[Methemoglobinemia as a result of acute accidental "poppres" poisoning ­ a case report].

Recently we observe an increase in the number of intoxications due to xenobiotics that may induce acute methemoglobinemia. Our study showed a case of acute methemoglobinemia (MetHb 55..2%) in 25 ­ year old man. Clinical symptoms were caused by ingestion of "poppers" which was used by patient as "aphrodisiac". Summary: Conclusions: 1. Oral intake of alkyl nitrites, including isobutyl nitrite, is burdened with the risk of life-threatening methemoglobinemia . 2. In the case of poisonings running with normal pO2, reduced level of oxygen saturation, clinical signs of cyanosis does not react to oxygen therapy, and "chocolate" tinge of blood methemoglobinemia should be suspected. 3. In every case of MetHb the use of antidote, which is methylene blue, should be considered. 4. The severity of cyanosis correlates with the level of methemoglobin.

[Toxicological consultation data management system based on experience of Pomeranian Center of Toxicology]. / System zarzadzania informacja toksykologiczna na podstawie doswiadczen Pomorskiego Centrum Toksykologii.

BACKGROUND: In this paper the structure of poisonings is described, based on the material collected from tele-toxicology consults by the Pomeranian Center of Toxicology in Gdansk and harvested from its Electronic Poison Information Management System. In addition, we analyzed conclusions drawn from a 27-month operation of the system. MATERIAL AND METHODS: Data were harvested from the Electronic Poison Information Management System developed in 2012 and used by the Pomeranian Center of Toxicology since then. The research was based on 2550 tele-toxicology consults between January 1 and December 31, 2014. Subsequently the data were electronically cleaned and presented using R programming language. RESULTS: The Pomeranian voivodeship was the prevalent localisation of calls (N = 1879; 73.7%). Most of the calls came from emergency rooms (N = 1495; 58.63%). In the case of 1396 (54.7%) patients the time-lag between intoxication and the consult was less than 6 h. There were no differences in the age distribution between genders. Mean age was 26.3 years. Young people predominated among intoxicated individuals. The majority of intoxications were incidental (N = 888; 34.8%) or suicidal (N = 814; 31.9%) and the most of them took place in the patient's home. CONCLUSIONS: Information about Poison Control Center consultations access should be better spread among medical service providers. The extent of poison information collected by Polish Poison Control Centers should be limited and unified. This should contribute to the increased percentage of properly documented consultations. Additional duties stemming from the need of digital archiving of consults provided, require the involvement of additional staff, leading to the increased operation costs incurred by Poison Control Centers.

[Analysis of intoxication with novel psychoactive substance (NPS) in Pomeranian region, from January to July 2015]. / Analiza zatruc nowymi substancjami psychoaktywnymi (NPS) w województwie pomorskim, w okresie od stycznia do lipca 2015 r.

INTRODUCTION: During initial months of the year 2015 we observed the increase number of patients intoxicated with NPS in Poland. In our work we analysed the scale of this phenomenon in Pomeranian region. MATERIALS AND METHODS: Study was carried out on period from 1 January 2015 to 31 July 2015. Analysis was based on records derived from Electronic Poison Information Database developed and used on a daily basis on Pomeranian Centre of Toxicology (PCT), data obtained from Centre for Monitoring of Adverse Effects of Medicaments and Chemical Substances based in PCT and on information gathered from patients treated in Pomeranian Centre of Toxicology for NPS intoxication. RESULTS: Our study has shown slow, continuous rise in the number of intoxications with NPS in analysed period. The most frequent cause of intoxication were synthetic compounds. 99 cases needed treatment in Clinical Toxicology Unit due to their severe state. The youngest exposed person was 13 y.o., while the oldest was 53 y.o. Mean age was 22.5 y.o. with median 20 years. Majority of intoxications were among males (80.54%). 61.53% of all patients came from Tricity agglomeration. Ethanol was the prevalent coingestant. The most commonly used substance was generic NPS (70.59% of cases), followed by unknowns psychoactive substance (16.29% of cases), herbal mixture (16.29% of cases) and dextrometorphan (5.88% of cases). The study did not find one drug name that would be prevalent over others, with the most frequent commercial name being "Mocarz", found in 4 cases. Most dangerous substances found in NPS were PMA, PMMA, 25C-NBOMe and 251-NBOMe. There were no deaths of patients treated in PCT because of acute intoxication with NPS.

[Electronic poison information management system]. / Elektroniczny system zarzadzania informacja toksykologiczna.

