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1.
G Ital Nefrol ; 37(2)2020 Apr 09.
Artigo em Italiano | MEDLINE | ID: mdl-32281758

RESUMO

Rhabdomyolysis (R) is a complex condition involving the rapid dissolution of damaged or injured skeletal muscle. This leads to the direct release of intracellular components, including myoglobin, creatine kinase, aldolase, and lactate dehydrogenase, as well as electrolytes, into the bloodstream and extracellular space. Clinically, R shows a triad of symptoms: myalgia, limb weakness, and myoglobinuria without hematuria, while myoglobin has been recognized as playing a part in the development of acute kidney injury. Coturnism is a relatively rare disease, mostly found in the European countries bordering the Mediterranean Sea, characterized by acute R. It follows the consumption of Coturnix coturnix, a species of quails common in Europe, that have ingested the toxic substances (and especially coniine) present in the herbaceous plant called hemlock (Conium maculatum). Coniine may be lethal at a dose of 150 mg but it has neurotoxic effects at smaller doses, with acute R and acute kidney injury. Freezing and cooking the meat does not inactivate the alkaloids present in the birds' flesh and digestive tract. The clinical course of coturnism includes neurotoxicosis, tremor, vomiting, muscle paralysis, respiratory paralysis/failure, R and acute kidney injury. In appropriate geographical and temporal settings, it should be considered when diagnosing patients with acute R. The genetic, biochemical and epidemiological characteristics of coturnism are not yet fully known, while we wait reliable data from experimental studies.


Assuntos
Alcaloides/envenenamento , Doenças Transmitidas por Alimentos/complicações , Piperidinas/envenenamento , Codorniz , Rabdomiólise/etiologia , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/etiologia , Animais , Doenças Transmitidas por Alimentos/diagnóstico , Humanos , Músculo Esquelético/lesões , Intoxicação por Plantas , Codorniz/metabolismo , Rabdomiólise/diagnóstico
2.
J Forensic Leg Med ; 65: 92-100, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31128567

RESUMO

In Hungary, N-ethyl-hexedrone (NEH) was the most frequently seized stimulant designer drug in 2017, while among synthetic cannabinoids ADB-FUBINACA and AB-FUBINACA were the most popular. Symptoms of intoxication by these substances are well known but less is known about the pathology of overdose-related death. NEH-induced fatal intoxication has not been described in the literature and knowledge surrounding the particular circumstances of death could be useful better public education of risk and more adequate treatment of overdose patients. In this report, we characterize the case of a 23-year-old male regular drug user who died a few hours after NEH and ADB-FUBINACA consumption. His medical history showed arrhythmia in childhood, and some seizures. Autopsy found he had a BMI of 42.9, a hypertrophic and dilated heart, severe atherosclerosis of the valves, coronaries and the arteries, and edema of the internal organs. Histology confirmed those findings. Postmortem blood levels of NEH were 285 ng/ml, along with 0.08 ng/ml ADB-FUBINACA and five ADB-FUBINACA metabolites. Based on the blood concentrations measured in suspected drug users (≤83.9 ng/ml) we hypothesize that NEH intoxication was the cause of death in this case, with heart disease being a co-factor and that the synthetic cannabinoid effect might have been accompaniment. This case also offered the opportunity to identify the metabolites of ADB-FUBINACA in the blood. We identified metabolites in the post-mortem blood by comparing them to human liver microsomal enzyme metabolites in vitro. Three major and two minor metabolites were found in the blood, of which two could only be derived from ADB-FUBINACA, as opposed to other cannabinoids. The case highlights the importance of the complex analysis of drug related deaths by medico-legal autopsy, histopathology and toxicology.


