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[Cyanide poisoning: forensic toxicology observations in the study of 54 cases of fatal poisoning].

The present study describes various observations made during the examination of 54 cases of lethal cyanide intoxication at the Institute of Forensic Medicine of the University of Zürich during a period of more than 40 years. Data pertain to the scene of death, the medicolegal inspection, the autopsy, the histological examinations, the chemical analyses, the various types of poisoning observed and the diagnostic criteria used. The intoxicated victims were mostly adults who had professional access to various cyanogenic compounds and had ingested them with the intention of committing suicide. Cases of accidental and criminal poisoning were rare. In spite of this fact, and although its frequency has not increased in the last few decades, cyanide poisoning has maintained undiminished importance.

Accidents, Occupational↗

Clinical predictors of completed suicide and repeated self-poisoning in 8895 self-poisoning patients.

The diagnoses of 8895 patients who were admitted for intentional self-poisoning with psycho-active drugs were studied in order to find predictors for subsequent completed suicide and repeated self-poisoning. Automated record linkage by means of the Swedish personal identification numbers was performed between the Stockholm County inpatient registry and the cause-of-death registry. With Cox regression models, several diagnostic predictors were identified although they were generally unspecific and insensitive. This may be due both to the low base rate of suicides, and to the omission of other more powerful non-clinical predictors, such as personality traits, hopelessness and social disruption. It is concluded that secondary psychiatric prevention may still be justified, although it will be applied to large numbers of patients who will not eventually commit suicide or repeat self-poisoning.

Adult↗

Vanadium poisoning of cattle with basic slag. Concentrations in tissues from poisoned animals and from a reference, slaughterhouse material.

In northern Sweden, 23 heifers out of 98 cattle died of acute vanadium toxicity in a 10-day period. Eight months earlier a pasture had been fertilized with basic slag, containing 3% vanadium. The fertilizer was laid on the surface without being ploughed in. Mainly heifers, and some cows, were fed with basic slag-contaminated fresh hay. The first signs of illness appeared 11 days later, and the first case of death appeared 14 days after the initial clinical signs. The signs were diffuse and difficult to interpret. Inappetence, black diarrhea, lethargy, dehydration and spontaneous abortions occurred. Further, pulmonary lesions, conjunctivitis, neurological disturbances such as depression, leg incoordination, and paralysis of the hind limbs and face were also noted. Although feeding with the contaminated hay was stopped at the outbreak of the toxicity, the 23 animals died or had to be slaughtered, and at necropsy of another heifer 4 weeks later, large amounts of basic slag were still found in the alimentary tract. High vanadium concentrations were found in the liver, kidneys, spleen and urine, 5.9, 5.5, 1.9 and 4.8 mg/kg w.w., respectively. In bone tissue (coccygeal vertebrae), the highest value in an acutely poisoned heifer was 0.680 mg/kd d.w., in the same range as that of an experimentally poisoned sheep. Surviving heifers were more affected than cows; the state of health of these heifers gradually deteriorated and, therefore, a few were slaughtered 3 months later. Because of residual neurological disturbances and decreased milk production, the rest of the herd was slaughtered 5 months after the outbreak, and samples were collected and analyzed. Elevated vanadium concentrations were found in the organs, especially in the spleen, where values of 1.40 and 1.42 mg/kg w.w. were found in 2 heifers at 3 months. The values in heifers (n = 6) were decreased 5 months after the outbreak. The median concentrations were somewhat higher in the liver than in the spleen, and lowest in the kidney (0.244, 0.213 and 0.058 mg/kg w.w., respectively). In the organs of the cows (n = 24), which were less exposed, the corresponding values were 0.012, 0.095 and 0.013 mg/kg w.w., respectively. Vanadium concentrations were also determined in livers of cows and calves at regular slaughter in four geographic regions of Sweden. In one of the regions, where basic slag (with 3% vanadium) had been used for many years, the values were significantly higher than those in the other regions. In a material of 293 specimens, an upper reference limit of 0.012 mg/kg liver w.w., with a 90% confidence interval of 0.011-0.019 mg/kg w.w., was found to be normal for cattle in Sweden. Concentrations above the Highest Swedish Reference Value, 0.019 mg/kg liver can be considered elevated. Vanadium-containing basic slag used as fertilizer caused poisoning in a herd of cattle and its regional use was detectable in livers from cattle at regular slaughter. Such fertilizer must be applied in a proper way. It should be ploughed in and any direct contact of grazing animals with the hazardous fertilizer should be prevented.

