One case of myocardial damage caused by carbamate pesticide poisoning / 中华劳动卫生职业病杂志

The data of a patient with carbamate pesticide poisoning were analyzed. Cardiac arrest, oliguria, acute renal injury and pulmonary infection occurred during treatment. After cardiopulmonary resuscitation, tracheal intubation, CRRT, anti-infection and other symptomatic support treatment, the patient recovered and discharged. The myocardial damage caused by carbamate pesticide poisoning is easy to be ignored, and it often causes cardiac manifestations such as arrhythmia and cardiac insufficiency, and the related markers of cardiac injury, electrocardiogram and echocardiogram are also changed. Therefore, the awareness of cardiac damage caused by carbamate pesticide poisoning should be improved.

Clinical features and follow-up outcomes of optic nerve injury induced by acute methanol poisoning / 中华劳动卫生职业病杂志

Acute methanol poisoning harms the optic nerve and central nervous system, can cause irreversible damage, even coma or death in severe cases. This article reported four cases of methanol poisoning. 3 patients mistakenly ingested industrial alcohol containing methanol, the most serious patient suffered from coma, vision loss and other symptoms, the blood methanol concentration was 869.3 μg/ml. Another patient was poisoning caused by inhalation of methanol, with symptoms such as total blindness in the right eye and decreased visual acuity in the left eye. After active supportive treatment, 2 patients had partial recovery of visual acuity, and 2 patients had no sequelae. This article discussed the clinical features, treatment and prognosis of optic nerve damage caused by methanol poisoning, in order to raise awareness of this disease.

A death case of oral lime sulfur mixture poisoning / 中华劳动卫生职业病杂志

The Second Affiliated Hospital of Shandong First Medical University treated a patient with oral sulfur mixture poisoning on January 14, 2020. The patient presented with cyanosis and disturbance of consciousness as the first manifestations, accompanied by metabolic acidosis, shock, hypercalcemia and severe liver function and myocardial damage. The patient was given active treatment, including gastric lavage, blood purification, methylene blue application, correction of shock, organ support and other therapies. However the treatment was poor. Finally, the patient's family chose to give up and requested to be discharged from the hospital, and the patient died on the same day after follow-up.

Analysis of risk factors for hemorrhage in patients with acute poisoning treated with hemoperfusion / 中华劳动卫生职业病杂志

Objective: To explore the clinical characterist ics and risk factors of hemorrhage complicated by hemoperfusion therapy in patients with acute poisoning. Methods: In January 2021, the clinical data of 196 patients with acute poisoning who received hemoperfusion therapy in the Second Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2020 were analyzed, and the patients were divided into bleeding group and non-bleeding group according to whether the patients were complicated with bleeding. Multivariate logistic regression was used to analyze the independent risk factors for hemorrhage in patients treated with hemoperfusion. Results: A total of 21 patients in the bleeding group and 175 patients in the non-bleeding group were included. There was no significant difference in general data such as gender, age, and body mass index between the two groups (P>0.05) . Organophosphorus pesticides (χ(2)= 4.56, P=0.030) , HA230 perfusion device (χ(2)=4.12, P=0.042) , platelet count (t=-2.33, P=0.009) and activated partial thromboplastin time (t=14.53, P<0.001) at 2 h of perfusion were the influencing factors of hemorrhage in patients with acute poisoning treated with hemoperfusion. Among them, organophosphorus pesticides, 2 h perfusion activated partial thromboplastin time ≥35 s and other factors were independent risk factors forcomplicated bleeding (P<0.05) . Conclusion: Patients with acute poisoning, especially organophosphorus pesticide poisoning, are at greater risk of bleeding during hemoperfusion therapy. Monitoring of changes in activated partial thromboplastin time should be strengthened and the dose of anticoagulants should be adjusted in time to reduce the risk of bleeding.

