Caracterización del uso de emulsiones lipídicas como terapia antidotal en intoxicaciones diferentes a anestésicos locales en un centro de alta complejidad en Medellín / Characterization of the use of lipid emulsions as antidotal therapy in intoxications other than local anesthetics in a high complexity center in Medellin

Introducción. Las emulsiones lipídicas intravenosas (ELI) son unas emulsiones grasas no tóxicas con fosfolípidos, actualmente aprobadas para su uso en el tratamiento de intoxicaciones, específicamente en las producidas por anestésicos locales. El propósito de este estudio es la caracterización del uso de ELI en pacientes mayores de 18 años, que presentaron intoxicación por sustancias y medicamentos diferentes a anestésicos locales, en un hospital de alta complejidad de la ciudad de Medellín, durante el periodo comprendido entre 2015 y 2020. Metodología. Se realizó un estudio descriptivo, retrospectivo, de casos que recibieron ELI como tratamiento para su intoxicación. Se hizo revisión de las historias clínicas de la población objeto de estudio. Se recolectó información acerca de variables sociodemográficas, clínicas y paraclínicas, y de atención. Se hizo análisis univariado de las variables de interés. Resultados. Del total de 1.966 intoxicaciones, se incluyeron 51 (2,6 %) casos de intoxicación por sustancias y medicamentos diferentes a anestésicos locales, que recibieron la terapia con ELI entre 2015 y 2020. La mediana de edad de los participantes fue de 27 años. Un 74,5 % de los participantes presentó intoxicación por medicamentos. El promedio de la dosis de ELI recibida fue de 1.036 mL en 24 horas, dosis inferior a la calculada por kilo de peso que debían recibir, de 1.149 mL en promedio. Un 86,3 % (n=44) de los casos presentaron neurotoxicidad, y 76,5 % (n=39) presentaron cardiotoxicidad. La neurotoxicidad mejoró en el 34,7 % y la cardiotoxicidad en el 59,1 % de los individuos que recibieron terapia con ELI. Conclusión. La aplicación de las ELI se hizo en personas en su mayoría intoxicadas por antipsicóticos, hombres, jóvenes; menos de la mitad tenía compromiso de la ventilación, y hubo mejoría en la cardiotoxicidad y neurotoxicidad. Hubo una diferencia entre la dosis recibida y la que debían recibir ajustada por el peso

Introduction. Intravenous lipid emulsions (IVLE) are non-toxic fatty emulsions with phospholipids, currently approved for use in the treatment of poisoning, specifically those produced by local anesthetics. The purpose of this study is to characterize the use of IVLE in patients over 18 years of age, who presented intoxication by substances and medications other than local anesthetics, in a high complexity hospital in the city of Medellín, during the period between 2015 and 2020. Methodology. A retrospective descriptive study was carried out on cases that received IVLE as a treatment for their poisoning. The clinical records of the study population were reviewed. Information was collected about sociodemographic, clinical and paraclinical variables, and care. Univariate analysis of the variables of interest was performed. Results. Of the total of 1,966 poisonings, 51 (2.6%) cases caused by substances and medications other than local anesthetics, received ELI therapy between 2015 and 2020 and were included in the study. The median age of the participants was 27 years. 74.5% of the participants presented drug poisoning. The average IVLE dose received was 1,036 mL in 24 hours, a lower dose than the one calculated per kilo of weight, which had been on average 1,149 mL. 86.3% (n=44) of the cases presented neurotoxicity, and 76.5% (n=39) presented cardiotoxicity. Neurotoxicity improved in 34.7% and cardiotoxicity in 59.1% of individuals receiving ELI therapy. Conclusion. The application of IVLE was made in people mostly poisoned by antipsychotics, men, young people, less than half had compromised ventilation, and there was improvement in cardiotoxicity and neurotoxicity. There was a difference between the dose received and the one they should have received adjusted for weight

Tratamiento de las intoxicaciones agudas por desinfectantes durante la COVID-19 / Treatment of acute poisoning by disinfectants during COVID-19

Introducción: El uso de productos de limpieza, a expensa de los desinfectantes se ha incrementado por la población mundial como consecuencia de la COVID-19. El manejo frecuente de estas sustancias químicas por las personas puede ocasionar cuadros de intoxicaciones agudas. Esta situación se evidencia en los reportes emitidos por los centros antitóxicos del orbe, donde consta el aumento en el número de consultas toxicológicas. Objetivo: Describir el tratamiento de las intoxicaciones agudas por desinfectantes durante la COVID-19. Métodos: Se realizó una revisión bibliográfica acerca del tratamiento de las intoxicaciones agudas por desinfectantes durante la COVID-19. Se incluyeron artículos escritos en español, inglés y portugués. Además, se abordaron aspectos relacionados con las intoxicaciones agudas por el uso de desinfectantes, el cuadro clínico, así como elementos del diagnóstico y tratamiento de las intoxicaciones agudas por estas sustancias químicas. Conclusiones: Las intoxicaciones agudas por hipoclorito de sodio y geles hidroalcohólicos son las más frecuentes en la población durante la COVID-19 en proporción con el uso de estos productos químicos. La atención médica precoz, eficaz y oportuna disminuirá la posibilidad de aparición de complicaciones. El tratamiento de estás intoxicaciones agudas está en relación con los síntomas y signos que presentan los pacientes al ser recibidos en los servicios de urgencia(AU)

