The Effect of Neuropsychiatric Drugs on the Oxidation-Reduction Balance in Therapy.

The effectiveness of available neuropsychiatric drugs in the era of an increasing number of patients is not sufficient, and the complexity of neuropsychiatric disease entities that are difficult to diagnose and therapeutically is increasing. Also, discoveries about the pathophysiology of neuropsychiatric diseases are promising, including those initiating a new round of innovations in the role of oxidative stress in the etiology of neuropsychiatric diseases. Oxidative stress is highly related to mental disorders, in the treatment of which the most frequently used are first- and second-generation antipsychotics, mood stabilizers, and antidepressants. Literature reports on the effect of neuropsychiatric drugs on oxidative stress are divergent. They are starting with those proving their protective effect and ending with those confirming disturbances in the oxidation-reduction balance. The presented publication reviews the state of knowledge on the role of oxidative stress in the most frequently used therapies for neuropsychiatric diseases using first- and second-generation antipsychotic drugs, i.e., haloperidol, clozapine, risperidone, olanzapine, quetiapine, or aripiprazole, mood stabilizers: lithium, carbamazepine, valproic acid, oxcarbazepine, and antidepressants: citalopram, sertraline, and venlafaxine, along with a brief pharmacological characteristic, preclinical and clinical studies effects.

The assessment of risk factors for febrile seizures in children.

OBJECTIVE: The aim of the paper was to assess the risk factors of febrile seizures in children. METHODS: The paper presents an analysis of a group of 176 children aged 6 months to 5 years who were admitted to A&E because of febrile seizures. RESULTS: The analysed group of 176 children comprised 61.96% boys and 38.07% girls, and the average age equalled 23 months. Family history was significant in 9.66% of patients. A statistically significant difference was noticed between insignificant family history and the incidence of febrile seizures. In all the studied groups of children the factor that determined the incidence of febrile seizures was a sudden increase in the body temperature with an infection of the upper respiratory tract of several day's duration as another cause. Febrile seizure incident was most frequently associated with a sudden increase in the body temperature in 53.40% children. A statistically significant difference was observed between persisting fever and an increase thereof during the day. Yet another factor predisposing for febrile seizures incidence was an infection of the upper respiratory system that could be observed in 32.95% patients. The mean body temperature when the seizures occurred was 38.9°C. CONCLUSIONS: A sudden increase in the body temperature within the first day of pyrexia predisposes for the incidence of febrile seizures and it was proved that it depends on how long fever persists during the day. The other factor triggering the seizures was an infection of the upper respiratory tract of several days' duration.

[Energy drinks as a cause of seizures--real or possible danger? Case report]. / Napoje energetyzujace jako przyczyna drgawek--realne czy potencjalne zagrozenie? Opis przypadku.

The consumption of energy beverages is increasing, especially among young people. The increasing consumption of these drinks increases the data of side effects. Case report: A 26-year old male was admitted to Toxicology Department suspected of intoxication due to ethyl alcohol and unknown psychoactive substances. The patient lost consciousness during a party in which he drank an unknown amount of ethyl alcohol mixed with an energy beverage ("Red Bull"). The patient and his friends strongly denied the use of psychoactive substances. On admission, the patient was stable, but unconscious (GCS 8 points), pupils wide, symmetric with weak reaction to light, respiratory rate 15/min. Neurological examination did not reveal any abnormalities. During the hospitalization, somnolence slowly disappeared and the patient became restless, with recurrent episodes of seizures not reacting to diazepam, clonazepam and midazolam infusion. The seizures finally abated after administration of barbiturates (Thiopental). This, in turn, caused respiratory insufficiency, requiring patient intubation and mechanical ventilation. The patients mental status and respiratory status slowly improved. After regaining consciousness, the patient strongly denied the use of psychoactive substances or of chronic alcohol use. He confirmed the single use of high, but not clearly defined, caffeine dosage (in the form of "Red Bull") mixed with alcohol. He mentioned that eight months earlier in similar circumstances he was admitted to the neurology department due to an episode of seizures. Ultimately the origin was not established, despite broad diagnostic testing. Thus the origin of the seizures was suggested to be of a toxicological origin. The patient was released home in good condition, without any side effects of the poisoning. The psychological examination doe not reveal any symptoms of alcohol or psychoactive substances addiction. In our case, due to the unclear nature of the history, we preformed broad diagnostic testing on admission to the hospital, which do not reveal the presence of any toxic substances except ethanol; concentration in the blood was 2,41 gil. Unfortunately, serum caffeine levels were not measured. There was no identification of any other factors that could be responsible for the observed symptoms. It appears that based on the interview, clinical manifestation, and negative toxicology laboratory testing (excluding the presence of ethanol), it is possible to connect the seizure state with the consumption of a high dose of energy drinks, rich in caffeine and taurine.

