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Background: In this case series abomasitis as a consequence of halofuginone intoxication is suspected. Case presentation: Seven Belgian-Blue calves with complaints of anorexia and weight loss were presented to an university clinic. Ultrasonography showed thickening and edema of the abomasal wall in all cases, suggesting abomasitis. Abomasitis was confirmed on necropsy in three cases. Retrospective analysis clarified the uptake of an overdose of halofuginone lactate (348–421 µg/kg/day). Four animals fully recovered after removal of halofuginone lactate administration, therapy for comorbidities (pneumonia, diarrhoea) and supportive therapy. Conclusion: To the authors' knowledge, this case series is the first report associating halofuginone lactate use with abomasitis. This was suspected after clinical improvement of four of the presented animals after terminating the administration of a high dose of halofuginone lactate, and exclusion of other possible causes. Underlying mechanisms are still unclear. [ABSTRACT FROM AUTHOR]

Introduction: Salbutamol is a moderately selective beta-2-adrenergic agonist. Various side effects can occur because of beta-1 and beta-2 receptor activation. Due to the large volume of distribution, it is not considered dialyzable. Case Presentation: A patient with salbutamol intoxication, which developed as a result of a medical error in a patient with sepsis, Down syndrome, and liver cirrhosis, is presented. Initial treatment was partially successful and antibiotic adjustments were made. After his respiratory failure worsened, the patient needed non-invasive ventilation, and previously undiagnosed chronic obstructive pulmonary disease was suspected. He was prescribed intravenous methylprednisolone but accidently received 5 mg of salbutamol (albuterol), which led to immediate severe arrhythmic tachycardia with hemodynamic collapse. After unsuccessful cardioversion and treatment with landiolol infusion, salvage hemodialysis was commenced to decrease suspectedly highly elevated serum salbutamol levels. After 30 min, sinus rhythm with normocardia was observed. After the hemodialysis termination, no rebound tachycardia was noted, but due to severe septic shock, the hypotension was ongoing and vasoactive medications were adjusted. However, the measured levels of plasma salbutamol and data from literature do not support the view that hemodialysis was the cause of the described improvement: the total amount of the drug cleared was very small (2.8% of total dose). Conclusion: Our results confirm a large volume of salbutamol distribution; the measured levels are within observed therapeutic levels; and the measured half-life time during hemodialysis (3.1 h) is comparable to observed half-life times in therapeutic settings. The observed favorable clinical benefit associated with dialysis may be fortuitous, highlighting potential bias toward positive clinical outcomes and unproven ("salvage") therapies. [ABSTRACT FROM AUTHOR]

Psychotropic prescription drugs are commonly involved in intoxication events. The study's aim was to determine a comparative risk for intoxication in relation to prescribing rates for individual drugs. This was a nationwide observational study in Slovenian adults between 2015 and 2021. Intoxication events with psychotropic drugs were collected from the National Register of intoxications. Dispensing data, expressed in defined daily doses, were provided by the Health Insurance Institute of Slovenia. Intoxication/prescribing ratio values were calculated. The correlation between trends in prescribing and intoxication rates was assessed using the Pearson correlation coefficient. In total, 2640 intoxication cases with psychotropic prescription drugs were registered. Anxiolytics and antipsychotics were the predominant groups. Midazolam, chlormethiazole, clonazepam, sulpiride, and quetiapine demonstrated the highest risk of intoxication, while all antidepressants had a risk several times lower. The best trend correlation was found for the prescribing period of 2 years before the intoxication events. An increase of 1,000,000 defined daily doses prescribed resulted in an increase of fifty intoxication events for antipsychotics, twenty events for antiepileptics, and five events for antidepressants. Intoxication/prescribing ratio calculation allowed for a quantitative comparison of the risk for intoxication in relation to the prescribing rates for psychotropic drugs, providing additional understanding of their toxicoepidemiology. [ABSTRACT FROM AUTHOR]

Background: Lithium is considered the gold standard for the treatment of bipolar affective disorder for the prevention of recurrence of manic and depressive episodes and for augmentation treatment in unipolar severe depressive episodes. The indications for treatment with lithium do not differ for older or younger patients. Nevertheless, there are a number of aspects to be considered with respect to drug safety in the group of old patients. Objective: The aim was to give an overview of the current literature on lithium treatment in old age and from this to derive recommendations for action. Material and methods: A selective literature review on lithium treatment in old age was conducted to answer questions on drug safety, monitoring (particularly with respect to comorbidities) and potential alternatives to lithium. Results and discussion: Lithium is an effective and, if used correctly, safe drug also in old people; however, with respect to somatic comorbidities that increase with age, special caution is required when using lithium in order to prevent nephropathy and intoxication. [ABSTRACT FROM AUTHOR]

In the past decade, the number of deliberate self-poisonings involving young people has increased strongly worldwide. This study aimed to gain insight into risk factors associated with deliberate self-poisonings among children and adolescents reported to the Dutch Poisons Information Center. A study was performed between 1 February 2022 and 31 January 2023 involving those aged 8–17 years of age with deliberate self-poisoning. Data were collected on patient characteristics (age, gender, body mass index and living situation) and exposure characteristics (type of toxicant, way of acquiring toxicant and day of exposure). The Dutch Poisons Information Center was consulted about 1,424 deliberate self-poisonings among children and adolescents (10–17 years old). A high percentage of patients were female (85 percent), had a body mass index classified as overweight/obese (27 percent) and lived in a mental healthcare facility (13 percent). Patients mainly exposed themselves to pharmaceuticals, especially over-the-counter medications such as paracetamol (46 percent) and ibuprofen (15 percent). Young people living with parents/caregivers had higher odds of ingesting prescription pharmaceuticals or over-the-counter medication, while those living in a mental healthcare facility were more likely to ingest household products, personal care products or foreign bodies (predominantly batteries). This study sheds light on the pervasive issue of deliberate self-poisoning among children and adolescents, advocating for poisoning prevention strategies and promoting mental health of youth. Limitations include reliance on self-reported data from patients and the absence of clinical outcome data. Female gender, a high body mass index and living in a mental healthcare facility are associated with in increased risk of deliberate self-poisonings in children and adolescents (10-17 years old). Prevention of deliberate self-poisonings among youth could focus on restricting access to medication and other potentially hazardous non-pharmaceuticals, such as household products and batteries, as well as limiting the sales of over-the-counter medication, especially paracetamol, to this young population. [ABSTRACT FROM AUTHOR]