We describe deployment of electronic toxicological information database in poison control center of Pomeranian Center of Toxicology. System was based on Google Apps technology, by Google Inc., using electronic, web-based forms and data tables. During first 6 months from system deployment, we used it to archive 1471 poisoning cases, prepare monthly poisoning reports and facilitate statistical analysis of data. Electronic database usage made Poison Center work much easier.

[Acute poisoning with sertindole--a case report]. / Ostre zatrucie sertindolem--opis przypadku.

The paper presents a case of acute, accidental sertindole poisoning. Intoxication had a stormy clinical course with symptoms of cardiovascular, respiratory and nervous system. A relatively small dose of ingested preparation and severe overdose course may indicate a low therapeutic drug index.

[Hepatoxic effect of a noni juice consumption--a case report]. / Hepatoksyczny efekt spozywania soku noni--opis przypadku.

UNLABELLED: Noni juice of an Indian mulberry fruit has recently become a very popular remedy for several diseases. The paper presents the case of hepatotoxic action of Noni juice in a previously healthy 55-years old female patient. After symptomatic therapy and cessation of exposure to the juice all symptoms dissapeared. CONCLUSIONS: 1. Indian mulberry formulations may, in some cases, lead to liver toxicity. 2. Treatment consists of cessation of exposure to preparations containing Indian mulberry fruits and a symptomatic therapy. 3 There is an urgent need to examine the therapeutic and toxic effects of commonly used herbal specifics.

[Acute intoxication with nutmeg used as a recreational purpose--a case report]. / Ostre zatrucie galka muszkatolowa stosowana w celach rekreacyjnych--opis przypadku.

We present a case of acute nutmeg poisoning used for recreational purposes. Poisoning had a stormy clinical course with symptoms of gastrointestinal, cardiovascular and nervous system. The widespread availability of nutmeg suggests that real number of these poisonings may be underestimated in our country.

[Recreational usage of dextromethorphan--analysis based on internet users experiences]. / Rekreacyjne stosowanie dekstrometorfanu--ocena na podstawie doswiadczen internautów.

UNLABELLED: In the last decade we have observed a considerable increase in nonmedical usage of dextromethorphan (DXM) among young age groups, especially school children between 13 and 16 yrs. We analysed the "trip reports" after use of DXM, available on a website: www.hyperreal.info in the years 1999-2013. The data collected by authors were analysed according to: age, sex, symptoms, dose of DXM, a reason and a place of using the drug. A review of 124 "trip reports" showed that the majority of their writers are male (M 90.3%, F 9.7%). Young people, aged 16-20 (80.4%), dominated among the study population. The most common place of using DXM was a flat of a drug user (70.2%), and the reason of using a willingness to experiment with new psychoactive substances (41.9%) as well as the desire of "get high" (25.8%). The majority of users used DXM at least once again in their lives (56.5%). A single dose of the ingested drug ranged from 120 mg to 1575 mg (mean 539.25 mg). Most often received doses were 450 mg (30.4%), 300 mg (12%), 900 mg (11.2%). DXM was positively assessed by the internauts as a recreational psychoactive substance (84.7%). The most common clinical symptoms described by internauts were: difficulties with walking (74.2%), visual illusions (73.4%), altered sense of time (41.9%), feeling of exteriorisation (35.5%), euphoria (33.1%), nausea and vomiting (32.3%), auditory illusions (30.6%) and pruritus (29.8%). CONCLUSIONS: 1. DXM is the popular psychoactive substance which has gained a positive opinion among the Internet users. 2. Easy accessibility of DXM may pose a serious threat to health of young people who experiment with psychoactive substances. 3. The improvement of DXM sales control should be considered.

Lithium batteries safety, wider perspective.

Energy production and storage has become a pressing issue in recent decades and its solutions bring new problems. This paper reviews the literature on the human and environmental risks associated with the production, use, and disposal of increasingly common lithium-ion batteries. Popular electronic databases were used for this purpose focused on the period since 2000. Assessment of the toxicological and environmental impact of batteries should then have a holistic scope to precede and guide the introduction of appropriate safety measures. In this short review the authors will try to touch upon this complex subject and point out some important issues related to an unprecedented development of lithium ion batteries-powered world. Given the multi-billion dollar business with the risks associated with the development of new technologies requires careful consideration of whether the balance of profits and losses is beneficial to humans and the planet. Int J Occup Med Environ Health. 2023;36(1):3-20.

Reports analysis of psychotropic drugs related adverse reactions in Australia and Poland during the COVID 19 pandemic.

