Self medication in the age of connectivity and its risks - the case report

Introduction: Public healthcare systems throughout the world are strained by demographic changes, soaring costs and insufficient resources. This can negatively affect access to health services, which forces patients to seek other treatment options. Websites and online forums have become one of the most common sources of health advice, with online medicine trade burgeoning as well. However, while the internet provides vast knowledge database, using unverified advice or product can have dangerous consequences. We present a patient with acute amphetamine poisoning, caused by ingestion of substance marketed online as weight loss drug. Aim of study: to discuss potential risks and problems of using online advice and products in self medication Results: Our patient, the 36 year old female, was admitted to Department of Toxicology and Cardiology with symptoms suggestive of poisoning of some kind. She admitted to using a weight- loss medication throughout the last month, in increasing dosages. The drug was bought from online trading platform. She lost 8 kilograms of body weight through this period. Subsequently, she noticed some disturbing symptoms, including dystonia movements of limbs, paresthesia in right half of the body and blurred vision. Episodes of tachycardia were reported as well. On admission, the patient was weakened and mildly depressed. She reported not eating anything for the last 2 days. Toxicological examination revealed the presence of psychoactive substances in the urine- amphetamine at 7800 ng/ml and LSD at 1,08ng/ml. Our patient was consulted by psychiatrist and psychologist. Fluid therapy was applied, along with Relanium, low molecular weight heparin, Dexaven and Polprazol. Due to elevated blood pressure, a 24-hour blood pressure measurement was performed. Next, hypotensive therapy was administered. The patient’s condition improved and she was discharged from the hospital after 4 days, with scheduled control in ambulatory setting and recommendation of beginning the psychotherapy. Conclusions: Online health advice and products can be dangerous if used inappropriately. A focus on education and provision of freely available, high quality medical information can make it safe and useful complement to healthcare systems throughout the world. Appropriate systems controlling online medicine distribution should also be instituted, with patients’ safety and wellbeing as prime goals

Severe beta-blocker overdose in a 65-year-old female

Introduction: Population of people over 65 years old is one of the groups of the greatest risk of suicide attempt. In this age range the highest suicide rate that results in death is observed. Metabolism alterations and co-morbidities development with age may play major role in increasing suicide rate. Accidental and intentional drug over-ingestions are more common for people with numerous prescriptions and comorbid conditions. Overdose in such patients can pose great threat to patients life. Aim of the study: The purpose of this study is to depict course of β-adrenolitics and benzodiazpines poisoning on the base of case report. Materials and methods: The analysis of the patient's medical history and the review of available literature in the PubMed and Google Scholar databases. Results: The 65-year-old female, was brought by emergency medical services to the Toxicology Clinic due severe drug poisoning. Upon admission patient was unconscious, intubated, on ventilator, in overall severe condition. She presented symptoms of circulatory insufficiency. History revealed overdose of β-adrenolitics and benzodiazepines. The application of proper pharmacological treatment and heart pacing resulted in gradual improvement of patients condition. After one-week stay she was discharged home in good condition. Conclusions: Course of β-adrenolitics poisoning with addition of benzodiazepines poses great threat, especially when one suffers from numerous comorbidities. Therefore, due to wider availability of drugs and rising number of suicide attempts, as well as events of medication errors, it is crucial to be aware of elder people problems and prevent such situations

The case series of baclofen intoxication

Baclofen, a gamma-amino butyric acid type B (GABAb) inhibitor, is commonly used in management of spasticity and other medical conditions, such as alcohol dependency. However, given its mechanism of action, increasing usage of baclofen raises concerns about possibility of intoxication. The authors present herein three cases of baclofen intoxication of patients in various age and general condition

Suicidal digoxin intoxication in 61 year old patient

Digoxin is one of the oldest drugs used in cardiology. It belongs to subgroup of cardiac glycosides. Currently, due to limited indications for use, cases of poisoning with this group of drugs are becoming less common. Ease of poisoning results from the low therapeutic index and symptoms of intoxication may include many different systems. The most serious symptoms of overdose are cardiac arrhythmias. We present a case of a patient with suicide poisoning due to ingestion of 30 tablets of 0.1mg digoxin

