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Lawson C, McCabe DJ, Feldman R. A Narrative Review of Aconite Poisoning and Management. J Intensive Care Med 2024:8850666241245703. [PMID: 38613376 DOI: 10.1177/08850666241245703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Aconite poisoning refers to toxicity resulting from plants belonging to the Aconitum genus, which comprises over 350 different species of perennial flowering plants that grow in temperate mountainous areas of the northern hemisphere (North America, Europe, Asia). These plants contain a group of toxins known as aconite alkaloids, which encompass numerous closely related toxic compounds. Conventional teaching from toxicology textbooks has broadly classified these alkaloids based on their mechanism of action, often simplifying them as substances that prevent sodium channel inactivation. However, this is an oversimplified and sometimes inaccurate description, as some aconite alkaloids can act as sodium channel blockers. Aconite alkaloids have a long history of use as poisonous substances and have been historically employed for hunting, assassinations, traditional medicine, and self-inflicted harm. Toxicity can occur due to the consumption of traditional medicines derived from aconitum plants or the ingestion of aconite plants and their derivatives. The clinical manifestations of aconite poisoning may encompass gastrointestinal symptoms, sensory alterations, seizures, and life-threatening dysrhythmias that may not respond to standard treatments. Treatment is primarily supportive however evaluation and management of these patients should be personalized and carried out in collaboration with a toxicologist.
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Affiliation(s)
- Christine Lawson
- Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA
| | - Daniel J McCabe
- Division of Medical Toxicology, Department of Emergency Medicine, University of Iowa, Iowa City, IA, USA
- Iowa Poison Control Center, Sioux City, IA, USA
| | - Ryan Feldman
- Department of Pharmacy, Froedtert and the Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin, School of Pharmacy, Milwaukee, WI, USA
- Department of Emergency Medicine Division of Medical Toxicology, Medical College of Wisconsin, Milwaukee, WI, USA
- Wisconsin Poison Center, Milwaukee, WI, USA
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Tusiewicz K, Wachełko O, Zawadzki M, Szpot P. The stability of cyanide in human biological samples. A systematic review, meta-analysis and determination of cyanide (GC-QqQ-MS/MS) in an authentic casework 7 years after fatal intoxication. Toxicol Mech Methods 2024; 34:271-282. [PMID: 38014466 DOI: 10.1080/15376516.2023.2280212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023]
Abstract
A 30 year old man was found with no signs of life in front of the house. The cyanide concentration in blood and urine was determined five years after the man's death. What is more, a stability study was conducted for 730 days in an authentic casework blood sample. Sample preparation procedure included precipitation with methanol:water mixture, solid phase extraction (SPE) and derivatization with the use of PFB-Br (pentafluorobenzyl bromide). The sample was analyzed using GC-QqQ-MS/MS (gas chromatopraphy coupled with tandem mass spectrometry) isotope dilution method. Separation was done using a SH-RXI-5MS column (30 m x 0.25 mm, 0.25 µm). Detection of PFB-CN and PFB-13CN was achieved using a triple-quadrupole mass spectrometer with an electron ionization (EI) ion source in multiple reaction monitoring (MRM) mode. After 5 years from the man's death, cyanide concentration was: 1900 ng/mL in blood and 500 ng/mL in urine. Stability study performed in an authentic blood sample 6 and 7 years after the man's death revealed cyanide concentrations of 1898.2 ng/mL and 1618.7 ng/mL, respectively. While spectrophotometric and colorimetric methods recorded both decrease and increase in cyanide concentration over time, newer chromatographic methods mainly indicate a decrease. The studies presented in this paper seem to confirm this trend. However, in order to interpretate the results of cyanide concentration in biological material reliably, more research is still necessary.
