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Introduction and purpose: Digoxin, a cardiac glycoside derived from Digitalis lanata, has stood as a cornerstone in the treatment of various cardiovascular disorders for centuries. This study aims to delve into the demographic aspects, clinical characteristics, and outcomes associated with Digoxin poisoning. By drawing upon a dataset involving 22 patients hospitalized for Digoxin intoxication at the Clinical Department of Toxicology and Cardiology in Lublin, Poland, spanning from April 2014 to December 2023, our investigation seeks to provide an understanding of this issue. Brief description of the state of knowledge: Despite the efficacy of Digoxin, the potential risk of intoxication, especially in the elderly, necessitate a comprehensive examination. Age-related changes, such as declining renal function, electrolyte imbalances, comorbidities and polypharmacy affect how drugs like Digoxin work. The symptoms of Digoxin poisoning can manifest in various organ systems such as cardiovascular, gastrointestinal, nervous system, highlighting the importance of prompt recognition to seek medical attention. Methods and results: In our study, we analyzed data from 22 patients hospitalized due to Digoxin intoxication, focusing on demographic aspects, clinical characteristics and outcomes. The cases of Digoxin poisoning were categorized according to several factors, including the quantity and nature of substances consumed, the cause of intoxication, gender, age brackets, health conditions, peak serum Digoxin levels, length and outcomes of hospitalization. Conclusions: Our study provides insights into the characteristics and outcomes of patients hospitalized due to Digoxin intoxication. The findings underscore the association of Digoxin poisoning, and emphasize the importance of monitoring serum levels to prevent adverse outcomes. As Digoxin continues to be relevant in treating cardiovascular conditions, our study calls for careful management and monitoring.

Introduction and Aim: Adolescent suicide attempts are a significant clinical and social issue. Often, young people resort to medications, alcohol, or psychoactive substances in their suicide attempts. The aim of this study was to analyze the factors contributing to suicidal behaviors and the characteristics of substances used by adolescents for suicidal purposes. Materials and Methods: In this retrospective study, medical documentation analysis was used. The study included the medical records of 45 individuals up to 18 years of age who were admitted to the Clinical Toxicology-Cardiology Department due to poisoning for the purpose of suicide in the year 2022. Results: The study group consisted of 45 individuals aged 15 to 18 years. Suicide attempts accounted for 37.5% of toxicology hospitalizations in the under 18 age group. The dominant group consisted of females (82.2%) and urban residents (62.2%). Those hospitalized following a suicide attempt primarily used medications, often over-the-counter analgesics. The majority (71.1%) suffered from mental disorders, predominantly depressive disorders (81.2%). Conclusions: Among suicide attempts involving intoxication, those utilizing medications are dominant. A concerning phenomenon is the use of over-the-counter (OTC) medications, commonly considered safe. Girls are particularly vulnerable to emotional difficulties that can lead to suicide. Mental disorders pose a suicidal risk, and patients with such disorders have access to psychiatric medications that can become tools for self-harm.

Introduction and purpose: Detergents are compounds that constitute the main component of cleaning products. Due to their varied chemical structure, they have different functions and a wide range of applications. The aim of this study is to draw attention to the problem of toxic effects of detergents on the basis of analysis of cases of detergent poisoning by patients of the Toxicology and Cardiology Ward of the Stefan Cardinal Wyszyński Provincial Hospital in Lublin. Material and methods: The study was retrospective in nature. It used an analysis of the medical records of 11707 intoxications in patients between 01.01.2013 and 31.12.2022, from which a group of individuals with a diagnosis of T55 according to the ICD 10 classification "Toxic effects of soaps and detergents" consisting of 36 cases was selected. Results: The study population consisted of 18 (50%) women and 18 (50%) men. The majority- 19 patients (52.78%) were exposed to the toxic effects of detergents accidentally. 10 patients (27.78%) were suicide attempts. Accompanying medical conditions were mostly psychiatric disorders, with alcohol dependence syndrome predominating - 9 cases (25%). The majority - 33 patients (91.67%) intoxified themselves with detergents in the form of liquids and solids by the oral route . Conclusions: Despite their usefulness in households and industry, detergents contribute to adverse health effects in situations of accidental exposure or intentional intake. In order to reduce the number of complications, preventive measures should be implemented - such as storing detergents in less accessible areas, in original boxes with retained labels, and increasing funding for psychological-psychiatric care in a crisis situation.

