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1.
Artigo em Alemão | MEDLINE | ID: mdl-31578622

RESUMO

Exotic poisonous animals such as snakes, marine animals, spiders, and scorpions are a rarity in Central Europe, but are kept as pets by some people. Poisoning caused by these animals is a particular challenge in medical care.Over a period of six years (2001-2006), a total of 202 cases of poisoning with exotic animals were registered and evaluated at four poison information centers in Germany and France. Of the accidents, 91% happened in the home environment; the rest in pet stores. The poisonings were caused by snakes (38%), marine animals (31%), arthropods (spiders and scorpions, 27%), and other poisonous animals (4%). Severe poisoning was involved in 8% of the cases, all caused by snake bites. The severe poisonings were in the form of coagulopathies, severe local symptoms, and a respiratory insufficiency requiring intubation. In six cases of severe poisoning, an immune serum (antivenom) was administered and in three cases a surgical procedure was needed. Deaths did not occur.After the bite of a poisonous animal, the affected limb should usually be immobilized and disinfected, but not tied, cut, or sucked. The exact biological name of the species should be identified. In addition to hospitalization, it is recommended to consult a poison information center.


Assuntos
Animais Exóticos , Envenenamento , Escorpiões , Mordeduras de Serpentes , Animais , Europa (Continente) , Alemanha , Humanos , Envenenamento/etiologia
3.
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
4.
Pan Afr Med J ; 33: 108, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489086

RESUMO

Home accidents are a serious public health problem in Pediatrics. They are responsible for heavy morbidity and mortality in the paediatric population. We conducted a retrospective study of 231 cases of domestic accidents in childhood in the Division of General Pediatrics at the Hedi Chaker Hospital, Sfax over a period of 5 years (2008-2012). During the study period, we collected data from 231 domestic accidents. The study involved 124 boys (53.7 %) and 107 girls (46.3%). The average age of patients was 2 years, ranging from 1 day to 14 years; children under 4 years were the most exposed to home accidents (88.7%). Accidental poisonings were the most common accidents (105 cases). Caustics were the most common toxic agents (33 cases), followed by drugs (28 cases) and hydrocarbons (16 cases). Foreign body accidents were the second most common mechanism of injury (64 cases). They included 43 cases of inhalation of foreign bodies and 21 cases of foreign body ingestion. We recorded 28 cases of trauma, 25 cases were caused by a fall from a certain height. We noted 26 cases of scorpion envenomation, 5 cases of drowning, 2 cases of burn and a single case of electric shock. Accidental poisonings and foreign body accidents were the main home accidents noted during our study and the age group 1 -4 years was the most exposed to home accidents.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Acidentes Domésticos/estatística & dados numéricos , Corpos Estranhos/epidemiologia , Envenenamento/epidemiologia , Adolescente , Fatores Etários , Queimaduras/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Envenenamento/etiologia , Estudos Retrospectivos , Picadas de Escorpião/epidemiologia , Tunísia/epidemiologia
6.
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
8.
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
9.
Toxicol Lett ; 308: 50-55, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-30940550

RESUMO

Tetramethylenedisulfotetramine (TMDT) is a synthetic neurotoxic rodenticide and potential chemical threat agent. Signs of TMDT poisoning include convulsions which can progress into status epilepticus and death. Although clinical reports clearly show that poisoning via food and drink is the main route of exposure, experimental studies have primarily utilized parenteral routes. Here we used two different modes of oral administration of TMDT and compared the toxic outcomes with two different parenteral routes. Adult male mice were given various doses of TMDT either perorally in peanut butter or cereal pellets, or injected intraperitoneally (i.p.) or subcutaneously (s.c.). All routes produced the complete TMDT syndrome including twitches, clonic and tonic-clonic seizures and death. However potencies varied with the following rank order: i.p. > s.c. > oral (cereal)>>oral (peanut butter). Our data clearly show that ingestion of TMDT with peanut butter markedly reduces the overall syndrome severity relative to oral exposure via cereals. No significant differences were observed by substituting peanut oil for water as a vehicle for i.p. administered TMDT. In conclusion, high vs low fat food can differentially affect TMDT onset of action, probably due to differences in availability from the gastrointestinal tract. These results should be considered when searching for effective treatments for TMDT poisoning.


