[Biological and toxic effects of ethanol: diagnostics and treatment of acute poisonings]. / Dzialanie biologiczne i toksyczne etanolu, diagnostyka i leczenie zatruc.

Ethyl alcohol (ethanol) is readily absorbed from all parts of the gastrointestinal tract due to its hydrophilic potential. The biological effects in humans refer to practically every organ and system. The basic enzyme involved in its oxidation is alcohol dehydrogenase. Another important metabolic pathway is the Microsomal Ethanol-Oxidizing System (MEOS). Toxic effect on basic cell functions is produced both by ethanol and acetic aldehyde, its oxidation product which accounts for most of the acute and delayed effects of ethanol toxicity. In acute ethanol intoxication's the CNS symptoms are the first to manifest. Ethanol affects the CNS functions mainly through stimulating opiate and benzodiazepine receptors and a number of neurotransmitters. However, the attempts to diminish the toxic effects of ethanol on CNS by blocking the affected receptors have proved to be ineffective. In acute poisoning a basic essential is to sustain vital functions by following the principles of intensive care. Each case of acute ethanol intoxication must be subject to neurological examination for possible cerebro-cranial traumas. The diagnostics and treatment procedures should take account of the possible symptoms: convulsions, respiratory and cardiac failure, hypoglycemia, hypothermia, and severe gastric dysfunction. Vital signs monitoring and control of acid-base and water-electrolyte balance are a must. The toxic properties of ethanol metabolites can be particularly hazardous to patients treated with disulfiram. The patients who develop "antabuse response" should be given immediately iron and vitamin C intravenously.

[Acute poisoning with selected hepatotoxic agents: biochemistry of toxic effect, clinical symptoms and treatment]. / Biochemiczne podstawy dzialania toksycznego, obraz kliniczny i leczenie ostrych zatruc niektórymi ksenobiotykami o dzialaniu hepatotoksycznym.

The paper discusses etiopathogenesis, clinical symptoms and treatment in acute poisoning with hepatotoxic agents. The liver is a critical organ in acute poisoning with Amanita phalloides, carbon tetrachloride, iron compounds and isonicotinic acid hydrazide. Based on literature reports and own experience the authors present the current outlook on the specific treatment of acute poisoning with these xenobiotics. Special consideration was given to biochemical etiopathogenesis of hepatoxicity: oxidative stress, lipid peroxidation and impaired homeostasis of calcium ions and glutathione. Basic principles were also discussed of conservative treatment in hepatic encephalopathy due to toxic liver necrosis.

[Paracetamol: therapeutic action, pathogenesis and treatment of acute poisonings complicated by severe liver damage]. / Paracetamol--mechanizm dzialania terapeutycznego, etiopatogeneza oraz leczenie zatruc powiklanych uszkodzeniem watroby.

The biosynthesis of prostaglandins proceeds in the presence of fatty acid cycloxygenases (COX-1, COX-2). COX-1 is responsible for the synthesis of prostaglandins indispensable for normal homeostasis, while COX-2 regulates local expression of pro-inflammatory prostaglandins. Paracetamol is a selective inhibitor of COX-2 thus having an analgesic and antipyretic potential. The drug is metabolised primarily in the liver. About 5% of the dose transforms into N-acetylo-p-benzoquinoneimine (NAPQI), a highly active compound. Ingestion of a single paracetamol dose higher than 8 g leads to a depletion of hepatic glutathione reserves and a loss of the detoxifying property of the liver. As a result, hepatic necrosis develops. The specific antidote is N-acetylcysteine (NAC). If applied within 10-15 h since the poisoning it enables complete survival. The efficacy of specific treatment decreases after 24 h but blood paracetamol is an indication for NAC therapy. The surviving patients with advanced paracetamol poisoning require long-lasting conservative treatment with ornithine and phospholipids as well as a light diet.

[MMPI- and BDI-scale-based self-assessment of the psychic condition of patients after a suicidal attempt]. / Samoocena stanu psychicznego pacjenta po próbie samobójczej na podstawie podskali MMPI i Kwestionariusza Becka.

UNLABELLED: Parasuicide (suicidal attempt) is an intentional, self-aggressive behaviour intended to damage the body rather than cause death. About 75% of suicidal attempts are those committed for the first time. The majority of suicidal attempts are impulsive. About 66% of the parasuicide patients said that they had thought about the act for less than an hour beforehand. Only 30% of the patients had been psychiatrically diagnosed before they were admitted to the hospital. After prompt re-diagnosing, the percentage was considerably lower. The aim of the work is to analyse, using Minnesota Multiphasic Personality Inventory (MMPI-DMS subscale) and Beck Depression Inventory (BDI), the self-assessment of the psychical condition of patients hospitalised at the Acute Poisonings Clinic, Nofer Institute of Occupational Medicine, Lodz, Poland, for attempted suicide. The study subjects included 222 patients (148 women and 74 men) treated in 2003. The control comprised 137 volunteers random-selected from among patients visiting Institute's Outpatient Clinic of Occupational Diseases. The psychiatric testing revealed mood and personality disorders, and acute stress disorders. Depression or other psychotic reactions were not diagnosed in any of the cases. Mean MMPI subscale scoring for the women was 10.7 (subjects) and 3.5 (control). The MMPI rating after 6 months since the attempted suicide was 6.03, i.e. by 4.3 scores lower. The corresponding values for the men were 10.1 (subjects) and 3.06 (control), and after 6 months the value was 4.64, by 5.46 scores lower. Mean BDI scale scoring for the women was 10.56 (subjects) and 7.9 (control). The BDI score after 6 months since the poisoning was 7.74, i.e. by 2.83 scores lower. The corresponding values for the men were 10.77 (subjects) and 5.27 (control), and after 6 months the value was by 2.86 scores lower. The results are statistically significant (p<0.001). CONCLUSION: The results show that 6 months after the suicidal attempt, the self-assessment of patients' psychical condition improves, the mood normalises. The suicidal attempt is often an impulsive act intended to relieve the rapidly growing stress.