BACKGROUND: The COVID-19 pandemic has caused significant changes to the global health care system AIMS: It is unknown whether the COVID-19 pandemic influenced the occurrence of adverse drug reactions (ADR) of antidepressive agents, benzodiazepines, and antipsychotics plus mood stabilizers (AaMS). The study was designed in order to compare the incidence of ADR during the COVID-19 pandemic with the period preceding the pandemic in Poland and Australia, different in terms of their COVID-19 prevention strategy. METHOD: We analysed ADR from the three surveyed pharmacological groups of drugs observed in Poland and Australia in the period prior to, and during the COVID-19 pandemic RESULTS: In Poland, a noticeable increase in the reported ADR of the assessed drug groups was observed during the COVID-19 pandemic. The highest was for antidepressive agents, but the reporting of ADR for benzodiazepines and AaMS drugs also increased significantly. In the case of ADR in Australian patients, the increase in the number of reported ADR for antidepressive agents was modest compared to that seen in Poland, but still noticeable, and there was a significant increase in ADR for benzodiazepines CONCLUSIONS: This study showed that the COVID-19 pandemic has had an impact on the incidence of ADR reported among both Polish and Australian patients but the modality of this was different.

[Cardiac arrest during intoxication with nicotine--a case report and a review of literature]. / Nagle zatrzymanie krazenia w przebiegu zatrucia nikotyna--opis przypadku i przeglad pismiennictwa.

There are numerous cases of acute intoxication with nicotine described in medical literature. The known routes of intoxication are transdermal, oral, inhalational, and intravenous. We presents a case of oral poisoning with nicotine from cartridges of e-cigaretes. According to the best of our knowledge this is first case of such poisoning in Poland. The intoxication had serious course, complicated with sudden cardiac arrest.

[Management of alcohol withdrawal syndromes]. / Postepowanie w alkoholowych zespolach abstynencyjnych.

Paper presents proposal of guidelines concerning management of alcohol withdrawal syndromes. The paper is based on scientific medical societies standards, meta analyses and significant papers supporting some controversial questions. There are represented some practices used in intensive care units, that are not present in standards.

[Metabolic acidosis--cause of sudden, unexplained death among chronic alcohol abusers]. / Kwasica metaboliczna--przyczyna naglych, niewyjasnionych zgonów u nalogowych alkoholików.

Metabolic acidosis (lactic and ketoacidosis) are frequent cause of sudden, unexplained deaths of alcohol abusers with negative results of pathomorphological and toxicological determinations. We described the pathomechanism leading to the acidosis.

Double, suicidal intoxication with hydroxycarbamide--a case report.

Hydroxycarbamide (HCB), also known as hydroxyurea, is an urea derivative used mainly as antineoplastic and antisickling agent. We described a 31 yrs. female, with essential thrombocythemia, who was admitted to our clinic because of double suicidal ingestion of hydroxycarbamide. First time it was 7.5 g of HCB with coingestion of 50 mg of diazepam, and several glasses of wine, second time it was 10 g of HCB, with coingestion of 100 mg paroxetine and few glasses of vodka. Both suicidal attempts were triggered by multiple reactive factors. At the time of admissions the patient was conscious, restless, with decreased mood. Transient decrease of total leukocyte count was noted on fourth day of first overdose. The second overdose led to no significant changes in blood count. There were no other abnormalities in biochemical results. According to the best of our knowledge this is the first report of acute suicidal intoxication with hydroxy-carbamide in an adult.

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

Paper presents Polish Medical Society, Section of Clinical Toxicology position statement on the prehospital and hospital management in case of suspicion of intoxication with paracetamol.

[Accidental intoxication with eucalyptus oil--a case report]. / Przypadkowe zatrucie olejem eukaliptusowym--opis przypadku.

Eucalyptus oil (EO) intoxications are rare. We present a case of 58 yrs old chemist, who due to intense delusions consumed 4-5 drops of concentrated EO in order to self-medication of ascariasis. Despite the low dose of ingested xenobiotic the course of poisoning was severe. The intoxication was complicated with acute lung and heart injury, tachycardia and hypertension. Most of the clinical symptoms and biochemical abnormalities disappeared after the treatment.

[Iatrogenic hypernatremia--report of two cases]. / Jatrogenna hipernatremia--opis dwóch przypadków.

