Complete atrio-ventricular block after furosemide.

We report a case of nonfatal complete atrio-ventricular (A-V) block after injection of 125 mg of furosemide by a central vena cava catheter. Accidents with this diuretic are very rare but this observation shows that it could induce A-V conduction disturbances. When large quantities of this diuretic must be used, we would recommend a slow injection rate to avoid such accidents.

Acute pancreatitis after carbamate insecticide intoxication.

A 29-year-old woman was admitted to the Rouen University Hospital for attempted suicide by ingestion of a carbamate insecticide (Temik G, containing 10% aldicarb). Cardio-respiratory arrest occurred at the second hour and acute necrotic hemorrhagic pancreatitis on the second day. Further evolution was uneventful, and the patient was discharged after 43 days. Carbamate intoxication was confirmed by high urinary aldicarb metabolite concentrations. Pseudocholinesterase levels took 77 days to return to normal. Carbamate pesticides share the same pancreatic risk as organophosphorus pesticides, and should be monitored similarly.

Toxicological analysis in agitated patients.

OBJECTIVE: To assess the toxicological etiologies in agitated patients and to evaluate their initial clinical diagnosis in the light of toxicological results analysis. DESIGN: Prospective clinical study. SETTING: Emergency Department (ED) in a 2,650-bed University Hospital. PATIENTS: Fifty-eight consecutively enrolled patients admitted to the ED in agitated states over a 6-month period. MEASUREMENTS AND RESULTS: All patients underwent laboratory tests including blood glucose, ethanol and serum drug screening. Toxicology tests were conducted by fluorescence polarization immunoassay and confirmed by high performance liquid chromatography/diode array detector and gas chromatography-mass spectrometry. The physician's initial diagnosis was evaluated in the light of toxicological analysis results. Serum toxicological analysis revealed that 50/58 patients were under the influence of alcohol and/or a drug. Benzodiazepines (22/58), selective serotonin reuptake inhibitors (5/58) and opiates (4/58) were the most frequently observed. The initial clinical diagnosis was alcohol intoxication in 39 patients, although 1 patient was not under the influence of alcohol and 16 also had benzodiazepine in their sera. Moreover, the diagnosis of serotonin syndrome was overlooked in two patients. CONCLUSION: Most agitated patients were under the influence of alcohol and/or a drug. Benzodiazepine alone or in association with alcohol was surprisingly frequent. A serotonin syndrome may explain the agitation state.

SETH: an expert system for the management on acute drug poisoning in adults.

The aim of SETH is to give end-users specific advice concerning treatment and monitoring of adult drug poisoning. SETH is developed with an off the shelf expert system shell (KBMS) and runs on a microcomputer. Technical choices were done according to this analysis, financial considerations and portability. Currently, the database contains 1000 French drugs from 75 different toxicological classes. The SETH expert system simulates the expert reasoning, taking into account for each toxicological class delay, signs and dose. Two phases of evaluation were performed. The experimental implementation of Seth began in April 1992 in our Poison Control Centre. Since then, 1100 cases inputted by residents were analysed by SETH. The extension of the knowledge base to child poisoning began in March 1993.

[Epidemiology of Ciguatera in the Iles Saintes (Guadeloupe)]. / Epidémiologie de la Ciguatera aux Iles Saintes (Guadeloupe).

A 1981 retrospective study in the Iles Saintes (Guadeloupe) points to an estimated average number of cases per year of 30 +/- 25 par 10,000 inhabitants, involving 2.6 +/- 1.6 outbreaks per year of this endemic disease. The infection is most common from August to October. The attack rate is 87%. The symptoms, as described by 112 former patients, include the usual digestive and neurological signs, with oculonasal symptoms being particularly frequent. Only in half the cases does the disease require medical care (doctor, dispensary, hospital). The median duration of the illness is 3 weeks. Two patients out of 3 are bedridden. More than one-third present sequelae. Three families of fish are responsible for these cases of food poisoning: the Carangidae, Sphyraenidae, and Muraenidae. The microphagous herbivora species are not incriminated. The results are compared to other series of data published for the Antilles and for the Pacific.

[Massive poisoning by African bee stings]. / Envenimation massive après piqûres d'abeilles africaines.