Assuntos
Alcaloides/envenenamento , Canabinoides/envenenamento , Estimulantes do Sistema Nervoso Central/envenenamento , Drogas Desenhadas/envenenamento , Indazóis/envenenamento , Alcaloides/sangue , Canabinoides/sangue , Cardiomiopatia Dilatada/patologia , Estimulantes do Sistema Nervoso Central/sangue , Cromatografia Líquida , Drogas Desenhadas/análise , Overdose de Drogas , Usuários de Drogas , Humanos , Indazóis/sangue , Rim/patologia , Masculino , Espectrometria de Massas/métodos , Edema Pulmonar/patologia , Detecção do Abuso de Substâncias , Adulto Jovem
3.
Toxicol Mech Methods ; 29(7): 518-530, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31099292

RESUMO

In this study, an analytical strategy to identify brucine, strychnine, methomyl, carbofuran (alkaline compounds), phenobarbital, and warfarin (acid compounds) using thin-layer chromatography (TLC) screening with ultraviolet (UV) detection at 254 nm in stomach content is shown. The optimum mobile phase was found to be a chloroform: ethyl acetate: diethylamine (0.5:8.5:1) mixture for alkaline substances while a mixture of chloroform: acetone (9:1) has given better results for acidic substances. As for extraction, an equal proportion between distillated water and crude material (1:1) is required. For alkaline compounds, a filtration system was created in order to avoid any interferences from the biological matrix while for acidic compounds only centrifugation (4000 rpm/10 minutes) was required to obtain an appropriate sample. After the respective pretreatments, a one-step liquid-liquid extraction (LLE) has been employed for alkaline substances using a 3 mL of chloroform: ethyl ether (2:1) mixture for 2 min while acidic analytes used 3 mL of chloroform only during 5 min. For both methodologies described, the respective organic layers were dried down and re-suspended with 50 µL of methanol for further TLC plate application. The methodologies have been developed, successfully validated and applied to gastric contents from real case samples of suspected animal poisoning. Positive results from TLC/UV screening were confronted with HPLC-UV and confirmed by GC-MS.


Assuntos
Alcaloides/análise , Carbamatos/análise , Conteúdo Gastrointestinal/química , Fenobarbital/análise , Envenenamento/veterinária , Varfarina/análise , Alcaloides/envenenamento , Animais , Carbamatos/envenenamento , Doenças do Gato/induzido quimicamente , Gatos , Cromatografia em Camada Delgada/veterinária , Doenças do Cão/induzido quimicamente , Cães , Fenobarbital/envenenamento , Envenenamento/etiologia , Varfarina/envenenamento
4.
J Forensic Sci ; 64(1): 304-308, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29768653

RESUMO

n-Ethyl pentylone (NEP) is a chemical substance derived from cathinone. Synthetic cathinones are an evolving group of drugs with stimulating, mind-altering effects sometimes referred to as novel or new psychoactive substances (NPS). There is scarce information in the medical literature regarding forensic cases in which NEP is detected in toxicological testing. We present four fatalities involving NEP from Alabama in 2017. Deaths were attributed to NEP toxicity in two cases (peripheral blood concentrations of 0.121 and 0.953 mg/L) and injuries caused by gunshot wounds in two cases (peripheral blood concentrations of 0.045 and 0.031 mg/L). One case involving NEP described an individual who exhibited classic CNS-stimulant induced erratic behavior before being found dead. These cases enhance the forensic literature regarding specific NPS like NEP and provide contextual reference for professionals considering the significance of NEP in toxicological interpretation.


Assuntos
Alcaloides/sangue , Drogas Ilícitas/sangue , Psicotrópicos/sangue , Transtornos Relacionados ao Uso de Substâncias/sangue , Acidentes , Adulto , Alabama , Alcaloides/envenenamento , Cromatografia Gasosa-Espectrometria de Massas , Homicídio , Humanos , Drogas Ilícitas/envenenamento , Masculino , Psicotrópicos/envenenamento , Transtornos Relacionados ao Uso de Substâncias/complicações , Ferimentos por Arma de Fogo/complicações
5.
Vet Ital ; 55(4): 369-373, 2019 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-31955560

RESUMO

An outbreak of neurological disorders in a flock of 20 sheep coming from a rural farm in Civitella Roveto, Italy, occurred in winter 2015. All the animals showed tonic-clonic convulsions followed by muscle paralysis associated with dilated pupils, tremor, tachycardia, tachypnea and diarrhea. The presence of bundles of dry broom of Spartium junceum L. in the feed, eaten by the animals supported the hypothesis of plant intoxication. Two animals died after worsening of clinical signs. The anatomopathological findings and the laboratory results ruled out viral or bacterial infections or accidental exposure to other toxics. Phytochemical study showed the presence of large amount of cytisine, a nicotinic acetylcholine receptor agonist, in all parts of the plant eaten by the animals. Clinical and pathological findings, the complete remission of clinical signs after the exclusion of dry broom from the diet, together with the results of phytochemical analyses results corroborated the hypothesis of S. junceum L. intoxication.


