activity, mostly in antrum region, were revealed by histopathological examination in all the cases. The higher histopathological dynamics of inflammatory changes and higher inflammation's activity, mostly in the stomach distal part, were found in the patients suffering from ethanol withdrawal syndrome.

[Self-poisonings of the addicted persons with corrosive substances]. / Samozatrucia substancjami zracymi u osób uzaleznionych.

In this paper we present two cases of suicidal behaviour; case (1)--patient dependent to medicines and case (2)--patient co-dependent, related with alcohol addicted person. Both of them combine suicidal corrosive substances consumption, but differ clinical course, finished by recover of addicted person and death of co-dependent person. In this paper we also present chemical burns of gastrointestinal tract algorithm procedure.

Multiorgan damage in acute oral carbamates poisonings.

The aim of the study was to evaluate the frequency and the kind of multiorgan damage in acute oral carbamates poisonings. Under analysis there were 36 carbamates orally poisoned patients treated at the Department of Clinical Toxicology in the years 1987-1997. Patients with the liver or biliary tract diseases, chronic circulatory insufficiency symptoms, HBs antigen carriers, who suffered head traumas, CNS illness and heavy drinkers were excluded from the study. The organs damage was noted in 91.7% of the poisoned patients. The respiratory system followed by the CNS and the liver were mostly affected by carbamates toxicity. The frequency of pathological changes in the kidney and circulatory system was relatively lower. Only in a few persons peripheral nervous system injuries were noted. In 15% of the examined group the injuries of one organ only was stated. In 48.5% of the patients simultaneous injury of two and three organs or systems were noted. 36.3% of the patients suffered from multiorgan (four or more) damage. In all the severely poisoned patients (III degree) the organs damage was noted. In 53% of them the simultaneous damage of four or more organs/systems was noted. In the group of patients stated as moderately poisoned on admission to the clinic, the multiorgan damage (2-3 organs/systems) was found in 77% of the patients. The lowest number of organ damage was observed in the group of slightly poisoned patients.

[Acute poisoning with psychoactive substances among adult abusers of the Krakow population]. / Ostre zatrucia srodkami psychoaktywnymi wsród uzaleznionych dorostych mieszkanców Krakowa.

The aim of the study was to evaluate a frequency and the course of acute poisonings with psychoactive substances in abusers, considering the kind of toxic substance. 25% of all acute poisonings treated in the Department of Clinical Toxicology in the year 1996 that were acute poisonings with psychoactive substances among the abusers of Kraków adult population. Alcohol followed by narcotics and drugs and by organic solvents was predominant cause of acute poisonings in that group. Opiates derivatives as the so called kompot produced at home from poppy straw or juice of poppy head were the most common narcotics. Pure amphetamine was detected only in 5.3%, while as combination with other narcotics (opioids, THC, LSD) was detected in 31.2% of narcomans and drug abusers. The combination of opioids, barbiturates and benzodiazepines was predominant cause of acute intoxications with mixed substances abuse. That was followed by combination of opiates and barbiturates in the group of patient identified positively as two or more substance abuse in the body fluids. Tramal and benzodiazepines were the most detected drugs responsible for acute intoxications between drug abusers. Acute intoxicated ethanol abusers aged from 30-49 years and were the oldest group compared to narcotics and drug abusers (20-29 years) and to organic solvent dependent patient (15-19 years).