BACKGROUND: Bee stings can cause severe toxic effects when envenomation is massive. CASE REPORT: While touring in Casamance (Southern Senegal) a white male was severely stung by a swarm of African bees. The massive envenomation caused rhabdomyolysis, hemolysis and acute renal failure. Pathology examination of kidney and bladder specimens showed vasculitis affecting both arteries and veins. The patient was treated with several hemodialysis sessions and renal function returned to normal three months after the incident. DISCUSSION: Bees in Africa, known as "killer bees", are particularly aggressive. They have recently been imported from tropical zones in America where a large number of deaths have been reported. Most cases of massive envenomation have shown acute tubular necrosis or renal involvement with myoglobinuria or hemoglobinuria. The renal pathology observed in our case is not usually described.

[Acute nicardipine and nifedipine poisoning. Multicenter study. Cooperative study by the french poison control centers and the ARIT]. / Intoxications aiguës par Nicardipine et Nifédipine. Etude multicentrique. Travail coopératif des Centres Anti-Poisons francais et de l'ARIT.

A study, that was realized by the French Association of Poison Control Centers, tried to estimate the toxicity of Dihydropyridine derivatives towards human beings, in comparison with other calcium antagonists, said to be more toxic. Though, the toxicity of the Dihydropyridine derivatives happens to be far less important considering the rarity or absence of their cardiac effects, it must not however be underestimated in the case of a mass ingestion, or if they are taken simultaneously with psychotropic or cardiotropic drugs.

[Iatrogenic ergotism. Apropos of a case]. / L'ergotisme iatrogène, à propos d'un cas.

A 36 year-old woman was given Ergotamine Tartrate 4.5 mg p.d. during seven days, after an abortion (a still birth). Subsequently she developed a generalised arterial spasm of the limbs producing a feet necrosis. A transmetatarsal amputation was performed. This observation and 63 others cases in the litterature call attention to the potential dangers of the ergot derivatives (ergotamine tartrate), even at normally accepted therapeutic doses. Arteriolar thrombosis and subsequent tissular gangrene can be presented by early administration of heparin, dextran infusions and, possibles, hyperbaric oxygen. Among the vasodilatation drugs, only sodium nitroprussiate seems to be effective.

Syndrome of inappropriate secretion of antidiuretic hormone in two elderly women with elevated serum fluoxetine.

OBJECTIVE: Fluoxetine is widely prescribed for depressed patients. Hyponatremia secondary to inappropriate secretion of antidiuretic hormone has been reported in a few cases associated with routine use of fluoxetine, especially in elderly patients. The mechanism has been postulated to be linked to the inappropriate secretion of antidiuretic hormone. Serum concentrations of antidiuretic hormone and fluoxetine have not been reported in previously published reports. CASE REPORT: We report two new cases of severe and reversible hyponatremia associated with routine use of fluoxetine therapy in two elderly women. Fluoxetine-induced inappropriate secretion of antidiuretic hormone was confirmed by elevated serum concentrations of antidiuretic hormone and fluoxetine.

Severe self-poisoning with oxetorone: report of one case.

The authors report a case of severe self-poisoning with oxetorone. Plasma concentration of the drug assessed by HPLC was a thousand times higher than therapeutic levels. Coma, convulsions, and cardiac conduction defects were observed, similar to those noted with tricyclic and tetracyclic antidepressant poisoning. Similar cardiac disorders consisting of conduction defects had not been previously described during oxetorone intoxication.

Fomepizole (4-methylpyrazole) in fatal methanol poisoning with early CT scan cerebral lesions.

BACKGROUND: Methanol poisoning, potentially fatal, is generally treated with the combination of ethanol as antidote, and hemodialysis. Fomepizole, a competitive inhibitor of alcohol dehydrogenase, has more recently been used, and is capable of blocking the toxic metabolism of methanol. To our knowledge, its use has never been reported as an antidote in severe methanol poisoning requiring hemodialysis. CASE REPORT: We report a case of fatal methanol poisoning (1.9 g/L on admission) suspected due to the combined presence of coma and severe metabolic acidosis with normokalaemia. CONCLUSION: The fomepizole treatment protocol (10 mg/kg by i.v. infusion over 1 hour before dialysis, repeated 12 hours later in combination with 1.5 mg/kg/h during dialysis) was simple to use and appeared effective in eliminating methanol in combination with hemodialysis. The case is also unusual in terms of severity and the early onset of cerebral lesions demonstrated by computed tomography (CT) scan.