Abattoirs↗

A survey of bacterial toxins involved in food poisoning: a suggestion for bacterial food poisoning toxin nomenclature.

There is at present no accepted nomenclature for bacterial protein toxins, although there have been several attempts at dividing them into groups by their mode of action. In this paper we will not try to describe all known bacterial protein toxins, but concentrate on the toxins involved in food poisoning. Although most of these toxins are enterotoxins (protein exotoxins with the site of action on the mucosal cells of the intestinal tract) there are also other toxins involved in food poisoning, like the neurotoxins. In Table 1 the most important food pathogens in Europe are listed. For most, but not all, of these food pathogens, toxins are virulence factors. Generally, we divide food poisoning into infections and intoxications, where Salmonella spp. and Shigella spp. are typical examples of infections and Clostridium botulinum and Staphylococcus aureus for intoxications. We consider it better to make four different groups of food pathogenic bacteria, according to Table 2. Today the first three groups are all defined as infections, although for both group 2 and 3 the bacterium itself does not harm the host directly. The bacterium in such locations is like an 'enterotoxin factory'. The bacteria belonging to group 3 do not even interact with the epithelial cells in the intestine, while the bacteria of group 2 must colonise the epithelial cells prior to enterotoxin production.

Bacillaceae↗

[Poisoning by hypochlorite-containing disinfectants. A retrospective analysis of 594 cases of poisoning].

Hypochlorite-containing disinfectants or bleaching fluids, if inhaled, may lead to life-threatening poisoning (56% of moderately severe cases, 5% of severe cases) through the immediate liberation of chlorine gas, if they are used together with another cleansing fluid which is very acid. A rough estimate suggests that there must be about 700 cases of such poisonings per year in the Federal Republic of Germany. The characteristic symptom is a respiratory distress syndrome when the liberated chlorine gas is inhaled. Toxic pulmonary oedema and cardiovascular failure can occur if the poisoning takes a fulminating course.

Adolescent↗

When should dialysis be performed in lithium poisoning? A kinetic study in 14 cases of lithium poisoning.

Lithium kinetics were studied in 14 patients with lithium poisoning. Three patients were treated by hemodialysis. Serum lithium peak concentrations ranged between 1.4 and 9.6 mmol/L. The apparent mean serum half-life was 23.16 +/- 9 h, the mean total clearance was 26.5 +/- 13.3 mL/min and the mean renal clearance was 17.2 +/- 5.4 mL/min. The kinetic parameters were dependent on the duration of the study and on the type of the poisoning: acute, acute upon chronic or chronic. During the first 12 h after admission ten patients were in a distribution phase, three were in an elimination phase and one was in an absorption phase. The serum half-life during hemodialysis ranged from 3.6 to 5.7 h and hemodialysis clearance was 63.2 to 114.4 mL/min. The mean volume of distribution calculated in six cases was 0.63 +/- 0.09 L/kg. The evolution of the lithium pools showed a different kinetic pattern between the extra- and the intracellular pool which decreased more slowly. During hemodialysis the decrease of the extracellular pool was about twice that of the cellular pool. Among the factors which may modify lithium toxicity and kinetics, are the type of the poisoning, the presence of an underlying disease and renal impairment. No general and rigid indication for hemodialysis can be set, but the need for hemodialysis should be based on clinical and kinetic data determined during the 12 h following admission.

Adolescent↗

[Acute poisoning with cardiovascular drugs: data from Acute Poisoning Ward in Tarnów].

In this paper an analysis of poisonings with cardiovascular drugs treated in the II Ward of Internal Diseases and Acute Poisonings in Tarnów, in the years from 1996 to 2001, is presented. In 6 years 66 patients were treated (4.5% of all treated toxicological cases). The most frequent kind of drugs were antihypertensive drugs (44 cases), mainly beta-blockers--17 cases. No fatalities were observed. Suicidal poisoning with propafenone in 22-year-old man is presented.

Acute Disease↗

[Poisoning with aluminum phospholipide used as a poison against moles].

