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Olanzapine is a thienobenzodiazepine class antipsychotic that strongly antagonises the 5-HT2A serotonin receptor, but acute poisonings are reported rarely. Symptoms of an overdose include disorder of consciousness, hypersalivation, myosis, and coma. Serum concentration higher than 0.1 mg/L is toxic, while concentration above 1 mg/L can be fatal. Here we report key data about 61 patients admitted to the National Poison Control Centre in Belgrade, Serbia over olanzapine poisoning in 2017 and 2018. The ingested doses ranged from 35 to 1680 mg, and time from ingestion to determination from two to 24 hours. In 34 patients olanzapine serum concentrations were in the therapeutic range and in 27 in the toxic range. In five patients they were higher than fatal, but only one patient died. The most common symptoms of poisoning were depressed consciousness (fluctuating from somnolence to coma), tachycardia, hypersalivation, hypotension, myosis, and high creatine kinase. All patients but one recovered fully after nonspecific detoxification and symptomatic and supportive therapy.

Introduction. Smederevo is the only town in Serbia with a steel factory, whose exhausts contribute to air pollution. Therefore, the city conducts continuous monitoring of air quality. In recent years, high levels of particulate matter (PM), including coarse (PM10) and fine (PM2.5) particles in the air have frequently been recorded. The aim of this study was to assess association between exacerbation of asthma or chronic obstructive pulmonary disease (COPD) in adults and air pollution or meteorological conditions. Methods. The study was conducted in the secondary care General Hospital in Smederevo covering approximately 81, 000 inhabitants living in the area of about 7 km around the automatic station for air quality monitoring from which the verified data were collected. Data on patients were obtained from medical records. The correlation between the incidence of diseases exacerbation and the number of days with exceedance of air pollutants limit level per month, as well as meteorological conditions, was tested with parametric Pearson bivariate correlation test in program SPSS. Results. The study population consisted of adults registered as asthma or COPD suffering patients (n = 1,624) with 570 episodes of remarkable exacerbations (moderate or severe) of the disease in 2011. Asthma exacerbation was significantly more frequent in women than in men. The number of days with high levels of PM2.5 per month was statistically significantly associated with the total number of exacerbation (moderate and severe of both asthma and COPD) episodes among the female patients. There was also a statistically significant association between the number of days with PM2.5 exceedance and the number of moderate exacerbations in the subgroups of nonsmokers and obese patients. A significant correlation of the number of days with the exceedance of PM10 limit level was shown only for the subgroup of obese, non-smoking patients with moderate exacerbation. A significant negative association with the average ambient temperature was proven for the obese female patients and obese non-smoking patients with moderate asthma exacerbations. The number of COPD exacerbation was in positive correlation with the average air pressure for the subgroup of female smokers, but the connection with air pollution was not proven. Conclusion. Exposure to airborne particles in the town of Smederevo, mainly to PM2.5, and to low temperature may trigger asthma exacerbation requiring emergency care. The most vulnerable may be women and obese patients. [ABSTRACT FROM AUTHOR]

Introduction. During the last few years, intravenous lipid emulsions have been effectively used in treatment of acute poisonings with lipophilic substances, including verapamil. Case report. A 37-year-old women presented 1 hour after ingestion of 2.8 g verapamil with hypotension and complete heart block. Because of the applied standard therapy failure and further patients impairment, Intralipid® 20% was used. Sinus rhythm was restored, arterial blood pressure increased and verapamile concentrations, both total and free decreased. Conclusion. Intravenous lipid emulsion can be important in treatment of severe acute intoxication and cardiotoxicity caused by verapamil. [ABSTRACT FROM AUTHOR]

Background/Aim. Benzodiazepines are among the most frequently ingested drugs in self-poisonings. Elderly may be at greater risk compared with younger individuals due to impaired metabolism and increased sensitivity to benzodiazepines. The aim of this study was to assess toxicity of benzodiazepines in elderly attempted suicide. Methods. A retrospective study of consecutive presentations to hospital after self-poisoning with benzodiazepines was done. Collected data consisted of patient's characteristics (age, gender), benzodiazepine ingested with its blood concentrations at admission, clinical findings including vital signs and Glasgow coma score, routine blood chemistry, complications of poisoning, details of management, length of hospital stay and outcome. According the age, patients are classified as young (15-40-year old), middle aged (41-65-year old) and elderly (older than 65). Results. During a 2-year observational period 387 patients were admitted because of pure benzodiazepine poisoning. The most frequently ingested drug was bromazepam, the second was diazepam. The incidence of coma was significantly higher, and the length of hospital stay significantly longer in elderly. Respiratory failure and aspiration pneumonia occurred more frequently in old age. Also, flumazenil was more frequently required in the group of elderly patients. Conclusion. Massive benzodiazepines overdose in elderly may be associated with a significant morbidity, including deep coma with aspiration pneumonia, respiratory failure, and even death. Flumazenil is indicated more often to reduce CNS depression and prevent complications of prolonged unconsciousness, but supportive treatment and proper airway management of comatose patients is the mainstay of the treatment of acute benzodiazepine poisoning. [ABSTRACT FROM AUTHOR]