Suicidal iron overdose: A case report and review of literature.

Acute iron toxicity in adults is rare, usually occurring due to intentional ingestion in suicide attempts. Few cases of the clinical and autopsy findings in acute iron toxicity have previously been reported in the literature. Ingestion of large amounts of iron salts can lead to hemorrhagic shock, multi-system organ failure, coagulopathy, and death. We present the case of a 25-year-old man who reportedly ingested a large quantity of iron tablets along with ethanol in a suicide attempt and subsequently died approximately 65.5 h later. His clinical course and laboratory findings demonstrated hepatic and renal compromise with markedly elevated serum iron levels. At autopsy, iron encrustations were present over the gastric rugae. Superficial deposits of stainable iron were present overlying areas of mucosal necrosis with underlying submucosal fibrin thrombi. No significant stainable iron was present in the liver. Literature review revealed that the clinical course and laboratory testing of severe acute iron overdose is fairly non-specific. The length and type of treatment may alter the clinical course and laboratory results. Peak serum iron levels may be helpful in differentiating acute toxicity from chronic iron overload states. Gross findings of gastric iron encrustation are specific for acute ingestion when present.

Bodybuilding supplements leading to copper toxicity, encephalopathy, fulminant hepatic failure and rhabdomyolysis.

Millions of people worldwide use nutritional and dietary supplements, such as vitamins and minerals. These and other performance-enhancing substances are also used by high school, college, and professional athletes, bodybuilders, and amateur sports enthusiasts. The constituents of these supplements and their metabolites may be harmful and not listed on the product label. We present a case report of a 32-year-old bodybuilder using myriad nutritional, performance-enhancing, and weight-loss supplements with life-threatening encephalopathy, hepatic failure, rhabdomyolysis, and copper toxicity mimicking Wilson's disease. Emergency physicians and nurses should be aware of these potential deleterious effects and inquire about supplement use by patients with unexplained multiorgan failure. Family, friends, or acquaintances should be asked to bring the actual products to the hospital for analysis.

Minimum ingested iron cut-off triggering serious iron toxicity in children.

BACKGROUND: Iron intoxication can occur accidentally in children or intentionally by adolescents as a suicide attempt. They usually present with various symptoms including vomiting and diarrhea. Clinical studies in this field has been reported different doses of ingested elemental iron that caused serious toxicity, but none of these studies determined the minimum cut-off of ingested iron that triggered the risk of severe toxicity. The aim of this study was therefore to investigate the demographic features of iron intoxication in Turkish children and to determine the lowest cut-off of ingested elemental iron triggering serious intoxication and the need for prompt management. METHODS: This retrospective study investigated 83 Turkish patients with accidental and intentional iron poisoning. RESULTS: Of the 83 cases of acute iron intoxication, accidental iron consumption was more common than intentional use. Fifty-three patients ingested a median toxic dose of elemental iron of 40.0 mg/kg (IQR, 33.5 mg/kg). The median serum iron concentration in the first 6 h of ingestion was 150 µg/dL (IQR, 282 µg/dL). Twenty patients were given deferoxamine, whereas 63 patients were given supportive treatment. CONCLUSION: The cut-off of ingested elemental iron that triggered serious toxicity and the need for deferoxamine in children <18 years of age was 28 mg/kg.

Concentração de elementos traços em serpentes do litoral e da região serrana do Espírito Santo / Trace element concentration in snakes of coastal and serrana region of the State of Espírito Santo, Brazil