Introduction: Poisonings with non-beverage alcohols remain a significant problem in contemporary toxicology. Due to the large quantity and severe course of intoxications with methanol, the authors of this study focused primarily on poisonings with this substance. Methanol is widely used in industry. Its toxicity is attributed to its metabolites - formaldehyde and formic acid. Poisonings with methanol often lead to the patient's death due to a wide range of complications associated with progressive metabolic acidosis. Material and Methods: The study is of a retrospective nature. It involved the analysis of medical records of patients admitted to the department of toxicology in 2022 after the consumption of non-beverage alcohols, with a particular focus on methanol. Data on the number of individuals admitted due to non-beverage alcohol intoxication between 2018 and 2022 was also analyzed. Results: Over the last 5 years (2018-2022), 36 individuals were hospitalized in the Clinical Toxicological-Cardiological Department due to non-beverage alcohol poisoning, with 16 (44.4%) cases involving methanol. In the year 2022, the department admitted 10 individuals aged 18 to 68, and 5 (50%) of them consumed methanol. Among the hospitalized, 90% were male, and 60% came from rural areas. Deliberate intoxications accounted for 70% of the cases. Four hospitalizations (40%) resulted in patient death. All deaths were associated with methanol intoxication. Conclusions: Non-beverage alcohol is often used by people with alcohol dependence syndrome. Among non-beverage alcohols, patients most often reached for methanol. Its consumption is associated with a high mortality rate and should be taken very seriously and treated immediately.

Introduction and purpose: Poisoning among children and adolescents is occurring on an ever-increasing scale. Women are particularly susceptible to intentional poisoning, and they predominate in the statistics of self-poisoning. The aim of the study is to analyze cases of poisoning in girls under 18 years of age hospitalized in the Clinical Toxicology and Cardiology Department of the Stefan Cardinal Wyszynski Regional Hospital in Lublin in 2022, taking into account the type of substance ingested, the place of residence of the patients and comorbidities. Material and methods: The study was retrospective in nature. It used the analysis of medical records of 84 cases of intoxication in girls under 18 years of age. Results: During the time period studied, 84 girls aged 13-18 were hospitalized for poisoning. Most of the cases were urban residents (64.3%). The toxic substances causing poisoning were mainly drugs (63.1%), narcotics (17.9%) and ethanol (17.8%). Poisoning of an intentional nature involved 80 (95.2%) cases, 37 (44%) cases were suicide attempts. In 54 (64.3%) cases, the patient was burdened with a mental illness, the most common being depressive disorders. There were no deaths in the study group. Conclusions: Due to the increasing phenomenon of mental disorders, as well as intentional poisoning among adolescent girls, special emphasis should be placed on psychological care, pedagogical care, of girls in adolescence. This is the time when girls have problems with acceptance of their bodies, with acceptance among peers. Parents and teachers should be made aware of this.

Introduction and purpose: Drug poisoning is one of the more common reasons for patients being hospitalized in toxicology wards. The wide availability and ease of obtaining a wide variety of drugs and supplements are the cause of adverse reactions associated with their use. Increasing life expectancy and emerging chronic diseases also require the use of sometimes many drugs to control people's health. This can lead to poly-pragmasy, which is an undesirable condition and leads to poisoning. The purpose of our work is to demonstrate the most common causes of drug poisoning considering the criterion of division according to ICD-10. Brief description of the state of knowledge: Any preparation, drug, supplement can cause negative effects on the organism. This depends on the dose, improper use, or cross-reactions of the relevant substances. The study compiled statistics on the cause of hospitalization of drug-poisoned patients based on ICD-10. 5433 patients were included in the study. Conclusions: Our work shows that the most common causes of hospitalization due to drug poisoning are those caused by antiepileptic drugs, sedative-hypnotics and antiparkinsonism medications. The data compiled in this article agree with scientific reports from different countries compiling the most common reason for hospitalization related to drug poisoning.