Introduction: The use of cleaning products, at the expense of disinfectants, has increased by the world population as a consequence of COVID-19. Frequent handling of these chemical substances by people can cause acute poisoning. This situation is evidenced in the reports issued by the world's anti-toxic centers, where the increase in the number of toxicological consultations is recorded. Objective: To describe the treatment of acute poisoning by disinfectants during COVID-19. Methods: A literature review on the treatment of acute poisoning by disinfectants during COVID-19 was carried out. Articles written in Spanish, English and Portuguese were included. In addition, aspects related to acute poisoning due to the use of disinfectants, the clinical condition, as well as elements of the diagnosis and treatment of acute poisoning by these chemical substances were addressed. Conclusions: Acute poisoning by sodium hypochlorite and hydroalcoholic gels are the most frequent in the population during COVID-19 in proportion to the use of these chemical products. Early, effective and timely medical care will reduce the possibility of complications. The treatment of these acute intoxications is related to the symptoms and signs presented by patients when they are received in the emergency services(AU)

Perfil das intoxicações exógenas por agrotóxicos de uso agrícola / Profile of exogenous poisonings by agrotoxics for agricultural use

Objetivo: apresentar o perfil das intoxicações exógenas por agrotóxicos de uso agrícola. Trata-se de um estudo retrospectivo, que correspondeu ao período de janeiro de 2007 a dezembro de 2015, descritivo, com elementos epidemiológicos de análise quantitativa e cunho documental. Para a análise utilizou-se dados das fichas de investigação disponíveis na base de dados DATASUS. De acordo com os dados analisados a faixa etária mais acometida por intoxicação devido ao uso de agrotóxicos foi a de 20 a 49 anos, sendo os principais casos acidentais e por tentativas de suicídio. A população acometida possui baixo grau de escolaridade e a principal via de intoxicação foi a via digestiva, seguida pela respiratória e cutânea. Conclui-se que a intoxicação pelo uso dos agrotóxicos precisa ser avaliada como um grave problema da saúde pública, uma vez que acomete não apenas a saúde do trabalhador, mas o meio ambiente e a comunidade.(AU)

Objective: to present the profile of exogenous intoxications by agricultural pesticides. This is a retrospective study, wich corresponded to the period from january 2007 to december 2015, descriptive, with epidemiological elements of quantitative analysis and documentary nature. For the analysis data from the research forms available in the DATASUS database were used. According to the data analyzed the age group most affected by intoxication due to the use of pesticides was 20 to 49 years, the main cases being accidental and due to suicide attempts. The affected population has low level of education and the main route of intoxication was to the digestive route, followed by respiratory and cutaneous. It is concluded that intoxication by the use of pesticides needs to be evaluated as a serious public health problem, since it affects not only the health of the worker, but the environment and the community.(AU)

Intoxicación por barbitúricos, una mirada toxicológica / Intoxication by barbiturates, a toxicological view / Intoxication par les barbituriques, une vue toxicologique / Intoxicação por barbitúricos, uma visão toxicológica

Resumen Objetivo: Actualizar los conocimientos acerca de las características desde el punto de vista toxicológico de las intoxicaciones por barbitúricos. Material y métodos: Se realizó un estudio donde se aplicó el método cualitativo, mediante una revisión bibliográfica y documental sobre el tema en fuentes de datos digitales. Se usaron los descriptores DeCs-MeSH: intoxicaciones, barbitúricos, tratamientos, hemoperfusión, toxicología. Se revisaron artículos publicados sobre el tema, a través de los buscadores habituales (Google, PubMed, Cochrane, Scielo, entre otros), teniendo en cuenta la calidad y la actualidad de ellos. Resultados: Tanto las dosis tóxicas como el comportamiento toxicocinético de estos fármacos son variables y dependen sobre todo del grupo al cual pertenezcan. Las intoxicaciones más frecuenten están relacionadas con los barbitúricos de acción prolongada. Debido a su alta liposolubilidad, los de acción ultracorta, pueden quedar acumulados en el tejido adiposo y al movilizarse estas reservas pueden ser fuente de toxicidad. Aunque no son comunes también hay que tener en cuenta la posible existencia de metabolitos activos. Conclusiones: Estos son fármacos en desuso debido a su estrecho margen terapéutico, la elevada dependencia y posterior tolerancia que provoca un aumento potencial de su toxicidad. Aun así, acompañados de una debida monitorización, pueden emplearse en situaciones concretas. Desafortunadamente todavía se producen numerosas muertes por sobredosis accidentales o con fines suicidas

Summary Object: To update the knowledge about the characteristics from the toxicological point of view of barbiturate intoxications. Materials and methods: A study was carried out where the qualitative method was applied, through a literature and documentary review on the subject in digital data sources. The DeCs-MeSH descriptors were used: intoxications, barbiturates, treatments, hemoperfusion, and toxicology. We reviewed articles published on the subject, through the usual search engines (Google, PubMed, Cochrane, Scielo, among others), taking into account the quality and topicality of them. Results: Both the toxic doses and the toxicokinetic behavior of these drugs are variable and depend mainly on the group to which they belong. The most common poisonings are related to long-acting barbiturates. Due to its high liposolubility, ultrashort action can be accumulated in the adipose tissue and these reserves can be a source of toxicity when mobilized. Although they are not common, one must also take into account the possible existence of active metabolites. Conclusion: These are drugs in disuse due to their narrow therapeutic margin, high dependence and subsequent tolerance that causes a potential increase in their toxicity. Even so, accompanied by a proper monitoring can be used in specific situations. Unfortunately, there are still many deaths due to accidental overdoses or suicide.