Metformin (N,N-dimethylbiguanide), an inhibitor of gluconeogenesis and insulin sensitizer, is widely used for the treatment of type 2 diabetes. In some patients with renal insufficiency, metformin can accumulate and cause lactic acidosis, known as metformin-associated lactic acidosis (MALA, defined as lactate ≥ 5 mM, pH < 7.35, and metformin concentration > 38.7 µM). Here, we report on the post-translational modification (PTM) of proline (Pro) to 4-hydroxyproline (OH-Pro) in metformin-associated lactic acidosis and in metformin-treated patients with Becker muscular dystrophy (BMD). Pro and OH-Pro were measured simultaneously by gas chromatography–mass spectrometry before, during, and after renal replacement therapy in a patient admitted to the intensive care unit (ICU) because of MALA. At admission to the ICU, plasma metformin concentration was 175 µM, with a corresponding lactate concentration of 20 mM and a blood pH of 7.1. Throughout ICU admission, the Pro concentration was lower compared to healthy controls. Renal excretion of OH-Pro was initially high and decreased over time. Moreover, during the first 12 h of ICU admission, OH-Pro seems to be renally secreted while thereafter, it was reabsorbed. Our results suggest that MALA is associated with hyper-hydroxyprolinuria due to elevated PTM of Pro to OH-Pro by prolyl-hydroxylase and/or inhibition of OH-Pro metabolism in the kidneys. In BMD patients, metformin, at the therapeutic dose of 3 × 500 mg per day for 6 weeks, increased the urinary excretion of OH-Pro suggesting elevation of Pro hydroxylation to OH-Pro. Our study suggests that metformin induces specifically the expression/activity of prolyl-hydroxylase in metformin intoxication and BMD. [ABSTRACT FROM AUTHOR]

A 4-month-old male Himalayan cat presented with clinical signs of acute lethargy and motor incoordination after being treated with amitraz for parasite control. On clinical examination, the patient was lethargic and ataxic with severe pulicosis, hypothermia, pale mucous membranes, bradycardia, weak femoral pulses, hyperglycemia, and bilateral mydriasis. Blood tests revealed non-regenerative hypochromic microcytic anemia. Serum alanine levels were elevated tenfold. The patient received supportive treatment with atipamezole (an α2-adrenergic antagonist) at a dose of 0.1 mg/kg intramuscularly. After 24 h of hospitalization and constant monitoring, the patient recovered and was discharged. The published literature showed that the active ingredient amitraz is effective in the treatment of some parasitic diseases in cats, such as scabies and demodicosis; therefore, it is still used for this purpose. Given the small therapeutic margin of this insecticide, veterinarians should caution owners about its potential toxicity. This report emphasized the significance of amitraz intoxication in feline species and the success of the treatment, which should be initiated in the first hour after intoxication. [ABSTRACT FROM AUTHOR]

Background: Overdose with calcium-channel blockers (CCBs) still maintain their importance with a high lethality rate after exposure. We report the intravenous lipid emulsion therapy (ILE) therapy in our CCB overdose patients. Methods: We retrospectively analyzed the records of 6 patients with CCB intoxication from Batman Training and Research Hospital PICU between March 2021 and September 2022. Patients aged 0-18 years who received ILE treatment for CCB poisoning were included. Results: All six patients ingested CCB with the intention of committing suicide and were followed up in the pediatric intensive care unit (PICU). All patients received ILE therapy due to hemodynamic instability despite intravenous fluid boluses, calcium, glucagon, insulin-dextrose, and vasoactive agents. Vasoactive-Inotropic Score (VIS) decreased after ILE treatment. All patients were transferred from the PICU after recovery. Conclusions. ILE therapy should be kept in mind as a salvage therapy in hemodynamically unstable CCB poisoning cases that do not respond to initial and advanced options. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Pediatric Emergency & Intensive Care Medicine / Çocuk Acil ve Voğun Bakım Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction and purpose: E-cigarettes have emerged as an alternative to traditional tobacco smoking. Toxicological studies have investigated the composition and potential toxicity of e-cigarette liquid components. While they are generally considered less harmful than combustible cigarettes, cases of poisoning associated with e-cigarette liquid ingestion or exposure have been reported. Brief description of the state of knowledge: Nicotine intoxication resulting from e-cigarette liquid ingestion can lead to a range of symptoms and complications, including cardiovascular effects, neurological symptoms, gastrointestinal disturbances, respiratory issues, and even death. This report presents a case of a 58-year-old woman hospitalized in the Toxicology and Cardiology Department due to poisoning with e-cigarette liquid. Conclusions: Accidental or intentional ingestion and/or injection of e-liquid is becoming a new emerging challenge for Emergency Medicine, mainly because of the easy accessibility of advertisements and the sales of e-cigarettes online, and the high nicotine concentration in e-liquids. It is important to report instances of e-liquid-related nicotine intoxication in order to improve the legal restrictions on the sale of e-liquid. [ABSTRACT FROM AUTHOR]

Guanfacine hydrochloride extended-release (GXR) is used to treat attention deficit hyperactivity disorder. It is a selective α2A-adrenorecepor agonist that was reported to cause QT prolongation and hypotension in the event of overdosing. We report the case of a 17-year-old man who took 226 tablets of GXR 3 mg for attempted suicide. He was found complaining of dyspnea, and emergency medical services were called. When the patient was transferred to our hospital, his Glasgow coma scale was 12 (E4V3M5). He was agitated and hypoxemic. He was intubated for invasive mechanical ventilation under sedation. His chest X-ray and computed tomography scan showed pulmonary edema. Transthoracic echocardiography showed markedly reduced cardiac function. His serum guanfacine concentration peaked on day 3 after admission. His pulmonary edema improved quickly after a decrease in serum guanfacine concentration, but cardiac decompensation persisted for about 1 month. This case reveals that the decline in cardiac function after guanfacine intoxication is prolonged even after its serum concentration has decreased. [ABSTRACT FROM AUTHOR]

Prallethrin ingestion and/or aspiration can manifest in a wide range of systemic effects. Evidence-based management of chemical pneumonitis following prallethrin aspiration does not exist yet. This case presents an unusual course of illness following prallethrin ingestion/aspiration that responded to antibiotics and steroid use. This is a previously well 22-month-old boy presented to the Emergency Department (ED) with a history of estimated 20 mL ingestion/aspiration of insecticide containing prallethrin 1.6% one hour earlier. The patient had bluish discoloration of his face, with eye tearing, drooling, and frothy secretions from his mouth. The patient was admitted for supportive care and observation. During his four days of admission, he progressively improved and returned to his previously healthy baseline. However, four hours after his discharge, he relapsed and was readmitted with an impression of superimposed pneumonia. During his second course of illness, the patient had worsening of his respiratory status requiring escalation of oxygen therapy and antibiotics. The patient received 21 days of intravenous (IV) antibiotics, and steroids, and was discharged on inhaled salbutamol and fluticasone. In conclusion, pyrethroid aspiration can lead to severe pneumonitis and secondary superimposed bacterial infection. [ABSTRACT FROM AUTHOR]

