Intoxication due to Papaver rhoeas (Corn Poppy): Five Case Reports

Introduction. In this paper, we aimed to present five Papaver rhoeas intoxication cases, which is very rare in the literature. Case 1. A 35-year-old female patient was admitted to our emergency room with the complaints of nausea, restlessness, and dyspnea developing 3 hours after eating Papaver rhoeas. On physical examination, her general condition was moderate; she was conscious and the vital findings were normal. The pupils were myotic. She was transferred to the toxicology intensive care unit as she experienced a generalized tonic clonic seizure lasting for three minutes. Case 2. A 41-year-old female patient was brought to our emergency room by 112 ambulance as she had contractions in her arms and legs, unconsciousness, and foam coming from her mouth two hours after Papaver rhoeas ingestion. On physical examination, she was confused, the pupils were myotic, and she was tachycardic. Arterial blood gases analysis revealed lactic acidosis. Case 3. A 38-year-old female patient was admitted to our emergency room with complaints of nausea and vomiting two hours after ingestion of Papaver rhoeas. Her physical examination and tests were normal. Case 4. A 34-year-old male patient was admitted to our emergency room with complaints of numbness and loss of power in his arms and legs one hour after Papaver rhoeas ingestion. He was hospitalized at the toxicology intensive care unit for follow-up and treatment. Dyspnea and bradycardia developed on the follow-up. The oxygen saturation without oxygen support was 90%. ECG revealed sinus bradycardia. The cardiac enzymes did not increase. Case 5. A 42-year-old female patient was brought to our emergency room by 112 ambulance with contractions in her arms and legs and unconsciousness two hours after Papaver rhoeas ingestion. On her physical examination, she was confused and the pupils were myotic. Arterial blood gases analysis revealed lactic acidosis. Conclusion. All patients were followed up for a few days and then discharged from the hospital with recovery. Unconscious consumption of Papaver rhoeas leads to a clinical condition resembling morphine intoxication, CNS depression, and epileptic seizures

Opioid Kötüye Kullanımına Bağlı Rabdomiyoliz: Olgu Sunumu

Opioid kötüye kullanımı ile ilişkili pek çok komplikasyon bildirilmiştir. Bunların arasında solunum depresyonu, bilinç bulanıklığı, aspirasyon ğnömonisi, pulmoner ödem, miyokardit, rabdomiyoliz ve kompartman sendromu sayılabilir. Bu komplikasyonların bazıları hayatı tehdit eder.Olgu Sunumu: Burada genç bir erkek hastada opioid kötüye kullanımına bağlı gelişen rabdomiyoliz vakası sunacağız. Sonuç: Rabdomiyoliz intravenöz opioid kötüye kullanımına bağlı nadir görülen bir komplikasyondur. Rabdomiyoliz hayatı tehdit edebilecek sonuçlar doğurabileceği için erken tanı ve tedavisi çok önemlidir. Bu nedenle klinisyenler opioid kullanıcılarında bu komplikasyona karşı uyanık olmalılardır.There are several complications associated with opiate abuse, including respiratory suppression, disturbance of consciousness, aspiration pneumonia, pulmonary edema, myocarditis, rhabdomyolysis, and compartment syndrome. Some of these complications may be life-threatening.Case Report: Herein, we present a case of rhabdomyolysis due to opiate abuse in a young man. Rhabdomyolysis is a known but rare complication of intravenous opiate abuse.Conclusion: Because rhabdomyolysis may be life-threatening, and prompt diagnosis and treatment are essential, physicians should be aware of this complication among opioid addicts

Comparison of carbon monoxide poisonings originated from coal stove and natural gas and the evaluation of Neutrophil/Lymphocyte ratio