Assuntos
Alcaloides/envenenamento , Ração Animal/envenenamento , Intoxicação por Plantas/veterinária , Doenças dos Ovinos/diagnóstico , Spartium/envenenamento , Animais , Azocinas/envenenamento , Diagnóstico Diferencial , Dieta/veterinária , Feminino , Itália , Masculino , Intoxicação por Plantas/diagnóstico , Quinolizinas/envenenamento , Ovinos , Doenças dos Ovinos/induzido quimicamente
6.
Toxicon ; 154: 42-49, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30273705

RESUMO

INTRODUCTION: Gelsemium poisoning is caused by consumption of the deadly Gelsemium species such as Gelsemium elegans, leading to significant gastrointestinal, neurological and cardio-respiratory toxicities. In 2011 (Cluster 1) and 2012 (Cluster 2), the authors encountered two clusters of gelsemium poisoning after consumption of the non-toxic parasitic plant Cassytha filiformis. The current study aims to examine the mechanism of gelsemium poisoning mediated by a benign parasitic plant. METHODS: Qualitative analysis of toxic gelsemium alkaloids using liquid chromatography-tandem mass spectrometry (LC-MS/MS) was performed on the herbal and urine samples from both clusters to confirm exposure. Morphological examination, qualitative analysis of aporphine alkaloids using liquid chromatography-ion trap-time of flight mass spectrometry (LC-IT-TOF/MS) and Sanger sequencing were performed on the plant sample from Cluster 2 to confirm its identity. A field study was conducted in local countryside and C. filiformis was collected for histological, LC-MS/MS and LC-IT-TOF/MS analyses to study its interaction with G. elegans. RESULTS: Gelsemium alkaloids that are not naturally present in C. filiformis were detected in the patients' herbal and urine samples. Misidentification and contamination with G. elegans during the preparation process were excluded by morphological examination of the plant sample from Cluster 2. Its identity as C. filiformis was verified with LC-IT-TOF/MS and molecular analyses. Histological, LC-MS/MS and LC-IT-TOF/MS analyses of C. filiformis collected during the field study confirmed that its haustoria penetrated the vascular bundles of G. elegans and absorbed its gelsemium toxins. CONCLUSIONS: The non-toxic plant C. filiformis absorbed toxic gelsemium alkaloids from its host, G. elegans, and led to gelsemium poisoning in our patients. Our study provides new insights into the toxicology of such plants. Benign parasitic plants may lead to potentially life-threatening poisoning if it parasitizes toxic hosts and absorbs their phytotoxins. The public awareness of risks associated with the use of these medicinal parasitic plants should be raised.


Assuntos
Alcaloides/química , Alcaloides/envenenamento , Gelsemium/química , Gelsemium/envenenamento , Lauraceae/envenenamento , Adulto , Alcaloides/metabolismo , Cromatografia Líquida de Alta Pressão , Gelsemium/metabolismo , Gelsemium/parasitologia , Humanos , Lauraceae/metabolismo , Pessoa de Meia-Idade , Espectrometria de Massas em Tandem , Adulto Jovem
7.
Leg Med (Tokyo) ; 35: 44-49, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30268690

RESUMO

We report a case of intoxication with a mixture of three synthetic cannabinoids and a synthetic cathinone, which have been disclosed by a highly sensitive progressing technology. A man was found dead, and his forensic autopsy was performed at our department. After further examinations of his specimens, EAM-2201 and α-PVP have been newly found in his lung. The concentrations of EAM-2201 have not been reported yet in any authentic human specimens although its existence (not quantified) in blood was reported in 2015. Therefore, a sensitive quantitation method of these compounds in blood and solid tissues has been devised using the sensitive instrument. The limits of detection of these compounds were in the range of 3-10 pg/ml with their quantification range of 10-1000 pg/ml in blood. The femoral vein blood levels of EAM-2201 and AB-PINACA were 56.6 ±â€¯4.2 and 12.6 ±â€¯0.1 pg/ml, respectively, and AB-FUBINACA could be detected but not quantifiable in the blood specimens; α-PVP could not be detected. The standard addition method was employed for the quantification of these compounds in the lung, liver and kidney specimens. The lung levels of EAM-2201, AB-PINACA, AB-FUBINACA and α-PVP were 348 ±â€¯34, 355 ±â€¯30, 124 ±â€¯12 and 59.0 ±â€¯7.4 pg/g, respectively. In conclusion, in this study, the concentrations of EAM-2201 in authentic human specimens including blood and solid tissues and those of AB-PINACA and AB-FUBINACA in solid tissue specimens were quantified for the first time to our knowledge.


