[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.

[Management of acute carbon monoxide poisoning--Polish Medical Society, Section of Clinical Toxicology position statement]. / Postepowanie w ostrych zatruciach tlenkiem wegla--stanowisko Sekcji Toksykologii Klinicznej Polskiego Towarzystwa Lekarskiego.

Paper presents Polish Medical Society, Section of Clinical Toxicology position statement on the prehospital and hospital management of carbon monoxide poisoning.

[Management of acute intoxication with paracetamol--Polish Medical Society, Section of Clinical Toxicology position statement]. / Postepowanie w ostrych zatruciach paracetamolem--stanowisko Sekcji Toksykologii Klinicznej Polskiego Towarzystwa Lekarskiego.

Paper presents Polish Medical Society, Section of Clinical Toxicology position statement on the prehospital and hospital management in case of suspicion of intoxication with paracetamol.

[Selected data of acute intoxications with glycol and methanol in Poland in the year 2009]. / Wybrane zagadnienia dotyczace ostrych zatruc glikolem i metanolem w Polsce w roku 2009.

BACKGROUND: There are no reliable studies in Poland evaluating the scale of acute intoxications with different types of xenobiotics. OBJECTIVE: The aim of the study was to evaluate selected problems referring to the patients intoxicated with glycol and methanol, who were given the medical treatment in all Toxicological (TUs) and Intensive Care Units (ICUs), having contract with Polish National Fund of Health, in the year 2009. METHODS: All cases of acute intoxications treated in Polish hospitals in 2009 and reported to the Polish National Fund of Health were included to the analysis. To further analysis were chosen only those patients, whose main diagnosis or comorbidities were coded as T51.1 or T52.3 according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision and, according to the state of health, patients were treated in TUs and ICUs. All the cases, in which intoxication was not the main health problem were excluded. RESULTS: There were 85 398 acute intoxications in Poland in 2009, 470 of them referred to glycol and methanol poisonings. 192 patients were treated in TUs and ICUs. The most common methods of therapy in those units were extracorporeal toxin removal (60.2% in TUs and 62.5% in ICUs) and conservative treatment (39.8% in TUs and 37.5% in ICUs). The mortality rate in glycol and methanol poisonings in TUs and ICUs were 24.2%, and 56.3% respectively. In the conservatively treated group the mortality rates in TUs and ICUs were 23.5%, and 66.7% respectively, while in extracorporeal toxin removal group the mortality rates in TUs and ICUs were 24.7%, and 50% respectively. The authors also observed two regions (Maków Mazowiecki and Slubice), in which the amount of glycol and methanol intoxications was much higher than in the rest part of the country. CONCLUSIONS: 1. All the cases of acute intoxications of glycol and methanol should be consulted with Polish Poison Control Centers. 2. It is necessary to establish diagnostic and treatment protocols for intoxicated patients in Poland. 3. There is a strong need for popularization of the modern methods of glycol and methanol poisonings therapy and increasing the availability of modern antidotes. 4. It is necessary to monitor diagnostics, treatment and mortality rate of glycol and methanol intoxicated patients in all types of hospital units in Poland. 5. There is a need of further toxicological education of medical students and doctors as well. 6. The cases of abnormally high rate of glycol and methanol intoxications in some hospitals should be investigated.

[Management of acute cyanide poisoning--Polish Medical Society, Section of Clinical Toxicology position statement]. / Postepowanie w ostrych zatruciach cyjankami - stanowisko Sekcji Toksykologii Klinicznej Polskiego Towarzystwa Lekarskiego.

Paper presents Polish Medical Society, Section of Clinical Toxicology position statement on the prehospital and hospital management of cyanide poisoning.

[System of biocide products control in Poland]. / System kontroli zatruc biocydami w Polsce.

In this article we presented actual legislation concerning biocide products in Poland. Rules of reporting and archiving of biocide products exposure were discussed. We presented the first results of monitoring of biocide poisoning cases in Poland from July 2007 to June 2008.

[Correlation between carbamazepine serum level and clinical condition of acute poisoned patient]. / Zaleznosc pomiedzy stanem klinicznym chorych ostro zatrutych karbamazepina a stezeniem leku w surowicy krwi.

UNLABELLED: The aim of our study was to find out the relationship between the serum CBZ level and the clinical symptoms of acute intoxication. The research was conducted on 130 patients including 64 females and 66 males, aged from 14 to 59 years. We noted 65 cases of acute CBZ intoxication and 65 cases of mixed intoxications. In 115 patients the CBZ plasma level was higher than therapeutic range. Acute pulmonary failure was observed in 3 persons. CONCLUSIONS: 1. Positive correlation has been found at the serum CBZ concentrations and systolic blood pressure and pulse. 2. We failed to find any significant correlation between CBZ plasma level and the remaining parameters. 3. The heavier course of poisoning was not affirmed in the case of mixed intoxication in comparison to poisonings with only CBZ. 4. In persons treated with CBZ earlier, the course of poisoning was less severe.

[Stinging catfish spine envenamation]. / Narazenie na jad suma indyjskiego.

