Nadużywanie benzydaminy

AbstractWe described the following case of benzydamine hydrochloride oral intoxication used for recreational purpose. The female patient showed extreme excitement with visual hallucinations that persisted for about 10 hours. The benzydamine hydrochloride was used as a drug which is a cheap, easy to acquire and hard to detect. On the basis of the described case and review of the literature, practical psychiatric and toxicological aspects of acute benzydamine misuse and its complications were discussed.StreszczenieW pracy przedstawiono kolejny w Polsce przypadek zatrucia chlorowodorkiem benzydaminy zawartym w preparacie Tantum Rosa. Preparat ten był przyjmowany doustnie w celach rekreacyjnych, a motywem jego używania była chęć znalezienia środka psychoaktywnego, który byłby łatwy do zdobycia, tani i trudny do wykrycia za pomocą powszechnie dostępnych testów narkotykowych. Podobnie jak w opisywanym w 2007 roku przypadku, także i w tym wystąpiło silne pobudzenie psychoruchowe oraz pojawiły się omamy wzrokowe, które utrzymywały się przez ok. 10 godzin. Na podstawie opisanych przypadków, a także przeglądu piśmiennictwa omówiono wybrane praktyczne addyktologiczne i toksykologiczne aspekty używania benzydaminy oraz powikłania z tym związane

Poisoning deaths in Poland : types and frequencies reported in Łódź, Kraków, Sosnowiec, Gdańsk, Wrocław and Poznań during 2009-2013

Objectives: The aim of this study has been to assess the characteristics of acute poisoning deaths in Poland over a period of time 2009–2013. Material and Methods: The analysis was based on the data obtained from the patient records stored in toxicology departments in 6 cities – Łódź, Kraków, Sosnowiec, Gdańsk, Wrocław and Poznań. Toxicological analyses were routinely performed in blood and/or urine. Major toxic substances were classified to one of the following categories: pharmaceuticals, alcohol group poisonings (ethanol and other alcohols), gases, solvents, drugs of abuse, pesticides, metals, mushrooms, others. Cases were analyzed according to the following criteria: year, age and gender of analyzed patients, toxic substance category and type of poisoning. The recorded fatal poisonings were classified according to the International Classification of Diseases. Results: The record of 261 deaths were retrospectively reviewed. There were 187 males (71.64%) and 74 females (28.36%) and the male to female ratio was 2.52. Alcohol group poisonings were more frequently responsible for deaths in men compared to all poisonings, 91.1% vs. 71.6%, respectively (p < 0.05), and pharmaceutical agents were more frequently responsible for deaths in women, 47.4% vs. 28.4%, (p < 0.05). Methanol was the most common agent in the alcohol group poisonings, accounting for 43.75% (N = 49), followed by ethylene glycol, 39.29% (N = 44), and ethanol, 16.96% (N = 19). Conclusions: Epidemiological profile data from investigation of poisoning deaths in Poland may be very useful for the development of preventive programs. Int J Occup Med Environ Health 2017;30(6):897–90

Self-poisonings before and during the initial year of the COVID-19 pandemic in northern Poland

Objectives The objectives of this study included evaluating and reporting on the initial impact of the COVID-19 pandemic and preventive measures in the form of a lockdown on self-poisoning tendencies in northern Poland. Material and Methods The authors retrospectively analyzed medical records of all patients (N = 2990) admitted to the Pomeranian Center of Toxicology in 2018–2020. Of those, further analysis included 2140 patients who had been admitted because of a suicide attempt by self-poisoning. The authors also selected a group of 40 patients on the basis of a self-reported direct relationship of the suicide attempt with the COVID-19 pandemic or the imposed lockdown. Results The rates of suicide attempts in toxicological patients over the years ranged 68.18–75.3%. The patients were predominantly female, with age between M±SD 33.2±16.9 and 36.0±16.4. Each year, over 60% of patients were admitted during their first attempt and were treated psychiatrically prior to their attempt, with differences observed in the COVID-19-related group. The alcohol intoxication during the suicide attempt was confirmed in 37.40–43.53% of the patients, with a higher rate of 52.50% observed in the COVID-19-related group. The main self-reported reason for the suicide was a romantic relationship conflict or breakup, and a conflict and/or violence in the family. The most frequent agents were over-the-counter painkillers, antidepressants, antipsychotics and benzodiazepines or Z-drugs. Conclusions During the initial year of the COVID-19 pandemic, there was a fall of suicide attempts by self-poisonings in northern Poland, significant only in the case of women. The self-reported reasons were similar in all years, with mainly minor changes. There was also an increase in attempts made using benzodiazepines or Z-drugs seen in 2020 and in the COVID-19-related group. The authors believe that there is a need for multi-center, large-scale prospective studies that would provide better insight into the pandemic-related suicidal trends