Assuntos
Alcaloides/envenenamento , Canabinoides/envenenamento , Indazóis/envenenamento , Indóis/envenenamento , Naftalenos/envenenamento , Pentanonas/envenenamento , Pirrolidinas/envenenamento , Valina/análogos & derivados , Alcaloides/sangue , Alcaloides/metabolismo , Autopsia , Canabinoides/sangue , Canabinoides/metabolismo , Medicina Legal , Humanos , Indazóis/sangue , Indazóis/metabolismo , Indóis/sangue , Indóis/metabolismo , Rim/metabolismo , Fígado/metabolismo , Pulmão/metabolismo , Masculino , Naftalenos/sangue , Naftalenos/metabolismo , Pentanonas/sangue , Pentanonas/metabolismo , Pirrolidinas/sangue , Pirrolidinas/metabolismo , Distribuição Tecidual , Valina/sangue , Valina/metabolismo , Valina/envenenamento
8.
JAAPA ; 31(8): 1-5, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30048361

RESUMO

Tens of thousands of ED visits each year are related to synthetic psychoactive drug intoxication. Signs, symptoms, and treatment of toxicity with synthetic cathinones, synthetic cannabinoids, or dextromethorphan overlap greatly and can be challenging. This article describes signs and symptoms of psychoactive drug abuse and how to properly manage these symptoms.


Assuntos
Alcaloides/envenenamento , Canabinoides/envenenamento , Dextrometorfano/envenenamento , Overdose de Drogas/diagnóstico , Overdose de Drogas/terapia , Psicotrópicos/envenenamento , Humanos
9.
J Anal Toxicol ; 42(9): 630-636, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-29931062

RESUMO

Ricin and abrin are toxic ribosome-inactivating proteins found in plants. Exposure to these toxins can be detected using the biomarkers ricinine and abrine, which are present in the same plant sources as the toxins. The concentration of the biomarkers in urine and blood will be dependent upon the purification of abrin or ricin, the route of exposure, and the length of time between exposure and sample collection. Here, we present the first diagnostic assay for the simultaneous quantification of both ricinine and abrine in blood matrices. Furthermore, this is the first-ever method for the detection of abrine in blood products. Samples were processed by isotope-dilution, solid-phase extraction, protein precipitation and quantification by HPLC-MS-MS. This analytical method detects abrine from 5.00 to 500 ng/mL and ricinine from 0.300 to 300 ng/mL with coefficients of determination of 0.996 ± 0.003 and 0.998 ± 0.002 (n = 22), respectively. Quality control material accuracy was determined to have <10% relative error, and precision was within 19% relative standard deviation. The assay's time-to-first result is three hours including sample preparation. Furthermore, the method was applied for the quantification of ricinine in the blood of a patient who had intentionally ingested castor beans to demonstrate the test was fit-for-purpose. This assay was designed to support the diagnosis of ricin and abrin exposures in public health investigations.


Assuntos
Abrina/urina , Alcaloides/urina , Toxicologia Forense/métodos , Alcaloides Indólicos/urina , Piridonas/urina , Ricina/urina , Alcaloides/envenenamento , Biomarcadores/urina , Calibragem , Humanos , Alcaloides Indólicos/envenenamento , Limite de Detecção , Envenenamento/urina , Piridonas/envenenamento , Reprodutibilidade dos Testes , Manejo de Espécimes
10.
Sao Paulo Med J ; 136(6): 591-593, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29116302

RESUMO

CONTEXT: The seeds from Lupinus mutabilis Sweet, also called "chocho", are an important part of the diet in several countries in South America. Prior to consumption, processing is required to remove toxic alkaloids. These alkaloids are known to have pharmacological properties as antiarrhythmics, antimuscarinics and hypoglycemics. CASE REPORT: We report a case in which a one-year-old male initially presented with altered mental status and respiratory distress and subsequently developed symptoms of anticholinergic toxicity, after ingesting a large amount of chocho seeds. CONCLUSION: In spite of going through a difficult clinical condition, the subject evolved favorably through receiving supportive treatment. The seeds from Lupinus mutabilis provide nutritional benefits when consumed, but people need to know their risks when these seeds are consumed without proper preparation.