Os elementos químicos, em sua maioria, encontram-se em ciclos bioquímicos e geoquímicos fechados e em concentrações que não causam efeitos nocivos aos organismos. Contudo, ações antrópicas aceleradas promovem alterações ambientais, como o aumento no aporte de contaminantes. Com essas informações, o presente trabalho buscou caracterizar a presença aos elementos traços em duas espécies de serpentes comuns na região sudeste, Boa constrictor e Bothrops jararaca. Os exemplares de B. constrictor (n=18) foram provenientes de atropelamentos ocorridos no trecho da Rodovia ES-060 do Km 0 ao Km 67,5. Os exemplares de B. jararaca (n=18) foram capturados por fazendeiros na zona rural da região serrana do Espírito Santo. Foram analisados 1 grama de fragmento de rim, de espécimes necropsiados. Os rins coletados foram digeridos com mistura ácida (HNO3;HCl; 1:1) a 300oC, 40min e a quantificação de microelementos (Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb e Zn) foi realizada por espectrometria de emissão óptica com plasma indutivamente acoplado (ICP OES). Não foram observadas diferenças significativas entre machos e fêmeas, exceto para Cromo nas B. constrictor (p=0,03), com média de 1,6595 nas concentrações de Cr nas fêmeas e 0,2896 em machos. Contudo, quando foram comparadas as diferentes espécies de serpentes, diferentes concentrações foram encontradas, para todos os elementos determinados, com destaque para o Ferro com uma concentração de 106,2mg/g em B. constrictor e 120,3mg/g em B. jararaca, provavelmente por esses animais virem de áreas próximas à portos de minério de ferro. A concentração de Zinco em B. constrictor foi de 1261,8mg/g e em B. jararaca foi de 28,4mg/g. O presente estudo indica que as serpentes analisadas, que habitam as regiões da Grande Vitória e serrana do Espírito Santo apresentam elevadas concentrações dos microelementos Zn e Fe.(AU)

Chemical elements are mostly involved in biochemical and geochemical cycles in concentrations which are harmless for organisms. However, accelerated human actions promote environmental changes such as the increase in contaminant intake. With this information, this study aimed to characterize the presence of trace elements in two snake species common in Southeastern Brazil, Boa constrictor and Bothrops jararaca. Copies of B. constrictor (n=18) were from pedestrian accidents which occurred on Highway stretch ES-060 from Km 0 to Km 67.5. Copies of B. jararaca (n=18) were captured by farmers in a rural mountainous area of Espíirito Santo State, Brazilo. They were analyzed 1 kidney fragment grass, autopsied specimens. Harvested kidneys were digested with acid mixture (HNO3 e HCl 1:1) at 300°C, 40 min and quantification of microelementos (Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb and Zn) were determined by spectrometric optical emission with inductively coupled plasma (ICP OES). significant differences between males and females were observed, except for Chrome in B. constrictor (p=0.03), with an average of 1.6595 in Cr concentration of females and 0.2896 in males. However, when different species of snakes were compared, different concentrations were found for all elements, especially iron with a concentration of 106.2mg/g in B. constrictor and 120.3mg/g in B. jararaca; probably these animals came from areas near iron ore ports. The concentration of zinc in B. constrictor was 1261.8mg/g and in B. jararaca 28,4mg/g. This study indicates that the analyzed snakes, which inhabit the regions of Greater Victoria and the mountainous region of the State of Espírito Santo have high concentrations of the microelements Zn and Fe.(AU)

Do Dietary Habits Influence Trace Elements Release from Fixed Orthodontic Appliances?

The objective was to investigate the effect of dietary habits on the release of Cr and Ni ions from orthodontic appliances by hair mineral analysis. Patients (N = 47) underwent electronic questionnaire survey to investigate the effect of dietary habits on Cr and Ni levels in hair. The research was carried out on hair sampled at the beginning and in the 4th, 8th, and 12th months of the treatment. The content of Cr and Ni in the collected samples was determined by ICP-OES. The study showed that consumption of acidic dietary products may have the effect on increasing the release of Cr and Ni ions from orthodontic appliances. The release of Cr from orthodontic appliances in patients who consumed fruit juice, coffee, yoghurt, and vinegar was higher. The coefficients enabling comparison of metal ions release pattern at a given sampling points were defined. The comparison of the coefficients yielded the information on the possible magnification of metal ions released as the result of the additional factor consumption of acidic food or drink that intensifies metal ions release. The following magnification pattern was found for chromium: coffee (7.57 times) > yoghurt (2.53) > juice (1.86) > vinegar (1.08), and for nickel: vinegar (2.2) > coffee (1.22) > juice (1.05). Yoghurt did not intensify the release of nickel. Concluding, orthodontic patients should avoid drinking/eating coffee, yoghurt, fruit juices, and vinegar.

Cobalt(II) Chloride Modifies the Phenotype of Macrophage Activation.