[Evaluation of selected socioeconomic factors in patients with acute ethanol intoxication and alcohol withdrawal syndrome]. / Ocena wybranych czynników socjoekonomicznych u chorych z ostrym zatruciem etanolem i alkoholowym zespolem abstynencyjnym.

INTRODUCTION: Ethanol is commonly overused psychoactive substance in Poland and all around the world. It causes addiction, which occurs as a result of its chronic administration. One of the main symptoms of addiction is hunger due to psychoactive substance that prevents interruption of its adoption and contributes to relapse drinking. Acute poisoning with ethyl alcohol and alcohol withdrawal syndrome are diseases causing a potential danger to life. The prevalence of use and abuse of alcoholic beverages is a potential risk, causing health problems, including permanent damage of the central and peripheral nervous system and socio-economic problems. OBJECTIVE: The aim of this study is to analyze certain aspects of the socio-economic situation of the patients hospitalized in the Department of Toxicology in Raszeja City Hospital in Poznan due to acute ethanol intoxication or alcohol withdrawal syndrome in 2010. MATERIAL AND METHODS: 299 patients history was evaluated, among which 161 were treated for acute intoxication with ethanol and 138 due to alcohol withdrawal syndrome. Objects of interest were elements of subjective tests including: marital status of patients, their education and professional activity and the problem of homelessness. RESULTS: The study group consisted of 299 patients in age from 16 to 77 years, hospitalized in the Department of Toxicology in Raszeja City Hospital in Poznan due to acute ethanol intoxication or alcohol withdrawal syndrome. It was found that the largest group consisted of patients remaining married (42.81%) and unmarried (30.43%). Alcohol abuse affects people of all levels of education. In the present study, most patients had a vocational education (37.79%) and medium (23.08%). Patients were analyzed in terms of economic activity, among which about 40% were unemployed. In the whole group more than 10% of those were homeless. CONCLUSIONS: Ethyl alcohol intoxication and alcohol withdrawal represents a significant hazard. As a result of reliance, patients lose control of alcohol consumption and they cannot reduce the amount and the time of its adoption. Reducing the dose of alcohol can lead to unpleasant withdrawal symptoms that the patient eliminate by adopting another dose. Typical is to continue the alcohol consumption despite knowledge of its harmful health and difficulties such as professional (problems at work or loss), financial (lack of livelihood, poverty) and interpersonal (loss of friends, marriage breakdown, loss of relationships with relatives).

[Usefulness of blood formic acid detection in the methanol poisoning in the practice of clinical toxicology department-preliminary assessment]. / Ocena wstepna przydatnosci oznaczenia kwasu mrówkowego w diagnostyce zatruc metanolem w praktyce oddzialu toksykologii klinicznej.

