Methadone toxicity

Cette étude permet d'étudier la toxicité de la méthadone (les ingestions accidentelles pédiatriques, les mésusages,les conduites suicidaires et les symptômes reportés chez des patients traités) à l'aide des bases de données des Centres antipoisons et également de l'étude Méthaville. Elle permet de souligner la gravité des intoxications pédiatriques à la méthadone, et de confirmer que la forme gélule ne paraît pas entraîner plus de risque que la forme sirop, qui est commercialisée depuis 1995. Nous avons pu également retrouver de nombreuses différences significatives entre les 2 types d’exposition à la méthadone permettant de définir des profils de patients bien distincts. L'étude des symptômes rapportés par les patients traités par méthadone nous permet d'identifier des facteurs de risques à prendre en compte pour une meilleure prise en charge globale.This study investigates the toxicity of methadone (accidental pediatric ingestions, misuses, suicidal behaviours and reported symptoms in treated patients) using Poison Center databases and also the Methaville study. It highlights the severityof pediatric methadone poisoning, and confirms that the capsule form does not appear more dangerous than the syrup form, which exists since 1995 in France. We also found many significant differences between the 2 types of methadone exposure to define distinct patient profiles. The study of symptoms reported by patients treated with methadone allows us to identify risk factors to consider for a better medical management

Comorbidities and the right dose: antipsychotics

Introduction: The effects of antipsychotic drugs are dose-dependent, which is particularly true for their efficacy, each antipsychotic having a specific dose-response curve. This may justify individualizing doses for these agents. Areas covered: We review the pharmacokinetic profiles of seven oral antipsychotics: haloperidol, risperidone, olanzapine, clozapine, quetiapine, ziprasidone, and aripiprazole. Their main indications are psychotic and affective disorders. They are prescribed in a very large population which may have comorbidities. Hence, we analyze the impact of the latter on the pharmacokinetic profiles of these antipsychotics, focusing on renal and hepatic impairment. Reviews and clinical trials were discussed based on a systematic literature search (PubMed) ranging from 1995 to 2022. Expert opinion: Factors liable to impact antipsychotic dosage are numerous and their subsequent effects often hard to predict, due to multilevel interactions and compensatory phenomena. In clinical practice, physicians must be aware of these potential effects, but base their decisions on monitoring antipsychotic plasma levels

Toxicological considerations in the prescription of baclofen for the treatment of substance use disorders

International audienceIntroduction: For many years, applications for baclofen have widened in the treatment of substance abuse disorder (SUD), mainly alcohol use disorder, with a growing rate of off-label prescriptions in Europe. Clinical effects seem to be both a decrease of craving and anxiety, leading to a decrease of drug or alcohol consumption. We described baclofen poisoning circumstances, therapeutic options and outcomes when used in substance use disorders. Areas covered: This review summarizes the toxicological considerations where baclofen was prescribed in humans for substance use or abuse disorder in randomized clinical trials, case series, case reports and observational studies between 1990 and 2020 according to the Preferred Reporting Items for Systemic reviews and Meta-Analysis. Expert opinion: The most frequent cause of severe intoxication is self-poisoning. A dose above 180 mg are expected to cause severe toxicity and death. The treatment is only symptomatic as no antidote is available. Off-label prescription remains unsafe because the optimal dose is not known and varies greatly between patients. As SUD are frequently associated with psychiatric disorders and such patients may have suicidal thoughts, the risk of self-poisoning is high. Potential co-ingestants should also be considered, especially CNS depressants, and they need to be closely monitored

Cerebellar syndrome associated with ingestion of Mediterranean Microcosmus : a French case series

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Envenomation by caterpillars of the genus Megalopyge in French Guiana with an atypical clinical presentation, based on three observations

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Hypervitaminosis A Following the Ingestion of Fish Liver: Report on 3 Cases from the Poison Control Center in Marseille

International audienceIn European countries, vitamin A toxicity is most often the result of an excessive intake of vitamin supplements and rarely the consequence of the ingestion of a large carnivorous fish liver. We report 3 cases of vitamin A poisoning after fish liver ingestion in mainland and overseas France. The patients were a 12-y-old girl, a 36-y-old pregnant woman, and a 62-y-old man. They experienced headache, nausea, emesis, and desquamation. Laboratory examination showed a high serum retinol level in the girl. The woman's pregnancy progressed to a miscarriage. This case series shows that this kind of poisoning is not restricted to the polar regions. In patients presenting with flushing combined with signs of intracranial hypertension, accurate questioning of the patient's diet is crucial to avoid misdiagnosis and unnecessary examinations. Pregnant women or women of child-bearing age should be informed of the risk to pregnancy in the case of excessive fish liver ingestion

Intoxication par la noix de muscade : revue rétrospective du Centre Antipoison de Marseille en dix ans (2008–2018)

International audienceNutmeg is a frequently used spice all over the world since centuries. It is the seed of a tree (Myristica fragrans, Family Myristicaceae) which can grow 10 to 20 meters high, and was discovered by the Portuguese in 1512 [1]. It is used grated in small quantities to season many dishes (meat, soup, cocktails etc.). When ingested in large quantities, it has been reported to have toxic effects such as tachycardia, nausea, vomiting, agitation, hallucinations and more generally anticholinergic symptom

Intoxication par palytoxines après manipulation de Zoanthides d’aquarium : à propos de 3 cas survenus en France

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A rarely described use of neostigmine in a case of acute anticholinergic poisoning

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Unusual Sting by a Nonindigenous Caterpillar in Europe.

On the French island of Corsica, a 57-y-old woman without significant medical history was stung on the left thumb while she was taking care of an ornamental Ficus benjamina plant. Immediately, she felt intense pain in her hand. She saw a strange caterpillar, later identified by the local poison center as Acharia stimulea. The pain in her hand was evaluated as 8 of 10 using the numerical pain rating scale; only a slight erythema was visible on her skin. Symptoms disappeared within 2 h with use of local anti-inflammatory ointment and oral painkillers. Three other caterpillars emerged out of the soil of the potted plant during the following week. This sting by a saddleback caterpillar is exceptional in Corsica. French garden store owners and healthcare professionals should be informed that caterpillars can be imported across the oceans to Europe on different plants