Objective: The aim of our study is to present the epidemiologic, clinical, laboratory and prognosis differences between the coal stove origin poisoning and natural gas leakages. We also aimed to investigate relationship between the severity of clinical picture, prognosis, complications develop in CO poisoning with neutrophil/lymphocyte ratio (NLR) at the initial admission. Methods: All the acute carbon monoxide cases who applied to Ankara Training and Research Hospital Emergency Medicine Clinic between October 2009 and April 2010 were included to this prospective study. CO poisoning diagnosis was made by the history of CO poisoning with carboxyl hemoglobin (COHb) concentration is over 10%. 100 patients were included to our study. Results: Of the patients, 55(55%) were poisoned from the coal-stove and 45(45%) from natural gas leakage. The mean COHb level of the natural gas group was significantly high (p=0.01). The mean value of GCS of the natural gas group was significantly lower (p=0.018). The number of patients with indication for HBO therapy were 17 and 6 in the natural gas group and coal-stove group, respectively, being significantly higher in the natural gas group(p=0.001). There was no statistically significant relationship between the value of NLR and values of COHb, troponin, and GCS (p=0.872, p=0.470, and p=0.896, respectively). Conclusions: Carbon monoxide poisoning from natural gas leakage is more toxic than that from the coal-stove. There is no relationship between NLR at the time of presentation and the severity of clinical findings, prognosis and complications

Kömür sobası ve doğal gaz kaynaklı karbonmonoksit zehirlenmelerinin karşılaştırılması ve Nötrofil/Lenfosit oranının değerlendirilmesi

Amaç: Bizim çalışmamızdaki amacımız ülkemizde karbonmo- noksit (CO) zehirlenmesinin en sık nedeni olan kömür sobasın- dan kaynaklanan zehirlenmeler ile doğal gaz kaçaklarının yol açtığı zehirlenmeler arasındaki epidemiyolojik, klinik, laboratu- ar ve prognoz farklılıklarını ortaya koymaktır. Ayrıca CO zehir- lenmelerinde oluşan klinik tablonun şiddeti, prognozu, kompli- kasyonları ile başvuru sırasındaki nötrofil/lenfosit oranı ( NLO ) arasındaki ilişkiyi incelemeyi amaçladık. Yöntemler: Bu prospektif çalışmaya Ankara Eğitim ve Araş- tırma Hastanesi Acil Tıp Kliniğine 2009 Ekim 2010 Nisan tarihleri arasında başvuran akut karbonmonoksit zehirlenmesi olgularının tümü alındı. CO zehirlenmesi tanısı, anemnezinde CO zehirlenmesine neden olabilecek öykünün olması ile birlikte karboksihemoglobin (COHb) konsantrasyonunun % 10nun üs- tünde olması şeklinde konuldu. Çalışmamıza toplam 100 hasta dahil edildi. Bulgular: 55 (%55) hasta kömür sobasıyla zehirlenirken, 45 (%45) hasta doğal gaz kaynaklı zehirlenmişti. Doğal gazdan zehirlenen grubun ortalama COHb düzeyi anlamlı bir şekilde daha yüksekti (p0,01). Doğal gaz grubunun ortalama Glas- kow koma skoru (GKS) değeri anlamlı bir şekilde daha düşüktü (p0,018). Doğal gazdan zehirlenen grupta 17 hastanın HBO (hiperbarik oksi jen) tedavisi ihtiyacı olurken, kömür sobasından zehirlenen grupta ise sadece 6 hastanın HBO tedavisi ihtiyacı oldu. Doğal gazdan zehirlenen grupta kömür sobasından ze- hirlenen gruba göre anlamlı bir şekilde HBO tedavisi ihtiyacı daha fazlaydı. (p0,001) NLO ile COHb oranı, troponin ve GKS değerleri arasında istatistiki olarak anlamlı bir ilişki bulunmadı (Sırasıyla; p0,872, p0,470, p0,896). Sonuç: Doğal gaz kaynaklı CO zehirlenmeleri kömür sobası zehirlenmelerine göre daha toksik olabilmektedir. CO zehirlen- melerinde oluşan klinik tablonun şiddeti, prognozu, komplikas- yonları ile başvuru sırasındaki NLO arasında her hangi bir ilişki yoktur.Objective: The aim of our study is to present the epi- demiologic, clinical, laboratory and prognosis differences between the coal stove origin poisoning and natural gas leakages. We also aimed to investigate relationship be- tween the severity of clinical picture, prognosis, complica- tions develop in CO poisoning with neutrophil/lymphocyte ratio (NLR) at the initial admission. Methods: All the acute carbon monoxide cases who ap- plied to Ankara Training and Research Hospital Emergen- cy Medicine Clinic between October 2009 and April 2010 were included to this prospective study. CO poisoning diagnosis was made by the history of CO poisoning with carboxyl hemoglobin (COHb) concentration is over 10%. 100 patients were included to our study. Results: Of the patients, 55(55%) were poisoned from the coal-stove and 45(45%) from natural gas leakage. The mean COHb level of the natural gas group was sig- nificantly high (p0.01). The mean value of GCS of the natural gas group was significantly lower (p0.018). The number of patients with indication for HBO therapy were 17 and 6 in the natural gas group and coal-stove group, respectively, being significantly higher in the natural gas group(p0.001). There was no statistically significant re- lationship between the value of NLR and values of COHb, troponin, and GCS (p0.872, p0.470, and p0.896, re- spectively). Conclusions: Carbon monoxide poisoning from natural gas leakage is more toxic than that from the coal-stove. There is no relationship between NLR at the time of pre- sentation and the severity of clinical findings, prognosis and complication

