Intoxicación por monóxido de carbono. Presentación de un caso / Carbon monoxide intoxication. Case presentation

RESUMEN Este caso se corresponde con un paciente de 19 años, masculino, que durante su trabajo en una construcción soterrada inhaló de forma accidental los gases de la combustión del vehículo con que trabajaba. Está acción se prolongó por aproximadamente 30 min y luego permaneció en el lugar durante 3 h sin medios de protección individual. Esto trajo como resultados la aparición de síntomas correspondientes a una intoxicación moderada por monóxido de carbono, por tal motivo fue ingresado en una institución hospitalaria para recibir tratamiento (AU).

ABSTRACT This is the case of a male patient, aged 19 years, who accidentally inhaled the combustion gases of the vehicle he worked with during his work in an underground construction. This action lasted for around 30 minutes, and after that he stayed in the place for three hours without individual protection devices. It resulted in the onset of symptoms of moderated carbon monoxide intoxication. That was the motivation of admitting him in the hospital for treatment (AU).

Characteristics Affecting Suicide Method : Based on the Analysis of Suicide Mortality Data in One District of Seoul / 우울ㆍ조울병

OBJECTIVES: Suicide has become one of the most serious public health problems today in Korea. In this study, we investigated the demographic and social characteristics affecting the use of various suicide methods.METHODS: The data relating to the types of suicide deaths including factors such as the age, gender, education level, the time of death, the place of death, and the method of death reported from 2008 to 2014 in Yeoungdeungpo-gu, Seoul, which were reviewed and analyzed in this study. The variants of each suicide method were compared using a Chi square and the Fisher's exact test. Additionally, a Spearman correlation analysis and a logistic regression analysis were also performed.RESULTS: The results noted that more than half of suicide victims (68.4%) were male. The most frequent suicide deaths were in the spring (29.1%), and were performed during the afternoon (33.4%). In this review, it is noted that the methods of hanging (59.4%), leaping (17.0%), and gas intoxication (8.9%) were the most frequent suicide methods used by the suicide victims. A logistic regression analysis showed that poisoning had a lower risk of occurrence in night/morning time. In fact, gas poisoning was more dangerous in males, especially males who were younger, and occurred more frequently in the winter months. In this respect, the method of hanging was found to be higher in the low-educated group of people who committed suicide as reviewed. It is noted that drowning was a riskier factor in females, who were elderly and who committed suicide more frequently in the summer. The risk of leaping was increased in elderly populations who were also noted to be highly-educated.CONCLUSION: There was a significant difference in sex, age, educational level, season, suicide time, and suicide location according to each suicide method as reviewed and utilized in this study. The results note that it is necessary to emphasize the prevention of different suicide methods according to population groups.

Attempted Suicide by Nitrogen Gas Asphyxiation: A Case Report

Nitrogen is an inert gas that is harmless to humans under normal conditions. While it is not inherently toxic, nitrogen gas becomes dangerous when it displaces oxygen, resulting in suffocation. Herein, we report a case of a 34-year-old man who attempted suicide by nitrogen asphyxiation who presenting with decreased mental function and agitation. Lactic acidosis and hyperammonemia were observed on presentation at the emergency department, but these improved after a few hours. After 2 days, the patient regained full consciousness, and was discharged without any complications. Survival after asphyxiation due to nitrogen gas is very rare, and these patients are more likely to have poorer outcomes. There is a potential for the increasing use of nitrogen gas as a method of committing suicide because of the ease of access to this gas.

Situación epidemiológica de intoxicación por monóxido de carbono (CO) / Epidemiological situation of carbon monoxide intoxication (CO)

El monóxido de carbono es un gas tóxico, incoloro, inodoro e insípido que se produce durante la quema de combustible. Las intoxicaciones por monóxido de carbono (CO) constituyen causa de enfermedad y muerte. Además del evento agudo, los cuadros de intoxicación graves pueden dejar secuelas cognitivas. La exposición crónica también es importante dado que puede producir sintomatología neurológica y cognitiva. Se presentan diferentes análisis de la serie histórica que va desde 2005 a la Semana Epidemiológica 38 de 2016, de las intoxicaciones por Monóxido de Carbono asistidas en la Ciudad de Buenos Aires. Los datos para la construcción de indicadores del presente informe provienen del registro de casos individuales de intoxicación por CO, en el módulo C2 de Vigilancia Clínica del Sistema Nacional de Vigilancia de la Salud (SNVS)