Assuntos
Síndrome Anticolinérgica/etiologia , Ingestão de Alimentos , Doenças Transmitidas por Alimentos/etiologia , Lupinus/envenenamento , Alcaloides/envenenamento , Síndrome Anticolinérgica/sangue , Síndrome Anticolinérgica/diagnóstico , Antagonistas Colinérgicos , Doenças Transmitidas por Alimentos/sangue , Doenças Transmitidas por Alimentos/diagnóstico , Humanos , Hipoglicemiantes , Lactente , Masculino
11.
J Med Toxicol ; 13(2): 180-182, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28168558

RESUMO

BACKGROUND: Poison hemlock (Conium maculatum) is a common plant with a significant toxicity. Data on this toxicity is sparse as there have been few case reports and never a documented poisoning after intravenous injection. OBJECTIVES: We present a case of intravenous poison hemlock injection encountered in the emergency department. CASE REPORT: We describe a 30-year-old male who presented to the emergency department after a brief cardiac arrest after injecting poison hemlock. The patient had return of spontaneous circulation in the emergency department but had prolonged muscular weakness and encephalopathy later requiring tracheostomy. CONCLUSION: Intravenous injection of poison hemlock alkaloids can result in significant toxicity, including cardiopulmonary arrest, prolonged weakness, and encephalopathy.


Assuntos
Alcaloides/envenenamento , Conium/envenenamento , Síndromes Neurotóxicas/etiologia , Insuficiência Respiratória/induzido quimicamente , Adulto , Alcaloides/administração & dosagem , Parada Cardíaca/induzido quimicamente , Humanos , Injeções Intravenosas , Masculino , Síndromes Neurotóxicas/diagnóstico , Síndromes Neurotóxicas/fisiopatologia , Síndromes Neurotóxicas/terapia , Envenenamento/diagnóstico , Envenenamento/fisiopatologia , Envenenamento/terapia , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapia , Tentativa de Suicídio , Fatores de Tempo
12.
J Forensic Sci ; 62(2): 553-556, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28028802

RESUMO

This study presents the fatal case of a young man who was admitted to the ICAU due to sudden cardiac arrest. An interview revealed that the patient had taken some unspecified crystals. From the moment of admission, his condition deteriorated dramatically as a result of increasing circulatory insufficiency. After a few hours, sudden cardiac arrest occurred again and the patient was pronounced dead. In the course of a medicolegal autopsy, samples of biological material were preserved for toxicology tests and histopathological examination. The analysis of samples using the LC-MS/MS technique revealed the presence of α-PVP in the following concentrations: blood-174 ng/mL, urine-401 ng/mL, brain-292 ng/g, liver-190 ng/g, kidney-122 ng/g, gastric contents-606 ng/g. The study also presents findings from the parallel histopathological examination. Based on these findings, cardiac arrest secondary to intoxication with alpha-PVP was determined as the direct cause of the patient's death.


Assuntos
Alcaloides/envenenamento , Drogas Desenhadas/envenenamento , Psicotrópicos/envenenamento , Pirrolidinas/envenenamento , Adulto , Alcaloides/análise , Química Encefálica , Cromatografia Líquida , Drogas Desenhadas/análise , Conteúdo Gastrointestinal/química , Parada Cardíaca/induzido quimicamente , Humanos , Rim/química , Fígado/química , Masculino , Psicotrópicos/análise , Pirrolidinas/análise , Espectrometria de Massas em Tandem
13.
Forensic Sci Int ; 267: e6-e9, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27591912

