ORIGINAL_ARTICLE
A Retrospective Analysis on Poison Related Mortalities in a Tertiary Care Centre in Pakistan
Background In Pakistan, most of the data on poisoning comes from scattered case series with data on poisoning mortality, and especially relating to people of lower socioeconomic status, lacking. We aim to shed some insight on the factors relating to poisoning mortality in Pakistan in an effort to appreciate the potential measures required to reduce it Methods A total of 204 cases of poisoning fatalities, occurring between May 29, 2013, and September 10, 2019, were reviewed retrospectively from the National Poison Control Centre at Karachi, Pakistan. Cases of poisoning by accident, suicide, and homicide were included and animal bites and food poisoning were excluded. Patients less than 13 years of age were excluded. Results From our deceased patient medical records, 67.2% were males and 32.8% were females. The mean age of the patients was 29.20 ± 13.04 years. Most of the deaths from poisoning were attributed to organophosphate consumption, mainly through the ingestion of rat killer (30.9%), dichlorvos based pesticide (23.5%), and insecticides (10.3%). A noteworthy number of the deceased patients were housewives (12.7%) and students (11%) and a significant association was seen between occupation and poison consumed (p=0.048). Treatment for most of the cases was non-specific. Conclusion Poisoning is a serious threat to all demographics and mortality can be attributed to substances that can be easily obtained and are widely used. This indicates a gap in safety measures and calls for tighter regulation standards.
https://apjmt.mums.ac.ir/article_16750_e6350809b5a3174a63db23ad19ec0eca.pdf
2020-09-01
85
90
10.22038/apjmt.2020.16750
Organophosphates
Atropine
Heroin
Opioids
Zohaib
Abubaker
zohaibjw@gmail.com
1
Ziauddin Medical College, Ziauddin University, Karachi, Pakistan
AUTHOR
Maheen
Nisar
maheenisar919@gmail.com
2
Ziauddin Medical College
LEAD_AUTHOR
Ahmed
Jamshed
ahmedjamshed@hotmail.com
3
Ziauddin Medical College, Ziauddin University, Karachi, Pakistan
AUTHOR
Mohammad
Abbas
mzainabbas@hotmail.com
4
Ziauddin Medical College, Ziauddin University, Karachi, Pakistan
AUTHOR
Kayhan
Hashmi
kayhan.hashmi@hotmail.com
5
Ziauddin Medical College, Ziauddin University, Karachi, Pakistan
AUTHOR
Muhammad
Arsalan
arsalanbashir2@gmail.com
6
Ziauddin Medical College, Ziauddin University, Karachi, Pakistan
AUTHOR
Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392(10159):1736-1788.
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Wang L, Wu Y, Yin P, Cheng P, Liu Y, Schwebel DC, et al. Poisoning deaths in China, 2006-2016. Bull World Health Organ 2018;96(5):314‐326A.
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GHO [Internet]. World Health Organization. World Health Organization; [cited 2020May22]. Available from: https://www.who.int/data/gho
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Khan NU, Khan UR, Feroze A, Khan SA, Ali N, Ejaz K, et al. Trends of acute poisoning: 22 years experience from a tertiary care hospital in Karachi, Pakistan. J Pak Med Assoc 2016;66(10):1237‐1242.
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9
Mehrpour O, Akbari A, Jahani F, Amirabadizadeh A, Allahyari E, Mansouriet B, et al. Epidemiological and clinical profiles of acute poisoning in patients admitted to the intensive care unit in eastern Iran (2010 to 2017). BMC Emerg Med 2018;18(1):30.
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Khan NU, Pérez-Núñez R, Shamim N, Khan U, Naseer N, Feroze A, et al. Intentional and unintentional poisoning in Pakistan: a pilot study using the Emergency Departments surveillance project. BMC Emerg Med 2015;15(2).
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Handley SA, Flanagan RJ. Drugs and other chemicals involved in fatal poisoning in England and Wales during 2000–2011. Clin Toxicol (Phila) 2014;52(1):1‐12.