What affects chronic lithium poisoning in psychiatric patients? - a case report

INTRODUCTION: Despite medical developments, drug poisoning still occurs. Lithium is a drug that has been used for more than 60 years as a mood stabilizer in the treatment and prevention of bipolar disorder, mania and recurrent depression. Lithium is the most commonly prescribed mood stabilizer. It has a narrow therapeutic index.  Its target concentration in acute mania should be 0.6-1.5 mEq/L and 0.6-0.8 mEq/L for maintenance therapy. Because of this, there is a risk of lithium intoxication. We would like to present to you the case of a patient with chronic lithium poisoning. MATERIALS  AND METHOD: Patient information was collected from hospital records available in the clinical toxicology department. In addition, we conducted a literature review on lithium treatment, its toxicity, side effects and pharmacokinetics using PubMed. CASE REPORT: The patient, 58, was referred for lithium poisoning and admitted to the Clinical Toxicology and Cardiology Department in Lublin for treatment. The patient had a previous diagnosis of bipolar affective disorder, hypertension and obesity. According to the history, the patient was admitted to the psychiatric ward due to deterioration of her mental state for a month. She was found to have a high lithium level -2.98 mmol/L and elevated renal function parameters-creatinine 2.13 mg/dl.  During treatment with hemodialysis, these parameters returned to normal. CONCLUSION: It is important to remember that lithium has a narrow therapeutic range. Attention should be paid during lithium treatment to situations that increase the risk of adverse effects and the development of toxicity, and serum lithium concentrations should be monitored during treatment

New psychoactive substances abuse and its clinical consequences - the case report

Introduction: The meteoric rise of new psychoactive substances' use has been a public health problem for at least few years. Their presence was noticed by EU authorities around 2005. First cases of NPS poisoning in Poland appeared shortly thereafter, in 2008. Due to great variety of used substances and lack of information about them, precise diagnosis and targeted treatment remain a significant problem. Hereby, we present a patient with multi-drug poisoning related to NPS abuse and discuss new psychoactive substances that are often found in such cases. Aim of study: To discuss most common new psychoactive substances and their health effects on the basis of the case report Results: A 28-year old patient was admitted to the Department of Toxicology and Cardiology with symptoms suggesting acute intoxication with psychoactive substances. The patient had a history of drug abuse. A few pouches containing unidentified psychoactive substances were found near the patient. On admission, his condition was serious- he was unconscious and required mechanical ventilation. Tachycardia and aspiration pneumonia were present as well.The applied therapy focused on restoring acid- base homeostasis, electrolyte balance and mitigating toxic influence of detected drugs, with preventive antibiotic administration used as well. His general and psychological condition improved with treatment, and he was discharged from the department after ten days, with continuation of the therapy in ambulatory setting. Conclusions: An increasing amount of patients present cases of polysubstance abuse, whose treatment may prove especially difficult. Such cases require extensive therapy to prevent debilitating complications. A focus on drug regulation and patient education could diminish the number of such cases in the future

What are the effects of taking 300 pills of sodium valproate? - case report

INTRODUCTION: Sodium valproate is one of the most important antiepileptic drugs. It can be effective as a preventive treatment for migraine, it has also found use in the maintenance treatment of bipolar disorder and acute mania,it is sometimes used in the treatment of chronic neuropathic pain and fibromyalgia, in the treatment of schizophrenia borderline personality disorder and acquired brain injury, this drug is used off-label. Its overdose can be fatal. MATERIALS    AND  METHOD:  Patient  information  was  collected  from  hospital  records available in the clinical toxicology department. In addition, we conducted a literature review on sodium valproate treatment, its toxicity, side effects and pharmacokinetics using PubMed. CASE  REPORT:  A 57-year-old patient with a history of depressive disorders was admitted to the Clinical Department of Toxicology and Cardiology in Lublin for intentional intoxication with the drug Absenor (sodium valproate). The patient had taken 3 packages of Absenor 500 mg (300 tablets in total) for suicidal purposes. The determined concentration of valproic acid was 841 µg/ml, and the patient's condition was very severe. Despite the treatment administered-multiple attempts at gastric lavage, administration of activated charcoal, performance of hemodialysis procedures, administration of infusion of catecholamines, the patient died on the fifth day of hospitalization. CONCLUSION:  An overdose of sodium valproate can be fatal. Keep this in mind when ordering this drug for patients with a positive history of suicide attempts.&nbsp