The stinging catfish Heteropneustes fossilis (Bloch, 1794) has become a popular aquarium fish in Poland and is available in almost every pet shop. The toxicological centers in Cracow, Gdansk and Warsaw have recorded twelve cases of envenomations caused by stinging catfish in the years 1994-2008. In most cases the injury was accompanied by oedema, erythema, intense pain, numbness of the site and dizziness. Schema of medical management was prepared using analysis of cases.

[Strategic preparedness of selected hospitals to act during massive chemical disasters]. / Strategiczne przygotowanie wybranych szpitali do dzialan w warunkach masowych skaien chemicznych.

The aim of our study was the evaluation of strategic preparedness of twelve hospitals in Kraków, Warsaw and the Triple City to give aid during massive chemical accidents. The study was carried on 146 persons, including 9 managers, 31 ward heads, 75 assistants, and 31 ward nurses. In statistical analysis the generalized linear model extended by random factors, particularly the Poisson's regression has been used. In any of the investigated hospitals, there were no plans regarding of action in case of chemical accidents. The knowledge about sources of possible contamination as well as environment threats were insufficient. The majority of the medical staff did not know their role as well as the role of their hospitals in case of a chemical accident. There is an urgent need for courses about the procedures which should be used during chemical accidents. The lack of hospital preparedness to act during chemical disasters in the big cities suggests that a similar situation is common in other such medical units all over the country. Further investigations, especially in the hospitals which are placed near the potentially dangerous factories, should be carried on in the near future.

[Logistic preparedness of chosen urban agglomeration hospitals to act during massive chemical disasters]. / Logistyczne przygotowanie szpitali w wybranych aglomeracjach miejskich do dzialan w warunkach masowych skaizen chemicznych.

Twelve hospitals--five form Warsaw, three from Kraków, and four from Gdansk and Gdynia were randomized for the study. The logistic preparedness of hospitals during massive chemical accidents has been investigated. There were 146 probands (9 managers, 31 ward heads, 75 assistants and 31 ward nurses) included in the study. In statistical analysis the generalized linear model extended by random factors, particularly the Poisson's regression has been used. No hospital in the three big cities in the country was prepared for any logistic action in case of massive chemical disaster. There were no stationary and mobile decontamination units in the investigated hospitals. There was no individual protective equipment in any of the analyzed hospitals. There were serious deficits in assortment and amount of antidotes which can be used in the treatment of contaminated patients. As much as 97.2% of respondents pointed the poison information centers as a main source of information in case of chemical accidents.

[Essential preparedness of physician to act during massive chemical disasters]. / Merytoryczne przygotowanie lekarzy do dzialan w warunkach masowych skazen chemicznych.

The aim of the study was the evaluation of some aspects of doctors knowledge about the treatment in case of massive chemical accidents. The study was conducted in twelve hospitals in Kraków, Warsaw, and the Triple City. There were 106 doctors (31 ward heads and 75 assistants) included in the study. The questions contained some aspects of: external decontamination, the usage of 0.5% of sodium hypochlorite, the knowledge about the use of selected antidotes and the symptoms of chosen toxidromes. In statistical analysis the generalized linear model extended by random factors, particularly the Poisson's regression was used. The results confirm, that the medical staff is not well prepared to take an effective action in case of a chemical contamination. The essential knowledge of the medical staff in all investigated aspects of chemical safety has been found out to be not satisfactory. There is an urgent need for medical staff to undergo theoretical and practical courses about toxicity of major chemicals. The clinical toxicologists should be asked to prepare up-to-date, advanced methods and regulations for life support in case of heavy chemical accidents.

Selected clinical aspects of acute intoxication with baclofen.

Baclofen is a lipophilic analogue of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in central nervous system. The aim of the study was to evaluate some clinical aspects of acute intoxication with baclofen. Fifty two patients (37 females and 15 males) aged from 14 to 58 (mean 30.6 +/- 13.7) years were analyzed. Patients were admitted to the Clinic of Internal Diseases and Acute Poisonings Medical University of Gdansk and the Centre of Acute Poisonings of Praski Hospital in Warszawa during the years 1996-2004 because of suicidal intoxication with baclofen. The doses of baclofen varied from 100 to 1500 (mean 444.8 +/- 317.8) mg. There were twenty eight patients (53.8%) in deep coma (III and IV grade of Matthew scale). Acute respiratory failure which required mechanical ventilation was observed in 18 cases (34.6%). Cardiac abnormalities included bradycardia (36.5%), hypertension (32.7%) and hypotension (3.8%). Toxic psychoses were observed in 6 cases (11.5%). The dosage of baclofen in patients with acute respiratory failure (ARF) was significantly higher than in patients without ARF. Treatment of patients with acute baclofen intoxication should take place in hospitals appropriately equipped which can provide artificial respiration.

Toxicological information conducted by Polish Poison Information Centres based on selected cases of acute intoxication.

The paper presents relatively diversified answers provided by Polish Poison Control Centres concerning the diagnosis and the treatment of the three standard acute poisonings. This diversity resulted from the lack of standardized, compatible, reliable and up-dated system of information. There is an urgent need to establish the national network of RPCC in Poland. The up-dated source of information and unified system of collecting data should be introduced as soon as possible.