BACKGROUND: Severe metabolic acidosis is one of the most difficult diagnostic and therapeutic challenges. The most common causes of this type of acid-base balance disorder are toxic alcohols, e.g. methanol poisoning. Metabolites of methanol, formaldehyde and formic acid are responsible for severe symptoms of this poisoning. OBJECTIVE: The aim of this study is a preliminary assessment of usefulness of formic acid detection by gas chromatography in the daily practice of clinical toxicology department in methanol poisoning confirmed by the designation of this alcohol in the blood. METHODS: The study included 9 patients from Greater Poland region diagnosed with methanol poisoning. Blood samples were collected during routine laboratory tests, on admission secured at-80°C, and then formic acid was determined by head-space gas chromatography. The relationship between the concentration of blood formic acid and methanol, ethanol, and the acid-base balance parameters were evaluated. RESULTS: The study group consisted of 9 men, aged 49.89 ± 6.17 years. All patients were diagnosed with alcohol dependence. In most cases (66.67%) and methanol poisoning occurred during ethanol abuse. The average blood methanol and ethanol concentrations were 2.48±1.74 g/L and 0.99±1.73 g/L respectively. The average blood formic acid concentration was 0.59±0.46 g/L, from 0.0 to 1.12 g/L. Acid-base balance parameters were (mean± SD): pH 7.00 ±0.36; pCO2 32.26 ± 14.54 mmHg; PO2 114.24±77.53 mmHg; BE -18.28 16.76 mmol/L; HCO3-12.70±11.53 mmol/L. There was a positive correlation be- tween the blood methanol and formic acid concentration. A negative correlation was found between the blood ethanol and formic acid concentration. In patients with positive blood ethanol concentration (1.74 to 5.0 g/L, mean 2.96±1.78 g/L) there was not any formic acid, despite the presence of methanol was confirmed. These patients did not demonstrate metabolic acidosis (mean±SD): pH 7.43 ±0.20; HCO3- 27.87 ± 2.36 mmol/L; BE 3.60 ±2.40 mmol/L. In contrast, in all patients with negative blood ethanol concentration, tests confirmed metabolic acidosis and elevated formic acid (mean SD): pH 6.80±0.20; HCO3- 5.12±1.67 mmol/L; BE-29.20±3.68 mmol/L; formic acid 0.89±0.16 g/L. CONCLUSION: Methanol poisoning cannot be confirmed by positive blood formic acid in patients with high blood ethanol concentration (≥1.74 g/L). In this kind of intoxication severe metabolic acidosis does not occur too. In patients with no detectable blood ethanol concentration, blood formic acid concentration can reach 1.12 g/L and correlates with the severity of metabolic acidosis.

[Fatal poisoning in the Department of Toxicology in Poznarn in 2008-2012--preliminary analysis]. / Zatrucia smiertelne w Oddziale Toksykologii w Poznaniu w latach 2008-2012--analiza wstepna.

This paper presents the results of a preliminary analysis of deaths from acute poisoning, which occurred in the Department of Toxicology in Poznan in 2008-2012. During this period, recorded 31 cases of fatal poisoning, representing 0.38% of all treated cases. In subsequent years the percentage of poisoning deaths ranged from 0.25 to 0.49%. Throughout the period leading cause of fatal poisoning were drugs (38.71%) and non-consumptive alcohols (methanol or ethylene glycol) (38.71%). In subsequent years, however, a decrease in the percentage of drug poisoning (from 75 to 0%) and an increase in the percentage of nonconsumptive alcohol poisoning (from 0% to 100%) were observed. In fatal cases were diagnosed among others olanzapine, carbamazepine, pseudoephedrine, tramadol, benzodiazepines, clozapine, morphine and benzodiazepines, insulin, verapamil, carbon monoxide and smoke fire, cyanide, Amanita phalloides, ethanol and a mixture of drugs with ethanol poisoning. The most common fatal poisoning occurred in people addicted (45.16%), mainly in alcohol dependence syndrome (35.48%). Suicidal poisoning was the cause of 32.26% of the deaths, while accidental of 19.35%. In nine cases, the procedure of diagnosis of death from irreversible cessation of brain stem function was performed in order to qualify donors of organs for transplantation or to terminate the therapy. One of the dead was liver and kidneys, and two were kidneys donors.

[Acute poisonings and organ donation--case reports and literature review]. / Ostre zatrucia a donacja narzadów--opis przypadkow i przeglad pismiennictwa.