Résumé Objectif: Mettre à jour les connaissances sur les caractéristiques du point de vue toxicologique des intoxications aux barbituriques. Matériels et méthodes: Une étude a été réalisée où la méthode qualitative a été appliquée, à travers une revue documentaire et documentaire sur le sujet dans les sources de données numériques. Les descripteurs DeCs-MeSH ont été utilisés: intoxications, barbituriques, traitements, hémoperfusion, toxicologie. Nous avons revu les articles publiés sur le sujet, à travers les moteurs de recherche habituels (Google, Pub Med, Cochrane, Silo, entre autres), en tenant compte de la qualité et de l'actualité de ceux-ci. Résultats: Les doses toxiques et le comportement toxicocinétique de ces médicaments sont variables et dépendent principalement du groupe auquel ils appartiennent. Les empoisonnements les plus fréquents sont liés aux barbituriques à longue durée d'action. En raison de sa liposolubilité élevée, une action ultracourte peut être accumulée dans le tissu adipeux et ces réserves peuvent être une source de toxicité lorsqu'elles sont mobilisées. Bien qu'ils ne soient pas communs, il faut également tenir compte de l'existence possible de métabolites actifs. Conclusions: Ce sont des médicaments en désuétude en raison de leur marge thérapeutique étroite, de leur dépendance élevée et de leur tolérance subséquente qui entraîne une augmentation potentielle de leur toxicité. Même ainsi, accompagné d'un suivi approprié peut être utilisé dans des situations spécifiques. Malheureusement, il y a encore beaucoup de décès dus à des surdoses accidentelles ou à des suicides.

Resumo Objetivo: Atualizar o conhecimento sobre as características do ponto de vista toxicológico das intoxicações por barbitúricos. Materiais e métodos: Foi realizado um estudo onde o método qualitativo foi aplicado, através de uma literatura e revisão documental sobre o assunto em fontes de dados digitais. Os descritores DeCs-MeSH foram usados: intoxicações, barbitúricos, tratamentos, hemoperfusão, toxicologia. Revisamos artigos publicados sobre o assunto, através dos mecanismos de pesquisa habituais (Google, PubMed, Cochrane,Scielo, entre outros), levando em consideração a qualidade e a atualidade deles. Resultados: As doses tóxicas e o comportamento toxicocinético dessas drogas são variáveis e dependem principalmente do grupo ao qual pertencem. Os envenenamentos mais comuns estão relacionados a barbitúricos de ação prolongada. Devido à sua alta lipossolubilidade, a ação ultrital pode ser acumulada no tecido adiposo e essas reservas podem ser uma fonte de toxicidade quando mobilizadas. Embora não sejam comuns, é preciso também ter em conta a possível existência de metabolitos ativos. Conclusões: Trata-se de drogas em desuso devido à sua estreita margem terapêutica, alta dependência e subsequente tolerância que provoca um aumento potencial da sua toxicidade. Mesmo assim, acompanhado de um monitoramento adequado pode ser usado em situações específicas. Infelizmente, ainda há muitas mortes devido a sobredosagem acidental ou suicídio.

Poisoning of cattle by Senecio spp. in Brazil: a review / Intoxicação por Senecio spp. em bovinos no Brasil: revisão de literatura

Poisoning of cattle by plants of the Senecio genus represents an important cause of death in cattle and has important economic repercussions in southern Brazil. This review is intended to provide a detailed review of Senecio spp. intoxication in cattle and addresses issues regarding the toxic principle and pathogenesis of the disease caused by these plants and the epidemiology, clinical signs, diagnosis, control and prophylaxis of the disease. Senecio brasiliensis is the main species associated with natural intoxication of livestock in Brazil, and the number of cases associated with the ingestion of S. madagascariensis is increasing. The toxic principle of Senecio spp. comprises the hepatotoxic alkaloids of the pyrrolizidine group (pyrrolizidine alkaloids, PAs). The resulting liver lesions are chronic and irreversible and result from the inhibition of hepatocellular mitosis. Deaths of adult cattle may occur both sporadically and in larger outbreaks over an extended period of time. In cattle raising, Senecio spp. are consumed mainly during the winter, when there is a dearth of forage; at this time the poisonous Senecio species are budding and contain high concentrations of PAs. Spontaneous Senecio spp. intoxication in cattle is a chronic condition that frequently involves acute clinical manifestations. Affected cattle may present ascites, emaciation, intermittent dark diarrhea, tenesmus, rectal prolapse, and neurological signs resulting from hepatic encephalopathy. Hepatogenous photosensitization may be observed but is uncommon. Necropsy findings include dependent subcutaneous edema, ascites, and edema of the mesentery, abomasal folds, and gallbladder. The liver is firm, normal or reduced in size with a white, thick capsule. Microscopically, the hallmarks of Senecio-associated disease are varying degrees of hepatocellular megalocytosis, bile duct hyperplasia and fibrosis. Sheep are significantly more resistant to Senecio intoxication than are cattle and avidly ingest Senecio plants; therefore, the use of sheep for grazing infested pasture is recommended for preventing the associated disease in cattle.(AU)