Colchicine is a tricyclic alkaloid that has both medicinal and poisonous properties. Colchicine poisoning is a life-threatening condition with high mortality. A 13-year-old girl presented to our department with vomiting, abdominal pain, and fever. She appeared generally ill with hypotension. Laboratory tests revealed thrombocytopenia, hyponatremia, acute kidney injury, elevated INR, markedly elevated troponin concentration (6721 pg/L), and elevated C-reactive protein (337 mg/L). Differential diagnoses were septic shock or pediatric inflammatory multisystem syndrome. She received hemodynamic support, empiric antibiotics, intravenous immunoglobulin, methylprednisolone, acetylsalicylic acid, and vitamin K. Her condition worsened, and she developed visual and auditory hallucinations on day 5. We then suspected drug intoxication, particularly with colchicine, which her mother took for Behçet's disease. Blood testing revealed a high colchicine concentration, and the patient admitted to ingesting 40 tablets of colchicine in a suicide attempt. She developed frontal alopecia on day 10. She was discharged on day 17 with psychiatric follow-up. Despite the initial delayed diagnosis of colchicine poisoning, supportive treatment with corticosteroids and immunoglobulin may have saved the adolescent. Future research may determine whether either of these is effective in treatment of severe colchicine intoxication. [ABSTRACT FROM AUTHOR]

Poison is a substance that has been used for assassination purposes from past to present. In addition to many individual works giving information about poison and its types in history, the poison was also discussed only in a chapter or a title. The feature that distinguishes the poison anecdotes in itineraries and geographical works about the Middle Ages from separates books of poison is that rather than a general narrative, the narrations of poison are treated by travelers and geographers who were not experts in this subject, by dealing with it between the lines. It is known that the knowledge of Indian physicians, known for their superior wisdom in the toxicology, was transferred to medieval scholars through translations and works were written on this subject. Besides medieval physicians and botanists, it is understood that travelers, geographers, and historiographer were also interested in the subject of poison and wrote what they heard and heard about it. When the details of travelers, geographers and similar historiographer about poisons are examined, it is seen that they deal with poisons in three aspects such as herbal, animal, and chemical, mention antidotes and give details about assassinations and murders based on different poisoning methods. [ABSTRACT FROM AUTHOR]

Organophosphorus agents, also known as nerve agents, are very dangerous chemicals that were used as chemical warfare agents. HI-6 is one of the most promising reactivators which is effective in reactivating AChE inhibited by many nerve agents. However, the fast in-vivo clearance of HI-6 became a large barrier for first aid use under some sophisticated circumstances. In this study, PEGylated liposomes loading HI-6 were prepared and evaluated in vitro and in vivo. For PEG-LP-HI-6, the optimal formulation's loading efficiency and encapsulation efficiency were 6.47 ± 0.10% and 71.2 ± 1.15%, respectively. According to the pharmacokinetic results, compared with free HI-6 and LP-HI-6, the intravenous injection of PEG-LP-HI-6 significantly extended t1/2 (1.47 ± 0.29 h), MRT (1.44 ± 0.07 h), and improved the AUC of HI-6 in vivo. Drug concentrations in the CNS also increased after the intravenous administration of PEG-LP-HI-6. For in vivo treatment study, twenty minutes after poison exposure, the survival rate of animals in saline, free HI-6, LP-HI-6 and PEG-LP-HI-6 groups were 0, 0, 30% and 70%, respectively. Compared with the non-PEGylated liposomes group and free HI-6, PEG-LP-HI-6 could prolong the survival time of experimental animals and alleviate the neurotoxic symptoms, which demonstrated great potential as a first-aid strategy for acute organophosphorus agent poisoning. [ABSTRACT FROM AUTHOR]

Objective: Methanol intoxication is among the common reasons for emergency department admissions, apart from suicide attempts. In this study, we investigated the predictive value of base excess (BE) for methanol-related mortality and its potential use in clinical practice. Materials and Methods: All patients with a confirmed diagnosis of methanol intoxication in an 8-year retrospective study were included. Cases with in-hospital mortality were included in the mortality group. Blood gas and biochemical parameters of the patients were recorded. Receiver operating characteristic curve and regression analyses were performed for variables with significant differences between the groups. Results We found that pH, HCO3, and BE were significantly lower, whereas lactate levels were significantly higher in the mortality group. According to the cut-off values of the independent variables, we determined the area under the curve values to be 0.852, 0.855, 0.900, and 0.708, respectively. We found that the BE value of <-23.65 had the highest sensitivity, specificity, and odds ratio (OR) values [sensitivity: 86.4%, specificity: 89.47%, OR: 0.780 (95% CI; 0.656-0.929)]. Conclusion: We suggest that BE values can be useful for clinicians in prioritizing patients in mass emergency department admissions, such as those with methanol intoxication. [ABSTRACT FROM AUTHOR]

Copyright of Kocatepe Veterinary Journal / Kocatepe Veteriner Dergisi is the property of Afyon Kocatepe University, Faculty of Veterinary Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In traditional Nigeria, moderate drinking was normative among adult men who occupied drinking spaces. Heavy drinking and intoxication were transgressive behaviours that attracted sanctions. Alcohol consumption among youth was taboo in most communities. Nowadays, young people drink, and many construct identities with heavy drinking and intoxication. Drawing on interviews and focus groups with students and nonstudents in Benin City, I explore how young people's participation in drinking games (DGs) facilitates heavy drinking, intoxication, and transgression of the local consumption norms. 'Mere arguments', betting, and assertions of masculinity initiate DGs, while fun, economic gain, and the construction of social identities motivate gameplaying. Aside from other DG categories, participants played a localized version of Truth-or-Dare, where losers are mandated to undress in public- or drink-specified quantities of alcohol. DGs were mostly played at bars and parties, which encouraged heavy drinking and drunkenness. DGs generate fun for players and partygoers; thus, party hosts often include gameplaying in party programmes. Winning a DG attracts titles like 'boss', 'champion', or 'guru' and a reputation among men. Therefore, they played DGs to reproduce/authenticate their masculinity and achieve such titles and prestige, while women mostly played DGs to win money, phones, and bags. Many participants' gameplaying resulted in heavy drinking, intoxication, and loss of control that subverted the local consumption culture, which prohibits heavy drinking and promotes moderation. The findings demonstrate how transgressive behaviours can be enjoyable to transgressors and also function as resistance to social norms/structures that encourage dominance/inequalities. [ABSTRACT FROM AUTHOR]