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Toxic liquor kills at least 32 in Pakistan. (2016, December 27). BBC News. Retrieved from https://www.bbc.com/news/world-asia-38441113
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Bhagavathula AS, Bandari DK, Khan M, Shehab A. A systematic review and meta-analysis of the prevalence and complications of paraphenylenediamine-containing hair dye poisoning in developing countries. Indian J Pharmacol 2019;51(5):302‐315.
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Tanweer S, Saeed M, Zaidi S, Aslam W. Clinical Profile and Outcome of Paraphenylene Diamine Poisoning. J Coll Physicians Surg Pak 2018;28(5):374‐377.
22
Qureshi MA, Nadeem S, Ahmed T, Tariq F, Rehman H, Qasim AP.Aluminium Phosphide Poisoning: Clinical Profile and Outcome of Patients Admitted in a Tertiary Care Hospital. APMC 2018;12(3):191-194.
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Ghazi MA. “Wheat pill (aluminum phosphide) poisoning”; Commonly ignored dilemma. A comprehensive clinical review. Professional Med J 2013;20(6): 855-863
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Jokanović M. Medical treatment of acute poisoning with organophosphorus and carbamate pesticides. Toxicol Lett 2009;190(2):107–115.
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Kharel H, Pokhrel N B, Ghimire R, Kharel Z. (March 04, 2020) The Efficacy of Pralidoxime in the Treatment of Organophosphate Poisoning in Humans: A Systematic Review and Meta-analysis of Randomized Trials. Cureus 12(3): e7174. doi:10.7759/cureus.7174
26
Lin CC, Hung DZ, Chen HY, Hsu KH. The effectiveness of patient-tailored treatment for acute organophosphate poisoning. Biomed J. 2016;39(6):391-399. 1
27
ORIGINAL_ARTICLE
Retrospective Study of Children with Scorpion Envenomation in a Tertiary Care Center of North India
Background: Scorpion envenomation is a common public health problem worldwide and children are at greater risk of developing severe cardiac, respiratory and neurological complications. Scorpion envenomation is a preventable life-threatening medical accident. This study aims at identifying the demographic parameters, clinical features, complications, outcome and response to prazosin in scorpion envenomation of children admitted at tertiary care hospital. Material and Methods: It was a retrospective cross sectionalstudy conducted on 52 pediatrics cases admitted in department of Paediatrics, Uttar Pradesh University of Medical Science (UPUMS), Saifai from Jan 2016 to Dec 2019 with history of scorpion sting. The clinical details, investigations, treatment and prognosis of all children were evaluated based on the scorpion envenomation. Parameters were expressed as percentage. Results: Majority of children were in the age group of 1 to 6 years 34 (65.38%) with 32 (61.53%) male and belonging to rural area 44 (84.62 %) with sting at lower limb 27 (51.92%) and gap b/w sting and hospitalization was < 6 hours 28 (53.85%). Most common clinical presentation was pain 46 (88.46%) and pulmonary edema 10 (19.23%) was common complications. Majority of children had received prazosin 49 (94.23%) within 6 hours 26 (51.02 %) with 3-6 doses 24 (48.98 %). 51 (98.0%) were successfully discharged and one patient was expired. Conclusion: Scorpion envenomation in children is a significant environmental health hazard especially in rural areas. Scorpion envenomation is an acute lifethreatening emergency, and recovery from scorpion sting is hastened by administration of prazosin therapy with excellent prognosis without use of scorpion antivenom
https://apjmt.mums.ac.ir/article_16749_27cdf1d956a2b21032cd094d1bc95dd5.pdf
2020-09-01
91
96
10.22038/apjmt.2020.16749
Scorpion sting
Scorpion Envenomation
Scorpion treatment
Prazosin
Children
Rajesh
Yadav
rajeshsaifai@gmail.com
1
Department of Pediatrics, Uttar Pradesh University of Medical University (UPUMS), Saifai, UP, India.
AUTHOR
Muniba
Alim
munibaalim@gmail.com
2
Department of Pediatrics, Uttar Pradesh University of Medical University (UPUMS), Saifai, UP, India
AUTHOR
Yogendra
Yadav
dryogendra83@gmail.com
3
Uttar Pradesh University of Medical Science (UPUMS), Saifai
LEAD_AUTHOR
Dinesh
Singh
drdksingh70@yahoo.co.in
4
Department of Pediatrics, FH medical College, Firozabad, UP, India
AUTHOR
Alok
Kumar
dean@upums.ac.in
5
Department of Forensic Medicine and Toxicology, Uttar Pradesh University of Medical University (UPUMS), Saifai, UP, India
AUTHOR
Bawaskar HS, Bawaskar PH. Sting by red scorpion (Buthustamulus) in Maharashtra State, India: A clinical study. Trans Roy Soc Med Hyg 1989; 83: 858-860.