Intoxicação por plantas do gênero Senecio representa uma importante causa de morte em bovinos com grande repercussão econômica na região sul do Brasil. O objetivo dessa revisão é fornecer uma abordagem detalhada da intoxicação por Senecio spp. em bovinos, com enfoque nos seguintes aspectos da intoxicação: princípio tóxico e patogenia, epidemiologia, sinais clínicos, diagnóstico e controle e profilaxia. Senecio brasiliensis constitui a principal espécie associada a intoxicações espontâneas em animais de produção e há uma crescente incidência de casos relacionados à intoxicação por S. madagascariensis. A toxicidade das espécies de Senecio deve-se à presença de alcaloides hepatotóxicos pertencentes ao grupo das pirrolizidinas (APs), que produzem lesão hepática crônica e irreversível, caracterizada pela inibição da mitose de hepatócitos. As mortes dos bovinos adultos acontecem de forma esporádica ou em surtos durante um período prolongado de tempo, e podem ocorrer durante o ano todo. As espécies do gênero Senecio são pouco palatáveis e consumidas pelos bovinos somente em determinadas circunstâncias, principalmente, no inverno, período em que as diferentes espécies estão em brotação, com maior concentração de alcaloides, e a disponibilidade de forragem é escassa. A intoxicação geralmente cursa com um quadro crônico, embora as manifestações clínicas sejam agudas. Os bovinos afetados podem apresentar ascite, emagrecimento, diarreia escura intermitente, tenesmo, prolapso retal e sinais neurológicos (encefalopatia hepática). Ocasionalmente ocorre fotossensibilização hepatógena. Na necropsia, os principais achados incluem edema subcutâneo ventral, ascite, edema de mesentério e das pregas do abomaso, distensão e edema da vesícula biliar e fígado firme, diminuído de tamanho e com a cápsula brancacenta. Microscopicamente, as principais alterações hepáticas consistem de graus variados de hepatomegalocitose, hiperplasia de ductos biliares e fibrose. A profilaxia inclui o uso de ovinos para pastorear os campos infestados pela planta, visto que essa espécie é mais resistente à ação dos APs e apresenta avidez no consumo da brotação da planta.(AU)

Algunos aspectos clínicos y epidemiológicos relacionados con las intoxicaciones exógenas en niños y adolescentes / Some clinical and epidemiological aspects related to the exogenous intoxications in children and adolescents

Se realizó una investigación descriptiva, observacional y prospectiva de 172 pacientes de hasta 18 años con diagnóstico de intoxicación exógena, ingresados en el Hospital Infantil Docente Sur Dr Antonio María Béguez César de Santiago de Cuba, de enero del 2015 a igual mes del 2016, a fin de caracterizarles de acuerdo con algunas variables clínicas y epidemiológicas. Como medida de resumen para las variables cualitativas se utilizó el porcentaje y los resultados se compararon mediante la prueba de la X², con 95 por ciento de confianza. Existió un predominio de los adolescentes en las edades de 14-18 años, del sexo femenino y del tipo de intoxicación voluntaria. En general, los medicamentos constituyeron el agente causal más frecuente, la mayoría de los pacientes evolucionó satisfactoriamente y el porcentaje de complicaciones fue bajo. Se recomendó continuar perfeccionando las estrategias de intervención comunitaria en los niveles primario y secundario de atención sanitaria, para lograr disminuir el número de afectados por este problema de salud.

A descriptive, observational and prospective investigation of 172 patients of up to 18 years with diagnosis of exogenous intoxication, admitted to Dr. Antonio María Béguez César Southern Teaching Children Hospital in Santiago de Cuba was carried out from January, 2015 to same month in 2016, in order to characterize them according to some clinical and epidemiological variables. The percentage was used as summary measure for the qualitative variables and the results were compared by means of the chi-square test, with 95 percent of confidence. There was a prevalence of adolescents aged 14-18, female sex and voluntary intoxication type. In general, medications constituted the most frequent causal agent, most of the patients had a favorable clinical course and the percentage of complications was low. It was recommended to continue improving the strategies of community intervention in the primary and secondary levels of health care, to be able to diminish the number of affected patients due to this health problem

Intoxicaciones agudas por baclofeno consultadas al Centro Nacional de Toxicología en cinco años / Acute intoxications by baclofen consulted to Toxicology National Center in five years

Introducción: el baclofeno se indica como relajante muscular para el alivio de espasticidad grave y ejerce sus efectos como agonista selectivo del receptor GABA-B. Objetivo: caracterizar las intoxicaciones por baclofeno según reportes al Servicio de Información de Urgencia del Cenatox entre 2011 y 2015. Métodos: se realizó un estudio observacional retrospectivo con un universo de 16 notificaciones, en las que se estudiaron: el centro de salud que asistió al paciente, provincia de procedencia por año de estudio, grupo de edad, sexo, circunstancias del evento, manifestaciones clínicas y severidad de la intoxicación. Resultados: el año 2014 aportó la mayor cantidad de reportes y los niños las mayores frecuencias absolutas, no hubo diferencias en relación al sexo, aunque entre los hombres predominó la causa accidental y entre las féminas las intencionales suicidas. Todas las notificaciones procedieron de atención secundaria, aunque cinco de los pacientes habían sido previamente asistidos en áreas de salud. Todos los afectados presentaron manifestaciones neurológicas, la mayoría fueron reportados de grave y la mitad de los casos presentaron alteraciones cardiorrespiratorias con inestabilidad hemodinámica que llevó a la asistencia ventilatoria. La recuperación fue completa en todos los pacientes y no se reportaron fallecidos por esta causa durante el período de estudio. Conclusiones: la sobredosis de baclofeno es más común en niños y cursa con manifestaciones de neurotoxicidad e inestabilidad hemodinámica(AU)