Cyanide poisoning from an alternative medicine treatment with apricot kernels in a 80-year-old female.

Introduction: Amygdaline, one of the most common cyanogenic glycosides, is present in the seeds and fruit pits of Prunus species. The excessive administration of this glycoside might lead to cyanide poisoning. Aim: The aim of the study is to depict the risk associated with apricot kernels ingestion on the base of the case report. Methods: The analysis of the patient’s medical history and the review of available literature. Results: 80- year- old female with the medical history of papillary thyroid cancer was admitted to the toxicology department due to accidental cyanide poisoning. The patient consumed extract consisted of milled apricot kernels, then suffered from dyspnea, vertigo and vomiting. After that, she lost consciousness. Lactic acidosis, highly specific for cyanide intoxication, was diagnosed during hospitalization. The patient was treated with fluid and steroid therapy, sodium bicarbonate and supplemental oxygen. On the 3rd day of stay, the patient was discharged with recommendation of control in toxicological clinic. Conclusions: Initial symptoms of cyanide poisoning are not specific, therefore it is worth taking this poisoning into account in differential diagnosis, especially in oncological patients or in children

Lead poisoning linked to occupational exposure - case reports

Introduction: Lead is one of the oldest widely used industrial metals. Throughout the ages, its significant toxicity caused poisoning of exposed people. Even today occupational exposure remains a significant hazard. Aim: The aim of the study is to depict the risk associated with lead exposure on the base of the case report. Methods: Patient’s medical history analysis and the review of available literature. Results: Two patients with history of occupational lead exposure were admitted to hospital. Their symptoms suggested chronic lead poisoning. Blood lead level was excessive in both cases. The patients were treated with antioxidants and advised to reduce their exposure to lead, with continuing ambulatory therapy. Conclusions: All known effects of Pb are extremely harmful to humans. Lead poisoning still appears to be a problem in some jobs and environments, particularly in cases of chronic low level exposure. Proper monitoring of workplace conditions and regular medical checkups for those at risk should be practiced to avoid cases of chronic poisoning in the future

Poisoning with cardiological drugs in patients hospitalized in the toxicological and cardiological department from 04/2013 to 12/2021

Introduction and purpose: Cardiological drugs are widely used in the management of various cardiovascular diseases, such as hypertension, angina, heart failure, and arrhythmias. However, when these drugs are taken in excessive amounts or are not used as prescribed, they can become toxic and cause significant harm to the heart and other organs. Our study aims to illustrate the most frequent causes of poisoning with cardiological drugs in patients hospitalized in the toxicological and cardiological department from April 2013 to December 2021. Brief description of the state of knowledge: Poisoning with cardiological drugs is a growing concern for healthcare professionals. In 2019, cardiovascular toxins were one of the top 10 categories of poisons evaluated by medical toxicologists. Data collected from the analyzed toxicology and cardiology department include a group of 387 hospitalized patients. The largest proportion were cases intoxicated by beta-adrenoreceptor antagonists. The second most common group was poisonings by angiotensin-converting-enzyme inhibitors. A slightly lower proportion implicated poisonings caused by other, unidentified substances affecting the cardiovascular system - calcium channel blockers and other antihypertensive drugs. Conclusions: All of the data demonstrated in our study shows the importance of understanding the pharmacology, pathophysiology, and treatment strategies of poisonings caused by cardiological drugs which are one the most widely used medications worldwide