RESUMO

A man in his 30's was found at home, not breathing. He was admitted to an emergency hospital and the doctor confirmed his death. He had a history of methamphetamine abuse spanning several years, and while fresh needle marks were visible on his arm, the only other autopsy findings indicated an acute death. A small plastic bag containing a pale brown white powder, and a small amount of liquid in a syringe were found at the scene. The police forensic laboratory detected acetyl fentanyl and 4-methoxy PV8 (4-methoxy PHPP) in both the powder and the liquid. Scan analysis by gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-mass spectrometry (LC-MS) identified acetyl fentanyl and 4-methoxy PV8 in the urine sample. Both drugs were quantitated simultaneously by liquid chromatography-tandem mass spectrometry (LC-MS/MS), using the selected reaction monitoring method. The concentration of acetyl fentanyl in the femoral vein blood, urine, and gastric contents were 153, 240, and 880ng/mL respectively, and the concentration of 4-methoxy PV8 in the femoral vein blood, urine, and gastric contents were 389, 245, and 500ng/mL respectively. Cause of death was attributed to acute poisoning by "bath salts" containing acetyl fentanyl and 4-methoxy PV8. Evidence indicated that self-administered intravenous injection was the most likely scenario, and that the deceased had been a habitual user of the "bath salt" drug for some time. Drugs detected in the gastric contents could be explained by the gastric secretion of basic drugs, or drug-containing bile entering the gastric contents.


Assuntos
Alcaloides/análise , Drogas Desenhadas/química , Drogas Desenhadas/envenenamento , Fentanila/análogos & derivados , Entorpecentes/análise , Adulto , Alcaloides/envenenamento , Fentanila/análise , Fentanila/envenenamento , Conteúdo Gastrointestinal/química , Humanos , Injeções Intravenosas , Masculino , Entorpecentes/envenenamento , Transtornos Relacionados ao Uso de Substâncias/complicações
14.
Ann Vasc Surg ; 36: 294.e1-294.e5, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27423726

RESUMO

"Bath salts" are synthetic designer drugs that have stimulant properties and are a growing medical concern. The chemical compounds in the mixtures have an affinity for receptors in the brain resulting in a stimulant effect similar to that seen with methamphetamines and cocaine. Although illegal in Canada, these drugs are widely available online with over 20 synthetic drugs marketed as "bath salts" and used increasingly among recreational drug users. Much of the medical literature regarding these drugs comes from emergency medicine case reports, which outline the acute, severe medical, and psychiatric effects of "bath salt" toxicity. In this report, we outline severe vascular limb compromise, which occurred in a 24-year-old man who took large doses of bath salts obtained online from China. We detail our experience to re-establish perfusion to the limbs, and the morbidities encountered due to the ischemic insult our patient experienced. The duration and clinical presentation of "bath salt" toxicity are frequently complicated by lack of toxicology screens for the agents on board, and lack of any pharmacokinetic evidence surrounding these synthetic compounds. Although "bath salts" are now illegal in Canada, these drugs are widely available online and have become an increasing public health concern that involves significant morbidity and mortality to users. Creating a base of knowledge and front-line experience are the only current tool in combating the diverse detrimental aftermath of these synthetic agents' abuse.


Assuntos
Alcaloides/envenenamento , Síndromes Compartimentais/induzido quimicamente , Isquemia/induzido quimicamente , Extremidade Inferior/irrigação sanguínea , Psicotrópicos/envenenamento , Transtornos Relacionados ao Uso de Substâncias/complicações , Amputação , Terapia Combinada , Síndromes Compartimentais/diagnóstico por imagem , Síndromes Compartimentais/fisiopatologia , Síndromes Compartimentais/terapia , Angiografia por Tomografia Computadorizada , Overdose de Drogas , Fasciotomia , Gangrena , Hemodinâmica , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Isquemia/terapia , Masculino , Fluxo Sanguíneo Regional , Resultado do Tratamento , Vasodilatadores/administração & dosagem , Adulto Jovem
15.
Chudoku Kenkyu ; 29(1): 21-5, 2016 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-27255020

RESUMO

The intoxication caused by "kiken" drugs (law-evading drugs), such as synthetic cannabinoids, cathinones, and methoxetamine, has recently increased in Japan. We retrospectively examined the characteristics of patients poisoned with the "kiken" drugs. We included patients who presented at the emergency department at the Tokyo Metropolitan Bokutoh Hospital from January 2011 to December 2014. Eighteen patients admitted between January 2011 and December 2013 were included in the early period group and 10 patients admitted between January and December 2014 were categorized into the late period group. The number of the patients transported to our emergency department between 2011 and 2014 increased annually. Patients were mainly admitted between May and October 2014; no patients were admitted after November 2014. The patients' age, history of previous mental disease, habitual use, Triage DOA results, serum creatinine values on admission, and respiratory management differed significantly between the groups. However, the median serum creatinine values of both groups on admission were within the normal level. Patients poisoned with the "kiken" drugs showed more severe symptoms, higher rate of habitual use, and higher average age. The annual increase in the number of the patients observed thus far is expected to decrease in the future. Maintenance of the law and expansion of medical institutions that treat patients addicted to the "kiken" drugs are warranted.