Introduction and aim: Paracetamol (acetaminophen) is a commonly used analgesics and antipyretics and it is a nonprescription medicine. Improper use of it may lead to accidental or intentional poisoning. The aim of the study was to analyse paracetamol poisonings in children and adolescents admitted to the Clinical Department of Toxicology and Cardiology in Stefan Wyszyński Regional Specialist Hospital in Lublin in 2022. Material and methods: The research was retrospective. Medical records of poisoning cases in patients up to the age of 18 were analysed specifically emphasizing acetaminophen poisonings. Results: In the studied period 120 adolescents were hospitalized due to intoxication, 65 of them due to medications intake, the most commonly used medicine was acetaminophen. There were 20 cases of hospitalization because of acetaminophen intake, 17 (85%) patients were female and 3 (15%) of them were male. Patients were from 15 to 17 years old. In 12 cases (60%) patients came from urban areas. The intentional intoxications were found in 18 (90%) cases, 13 of them were suicide attempt. Majority of cases of attempted suicide were female (92%). The other intoxications were accidental, where patients took acetaminophen as a painkiller. In the researched group there were no deaths. Conclusions: Paracetamol overdosing is always associated with the risk of liver damage.This medicament as a potentially hepatotoxic drug should not be sold over the counter. The availability of paracetamol is too widespread, which poses a risk especially to children and adolescents. The ubiquitous advertising of acetaminophen products as well as their popular use, for example, in menstrual pain, favor their presence in almost every Polish home. Parents and guardians should be educated about the dangers of uncontrolled use of so-called OTC drugs - incorrectly commonly considered safe.

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.

Introduction and purpose: Poisoning in children and adolescents remain a serious medical, psychological and social problem. The aim of the study was to analyse poisonings in patients up to 18 years old admitted to the Clinical Department of Toxicology and Cardiology in Stefan Wyszyński Regional Specialist Hospital in Lublin in 2022. Material and method: The research was retrospective. Medical records of 120 cases of poisoning in patients up to the age of 18 were analysed. Results: In the studied period 120 patients from 13 to 18 years old were hospitalized due to intoxication, 84 (70%) of them were female and 36 (30%) of them were male. Majority of cases came from urban areas (69,2%). The most frequent causes of poisonings were medicaments (55%), drugs (29,2%) and alcohol (28,3%). The intentional intoxications were found in 113 (94,2%) cases, 45 (39,8%) of them were suicide attempt. Mental diseases were found in 71 (59,1%) cases, the most common one was depressive disorder. There were no deaths in the researched group. Conclusions: Because of the relevance of child patients poisoning young people should be provided with psychological care. Female teenagers must get special kind of support. The availability of child psychiatrists and psychologists is still too poor. Prohibition of selling alcohol to minors should be enforced stricly. It seems that acces to OTC drugs is way much too easy for people. There is a necessity of parents’education about children poisoning.