IntroductionMood stabilisers and other psychotropic drugs can lead to serious adverse drug events (ADEs). However, the incidence remains unknown. We aimed to (a) determine the incidence of serious ADEs in patients with bipolar or schizoaffective disorders, (b) explore the role of lithium exposure, and (c) describe the aetiology.MethodsThis study is part of the LiSIE (Lithium—Study into Effects and Side Effects) retrospective cohort study. Between 2001 and 2017, patients in the Swedish region of Norrbotten, with a diagnosis of bipolar or schizoaffective disorder, were screened for serious ADEs to psychotropic drugs, having resulted in critical, post-anaesthesia, or intensive care. We determined the incidence rate of serious ADEs/1,000 person-years (PY).ResultsIn 1,521 patients, we identified 41 serious ADEs, yielding an incidence rate of 1.9 events per 1,000 PY. The incidence rate ratio (IRR) between ADEs with lithium present and causally implicated and ADEs without lithium exposure was significant at 2.59 (95% CI 1.20–5.51; p = 0.0094). The IRR of ADEs in patients

Abstract Diazepam poisoning is a common emergency situation, but propafenone poisoning is relatively rare. We reported a case of propafenone poisoning combined with diazepam. An 18‐year‐old female patient was admitted to our hospital with an overdose of oral propafenone and diazepam. The patient was treated with medication that proved to be useful, but the sinus rhythm could not be recovered, and cardiac arrest occurred. A bipolar temporary pacemaker and extracorporeal membrane oxygenation (ECMO) were installed. However, even with multiple electrode positions, effective capture could not be achieved. The patient eventually died. We should be alert to the possibility of co‐poisoning.

The aim of the study was to evaluate the overtime histological changes in the lungs after intoxication with baclofen alone or in combination with ethanol.Materials and methods. The experiment was carried out on 35 male Wistar rats weighing 290-350 g and aged 20 weeks. The animals were split into 7 equal groups (n=5); test drugs were administered via nasogastric tube: rats from Groups 1, 3 and 5 were treated with baclofen at 85 mg/kg; rats from Groups 2, 4 and 6 received similar dose of baclofen and 40% alcohol by volume at a dose of 7 ml/kg; control group rats were not administered with any drugs. Animals of all groups were removed from the experiment by cervical dislocation under anesthesia (chlorolase) after 3 hours (Groups 1, 2), 4.5 hours (Groups 3, 4) and after 24 hours (Groups 5, 6, and the controls). Lung tissue samples were examined by light microscopy. The nonparametric Kraskel-Wallis test was used for multiple comparisons between the groups, and nonparametric Mann–Whitney test with Bonferroni correction was used for pairwise comparison.Results. Light microscopy showed no pathological changes in the lungs of the Control group animals. Baclofen alone, or in combination with ethanol caused significant circulatory disorders (venular and capillary fullness, hemorrhages in the interalveolar septa (IAS) and alveoli, sludge phenomenon), emphysema, atelectasis and distelectasis, and pulmonary edema. IAS thickness in rats from all experimental groups was different from that in animals from the Control group, all differences confirmed by the Kruskel-Wallis test: H=748, p=0.00001.In Group 1 animals IAS was 44.2% thinner (p=0.00052) vs the control Group, while in all remaining experimental groups it was, on the contrary, thicker: in Group 2 – 57.6% increase in thickness (p=0.000038), in Group 3 – 99 % (p=0.00001), in Group 4 – 2.2-fold increase (p= 0.00001), in Group 5 – 2.1-fold (p= 0.00001), in Group 6 – 2.5-fold increase (p= 0.00001). Most significant increase in IAS thickness (6-fold, p=0.00001) occurred within the period from 3 to 4.5 hours after administration of baclofen, while within the period from 4.5 to 24 hours no statistically significant increase occurred (p=0.99). Co-administration of baclofen and ethanol caused 2.8-fold (p=0.00001) increase in IAS thickness after 3 hours as compared to the effects of baclofen only. IAS thickness at 4.5 hours after baclofen and ethanol co-administration increased by additional 41.8% as compared to thickness at 3 hours (p=0.00001). IAS became 11.8% thicker at 24 hours vs 4.5 hours (p=0.87). At 24 hours IAS was 21.7% (p= 0.0011) thicker after baclofen and ethanol co-administration vs baclofen alone. The alveoli size increased by 69.4% (p=0.00001) in Group 1 animals vs the Control group, by 14.3% (p=0.43) - in Group 2, by 55% (p=0.00004) - in Group 3, by 26.3% (p=0.002) - in Group 4, by 45% (p=0.0003) - in Group 5 (baclofen, 24 h), by 43.3% (p=0.0004) – in Group 6 (baclofen and ethanol, 24 h). Co-administration of baclofen and ethanol initially caused a slight increase in alveoli size, bur 3 hours later there was a visible shrinkage in the diameter of alveoli by 32.5% (p= 0.003) vs baclofen mono, 4.5 hours later – by 18.5% (p= 0.062), and 24 hours later – by 1.2% (p= 0.99), that is, the differences were leveled.Conclusion. The combined effects of baclofen and ethanol induce more severe alterations in pulmonary tissue compared to baclofen alone. The pathological changes in the lungs reached their maximum by 24 hours, which confirmed by morphometric assessment. Morphological changes in pulmonary tissue alongside with established chemical properties of the two agents can be used to diagnose cases of intoxication either with baclofen alone or in combination with ethanol.