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Affiliation(s)
- Kaja Tusiewicz
- Department of Forensic Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Marcin Zawadzki
- Faculty of Medicine, Department of Social Sciences and Infectious Diseases, Wroclaw University of Science and Technology, Wrocław, Poland
| | - Paweł Szpot
- Department of Forensic Medicine, Wroclaw Medical University, Wroclaw, Poland
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Tusiewicz K, Kuropka P, Workiewicz E, Wachełko O, Szpot P, Zawadzki M. Nitrites: An Old Poison or a Current Hazard? Epidemiology of Intoxications Covering the Last 100 Years and Evaluation of Analytical Methods. TOXICS 2023; 11:832. [PMID: 37888684 PMCID: PMC10611400 DOI: 10.3390/toxics11100832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023]
Abstract
In recent times, there has been a concerning and noteworthy rise in the global use of sodium nitrite for suicidal purposes. This is facilitated either through the employment of specialized "suicide kits" or by acquiring sodium nitrite through alternative means. Additionally, another occurrence contributing to nitrite poisoning is the recreational utilization of nitrites in the form of volatile aliphatic esters of nitrous acid, commonly referred to as "poppers". Based on current available papers and reports on the subject of nitrates, nitrites, and poppers intoxications, an epidemiological analysis and evaluation of analytical methods were performed. A total of 128 papers, documenting a collective count of 492 intoxication cases, were identified. Additionally, in order to complete the epidemiological profile of nitrite poisoning, the authors briefly examined six cases of nitrite intoxication that were under investigation in our laboratory. Furthermore, a review of nitrite poisoning cases over the past 100 years shows that the old poison is still in use and poses a substantial risk to society.
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Affiliation(s)
- Kaja Tusiewicz
- Department of Forensic Medicine, Wroclaw Medical University, 4 J. Mikulicza-Radeckiego Street, 50345 Wroclaw, Poland; (K.T.); (P.S.)
| | - Patryk Kuropka
- Institute of Toxicology Research, 45 Kasztanowa Street, 55093 Borowa, Poland; (P.K.); (E.W.)
| | - Elżbieta Workiewicz
- Institute of Toxicology Research, 45 Kasztanowa Street, 55093 Borowa, Poland; (P.K.); (E.W.)
| | - Olga Wachełko
- Institute of Toxicology Research, 45 Kasztanowa Street, 55093 Borowa, Poland; (P.K.); (E.W.)
| | - Paweł Szpot
- Department of Forensic Medicine, Wroclaw Medical University, 4 J. Mikulicza-Radeckiego Street, 50345 Wroclaw, Poland; (K.T.); (P.S.)
| | - Marcin Zawadzki
- Faculty of Medicine, Wroclaw University of Science and Technology, 27 Wybrzeże Wyspiańskiego Street, 50370 Wroclaw, Poland
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Tong HF, Chan CY, Ng SW, Mak TWL. Strychnine poisoning due to traditional Chinese medicine: a case series. F1000Res 2021; 10:924. [PMID: 35169461 PMCID: PMC8817065 DOI: 10.12688/f1000research.73072.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Strychnine poisoning is rare but possibly fatal. The most reported sources of strychnine poisoning include rodenticides and adulterated street heroin. Here we report a case series of an unusual cause of strychnine poisoning –
Strychnisemen, a herb known as “maqianzi” in traditional Chinese medicine (TCM). Methods: All cases of strychnine poisoning confirmed by the Hospital Authority Toxicology Reference Laboratory (HATRL, the highest-level clinical toxicology laboratory in Hong Kong) between May 2005 and May 2018 were reviewed. Results: Twelve cases of strychnine poisoning were recorded, and
Strychni semen was the exclusive source. Ten (83%) patients presented with muscle spasms, and four (33%) developed typical conscious convulsions. The poisoning was severe in two (17%) patients, moderate in three (25%) and mild in eight (58%). No case fatality was recorded. Three (25%) patients were TCM practitioners and two (17%) were laymen who bought the herb themselves without a proper prescription. Conclusion: The practice of TCM is becoming popular in different parts of the world amid the COVID-19 pandemic. The spectrum of clinical features of strychnine poisoning secondary to
Strychni semen are similar to those arising from different origins. Eliciting a history of TCM use, apart from exposure to rodenticides and drugs of abuse, may allow timely diagnosis in patients with compatible clinical features. Enhancement of TCM safety could minimize the hazard.