Cobalt (Co) is vital for cells in trace amounts, but excessive exposure to Co is possible due to surgical devices such as artificial metal-on-metal joints. Cobalt(II) chloride (CoCl2 ) has also been shown to imitate hypoxic conditions in cells by stabilizing the transcription factor hypoxia-inducible factor-1α (HIF-1α). The purpose of this study was to investigate the possible immunomodulatory action of CoCl2 by investigating its effects on the expression of inflammatory genes in macrophages. The following factors were assessed: inducible nitric oxidase synthase (iNOS), nicotinamide adenine dinucleotide phosphate-oxidase 2 (NOX2), interleukin-6 (IL-6), arginase-1 and HIF-1α. In the absence of exogenous cytokines, CoCl2 enhanced alternative (M2) macrophage activation as demonstrated by increased arginase-1 expression, but had no direct effect on inflammatory factors associated with classical (M1) activation. Interestingly, in lipopolysaccharide (LPS)-stimulated macrophages, CoCl2 modified the M1-type activation profile by increasing iNOS expression and nitric oxide production and decreasing NOX2 and IL-6. Also, CoCl2 increased HIF-1α levels in unstimulated and LPS-stimulated cells as expected. In conclusion, we showed that CoCl2 enhanced alternative (M2) activation in resting macrophages. In addition, CoCl2 was found to remodel the classical M1 phenotype of macrophage activation by changing the balance of iNOS, NOX2 and IL-6.

Characterizing 1341 cases of veterinary toxicoses confirmed in western Canada: A 16-year retrospective study.

Veterinary toxicoses are frequently observed in western Canada. This study reports the frequency and characteristics of intoxications in animals reported between January 1, 1998 and December 31, 2013. Information was obtained from toxicological case records from the Prairie Diagnostic Services, Saskatoon, Saskatchewan. There were 1341 animal poisonings with 19 compounds over the investigational period. Lead poisoning was the most common toxicity (43.7%). Poisoning with acetylcholinesterase inhibitors and strychnine were also common events. Poisonings were most common in 2001, 2009, and 2012. Intoxications occurred most frequently during the months of May through July. Cattle were the most commonly poisoned species (n = 696), followed by dogs and eagles.

Caractérisation de 1341 cas confirmés de toxicoses vétérinaires dans l'Ouest canadien : une étude rétrospective de 16 ans. Les toxicoses vétérinaires sont fréquemment observées dans l'Ouest canadien. Cette étude présente un rapport de la fréquence et des caractéristiques des intoxications chez les animaux signalées entre le 1er janvier 1998 et le 31 décembre 2013. Des renseignements ont été obtenus dans les dossiers de cas toxicologiques de Prairie Diagnostic Services, à Saskatoon, en Saskatchewan. Il y a eu 1341 empoisonnements d'animaux causés par 19 composés pendant la période d'enquête. L'empoisonnement au plomb était la toxicité la plus fréquente (43,7 %). L'empoisonnement aux inhibiteurs d'acétylcholinestérase et à la strychnine était aussi fréquemment observé. Les empoisonnements ont été les plus fréquents en 2001, en 2009 et en 2012. Les intoxications se sont le plus fréquemment produites durant les mois de mai à juillet. Les bovins de boucherie représentaient l'espèce la plus fréquemment empoisonnée (n = 696), suivie des chiens et des pygarques.(Traduit par Isabelle Vallières).

Bioaccumulation of trace metals in mussel (Mytilus galloprovincialis) from Mali Ston Bay during DSP toxicity episodes.

The Croatian National Monitoring Program revealed the presence of Diarrhetic Shellfish Poisoning (DSP) toxicity in Mediterranean blue mussel (Mytilus galloprovincialis) from breeding farms in southern Adriatic Sea through January to June 2011. The mouse bioassay tests (MBA; at the time the official method for DSP toxins) were accompanied by atypical symptomatology in the animals and this caused doubts about the assay results. Consequently, in parallel studies reported here, the concentration of Cd, Cr, Cu, Ni, Pb and Zn in soft tissue of DSP positive and negative mussels samples was determined. Cd, Cr, Zn and Ni show higher values in approximately 75% of the DSP positive samples, whereas for Pb and Cr the values were 26% and 34%, respectively. This trend was unchanged during the whole observation period.

Physical setting and natural sources of exposure to carcinogenic trace elements and radionuclides in Lahontan Valley, Nevada.