Disulfiram-ethanol reaction (DER) and disulfiram-like reaction (DLR) are defined as acute intoxication with acetaldehyde after exposure to ethanol with disulfiram or a specific drug. The reaction is still considered as a problem of modern pharmacotherapy. The name of the reaction comes from a drug called disulfiram. In the 1940s, in United States disulfiram was registered for the treatment of alcoholism. DER is the effect of disulfiram’s mechanism of action consisting in inhibition of acetaldehyde dehydrogenase (ALDH), which causes accumulation of acetaldehyde, with accompanying alcohol intolerance and aversion to alcohol consumption. Many commonly used drugs have an ability to interact with ethanol and produce the DLR. The reaction can vary in severity of clinical course and can rarely be fatal. Specific for DER mechanism and symptoms have been observed for drugs such as abacavir, several cephalosporins and procarbazine. Based on clinical symptoms, many active agents such as chloramphenicol, griseofulvin, metronidazole and propranolol were considered as active agents increasing the risk of DLR occurrence. However no increase of acetaldehyde level in blood serum was observed, and the mechanism of interaction was different, often including changes in the level of neurotransmitters within the central nervous system. According to other drugs discussed in the article the mechanism of interaction remains unknown. For these reasons reported interactions of drugs (other than disulfiram) have been referred as DLR. For many drugs the available data is limited to only few clinical cases of acute alcohol intolerance. Furthermore, in these cases the mechanism of interaction has not been studied which limits the conclusions and indicates the need for further research in this area. The description of selected drugs also includes information on the potential risk of disulfiram-like reaction obtained from the Summary of Product Characteristics (SmPC) of drugs registered in Poland.

Apixaban is a direct oral anticoagulation agent that exerts its effect through the direct inhibition of factor Xa. We treated a case of massive intoxication with 70 tablets of apixaban and have presented the clinical course of the associated anti-Xa activities. A 49-year-old woman was admitted to the emergency department approximately 1.5 h after impulsive self-intoxication with 175 mg of apixaban. She developed coagulopathy with prothrombin time-international normalized ratio (PT-INR) of 3.65, activated partial thromboplastin time of 56.5 s, and antithrombin activity (AT) of >150% (at 1.5 h post-ingestion). The patient’s initial and peak anti-Xa activity was 17.7 IU/mL, and its elimination displayed first-order kinetics with a half-life of 10.5 h. The patient’s anti-Xa activity was within the therapeutic dose range at 26 h post-ingestion, and she recovered without experiencing any bleeding complications. Her coagulopathy also returned to normal level at the same timing. This result suggests that PT-INR and AT can be used as substitute markers of overwhelmed anticoagulation following massive overdose of apixaban. A case of apixaban overdose with associated anti-Xa activities was presented. There was favorable resolution of anticoagulation without specific treatments.

Increased reports of domestic violence and abuse (DVA) have been identified following football games. Yet, the relationship between DVA and football culture remains qualitatively underexplored. To better understand this phenomenon, we conducted a focus group with male, non-abusive football youth fans to gain their perceptions of why domestic violence increases following football matches in England. Using thematic analysis, we present a unique insight into the link between DVA and football culture. The findings align with previously identified risk factors for DVA, including the role of alcohol consumption, gambling, and other violent behaviours. We also identified game-specific (e.g., the intensity of winning or losing) and individual factors (e.g., previous exposure to violence and awareness of what constitutes DVA) as heightening the effects of these cultural behaviours, alongside an increased sense of identity with ‘football culture’ after attending a game. We conclude by considering the implications of these findings for policy and practice, such as considering placement of advertising campaigns during matches to increase awareness, increasing threats of punishment and considering the scheduling of matches to reduce triggers of such cultural, and often violent, behaviours associated with football fandom. In addition, we call for further research in this area.

Background and Aim: Poisonings commonly bring cats and dogs to veterinary emergency facilities. This retrospective study aimed to analyze clinical signs, confirmed or suspected toxicants, treatments, and outcomes of feline poisoning cases presented over 5 years to the emergency service of a small animal referral center. Materials and Methods: Medical records of 166 cats were evaluated for a history of confirmed or presumed poisoning, suspected toxicant, clinical signs, treatment, and outcome. Poisoning probability was determined using patient history, clinical findings, observation, toxicologic examination, and, in some cases, gastric contents. Results: Most cats were hospitalized (94.0%) due to poisoning with mostly unknown toxicants (48.2%), rodenticides (21.1%), and various toxic plants (12.0%), followed by antiparasitics (6.0%), chemicals (6.0%), drugs (4.2%), tetrahydrocannabinol (1.2%), or inhaled smoke (1.2%). Patients presented predominantly with neurologic deficits (68.7%), reduced general condition (60.2%), and hypothermia (43.4%). The survival rate was 88.6%. Most cats (93.2%) showed no apparent complications at the time of discharge from the hospital. Toxicant-related complications (48.2%) included thermodysregulation (22.9%), central nervous system signs (18.7%), respiratory issues (6.0%), nephrotoxicity (2.4%), gastrointestinal complications (4.8%), evidence of hepatic failure (4.8%), and hemorrhage (1.8%). Conclusion: In this study, the causative toxicant remained unidentified in many cases. Known poisonings were mostly caused by rodenticides. Neurological signs were the most common clinical presentation. Survival rates were high and comparable with those reported by others.

Rationale and objectivesRecent studies reported that when given a mutually exclusive choice between cocaine and palatable food, most rats prefer the non-drug reward over cocaine. However, these studies used rat strains with limited genetic and behavioral diversity. Here, we used a unique outbred strain of rats (Heterogeneous Stock, HS) that mimic the genetic variability of humans.MethodsWe first identified individual differences in addiction-like behaviors (low and high). Next, we tested choice between cocaine and palatable food using a discrete choice procedure. We characterized the individual differences using an addiction score that incorporates key features of addiction: escalated intake, highly motivated responding (progressive ratio), and responding despite adverse consequences (footshock punishment). We assessed food versus cocaine choice at different drug-free days (without pre-choice cocaine self-administration) during acquisition of cocaine self-administration or after escalation of cocaine self-administration. We also assessed drug versus food choice immediately after 1-, 2-, or 6-h cocaine self-administration.ResultsIndependent of the addiction score, without pre-choice cocaine (1 or more abstinence days), HS rats strongly preferred the palatable food over cocaine, even if the food reward was delayed or its size was reduced. However, rats with high but not low addiction score modestly increased cocaine choice immediately after 1-, 2-, or 6-h cocaine self-administration.ConclusionsLike other strains, HS rats strongly prefer palatable food over cocaine. Individual differences in addiction score were associated with increased drug choice in the presence but not absence (abstinence) of cocaine. The HS strain may be useful in studies on mechanisms of addiction vulnerability.

