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2.
J Forensic Sci ; 65(1): 288-294, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31454427

RESUMO

Lacosamide is a functionalized amino acid with antiepileptic function. Therapeutic drug monitoring (TDM) in patients for lacosamide is critical as it allows clinicians to control epileptic seizures. A single liquid-liquid extraction step was applied for the extraction of lacosamide from whole blood samples which were thereafter analyzed by GC-MS. Optimum extraction conditions were selected on the basis of experiments with various solvents at different pHs, indicating ethyl acetate at pH 12 as the most efficient parameters for the extraction of lacosamide. Method exhibited linearity from 2 to 100 µg/mL with R2  = 0.998. Accuracy and precision were evaluated at three concentrations and found to be within acceptable limits. LOD and LOQ were determined at 0.1 and 0.5 µg/mL, respectively. Lacosamide was found to be stable at storage conditions. The developed method was applied successfully in clinical samples and postmortem blood sample from an overdose case.


Assuntos
Anticonvulsivantes/sangue , Cromatografia Gasosa-Espectrometria de Massas , Lacosamida/sangue , Anticonvulsivantes/envenenamento , Monitoramento de Medicamentos , Toxicologia Forense , Humanos , Lacosamida/envenenamento , Limite de Detecção , Modelos Lineares , Extração Líquido-Líquido , Envenenamento/diagnóstico
3.
Praxis (Bern 1994) ; 108(16): 1097-1099, 2019.
Artigo em Alemão | MEDLINE | ID: mdl-31822237

RESUMO

A Sweet Drink with Consequences Abstract. Intoxications with ethylene glycol are rare, however, small quantities from the substance can be life-threatening. Regarding the treatment it is important to recognize the intoxication quickly and to immediately start the appropriate treatment. Intoxications with ethylene glycol or with methanol should always be considered as differential diagnosis in patients with severe metabolic acidosis. It is also very important to calculate the osmolal gap.


Assuntos
Etilenoglicol , Metanol , Diagnóstico Diferencial , Etilenoglicol/envenenamento , Humanos , Metanol/envenenamento , Envenenamento/diagnóstico
4.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi ; 37(11): 855-857, 2019 Nov 20.
Artigo em Chinês | MEDLINE | ID: mdl-31826555

RESUMO

Objective: To analyze the clinical characteristics caused by acute poisoning by inhalation of hydrogen chloride (HCl) and to raise awareness and treatment level of the disease. Methods: The clinical manifestations, imaging features, diagnosis, treatment and prognosis of 5 patients with acute HCl poisoning were analyzed retrospectively. Results: Among the 5 cases of HCl poisoning, 2 cases were severe poisoning, 3 cases were moderate poisoning. All patients were treated with corticosteroids and symptomatic treatment, one of them was treated with venovenous extracorporeal membrane oxygenation (VV-ECMO) . All patients were recovered and discharged from hospital. Conclusion: The lung damage of acute poisoning by inhalation of HCl is rapidly progressing, early detection and timely medical treatment can obtain a better prognosis.


Assuntos
Ácido Clorídrico , Pulmão , Envenenamento , Oxigenação por Membrana Extracorpórea , Humanos , Ácido Clorídrico/envenenamento , Pulmão/efeitos dos fármacos , Envenenamento/diagnóstico , Envenenamento/terapia , Prognóstico
5.
Sud Med Ekspert ; 62(5): 43-46, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31626194

RESUMO

The purpose of the work is the development of mathematical models in the forensic diagnosis of poisonings by the main groups of toxicologically important substances, on the basis of biochemical characteristics of blood. The most informative forensic and biochemical indicators of cadaveric blood used to detect lethal poisoning are the urea content, total protein content, and the ratio of urea to creatinine. Mathematical models of poisoning can be used to diagnose poisoning with narcotic drugs, psychotropic substances and substitutes of ethyl alcohol.