Poland is one of the European countries where serious problem of shortage of organ donors is observed. Organ donation from victims following fatal acute intoxications is extremely rare, and there's only several such case reports published in Poland. There's a need to establish guidelines of instrumental confirmatory tests of brain death determination according to acute poisonings. Authors present two cases of poisoned donors following acute poisonings with drugs. Current opinions concerning poisoned patients as a potential organ donors are also described. Case 1: A 36-years old male poisoned intentionally with insulin was admitted to Toxicology Department in Poznan. Patient was unconscious (GCS:3), hypoglycemic (glycaemia: 0). In 3rd day of treatment brain death was determined using clinical tests and instrumental confirmatory test (transcranial Doppler ultrasonography). Both kidneys were procured for transplantation. Case 2: A 23-years old male after prehospital sudden cardiac arrest in the course of suicidal carbamazepine intoxication was admitted to Toxicology Department. During whole hospitalization patient was unconscious, unresponsive to the pain (GCS:3), with circulatory and respiratory insufficiency. Despite intense treatment and decrease of carbamazepine level to therapeutic values there were no signs of patient recovery on the 9th day of treatment. After brain death determination patient was qualified as a kidneys and liver donor. Each patient diagnosed of brain death in the course of acute intoxication should be considered as a potential organ donor. Brain death determination in poisoned patients requires consultation by clinical toxicologist to exclude influence of neurotoxic xenobiotics on the central nervous system. Standards of instrumental confirmatory tests in victims following fatal poisonings should be established. Introduction of guidelines concerning donors intensive care procedures that allows successful organ procurement. All organ donations and transplantations from poisoned donors should be registered in national and/or international databases to provide an exchange of experiences and improve understanding of such cases.

[Acute poisoning with weight-loss dietary supplement falsely suggesting the use of amphetamine]. / Ostre zatrucie suplementem diety wspomagajacym odchudzanie falszywie sugerujace uzycie amfetaminy.

OBJECTIVE: We report a case of abuse of weight-loss dietary supplement in 27-year-old man, with characteristic for amphetamine sympathomimetic symptoms and positive analysis of this drug in the urine by immunoassay method (FPIA; Axsym, Abbott). However positive result was not confirmed by liquid chromatography coupled with tandem mass spectrometry (LC-MS-MS). CASE REPORT: The patient ate nine tablets of the Thermal Pro with declared composition of caffeine (250 mg), bitter orange (200 mg), beta-phenylethylamine (100 mg), willow bark (75 mg), Cayenne pepper (40 mg), 1,3-dimethyloamyloamine (DMAA, 35 mg), gooseberry extract (20 mg), bergamot orange (20 mg), black pepper (5 mg), after two-month period of regular consumption at dose of 2-3 capsules per day. After 4 hours, during admission to the Department of Toxicology, patient manifested typical sympathomimetic symptoms: anxiety, agitation, pale skin, sweats, tachycardia 120/min, mydriasis. Following the outcome of detecting amphetamine/methamphetamine in the patient's urine at 2377 ng/mL concentration using FPIA method, drug intoxication was suspected. It was considered that the ingestion was intentional or unconscious of adulterated dietary supplement. In view of the strong opposition of the patient, who denied any use of psychoactive substances, it was decided to re-examine collected speciments. The liquid chromatography coupled to tandem mass spectrometry (LC-MS-MS) method did not confirm the presence of amphetamine in the patient's blood and urine. Based on the composition of dietary supplements for substances which could be responsible for the positive amphetamine result in urine by FPIA method and available literature data, it was concluded that the substances that may react in the immunoassay could be dimethylamyloamine (DMAA, geranamine) or bitter orange components. CONCLUSION: False positive urinalysis towards amphetamine/methamphetamine by immunoassay and presence of sympathomimetic effects may contribute to a false diagnosis of this drug poisoning. Definitive confirmation of such intoxication requires the use of the reference methods.

[Acute methoxetamine intoxication--a case report with serum and urine concentrations]. / Ostre zatrucie metoksetamina--opis przypadku z wyznaczonymi stezeniami w surowicy i moczu.