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Rajarajeswari G, Sivaprakasam S, Viswanathan J. Morbidity and mortality pattern in scorpion sting–a review of 68 cases. J Indian Med Assoc 1979; 73: 123-126.
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Mahadevan S, Choudhury P, Puri RK, Srinivasan S. Scorpion envenomation and the role of lytic cocktail in its management. Indian J Pediatr 1981; 48: 757-761.
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Biswal N, Charan MV, Betsy M, Nalini P, Srinivasan S, Mahadevan S. Management of scorpion envenomation. Paediatrics Today 1999; 2: 420-426.
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Ismail M. The scorpion envenoming syndrome. Toxicon 1995; 33: 825-828.
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Bawaskar HS, Bawaskar PH. Efficacy and safety of scorpion antivenom plus prazosin compared with prazosin alone for venomous scorpion (Mesobuthustamulus sting: randomised open label clinical trial. BMJ. 2011;341:c7136.
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Bahloul M, Chabchoub I, Chaari A, Chatara K, Jallel H, DammakH, et al. Scorpion envenomation among children: clinical manifestations and outcome (analysis of 685 cases). Am J Trop Med Hyg 2010;83:1984- 1092.
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Bawaskar HS, Bawaskar PH. Prazosin in the management of cardiovascular manifestations of scorpion sting. Lancet 1986; 1: 510-511.
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Abroug F, ElAtrous S, Nouira S, Haguiga H, Touzi N, Bouchoucha S. Serotherapy in scorpion envenomation: a randomised controlled trial. Lancet 1999; 354: 906-909.
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Clark RF. Scorpion Envenomation. In: Clinical Toxicology. Ford MD, Delaney KA, Ling LJ, Erickson J, edt., 1stEdn,. W.B. Saunders company; Pennsylvania: 2004,p.290-93.
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Bawaskar HS, Bawaskar PH. Indian Red Scorpion Envenoming. Indian J Pediatr 1998; 65:383-91
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Mahadevan S. Scorpion Sting. Indian Pediatr 2000; 37:504-14.
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Subrahmanyam GVS, Varahala AM, Chandraiah D, Amrutha PR. Clinical profile of envenomation in children with reference to scorpion sting. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS). 2016;15(1):38-43.
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Jagannathan H, Ramamoorthy K, Naaraayan SA. Clinical profile and outcome of scorpion sting envenomation in children admitted in a tertiary care hospital. J. Evolution Med. Dent. Sci. 2016;5(57):3941-3945
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Shoreit AH, Eltayeb AA, Ali SS. Role of prazosin in management of scorpion sting in Paediatrics: a comparative study. J curr Med Res Pract 2019:4:174-9.
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Singhal A, Mannan R, Rampal U. Epidemiology, Clinical Presentation and Final Outcome of Patients with Scorpion Bite. J Clinc. Diagn Res. 2009 June; 3(3):1523-28.
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Bosnak M, Levent Yi lmaz H, Ece A, Yildizdas D, Yolbas I, Kocamaz H, et al. Severe scorpion envenomation in children: Management in pediatric intensive care unit. Hum Exp Toxicol2009;28:721-8.
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Bharath RV, Kumar MR, Subrahmanyam BV, Rammohan P, Agrawal A. Scorpion envenomation in children and its management. Arch Med Health Sci 2014;2:131-5.
20
Rajarajeshwari G, Sivapraksam S, Vishwanathan J. Morbidity and Mortality pattern in Scorpion Stings. J.Indian Med Assoc1979;73(7&8):123-126.
21
Amaral CF, Barbosa AJ, Leite VH, Tafuri WL, de Rezende NA. Scorpion sting-induced pulmonary oedema: evidence of increased alveolocapillary membrane permeability. Toxicon 1994; 32: 999–1003.