Illicit drug use is common among attendees of electronic dance music (EDM) festivals, but is often significantly underreported by participants. The current study aimed to compare the prevalence and over- and under-reporting of illicit drug use among attendees at EDM festivals in two European countries with distinct drug laws and cultures. Self-reported data regarding recent drug use were collected through interviews. Participants’ blood alcohol concentrations were measured using a breathalyzer. Recent illicit drug use was assessed through sampling microparticles in the breath and consequent off-site analysis through liquid chromatography and tandem mass spectroscopy. Illicit drug use was higher in Belgium than in Sweden as indicated by self-reports (56.8 vs. 4.3%) and drug testing (37.2 vs. 12.5%). Underreporting was higher in Sweden than in Belgium; in Sweden, only 2.6% reported taking an illicit drug other than cannabis, whereas 11.6% tested positive, while the corresponding figures in Belgium were 36.5% and 36.9%. In both countries, results from self-reporting and drug testing for specific drugs matched poorly at the individual level, indicating unwitting consumption of substances. This study indicates that the drug use prevalence and the likelihood of disclosure may differ between countries or cultures, which should be considered when choosing methods to investigate drug use prevalence.

Fentanyl is an opioid with powerful analgesic effects and a high speed of action. Due to its pharmacological properties, this molecule has therapeutic application as an anesthetic in surgery or as palliative therapy for cancer patients. Unfortunately, in recent years, the easy availability of this substance, the low cost and the illegal online market have favored the large-scale diffusion of fentanyl. Fentanyl is available in different forms, including nasal spray, oral patches, soluble capsules, aerosol or the new version of fentanyl mixed with other drugs, making its use very widespread. Subjects of various ages are involved in fentanyl consumption, including minors that have not yet reached adolescence. In this work, we performed a literature review using the search engines PubMed NCBI and SCOPUS regarding episodes of acute fentanyl intoxication occurring in those of a pediatric age using the Mesh Terms “fentanyl” AND “overdose” AND “children”. The inclusion criteria were English papers published in the last 10 years regarding the cases of children under the age of 10. We evaluated the most frequent methods of intake and the circumstances of such episodes. In cases of death, we analyzed the autopsy, the toxicological findings and the investigations carried out. The review results show that in this age group (under < 10 y.o. s), it is possible to identify the risk factors for fentanyl intake, such as the presence of this molecule within the family unit due to drug addiction or medical therapy. The results also demonstrate a significant risk of underestimation of this phenomenon, since the molecule is often not investigated through adequate toxicological analysis. These results, therefore, suggest always carrying out toxicological investigations in the case of suspected fentanyl intoxication, both on patients or cadavers. The investigations must always include a urinary screening for opiates, and the request for a second level analysis with molecule dosage in cases of positivity or in cases of strong suspicion for assumption. In cases of intoxication in a family context of drug addiction, it is necessary to investigate the chronicity of the intake through hair analysis and evaluate the possible co-administration of other drugs. In conclusion, we suggest a protocol, applicable both on patients or cadavers, which can be useful for physicians and forensic pathologists in order to promptly identify these cases and allow for the reporting of them to the judicial authorities with the adoption of strict prevention and control measures.

Cadmium (Cd) toxicity poses a significant threat to human health and the environment due to its widespread occurrence and persistence. In recent years, considerable attention has been directed towards exploring natural compounds with potential protective effects against Cd-induced toxicity. Among these compounds, resveratrol (RV) has emerged as a promising candidate, demonstrating a range of beneficial effects attributed to its antioxidant and anti-inflammatory properties. This literature review systematically evaluates the protective role of RV against Cd toxicity, considering the various mechanisms of action involved. A comprehensive analysis of both in vitro and in vivo studies is conducted to provide a comprehensive understanding of RV efficacy in mitigating Cd-induced damage. Additionally, this review highlights the importance of phytoremediation strategies in addressing Cd contamination, emphasizing the potential of RV in enhancing the efficiency of such remediation techniques. Through the integration of diverse research findings, this review underscores the therapeutic potential of RV in combating Cd toxicity and underscores the need for further investigation to elucidate its precise mechanisms of action and optimize its application in environmental and clinical settings.

An outbreak of acute encephalopathy occurred in pregnant ewes and their newborn lambs associated with consumption of Talisia esculenta fruits and bark. Clinical signs in 5 adult pregnant ewes included drooling, bloat, tachypnea, depression, ataxia, body shaking, difficulty in rising, and recumbency. Three neonatal lambs born to some of those ewes had similar clinical signs. No significant gross abnormalities were observed on autopsy. Histologically, neuronal necrosis, axonal and dendritic swelling, and loss of Purkinje neurons were observed in the cerebellum. The observation of similar neurologic clinical signs and lesions in pregnant ewes and their neonatal lambs suggests that the toxic principle of T. esculenta crosses the placenta and reaches the fetus.

Abstract Background Renal dysfunction is one of the adverse effects observed in methamphetamine (MET) or tramadol abusers. In this study, we aimed to review articles involving intoxication with MET or tramadol to assess the occurrence of renal dysfunction. Methods Two researchers systematically searched PubMed, Scopus, Web of Sciences, and Google Scholar databases from 2000 to 2022. All articles that assessed renal function indexes including creatine, Blood Urea Nitrogen (BUN), and Creatine phosphokinase (CPK) in MET and tramadol intoxication at the time of admission in hospitals were included. We applied random effect model with Knapp-Hartung adjustment for meta-analysis using STATA.16 software and reported outcomes with pooled Weighted Mean (WM). Results Pooled WM for BUN was 29.85 (95% CI, 21.25–38.46) in tramadol intoxication and 31.64(95% CI, 12.71–50.57) in MET intoxication. Pooled WM for creatinine in tramadol and MET intoxication was respectively 1.04 (95% CI, 0.84–1.25) and 1.35 (95% CI, 1.13–1.56). Also, pooled WM for CPK was 397.68(376.42-418.94) in tramadol and 909.87(549.98-1269.76) in MET intoxication. No significance was observed in publication bias and heterogeneity tests. Conclusion Our findings showed that tramadol or MET intoxication is associated with a considerably increased risk of renal dysfunction that may result in organ failure.

Introduction:We aimed to compare the patient reported ingested and blood paracetamol concentrations (BPC) and to investigate the indications for N-acetylcysteine (NAC) administration in referred patients.Methods:This is a retrospective study of acute paracetamol intoxications (API) at the tertiary paediatric emergency department (ED) between June 2015-June 2019. We evaluated the demographics, cause of intoxications, reported doses (mg/kg), BPCs (8/4/12/16 and/or 24th hours). Indications of antidote usage and referral to ED were accepted as BPC >150 mg/kg.Results:Overall, we reviewed 117 cases of acute API. The mean age was 8.97 (±6.0) years, and 68.3% were female. The reported ingested of paracetamol (RIP) median dose was 2725 mg (mean 138±51.9 mg/kg). Adolescents had a significantly higher RIP than that of younger subjects (p150 mg/kg, physicians at the first healthcare facility tended to administer activated charcoal (90.9%), gastric lavage (68%) and intravenous NAC (48%). The referring healthcare facility physicians-initiated NAC particularly for patients who reported ingesting >150 mg/kg (p=0.001).Conclusion:RIP doses should not be used to determine the need for NAC. The antidote should be used in centres where BPCs are not available or in a group of patients who cannot be transferred to a referral centre within the first eight hours.