Aluminium phosphide (AIP) is a poison used in Denmark to combat moles and vermines e.g. in granaries. On contact with water AIP releases phosphine gas, which has a strong cytotoxic action. We describe a lethal poisoning in a healthy 83 year old man, caused by ingestion of pellets containing AIP. After ingestion the primary symptoms were burning retrosternal pain, severe vomiting and diarrhoea which progressed to cardiac failure, arrhythmias and severe metabolic acidosis. The patient and his excreta smelled of garlic, ammonium carbide and decaying fish, which is characteristic of this poisoning. In spite of intensive care support the patient died in cardiac and respiratory failure 17 hours after ingestion of the pellets. Treatment is supportive. Knowledge about the toxicity of AIP is described and discussed.

Aged↗

[Poisoning with narcotics and hallucinogens in material from the Clinic of Acute Poisoning in Lodz (1993-1996)].

Our material consists of the patients treated for poisonings with street-drugs in Clinic of Acute Poisonings, Lódź, Poland during the period 1993-1996. During the time of 4 years, the number of hospitalised patients have grown up 4.5 times. The structure of used drugs has also changed. Up to 1993 the most popular were opiates derivatives and narcotic analgetics-morphine derivatives. In 1996 almost all narcotics are common, opiates (both natural and synthetic), cocaine, LSD, amphetamine and commonly used (by youngsters especially) Cannabis sativa (marihuana etc). The most common sources of poisoning in our material were opiates and amphetamine, followed by tetrahydrocannabinol derivatives-marijuana.

Adolescent↗

A "pennurth of arsenic for rat poison": the Arsenic Act, 1851 and the prevention of secret poisoning.

In this country any chemist or druggist can furnish the means of self-destruction or murder for a few pence, and in too many instances have done so with the utmost indifference. The sale of a poison is regarded as a mere act of commercial intercourse; tant pis for the unfortunate victim of error or passion; he has the benefit of a coroner's inquest; the vendor of the poison receives a reprimand, and things resume their natural course--that is, arsenic and oxalic acid are retailed without compunction, and men are hurried from time to time into eternity.

Animals↗

Quality improvement process in the adherence to gastric decontamination guidelines for poison exposures as recommended by a poison control center.

PURPOSE: Adherence to new guidelines for the use of ipecac syrup, gastric lavage, cathartics, and activated charcoal by a poison control center was studied with a quality improvement framework. METHODS: The rates of gastric decontamination were monitored through an electronic case record system. In February 2002, a revised guideline that narrowed the use of gastric decontamination was implemented with a performance improvement process. The rates of recommendation and utilization during 12 months following implementation of the new guidelines were compared with those during 12 previous months. RESULTS: Recommendations for the use of ipecac syrup declined from 1.50% to 0.02% (OR; 95% CI = 0.02; 0.01, 0.03), single-dose-activated charcoal declined from 5.39% to 1.38% (0.25; 0.22, 0.28), gastric lavage declined from 4.19% to 0.22% (0.05; 0.04, 0.06), and a cathartic declined from 1.48% to 0.13% (0.08; 0.06, 0.12). Declines in utilization were also significant (P < .001) for all forms of gastric decontamination. The proportions of patients managed at the scene of the poisoning were unchanged (1.04; 0.99, 1.09) before (67.64%) and after (68.50%) the new guidelines as were those for referral to a health care facility (20.57% and 21.42%, respectively, 1.05; 1.00, 1.11). CONCLUSION: Recommendations on gastric decontamination can be effectively modified with no detriment to patient outcome.

Decontamination↗

Plant poisoning and oto-rhino-laryngology. Poisonous plants, growing or used in Europe and the United States.

Poisoning often affects the ear, nose, mouth and throat. Sialorrhea, stomatitis, oropharyngeal dryness, a burning sensation in the mouth, rhinitis and nasal septal perforation, hearing loss and vestibular disturbances can be the result of intoxications by poisonous plants, growing or used in Europe and the United States. This article has not the intention to be exhaustive, but to give a synopsis of this topic.

Hearing Disorders↗

Poison queries received during 1985 by the Regional Drug and Poison Information Centre, Durban.

The Regional Drug and Poison Information Centre at Addington Hospital, Durban, received a total of 3,177 requests for information on poisoning during 1985, with the highest incidence in August. The most common substances involved were prescribed medicines (895 calls, 28%) and household products (708 calls, 22%). The most frequent enquirers were hospital doctors (1,468 calls, 46%).