Introduction: Baclofen is indicated as a muscle relaxant for the relief of severe spasticity and exerts its effects as a selective agonist of the GABA-B receptor. Objective: To characterize baclofen poisonings according to reports to the Cenatox emergency information service between 2011 and 2015. Methods: A retrospective observational study with a universe of 16 notifications, in which the health center that attended the patient and province of origin was studied by year of study, age group, gender, circumstances, clinical manifestations and severity of intoxication. Results: The bigger number of reports and the highest absolute frequencies occurred in the year 2014, there were no differences with regard to sex, although among the men, the accidental cause was predominant, and among women the suicides attemps were predominant. All reports came from secondary care, although five of the patients had previously been assisted in health care areas; all affected had neurological manifestations, most were reported as severe and half of the cases presented cardiorespiratory alterations with hemodynamic instability leading to ventilatory assistance. Recovery was complete in all patients and no deaths were reported for this cause during the study period. Conclusions: Baclofen overdose was more common in children and was characterized by neurotoxicity and hemodynamic instability(AU)

Toxicity assessment and screening of tetrodotoxin in the oblong blowfish (Takifugu oblongus) from the Tamil Nadu Coast of Bay of Bengal, India

Objective To assess the toxicity of the pufferfish Takifugu oblongus, from Chennai coast, Tamil Nadu, India and to detect the presence of Tetrodotoxin (TTX). Methods The toxicity was evaluated by mouse bioassay using Swiss Albino mice which were expressed in mouse units (MU). Gross anatomical features were observed which is followed by histopathology of the dead mice tissues to establish the toxicity. Instrumental analysis for the presence of tetrodotoxin was also performed through GC–MS and HPLC. Results The toxicity of ovary was the maximum with 163 MU/g and lowest toxicity was observed in skin with 75.88 MU/g. Histopathological analyses of the dead mice showed various cellular degenerations and inflammations. The amount of Tetrodotoxin detected through GC–MS and HPLC was more reliable and sensitive than the customary mouse bioassay as instrumental analyses were able to detect even nanograms of the toxin. Conclusions The present study evidently proved that Takifugu oblongus is highly toxic and consumption of the same can pose serious threat for health and possible lethality to humans.

Intoxicaciones agudas en el Centro de Emergencias del Hospital General Docente Enrique Cabrera, 2009-2010: serie clínica retrospectiva / Acute intoxications in the Emergency Center of the Enrique Cabrera General Teaching Hospital, 2009-2010: retrospective clinical series

Introducción: las intoxicaciones agudas son una emergencia médica determinada por la exposición a diferentes sustancias, las cuales pueden terminar con la vida del paciente. Objetivos: caracterizar los pacientes con intoxicaciones agudas atendidos en el Centro de Emergencias del Hospital General Docente Enrique Cabrera, La Habana, desde el 1 de enero de 2009 hasta el 31 de diciembre de 2010. Método: se realizó un estudio de serie clínica retrospectiva en 208 pacientes con intoxicaciones agudas. Se seleccionaron las variables para el estudio según los objetivos y se construyeron distribuciones de frecuencias absolutas y relativas. Resultados: predominaron los pacientes del sexo femenino y del grupo etario de 20 a 29 años. La intención de suicidio fue el tipo de intoxicación más frecuente y el tipo accidental mostró aumento según mayor edad. Los medicamentos fueron los agentes etiológicos más utilizados, predominando los psicofármacos y el uso de polimedicamentos en la intención de suicidio. La bronconeumonía bacteriana fue la complicación más frecuente de los casos ingresados. Conclusiones: Se apreciaron intoxicaciones principalmente en mujeres de edad joven y presentarse con intención suicida, siendo los medicamentos los agentes más utilizados.

Introduction. Acute poisoning is a medical emergency determined by exposure to different substances, which can result in patient demise. Objectives. To characterize patients exposed to acute poisoning treated at the Emergency Center of the “Enrique Cabrera” General Teaching Hospital, Havana, from January 1, 2009 to December 31, 2010. Method. A retrospective clinical series of 208 patients admitted with acute poisoning. Variables were selected for the study according to the objectives and distributions of absolute and relative frequencies were calculated. Results. Patients were predominantly female and in the 20-29 age group. Suicide intent was the most frequent factor while accidental poisoning increased with age. Pharmaceutical drugs were the most common etiologic agents, with predominance of psychotropic drugs and poly-medication. Bacterial bronchopneumonia was the most common complication of hospitalized cases. Conclusions. Acute poisoning was seen mainly in young women as suicidal intent, being drugs the most common agents.

Caracterización del perfil epidemiológico de las llamadas alCentro de Información Toxicológica de la Universidad Católica (CITUC), en el año 2010 / Characterization of the epidemiological profile of calls received at the Poison Information Center of the Catholic University (CITUC), in 2010