Accidental phosphine gas poisoning with fatal myocardial dysfunction in two families

Aluminum phosphide is commonly used as a rodenticide and insecticide and is one of the most fatal poisons. The active ingredient is Phosphine gas which inhibits cytochrome oxidase and cellular oxygen utilization. The clinical symptoms are due to multiorgan involvement including cardiac toxicity which is the most common cause of mortality. Severity of clinical manifestations depends upon the amount of the gas to which a person is exposed. There is no specific antidote available. High index of suspicion and early aggressive treatment is the key to success. We report 2 cases of aluminum phosphide toxicity in 2 families due to incidental exposure after fumigation

Análisis descriptivo de la vigilancia epidemiológica intramural de la intoxicación por monóxido de carbono (CO) en el Distrito Capital (2011) / Descriptive Analysis of the Epidemiological Surveillance Intramural Poisoning from Carbon Monoxide (CO) in the Capital District 2011 / Análise descritiva da vigilância epidemiológica intramural de envenenamento por monóxido de carbono (CO) no capital de distrito 2011

El monóxido de carbono (CO) es un gas tóxico, inodoro e incoloro que se produce por la combustión incompleta de los hidrocarburos. Las principales fuentes de este veneno son los vehículos motorizados, los calentadores, los aparatos que utilizan el carbono como combustible y el fuego dentro de los hogares. Los síntomas que vienen a definir la intoxicación por CO son: cefaleas, vértigo, disnea, confusión, midriasis, convulsiones y coma. Objetivo: Describir el comportamiento de la intoxicación aguda por CO intramural durante 2011 en Bogotá, D. C., a través de los casos reportados por los diferentes sistemas de información en salud y ambientales. Métodos: Estudio descriptivo; se tuvo en cuenta la información de base de datos del Sistema Nacional de Vigilancia en Salud Pública (Sivigila) en 2011. La información fue tabulada con Microsoft Excel. Los análisis fueron realizados en STATA 9 y Epidat 3.1. Resultados: Para 2011 se presentaron 19 brotes de intoxicación por CO en el distrito, que afectaron, en total, a 60 personas. Durante el mismo año ocurrieron 4 muertes a causa de esta clase de envenenamiento. El promedio de edad de intoxicación estuvo en los 27 años; la menor de sus víctimas tenía un año, y las mayores, 80 años. En cuanto al sitio de ocurrencia, la localidad que reportó más casos fue Suba, seguida de Usaquén y Usme. Discusión: Hay subregistro frente a la ocurrencia de los casos de intoxicación por CO que no son atendidos en los servicios de salud y de los que producen la muerte inmediata y son llevados directamente a Medicina Legal, además de las fallas que se siguen identificando; también, fallas de clasificación del evento frente a la ocurrencia de intoxicaciones por CO y de calidad en algunos registros del Sivigila.

Introduction: Carbon monoxide (CO) is a toxic, odorless, colorless gas, produced by the incomplete combustion of hydrocarbons. The main sources for this toxic gas are motorized vehicles, heaters, machinery that uses coal as fuel, and fire in closed spaces like houses. Symptoms for this type of intoxication include headaches, vertigo, dyspnea, confusion, mydriasis, seizures, and coma. Objective: The main objective is to describe the behavior of acute intoxication caused by carbon monoxide in closed spaces in Bogota during 2011, through reported cases by different healthcare and environmental systems. Methods: Descriptive study with information obtained from SIVIGILA 2011 database. Data was tabulated with Microsoft Excel, and analysis was done with STATA 9 and Epidat 3.1. Results: In 2011, 60 individuals were affected by 19 different outbreaks. During this year, 4 intoxications caused by carbon monoxide resulted fatal. The average age for intoxication was 27. The youngest reported patient was 1 year old, while the oldest was 80 years old. Suba was the district with higher reported cases, followed by Usaquen and Usme. Discussion: Under-reporting for cases involving intoxication by carbon monoxide occurs, as some are not reported by any healthcare system. The same happens for lethal intoxication cases taken directly to Legal Medicine that are not reported. Other problems arise, like failure to classify events as carbon monoxide intoxication, and lack of quality in some SIVIGILA reports.