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Affiliation(s)
- Hok-Fung Tong
- Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Hospital Authority, Hong Kong
| | - Candace Yim Chan
- Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Hospital Authority, Hong Kong
| | - Sau-Wah Ng
- Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Hospital Authority, Hong Kong
| | - Tony Wing-Lai Mak
- Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Hospital Authority, Hong Kong
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Wachełko O, Chłopaś-Konowałek A, Zawadzki M, Szpot P. Old Poison, New Problem: Cyanide Fatal Intoxications Associated with Internet Shopping. J Anal Toxicol 2021; 46:bkab039. [PMID: 33851707 DOI: 10.1093/jat/bkab039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 11/14/2022] Open
Abstract
Widespread access to the Internet has an increasing influence on how suicides are committed. On websites such as eBay® or Amazon.com® highly toxic substances including cyanides are available for purchase. In the last 5 years, a few fatal intoxications associated with Internet shopping and buying "suicide kits" have been reported. Epidemiology of intoxications reported by American Association of Poison Control Centers between 2000-2018 shows that about 10% of all exposures to cyanide were related to suicide attempts and intentional ingestion of this substance. In order to determine the cyanide concentration in four fatal intoxication cases associated with Internet shopping, a headspace gas chromatography with dual column/dual flame ionization detector (HS-GC-FID/FID) method was validated and applied to casework. The method was linear in range, from 1 to 50 µg/mL, with a coefficient of determination of 0.999 (R2). The limit of quantification was 1.0 µg/mL; the detection limit was 0.5 µg/mL. Intra- and inter-day validation precision and accuracy did not exceed 10% and 15%, respectively. Recovery and matrix effect values ranged from 94.8- 103.8% and -5.2─3.8%, respectively. The cyanide concentrations were determined in biological fluids (blood, urine, bile, vitreous humor, gastric content) and postmortem tissue samples (spleen, kidney, liver, brain). The headspace gas chromatographic method, which is routinely used in clinical and forensic toxicology to quantify ethanol with its congeners (methanol, acetone, isopropanol, n-propanol and n-butanol), can be also applied to determine cyanide in intoxication cases. The global problem of a high number of suicides each year, requires increasing and more restrictive control of highly toxic substances available online as well as caution monitoring of human exposure to cyanide. This old and well known poison is being increasingly used nowadays for suicidal purposes, therefore determination of cyanide in biological samples is still important in terms of clinical and forensic toxicology.
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Affiliation(s)
- Olga Wachełko
- Institute of Toxicology Research, 45 Kasztanowa Street, Borowa 55093, Poland
| | | | - Marcin Zawadzki
- Department of Forensic Medicine, Wroclaw Medical University, 4 J. Mikulicza-Radeckiego Street, Wroclaw 50345, Poland
| | - Paweł Szpot
- Department of Forensic Medicine, Wroclaw Medical University, 4 J. Mikulicza-Radeckiego Street, Wroclaw 50345, Poland
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Selling poison by the bottle: Availability of dangerous substances found on eBay®. Am J Emerg Med 2019; 38:846-848. [PMID: 31862190 DOI: 10.1016/j.ajem.2019.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 11/22/2022] Open
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Leonard JB, Hines EQ, Anderson BD. Prime eligible poisons: identification of extremely hazardous substances available on Amazon.com ®. Clin Toxicol (Phila) 2019; 58:45-48. [PMID: 31035804 DOI: 10.1080/15563650.2019.1594870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Widespread use of the Internet has increased availability of numerous products. Multiple published cases highlight that toxic xenobiotics are available for purchase online. Most cases describe purchase from the deep web. We sought to identify extremely hazardous substances available from an online retailer.Methods: Over a 10-month period, the online retailer Amazon.com® was searched for each of the products listed by the Environmental Protection Agency's "List of Extremely Hazardous Substances." Product names, availability on Amazon Prime®, need for a business account, price, and quantity were collated.Results: We identified 79/340 (23.2%) of these substances were available on Amazon.com®. Almost one-third of the available substances were eligible for Amazon Prime®. Approximately one-third of the products were available in an amount that could be toxic by purchasing a single unit (31/79). Of these 31 products, only four required a business account, 18 were eligible for Amazon Prime®, and nine were neither eligible for Prime nor required a business account. Notable products include sodium azide, acrylamide, mercuric acetate, and hydrazine.Conclusions: The ease of purchase and ready availability of such highly toxic substances is concerning. Online retailers like Amazon.com® should consult with toxicologists or other qualified experts and governmental agencies to identify which products should be removed or restricted to business accounts.