Methoxetamine (MXE) is a novel synthetic drug, structurally related to phencyclidine, with ketamine-like properties. Available in Poland since 2010, with no legal control, is adverti. sed as the "ideal dissociation drug". The aim of this study was to present a case of nasal methoxetamine acute poisoning in a 28-year-old man, the course of treatment, and the method of identification of this substance in serum and urine. In the course of this intoxication extreme agitation and aggression with slight response to benzodiazepines were observed. The patient was confused, hallucinated. In addition, the physical examination re. vealed tachycardia 120/min and normal blood pressure (130/80 mm Hg). The period of acute poisoning was covered by amnesia. The MXE concentrations in serum and urine were determined using liquid chromatography-mass spectrometry (LC-MS-MS) method, and were respectively 270 ng/ml and 660 ng/ml. Confirmed MXE poisoning increases our knowledge about this new substance, providing relevant clinical and analytical data.

Severe and Fatal Fentanyl Poisonings from Transdermal Systems after On-Skin and Ingestion Application.

In recent years, the administration of fentanyl (FNTL) implicitly in transdermal drug delivery systems (TDDS) has vastly increased in chronic pain treatment. Non-medical and uncontrolled use of FNTL in TFDS (transdermal fentanyl delivery systems) may reveal toxic effects by the route of exposure, dermal or alternative, by ingestion of patches, and drug release in the stomach. The purpose of this study was to present three different cases of FNTL poisonings, two of which resulted in death due to TFDS abuse. The first case is a 66-year-old woman treated for accidental FTNL poisoning resulting in acute respiratory distress syndrome. Two remaining cases are a 31-year-old woman and a 25-year-old man who died as a result of FNTL overdose after on-skin and ingestion application of the drug patches. During the hospitalization of the 66-year-old patient, in blood samples, FNTL was confirmed at a concentration of 10.0 ng/mL. Tests run on blood taken from the corpses of 25- and 31-year-old patients exhibited FNTL presence in concentrations of 29.1 ng/mL and 38.7 ng/mL, respectively. The various routes of administration and ultimately toxic effects are important to present because, in TDDS, fentanyl can be a reason for severe to fatal poisoning, as shown by the three cases above.

Causes of Death during the Intravenous Infusion of Dimethylsulphoxide and Hydrogen Peroxide in the Course of Alternative Medicine Therapy.

Unconventional (alternative, natural) medicine in Poland and worldwide includes hundreds of non-scientifically verified "treatment" modalities. Among the most popular are biological therapies using chemical or natural compounds administered with injection or drip infusion. The latter has found the most excellent use in treating rheumatological and dermatological diseases and certain types of cancer. Vitamin infusions, curcumin, glutathione, perhydrol and dimethylsulphoxide (DMSO) have gained popularity among clients of natural medicine clinics. The present study aims to analyse the case of a 37-year-old woman who was administered infusions containing perhydrol and DMSO (0.5 mL 0.04% hydrogen peroxide/0.5 mL p.d.a DMSO in saline) due to a MTHFR A1298C mutation. After having the next infusion, the woman complained of nausea and then became unconscious. Subsequently, she suffered respiratory and cardiac arrest. Adequate resuscitation was undertaken. After being taken to the hospital, the patient was in critical condition and died due to increasing multiple-organ failure. Initially, there was suspected DMSO poisoning as it was the only compound to have been administered as an intravenous infusion. However, it was not until the analysis of the secured evidence that it became clear that the patient had also been given an intravenous solution of hydrogen peroxide, H2O2, and that there had been a mistake in preparing the intravenous perhydrol solution. The autopsy concluded that the immediate cause of death was an acute cardiopulmonary failure due to the toxic effects of intravenously administered hydrogen peroxide. This conclusion was established after the toxicological testing of the evidence and biological material secured during the patient's treatment and autopsy. Products containing DMSO and perhydrol are not included in the lists of medicinal/therapeutical forms and preparations and thus are not authorised for marketing in Poland. In the case of perhydrol, apart from the topical use of diluted preparations for washing and cleansing wounds, no data on therapeutic use exist in the available scientific literature. Furthermore, "DMSO and perhydrol therapy" cannot even be considered a placebo effect, as both are toxic compounds which could, at most, cause poisoning symptoms rather than improve health.