Introduction Clinical manifestation of organophosphates toxicity may be differentiate and include cholinergic toxidrome, intermediate syndrome, OP-induced delayed polyneuropathy to chronic OP-induced neuropsychiatric disorder (OPIDN). Patients symptoms, along with decrease in cholinesterase serum level, determines the possible diagnosis of organophosphate poisoning. Objective The aim of the study was to present the clinical manifestation and cholinesterase level changes in intoxication with organophosphorus compounds in patients. Material and methods A data base was created by analysis of the hospital documents of 34 patients hospitalized due to organophosphate intoxication. Statistical analysis involved frequency tables with percentage values, the application of non-parametric Chi-square test and parametric t-Student test (with homogeneity of variance Levine test). The level of static significance was set to p=0.05. Results In fatal hospitalizations (20.6%), cholinesterase level was significantly lower (265.87 U/l) than in other patients (4254.78 U/l; p

During the autumn season, it is common for mushroom pickers to eat poisonous mushrooms. This is due to many reasons, including the ignorance of pickers. The most common is the misidentification of inedible species as edible mushrooms. The result is poisoning, which in many cases requires hospitalization. This paper presents a case report of toadstool poisoning by a 62-year-old female patient. In addition, other relevant publications on intoxication, diagnostic methods and treatment are reviewed. The purpose of this paper is to present the management and treatment of a case of toadstool poisoning. The effects of mushroom poisoning can range from mild disorders, mainly gastrointestinal to organ failure and even death. Significant elevations of liver enzymes and prothrombin time are important in laboratory tests in cases of intoxication. Treatment most often involves specific antidotes, such as Sylimarin, Acetylcysteine. The diagnosis in most cases is made on the basis of the clinical picture and a thorough interview with the patient, and the diagnosis is established by detecting toxins in a urine test. The prognosis is better if patients with toadstool poisoning are admitted to the hospital early. It is worth noting that gastrointestinal syndromes can also result from eating raw or inadequately cooked mushrooms, and by eating them excessively or too often. Proper diagnosis and treatment of mushroom poisoning can save lives. It is very important to raise public awareness of mushroom poisoning, as well as early detection of potential signs of intoxication. Cooperation with the poison center and mycologists is very important, especially in high-risk cases.

INTRODUCTION Paracetamol is one of the most widely used analgesics and antipyretics in the world. An overdose of this drug can occur after a single ingestion of a large amount of paracetamol or after repeated ingestion of smaller amounts that eventually exceed the recommended total dose and can result in liver damage. It is believed that the maximum daily dose of paracetamol for an adult is 4g. MATERIALS AND METHOD Patient information was collected from hospital records available in the clinical toxicology department. In addition, we conducted a literature review on paracetamol using PubMed. CASE REPORT A patient, 16 years old, was admitted from a district hospital to the Clinical Toxicology and Cardiology Department in Lublin for paracetamol intoxication and suspected intoxication with a psychoactive substance. The patient's history revealed that he had taken a total of 20 paracetamol 500mg (10g) tablets in short intervals of 2 h for abdominal pain. The patient was treated with a full dose of antidote (ACC), and the drug infusion was continued at a maintenance dose. Despite the treatment administered, increasing features of liver damage were observed (INR 2.78, AST 6273 U/l, ALT 8854 U/l, bilirubin 3.83 mg/dl).The patient was consulted to qualify for a possible liver transplant. With intensive treatment maintained, a downward trend in liver damage parameters was achieved. The patient was discharged from the Department in good general condition, without complaints. CONCLUSION Due to the increasing number of paracetamol overdoses (intentional or accidental), strategies should be implemented to raise awareness and prevent this-educating patients, encouraging label/leaflet reading, reducing the amount of paracetamol in packages, more visible warnings on packages.

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.

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.

Introduction Verapamil is a widely used cardiac drug. It belongs to the non-dihydropiridine subgroup of calcium channel blockers (CCBs), and is used mainly for the treatment of atrial dysrhythmias, hypertension or angina. In this article, we describe a case of poisoning with verapamil mixed with ethanol and review current treatment options. A 54-year-old female was admitted to the Toxicology Clinic by emergency medical services after ingesting sustained-release CCBs and ethanol in a suicidal attempt. The patient was successfully treated by administration of catecholamines and calcium, and the introduction of a high-dose insulin infusion (HDI). Conclusions This case report emphasizes that even in severe poisoning, early and proper intervention may prevent circulatory breakdown. It also summarizes treatment options in patients after verapamil overdose. Along with decontamination, administration of catecholamines and correcting electrolyte abnormalities, the main options are HDI and lipid emulsion therapy (LET)