Clozapine is a frequently used antipsychotic that, in case of overdose, can cause severe adverse side effects, such as hematological, cardiovascular, and neurological complications. As there is no specific antidote or reversal agent available, extracorporeal techniques such as CytoSorb hemoadsorption might represent a viable option, having already been used in a variety of intoxication scenarios with favorable rates of success. A 56-year-old male was admitted with generalized epileptic seizures and arrhythmias following ingestion of clozapine in a suicide attempt (5,000 mg). Subsequently, conventional supportive care was initiated. To accelerate drug removal, continuous veno-venous hemodiafiltration including the application of CytoSorb hemoadsorption therapy was started. Serial measurements confirmed rapid reduction of clozapine plasma levels. The patient remained hemodynamically stable throughout this period. Furthermore, there were no cardiac arrhythmias detected and liver values were normal. The patient improved and was successfully extubated 3 days after admission with good vigilance and no residual neurological abnormalities. This is the first clinical case report on the use of CytoSorb hemoadsorption in severe clozapine intoxication which helped quickly and efficiently reduce clozapine levels to nontoxic serum levels while preserving organ function. Therefore, CytoSorb might represent an alternative treatment modality to be considered for potentially lethal clozapine intoxications.

Thallium poisoning is usually accidental. We present a case of a 51-year-old woman who was evaluated in June 2018 for myalgia, vertigo, asthenia, and abdominal pain. Physical examination revealed temporal-spatial disorientation, jaundice, and asterixis. The laboratory reported the following: bilirubin, 10.3 mg/dL; aspartate transaminase, 78 U/L; alanine transaminase, 194 U/L; albumin, 2.3 g/dL; prothrombin time, 40%; and platelet count, 60,000/mm3. Serology performed for hepatitis A, B, and C; Epstein-Barr virus; cytomegalovirus; and human immunodeficiency virus was negative, and a collagenogram was negative. Physical reevaluation revealed alopecia on the scalp, armpits, and eyebrows; macules on the face; plantar hyperkeratosis; and ulcers on the lower limbs. Tests for lead, arsenic, copper, and mercury were carried out, which were normal; however, elevated urinary thallium (540 µg/g; range, 0.4–10 µg/g) was observed. The patient was treated with D-penicillamine 1,000 mg/day and recovered her urinary thallium levels were within normal range at annual follow-up. Thallium poisoning is extremely rare and can be fatal in small doses. An adequate clinical approach can facilitate early diagnosis.

Abstract The objective of this case report is to describe the use of extracorporeal therapy, specifically hemodialfiltration, for the treatment of caffeine intoxication. A 12 year old Border Terrier consumed up to 1440 mg/kg of caffeine and rapidly developed clinical signs of tachycardia and tremors. Hemodiafiltration was instituted, using an M60 PrismaFlex cartridge using blood to prime the system due to patient size. Treatment with 11.25 L of therapy fluid (83% dialysate, 17% replacement fluid), or 1.8 L/kg, was provided over 6 h. Pre‐treatment serum caffeine concentration of 233 µg/mL was decreased by 89% to 25 µg/nL by the end of treatment. Despite prompt institution of extracorporeal toxin removal therapy, ventricular ectopy developed necessitating sotolol treatment for the following week. Caffeine is efficiently removed via hemodialysis, as predicted by small size, small volume of distribution, and minimal protein binding. A CRRT platform can be used to provide adequate clearance.

IntroductionFungi that produce mycotoxins can grow on certain food products, such as grains and feed, and can cause a variety of health issues if consumed by animals, including chickens. The use of spray-dried plasma (SDP) is one strategy for combating the health problems caused by mycotoxins.Materials and methodsIn the present study, Ross 308 chickens (n = 960) were divided into four treatment groups. T1 group was given a control diet (corn–soybean meal), T2 group was given a control diet +2% SDP, T3 group was given a control diet +2% SDP + mixture mycotoxins and T4 group was givena control diet + mycotoxin mixture.ResultsThe presence of SDP resulted in weight gain and decreased feed efficiency, whereas mycotoxins resulted in weight loss and increased feed efficiency. SDP increased the thymus’ relative weight. The presence of mycotoxins increased the heterophile/lymphocyte ratio. The presence of mycotoxins reduced the production of IL-2 and macrophage inflammatory protein-3 Alpha (MIP-3a), whereas the presence of SDP increased the production of macrophage colony-stimulating Factor (M-CSF). SDP resulted in higher IgA concentrations in the intestinal and tracheal washes than mycotoxin. Finally, adding SDP to broiler diets boosts weight gain, feed efficiency, and immune system development.DiscussionOur results provide information supporting that SDP is a promising tool for improving poultry immunity and performance.

Background: This study evaluates the role of oral melatonin in improving vision in methanol toxicity since vision disorders are one of the side effects related to methanol toxicity and assumes the potential effects of melatonin in protecting neurons and optic nerves. Meanwhile, little attention has been paid by researchers to the effect of melatonin in these patients. Methods: A double-blind randomized controlled clinical trial study was conducted on 40 patients diagnosed with methanol toxicity who were referred to Khorshid Hospital of Isfahan City, Iran, from May 2022 to May 2023. These patients were randomly divided into two groups. In the first group (the intervention group), in addition to the usual treatment, the patients were prescribed orally 3 mg of melatonin every morning and 6 mg of melatonin every night for 10 days. In the second group (the control group), in addition to the usual treatment, a placebo was administered similar to the intervention group protocol. Then, the clinical and vision parameters of the patients were evaluated before, during, and after the intervention. Results: The mean pH, PCO2 and HCO3 increased significantly after the intervention compared to the pre-intervention in both groups (P0.05). The most common visual complication caused by methadone toxicity was blurred vision with 71.4% and 90% in the melatonin and non-melatonin groups, respectively. Visual complications improved significantly after the intervention compared to the pre-intervention; accordingly, the complete improvement of vision complications in the melatonin group (76.2%) was significantly more than the non-melatonin group (53.3%) (P=0.040). Conclusion: Melatonin improves blurred or snowfield vision in methanol poisoning. Therefore, the administration of melatonin plus routine treatment can be effective in improving vision disorders (blurred or snowfield vision) caused by methanol poisoning.

