Intoxicaciones por neurolépticos / No disponible

Cada vez es más frecuente el uso de neurolépticos en la infancia y adolescencia, y las intoxicaciones por estos fármacos no son despreciables. Unas veces son debidas al aumento de las dosis de forma accidental o a ingestiones accidentales en los niños más pequeños que toman la medicación de sus familiares. Asimismo, entre los niños más mayores y adolescentes se describen casos de intentos suicidas o de llamar la atención. Se ha hecho una revisión de las intoxicaciones por neurolépticos en la infancia y en la adolescencia, incluyendo las exposiciones tóxicas registradas en el Servicio de Información Toxicológica (SIT). También se describen los diferentes principios activos antipsicóticos, mecanismos de acción, toxicocinética, manifestaciones clínicas de la intoxicación aguda y medidas terapéuticas (AU)

Neuroleptic use in both childhood and adolescence is increasing, and the toxic exposures by these drugs are not negligible. In several cases neuroleptic intoxications are due to therapeutic errors or to accidental ingestion of parent medications by children. Other toxic exposures are the result of suicidal attempts, essentially in adolescents. We have reviewed the neuroleptic intoxications in children and adolescents, including the toxic exposures registered in the Spanish Poison Control Centre (SPCC). Antipsychotic compounds, mechanisms of action, kinetics, clinical manifestations of acute intoxications and therapeutic measures are also described (AU)

Empleo de carbón activado en el tratamiento de las intoxicaciones pediátricas en atención primaria y en el domicilio. Propuesta de actuación / Use of activated charcoal in the treatment of pediatric intoxication in primary care and at home. Proposal of performance

Introducción: Los objetivos principales del presente estudio son conocer qué opinan los padres y pediatras sobre la prevención y el tratamiento de las intoxicaciones y ver en qué situaciones se está utilizando el carbón activado en atención primaria para evaluar su empleo en el domicilio. Material y métodos: Se realizaron dos encuestas en el Área 2 del Insalud de Madrid, una entre los padres y otra a los pediatras,para valorar sus conocimientos y actitud ante una intoxicación. Además, se estableció la incidencia de intoxicaciones en el Hospital «San Rafael» de Madrid y se analizaron las llamadas recibidas en el Instituto Nacional de Toxicología. Los datos recogidos fueron tratados mediante el programa estadístico SPSS 10.0.Resultados: La mayoría de los 212 padres encuestados mantiene el posible tóxico fuera del alcance de los niños. Ante una intoxicación,los familiares acudirían a urgencias(150/212), contactarían telefónicamente con el Instituto Nacional de Toxicología (96/212), irían al consultorio más cercano (21/212) o llamarían a su médico( 18/212). La mayor parte de los 47 pediatras encuestados se siente capacitado para atender a un niño intoxicado, aunque no disponen de recursos suficientes para ello. El 83% de los facultativos considera que el carbón activado puede utilizarse en atención primaria, aunque sólo el 29%opina que deba ser un medicamento de uso domiciliario. Conclusiones: Dado que la mayoría de las intoxicaciones ocurren en el domicilio, el uso del carbón activado durante la primera media hora conllevaría muchos beneficios, como el menor gasto hospitalario y la precocidad del tratamiento. El papel de los padres ante su posible introducción debería ser activo. Primero adoptando las medidas preventivas recomendadas por los profesionales y autoridades sanitarios, y ante la sospecha de intoxicación, poniéndose en contacto con los institutos de toxicología o su médico para saber si la sustancia es tóxica, y en este caso, su tratamiento con carbón activado en el domicilio, para lo cual sería interesante que los padres hubieran recibido de forma previa algún tipo de entrenamiento

Introduction: The main objectives of present study are to know the opinion of parents and pediatricians concerning to the prevention and treatment of intoxications and to check in which situations the activated charcoal is used in Primary Care and at home in order to evaluate the results. Material and methods: Two polls were accomplished in Area 2 of the IMSAlUD in Madrid in order to appraise the knowledge and behaviour in presence of the intoxication one among the parents and the other among the pediatricians. Moreover, the San Rafael Hospital of Madrid showed the incidence of intoxications in addition to the examination of the calls received from Spanish Toxicology National Institute. These data were treated throuhg the statistical program SPSS 10.0. Results: The majority of the 212 inquired parents would take tour different ways of behaving of a possible intoxication, they would call to the Emergency Department(150/212), they would contact to the Spanish Toxicology National Institute by telephone (96/212); they would visit the nearest doctor's office(21/212); they would call their doctor (18/212). In relation tothe 47 inquired pediatricians, we can verify that the majority of them are qualified for the treatment of the intoxication in children with the proviso that they don't have the necessary resources for it. The 83% of the doctors considerer the activated charcoal should be employed in Primary Care; however,only the 29% of them approve the drug in domicilary use. Conclusions: Since the majority of intoxications occur at home, the use of the activated charcoal during the first shocking hour would bring many advantages as the minar hospitable expense and significance of being a precocious treatment. Therefore the parents should take an active raje since they could make use of this treatment, just embracing the preventive measures recommended by the professional and sanitary authorities: well getting in touch to the Toxicology Institutes well phoningt heir doctor in arder to letting know the ingested substance. Once the toxicity is confirmed, the parents could treat their childrenw in the activated charcoal at home. Finally we suggest providinga previous training to the parents for the use of this treatment