Introduction and purpose: Designer drugs also known as legal highs, research chemicals or herbal highs become more and more popular not only in Poland but also in other countries around the world. That might have many reasons but the most crucial is their easy availability and rather cheap price in comparison to other psychoactive substances. Material and methods: We analyzed the data of patients hospitalized in years 2013-2018 in the Toxicology Department in Lublin and evaluated patients hospitalized due to psychoactive substance poisoningT40 according to ICD10). Moreover the review of available scientific articles was done. Results: After analysis the data of patients hospitalized in years 2013-2018 we can observe increasing tendency of poisonings. The growing number of designer drug poisonings may be the result of many factors - the phenomenon of these substances is based not only on a wide range of products, but also on various advertising strategies and patterns of use. Conclusions: There can occur big diagnostic difficulties due to unpredictability of the course of poisoning and unpredictability of composition. Therefore it is very important to react quickly and choose the right treatment. Many of these poisonings are really severe and often cause death. It is worth saying that side effects occur more often in combined preparations. It is also very important to educate young people and warn against using NPS, which are particularly dangerous and risky for human organism.

Poland is among the infamous leaders among countries when it comes to the percentage of suicide attempts among young people. Methadone is a long-acting opioid agonist, which is mainly used as substitution treatment for heroin and morphine addiction. There is a typical triad for methadone overdose consisting of respiratory failure, myopic pupils and central nervous system depression. It may also lead to QT prolongation with following torsade de pointes. We present two teenager patients, who were poisoned with methadone. They were both under the influence of their boyfriend who was drug addicted. What is more, the girls both were in toxic relationship with the same man, who had similar influence on them. First patient was 18 years old. She was admitted to Department of Toxicology and Cardiology because of intravenous methadone overdose. The treatment used improved the general condition. No abnormalities were seen in the clinical examination. Teenager was examined by psychiatrist and psychologist. Second patient, 16 years old, was hospitalized twice. Teenager admitted that she got methadone from her boyfriend who is being treated for drug addiction. At the time of admission, the patient was emotionally disturbed, tearful, and periodically aroused. After two days of hospitalization girl was discharged home under mother’s protection. Three months later, 16 years old patient was admitted to the hospital again, because of intoxication with psychoactive substances and self-injuries. After three days of hospitalization, she was transferred to psychiatric hospital for further therapy. We can indicate methadone use not only as methadone’s level in urine, but also as EDDP, methadone’s metabolite concentration in urine. Every person with symptoms of behavioural disorder should be as fast as possible be examined by psychiatrist and psychologist, to avoid suicide attempts.

Introduction Despite developing strategies for treatment of people with schizophrenia, earlier mortality rate is still observed in this group of patients. One of the major causes remains suicides due to drug overdose. Main approach to the treatment of schizophrenia is pharmacotherapy that is based on antipsychotics. Yet, in order to sustain patients well being, medicaments from other groups may be introduced. Pharmacological treatment should be accompanied by psychotherapy to prevent suicidal attempts. Case report A 28 years old woman diagnosed with paranoid schizophrenia was brought by the ambulance and admitted to the Clinical Toxicology Department due to deliberate drug overdose. Her history indicated previous suicidal attempt. A patient took all her psychiatric medications that included 240 tablets of quetiapine (Ketrel a 200 mg), 100 tablets of zuclopenthixol (Clopixol a 25 mg), 100 tables of chlorprotixen, several tablets of escitalopram (Aciprex) and 12 tablets of bisoprolol (Bibloc a 5 mg) - in summary around 470 tablets. This suicidal attempt was probably the cause of abrupt drugs withdrawal after discharge from recent hospitalization in psychiatric department. Complications involved allo- and autodisorientation, enhancement of imperative auditory hallucinations and psychotic symptoms, respiratory failure and aspiration pneumonia. After admission, intensive symptomatic treatment was introduced in order to sustain living functions of the patients. Due to respiratory failure, she was in need of external mechanical ventilation. The end of hospitalization was followed by implementation of new drug (perazine) and transportation to Neuropsychiatric hospital for further diagnosis and treatment. Conclusion Process of pharmacotherapy in case of patients with schizophrenia should be continuously and precisely monitored by psychiatrists. Such control would minimize the chance of suicidal attempt. What is more, patient should not limit the therapy to drugs and psychiatric appointments, but also should attend to community health services.