Cardiogenic shock induced by a high dose of intravenous morphine

Morphine is an opiate alkaloid characterized by various clinical effects, among which the most prominent are its analgesic and psychoactive effects. It also has a prominent depressive effect on the respiratory and cardiovascular system. Because of its psychoactive effect, morphine is very addictive and often used as a recreational narcotic. As a medication, it has found its use as an analgesic agent in chronic pain treatment, in hemorrhagic shock, and in acute heart failure with pulmonary edema. Albeit, morphine use in heart failure is controversial, based on many observational studies showing the negative effect on the outcomes of the patients treated with morphine during acute cardiovascular incidents. In this report, the authors present a case of cardiogenic shock (CS) with transient left ventricular ejection fraction reduction, occurring in a patient attempting suicide using a high dose of intravenous morphine sulphate administration. Other CS causes were ruled out. To the best of the authors’ knowledge, this is the second case of a morphine-related CS reported in literature

Chemical analysis of wastewater as a new way of monitoring drugs and medicines consumption at workplace

The available information on the quality and frequency of illegal psychoactive substances used or medicines misused by workers, are often out of date at the time of its publication. This is due to the dynamic introduction of new synthetic drugs on the black market, changes in trends in the recreational use of medicines and the lack of readily available and reliable tests for fast identification. Strategy for detection of narcotic and non-medical psychoactive drugs use at workplace should embrace all possible sources of information. Classical sources of information on the use of psychoactive substances at the workplace include: statistical data (general information on trends and magnitude of drug and medicine addiction collected by the Polish National Police, the National Bureau for Drug Prevention and emergency medical services), surveys, psychomotor tests and qualitative and quantitative analyses of biological material. Of the new and promising methods, used throughout the world in recent years, chemical-toxicological analysis of surface water and wastewater deserve special mention. An increasing interest in the study of urban waste water can significantly complement the source of knowledge about drug and medicine addiction using obtainable conventional methods. In recent years, a municipal wastewater analysis has become a new and very promising way of collecting updated information on the use of psychoactive substances and medicines. It seems that this kind of study may play an important role in the ongoing monitoring of drug and/or medicines use by selected groups of population (e.g., students, military, firemen, policemen, etc.). Med Pr 2015;66(6):837–84

The characteristics and outcomes of toxin-induced massive rhabdomyolysis

ObjectivesThis study investigates common patterns in patients with exceptionally high creatine kinase (CK) levels to identify factors that could have contributed to the development of severe rhabdomyolysis in the studied cohort.Material and MethodsThe authors present a retrospective analysis of patients with massive rhabdomyolysis (measured CK activity >50 000 U/l) caused by xenobiotics. The patients were selected from a group of 7708 patients treated at the Regional Toxicological Center.ResultsThe most frequent causative agents were recreational drugs, sedatives and anti-epileptics. Six patients developed multi-organ failure, including 1 who died. Substance abuse disorder was diagnosed in 90% of the patients. Each patient had at least 1 contributory factor present (hypothermia, hyperthermia, injury, an episode of agitation, seizures, prolonged immobilization), and the median was 3 factors. Acute kidney injury was observed in 90% of the patients, and 70% needed renal replacement therapy due to acute renal failure, which meant a longer hospital stay. Creatinine concentration differences between days 2 and 1 of the presentation (Cdiff) correlated with the length of hospital stay (r = 0.73, p = 0.02). All patients with negative Cdiff values did not need dialysis. No patients experienced liver failure.ConclusionsMassive rhabdomyolysis seems to be the effect of coincidence of several factors rather than the myotoxic effect alone. A creatinine concentration difference between days 2 and 1 of hospitalization was a good prognostic factor for the need for further dialysis

Toxicological consultation data management system based on experience of Pomeranian Center of Toxicology

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 Gdańsk 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. Med Pr 2015;66(5):635–64