Assuntos
Hidrocarbonetos Aromáticos com Pontes/administração & dosagem , Hidrocarbonetos Aromáticos com Pontes/envenenamento , Modelos Animais de Doenças , Síndromes Neurotóxicas/etiologia , Administração Oral , Animais , Relação Dose-Resposta a Droga , Humanos , Injeções Intralinfáticas , Injeções Intraperitoneais , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Envenenamento/etiologia
10.
Rev Bras Epidemiol ; 22: e190018, 2019 Apr 01.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30942327

RESUMO

INTRODUCTION: Drug-related poisonings have a high impact on morbidity and mortality, representing the first cause of intoxication in Brazil. OBJECTIVE: To describe the trends of cases of drug-related poisonings attended to by a poison control center. METHOD: A quantitative approach (cross-sectional trend study) with data analysis of cases of drug-related poisonings attended to at the Poison Control Center of University Hospital of the State University of Londrina. Data were collected from service notification records for the period 1985 to 2014. For statistical analysis, a simple linear regression model was used. RESULTS: Of the 36,707 cases attended to by the service, 22.5% (n = 8,608) were drug-related poisonings. There was an increase in the proportion of cases for both sexes (R2 = 0.195, p = 0.014) and males (R2 = 0.403, p < 0.001). There was a trend towards a higher proportion of cases involving the analgesic, anti-inflammatory and immunosuppressive drug classes (R2 = 0.521, p = 0.018), antidepressants (R2 = 0.923, p < 0.001) and antipsychotics (R2 = 0.869; p < 0.001). Antibiotics showed a trend toward a lower proportion of cases (R2 = 0.773, p = 0.001). CONCLUSIONS: There was a trend for a higher proportion of cases of drug-related poisonings in males. Also, there was an increased trend towards cases involving analgesics/anti-inflammatories/immunosuppressants, antidepressants and antipsychotics.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Preparações Farmacêuticas , Envenenamento/epidemiologia , Envenenamento/etiologia , Adolescente , Adulto , Fatores Etários , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/classificação , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Centros de Controle de Intoxicações , Fatores Sexuais , Adulto Jovem
11.
Rev Bras Enferm ; 72(suppl 1): 32-40, 2019 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942342

RESUMO

OBJECTIVE: to describe case of occupational exposure to chemical products. METHOD: descriptive retrospective study using record data of 382 workers assisted in the Outpatient Care for Occupational Toxicology of the Reference Center of Workers' Health of the Federal District, between 2009 and 2013. RESULTS: From the total, 66.7% were men, 55.2% had up to 9 years of activity and 81% did not use personal protective equipment (PPE). Nearly 60% were farmers and environmental surveillance agents, exposed to pesticides (63%), of which 40% were organophosphorus insecticides. The majority (68%) presented butyrylcholinesterase activity decreased, mostly farmers (85.9%); 57.3% of workers were considered poisoned - 61.6% by pesticides and 37.9% by industrial chemicals -, and away from work for at least 10 days. CONCLUSION: The profile was male workers, from 30 to 39 years, which not used PPE, indicating the need for prevention together with them to prevent poisonings.


Assuntos
Exposição Ocupacional/efeitos adversos , Envenenamento/etiologia , Adulto , Vazamento de Resíduos Químicos/estatística & dados numéricos , Fazendeiros/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/estatística & dados numéricos , Equipamento de Proteção Individual , Praguicidas/efeitos adversos , Envenenamento/complicações , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Inquéritos e Questionários
12.
BMJ Case Rep ; 12(2)2019 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-30739090

RESUMO

We report a case of 50-year-old male patient from tribal area in South Indian state of Telangana, who ingested the liquid extract from crushed leaves of the plant, cleistanthus collinius with the intention of self-harm. Immediate gastric lavage and activated charcoal administration was done and the patient was subsequently admitted into an acute medical care unit. During first 24 hours of monitoring, the patient was clinically stable. There was mild normal anion gap metabolic acidosis and hypokalaemia on arterial blood gas (ABG) and was corrected accordingly. On second day of admission he developed acute onset shortness of breath. Chest auscultation revealed extensive bilateral coarse crackles. Chest X-ray was suggestive of acute respiratory distress syndrome (ARDS). The patient had to be intubated. Continuous renal replacement therapy (CRRT) was initiated in view of worsening metabolic acidosis and unstable haemodynamics. In spite of appropriate intensive care measures, the patient succumbed to illness. Immediate gastric lavage and activated charcoal administration was done and the patient was subsequently admitted into an acute medical care unit. During first 24 hours of monitoring, the patient was clinically stable. There was mild normal anion gap metabolic acidosis and hypokalaemia on ABG and was corrected accordingly. On second day of admission, he developed acute onset shortness of breath. Chest auscultation revealed extensive bilateral coarse crackles. Chest X-ray was suggestive of ARDS. The patient had to be intubated on day 2. CRRT was initiated in view of worsening metabolic acidosis and unstable haemodynamics. In spite of appropriate intensive care measures, the patient gradually deteriorated, had cardiac arrest and passed away on day 5 of his hospital stay.