BackgroundSocioeconomic factors and the COVID-19 pandemic influence children’s physical and mental health. We aimed to investigate the association between a census tract’s median household income [MHI in United States Dollars ($)] and pediatric intoxications in Rhode Island, the smallest state in the United States of America. Geographical hotspots, as well as interactions with the COVID-19 pandemic, should be identified.MethodsThis study is a retrospective analysis of ambulance calls for pediatric (

Introduction and purpose: E-cigarettes have emerged as an alternative to traditional tobacco smoking. Toxicological studies have investigated the composition and potential toxicity of e-cigarette liquid components. While they are generally considered less harmful than combustible cigarettes, cases of poisoning associated with e-cigarette liquid ingestion or exposure have been reported. Brief description of the state of knowledge: Nicotine intoxication resulting from e-cigarette liquid ingestion can lead to a range of symptoms and complications, including cardiovascular effects, neurological symptoms, gastrointestinal disturbances, respiratory issues, and even death. This report presents a case of a 58-year-old woman hospitalized in the Toxicology and Cardiology Department due to poisoning with e-cigarette liquid. Conclusions: Accidental or intentional ingestion and/or injection of e-liquid is becoming a new emerging challenge for Emergency Medicine, mainly because of the easy accessibility of advertisements and the sales of e-cigarettes online, and the high nicotine concentration in e-liquids. It is important to report instances of e-liquid-related nicotine intoxication in order to improve the legal restrictions on the sale of e-liquid.

AbstractPrallethrin ingestion and/or aspiration can manifest in a wide range of systemic effects. Evidence-based management of chemical pneumonitis following prallethrin aspiration does not exist yet. This case presents an unusual course of illness following prallethrin ingestion/aspiration that responded to antibiotics and steroid use. This is a previously well 22-month-old boy presented to the Emergency Department (ED) with a history of estimated 20 mL ingestion/aspiration of insecticide containing prallethrin 1.6% one hour earlier. The patient had bluish discoloration of his face, with eye tearing, drooling, and frothy secretions from his mouth. The patient was admitted for supportive care and observation. During his four days of admission, he progressively improved and returned to his previously healthy baseline. However, four hours after his discharge, he relapsed and was readmitted with an impression of superimposed pneumonia. During his second course of illness, the patient had worsening of his respiratory status requiring escalation of oxygen therapy and antibiotics. The patient received 21 days of intravenous (IV) antibiotics, and steroids, and was discharged on inhaled salbutamol and fluticasone. In conclusion, pyrethroid aspiration can lead to severe pneumonitis and secondary superimposed bacterial infection.

Résumé Le Daturastramonium est une plante de la famille des Solanacées. Elle contient une variété d’alcaloïdes tropaniques toxiques dont la consommation peut entraîner une toxicité anticholinergique grave. Nous rapportons le cas d’une intoxication accidentelle chez un enfant âgé de 7 ans qui a été amené par sa mère aux urgences pour des troubles du comportement et des nausées d’installation aigüe. A l’examen, l’enfant présentait une agitation, des hallucinations visuelles et une mydriase bilatérale qui se sont améliorées sous benzodiazépine. L’interrogatoire a révélé l’ingestion de graines identifiées comme appartenant au Datu­ra Stramonium. Le diagnostic reposait sur les données anamnestiques et cliniques. Le traitement était essentiellement symptomatique et le pronostic était favorable Abstract Datura Stramonium is a plant of the Solanaceae family. It contains a variety of toxic tropanic alkaloids whose consumption may cause severe anticholinergic toxicity. We report the case of 7 year-old who suffered accidental poisoning, the child was brought by his mother to the emergency department for acute nausea and behavioral disorders. On examination the child was agitated, had visual hallucinations and bilateral mydriasis, which improved under benzodiazepine. Interrogation revealed the ingestion of seeds identi­fied as belonging to Datura Stramonium. The diagnosis was based on anamnestic and clinical data. The treatment was primarily symptomatic and prognosis was favorable.

AbstractColchicine is a tricyclic alkaloid that has both medicinal and poisonous properties. Colchicine poisoning is a life-threatening condition with high mortality.A 13-year-old girl presented to our department with vomiting, abdominal pain, and fever. She appeared generally ill with hypotension. Laboratory tests revealed thrombocytopenia, hyponatremia, acute kidney injury, elevated INR, markedly elevated troponin concentration (6721 pg/L), and elevated C-reactive protein (337 mg/L). Differential diagnoses were septic shock or pediatric inflammatory multisystem syndrome. She received hemodynamic support, empiric antibiotics, intravenous immunoglobulin, methylprednisolone, acetylsalicylic acid, and vitamin K. Her condition worsened, and she developed visual and auditory hallucinations on day 5. We then suspected drug intoxication, particularly with colchicine, which her mother took for Behçet’s disease. Blood testing revealed a high colchicine concentration, and the patient admitted to ingesting 40 tablets of colchicine in a suicide attempt. She developed frontal alopecia on day 10. She was discharged on day 17 with psychiatric follow-up.Despite the initial delayed diagnosis of colchicine poisoning, supportive treatment with corticosteroids and immunoglobulin may have saved the adolescent. Future research may determine whether either of these is effective in treatment of severe colchicine intoxication.

Background: Self-discharge is a risk factor for readmission and excess mortality. We assess the rate of self-discharge from the emergency department (ED) among presentations for acute recreational drug toxicity and identify factors associated with self-discharge. Methods: From the Euro-DEN Plus database of presentations to the ED with acute recreational drug toxicity, we extracted data from 11 centres in seven European countries from 2014 to 2017. Self-discharge was defined as taking one's own discharge or escaping from the ED before being medically cleared. We used multiple logistic regression analyses to look for factors associated with self-discharge. Results: Among 15,135 included presentations, 1807 (11.9%) self-discharged. Self-discharge rates varied from 1.7 to 17.1% between centres. Synthetic cannabinoids were associated with self-discharge, adjusted odds ratio 1.44 (95% confidence interval 1.10–1.89), as were heroin, 1.44 (1.26–1.64), agitation, 1.27 (1.10–1.46), and naloxone treatment, 1.27 (1.07–1.51), while sedation protected from self-discharge, 0.38 (0.30–0.48). Conclusion: One in eight presentations self-discharged. There was a large variation in self-discharge rates across the participating centres, possibly partly reflecting different discharge procedures and practices. Measures to improve the management of agitation and cautious administration of naloxone to avoid opioid withdrawal symptoms may be approaches worth exploring to reduce self-discharge. [ABSTRACT FROM AUTHOR]