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Abroug F, Ayari M, Nouira S, Gamra H, Boujdaria R, Elatrous S et al, Assessment of left ventricular function in severe scorpion envenomation in a combined haemodynamic and echo Doppler study. Int Care Med 1995; 21: 629–635.
23
Hedayat, B., Rahmani, A., Matinrad, M., Nazari, P. The Epidemiologic and Clinical Study on Hemiscorpius Lepturus (Gadim) Envenomation with Focus on Clinical Manifestations, Prognosis Factors, and Outcomes. Asia Pacific Journal of Medical Toxicology, 2018; 7(4): 96-99. doi: 10.22038/apjmt.2018.11982
24
Alsawafi, F., Alhinai, H., Alhattali, B., Awad, S., Alreesi, A., Alshamsi, M. Demyelinating Polyneuropathy Following Scorpion Sting Envenomation; a Case Report and Review of Literature. Asia Pacific Journal of Medical Toxicology, 2015; 4(4): 161-164. doi: 10.22038/apjmt.2015.6259
25
Saminathan D, Thangavel A, Balaji K, Harshitha C. Mouli. Clinical profile and outcome of scorpion sting in children between 1-12 years of age admitted in a tertiary care hospital. Journal of Evolution of Medical and Dental Sciences 2015;4(44):7597-603.
26
Bawaskar HS, Bawaskar PH. Prazosin therapy and scorpion envenomation. J Assoc Physicians India 2000; 48: 1175–1180.
27
Pol R, Vanaki R, Pol M. The clinical profile and the efficacy of prazosin in scorpion sting envenomation in children of north Karnataka (India). Journal of Clinical and Diagnostic Research 2011;5(3):456-8.
28
BencheikhSR ,Idrissi M , Tamim O , Semlali I, Mokhtari A, Tayebi M, et al. Scorpion stings in one province of Morocco: epidemiological, clinical and prognosis aspects. J Venom Anim Toxins inclTropDis. 2007;13(2):462-7.
29
Ganesh J, Kumaravel KS. A study on the clinical profile of scorpion envenomation in children. Int J ContempPediatr2016;3:125-8.
30
Balaji J, Punitha P, Sasikala K,BabuBR,KumaravelKS.Evaluation of prazosin therapy at primary health care level and clinical profile and outcome of scorpion envenomation in a rural medical college. Stanley Medical Journal 2017; 4(1): 83-88.
31
ORIGINAL_ARTICLE
Epidemiologic Characteristics and Outcomes of Drugs Poisoning in the Hamadan, Iran: (2015-2019))
Background: Drug abuse is a global problem in most countries and poisoning caused by them has involved the emergency department (ED). This paper aims to investigate the changes in the epidemiological pattern of poisoned cases due to drugs in Hamadan province of Iran.Methods: In this five year cross - sectional study, we assessed the epidemiologic pattern of poisoned cases due to drugs hospitalized in Farshchian - Sina Hospital of Hamadan, west Iran from March 2015 to March 2019.Results: During this period, 7199 poisoned patients referred to hospital and 1773 of them hospitalized due to any kind of drugs.81% were male and 19% were female (p <0.001). The mean age in male cases was 40.85 ± 16.85 and in female cases was 42.37 ± 18.36. 86.4% of the cases lived in urban areas and 13.6% of them lived in rural areas. The most common drugs were opium (33%), methadone (22.7%) and methamphetamine (20.9%). In 35.1% male cases and in 45.8% female cases the most common drugs were opium and methamphetamine, respectively (p <0.001). In 79.2% of cases, overdose and in 20.5% of them, suicide attempt was the most common causes of use. Most cases were alive and only 1.7% were deceased.Conclusions: Although, poisoning by traditional drugs was still the most common cause of poisoning at the time of the study in this province, poisoning by synthetic drugs are on the rise.