Assuntos
Antídotos/uso terapêutico , Carvão Vegetal/uso terapêutico , Lavagem Gástrica/métodos , Malpighiales , Extratos Vegetais/envenenamento , Envenenamento/terapia , Suicídio , Acidose/induzido quimicamente , Acidose/terapia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Envenenamento/etiologia , Terapia de Substituição Renal , Síndrome do Desconforto Respiratório do Adulto/induzido quimicamente , Síndrome do Desconforto Respiratório do Adulto/terapia
13.
Basic Clin Pharmacol Toxicol ; 125(1): 62-74, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30712291

RESUMO

Aluminium phosphide (AlP) is a highly toxic substance with a high mortality rate and no effective antidote. Once exposed to the moisture and acidic conditions of the stomach, AlP releases toxic phosphine (PH3 ) gas, which results in severe toxicity in poisoned subjects. Selegiline is a monoamine oxidase inhibitor with antioxidant and anti-apoptotic properties, which is mostly prescribed for the treatment of mood disorders and Parkinson's disease. Since AlP has detrimental effects on cardiac physiology and mitochondrial function, we tested the protective effects of acute selegiline treatment on cardiac mitochondrial function, redox status and electrocardiographic parameters in rats after AlP poisoning. To do this, AlP was given to rats by gavage to induce toxicity. Selegiline was injected intraperitoneally in the treatment groups 1 hour after AlP poisoning. Selegiline treatment after AlP intoxication was not associated with a significant difference in the mortality rate of animals. However, selegiline reduced oxidative stress (decreased the reactive oxygen species and malondialdehyde) and increased glutathione in the cardiac tissue of rats exposed to AlP. Further, the mitochondrial membrane potential (ΔΨm) collapse reversed after treatment with selegiline. Selegiline also improved the electrocardiographic (ECG) parameters and enhanced heart rate. The histopathological evaluation revealed that selegiline eliminated the inflammation and injuries induced by AlP in the stomach and duodenum, as well as cardiac tissue. In conclusion, selegiline treatment can ameliorate the AlP-induced cardiac and gastrointestinal injuries in rats via boosting redox status and mitochondrial function with no significant effect on survival. We suggest that using selegiline, apart from other clinical treatments, may improve the quality of treatment process for AlP toxicity.


Assuntos
Compostos de Alumínio/envenenamento , Antídotos/administração & dosagem , Praguicidas/envenenamento , Fosfinas/envenenamento , Envenenamento/tratamento farmacológico , Selegilina/administração & dosagem , Animais , Modelos Animais de Doenças , Avaliação Pré-Clínica de Medicamentos , Duodeno/efeitos dos fármacos , Duodeno/patologia , Coração/efeitos dos fármacos , Humanos , Injeções Intraperitoneais , Masculino , Potencial da Membrana Mitocondrial/efeitos dos fármacos , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/patologia , Miocárdio/patologia , Estresse Oxidativo/efeitos dos fármacos , Envenenamento/etiologia , Envenenamento/patologia , Ratos , Espécies Reativas de Oxigênio/metabolismo , Estômago/efeitos dos fármacos , Estômago/patologia , Resultado do Tratamento
15.
Clin Toxicol (Phila) ; 57(4): 282-286, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30430874