[Ethylene glycol poisoning--the significance of analytical diagnosis based on reports from Wielkopolska]. / Znaczenie diagnostyczne oznaczenia glikolu etylenowego w ostrych zatruciach--analiza przypadków z terenu województwa wielkopolskiego.

Ethylene glycol (EG) is a multidirectional, dihydric alcohol, which is widely used in food, chemical and automotive industries. EG is a compound of similar toxicity to ethanol (EA). The EG biotransformation undergoes, mainly to glycolaldehyde and acids: glycolic, glyoxylic and oxalic acid, such metabolites, which exhibit strong narcotic effect on the central nervous system, causing profound metabolic acidosis and lead to severe nephropathy. Due to the wide availability of products containing ethylene glycol and its potential toxicity, in the case of the alcohol poisoning, the significant role in the diagnosis play: medical interview, observation of characteristic clinical symptoms, basic laboratory tests and detection of ethylene glycol in the biological material that confirm EG poisoning.

[Management of acute carbon monoxide poisoning--Polish Medical Society, Section of Clinical Toxicology position statement]. / Postepowanie w ostrych zatruciach tlenkiem wegla--stanowisko Sekcji Toksykologii Klinicznej Polskiego Towarzystwa Lekarskiego.

Paper presents Polish Medical Society, Section of Clinical Toxicology position statement on the prehospital and hospital management of carbon monoxide poisoning.

[Suicidal poisoning with cyanide bought on the internet--case report]. / Samobójcze zatrucie cyjankami zakupionymi w Internecie--opis przypadku.

Cyanides are relatively rare cause of acute poisonings. The majority of data on toxic effects of cyanide compounds on the human body, come from the experiences gained from accidental poisonings in the workplace, with fire smokes or during chemical incidents. However, from immemorial time, cyanides were also used in suicide attempts. The aim of this paper is to present the case of suicidal cyanide poisoning of 26-year-old woman, who was admitted to the toxicology department one hour after ingestion of unknown cyanogenic compound, probably bought on the Internet. Despite intensive symptomatic treatment and antidote administration (hydroxocobalamine), patient died after 78 hours of treatment.

Oxidative stress and biochemical indicators in blood of patients addicted to alcohol treated for acute ethylene glycol poisoning.

Ethylene glycol (EG), in addition to its neurotoxic and nephrotoxic effects, evokes oxidative stress. The aim of this study was to assess the influence of the ethylene glycol on the biochemical indicators and oxidoreductive balance of patients treated for acute poisoning. The total study group consisted of 56 persons including 26 alcoholics who took EG as a substitute for ethyl alcohol in the course of alcohol dependence syndrome and 30 controls. Severity of poisoning, results of acid-base parameters, biochemical, and toxicological tests as well as biomarkers of the oxidative stress in blood were analyzed during the patients' hospitalization. The key issue was to assess the oxidative stress and biochemical disturbances caused by EG and the type of treatment applied in the course of poisoning. Significant changes in some parameters were found both at time of diagnosis and after treatment initiation (ethanol as an antidote and hemodialysis). The most important differences included the activity of hepatic parameters (aspartate aminotransferase, AST) and oxidative stress markers like catalase (CAT); correlation of the lipid peroxidation products level (TBARS) with urea concentration has been shown. On the last day of the hospitalization, in some cases, the mutual correlation between the evaluated markers were observed, for example, between alanine transaminase (ALT) and glutathione reductase (GR), and urea concentration and glutathione level (GSH/GSSG). The concentration of ions (H+) had a major impact on the oxidoreductive balance, correlating with the elevated GR and GSH/GSSG levels.

[Biocide exposures reported to Poznan Toxicological Information Center]. / Zatrucia biocydami zarejestrowane w Osrodku Informacji Toksykologicznej w Poznaniu.