Introduction Moya-Moya disease is a rare disease of unknown etiology that causes pathological occlusion changes in the large intracranial arteries - the internal carotid artery and the proximal parts of the anterior and middle cerebral arteries. The disease occurs most often among young Asian women, and its most intensive development falls on the first decade of life. In most cases, Moya-Moya occurs in the form of transient ischemic attacks, strokes or cerebral hemorrhages. Case report A 20-year-old woman was admitted to the Neurosurgery Clinic for the surgical treatment of Moya-Moya disease. Patient with paroxysmal paresis of left and right limbs several times since 2016. In CT, MRI and angio-MRI, as well as DSA, critical narrowing of the internal carotid arteries, obstruction of the anterior and central lights of the cerebral arteries, with small vessels around the central arteries and their branches marked - bilaterally, but mainly on the right. The changes create an image resembling "clouds of smoke" that is characteristic of Moya-Moya's disease. The patient was qualified for surgical treatment - revascularization of the cerebral cortex with the use of periosteal strips by multi-hole trepanation in the right fronto-temporo-parietal region. Periosteal stripes were introduced into the subarachnoid space to reproduce vessels of the cerebral cortex. Conclusion Because of the rarity of Moya Moya disease, it is very important to be alert vigilantly to avoid complications such as tetraparesis or mental retardation. Japanese surgery allows revascularization of the cerebral cortex without the need for an arterial bypass. The presented surgical method ensures good treatment effects and is preferred in young people due to the safety of the technique used. Keywords: Moya Moya disease, neurosurgery, hemorrhages

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.

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.

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.

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.

Introduction Suicidal risk caused by drug overdose is a considerable factor influencing earlier mortality among people with schizophrenia. An adjustment of effective pharmacological treatment is essential to sustain the stability of the patient. Commonly, the treatment divides to two groups: first generation antipsychotics (FGA) and second-generation antipsychotics (SGA). Yet, due to significant risk of depression and possible side effects of the drugs, other medicaments should also be introduced. Case report A 38 years old woman that was repeatedly hospitalized at the local ward, brought by ambulance and admitted to the Clinical Toxicology Department. She was admitted to the department for 20th time in period between April 2013 and May 2019 due to deliberate drug overdoses. During last hospitalization laboratory tests indicated presence of valproic acid (121,41 μg/ml). Moreover, psychiatric consultation revealed that although she was balanced state, she was not critical about her behavior. Patient was diagnosed with schizophrenia and mild intellectual disability. Each time, the intoxication was followed by medications from group of antipsychotics and tranquilizers used in treatment of the illness. Additionally, she confirmed that some of intoxications had suicidal attempt. 60% of hospitalizations of the patient were followed by stay in Neuropsychiatric hospital for further observation and treatment. Conclusion The administration of proper dosage of antipsychotics should be precisely controlled by the psychiatrist that takes care of the patient. For patients with greater suicidal risk, SGA are more recommended than FGA. Moreover, drugs from other groups such as antidepressants should also be introduced. Undoubtedly, efficient pharmacological treatment should be supported by psychotherapy of the patient.

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.