O monóxido de carbono (CO) é um gás tóxico, incolor, inodoro e é produzido pela combustão incompleta de hidrocarbonetos. As principais fontes deste veneno são os automóveis, aquecedores, aparelhos que usam carvão como combustível, e o fogo utilizado dentro das casas. Os sintomas que definem esta intoxicação são dor de cabeça, tontura, dispnéia, confusão, midríase, convulsões e coma. Objetivo: Descrever o comportamento da intoxicação aguda do monóxido de carbono intramural de 2011, em Bogotá através dos casos apresentados nos sistemas de saúde e ambiental. Métodos: Estudo descritivo que levou em conta as informações da base dados de SIVIGILA de 2011, os dados foram tabulados com o Microsoft Excel. As análises foram realizadas no STATA 9 e Epidat 3.1. Resultados: Para o ano de 2011, apresentaram 19 casos no distrito, afetando 60 pessoas. Durante este ano ocorreu quatro mortalidades devido a intoxicação por monóxido de carbono. A média de idade dos intoxicados foi de 27 anos, o caso mais jovem foi de 1 ano e mais velho foi de 80 anos. Com relação ao local de ocorrência, a cidade que registrou mais casos foi Suba, seguida por Usaquén e Usme. Discussão: Há uma subnotificação de ocorrência de casos de intoxicação por monóxido de carbono que não são atendidos nos serviços de saúde e aqueles que causam a morte imediata e são levados diretamente à Medicina Legal, além das falhas que continuam sendo identificadas; falhas na classificação de eventos e a ocorrência de intoxicação por monóxido de carbono e qualidade em alguns registros SIVIGILA.

Method development and validation for determining 1,3-butadiene in human blood by gas chromatography-mass spectrometry and head-space gas chromatography / 法医学杂志

To develop a simple, validated method for identifying and quantifying 1,3-butadiene (BD) in human blood by gas chromatography-mass spectrometry (GC-MS) and head-space gas chromatography (HS-GC). BD was identified by GC-MS and HS-GC, and quantified by HS-GC. The method showed that BD had a good linearity from 50 to 500 microg/mL (r > 0.99). The limits of detection and quantification were 10 microg/mL and 50 microg/mL, respectively. Both the intra-day precision and inter-day precision were < 6.08%, and the accuracy was 96.98%-103.81%. The method was applied to an actual case, and the concentration of BD in the case was 242 microg/mL in human blood. This simple method is found to be useful for the routine forensic analysis of acute exposure to BD.

A pragmatic & translational approach of human biomonitoring to methyl isocyanate exposure in Bhopal.

Human biomonitoring has evolved beyond margins to ascertain exposure-response relationship in environmental associated human diseases. As occupational ailments continue to dominate global concerns, biomonitoring strategies have evolved better in terms of evaluating health risks associated with systemic uptake from chronic (long-term) environment exposures. Even though contributions of acute toxic exposures (short-term) towards initiation of disease processes have been gradually recognized, a comprehensive approach delineating mechanistic insights of such an implication remains elusive. Molecular biomonitoring in a strictly selected defined surviving cohort of the infamous Bhopal gas tragedy “as a model”, could provide an unparallel opportunity to discern the long standing implications of acute exposures. Besides comprehending clinical significance of isocyanate toxicity, the results might provide a framework for understanding the molecular repercussions pertaining to a host of other such acute environmental exposures. The investigative strategy might also be helpful in identification of biomarkers with potential for translational research.

