Fulminant hepatic failure in woman with iron and non-steroidal anti-inflammatory drug intoxication

A 17-year-old, previously healthy female ingested 16,000 mg iron sulphate (96.15 mg of iron ions per kg of b.wt.) with a suicidal intent. The patient was admitted to a toxicology unit 10 hours after the drug ingestion. Serum iron concentration at admission was 2351 μg% (421.0 μmol/L). In the course of the intoxication, hemorrhagic gastritis, renal insufficiency and increasing signs of fulminant hepatic failure complicated with coagulopathy and encephalopathy were observed. Treatment with deferoxamine was started immediately after admission to the hospital and continued for 15 hours until the serum concentration of iron decreased to 145 μg% (25.9 μmol/L). Patient was qualified for liver transplant, therefore albumin dialysis as a bridge to liver transplantation was performed. In spite of two procedures of albumin dialysis using the Prometheus system, deep coma, shock and respiratory insufficiency developed. The patient died 80 hours after iron ingestion. In the presented case, the ingestion of a very high dose of iron and late introduction of deferoxamine treatment contributed to fulminant liver failure and fatal outcome of the intoxication. </jats:p

Fatal intoxication with hydrocarbons in deltamethrin preparation

Pyrethroid insecticides are very widely used in agriculture and household due to high effectiveness and low toxicity to humans. We have described a case of a fatal oral intoxication with decis, the insecticide containing pyrethroid (deltamethrin) in a hydrocarbon base. Pyrethroids, including deltamethrin, undergo rapid biotransformation by liver enzymes, which limit their systemic toxicity. Thus, we assume that in the presented case, fatal outcome of poisoning with decis was rather connected with toxic effects of hydrocarbon base (solvent naphtha) than with deltamethrin action. In the described case, detection of aromatic hydrocarbons in blood and lung tissue and their metabolites in urine confirms that these substances were absorbed from gastrointestinal tract to the systemic circulation. Predominant among the clinical outcomes in our patient was profound depression of CNS with apnea, which could be connected with narcotic action of organic solvents. The cardiac arrest was in mechanism of asystolia with prior non-responsive to catecholamines bradycardia and vascular collapse. We connect it with hydrocarbon-induced cardiotoxicity. It is worth remembering that many pyrethroid-containing insecticides are formulated in a hydrocarbon base. Intoxication with such preparations should always be considered not only as poisoning with pyrethroid alone but also as intoxication with hydrocarbons. </jats:p