Assuntos
Etanol/sangue , Medicina Legal/métodos , Entorpecentes/sangue , Envenenamento/diagnóstico , Psicotrópicos/sangue , Cadáver , Etanol/envenenamento , Humanos , Modelos Teóricos , Entorpecentes/envenenamento , Envenenamento/sangue , Psicotrópicos/envenenamento
6.
Artigo em Alemão | MEDLINE | ID: mdl-31578621

RESUMO

Acute drug poisoning due to accidental or self-damaging overdoses is responsible for 5-10% of emergency medical interventions in Germany. The treatment of asymptomatic to life-threatening courses requires extensive expertise. On the basis of a selective literature search, this article gives an overview of selected clinically relevant, acute drug poisonings with regard to epidemiology, symptomatology, diagnostics, and therapy.Intoxications with psychotropic drugs are the most common drug intoxications. Poisoning with tricyclic antidepressants causes anticholinergic, central nervous, and cardiovascular symptoms. Less toxic are selective serotonin reuptake inhibitors (SSRIs); the intoxication may be characterized by serotonin syndrome. Malignant neuroleptic syndrome is a severe complication of neuroleptic poisoning.Poisoning with analgesics is clinically relevant due to its high availability. For paracetamol poisoning, intravenous acetylcysteine is available as an antidote. Hemodialysis may be indicated for severe salicylate intoxication. Poisoning with nonsteroidal anti-inflammatory drugs is usually only associated with mild signs of intoxication.Poisoning with cardiac drugs (ß-blockers and calcium antagonists) can cause life-threatening cardiovascular events. In addition to symptomatic therapy, insulin glucose therapy also plays an important role.The majority of acute drug poisonings can be treated adequately by symptomatic and partly intensive care therapy - if necessary with the application of primary and secondary toxin elimination. Depending on the severity of the intoxication, pharmacology-specific therapy must be initiated.


Assuntos
Antidepressivos Tricíclicos , Envenenamento , Psicotrópicos , Antidepressivos Tricíclicos/envenenamento , Cuidados Críticos , Alemanha , Humanos , Envenenamento/diagnóstico , Envenenamento/terapia , Psicotrópicos/envenenamento , Transtornos Relacionados ao Uso de Substâncias
7.
Environ Sci Pollut Res Int ; 26(32): 33135-33145, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31520378

RESUMO

Aluminum phosphide (AlP) is considered now one of the most common causes of poisoning among agricultural pesticides. Poisoning with AlP is extremely toxic to humans with high mortality rate. The aim of this work was to evaluate the prognostic factors and outcome of acute aluminum phosphide poisoning in Alexandria Main University Hospital during a period of 6 months from 1 November 2017 until the end of April 2018, highlighting the role of SOFA score and echocardiography in predicting the mortality. The prospective study was conducted on all patients admitted with acute AlP poisoning to Alexandria Main University Hospital for those 6 months. Patients' data were collected in a special sheet and included biosocial data, medical history, poisoning history, complete medical examination, investigations, duration of hospital stay, and the outcome. All patients were assessed according to SOFA score on admission. Thirty patients were admitted during the period of the current study. Females outnumbered males in all age groups with a sex ratio of 2.75:1. The mean age of patients was 22.77 ± 12.79 years. 96.6% of patients came from rural areas. 93.3% of the cases were exposed to poisoning at home, where suicidal poisoning accounted for (86.7%) of cases. 43.3% of patients died (n = 13), and the median value of SOFA score among non-survivors was 10, versus 1 among survivors. The median value of ejection fraction among non-survivors (25%) was half its value in survivors (50%). Although there were many predictors of severity of AlP poisoning, SOFA score was the most predictive factor of mortality detected by multivariate analysis.