Analysis of clinical effect of blood purification on acute benzene-based thinner poisoning / 中华劳动卫生职业病杂志

Objective: To investigate the clinical significance of blood purification on changes in serum toxicant concentration and prognosis of acute benzene-based thinner poisoning. Methods: A total of 44 patients with acute benzene-based thinner poisoning admitted to the emergency department of Characteristic Medical Center of Armed Police from August 2013 to August 2020 were collected and divided into a blood purification group (24 cases) and a conventional treatment group (20 cases) , the general data, toxicant concentrations and prognosis of the two groups of patients were analyzed, and logistic regression analysis was performed on the influencing factors of the prognosis to explore the clinical effect of blood purification. Results: The concentration of poisons in the blood purification group at 24 hours after treatment was significantly lower than that in the conventional treatment group (t=6.76, P<0.001) , and the reduction in the concentration of poisons was significantly higher than that in the conventional treatment group (t=3.33, P=0.002) . The overall improvement rate in the blood purification group was 91.7% (22/24) , which was higher than that in the conventional treatment group (60.0%, 12/20) . Logisitic regression analysis showed that blood purification treatment method was the main factor affecting the prognosis of patients (OR=7.605×10(-5), 95%CI: 6.604×10(-8)-0.087, P=0.008) , and the toxic dose was a synergistic effect on the prognosis of patients factor (OR=1.038, 95%CI: 1.008-1.068, P=0.011) . Conclusion: Early blood purification treatment in patients with acute benzene-based thinner poisoning can rapidly reduce blood toxin concentration, avoid disease progression, and ultimately improve patient prognosis.

Intoxicación severa por Nicotiana glauca (Palán Palán) con miocardio atontado / Severe poisoning by Nicotiana glauca (Palán Palán) with stunned myocardium

Resumen Nicotiana glauca también llamada Palán Palán, es un arbusto con hojas verdes azuladas y despulidas y una flor amarilla tubular pendulante que presenta alcaloides piridínicos, como nicotina, nornicotina, anatabina y anabastina (análogo estructural de la Nicotina). Se presenta el caso clínico de una paciente de 50 años con cuadro agudo de debilidad muscular generalizada que evoluciona con paro respiratorio, tras la ingesta accidental de una cantidad desconocida de hojas de Nicotiana glauca, cultivadas en una huerta hogareña mediante técnica de hidroponía y confundidas por su conviviente con espinaca. Presentó aumento de lactato y Troponina Ultra Sensible e Hipoquinesia Global de Ventrículo Izquierdo en el ecocardiograma, compatible con Aton tamiento Miocárdico (AM), que evolucionó favorablemente. Si bien hay pocos reportes, se han informado muertes de animales y humanos, tras la ingesta accidental de Nicotiana glauca. El inicio del cuadro es rápido, con patrón bifásico, con vómitos y estímulo simpático, seguido por bloqueo ganglionar y neuromuscular, pudiendo presentar paro respiratorio, shock, convulsiones y coma. El AM es una disfunción miocárdica prolongada con retorno gradual de la actividad contráctil, posterior a un episodio breve de isquemia grave, puede ser asintomático, pudiendo presentar alteraciones en el electrocardiograma, enzimas cardíacas o ecocardiograma. Generalmente presenta pronóstico favorable, pudiendo presentar insuficiencia cardíaca ante patologías concurrentes o aumento de requerimientos de oxígeno.

Abstract Nicotiana glauca is a shrub with bluish green leaves and a pendulous tubular yellow flower. It has pyridine alkaloids, such as nicotine, nornicotine, anatabine and anabastine (structural analog of Nicotine). We present the case of a 50 years old pa- tient with acute generalized muscle weakness that evolves to respiratory arrest, after accidentally ingesting an unknown quantity of Nicotiana glauca leaves, grown in a home vegetable garden, using a hydroponic technique and confused by her cohabiting with spinach. She presented increased lactate and Ultra Sensitive Troponin and Left Ventricular Global Hypokinesia in the echo- cardiogram, compatible with Myocardial Stunned, that it evolved favorably. There are few reports, animal and human deaths have been reported following accidental ingestion of Nicotiana glauca. The onset of the symptoms is early, with a biphasic pattern, with vomiting and sympathetic stimulation, followed by ganglionic and neuromuscular blockage and may present respiratory arrest, shock, seizures and coma. Myocardial Stunned is a prolonged myocardial dysfunction with gradual return of contractile activity after a brief episode of severe ischemia, it can be asymptomatic, and it can present alterations in the electrocardiogram, cardiac enzymes or echocardiogram. Generally presents a benign prognosis, being able to present heart failure with concurrent patholo- gies or increased requirements.