System of biocide products control in Poland started from 1st of July 2007. 364 biocide exposures were reported to Poznan Toxicological Information Center at that time. Most of them happened by accident (88.7%), 7,7% were suicidal instances. Men were exposed more often than women (51.4 v. 43.7%). Young children up to age of five were the most numerous group of exposed persons. Most of victims (87.6%) recovered without sequelae. Only one death was reported.

[Pancytopenia in the course of acute valproic acid poisoning--case report]. / Pancytopenia w przebiegu ostrego zatrucia kwasem walproinowym--opis przypadku.

Hematological disturbances are rare, but potentially serious complication of chronic valproate therapy. Transient asymptomatic thrombocytopenia is most frequently described. Less common toxicities include neutropenia and anemia. 58 years old female with pancytopenia in the course of acute valproic acid intoxication was described. She had been treated with unknown dose of valproic acid for eight years. At admission leucocytes and erythrocytes counts were normal, but platelets were diminished (36 x 10(9)/ L). Maximum serum concentration of valproic acid reached 668 microg/mL in first 24 hours of treatment, and had dropped into the therapeutic range during following 12 hours. Thrombocytopenia, leucopenia and anemia with minimal values that reached 10x10(9)/L, 1,97 x 10(9)/L and 1,71 x 10(9)/L were observed. These disturbances were accompanied by spontaneous nasal bleeding that required tamponade. Symptomatic treatment with platelets (25 units) and red blood cells (2 units) transfusions were effectively applied. After 197 hours of treatment trend in blood parameters improvement was seen.

[Some issues of death cap (Amanita phalloides) poisoning based on cases treated in Poznan Department of Toxicology in 2010]. / Wybrane aspekty zatruc muchomorem sromotnikowym - na podstawie przypadków leczonych w Oddziale Toksykologii w Poznaniu w 2010 roku.

Death cap (Amanita plalloides) poisonings are still a great diagnostic and therapeutic problem in Poland. Despite of regular educational activity, the Poles are confusing toxic mushrooms with edible ones. Death cap is mainly a cause of accidental poisoning, although suicidal intoxications also occur. This study presents some authors'observations which were made during diagnosing and treatment of patients hospitalized in Poznan Department of Toxicology in 2010 year. The circumstances of poisonings, kind of symptoms and time when they developed, the main biochemical abnormalities are shown. The way of treatment with N-acetylcysteine and silibinin is discussed.

[Clinical symptoms and circumastances of acute poisonings with fly agaric (Amanita muscaria) and panther cap (Amanita pantherina)]. / Obraz kliniczny i okolicznosci ostrych zatruc muchomorem czerwonym (Amanita muscaria) i muchomorem plamistym (Amanita pantherina).

Mushroom poisonings in Poland are quite common, especially in summer and autumn, but fly agaric (Amanita muscaria) and panther cap (Amanita pantherina) are rather rare cause of these intoxications. Fly agaric is a cause of deliberate poisoning, whereas panther cap poisoning also happens accidentally. The main toxins of these two mushrooms are ibotenic acid (pantherine, agarine), muscimol, muscazone and muscaridine. The other bioactive substances are stizolobic and stizolobinic acids and aminodicarboxyethylthiopropanoic acids. All these compounds are responsible for diverse picture of intoxication. An analysis of patients with Amanita muscaria and Amanita pantherina poisoning hospitalized in the Poznan Departament of Toxicology revealed that symptoms occurred after 30 minutes to 2 hours with vomiting, hallucinations, restlessness, increased psychomotor drive and central nervous system depression. Other antycholinergic symptoms like tachycardia and increased blood pressure, mydriasis, dry and red skin were seen only in a few cases. Acute respiratory failure was the most dangerous symptom observed in the course of poisoning.

[Management of acute cyanide poisoning--Polish Medical Society, Section of Clinical Toxicology position statement]. / Postepowanie w ostrych zatruciach cyjankami - stanowisko Sekcji Toksykologii Klinicznej Polskiego Towarzystwa Lekarskiego.

Paper presents Polish Medical Society, Section of Clinical Toxicology position statement on the prehospital and hospital management of cyanide poisoning.