Objetivo: Describir y caracterizar el perfil epidemiológico de las llamadas recibidas en el año 2010 correspondiente a exposiciones, por el Centro de Información Toxicológica de la Pontificia Universidad Católica de Chile. Método: Se realizó un estudio retrospectivo y descriptivo de las llamadas registradas por el CITUC durante el año 2010. Se analizaron los siguientes datos: número total de llamadas, lugar de la llamada, circunstancia de la exposición, tipo y número de los agentes involucrados, vías de exposición, tiempo desde la exposición, género y edad de los pacientes. Resultados: Se registraron 29.592 llamadas. 45,2 por ciento de las consultas provenían del hogar y 53,2 por ciento de instalaciones médicas. 69,3 por ciento fueron exposiciones accidentales y 27,6 por ciento intencionales. Los medicamentos se presentaron como agente causal de una exposición en 58,4 por ciento de las llamadas, seguidos por los productos de uso doméstico (18,7 por ciento) y plaguicidas (5,8 por ciento). La ingestión fue la vía de exposición que predominó en un 79,3 por ciento del total de casos. 41,0 por ciento del total de las llamadas, se realizaron dentro de la primera hora post-exposición. Las exposiciones en niños menores de 14 años correspondieron a 51,6 por ciento de las llamadas. Conclusiones: Los medicamentos constituyen el principal agente involucrado en intoxicaciones. La principal vía de exposición es la ingesta y el principal grupo de población afectado son los niños menores de 14 años,. Estos indicadores muestran la necesidad imperante de desarrollar campañas de prevención e información avaladas por el Ministerio de Salud, respecto al correcto uso de los medicamentos, como también la introducción del envase resistente ala manipulación de los niños y la educación de la población.

Objective: To describe and to characterize the epidemiologoc profile of the entering pone calls in 2010 belonging to exposures by the Centro de Información Toxicológica de la Pontificia Universidad Católica de Chile. Method: A retrospective and descriptive study of pone calls registered by the CITUC has been made during 2010. The following has been analyzed: total pone calls number, place of the call, exposure circumstances, kind and number ofagents involved, exposure way, time from exposure, gender and age of the patients. Outcomes: 29.592 phone calls were registered. 45,2 percent of the questions came from home and 53,2 percent from medical institutions. 69,3 percent were non intented exposures and 27,6 percent were intented. The drugs were the causal agent of exposures in 58,4 percent of the phone calls, followed by cleaning use products (18,7 percent) and insecticides (5,8 percent). Swallowing was the predominant exposure way with 79,3 percent of the total. 41 percent of total of phone calls, were made in the first hour after exposure. The children under 14 years exposure cases, were were 51,6 percent of total phone calls. Conclusions: Medical drugs are the principal involved agent in intoxications. The main way of exposition is swallowing and the major population group involved is children under 14 years. These indicators shows the need of developing prevention and information campaigns supported by Secretary of Health, oriented to right use of drugs, as well as the use of safety drug boxes for children and population education.

Análise clínica e epidemiológica das internações hospitalares de idosos decorrentes de intoxicações e efeitos adversos de medicamentos, Brasil, de 2004 a 2008 / Clinical and epidemiological analysis of hospitalizations of elderly due to poisoning and adverse effects of medications, Brazil from 2004 to 2008

Os idosos são mais suscetíveis aos efeitos adversos dos medicamentos devido a uma diversidade de fatores, tais como o uso excessivo e concomitante de diversos fármacos, erros de administração, alterações fisiológicas no organismo que alteram a farmacodinâmica e a farmacocinética. Com o objetivo de determinar as principais classes terapêuticas envolvidas nas internações hospitalares de idosos decorrentes de intoxicação e efeito adverso de medicamentos, bem como os principais agravos relacionados a esses eventos, foram analisadas 9.793 internações hospitalares de pessoas com 60 anos ou mais, registradas no Brasil pelo Sistema de Internações Hospitalares do SUS (SIH-SUS), no período de 2004 a 2008. Medicamentos não especificados, antibióticos sistêmicos, psicotrópicos, psicoativos, antiepilépticos, sedativos, hipnóticos e antiparkinsonianos, responderam por 57% do total de internações analisadas. Traumatismos e quedas foram os principais agravos relacionados a intoxicação e efeito adverso de medicamentos. As internações por traumatismo apresentaram relação com analgésicos, antitérmicos e antirreumáticos não opiáceos. Já as quedas estavam associadas aos antibióticos sistêmicos, contrariando os estudos que apontam os psicotrópicos como os principais medicamentos envolvidos nesses eventos. Os resultados encontrados refletem a tendência crescente dos problemas associados ao uso de medicamentos por idosos. Verificou-se que o perfil de consumo não é suficiente para explicar as concentrações de casos nas principais classes terapêuticas. Na busca pelas causas, sugere-se a adoção de programas mais efetivos de farmacovigilância, capazes de monitorar as diferentes etapas do processo de uso de medicamentos: prescrição, dispensação, comercialização, administração e adesão ao tratamento.

The elderly are more susceptible to adverse drugs effects due to a variety of factors, such as excessive and concomitant use of several drugs, administration errors, physiological changes in the body that alter the pharmacodynamics and pharmacokinetics. In order to determine the main therapeutic classes involved in hospital admissions of elderly people due to intoxication and adverse drug effects, as well as major health problems related to these events, 9,793 hospitalizations of people aged 60 or over registered in the Hospital Information System of the Unified Health System (SIH-SUS) in the period of 2004 to 2008 were analyzed. Unspecified drugs, systemic antibiotics, psychotropics, psychoactives, antiepileptics, sedatives, hypnotics and antiparkinsonians accounted for 57% of the total of admissions analyzed. Injuries and falls were the main health problems related to intoxication and adverse drug effects. Hospitalizations due to injuries were associated with analgesic, antipyretic and antirheumatic non-opioid. Falls were associated with systemic antibiotics, contradicting studies which point out psychotropic drugs as the main drug involved in these events. The results reflect the growing trend of problems associated with drug use by elderly people. It was verified that the consumption profile alone is not sufficient to explain the concentration of cases of the major therapeutic classes. We suggest the adoption of more effective programs of pharmacovigilance, capable of intervening at different stages of drug use: prescribing, dispensing, marketing, administration and compliance.