https://apjmt.mums.ac.ir/article_16752_d34b0567bb783799ba622269a43ed01d.pdf
2020-09-01
97
103
10.22038/apjmt.2020.16752
Drugs
Poisoning
Epidemiology
Traditional Drugs
Synthetic Drugs
Saeed
Afzali
afzali691@yahoo.com
1
Department of Forensic Medicine and Toxicology, School of Medicine, Hamadan University of Medical Sciences
LEAD_AUTHOR
Abass
Moradi
a.moradi@umsha.ac.ir
2
Member, Department of Community Medicine, School of Medicine, Hamadan University of Medical Sciences
AUTHOR
Hasti
Alinaghizadeh
sidino901@gmail.com
3
School of Medicine, Hamadan University of Medical Sciences
AUTHOR
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3-Raesi -Vanani A, Rahmani AH, Parsa -Payam S. An investigation of the clinical signs, and frequency of street drug poisoning in patients referred to Razi Hospital of Ahvaz city, 2008-2013. APJMT2019; 8:56-60. DOI: 10.22038/APJMT.2019.13431.
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18
ORIGINAL_ARTICLE
Prevalence of symptoms in patients poisoned with iron in Ahvaz Razi Hospital in 2014-2017
Background: Iron is an important element for normal cell metabolism, but in excess amounts is quite cytotoxic, and even deadly. Iron poisoning is a calamity repeated many times in the world. The clinical signs of the patients include gastrointestinal symptoms, a short period of relative stability, Cardiogenic shock, liver failure, and scarring of the gastrointestinal tract. Iron tablets are specifically tempting to children because they are similar to candy. Iron overdose in adults is usually to attempt suicide. Methods: The present study is a descriptive-analytic study based on hospital information, that was conducted among the patients affected with iron poisoning admitted to Razi hospital (a referral medical setting for poisoning treatment in southwest Iran) during 2014-2017. Patient information has been extracted and inserted in the inquiry form and data were analyzed by SPSS software. Results: In this study, 52 patients (94.2% female) were studied. 5 (9.6%) of women were pregnant. The majority of them (69.2%) were between 15-25 years of age. Nausea and vomiting (50%) are two of the most common side effects. 5 patients (9.6%) received deferoxamine. All Patients who received deferoxamine, symptoms had less than 6 hours of onset. Most patients were hospitalized between 6-24 hours. 25% of patients took vitamins simultaneously with iron. The Serum level of iron in 3 patients (5.8%) was above 300 µg/dL. Based on this research, mortality was reported in one patient. Conclusion: In this study, the prevalence of iron poisoning was examined based on demographic and clinical characteristics. Considering the most prevalent iron poisoning in the young age group (96.2% suicides), more research in the psychological and social problems is critical for preventative behaviors.
https://apjmt.mums.ac.ir/article_16751_b7ed95eafedb882181c1a6ce965e7173.pdf
2020-09-01
102
111
10.22038/apjmt.2020.16751
Poisoning
Iron
Deferoxamine
Ali hassan
Rahmani
alir884@yahoo.com
1
Department of Clinical Toxicology, Razi Hospital, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
LEAD_AUTHOR
Shahrzad
Molavinia
shahrzadmolavinia@gmail.com
2
Department of Pharmacology and Toxicology, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
AUTHOR
Fatemeh
Boustani
f.boustani67@gmail.com
3
School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
AUTHOR
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6. Yuen H-W, Becker W. Iron Toxicity. In: StatPearls [Internet]. StatPearls Publishing; 2019.
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24
ORIGINAL_ARTICLE
Clinical and Forensic Toxicological Aspects of Synthetic Cannabinoids: A Review and Update
Abstract
Background: Synthetic cannabinoids (SCs) are highly abused of New Psychoactive Substances (NPS). SCs has known under street names such as “Spice”, “herbal incense” and “K2”, act as endocannabinoids (CB) receptor full agonists and have unpredictable toxicity and abuse potential. This narrative review was conducted to update the present evidence about the clinical and forensic toxicological aspects of SCs.
Methods: PubMed, Scopus and Google Scholar databases from 2015 to 2020 (up to 1st May) were searched using the terms “synthetic cannabinoids”, “synthetic cannabimimetics”, “ K2”, “Spice”, “clinical toxicology”, “forensic toxicology”, “poisoning”, “toxicity”, “abuse” , “addiction “analysis” and “determination” to identify the relevant articles. In addition, a manual search of reference lists of the retrieved articles was conducted.