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Affiliation(s)
- James B Leonard
- Maryland Poison Center, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Elizabeth Quaal Hines
- Maryland Poison Center, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Department of Pediatric Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bruce D Anderson
- Maryland Poison Center, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
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Ohtani H, Imaoka A, Akiyoshi T. [Current status of illegal trade in pharmaceutical products on Internet auction sites in Japan and responses of site administrators to such transactions]. YAKUGAKU ZASSHI 2015; 135:529-34. [PMID: 25759061 DOI: 10.1248/yakushi.14-00238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In Japan, it is illegal to sell pharmaceuticals on Internet auction sites, although a considerable number of pharmaceuticals are listed on such sites. We investigated the current situation regarding the illegal trade in pharmaceuticals on Japanese Internet auction sites and the responses of site administrators to such transactions. We searched for pharmaceuticals and "gray" items that were suspected of being pharmaceuticals on Yahoo-oku! (Yahoo! Auctions, Japan) over a 37-day period and then submitted violation reports indicating that selling pharmaceuticals is illegal or that the description of an item was insufficient. The reports were directed to the site administrators and forwarded to the sellers. One hundred and six pharmaceutical products and 34 gray items were identified during the study period. After the submission of the violation reports, only 28 of the pharmaceutical products and one of the gray items were deleted by the administrator, while 18 of the pharmaceutical products and 7 of the gray items were withdrawn by their sellers. However, 41 pharmaceuticals and 20 gray items were sold. Most of the gray items were listed using characteristic terms or abbreviations without photographic images. More than 70% of the identified pharmaceuticals had a contraindication(s) other than hypersensitivity. In conclusion, the illegal trade in pharmaceuticals on Internet auction sites remains a serious problem in Japan, and the responses of site administrators to such transactions are inadequate. The government and pharmaceutical industry may have to take measures such as providing public and administrative guidance to stop the illegal trade in pharmaceuticals on the Internet.
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Lung DD, Scott BJ, Wu AHB, Gerona RR. Prolonged ventilatory failure and flaccid quadriparesis after ingestion of poison hemlock. Muscle Nerve 2013; 48:823-7. [PMID: 23733387 DOI: 10.1002/mus.23916] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 05/13/2013] [Accepted: 05/16/2013] [Indexed: 12/17/2022]
Abstract
INTRODUCTION A 28-year-old man presented with acute flaccid paralysis and respiratory failure that persisted for 2 weeks after suicidal ingestion of unknown substances. METHODS Extensive clinical, nerve, laboratory, and neuroimaging testing excluded alternative causes of this neuromuscular syndrome. Prompted by clues provided by family members, liquid chromatography time-of-flight mass spectrometry was used to investigate for the presence of poison hemlock. RESULTS Testing of the residue in a jar used for the ingestion of a poisonous concoction confirmed the presence of the nicotinic alkaloid coniine. Analysis of patient serum suggested the presence of conhydrine. Concentrations of amitriptyline and diazepam were also found to be supratherapeutic, but only through the first few days of hospitalization. CONCLUSIONS Herein we describe a case of reversible coma, flaccid quadriparesis, and neuromuscular respiratory failure caused by intentional ingestion of poison hemlock.
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Affiliation(s)
- Derrick D Lung
- Department of Emergency Medicine, University of California, San Francisco, 1001 Potrero Avenue, Room 1E21, San Francisco, California, 94110, USA
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Montes S, Pérez-Barrón G, Rubio-Osornio M, Ríos C, Diaz-Ruíz A, Altagracia-Martínez M, Monroy-Noyola A. Additive effect of DL-penicillamine plus Prussian blue for the antidotal treatment of thallotoxicosis in rats. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2011; 32:349-355. [PMID: 22004953 DOI: 10.1016/j.etap.2011.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Revised: 06/22/2011] [Accepted: 07/06/2011] [Indexed: 05/31/2023]
Abstract
DL-penicillamine (DL-P) and Prussian blue (PB) given alone or in combination were tested as possible treatments against acute thallium toxicity. Rats were intoxicated by i.p. injection of thallium (I) acetate at LD(50) (32 mg/kg). A day later, pharmacological treatment was administered until day 4 as follows: (1) vehicles, (2) PB 50mg/kg, by oral route, twice a day, (3) DL-P 25mg/kg i.p. route, twice daily and (4) PB+DL-P. The Estimated Probability Survival (EPS) was recorded during the experiment for each treatment. DL-P alone did not show a significant effect on survival. However, when it was used in combination with PB, it increased the survival significantly (EPS=0.8, P<0.05) as compared to the control group (EPS=0.4). In a different experiment, using 16 mg/kg of Thallium I acetate, the metal levels were analyzed in blood, body organs and brain regions after treatments. DL-P given alone decreased slightly the thallium content in blood, organs and brain. Meanwhile, its administration in combination with PB diminished the thallium levels significantly (P<0.05) in the majority of tissues, at levels lower than those achieved in the PB group. Those results indicate that DL-P administered alone did not prevent the mortality nor accumulation of the metal in body tissues. Its combination with PB could be considered an alternative antidotal treatment in thallium toxicity, because this chelating agent given alone did not cause thallium redistribution to the brain. When given in combination with PB it has an additive effect in the treatment of acute thallotoxicosis.