Surtos de intoxicação por salinomicina em chinchilas (Chinchilla lanigera) / Outbreaks of salinomycin toxicosis in Chinchillas (Chinchilla lanigera)

Quatro surtos de intoxicação por salinomicina são descrito em chinchilas de três municípios do Estado do Rio Grande do Sul. Uma semana após a ingestão de ração contendo 37 ppm de salinomicina, aproximadamente duas mil chinchilas de quatro fazendas expostas diminuíram o consumo da ração. Quatrocentos e vinte sete chinchilas demonstraram apatia. Dessas, duzentos e setenta e sete desenvolveram decúbito esternal e lateral, dispneia e coma, seguidos de morte. As primeiras mortes ocorreram oito dias após a ingestão da ração. A evolução dos sinais clínicos até a morte ou eutanásia foi de 2-5 dias. Os exames bioquímicos do soro sanguíneo em quatro chinchilas revelaram níveis aumentados da alanina aminotransferase, aspartato transaminase, fosfatase alcalina, creatina cinase, glicose, triglicerídeos e colesterol total. Quarenta e cinco chinchilas foram submetidas à necropsia. Os achados macroscópicos consistiam de marcada lipidose hepática em todas as chinchilas necropsiadas; fetos em estado de decomposição em doze chinchilas que estavam prenhes. Microscopicamente, múltiplas fibras musculares esqueléticas estavam hipereosinofílicas, tumefeitas e com perda das estriações. Nas chinchilas que sobreviveram por mais dias era possível observar segmentos fragmentados de miofibras afetadas (necrose flocular) e regeneração de miofibras. No fígado foi observada marcada degeneração gordurosa. Não foram observadas anormalidades microscópicas nos demais órgãos analisados. Análises à procura de aflatoxinas, resíduos de pesticidas e isolamento bacteriano foram negativos. A análise da ração por cromatografia líquida revelou 37ppm de salinomicina na ração. A ração suspeita foi administrada a 12 chinchilas, três das quais (25 por cento) morreram apresentando lesões semelhantes às observadas nas chinchilas com a doença natural. O diagnóstico de intoxicação por salinomicina foi baseado na epidemiologia, lesões histológicas características e na presença de salinomicina na ração administrada nas quatro criações envolvidas.

Four outbreaks of ionophore toxicosis are described in chinchillas from four commercial farms located in three municipalities in the state of Rio Grande do Sul, southern Brazil. Approximately 2,000 chinchillas showed decrease in food intake one week after start ingesting a ration containing 37 ppm of salinomycin. Four hundred and twenty seven chinchillas showed apathy. Of those 277 develop sternal and lateral recumbence, dyspnea and coma followed by death. First deaths occurred eight days after the start on the salinomycin containing ration; clinical course was 2-5 days. Serum chemistry carried out in four chinchillas revealed increased levels of alanine transaminase, aspartate transaminase, alkaline phosphatase, creatinenin kinase, glucose, triglicerids and total cholesterol. Forty five affected chinchillas were necropsied; consistent necropsy findings were marked hepatic lipidosis; additionally twelve pregnant chinchillas had dead decomposing fetuses. Microscopically skeletal muscles had multifocally swollen hypereosinophilic myofibers with loss of cross striations. In those chinchillas that survived longer than a few days, microscopic features in the skeletal muscle included segmental fragmentation of dead fibers (floccular necrosis) and myofiber regeneration. Marked fatty degeneration was observed in the livers of all affected chinchillas. No microscopic changes were observed in other organs. Chemical analysis in the feed consumed by the chinchillas did not detect aflatoxins or pesticides residues; bacterial culture performed in samples of liver and intestinal contents from necropsied chinchillas yielded no significant bacterial growth. Analysis by thin layer chromatography performed in the ration consumed by the chinchillas detected 37 ppm of salinomycin. The suspected ration was fed to 12 chinchillas three of which (25 percent) died with similar lesions to those observed in the natural cases. The diagnosis of salinomycin toxicosis was based in the epidemiology, histology of the lesions, on the detection of significant amounts of salinomycin in the ration used to feed the chinchillas in the four involved farms and on the reproduction of disease by feeding the suspected ration to susceptible chinchillas.

Intoxicaciones agudas en pediatría / Acute intoxications in pediatrics

Introducción: las intoxicaciones han sido en los últimos años una importante causa de aumento de la morbilidad y mortalidad en edades pediátricas. Objetivo: determinar el comportamiento clínico de las intoxicaciones agudas en la etapa de enero de 2005 a diciembre de 2009 en el Hospital Pediátrico William Soler. Métodos: el estudio se realizó en el Hospital William Soler. Se revisaron las historias clinicas, los registros de intoxicaciones agudas y las tarjetas de codificación de egresos hospitalarios por intoxicaciones de los pacientes llegados al hospital en esta etapa. Resultados: se recibieron en el hospital 886 pacientes. El grupo de mayor frecuencia de intoxicaciones fue el de 1 a 5 años, con predominio del sexo masculino, aunque sin diferencias significativas con respecto al sexo femenino. Las intoxicaciones más frecuentes fueron por medicamentos, fundamentalmente psicofármacos y antibióticos, seguido por alimentos y por productos químicos del hogar. El 30,2 por ciento de los casos fueron ingresados. Conclusiones: estos resultados nos hacen pensar en la necesidad de estar alertas y crear acciones encaminadas a proteger o evitar las intoxicaciones en edades tan vulnerables