In Poland in 2016, there were almost 10,000 suicide attempts, in which about 55% ended up with death. Suicidal attempts are more often taken by women, but they are more effective in the case of men. Most of these people are afflicted with mental illness such as depression. A 49 year old man was admitted to Cardiology and Toxicology Department, because of poisoning with antipsychotic drugs and ethanol. It was his second suicide attempt. The day he was admitted to the hospital he was in serious condition. Patient was monitored, symptomatic treatment and pharmacotherapy were initiated. The patient required intubation and the use of respiratory therapy because of breathing problems. In the clinical study and imaging examinations massive pneumonia, was confirmed. His pharmacotherapy was modified and the antibiotics were given because of inflammation of a lungs. For patients poisoned by various substances, respiratory failure often has a complex medium. It may result from the depression itself of the xenobiotics on the respiratory system, the influence of the indirect mechanism of breathing or the result of aspiration and development of pneumonia. In therapy the most important is the monitoring of the patient's condition, electrolyte imbalance and symptomatic treatment. In a few cases and only for some drugs, we can use a specific antidote.

Introduction: Hydrogen peroxide is well soluble, odourless and colourless liquid with syrup consistency. It has different application depending on concentration. In 3% of concentration is present in almost every home as a disinfectant product, in higher concentration (35%) is used in pharmaceutical, chemical and cosmetic industry. The aim of the study: The purpose of this systemic review was to collect and analyse causes and possibilities of treatment a patient after ingestion a caustic substance. Material and method: Standard criteria were used to review the literature data. The search of articles in the PubMed and Google Scholar database was carried out using the following keywords: hydrogen peroxide, exposure, toxicology. Description of the state of knowledge: Exposure for hydrogen peroxide is not very common and most of the times is unintentional, except suicide attempts. Because it is a caustic substance and the main route of exposure is ingestion, most of symptoms are due to damage of gastrointestinal tract. However, the consequences of exposure range from short-time illness to brain damage or even death. Summary: Patient after exposure to >30% hydrogen peroxide should receive a complex treatment. Physicians need to be alert to the symptoms of not only gastrointestinal tract but also CNS. The patient may require specialized care by many specialists.

Backgrounds: Ethylene glycol poisoning is one of the heaviest poisonings in the toxicological practice of. Ethylene glycol is quickly absorbed from the digestive tract. Its toxicity is the result of combining few different mechanisms. Metabolites of decomposition, especially glycolic acid, are responsible for appearance of metabolic acidosis. Precipitated crystals of calcium oxalate additionally impair the function of organs such as kidneys, central nervous system (CNS) and circulatory system. Worldwide, from 2013 to 2018 about 30% of ethylene glycol poisoning cases end in death. Case report: We present the case of 56 years old woman, who was admitted to Toxicology Department because of ethylene glycol poisoning. We could observe presence of metabolic acidosis, respiratory insufficiency and organ damage. The patient has been treated pharmacologically and has been given specific antidote. Due to the ethylene glycol intoxication, metabolic acidosis and increasing parameters of kidney failure the patient also underwent hemodialysis. Conclusions: In pathogenesis of ethylene glycol poisoning toxic metabolits are crucial. The diagnosis of ethylene glycol is often a very hard task. In the clinical aspect it is based on the interview, a set of syndromes and biochemical tests and targeted toxicological tests. This kind of poisoning occur the most often among patients addicted to alcohol. It may lead to multi- organ damage or even death. It is very important to react quickly and implement pharmacotherapy and hemodialysis. The other essential aspect is to improve the level of knowledge of students and doctors about symptoms, diagnostics and proper proceeding with a patient poisoned with ethylene glycol. According to statistics and knowing how often the alcohol poisoning happens it is necessary to have knowledge in this field, be fluent in management and choosing methods of treatment in such cases.

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.

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.

Alcoholism is a disease in which person lose control over the amount of consumed alcohol. The problem of alcohol abuse in Poland concerns about 9% of the population. One of the treatment methods is disulfiram therapy, which is associated with the risk of disulfiram-alcohol reaction. Due to many negative reports of side effects and questionable efficacy, this drug is nowadays rare used. We present a case of a patient who had a disulfiram reaction due to alcohol consumption during disulfiram therapy.

