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Organophosphate (OP) poisoning is one of the most common causes of poisoning in the world, due to its easy availability, low cost, and wide occupational exposure. It has a significant death and morbidity rate. Cholinergic syndrome, intermediate syndrome (IMS), and syndrome of delayed polyneuropathy are the three primary syndromes that define OP poisoning. We report the case of a 44‑year‑old male patient who had a history of OP poisoning by inhalation and later developed altered mental status (AMS). The patient transiently improved and regained consciousness following treatment with atropine and obidoxime. He deteriorated the following day with AMS and generalized muscle weakness consistent with IMS and was intubated for airway protection. Despite further complication by Klebsiella and COVID‑19 infections, he recovered to hospital discharge on day 14. [ABSTRACT FROM AUTHOR]

Introduction: Methanol intoxication causes high anion gap metabolic acidosis in addition to Central Nervous System (CNS) depression. Benzodiazepines in co-ingestion with other CNS depressants as alcohol can cause significant respiratory depression. Liraglutide is a novel antidiabetic agent whose acute overdose is not well studied. This case report aimed to present a case with combined intake of the three above-mentioned chemicals. Case Description: A case of 43-year-old male not diabetic, not an alcohol consumer, uses benzodiazepines regularly for sleep disorders. The patient unintentionally took 10 tablets of benzodiazepines over a period of 24 hours, aiming to sleep. He also consumed one glass of ethanol containing methanol (used for disinfection). The patient was on liraglutide subcutaneous injections for weight loss, with one injection 2 days before admission. The night before admission, the patient first felt light headed and complained of blurring of vision. The condition progressed and the patient was taken to the emergency department where he presented with coma, apnea, and shock. On the arrival of the patient, he was intubated and mechanically ventilated for having a disturbed conscious level and apnea. Laboratory testing identified severe persistent mixed type acidosis, hypoglycemia, and urinary toxicology screen was positive for benzodiazepine. IV fluids, vasopressors, Dextrose, bicarbonate, flumazenil, vitamin B, and folinic acid were given. Although urgent haemodialysis was undertaken, acidosis continued. The patient passed away after 37 hours of intensive care unit admission. Conclusion: Combined exposure to alcohol and benzodiazepines can cause significant mixed type acidosis. CNS depression can result from combined alcohol, benzodiazepines, and prolonged hypoglycemia. [ABSTRACT FROM AUTHOR]

Snakebite is a significant public health issue in which venom-induced consumption coagulopathy is a common and serious complication that results from the activation of the coagulation pathway by snake toxins. We report a male patient, 56 y old, who was thought to have been bitten by a snake on his left foot. He was transported to a nearby hospital where he received analgesics and 3 snake polyvalent antivenom vials, and then he was transported to our hospital after 12 h. He presented with 2 small puncture wounds, pain, blistering, and edema of the left foot. On the 2nd day, the patient developed gingival bleeding and hematuria. Laboratory investigations upon admission revealed prothrombin time (PT) of more than 3 min, prothrombin concentration (PC) of less than 2.5%, and an international normalized ratio (INR) of 23.43. Further investigation of urine showed more than 100 RBCs. Despite receiving 16 packs of plasma and 40 snake polyvalent antivenom vials manufactured by VACSERA over 3 days, hemoglobin concentration and platelet count decreased with the appearance of jaundice, lactate dehydrogenase was 520, and reticulocytes were 3.5%. PT was more than 300 s, and INR was still over range. Plasmapheresis and corticosteroids were provided, which improved the patient's general condition, PT, PC, and INR, and the patient was discharged after 6 days of hospital stay. This case report indicated that plasmapheresis and corticosteroids were clinically efficient approaches in the management of snake envenomation unresponsive to antivenom.