Introduction: the intoxications have been in past years a major cause of increase of morbidity and mortality in pediatric ages. Objective: to determine the clinical behavior of acute intoxications from January, 2005 to December, 2009 in the William Soler Children Hospital. Methods: in above mentioned hospital the study was conducted. The medical records, acute intoxications registry and the coding cards of hospital discharges were reviewed due to intoxications of patients admitted at hospital in this period. Results: in hospital 886 patients were admitted. The group with a greater frequency of intoxications was that aged 1 to 5 with predominance of male sex although without significant differences regarding female sex. The more frequent intoxications were due to drugs mainly the psychogenic drugs and antibiotics, followed by foods and by chemical products at home. The 30,2 percent of cases were admitted. Conclusions: these results make us to think in the need to be on the alert and to create actions aimed to protect or to prevent the intoxications in so vulnerable ages

A importância dos centros de informação e assistência toxicológica e sua contribuição na minimização dos agravos à saúde e ao meio ambiente no Brasil

Estima-se que milhares de produtos potencialmente perigosos para a saúde humana e para a homeostasia1 ambiental (medicamentos, saneantes, agrotóxicos, cosméticos e demais agentes químicos e biológicos) estejam hoje no mercado e que dezenas de novos ingressem a cada ano. O presente estudo tem como objetivo discutir, por meio de análise de documentos e da legislação pertinente, a importância dos Centros de Informação e Assistência Toxicológica (CIATs) para a minimização dos agravos à Saúde e ao Meio Ambiente provocados por esses produtos. A incidência de intoxicações e envenenamentos no Brasil e a abordagem precária da temática em apreço nos currículos universitários do país revelam o imperativo de se ampliar e sistematizar a atuação dos CIATs. A detenção dessas informações sobre intoxicação a tempo é condição primordial para se traçar estratégias eficazes e efetivas de vigilância pidemiológica e sanitária. Tomando como referência as dimensões da organização dos CIATs, a constatação da formalização de uma REDE, estabelece um avanço do poder público enquanto ente responsável pela avaliação do risco do pós-registro de produtos autorizados que ontêm substâncias químicas e biológicas e seus possíveis efeitos adversos à população e ao meio ambiente. Os dados registrados hoje no Sistema Nacional de Informações Tóxicofarmacológicas – SINITOX e o Sistema Nacional de Agravos Notificáveis – SINAN, não contemplam a totalidade dos casos de intoxicações verificadas no Brasil; seja porque as informações colhidas pelos CIATs não são necessariamente divulgadas ou porque são nsuficientes, ou ainda porque não são efetivamente cumpridas. Para minimizar os agravos à saúde e aos ativos ambientais devido à subnotificação, a RENACIAT, surge com a proposta de consolidação dos CIATs por meio de um sistema mais abrangente de informação e documentação em Toxicologia e Farmacologia de alcance nacional, capaz de subsidiar autoridades e profissionais de saúde pública, saúde ambiental e a população em geral com dados sobre Toxicologia

According to estimates, thousands of products that are potentially hazardous to human health and environmental homeostasis 2 (medicines, cleaning products, pesticides, cosmetics, and other chemical and biological agents) are now on the market, and that dozens more enter the market every year. Based on an analysis of documents and the pertinent legislation, the current study aims to discuss the importance of Brazil’s Centers for Toxicological Information and Assistance (CIATs) for minimizing the harm to health and the environment caused by such products. The incidence of intoxications and poisonings in Brazil and the precarious approach to this issue in the country’s university curricula highlight the need to expand and systematize the work of the CIATs. Timely access to information on intoxication and poisoning is crucial for establishing efficacious and effective strategies for epidemiological and health surveillance. Taking as its reference the organizational dimensions of the CIATs in relation to a formally organized NETWORK, the study highlights the importance of the public sector as the entity responsible for evaluating post-marketing risk of approved products containing chemical and biological substances and their possible adverse effects on the population and the environment. The data currently recorded in the National oxicological and Pharmacological Data System (SINITOX) and the National System for Reportable Diseases (SINAN) do not cover all the cases of intoxications in Brazil, either because the data collected by the CIATs are not necessarily reported or are insufficient, or because the reporting is not effectively enforced. To minimize harm to health and environmental assets due to underreporting, the National Network for Toxicological Information and Assistance (RENACIAT) has emerged as a proposal for consolidating the CIATs through a more comprehensive information and documentation system in Toxicology and Pharmacology with a nationwide scope, capable of supporting public health authorities and professionals and the general population with timely and comprehensive toxicological data

A Case of Acute Renal Failure after Application of Mercury to the Skin / 대한신장학회잡지

Mercury is one of the heavy metals that cause intoxications. Mercury can cause muscular tremor, psychic irritability, renal toxicity and so on. Mercury intoxications usually occur chrough chronic respiratory ingestion. We describe a case in that a woman had applicated inorganic mercury to her whole body and developed mercury intoxications which can be characterized by the whole body skin rash, fever, acute renal failure and the hepatotoxicity appeared. We managed the patient with diuretics, antibiotics and continuous veno-venous hemodiafiltration. On the 6th hospital day, serum creatinine was normalized. Since then, the skin rash and hepatotoxicity were gradually alleviated.