Intoxicaciones con aceite de lamparillas en sacerdotes católicos / Intoxications with lamp oil in catholic priests

Este estudio se llevó a cabo ante la detección de casos de ingestión de aceite de lamparillas por parte de sacerdotes católicos de diferentes comunidades autónomas españolas. Los datos analizados, desde enero de 1991 a Julio del 2003, fueron: edad del paciente, circunstancias de la exposición (horario, lugar, cantidad) y manifestaciones clínicas. Un total de 16 casos cumplieron los parámetros de inclusión. La primera consulta se recibió en noviembre de 1997. El número de exposiciones fue mayor los miércoles, sábados y domingos. El horario de los incidentes reflejó los horarios de las misas (por la mañana temprano 2, mediodía 5, tarde 3 y tarde-noche, 6 casos). La edad media de los pacientes fue de 49 años. El aceite se bebía después de ser mezclado con el vino durante la misa o directamente de la botella, en el intervalo entre las celebraciones. La cantidad ingerida fue de solo uno o dos tragos aunque ocasionalmente la mezcla de aceite y vino se bebió totalmente (unos 200 ml). Los síntomas fueron: diarrea (4), vómitos (2), dolor abdominal (2) y esputo hemoptoico (1). En 10 episodios los pacientes permanecieron asintomáticos. Las intoxicaciones laborales en el ambiente religioso representan una circunstancia infrecuente. La confusión se debió a la similitud del envase de aceite de parafina con las botellas de agua mineral. Los datos reportados indican que es necesario hacer toxicovigilancia en lugares inusuales

This investigation was prompted by the detection of lamp oil ingestions among catholic priests from different regions of Spain. Data analysed from January 1991 to July 2003 was for patient age, circumstances of exposure (timetable, site, amount) and clinical symptoms. A number of 16 cases met inclusion criteria. The first case was recorded in November 1997. The number of exposures was higher on Wednesday, Sunday and Saturday. Time of the incidents reflected the timetable of Mass (early morning 2, midday 5, afternoon 3 and evening 6 cases). The mean age was 49 year old. Lamp oil was drunk after being mixed with wine during the Mass or directly from the bottle between services. The amount swallowed was only one or two sips although occasionally the mixture of oil and wine was drunk totally (around 200 ml). Symptoms were: diarrhoea (4), vomiting (2), abdominal pain (2) and hemoptoic sputa (1). In 10 occasions the patients remained asymptomatic. Occupational toxic exposure in a religious environment is an uncommon event. The confusion was due to the similarity of the paraffin oil container with the bottles of mineral water. Data reported in this study indicates the need for workplace surveillance in unusual places

Intoxicaciones en las Instituciones Penitenciarias españolas / Poisoning in Spanish Penitentiary Institutions

La institución penitenciaria es uno de los ámbitos donde las intoxicaciones, si excluimos las dependencias a drogas de abuso, están peor analizadas. El objetivo de este trabajo es evaluar las características de las intoxicaciones que suceden en la prisión y por las que nos consultan en el Servicio de Información Toxicológica. Para ello se hizo un estudio retrospectivo y descriptivo en el período comprendido entre enero de 1991 y diciembre de 2001. De los 246 pacientes registrados, el 81,3% se correspondió al sexo masculino y la edad media era de 26,2 años. Vías de entrada del tóxico: oral 90,6%, inhalación 4%, parenteral 1,6%, mucosas 1,6%, cutánea 0,8% y varias 1,4%. Tipos de productos: medicamentos 41,1%, productos de limpieza y blanqueantes 26,1%, productos del hogar 15,3%, cosméticos 4,5%, productos industriales 3,2%, drogas de abuso 2,4%, pesticidas 1,6%, varios 3,4% y otros 2,4%. La principal etiología fue suicida 83,6%, seguida de la causa accidental 9,8%, laboral 3,2%, dependencia 1,8%, homicida 0,4% y otras 1,2%. Como conclusión destacamos el alto número de intoxicaciones de etiología voluntaria y el tipo de productos implicados: pilas, medicamentos psicotrópicos, antivirales y tuberculostáticos. Los datos obtenidos sirven para poder intervenir en la prevención de las intoxicaciones (AU)