Acetaminophen↗

[Poisoning by anorexigenics. Information from the data bank of the Anti-Poison Center of Marseille (1973)].

Using the data bank developed by the Computer Service of the Lyon Hospitals, the Anti-Poisons Centre of Marseille presents an initial study of intoxications by appetite suppressants. The work was complemented by a simultaneous study using conventional manual techniques. An epidemiologic review of 1973 and an approximate assessment of toxic doses in the adult and child were possible. They should be of particular use in answering telephone enquiries at anti-poison centres.

Adolescent↗

Expansion of methylmercury poisoning outside of Minamata: an epidemiological study on chronic methylmercury poisoning outside of Minamata.

The first methylmercury poisoning by consumption of fish arose in Minamata, Japan, in 1953. Methylmercury dispersed from Minamata to the Shiranui Sea until 1968. Mercury concentration in the hair of residents on the coast of the Shiranui Sea was 10 to 20 times higher than that in nonpolluted people in Kumamoto Prefecture in 1960. People on the coast of the Shiranui Sea have consumed fish containing low-dose methylmercury without a ban over decades until 1968. We studied the effect of long-term consumption of methylmercury on those people 10 years later after the end of methylmercury dispersion. Our epidemiological study clarified that people in a fishing village (Ooura) on the coast of the Shiranui Sea showed a significantly higher frequency of neurological signs characteristic of methylmercury poisoning (hypoesthesia, ataxia, impairment of hearing, visual change, and dysarthria) in comparison with people in a nonpolluted fishing village (Ichiburi). The neurological disorders were still detected 10 years later in Ooura after the end of methylmercury dispersion from Minamata; hypoesthesia showed the highest frequency in Ooura. These results suggest that people on the coast of the Shiranui Sea were afected by long-term dietary exposure to methylmercury.

Adult↗

Motor nerve conduction velocity after carbon monoxide or m-dinitrobenzene poisoning following elimination of the poisons.

24 hrs after acute carbon monoxide or m-dinitrobenzene poisoning (about 60% CO-Hb or Met-Hb) the sciatic motor conduction velocity of rats is significantly reduced by 33% and 16% respectively. Whereas 48 hrs after methemoglobinemia the nerve conduction is normal, a retardation is detectable even 4 weeks following carboxyhemoglobinemia. Also, 4 weeks after single carbon monoxide intoxication producing a mean CO-Hb content of 19%, the motor conduction velocity is significantly decreased. This effect may be useful for detection of carbon monoxide intoxication after elimination of the poison. The results show that there are carbon monoxide effects independent of blockade of hemoglobin.

Animals↗

Interrelation between the Poisoning Severity Score, carboxyhaemoglobin levels and in-hospital clinical course of carbon monoxide poisoning.

The aim of the present study is to evaluate the relationship between the Poisoning Severity Score (PSS) and carboxyhaemoglobin (COHb) levels in patients with carbon monoxide poisoning (COP) using outcome as the measure. The study was designed as a retrospective chart review of patients with final diagnosis of COP. Correlation of PSS and COHb levels at presentation was evaluated with collected data. Majority of the cases were grade 1 (minor) PSS (134 cases, 73.6%) and 93.4% of these patients made a complete recovery. There were six deaths (mortality 3.3%) and six in-hospital major complications (IHMCs) (3.3%) (please specify whether the complications were in the patients who died). There is moderate correlation between PSS and outcome (p < 0.001, r = 0.493). Grade 3 (severe) PSS was significantly different from other grades for outcome (six mortalities and three IHMCs). Patients classified as grade 3 and patients who died had a significantly higher mean age (p < 0.05, 41.8 +/- 23.6 and p < 0.01, 60.1 +/- 20.3, respectively). Mean COHb level of grade 3 (33.2 +/- 13.9%) was significantly higher than that of other grades (p < 0.05). COHb levels according to outcome were not different (? within the patients in grade 3). Decreased level of consciousness, acidosis, tachycardia, high glucose and leucocyte levels showed significant relation with higher PSS, COHb level and adverse outcome. We conclude that the PSS is a reliable guide in COP. Value of the PSS in COP may be enhanced if additional factors and investigations are included.

Adult↗