INTRODUCTION: Despite the many side effects solutions of kitchen salt are still being used as efficient and safe homemade emetics. CASE REPORTS: Saturated solutions of kitchen salt have been used by paramedics to provoke vomiting in two patients: a 50-years-old woman and a 44-years-old man. According to anamnesis patients received respectively around 330 and 500 g of dissolved kitchen salt. In both cases bloody emesis and bloody diarrhea, alteration of consciousness and low blood pressure were noted. Maximum blood sodium level was 177 and 173 mmol/l respectively. Due to signs of gastrointestinal bleeding gastric endoscopy was performed in both cases, which demonstrated widespread damage of gastric mucosa. Normalization of electrolyte disturbances and improvement of patients' status was achieved with intravenous infusion of 5% glucose. Both patients have been discharged to further outpatient treatment after 10-days hospitalization. CONCLUSIONS: 1. Use of salt kitchen solutions to induce emesis results in a high risk of life-threatening complications. 2. Particular emphasis must be put on training of paramedics in pre-hospital management of acute poisonings.

[Psychosis caused by the treatment with clarithromycin--a case report]. / Psychoza spowodowana terapia klarytromycyna--opis przypadku.

We present a case of psychosis caused by intake of clarithromycin in a young, healthy patient. Disturbance of consciousness occurred a few hours after the intake of the first dose and persisted for four days after drug discontinuation. Conducted numerous medical tests excluded other possible causes of psychotic disorders. The patient was observed in hospital, without using antipsychotic preparations up to the spontaneous resolution of the aforementioned disorders.

[Reactive oxygen species and 3,4-dihydroxyphenylacetaldehyde in pathogenesis of Parkinson disease]. / Reaktywne formy tlenu i aldehyd 3,4-dihydroksyfenylooctowy w patogenezie choroby Parkinsona.

Reactive oxygen species, which plays a role in pathogenesis of many neurodegenerative diseases, seems to be important also in pathogenesis of the Parkinson's disease. Experiments performed recently, revealed in the cerebrum of patients suffering from this disease (induced by the oxidative stress) elevated levels of 3,4-dihydroxyphenylacetaldehyde (DOPAL)--a strong endogenous neurotoxin to dopamine neurons.

Rhabdomyolysis related to acute recreational drug toxicity-A Euro-DEN study.

BACKGROUND: This study was conducted to retrospectively assess the relationships between: rhabdomyolysis (quantified by creatine kinase (CK) activity) and kidney injury (quantified by serum creatinine concentration), sex, age, body temperature on admission, presence of seizures, and agitation or aggression in patients presenting to the Emergency Department with acute recreational drug toxicity. We also investigated the association with the substances ingested. METHODS: All presentations to the 16 sentinel Euro-DEN centres in 10 European countries with acute recreational drug toxicity during the first year of the Euro-DEN study (October 2013 to September 2014) were considered. Cases that had abnormal CK activity recorded as part of routine clinical care were divided into 3 cohorts depending on peak CK activity. Cases with normal CK activity were included as a control group (4th cohort). RESULTS: Only 1,015 (18.4%) of the 5,529 Euro-DEN presentations had CK activity concentration recorded. Of this group 353 (34.8%) had also creatinine concentration measured. There were 375 (36.9%) with minor rhabdomyolysis, 69 (6.8%) with moderate rhabdomyolysis, and 24 (2.4%) with severe rhabdomyolysis; 547 (53.9%) were included in the control group. There was a positive correlation between CK activity and creatinine concentration (correlation coefficient r = 0.71, p<0.0001). There was no correlation between CK activity and body temperature at the time of presentation to the ED (correlation coefficient r = 0.07, p = 0.03). There was a positive correlation between CK activity and length of stay in the hospital (r = 0.31, p<0.001). There was no association between CK activity and the presence of seizures (p = 0.33) or agitation/aggression (p = 0.45), patients age (p = 0.4) or sex (p = 0.25). The 5 most common agents amongst patients presenting with rhabdomyolysis were: cocaine (n = 107; 22.9% presentations), amphetamine (76; 16.2%), cannabis (74; 15.8%), GHB/GBL (72; 15.4%) and heroin (67; 14.3%). The distribution of rhabdomyolysis in 5 most common drugs was (drug; patients with rhabdomyolysis, patients without rhabdomyolysis): cocaine (107, 122), cannabis (74, 117), GHB/GBL (72, 81), amphetamine (76, 66), heroin (67, 70). CONCLUSIONS: Abnormal values of CK activity occurred in almost half (46.1%) of presentations to the Emergency Department with acute recreational drug toxicity in whom CK activity was measured; however, severe rhabdomyolysis is seen in only a small minority (2.4%). Those with rhabdomyolysis are at significantly higher risk of kidney injury and have a longer length of hospital stay.