Results: ADB-FUBINACA , XRL-11, 5F-ADB, 5F-PB-22, MDMB-CHMICA and MMB-2201 are the commonly reported SCs analogues among acute toxicities and fatalities cases. Adverse reactions and toxic effects of SCs includes psychoneurological, cardiovascular, renal and gastrointestinal involvements. Deaths related to SCs have been reported due to stroke and cardiac dysrhythmia. Analysis of SCs in biological samples in the clinical and postmortem setting needs sophisticated analytical instruments. Liquid gas chromatography tandem mass spectrometry (LC-MS/MS) has a crucial role for detection of SCs and their metabolites in biological samples. Conclusion: Unlike natural cannabinoids, the SCs abuse/poisoning has serious and life-threatening effects in abuser. Also, analysis of SCs is not included in the routine forensic urine drug testing. Therefore, suitable measures of informing the public and health care professionals for prevention of SCs abuse are recommended.
https://apjmt.mums.ac.ir/article_16748_a96f0c8b52058544c7573a49e198347b.pdf
2020-09-01
108
118
10.22038/apjmt.2020.16748
Cannabinoids
synthetic cannabinoids
Spice, Forensic toxicology
Kambiz
Soltaninejad
kamsoltaninejad@gmail.com
1
Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
LEAD_AUTHOR
1. Yeruva RR, Mekala HM, Sidhu M, Lippmann S. Synthetic cannabinoids-"spice" can induce a psychosis: A brief review. Innov Clin Neurosci 2019;16(1-2):31-2.
1
2. Basavarajappa BS, Subbanna S. Potential mechanisms underlying the deleterious effects of synthetic cannabinoids found in spice/K2 products. Brain Sci 2019;9(1): pii: E14. doi: 10.3390/brainsci9010014
2
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Am J Drug Alcohol Abuse 2016; 42(5):520-29. 76. Klavž J, Gorenjak M, Marinšek M. Suicide attempt with a mix of synthetic cannabinoids and synthetic cathinones: Case report of non-fatal intoxication with AB-CHMINACA, AB-FUBINACA, alpha-PHP, alpha-PVP and 4-CMC. Forensic Sci Int 2016;265:121-4 77. Sherpa D, Paudel BM, Subedi BH, Chow RD.Synthetic cannabinoids: the multi-organ failure and metabolic derangements associated with getting high. Community Hosp Intern Med Perspect 2015;5(4):27540. 78. Arntson A, Ofsa B, Lancaster D, Simon JR, McMullin M, Logan B.Validation of a novel immunoassay forthe detection of synthetic cannabinoids and metabolites in urine
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ORIGINAL_ARTICLE
Venlafaxine poisoning-induced severe hypoglycemia in a non-diabetic patient: a case report
Abstract Introduction: Venlafaxine is a serotonin and norepinephrine reuptake inhibitor (SNRI) used to treat major depressive episodes and anxiety. The risk of hypoglycemia is mentioned in the Summary of Product Characteristics (SmPC) of venlafaxine in the “warnings and precautions” section in diabetic patients. This effect appears neither in the “adverse reactions” nor in the “overdose” section. We herein report a case of severe hypoglycemia with coma in relation to venlafaxine poisoning. Case Report: A 35-year-old non-diabetic obese woman (BMI, 29 kg/m2) was found unconscious a few hours after ingesting venlafaxine and bromazepam in a suicide attempt. Vital signs on day 1 were as follows: Glasgow Coma score of 7, blood pressure of 99/66 mmHg and heart rate of 100/min. Electrocardiogram showed no abnormality. She was admitted to the intensive care unit. Due to sustained hypoglycemia [0.5 g/L (day1); 0.41 g/L (day2); 0.8 to 1.20 (day3)], she received continuous intravenous 10% glucose infusion for 3 days to normalize blood glucose. Plasma venlafaxine concentration was 11.7 times the upper the limit of therapeutic dose range (UTDR) on day 2 and reached the therapeutic dose range (TDR) on day 6. Plasma bromazepam concentration was 6.7 times UTDR on day 3 and reached TDR on day 8. Alternative etiologies of hypoglycemia were excluded, i.e. hypoglycemic sulfonamide, insulin poisoning, insulinoma, and disease of the adrenal gland, liver and thyroid. She was transferred to a psychiatric unit after one week. Discussion: Impairment of blood glucose homeostasis is rarely described with venlafaxine. In our patient, hypoglycemia appeared to be correlated with plasma venlafaxine concentrations and may be explained by increased insulin sensitivity, considering her obesity. Conclusion: Healthcare professionals should be aware of hypoglycemia induced by venlafaxine or other SNRIs in non-diabetic patients.