One of the areas where poisoning, excluding drug abuse dependency, has been least analyzed is the penitentiary institution. The aim of this article is to assess the features of intoxications in jails referred to us in the Toxicology Information Service. This is a descriptive, retrospective study carried out between January 1991 and December 2001. Of the 246 registered patients, 81,3% were male, mean age 26,2 years. Routes of exposure: oral 90,6%, inhalation 4%, parenteral 1,6%, membrane mucoses 1,6%, cutaneous 0,8% and other routes 1,4%. Products: drugs 41,1%, cleaning products and bleaches 26,1%, household products 15,3%, cosmetics 4,5%, chemicals 3,2%, drugs of abuse 3,2%, pesticides 1,6%, various 3,4%, and others 2,4%. The main etiology was suicide attempts 83,6%, followed by accidental 9,8%, occupational 3,2%, drug dependence 1,8%, homicides 0,4% and others 1,2%. As a conclusion we highlight the high number of voluntary poisonings and the type of products involved such as batteries and psychotropic, antiviral and tuberculostatic drugs. The data obtained enable us to propose suitable preventive measures (AU)

[Cases of neurological symptoms associated with star anise consumption used as a carminative]. / Casos de enfermedad de sintomatología neurológica asociados al consumo de anís estrellado empleado como carminativo.

BACKGROUND: Since March 2000, a series of infants with serious gastrointestinal and neurological symptoms have been observed in Spain. These symptoms were suspected to be associated with the use of star anise infusion. We performed an epidemiological study to determine the characteristics of these patients and to evaluate the association between the symptoms and anise consumption. METHOD: From February to September 2001, a matched case-control study (1:2) was performed among infants aged less than 3 months admitted to the pediatric emergency departments of two hospitals in Madrid. Mantel-Haenszel and conditional logistic regression odds ratios (OR) were calculated to quantify the association and the dose-response relationship. Laboratory analyses of the implicated substances were performed. RESULTS: Twenty-three cases were studied. The mean age was 29.2 days (SD: 25.5). The symptoms observed were irritability, abnormal movements, vomiting and nystagmus. Eighteen cases and 36 controls were included in the case-control study. Nine controls (25 %) consumed anis infusion (consumption was high in five and low in four). The Mantel-Haenszel OR was 18.0 (2.03-631) and the OR for the dose-response relationship was 11.7 (95 % CI: 1.3-188.5) for low levels of consumption and 18.2 (95 % CI: 1.8-183.5) for high levels. Laboratory analyses revealed contamination of Illicium verum by Illicium anisatum. CONCLUSIONS: This study confirms the association between the symptoms described and the use of anise infusion. The dose response analyses provide further evidence for the association. Cross-contamination was found between the product and other anise species. We recommend destruction of the contaminated products, avoidance of anise infusions among infants, and dissemination of the results among pediatricians.

Casos de enfermedad de sintomatología neurológica asociados al consumo de anís estrellado empleado como carminativo / Cases of neurological symptoms associated with star anis consumption used as a carminative

Antecedentes: Desde marzo de 2001 se observaron en España una serie de niños, menores de 3 meses, que presentaban sintomatología digestiva y neurológica grave, presuntamente asociada al consumo de anís estrellado. Se inició un estudio epidemiológico con el objetivo de conocer las características de los afectados y valorar la asociación entre el cuadro y el consumo de anís. Método: Estudio de casos-controles apareados (1:2), en niños menores de 3 meses ingresados en las urgencias pediátricas de dos hospitales de Madrid, entre febrero y septiembre de 2001. Se emplearon odds ratio (OR) de Mantel-Haenzel y regresión logística condicionada para cuantificar la asociación y la dosis-respuesta. Se realizaron análisis de laboratorio de las sustancias implicadas. Resultados: Se estudiaron 23 casos. La sintomatología consistió en irritabilidad (78,3%), movimientos anormales y vómitos (56,5%), nistagmo (52,2%) y episodios de desaturación de oxígeno (21,7%). En el estudio de casos-controles se emplearon 18 casos y 36 controles. Nueve (25%) controles consumieron anís estrellado (exposición leve, 5 casos; alta, 4 casos). La OR de Mantel-Haenzel fue de 18,0 (intervalo de confianza [IC] del 95%, 2,03-631) y para la dosis-respuesta de 11,7 (IC 95%, 1,3-188,5) en la exposición leve y de 18,2 (IC 95%, 1,8-183,5) en la alta. Los análisis de laboratorio mostraron contaminación de Illicium verum con Illicium anisatum. Conclusiones: Se confirma la relación entre la enfermedad y el consumo de anís estrellado. La asociación se refuerza en los análisis de dosis-respuesta. Se encontró contaminación del producto con otras especies de anís. Se recomienda destrucción de las partidas contaminadas, no utilizar en lactantes y divulgación de los resultados entre pediatras (AU)