Assuntos
Compostos de Alumínio/envenenamento , Praguicidas/envenenamento , Fosfinas/envenenamento , Envenenamento/diagnóstico , Adolescente , Adulto , Criança , Ecocardiografia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Envenenamento/epidemiologia , Envenenamento/etiologia , Estudos Prospectivos , Adulto Jovem
8.
Vet J ; 251: 105349, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31492383

RESUMO

Organophosphates (OP) and carbamates are commonly used insecticides and important intoxication sources of humans and animals. Nevertheless, large scale studies of these intoxications in dogs are unavailable. The medical records of dogs presented to a veterinary hospital were reviewed retrospectively. The study included 102 dogs definitely diagnosed with acute OP or carbamate intoxication. The most common presenting clinical signs included muscle tremor, hypersalivation, miosis, weakness, vomiting and diarrhea. Hypersalivation, muscle tremor and tachypnea were significantly (P < 0.05) associated with survival to discharge; while weakness, mental dullness, anorexia, pale mucous membranes and paddling were significantly associated with death. Common laboratory abnormalities included decreased butyrylcholine esterase activity, acidemia, increased total plasma protein, leukocytosis, hypochloridemia, hyperbilirubinemia, increased creatinine and alanine transaminase (ALT), aspartate transaminase (AST) and creatine kinase activities, and prolonged activated partial thromboplastin time (aPTT). Compared to the survivors, the non-survivors showed significantly: higher frequencies of thrombocytopenia, hypocarbemia, prolonged prothrombin time (PT), hypernatremia, hyperkalemia, hypocholesterolemia, hypoproteinemia, hypertriglyceridemia, increased ALT activity and increased urea concentration; lower median concentrations of venous blood bicarbonate, serum chloride and total CO2; and higher medians of PT, serum total bilirubin and urea concentrations, and ALT and AST activities. Intoxicated dogs were commonly treated with diphenhydramine, atropine-sulfate, antibiotics, diazepam and pralidoxime, while some (19.2%) required general anesthesia and mechanical ventilation. The survival rate of dogs treated by gastric lavage was higher (P = 0.041) compared to that of the remaining dogs. Development of respiratory failure and mechanical ventilation requirement were significantly associated (P < 0.001) with death. The mortality rate was 17%.


Assuntos
Carbamatos/envenenamento , Doenças do Cão/induzido quimicamente , Inseticidas/envenenamento , Intoxicação por Organofosfatos/veterinária , Envenenamento/veterinária , Animais , Cães , Lavagem Gástrica/veterinária , Intoxicação por Organofosfatos/diagnóstico , Intoxicação por Organofosfatos/terapia , Envenenamento/diagnóstico , Envenenamento/terapia , Respiração Artificial/veterinária , Insuficiência Respiratória/terapia , Insuficiência Respiratória/veterinária , Estudos Retrospectivos , Resultado do Tratamento
9.
J Forensic Leg Med ; 67: 28-36, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31398663

RESUMO

The application of forensic entomotoxicology in investigations of death by poisoning has gained popularity as insects serves as an alternative specimen (evidence) when conventional toxicological samples have degraded or are no longer available. Successful detection, identification, and quantification of drugs and toxic substances from insects have been demonstrated through various research experiments. In the present review paper, role of insects as toxicological sample, its collection and preservation, analysis using various instrumental techniques, and trends in the use of analytical techniques have been discussed. Limitations hindering the growth of this field and the way forward for future studies have been highlighted. In addition, the effect of poisons on insects used for postmortem interval estimation has been described.


Assuntos
Entomologia , Comportamento Alimentar , Toxicologia Forense/métodos , Envenenamento/diagnóstico , Mudanças Depois da Morte , Animais , Depressores do Sistema Nervoso Central/análise , Besouros , Dípteros , Etanol/análise , Humanos , Larva , Extração Líquido-Líquido , Praguicidas/análise , Preparações Farmacêuticas/análise , Extração em Fase Sólida , Xenobióticos
10.
Sud Med Ekspert ; 62(4): 10-13, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31407699

RESUMO

A statistical analysis of cases of chemical poisonings over a six-year period in Volgograd was conducted. The features and circumstances of 209 fatal poisonings by an unidentified substance were analyzed and systematized. The number of poisoning deaths rose during this period. It was found that the circumstances of death help in diagnosing the possible characteristics of the poison. Attention is drawn to the problems that arise when conducting a forensic chemical analysis, which may be useful for deciding the specific cause of death in future cases.