Methanol is a toxic alcohol that can imitate ethanol in smell and taste. It has many household and industrial applications but can also be present in informally-produced alcoholic beverages. Methanol poisoning feature with high mortality and may be seen due to its intentional or unintentional ingestion. Metanol does not have significant intrinsic activity but its metabolites, especially format lead to severe metabolic acidosis, visual disturbances and neurological deficit. Diagnosis is mainly based upon the typical clinical course, metabolic acidosis with high osmolar gap and detection of methanol in plasma or urine. Recent guidelines recommend therapy using the competitive alcohol dehydrogenase inhibitors - fomepizol or ethanol. In cases of severe poisoning hemodialysis should be considered. We present a case of a 39-year-old male who was considered to Emergency Department due to consumed high amount of windshield washer fluid containing methanol. Intoxicated patient was unstable with respiratory insufficiency and consciousness impairment. Despite of implemented treatment - hemodialysis, ethanol infusion and active respiratory therapy - patient died on seventh day after admission to a hospital. Methanol poisonings feature with high mortality even when the best healthcare is provided. It depends mainly on a dose of ingested alcohol and delay in admission to a hospital.

Introduction: In Poland, mushrooms poisonings, are still quite often, especially in autumn. Each year, in our country 500-1000 cases of mushrooms poisoning are registered, from which 70% are adults, and 30% children. Amanita Phalloides, also known as a ‘death cap’ is one of the most poisonous mushrooms in our climatic zone, and is responsible for ca. 90-95 % of all deadly mushroom poisonings. Aim of the study: is to present an epidemiology of Amanita poisonings in a Lublin voivodeship in a last 5 years, as well as the up to date methods of managing this kind of poisonings. Materials and methods: Data comes from the database of the Department of the Toxicology of Medical University of Lublin. To present the methods of treatment, the analysis of the available publications was made. Results: In years 2013-2018 in a Clinical Department of Toxicology of the Medical University in Lublin, 78 patients were hospitalized because of the mushroom intoxication. 37 (47.5%) of them were male and 41 (52,5%) - women. In 27 patients (34%), the poisoning with Amanita Phalloides was confirmed. The most mushrooms poisonings occurred in 2017 (21). Mushroom poisoning is the most common in summer and autumn - the most cases occured in August, September and October. Discussion: First steps in case of suspecting amatoxins intoxication is to take the clinical history of the patient and start stabilizing measures. To confirm Amanita poisoning, a test that allows to detect α-amanitine in urine can be made. Several drug treatments have been applied in intoxications by amatoxins, from which the biggest role plays sylibin and N-acetylcystein.

Pesticides is a collective term for a group of chemicals used predominantly in agriculture and against vectors in vectorborne diseases such as malaria, filariasis, etc. Organophosphates (OP) have become nowadays the most widely used pesticides among the world. However, they are very highly toxic to humans. Poisoning with OP is a life - threatening condition. It is responsible for the symptoms due to a cholinergic effects. The Acetylcholinesterase (ACHE) enzyme inhibition leads to an acetylcholine accumulation, which causes symptoms such as diarrhea, sweating, vomiting, small pupils, muscle tremors, increased saliva and tears production and confusion. Other type of pesticides are also common used in agriculture. Glyphosate is a broad‐spectrum systemic herbicide used to kill weeds. It is promoted by the manufacturer as having no risks to human health. We present two patients with a fatal pesticide poisoning. First patient drank OP agent, which was decanted in a non-original bottle. Despite the intensive treatment, including high doses of atropine, and toxogonine, patient died after 6 days due to acute respiratory failure. The second one, tried to commit suicide by drinking 2 glasses of a pesticide called ‘Roundap’ (glyphosate). Short time after admission to a hospital, a myocardial infarction occurred. The patient died the same day, due to a cardiac arrest.