The changes of peripheral blood lymphocyte subsets in patients with acute hydrogen chloride gas poisoning / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To explore the changes of peripheral blood lymphocyte subsets in patients with acute hydrogen chloride gas poisoning.</p><p><b>METHODS</b>When the patients were admitted or on the secondary day, the percentages of total T-cell lymphocyte subsets (CD(3)(+)CD(19)(-)), CD(4)(+)T cells (CD(3)(+)CD(4)(+)), CD(8)(+)T cells (CD(3)(+)CD(8)(+)), B cells (CD(3)(-)CD(19)(+)) and NK cells (CD(3)(-)CD(16)(+)CD(56)(+)), and the ration of CD(4)(+)/CD(8)(+) in 37 cases with acute hydrogen chloride gas poisoning and 49 healthy controls were detected with flow cytometer.</p><p><b>RESULTS</b>The total T-cell percentage and total CD(4)(+)T cell percentage in 37 cases were significantly lower than those in 47 controls (P < 0.05). The percentages of NK cells and B lymphocytes in 37 cases significantly increased, as compared with controls (P < 0.05). The ration of CD(4)(+)/CD(8)(+) in 37 cases significantly decreased, as compared with controls (P < 0.05).</p><p><b>CONCLUSION</b>The lymphocyte subsets in the patients with acute hydrogen chloride gas poisoning changed, which could influence the immune function of patients.</p>

The Neuroprotective Effect of delta-opioid Receptor Stimulation with D-Ala2, D-Leu5 Enkephalin Against Ischemic Neuronal Injury

PURPOSE: Oxygen is indispensable for survival and aerobic metabolism in all mammalian cells. Inadequate oxygen triggers a multifaceted cellular response negatively impacting important physiological functions which are observed in clinical diseases such as stroke, drowning, cardiac arrest, hazardous gas poisoning, myocardial infarction and vascular dementia. In this study, we investigated the neuroprotective effect of a synthetic delta-opioid agonist, [D-Ala2, D-Leu5] enkephalin (DADLE), and its role in ischemic neuronal injury. METHODS: This experiment was conducted in vitro using a primary culture of rat cortical neurons. Ischemia induction was performed using a hypoxic chamber. To test the degree of neuronal viability, as protected by delta-opioid stimulation with DADLE under ischemia, we used three independent approaches including a lactate dehydrogenase assay, MTT assay, and an immunofluorescent staining assay for viable cells. In addition, the gene expressions of caspase-3 and heat shock protein 70 were analyzed using real-time PCR. RESULTS: Incubation of the cortical neurons with DADLE protected them from ischemia-induced cytotoxicity, as observed by all three independent viability assays. Also, we found that its neuroprotective effect might be related with suppression of the caspase-3 gene. CONCLUSION: The results of this study suggested that DADLE exhibits a neuroprotective effect against ischemia-induced neuronal cell death.

The Neuroprotective Effect of delta-opioid Receptor Stimulation with D-Ala2, D-Leu5 Enkephalin Against Ischemic Neuronal Injury

PURPOSE: Oxygen is indispensable for survival and aerobic metabolism in all mammalian cells. Inadequate oxygen triggers a multifaceted cellular response negatively impacting important physiological functions which are observed in clinical diseases such as stroke, drowning, cardiac arrest, hazardous gas poisoning, myocardial infarction and vascular dementia. In this study, we investigated the neuroprotective effect of a synthetic delta-opioid agonist, [D-Ala2, D-Leu5] enkephalin (DADLE), and its role in ischemic neuronal injury. METHODS: This experiment was conducted in vitro using a primary culture of rat cortical neurons. Ischemia induction was performed using a hypoxic chamber. To test the degree of neuronal viability, as protected by delta-opioid stimulation with DADLE under ischemia, we used three independent approaches including a lactate dehydrogenase assay, MTT assay, and an immunofluorescent staining assay for viable cells. In addition, the gene expressions of caspase-3 and heat shock protein 70 were analyzed using real-time PCR. RESULTS: Incubation of the cortical neurons with DADLE protected them from ischemia-induced cytotoxicity, as observed by all three independent viability assays. Also, we found that its neuroprotective effect might be related with suppression of the caspase-3 gene. CONCLUSION: The results of this study suggested that DADLE exhibits a neuroprotective effect against ischemia-induced neuronal cell death.