Assuntos
Alcaloides/envenenamento , Canabinoides/envenenamento , Cicloexanonas/envenenamento , Cicloexilaminas/envenenamento , Drogas Ilícitas/envenenamento , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/etiologia , Adulto , Fatores Etários , Creatinina/sangue , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Tóquio/epidemiologia , Triagem , Adulto Jovem
16.
Am J Drug Alcohol Abuse ; 42(5): 520-529, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27283516

RESUMO

BACKGROUND: Sixty-one autopsy cases involving cathinones and/or cannabinoids (synthetic cathinones/cannabinoids) use have been reported. However, little is known about the demographics and autopsy findings in fatal synthetic cathinones/cannabinoids users. OBJECTIVES: To elucidate demographic and autopsy findings (i.e. major organ pathology and causes of death) in synthetic cathinones/cannabinoids cases. METHODS: We reviewed forensic autopsy reports in Department of Legal Medicine of Tokyo Women's Medical University (Tokyo, Japan) between 2011 and 2015 (a total of 359). We compared demographic and autopsy findings between synthetic cathinones/cannabinoids and methamphetamine cases (as control subjects). RESULTS: There were 12 synthetic cathinones/cannabinoids cases and 10 methamphetamine cases. Synthetic cathinones/cannabinoids users were significantly younger than methamphetamine users (p < 0.01), and there were no cases that used both synthetic cathinones/cannabinoids and methamphetamine. Acute intoxication and cardiac ischemia were the two most prominent causes of death in both synthetic cathinones/cannabinoids users and methamphetamine users. Excited delirium syndrome and pulmonary aspiration were found only in synthetic cathinones/cannabinoids cases. CONCLUSIONS: The populations of synthetic cathinones/cannabinoids and methamphetamine users who died of an overdose are different in Japan. Acute intoxication, cardiac ischemia, excited delirium syndrome, pulmonary aspiration, and drowning are the major autopsy findings in synthetic cathinones/cannabinoids-related death. Clinicians shuld be aware of these potentially fatal complications in the medical management of synthetic cathinones/cannabinoids users.


Assuntos
Alcaloides/envenenamento , Canabinoides/envenenamento , Overdose de Drogas/mortalidade , Propiofenonas/envenenamento , Adulto , Causas de Morte , Demografia , Feminino , Humanos , Japão/epidemiologia , Masculino , Metanfetamina/envenenamento , Pessoa de Meia-Idade , Adulto Jovem
17.
Tidsskr Nor Laegeforen ; 136(8): 714-7, 2016 May.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-27143461

RESUMO

There has been a significant increase in the number of new intoxicants on the illegal drugs market globally, also in Norway. The substances are given the name NPS: Novel Psychoactive Substances, and are mainly sold over the Internet. Uncertain dosage of potent substances entails a risk of accidental overdose, and therefore serious intoxication and death. In this article we provide an overview of current knowledge with regard to these substances.


Assuntos
Drogas Ilícitas/envenenamento , Psicotrópicos/envenenamento , Alcaloides/farmacologia , Alcaloides/envenenamento , Canabinoides/farmacologia , Canabinoides/envenenamento , Drogas Desenhadas/farmacologia , Drogas Desenhadas/envenenamento , Humanos , Drogas Ilícitas/farmacologia , Fenetilaminas/farmacologia , Fenetilaminas/envenenamento , Piperazinas/farmacologia , Piperazinas/envenenamento , Psicotrópicos/farmacologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Triptaminas/farmacologia , Triptaminas/envenenamento
18.
Forensic Sci Int ; 265: 121-4, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26890319