RESUMO

IMPORTANCE: Exposures to novel psychoactive substances are reported with increasing frequency in both the medical literature and the lay press. While the majority of reports describe synthetic cannabinoids and cathinones, a lesser understood family is the "designer benzodiazepines". The current literature describing human exposures to these compounds is comprised of case reports and small case series. OBJECTIVE: The primary objectives of this study are to describe epidemiologic trends and clinical effects of designer benzodiazepine use. METHODS: Data regarding single agent exposures to designer benzodiazepines between 1 January 2014 and 31 December 2017 was obtained from the National Poison Data System. Substances queried include: adinazolam, clonazolam, cloniprazepam, diclazepam, etizolam, flubromazepam, flubromazolam, meclonazepam, nifoxipam, norflurazepam, and pyrazolam. Data was summarized descriptively. RESULTS: 234 single agent exposures in 40 states were reported during the study period. The annual number of exposures increased each year, from 26 in 2014 to 112 in 2017, amounting to a 330% increase. The most common exposures were etizolam (n = 162) and clonazolam (n = 50). The most common clinical effects were drowsiness/lethargy (65%), and slurred speech (17%). 3% required intubation, 36% of cases required hospital admission, 22% to the intensive care unit. There was 1 death in the study population. CONCLUSIONS: The incidence of exposures to designer benzodiazepines is rising. Clinical effects are generally consistent with a sedative-hypnotic toxidrome. Severe effects, including death, seemed relatively uncommon in the study population.


Assuntos
Benzodiazepinas/toxicidade , Drogas Desenhadas/toxicidade , Envenenamento/epidemiologia , Adolescente , Adulto , Diazepam/análogos & derivados , Diazepam/toxicidade , Feminino , Humanos , Letargia/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Centros de Controle de Intoxicações/estatística & dados numéricos , Envenenamento/etiologia , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
16.
J Pharm Biomed Anal ; 164: 636-641, 2019 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-30471636

RESUMO

A method based on gas chromatography-mass spectrometry (GC-MS) is described for the determination of opioids (6-monoacetylmorphine, morphine, methadone and tramadol) and cocaine and its major metabolite in human bone. After the addition of nalorphine as internal standard, pulverized samples were incubated in acetonitrile for 1 h under ultrasounds. After adjusting the pH of the samples to 6, they were subjected to solid phase extraction and the analytes were eluted using 2 ml of dichloromethane/isopropanol/ammonia (78:20:2). Chromatography was performed on a fused silica capillary column and analytes were determined in the selected-ion-monitoring (SIM) mode. The assay was validated in the range 0.3-1 ng/mg (depending on the drug) to 150 ng/mg, the mean absolute recoveries ranging from 66% to 110%, the matrix effect from 62% to 121% and process efficiency from 61% to 89% depending on the analyte. The intra- and inter-assay accuracy values were always better than 20%. The validated method was then successfully applied to real bone samples from forensic cases in which toxicological analysis for these drugs in blood was positive. Drugs were detected in bone in 12 of the 15 blood positive results. The approximate concentration range was 3-5 ng/g for 6-monoacetylmorphine, 3-7 ng/g for morphine, 14-28 ng/g for methadone and 6 ng/g and 11 ng/g for tramadol and benzoylecgonine.


Assuntos
Analgésicos Opioides/análise , Osso e Ossos/química , Cocaína/análise , Toxicologia Forense/métodos , /análise , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/toxicidade , Criança , Cocaína/toxicidade , Feminino , Cromatografia Gasosa-Espectrometria de Massas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Envenenamento/diagnóstico , Envenenamento/etiologia , Reprodutibilidade dos Testes , Extração em Fase Sólida/métodos , Espectrometria de Massas por Ionização por Electrospray/métodos , Detecção do Abuso de Substâncias/métodos , Adulto Jovem
17.
J Int Med Res ; 47(2): 600-614, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30392424