Assuntos
Medicina Legal , Envenenamento/diagnóstico , Causas de Morte , Humanos
11.
Emerg Med J ; 36(9): 573-575, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31427477

RESUMO

A short cut review of the literature was carried out to establish whether any risk factors would predict the need for endotracheal intubation in undifferentiated adult patients presenting with poisoning/overdose with unknown substance. Five papers presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that further robust studies of large cohorts are needed to answer this difficult question.


Assuntos
Overdose de Drogas/terapia , Medicina de Emergência Baseada em Evidências/métodos , Intubação Intratraqueal , Envenenamento/terapia , Adulto , Tomada de Decisão Clínica , Overdose de Drogas/diagnóstico , Humanos , Envenenamento/diagnóstico , Prognóstico
12.
J Assoc Physicians India ; 67(4): 55-57, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31309798

RESUMO

Aims of the study: To study clinical presentation, complications and response to supportive management of Amitraz poisoning. Methods and Material: Fifty cases of acute Amitraz poisoning were studied in detail and compared with previous data from literature. Results: All the fifty cases were brought to Dr. V.M. Govt. Medical college, among them thirty one cases were males and nineteen were females, with their age ranging from 14 years to 62 years. Mode of intoxication was oral route. Twenty cases were farmers. Two cases had accidental poisoning. The ingested amount was ranging from 10ml to 80 ml. Vomiting and nausea were the prominent symptoms, next were dizziness, lethargy, respiratory distress and pain abdomen. Hyperglycemia, glycosuria, were commonest manifestations. Three cases were treated with mechanical ventilation. All the cases responded to supportive treatment and recovered completely. Conclusion: Vomiting and nausea were the commonest symptoms. Hyperglycemia and glycosuria was commonest sign. There was good response to supportive treatment. There was no complication and no mortality.


Assuntos
Inseticidas/envenenamento , Envenenamento/diagnóstico , Toluidinas/envenenamento , Adolescente , Adulto , Feminino , Humanos , Hiperglicemia , Masculino , Pessoa de Meia-Idade , Náusea , Adulto Jovem
15.
Lakartidningen ; 1162019 Jul 29.
Artigo em Sueco | MEDLINE | ID: mdl-31361324

RESUMO

Toxicological analysis is an important part of the acute treatment of various intoxications. Rapid laboratory responses are important for the patient to be assessed and treated correctly, and also to exclude poisoning and thus avoid unjustified and costly overtreatment. In Sweden, paracetamol (acetaminophen) is one of the most common pharmaceuticals in drug poisoning. Paracetamol overdose can cause severe liver damage unless treated early with the antidote acetylcysteine. A nation-wide initiative for improved laboratory measurement of paracetamol in plasma/serum samples has resulted in a marked reduction in the inter-laboratory coefficient of variation to generally below 10%. The introduction of a harmonized national reporting range for plasma/serum paracetamol covering at least 50-5 000 µmol/l was also recommended. This initiative will hopefully contribute to better healthcare from both a patient and health resource perspective in cases of paracetamol poisoning.


Assuntos
Acetaminofen , Analgésicos não Entorpecentes , Serviços de Laboratório Clínico/normas , Acetaminofen/sangue , Acetaminofen/envenenamento , Acetilcisteína/administração & dosagem , Acetilcisteína/uso terapêutico , Analgésicos não Entorpecentes/sangue , Analgésicos não Entorpecentes/envenenamento , Antídotos/administração & dosagem , Antídotos/uso terapêutico , Overdose de Drogas/diagnóstico , Overdose de Drogas/tratamento farmacológico , Humanos , Envenenamento/diagnóstico , Envenenamento/tratamento farmacológico , Guias de Prática Clínica como Assunto , Suécia , Fatores de Tempo
18.
Forensic Sci Int ; 301: 341-349, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31202147