RESUMO

We report on a case of intoxication with a mix of new psychoactive substances. A 38-year-old male was brought to the emergency department (ED) following the ingestion of an unknown drug in a suicide attempt. During the transport, he became progressively more somnolent and unresponsive to painful stimuli. Urine and stomach content were collected on admission to be screened for drugs of abuse and medicinal drugs. After admission, the patient's next of kin presented five small grip seal plastic bags containing different powders/crystals, and they were sent for analysis along with urine and stomach content to the toxicology laboratory. An easy and rapid sample preparation technique was applied for the extraction of urine and stomach content. Samples were extracted with liquid-liquid extraction (LLE) technique and analysed using gas chromatography-mass spectrometry (GC-MS). A small amount of powder material from the bags was diluted in methanol and injected directly into the GC-MS instrument. Obtained spectra (EI) were evaluated against SWGDRUG library. Five different designer drugs were identified in the powder material, including synthetic cannabinoids (AB-CHMINACA, AB-FUBINACA) and synthetic cathinones (alpha-PHP, alpha-PVP and 4-CMC). With the exception of 4-CMC, all of these substances were also detected in the stomach content along with the prescription drugs. This is the first time that a positive identification of these five drugs has been made by a clinical laboratory in Slovenia.


Assuntos
Alcaloides/envenenamento , Canabinoides/envenenamento , Psicotrópicos/envenenamento , Tentativa de Suicídio , Adulto , Alcaloides/análise , Canabinoides/análise , Diagnóstico Diferencial , Toxicologia Forense , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Masculino , Envenenamento/diagnóstico
19.
Neurocrit Care ; 24(3): 454-8, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26666544

RESUMO

BACKGROUND: "Bath salts" or synthetic cathinone toxicity remains a potentially deadly clinical condition. We report a delayed leukoencephalopathy with persistent minimally conscious state. METHODS: Case report. RESULTS: A 36-year-old man presents with delayed encephalopathy, dysautonomia, fulminant hepatic failure, and renal failure from severe rhabdomyolysis after consuming bath salts. MRI showed diffusion restriction in the splenium of the corpus callosum and subcortical white matter. CONCLUSIONS: The combination of acute leukoencephalopathy, rhabdomyolysis and fulminant hepatic failure may point to bath salt inhalation and should be known to neurointensivists.


Assuntos
Alcaloides/envenenamento , Benzodioxóis/envenenamento , Cosméticos/envenenamento , Leucoencefalopatias/induzido quimicamente , Falência Hepática/induzido quimicamente , Estado Vegetativo Persistente/induzido quimicamente , Pirrolidinas/envenenamento , Insuficiência Renal/induzido quimicamente , Adulto , Humanos , Masculino , Rabdomiólise/induzido quimicamente
20.
Phytother Res ; 30(1): 3-8, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26481590

RESUMO

Aconitum alkaloid poisoning can occur after drinking decoction and soup made from non-toxic herbs contaminated by aconite roots. In the present review, the main objective is to describe the clinical features, investigations and possible sources of contamination. A combination of neurological, gastrointestinal and cardiovascular signs and symptoms was seen. Ventricular tachyarrhythmias could occur in 18% of subjects. Yunaconitine and crassicauline A, mainly found in certain aconite roots from Southwest China, are most commonly involved. Herbal residues and unused herbs should first be inspected for gross contamination. On-site inspection at the retailer should exclude accidental mix-up or cross-contamination when handling aconite roots. Samples of prescribed herbs are examined for gross contamination and analysed for the presence of Aconitum alkaloids. Samples of the implicated herb are also collected from the wholesaler for investigation. If post-import contamination is unlikely, the regulatory authorities of the exporting countries should be notified for follow-up actions. It is a challenging task to work out how non-toxic herbs become contaminated by aconite roots. The source control with good agricultural and collection practices and quality assurance must be enhanced.


Assuntos
Aconitum/envenenamento , Alcaloides/envenenamento , Contaminação de Medicamentos , Medicamentos de Ervas Chinesas/envenenamento , Raízes de Plantas/envenenamento , Aconitina/análogos & derivados , Aconitina/envenenamento , Aconitum/química , Adulto , Idoso , Idoso de 80 Anos ou mais , Alcaloides/química , China , Medicamentos de Ervas Chinesas/química , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
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