Household bleaches based on sodium hypochlorite: review of acute toxicology and poison control center experience.

Bleaches based on solutions of sodium hypochlorite (NaOCl) are widely used in the household to disinfect and clean hard surfaces and to bleach the laundry. A review of both published and unpublished toxicological data is presented. In addition, the results of a survey of human accidents with hypochlorite bleaches by the Poison Control Centers of France, Italy, Belgium, Greece, Turkey, Spain and Portugal for the period 1989-1992 are presented. The data show that acute accidental exposure to household bleach in use or in foreseeable misuse situations results, in the great majority of the cases, in minor, transient adverse effects on health, with no permanent sequelae. Ingestion is the most frequent route of exposure, followed by inhalation of gases evolved by mixing sodium hypochlorite bleach with acid or alkaline products. All evidence presented confirms the normal safety profile of hypochlorite-based bleaches to be similar to that of other 'generally recognized as safe' household products.

Possible direct effect of prolactin on catecholamine synthesis and release in rat adrenal medulla: in vitro studies.

It has been recently shown that chronic increase in circulating prolactin (PRL) levels can affect the catecholamine (CA) synthesis and release in the adrenal medulla of female and male rats. However, it is not established if this effect is directly exerted on the adrenomedullary cells. To elucidate this question, we have studied the possible capacity of PRL to modify the in vitro synthesis and release of CA in isolated adrenal medullas of female rats. The study has been performed in animals with hyperprolactinemia induced by pituitary grafts (GRAFT) or with low PRL levels induced by ovariectomy (OVX), and in their respective sham-operated controls (SHAM), in order to establish if the previous plasma levels of this hormone could modify the effects observed in vitro. Basal release of adrenaline (A), noradrenaline (NA) and total CA observed during the first h of tissue incubation was similar in the three groups of animals. However, OVX animals exhibited a decreased release of both CA in the second h of incubation. This low CA release was partially reversed after the exposure of the incubated adrenal medullas of these animals to a medium containing PRL, whereas this hormone was ineffective to modify the CA release in SHAM and GRAFT animals. Moreover, PRL caused a significant decrease in the A production by the adrenal medullas of SHAM animals, since the amount of A released plus the amount of A stored after incubation in presence of PRL was significantly decreased. Finally, the exposure of the adrenomedullary cells from GRAFT rats to PRL was followed by an increase in the contents of both NA and A in the tissues.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of estrogens and progesterone on the catecholaminergic activity of the adrenal medulla in female rats.

Some reports in the literature allow to suspect the existence of an effect of sexual steroids on the adrenal catecholamines. To test this possibility, we have examined the catecholaminergic activity in the adrenal medulla of normal cycling rats in three phases of estrous cycle and of ovariectomized (OVX) rats injected with pharmacological doses of estradiol (ES), 2-hydroxyestradiol (HE) and/or progesterone (P). Adrenomedullary content of norepinephrine (NE) was similar during the estrous cycle, while epinephrine (E) content was increased during diestrous. This increase was concomitant with an increased phenylethanolamine-N-methyltransferase (PNMT) activity. Moreover, the monoamine oxidase (MAO) activity was significantly increased during proestrous, while the catechol-O-methyltransferase (COMT) activity was significantly decreased during estrous. In addition to these observations, ovariectomy caused a significant reduction of the E/NE ratio and of COMT and MAO activities. Administration of ES to OVX rats increased the E content, the E/NE ratio and the COMT activity as compared to vehicle-treated OVX rats. Administration of P to OVX animals led also to a significant increase of the E/NE ratio and of the COMT activity but not of the E content, while the administration of this steroid to OVX rats previously treated with ES only increased the COMT activity. Finally, administration of HE caused non-significant changes in NE and E contents and in MAO, COMT and PNMT activities. We can conclude that sexual steroids seem to be able to modify the catecholamine metabolism in the adrenal medulla and, hence, they could alter the ability of this gland to store and release these amines.