Diffusing capacity for lung carbon monoxide [DLCO] in chemical lung injuries due to the use of mustard gas in the poisoned soldiers of Iran-Iraq war 2006

To assess the Mustard gas exposure effects on pulmonary system, particularly on diffusing capacity for lung carbon monoxide [DLCO] and simple spirometry. Sixty-five sulfur mustard- poisoned soldiers from Mostazafan and Janbazan organization were referred to our center in 2005. Complete history, physical examination, chest X ray, Echocardiography, Arterial blood gas, high - resolution computerized tomography, diffusion capacity for lung carbon monoxide and spirometry of these were performed and compared this result with normal value. The mean value of indices in studied injured subjects was: Spirometry: forced expiratory volume in one second [FEV1] = 70.4, Forced vital capacity [FVC] = 66.5, EFE 25-75=81.1, FEV1/FVC=101.9, Flow 25% = 28.7, Flow 50%= 72.9, Flow 75%= 100.1, Sample volume: Functional residual capacity of lungs [FRC] = 131.5, residual volume [RV] = 157.3, RV/TLC= 169.1, Total lung capacity [TLC] = 91.3, KCO= 131.6, TLCO= 116.3. No significant correlation was observed between TLCO values with HRCT, echocardiography, ABG and spirometry values [P>0.05]. We recommend TLCO and RV/TLV tests to assess severity of Injuries as there is no a suitable criterion to measure the real consequences of mustard gas on affected combatants and Biological markers are also needed to determine cause- effect relations

Situación socio-sanitaria. síntomas respiratorios y función pulmonar medida por espirometría en ex trabajandores de la Industría del calzado, La Calera, Córdoba, Argentina / Socio-health. respiratory symptoms and lung function measured by spirometry in ex trabajandores of the footwear industry, La Calera, Córdoba, Argentina

Se evaluó la situación socio-sanitaria, los síntomas respiratorios y la función pulmonar en una muestra de 60 ex trabajadores (47 por ciento hombres y 53 por ciento mujeres, de una edad promedio de 47 años) que fueron empleados en una fábrica de la industria del calzado en la localidad de La Calera, Provincia de Córdoba, Argentina. Los mismos estuvieron expuestos a irritantes de la víaaérea (solventes, polvos de cuero y vapores) durante el tiempo en que trabajaron en la empresa, pero luego de ser despedidos su situación socio-sanitaria empeoró aún más debido a las consecuencias de la falta de cobertura médicas y al impacto físico y moral surgido del desempleo. Por este motivo, el objetivo principal de este trabajo fue realizar un estudio epidemiológico observacional analítico sobre la situación socio-sanitaria, síntomas respiratorios y función pulmonar medida por espirometría en extranbajadores de la industría del calzado, La Calera, Córdoba, Argentina.

Genetic damages in somatic and germ cells from patients of benzene poisoning, asbestosis and gas poisoning / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To compare the extent of genetic damages in somatic and germ cells from patients of benzene poisoning, silicosis and gas poisoning, which may provide clues for protection and reproductive healthcare.</p><p><b>METHODS</b>174 patients with three types of occupational disease (including 48 with benzene poisoning, 71 with silicosis and 55 with gas poisoning) and 80 healthy controls had their aberrant chromosome and micronuclei rates measured with routine methods. Male patients also had their sperm samples measured for sperm abnormities and de novo mutations.</p><p><b>RESULTS</b>The aberrant chromosome rate, micro-nuclei rate and sperm abnormity were as followed: benzene poisoning 0.4%, 1.52 per thousand, (62 +/- 14%), silicosis 0.51%, 2.31 per thousand, (41 +/- 7%), harmful gas poisoning 0.42%, 1.55 per thousand, (48 +/- 8%), all being significantly higher than those of the controls [0.20%, 0.34 per thousand, (27 +/- 5)%]. The aberrant chromosome and micro-nuclei rates of silicosis group were higher than other two groups, but without statistical significance. Sperm abnormity of benzene poisoning group was significantly higher than that of other groups. In addition, de novo mutations in sperm of benzene poisoning group were detected.</p><p><b>CONCLUSION</b>Patients with the studied occupational diseases not only have genetic damage in their somatic cells, but also acquire de novo mutations in germ cells.</p>