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Affiliation(s)
- Sergio Montes
- Departamento de Neuroquímica, Instituto Nacional de Neurología y Neurocirugía, Manuel Velazco Suárez, SS, Av. Insurgentes Sur No. 3877, CP 14269, México, DF, México
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Arzalier-Daret S, du Cheyron D. Intoxication par la strychnine en 2011 : une menace toujours présente ! ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s13546-011-0293-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
The review includes 103 references on the genus Gelsemium, and comprises ethnopharmacology, morphology, phytoconstituents, pharmacological reports, clinical studies and toxicology of the prominent species of Gelsemium. Alkaloids and iridoids constitute major classes of phytoconstituents of the genus. Most popular species of the genus are the Asian G. elegans and the two North American related species, G. sempervirens and G. rankinii. Gelsemium species are categorized under medicinal as well as poisonous plants. Amongst various species, G. elegans and G. sempervirens possess medicinal value, and have been traditionally used as nervous system relaxant. These plants have been explored exhaustively for their anticancer activity. In the concluding part, the future scope of Gelsemium species has been emphasized with a view to establish their multifarious biological activities and mode of actions.
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Affiliation(s)
- V. Dutt
- Guru Gobind Singh College of Pharmacy, Yamuna Nagar, Haryana, Punjab, India
| | - S. Thakur
- S.D. College of Pharmacy, Barnala, Punjab, India
| | - V. J. Dhar
- Swift School of Pharmacy, Rajpura, Punjab, India
| | - A. Sharma
- University Institute of Pharmaceutical Science, Punjab University, Chandigarh, India
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Taylor CL, Taylor SF. Atropine autoinjector use as a suicidal gesture. J Emerg Med 2008; 34:397-400. [PMID: 17931821 DOI: 10.1016/j.jemermed.2007.05.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Revised: 11/28/2006] [Accepted: 02/11/2007] [Indexed: 05/25/2023]
Abstract
Atropine autoinjectors are used by the U.S. military as pre-hospital first-line therapy for nerve agent exposure. This case report examines the misuse of these devices in a suicide attempt. An anticholinergic toxidrome resulted from this misuse. The patient was successfully treated.
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Affiliation(s)
- Charles L Taylor
- Department of Emergency Medicine, Womack Army Medical Center, Fort Bragg, North Carolina, USA
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Wang EE, Mahajan N, Wills B, Leikin J. Successful Treatment of Potentially Fatal Heavy Metal Poisonings. J Emerg Med 2007; 32:289-94. [PMID: 17394994 DOI: 10.1016/j.jemermed.2006.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2005] [Revised: 12/09/2005] [Accepted: 07/05/2006] [Indexed: 01/17/2023]
Abstract
Pure inorganic heavy metal ingestions for suicidal intent are a rare occurrence. Most case reports on this subject focus on the serious neurological, hepatic, or renal side effects. We describe two cases of significant heavy metal poisonings (arsenic trioxide and mercuric chloride) that were successfully managed with aggressive decontamination and combined chelation therapy. Both chemicals were obtained in pure powder form through the Internet.
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Affiliation(s)
- Ernest E Wang
- Division of Emergency Medicine, Evanston Hospital, Evanston, Illinois 60201, USA
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Arachchillage DRJ, Hewapathirana N, Fernando DJS. The role of the internet in facilitating yellow oleander poisoning and in providing effective treatment. Eur J Intern Med 2007; 18:167. [PMID: 17338978 DOI: 10.1016/j.ejim.2006.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Accepted: 09/19/2006] [Indexed: 11/22/2022]
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Koschel MJ. Cyanide: An Old Enemy With Heightened Risks. J Emerg Nurs 2006. [DOI: 10.1016/j.jen.2006.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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