RESUMO

A rapid, sensitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the determination and quantification of 12 psychotropic drugs and metabolites in hair was developed and validated. After freeze grinding with methanol, the supernatant was determined by LC-MS/MS using an Allure PFPPropyl column (100 × 2.1 mm, 5 µm) with a gradient elution of acetonitrile and 10 mmol/L ammonium acetate with 0.1% formic acid, and in the subsequent analysis using multiple reaction monitoring (MRM) mode, two ion transitions were monitored for each analyte. The limits of detection ranged from 0.002 to 0.05 ng/mg, and the limits of quantitation were in the range of 0.005-0.1 ng/mg. Good linearity (r > 0.995) was observed for all analytes over the linear range. Acceptable intraday and interday precision (RSD ≤ 20%) and accuracy (85.3%-112.9%) were achieved. This method of detection was applied to the analysis of guinea pig hair roots after a single dose of quetiapine. Quetiapine and 7-hydroxyquetiapine were both detected in guinea pig hair roots from 5 min post administration. The concentration of quetiapine (10.3-1733.8 ng/mg) was much higher than that of 7-hydroxyquetiapine (0.1-40.6 ng/mg) in the hair roots of guinea pigs, and higher concentrations of quetiapine and 7-hydroxyquetiapine occurred in black hair root than in that of white and brown. The animal experiment demonstrated that hair roots may be a good specimen for proving acute quetiapine poisoning when other biological matrices are not available.


Assuntos
Cabelo/química , Psicotrópicos/análise , Animais , Cromatografia Líquida , Dibenzotiazepinas/análise , Toxicologia Forense , Cobaias , Limite de Detecção , Modelos Animais , Envenenamento/diagnóstico , Fumarato de Quetiapina/análise , Detecção do Abuso de Substâncias/métodos , Espectrometria de Massas em Tandem
19.
Forensic Sci Int ; 301: 388-393, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31226641

RESUMO

Brain tissue is a useful supplement to blood in postmortem investigations, but reference concentrations are scarce for many opioids. Heroin cases may be difficult to distinguish from morphine cases as heroin and its metabolites are rapidly degraded. We present concentrations from brain and blood and brain-blood ratios of 98 cases where morphine was quantified. These cases were grouped according to the cause of death: A: The compound was solely assumed to have caused a fatal intoxication. B: The compound presumably contributed to a fatal outcome in combination with other drugs, alcohol or disease. C: The compound was not regarded to be related to the cause of death. The cases were further classified as heroin cases if 6-acetyl-morphine or noscapine were detected. The analyses were carried out using solid-phase extraction or protein precipitation followed by ultra high-performance liquid chromatography coupled to mass spectrometry. The average brain-blood ratios of morphine were 1.2 and 1.8 for 69 morphine and 29 heroin cases, respectively. Differences in the brain-blood ratios were found for cases where heroin and morphine were involved in the cause of death, either in combination or on its own (P<0.001 and P=0.004, respectively). However, the overlap between morphine and heroin cases precludes the use of the brain-blood ratio to distinguish heroin from morphine intake. Morphine-6-glucuronide and 6-acetyl-morphine were quantified in brain and blood in a subset of the samples, yielding median brain-blood ratios of 5.1 and 8.3, respectively. The brain concentrations may aid the toxicological investigation in cases where heroin or morphine intoxications are suspected, but blood is not available.


Assuntos
Química Encefálica , Heroína/análise , Morfina/análise , Entorpecentes/análise , Cromatografia Líquida , Overdose de Drogas/diagnóstico , Toxicologia Forense/métodos , Humanos , Espectrometria de Massas , Derivados da Morfina/análise , Noscapina/análise , Envenenamento/diagnóstico
20.
Pediatr Ann ; 48(5): e205-e207, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31067337

RESUMO

Toxin ingestion is a significant public health issue for children, accounting for hundreds of visits per day to emergency departments. The most common substances are household cleaning products, personal care products, and medications. This article describes an ingestion of a rare substance called strychnine, which is a plant-based odorless powder that was previously used as a nonspecific stimulant. This toxicity can mimic other ingestions, thus delaying diagnosis, so an increased awareness of the common symptoms and laboratory findings may lead to a more targeted management of strychnine poisoning. [Pediatr Ann. 2019;48(5):e205-e207.].


Assuntos
Envenenamento , Venenos/toxicidade , Estricnina/envenenamento , Adolescente , Diagnóstico Diferencial , Humanos , Masculino , Envenenamento/diagnóstico , Envenenamento/etiologia , Envenenamento/terapia
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