Characterization of severe acute occupational poisoning accidents related to asphyxiating gases in China between 1989 and 2003 / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To analyze severe acute occupational poisoning accidents related to asphyxiating gases reported in China between 1989 and 2003, and to study the characteristics of severe acute occupational poisoning accidents and provide scientific evidences for prevention and control strategies.</p><p><b>METHODS</b>The data from the national occupational poisoning case reporting system were analyzed with descriptive methods.</p><p><b>RESULTS</b>(1) There were 273 severe acute occupational poisoning accidents related to asphyxiating gases for 15 years with 1638 workers poisoned and 600 workers died, which accounted for 53.95% in total accidents and 35.17% of workers poisoned and 78.64% of workers died of all severe acute occupational poisoning accidents. The average poisoning age was (33.8 +/- 9.7) years old and the average death age was (36.6 +/- 10.0) years old. (2) Most of the accidents were caused by hydrogen sulfide, carbon monoxide and carbon dioxide respectively, and mainly occurred in chemical industry, mining, water disposal industry, paper making industry and brewing industry. The risk was higher in some jobs than others, such as cleanout, machine maintenance and repair, production, mine and digging. The poisoning accidents occurred more frequently from April to September each year and occurred in the confined space, in the basement and the mine, and workers died of poisoning mostly were men.</p><p><b>CONCLUSION</b>(1) The severe acute occupational poisoning accidents related to asphyxiating gases are more dangerous than others. (2) The control of poisoning accidents related to hydrogen sulfide, carbon monoxide and carbon dioxide, which occurred easily in the confined space, should be paid more attention to, and good work practice should be developed on some posts, such as digging, cleanout, dredge, machine maintenance and repair and mine.</p>

Characterization of severe acute occupational poisoning accidents related to irritating gases in China between 1989 and 2003 / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To analyze severe acute occupational poisoning accidents related to irritating gases reported in China between 1989 and 2003, and to study the characteristics of severe acute occupational poisoning accidents and provide scientific evidences for prevention and control strategies.</p><p><b>METHODS</b>The data from the national occupational poisoning case reporting system were analyzed with descriptive methods.</p><p><b>RESULTS</b>(1) There were 92 severe acute occupational poisoning accidents related to asphyxiating gases during 15 years, which showed that there were 14.5 accidents occurred each year. Forty types of chemicals were reported to cause poisoning accidents directly. On average, there were 14.5 persons poisoned and 0.8 persons died of poisoning in each event. The number of death of poisoning reached 7 in most of the severe accidents. Chlorine was the main irritating gas resulting in poisoning accidents according to the number of accidents, cases and death.</p><p><b>CONCLUSION</b>(1) The severe acute occupational poisoning related to irritating gases are more dangerous than others because of it is involved in more cases in each accident. (2) The accidents have concentricity in the certain types of chemicals, industries and jobs, and should be focused on control. (3) It is important to develop the program about early warning and forecast and the first aid.</p>

Intoxicación con gas fosfina. Presentación clínica y tratamiento / Phosphine gas poisoning. Clinical presentation and treatment

Se presenta el caso clínico de un paciente, que ingresó a nuestro Hospital, bajo los efectos de una intoxicación con fosfuro de aluminio, un componente químico de plaguicidas. Cuando el fosfuro de aluminio entra en con- tacto con aire o humedad, genera el gas fosfina, producto altamente tóxico para el organismo. El objetivo de nuestro trabajo, es poner en conocimiento de los médicos de nuestro medio (donde la frecuencia de uso de este tóxico es habitual), sobre la presentación clínica de la intoxicación y los lineamientos a seguir para su correcto tratamiento. Se informa sobre las propiedades del fosfuro de aluminio, vías de absorción, biotransformación, dosis letales, fisiopatología y las bases moleculares de la acción del fosfuro de aluminio.

The clinical case of a patient admitted at our hospital under the effects of phosphine gas intoxication is presented. The objective of this work is to inform medical doctors at our institution, where this toxic is frequently used, on the clinical occurrence of the intoxication and the guidelines to follow for its correct treatment. Information on the properties of aluminum phosphide or phosphine gas, lethal doses, absorption paths, biotransformation, molecular bases, and physiopathological bases of the intoxication is also given.

Intoxicaçäo exógena por formol / Exógen intoxication for formaldehyde

A intoxicaçäo exógena por ingestäo de formol é responsável por distúrbios gastrointestinais decorrentes da irritaçäo e necrose de mucosas. O caso relata paciente do sexo feminino, 55 anos, em quadro depressivo, com história de ingestäo de aproximadamente 100 ml de formol, evoluindo com lesäo ulcerada de mucosa gástrica, com posterior atrofia e estenose. Realizou tratamento clínico e atualmente está em acompanhamento ambulatorial, endoscópico e psicológico.