Teško oštećenje bubrežne funkcije u odraslih bolesnika s akutnim trovanjem octenom kiselinom

Acetic acid is a widely used organic acid with corrosive properties that depend on its concentration. If acetic acid is ingested in concentrations above 30 % it may severely damage the upper gastrointestinal tract and cause intravascular haemolysis, which can result in severe kidney and liver disorders and disseminated intravascular coagulation. In this retrospective study, we analysed acetic acid ingestion data collected at the University Clinic for Toxicology of Skopje, Macedonia from 1 January 2002 to 31 December 2011. The analysis included systemic complications, kidney damage, and the outcomes in particular. Over the ten years, 84 patients were reported at the Clinic to have ingested highly concentrated acetic acid. Twenty-eight developed kidney disorders, while the remaining 56 had no complications. Fatal outcome was reported for 11 patients, seven of whom had systemic complications and four severe gastrointestinal complications.Octena kiselina organska je kiselina s korozivnim svojstvima koja ovise o njezinoj koncentraciji. Ako se unese u koncentracijama iznad 30 %, može teško oštetiti gornji dio gastrointestinalnog sustava i izazvati intravaskularnu hemolizu, što može dovesti do teških oštećenja bubrega i jetara te do diseminirane intravaskularne koagulacije. U ovome retrospektivnom ispitivanju analizirani su slučajevi gutanja octene kiseline prikupljeni u Sveučilišnoj klinici za toksikologiju u Skopju od 1. siječnja 2002. do 31. prosinca 2011. Analize su obuhvatile sistemske komplikacije, oštećenja bubrega i ishode. Tijekom deset godina, u Kliniku su se javila 84 bolesnika zbog gutanja visokokoncentrirane octene kiseline. Njih 28 dobilo je bolest bubrega, a preostalih 56 nije imalo komplikacije. Smrtni je ishod bio zabilježen u 11 bolesnika, od kojih je sedam imalo sustavne komplikacije, a četiri teške gastrointestinalne komplikacije

Malignancy in patients with opioid use disorder A late diagnosis in patient on maintenance treatment with Buprenorphine, with lethal effect a case report

Heroin dependents might be at a higher risk of death from cancer than the general population. A 31-year-old male on maintenance treatment with Buprenorphine, came to our Clinic with paralysis of his legs. He also complained on spinal pains. He couldn’t walk and he was in forced position. The biochemical analysis showed high values of SE, LDH, globulins, CRP, D-dimer, Tu markers: beta HCG, CYFRA 21-1, presence of paraproteins. The other investigations showed enlarged lymph nodes in the abdomen and small pelvis, thrombosis of v.cava inf and right v. iliaca. The histological finding from the biopsy of the sacrum showed a metastatic process on the skeletal muscles. The patient was treated with buprenorphine, antibiotic therapy, Carbamazepine, anticoagulant therapy and other symtomatic therapy. Despite numerous investigations and treatment, bleeding and abscesses in the cerebrum occurred. The patient immediately underwent surgery and his recovery was well. He was discharged on his request, but his condition was deteriorated sharply at home and he died in a short time. There are few studies on malignant diseases found in heroin dependents. It is a challenge to monitor and also to compare the incidence of malignancy between heroin dependents and healthy population. Keywords: Buprenorphine, Heroin dependents, Lethal effect, Malignancy Thrombosi

Acute venlafaxine overdose with positive urine immunoassay for tramadol – clinical and diagnostic overlap - case report and literature overview