Datura Stramonium Poisoning: Two Case Reports

WOS:000392193000002Introduction: Datura stramonium is a wild plant, which grows in almost every region of Turkey and is found in the native flora. D. stramonium is used as a herbal medicine for asthma, bronchitis, eczema, and hemorrhoid treatment. Because of D. stramonium’s hallucinative and euphoric effects, it can be abused, particularly by drug addicts. Excessive oral intake may cause anticholinergic toxicity. In the case of a very high dose intake, it may result in coma. In this study, we have discussed two patients who presented to the emergency department of our hospital with anticholinergic findings and were diagnosed with D. stramonium intoxication.Case Report: Two patients presented to the emergency department of our hospital with signs and symptoms of anticholinergic poisoning. Two cases were also fell complaints with symptomatic treatment. Both the patients were admitted to the toxicology department and were followed-up for 2 days. The complaints regressed the next day, and the both the patients were discharged with complete recovery.Conclusion: Our study reporting the present cases shows that D. stramonium, which is used for therapeutic purposes, also causes severe intoxication. Therefore, wild plant poisoning should be considered for every patient presenting to the emergency department with unexplained anticholinergic symptoms and complaints

Antiepileptic drug poisoning: Three-year experience

Introduction: Antiepileptic drugs, which are also called anticonvulsants, are used in the therapy and prophylaxis of epileptic seizures. The purpose of this paper was to investigate the relevant epidemiological data and to determine which of these drugs was the most frequent cause of intoxication. Another purpose of this study was to determine the neurological, cardiac, and biochemical problems caused by antiepileptics. Material and method: This retrospective study included 95 consecutive patients under 18 years of age with antiepileptic intoxication, presenting to and being followed-up in, the Toxicology Unit between January 2010 and February 2013. The data were obtained by screening the patient files. Results: Of the cases, 67 (70.5%) were self-poisoned by first generation antiepileptics (FGAEs) and 28 (29.5%) by second generation antiepileptics (SGAEs). The Glasgow Coma Scale (GCS) scores and the serum lactate levels of the patients poisoned by FGAEs and SGAEs on admission to emergency department were 15 (25th: 12; 75th: 15; 95th: 15; IQR: 3) and 1.9 (25th: 1.4; 75th: 3.1; 95th: 5.6; IQR: 1.7), and 15 (25th: 14.3; 75th: 15; 95th: 15; IQR: 0.75) and 1.07 (25th: 0.9; 75th: 1.6; 95th: 5.5; IQR: 0.71), respectively. The serum lactate levels of patients poisoned by FGAEs were significantly higher (p < 0.001). Among the cases poisoned by carbamazepine, the most frequent cause of intoxication, the GCS score was significantly lower and serum lactate level was significantly higher in the group with high serum levels of carbamazepine (p = 0.004 and p < 0.001, respectively). In cases poisoned by valproic acid (VPA), the second frequent cause of intoxication, there was neither a significant association between the serum VPA level and the GCS score, nor between the serum lactate level and the systolic blood pressure (p = 0.470, p = 0.897, and p = 0.088, respectively). However, there was a positive correlation between the serum VPA level and the serum ammonia level (kk = 0.742, p < 0.001). Conclusion: First generation antiepileptics are more toxic than SGAEs. In patients with serum carbamazepine level, particularly those over 30 mg/L, serious disorders of consciousness, cardiovascular toxicity, and metabolic disorders may occur. In VPA intoxication, there is a positive correlation between the serum VPA levels and ammonia levels. On account of this finding, one should be more careful about hyperammonemic hepatic encephalopathy as the serum VPA level rises