In Lahontan Valley, Nevada, arsenic, cobalt, tungsten, uranium, radon, and polonium-210 are carcinogens that occur naturally in sediments and groundwater. Arsenic and cobalt are principally derived from erosion of volcanic rocks in the local mountains and tungsten and uranium are derived from erosion of granitic rocks in headwater reaches of the Carson River. Radon and 210Po originate from radioactive decay of uranium in the sediments. Arsenic, aluminum, cobalt, iron, and manganese concentrations in household dust suggest it is derived from the local soils. Excess zinc and chromium in the dust are probably derived from the vacuum cleaner used to collect the dust, or household sources such as the furnace. Some samples have more than 5 times more cobalt in the dust than in the local soil, but whether the source of the excess cobalt is anthropogenic or natural cannot be determined with the available data. Cobalt concentrations are low in groundwater, but arsenic, uranium, radon, and 210Po concentrations often exceed human-health standards, and sometime greatly exceed them. Exposure to radon and its decay products in drinking water can vary significantly depending on when during the day that the water is consumed. Although the data suggests there have been no long term changes in groundwater chemistry that corresponds to the Lahontan Valley leukemia cluster, the occurrence of the very unusual leukemia cluster in an area with numerous 210Po and arsenic contaminated wells is striking, particularly in conjunction with the exceptionally high levels of urinary tungsten in Lahontan Valley residents. Additional research is needed on potential exposure pathways involving food or inhalation, and on synergistic effects of mixtures of these natural contaminants on susceptibility to development of leukemia.

Fatal poisoning by vanadium.

We report here a fatal intoxication case involving ammonium vanadate. A 24-year-old woman was admitted to the Emergency Department for abdominal pain, nausea, vomiting, multiple daily diarrheas, hypoglycaemia (0.2g/L) and severe acute renal failure with glomerular filtration rate estimated at 21 ml/min. This patient had taken an undetermined amount of ammonium vanadate 12h after ingesting. She died next morning in the context of respiratory distress despite intensive care and oxygen therapy. The autopsy revealed widespread asphyxia syndrome and erosive gastritis. Determination of vanadium concentration in blood was carried out by means of mass spectrometer (ICP-MS) using rhodium ((103)Rh) as the internal standard. The vanadium concentration was 6.22 mg/L, corresponding to 6000 times higher than normal concentration in the general population. The latency and the brutality of clinical picture degradation seem to be in consideration of systemic poisoning by vanadium leading to inhibition of the cellular respiratory process.

Copper toxicosis in a dairy goat herd.

CASE DESCRIPTION: A closed herd of 400 mixed-breed dairy goats was examined because of a decrease in milk production and increase in mortality rate. Nine animals had died within a 1-month period. CLINICAL FINDINGS: Clinical signs were evident only in lactating goats and included anorexia and recumbency. In the most severely affected goats, signs progressed to neurologic abnormalities and death. Serum aspartate aminotransferase activity, gamma-glutamyltransferase activity, and total bilirubin concentration were high in clinically affected does, but no evidence of hemolysis was found. A diagnosis of copper toxicosis was made on the basis of high liver and kidney copper concentrations and histologic evidence of hepatic necrosis. Goats were found to have been fed a mineral mix containing 3,050 ppm copper for 9 months prior to the onset of copper toxicosis. Overall, there was no consistent relationship between serum hepatic enzyme activities, serum copper concentration, and liver copper concentration. TREATMENT AND OUTCOME: Clinically affected goats were treated with penicillamine, ammonium molybdate, sodium thiosulfate, and vitamin E. Penicillamine increased urine copper excretion in treated does versus untreated control animals. An increased incidence of infectious disease was identified in the herd 9 months later. Liver vitamin E concentration was low in 10 of the 12 goats that underwent necropsy. CLINICAL RELEVANCE: Findings suggested that penicillamine may be an effective treatment for goats with copper toxicosis. Production losses months after the diagnosis was made suggested that the intoxication had a prolonged animal welfare and economic impacts.

Zinc intoxication in dogs: 19 cases (1991-2003).