https://apjmt.mums.ac.ir/article_16753_bd6fd3877544999fbc86fa82d7bd2ca7.pdf
2020-09-01
119
122
10.22038/apjmt.2020.16753
Venlafaxine
Poisoning
hypoglycemia
Antidepressant
Serotonin
Thomas
Schiestel
thomas_schiestel@hotmail.fr
1
Regional Pharmacovigilance Center, Fernand-Widal Hospital, APHP, 200 rue du Faubourg Saint-Denis, 75475 Cedex 10, Paris, France
LEAD_AUTHOR
1.Erenmemisoglu A, Ozdogan UK, Saraymen R, Tutus A. Effect of Some Antidepressants on Glycaemia and Insulin Levels of Normoglycaemic and Alloxan-induced Hyperglycaemic Mice. J. Pharm. Pharmacol. 1999, 51: 741-743.
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2. Gomez R, Huber J, Tombini G, Barros HMT. Acute effect of different antidepressants on glycemia in diabetic and non-diabetic rats. Brazillian Journal of Medical and Biological Research (2001) 34: 57-64.
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3. Khoza S, Barner JC. Glucose dysregulation associated with antidepressant agents: an analysis of 17 published case reports. Int J Clin Pharm. 2011 Jun;33(3):484-92. 4. Biagetti B, Corcoy R. Hypoglycemia associated with fluoxetine treatment in a patient with type 1 diabetes. World J Clin Cases. 2013 Aug 16;1(5):169-71.
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5. Deeg MA, Lipkin EW. Hypoglycemia associated with the use of fluoxetine. West J Med 1996; 164:262-263.
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6. Fernández Lópeza MI, Sánchez Esteban J, Jímenez Belló J, Meseguer Zaragoza A. Suggestive episodes of hypoglycemia related to fluoxetine. Aten Primaria. 1996 Dec;18(10):581.
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7. Sawka AM, Burgart V, Zimmerman D. Loss of hypoglycemia awareness in an adolescent with type 1 diabetes mellitus during treatment with fluoxetine hydrochloride. J Pediatr. 2000 Mar;136(3):394-6.
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13. Meertens JH, Monteban-Kooistra WE, Ligtenberg JJ, Tulleken JE, Zijlstra JG. Severe hypoglycemia following venlafaxine intoxication: a case report. J Clin Psychopharmacol. 2007 Aug;27(4):414-5. 14. Yamada J, Sugimoto Y, Kimura I, Takeuchi N, Horisaka K. Serotonin-induced hypoglycemia and increased serum insulin levels in mice. Life Sci. 1989;45(20):1931-6.
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15. Stapel B, Gorinski N, Gmahl N, Rhein M, Preuss V, Hilfiker-Kleiner D, et al. Fluoxetine induces glucose uptake and modifies glucose transporter palmitoylation in human peripheral blood mononuclear cells. Expert Opin Ther Targets. 2019 Oct;23(10):883-891.
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16. Odonkor CA, Chhatre A. What's Tramadol Got to Do with It? A Case Report of Rebound Hypoglycemia, a Reappraisal and Review of Potential Mechanisms. Pain Physician. 2016 Nov-Dec;19(8):E1215-E1220.
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17. Senthilkumaran S, Ananth C, Menezes RG, Thirumalaikolundusubramanian P. Tramadol-induced hypoglycemia: An unusual adverse effect. J Anaesthesiol Clin Pharmacol. 2017 Oct-Dec;33(4):554-555. 18. Bourne C, Gouraud A, Daveluy A, Grandvuillemin A, Auriche P, Descotes J, Vial T; French Association of Regional Pharmacovigilance Centres. Tramadol and hypoglycaemia: comparison with other step 2 analgesic drugs. Br J Clin Pharmacol. 2013 Apr;75(4):1063-7. 19. Cheng JT, Liu IM, Chi TC, Tzeng TF, Lu FH, Chang CJ. Plasma glucose-lowering effect of tramadol in streptozotocin-induced diabetic rats. Diabetes. 2001 Dec;50(12):2815-21.