Objective. The overlapping of pharmacokinetics and/or the pharmacodynamics of medicines causes the occurrence of overlapping clinical syndromes and diagnostic issues, potentiated in overdoses. We report a case of severe venlafaxine poisoning where the clinical presentation and the results of rapid immunoassay test overlapped with tramadol intoxication. Case presentation. An unconscious women with recurrent seizers, hypertension and supposed acute medication poisoning in suicidal attempt was transported to our clinic. Previously, she had been lavaged, rehydrated and treated with 20 mg diazepam iv, 40 mg furosemide at the local general hospital. Her regular tablet therapy consisted of losartan, levothyroxine, venlafaxine, occasionally tramadol. At admission she was comatose, with isochoric normal pupils, BP 130/80 mm Hg, SaO2 86%, and recurrent episodes of seizures treated with 10mg diazepam iv, ocular clonus, hypertonus, temperature 38.9C, diaphoresis, facial hyperaemia, dark coloured urine, hyponatremia and rhabdomyolisis. The lateral flow immunoassay (AbuGnostR) was positive for tramadol, but the homogeneous enzyme immunoassay did not confirm it. After 36 hours of intensive treatment she became somnolent and reported ingestion of 2250 mg tbl Venlafaxine. The AbuGnost R test detects tramadol at cut off urine values 200ng/ml, but present cross reactivity with O-desmethyl-venlafaxine at cut off values up to 25000ng/ml. The following days she complained of muscular weakness, headaches and cognitive impairment, which lasted for more then one month after release from hospital. Conclusion. High concentrations of venlafaxine metabolites induce false positive tramadol immunoassay (AbuGnostR) test. Overlapping clinical presentations and metabolic pathways of venlafaxine and tramadol should alert physicians when interpret rapid immunoassay test. The mandatory principle when making medical decisions should cover synthesis of critically interpreted toxicology analysis, interview data and clinical features of the poisoning, which may help to avoid misleading conclusions and improve the diagnostic and therapy decisions

The presence of some humoral immunologic indicators and clinical manifestations in cryoglobulin positive heroin addicts without evidence of hepatitis virus infection

Introduction. Cryoglobulins are single or mixed immunoglobulins that are subject to reversible precipitation at low temperatures. Objective. The aims of this paper were: 1. Comparison of cryoglobulin positive (CP), cryoglobulin negative (CN) heroin addicts and the control group (CG) in terms of serum immunoglobulins IgG, IgA and IgM and complement components C3 and C4; 2. Comparison of CP and CN heroin addicts in terms of rheumatoid factor (RF) and circulating immune complexes (CIC); 3. Assessment of clinical manifestations in CP heroin addicts. Methods. This is a comparative study of cases (outpatients) treated at the University Clinic of Toxicology in Skopje over 3.5 years, from January 2009 to June 2012. In this study 140 heroin addicts without HbsAg were examined, seronegative for HCV and HIV infections. They were divided into 2 groups: 70 CP and 70 CN heroin addicts. A previously designed self-administered questionnaire was used as a data source on participants. All heroin addicts underwent the following analyses: urea and creatinine in serum; creatinine in urine; proteinuria; 24-hour proteinuria; IgM, IgG, IgA, C3, C4 ; RF; CIC; creatinine clearance; ECG; toxicological analyses for opioids in a urine sample; cryoglobulins. In addition to these 2 groups, IgG, IgA, IgM, C3 and C4 were also examined in 70 healthy subjects (CG). Results. The study showed that there was no statistically significant difference between CP, CN heroin addicts and CG regarding the concentration of IgA, IgG, IgM, C3 and C4, and between CP and CN regarding the concentration of CIC. There was significant difference between CP and CN regarding the concentration of RF. The following conditions were significantly more frequently manifested in CP than in CN heroin addicts: arthralgia, Raynaud’s phenomenon, respiratory difficulties, neurological disorders, manifested skin changes, hematuria, 24-hour proteinuria levels, and decreased renal clearance. Conclusion. There were no differences in concentrations of IgG, IgA, IgM, C3, C4 and CIC, while there was a difference in concentration of RF between CP and CN heroin addicts. Clinical manifestations (arthralgias, Raynaud’s phenomenon, respiratory, neurologic, renal disorders and skin changes) were more common in CP heroin addicts