OBJECTIVE: To determine physical examination findings, clinicopathologic changes, and prognosis in dogs with zinc toxicosis. DESIGN: Retrospective case series. ANIMALS: 19 dogs with zinc toxicosis. PROCEDURES: Medical records from 1991 through 2003 were searched for animals with a diagnosis of zinc toxicosis. Information concerning signalment, body weight, historical findings, initial owner complaints, physical examination findings, clinicopathologic findings, blood zinc concentrations, source of zinc, treatments given, duration of hospital stay, and outcome was collected. RESULTS: Records of 19 dogs with zinc toxicosis were reviewed. The most common historical findings were vomiting (n = 14) and pigmenturia (12). The most common clinicopathologic findings were anemia (n = 19) and hyperbilirubinemia (12). Median age was 1.3 years, and median weight was 5.6 kg (12.3 lb). The prognosis was favorable, with 17 dogs surviving after a median hospital stay of 2 days. CONCLUSIONS AND CLINICAL RELEVANCE: Hemolytic anemia as a result of zinc toxicosis appeared to affect young small-breed dogs more frequently than older large-breed dogs. The prognosis with treatment is good, and most affected dogs had a short hospital stay.

Two fatal cases of selenium toxicity.

Two patients, a 36-year-old female and a 36-year-old male, separately experienced new onset nausea, vomiting, diarrhea, abdominal pain, muscle weakness and pallor. Over a period of 14-16 h these symptoms continue and progress to include hypotension refractory to therapy, pulmonary edema and cardiovascular collapse. Autopsies show hemorrhagic pulmonary edema, splenomegaly and lack of anatomical cause for sudden death. Postmortem analysis, in one case post-embalming and exhumation, revealed elevated selenium concentrations and a determination of the cause of death. These two cases present several important features associated with selenium toxicity, two of which are previously unreported: (1) selenium as a potential homicidal agent, (2) the toxidrome and time frame of selenium toxicity, (3) selenium determination in exhumed, embalmed tissues, (4) postmortem urinary selenium concentration, and (5) decrease in tissue concentrations over time.

Evaluating selenium poisoning.

Selenium poisoning in humans is reviewed from the perspective of the clinical laboratory. While evaluation of selenium poisoning is straightforward when the analytic results are markedly elevated and the patient is acutely symptomatic, distinguishing toxic from non-toxic elevations is a more frequent issue and more challenging. A significant problem is that selenium is determined as its total concentration in spite of the fact that different chemical forms of selenium have different toxic potentials. In the published reports reviewed herein, serum selenium concentrations span the following ranges: 400-30,000 micro g/L associated with acute toxicity, 500-1400 micro g/L associated with chronic toxicity, and <1400 micro g/L free of toxicity; the category is determined by signs and symptoms in the patient. Most reports that describe acute selenium poisoning involve ingestion of inorganic compounds such as selenious acid, found in gun-bluing agents, and fatalities that occur within the first day are associated with postmortem blood selenium levels >1400 micro g/L. Tissue selenium levels show a complex pattern and significant elevations in organs such as kidney are not always indicative of toxicity. As with many trace elements, measuring selenium concentrations in body fluids and tissues tends to be easier than understanding what the results mean.

Accidental death from acute selenium poisoning.

We report a fatal case of acute selenium poisoning in a 75-year-old man. After reading on the Internet about a possible role of selenium in prostate cancer, the patient ingested 10 g of sodium selenite. Despite intensive care treatment, he suffered a cardiac arrest and died 6 hours after ingestion. This case illustrates the risks of failing to critically evaluate Internet information and exposes the myth that natural therapies are inherently safe.

Hepatic cobalt and copper levels in lambs in Norway.

Cobalt and copper concentrations were measured in 599 lamb livers collected at slaughter from 58 sheep flocks in 6 different parts of Norway in 1993. Information about pasture, additional feeding and mineral supplements in the flocks was obtained through a questionnaire. Average hepatic levels of cobalt in the lamb flocks varied from < 0.003 to 0.22 microg/g ww, and of copper from 5 to 240 microg/g ww. Flocks with deficient or marginal cobalt status were found in all parts of southern Norway, but primarily in the west and south-west. Some flocks with marginal copper status were found in the south-west, while flocks with signs of excessive hepatic copper concentrations were found mainly in inner parts of central and northern Norway. Hepatic copper concentrations were significantly higher in lambs that had grazed mountain pastures than in those that had grazed lowland pastures in the summer.