RESUMO

OBJECTIVE: To investigate the effects of parenteral nutrition (PN) including ω-3 fish-oil emulsion on nutritional state, inflammatory response, and prognosis in patients with acute paraquat poisoning. METHODS: Patients randomized to receive medium chain triglycerides (MCT)/long chain triglycerides (LCT)-based PN (control group) or MCT/LCT-based PN containing ω-3 fish-oil emulsion (intervention group) were compared for 90-day survival and short-term treatment efficacy. RESULTS: Tumour necrosis factor-α levels were significantly lower in the intervention group ( n = 101) versus controls ( n = 73) on treatment days 4 and 7. Intervention group C-reactive protein (CRP) levels were significantly increased on day 4, decreased to baseline (day 1) levels on day 7, and were significantly lower than baseline on day 10. Control group CRP levels were significantly increased on days 4 and 7 versus baseline, and returned to baseline levels on day 10. On day 7, retinol binding protein had recovered to baseline levels in the intervention group only. Intervention group mortality rate (36.6%) was significantly lower than controls (57.5%). ω-3 fish-oil PN was associated with reduced risk of death (hazard ratio 0.52; 95% confidence interval 0.33, 0.82). CONCLUSION: In patients with acute paraquat poisoning, MCT/LCT with ω-3 fish-oil emulsion PN plus combination treatment advantageously attenuated the inflammatory response, modified the nutritional state, and was associated with significantly improved 90-day survival versus treatment without ω-3 fish oil.


Assuntos
Ciclofosfamida/uso terapêutico , Óleos de Peixe/administração & dosagem , Herbicidas/efeitos adversos , Metilprednisolona/uso terapêutico , Paraquat/efeitos adversos , Nutrição Parenteral , Envenenamento/terapia , Doença Aguda , Adolescente , Adulto , Idoso , Anti-Inflamatórios/uso terapêutico , Estudos de Casos e Controles , Terapia Combinada , Emulsões , Ácidos Graxos Ômega-3/administração & dosagem , Feminino , Seguimentos , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Envenenamento/etiologia , Prognóstico , Estudos Prospectivos , Taxa de Sobrevida , Adulto Jovem
18.
Nefrologia ; 39(2): 115-123, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30360922

RESUMO

Pica is an individual entity in the patient with chronic kidney disease (CKD), which phenomenon has not been widely studied despite the high reported prevalence. Moreover, pica complications (anemia, altered electrolytes, poor absorption of micro and macronutrients and malnutrition) could be exacerbated in CKD and limit the quality of renal replacement therapy. The intake of non-caloric and non-nutritional substances could be harmful and cause effects on satiety and metabolic / electrolyte imbalance and modify the biocompatibility of micronutrients, toxins and pathogens worsening health status. In daily practice, pica could be under-reported because patient's shame to recognize it, or fear that such behavior influences their treatment. Additionally, clinicians who not investigate the presence of pica or its complications contribute to the lack of information about the magnitude and relevance of this problem in CKD.


Assuntos
Falência Renal Crônica/complicações , Pica/complicações , Anemia/etiologia , Criança , Feminino , Humanos , Falência Renal Crônica/psicologia , Micronutrientes/deficiência , Transtornos Nutricionais/etiologia , Pica/diagnóstico , Pica/psicologia , Pica/terapia , Envenenamento/etiologia , Gravidez , Complicações na Gravidez
20.
Pediatr Emerg Care ; 35(3): 216-219, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29538264

RESUMO

BACKGROUND: Mistaken ingestion of all manner of toxic matter is common in childhood, but poisoning with fireworks and matchsticks is rare. Fireworks usually contain 10% yellow phosphorus and 50% potassium chlorate. Potassium chlorate is an extremely reactive and toxic agent that is used in fireworks and matchstick heads. METHODS: Eleven cases (7 females and 5 males; median age, 36 months [ranging from 24 to 48 months]) of poisoning after ingestion of fireworks and matchstick(s), between February 2008 and June 2014, were reviewed. RESULTS: The most common initial symptom was vomiting except for 2 cases in this group. Biochemical tests indicated that hyperphosphatemia was present in all patients, 8 patients (72.7%) had subclinical hepatic injury, 1 (9%) had acute hepatic failure, and 2 patients had no clinical or biochemical evidence of hepatic damage. Three patients had renal impairment, but none of them required dialysis. All of the patients recovered with supportive therapy except for 2 cases. One patient underwent cadaveric liver transplantation, whereas the other died because of circulatory dysfunction and respiratory failure due to pulmonary alveolar hemorrhage. CONCLUSIONS: Without prompt intervention, poisoning with fireworks carries high morbidity and mortality in children. It can cause pulmonary hemorrhage, in addition to other organ damage, including liver and kidney. Hyperphosphatemia is common, as it was seen in all of the study patients.


Assuntos
Fósforo/envenenamento , Envenenamento/epidemiologia , Pré-Escolar , Ingestão de Alimentos , Feminino , Humanos , Masculino , Envenenamento/etiologia , Envenenamento/terapia
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