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20. Olguner EkerÖ, Özsoy S, Eker B, Doğan H. Metabolic Effects of Antidepressant Treatment. Noro Psikiyatr Ars. 2017 Mar;54(1):49-56.
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21. Schiemsky T, Vundelinckx G, Croes K, Penders J, Desmet K, Pauwels S, et al. An unconscious man with profound drug-induced hypoglycaemia. Biochem Med (Zagreb). 2020 Feb 15;30(1):010802.
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22. Stahl SM, Grady MM, Moret C, Briley M. SNRIs: their pharmacology, clinical efficacy, and tolerability in comparison with other classes of antidepressants. CNS Spectr. 2005 Sep;10(9):732-47.
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24. Holstein A, Beil W. Oral antidiabetic drug metabolism: pharmacogenomics and drug interactions. Expert Opin Drug Metab Toxicol. 2009 Mar;5(3):225-41.
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ORIGINAL_ARTICLE
A Fatal Case of Suicide Fruit Ingestion in Singapore by Cerbera Cardiac Glycoside Intoxication: Case Report and Review of Literature
Case Presentation: We present a case of Cerbera fruit ingestion which highlight the knowledge gap in unusual glycoside poisoning. Despite the patient’s asymptomatic presentation, life threatening clinical features such as hyperkalaemia, hypotension and arrhythmia occurred later. Treatments instituted were activated charcoal (AC), atropine, hyperkalaemia management, Digoxin Fab and intravenous lipid emulsion (ILE). Advanced Cardiac Life Support (ACLS) was instituted with automated chest compression device. The patient died despite prolonged of resuscitation effort. Cerbera glycoside toxicity warrants serious consideration in view of rare presentation and unpredictable nature of toxicology. Discussion: We highlight the prevalence of Cerbera species in Asia-Pacific and present the similarities of cardiac glycosides pharmacology. Early recognition of ingestion and cardiac monitoring are particularly important. In this case, we highlight the diagnostic and prognostic challenge as patient deteriorated despite normal serum digoxin level. As the evidence of Cerbera glycoside poisoning treatment options is lacking, we take this opportunity to examine treatment options assuming similar pharmacology among cardiac glycoside family. We argue for a case for use of Digoxin Fab which is the prevailing treatment for glycoside poisoning. Multi-dose-activated charcoal (MDAC) and ILE are postulated to have physiological basis given current evidence. Electrical and pharmacology treatment for arrhythmia were explored as there is limited evidence. We propose ECMO should always be considered for cardiac toxicity in anticipation of treatment failure as the novel therapy has shown great promise. Conclusion: Cerbera glycoside poisoning should be treated with utmost caution as the fruit is easily accessible and highly toxic. Close cardiac monitoring is a must due to high mortality risk. Digoxin Fab should be instituted as guided by toxicologist. Patients should be transferred to ECMO centre for observation in all cases due to the unpredictable nature of toxin. Further investigation of treatment is awaited.
https://apjmt.mums.ac.ir/article_16754_e18f3b88c7b06abbf2ce20d5bab31a3e.pdf
2020-09-01
123
128
10.22038/apjmt.2020.16754
Cardiac glycoside
Apocynaceae
Forensic Toxicology
extracorporeal membrane oxygenation
Yee Shay
Lee
lee.yeeshay@gmail.com
1
Juronghealth Campus - Ng Teng Fong General Hospital, National University Health System
LEAD_AUTHOR
Deepak
Ghimiray
deepak.ghimiray@mohh.com.sg
2
Department of Intensive Care Medicine, Ng Teng Fong General Hospital, National University Health System, Singapore
AUTHOR
To Hang
Lui
tohang.lui@mohh.com.sg
3
Department of Intensive Care Medicine, Juronghealth Campus, National University Health System, Singapore.
AUTHOR
Yi Ju
Yao
yao_yi_ju@hsa.gov.sg
4
Division Director, Analytical Toxicology Division, Applied Science Group, Health Sciences Authority (HSA) Singapore
AUTHOR
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