Poisoning by metals used in prothetic materials in orthopedics and its current management / Envenenamiento por metales en materiales protésicos en ortopedia y su tratamiento actual

Poisoning by metals present in prosthetic materials used in orthopedics is caused by the release of waste metals that are generated mainly by wear and corrosion. The objective of this study is to detail which are the current clinical and pathophysiological manifestations of the prosthetic metals used in orthopedics as well as the management of the most frequent arthroplasty associated with metal toxicity, hip arthroplasty, mentioning the most frequent metals that produce toxicity and implants or arthroplasties that carry a risk of developing intoxication. A narrative review was carried out through various databases from January 2005 to January 2021; the search and selection of articles were carried out in journals indexed in English. The results provided updated and organized information on the clinical and pathophysiological manifestations caused by the different types of frequent metals that produce toxicity present in prosthetic materials, as well as the management of hip arthroplasty(AU)

La intoxicación por los metales presentes en materiales protésicos utilizados en ortopedia se produce por la liberación de metales de desecho, que se generan principalmente por el desgaste y la corrosión. El objetivo de este estudio es detallar cuáles son las manifestaciones clínicas y fisiopatológicas actuales de los metales protésicos utilizados en ortopedia así como el tratamiento de las artroplastias más frecuentes asociadas a toxicidad por metales, la artroplastia de cadera, mencionando los metales más frecuentes que producen toxicidad e implantes o artroplastias que conllevan riesgo de intoxicación. Se realizó una revisión narrativa a través de varias bases de datos desde enero de 2005 hasta enero de 2021; la búsqueda y selección de artículos se realizó en revistas indexadas en inglés. Los resultados proporcionaron información actualizada y organizada sobre las manifestaciones clínicas y fisiopatológicas provocadas por los diferentes tipos de metales frecuentes que producen toxicidad que están presente en los materiales protésicos, así como el manejo de la artroplastia de cadera(AU)

Clinical and epidemiological analysis of suicide attempts in children assisted by a poison control center / Análise clínica e epidemiológica das tentativas de suicídio em crianças atendidas em um centro de informação e assistência toxicológica

ABSTRACT Objective: To assess suicide attempts in children seeking care at a Poison Control Center. Methods: Cross-sectional study with children (<12 years old) that attempted suicide and were cared at the Poison Control Center in Londrina, Paraná, Southern Brazil, from April 1985 to December 2018. Results: We identified 59 children, most of them females (74.6%), who used only one product (77.9%). Among the products involved, medications were the most important ones (88.1%). Neurological/psychiatric/muscular manifestations (61.0%) were the main symptoms presented. The main reason identified for the suicide attempt was conflicts with family and/or friends (27.1%). Suicide attempts were more frequent in 2001-2003 and 2016-2018. Conclusions: Suicide attempts occurred mainly in female children with a single agent (mainly medications), and the main reason was family conflicts..

RESUMO Objetivo: Analisar as tentativas de suicídio em crianças atendidas em um Centro de Informação e Assistência Toxicológica (CIATox-Londrina). Métodos: Estudo transversal com crianças (<12 anos) atendidas no CIATox-Londrina, Paraná, de abril/1985 a dezembro/2018, com tentativa de suicídio. Resultados: Identificaram-se 59 crianças, com predomínio do sexo feminino (74,6%) e com o uso de apenas um produto (77,9%). Entre os produtos envolvidos, destacaram-se os medicamentos (88,1%). As manifestações neurológicas/psíquicas/musculares (61,0%) foram os principais sintomas apresentados. O principal motivo identificado da tentativa de suicídio foram os conflitos com familiares e/ou amigos (27,1%). Houve maior frequência de tentativas de suicídio nos triênios 2001-2003 e 2016-2018. Conclusões: As tentativas de suicídio ocorreram predominantemente nas crianças do sexo feminino, com um único agente (em geral, medicamentos), em que o principal motivo foram os conflitos familiares, observando-se um aumento ao longo dos anos.

Análise crítica da indicação da lavagem gástrica em intoxicações atendidas em um hospital de ensino / Critical analysis of gastric lavage indication for poisoning cases attended in a university hospital

Objetivo: Avaliar a indicação da lavagem gástrica no tratamento de intoxicações causadas por ingestão. Métodos: Todos os casos de intoxicação causada por ingestão que foram atendidos em dois hospitais do interior de São Paulo e submetidos à lavagem gástrica no período de 1° de janeiro de 2011 a 31 de dezembro de 2015 foram avaliados retrospectivamente quanto à indicação do procedimento, considerando o tempo entre ingestão e atendimento, a toxicidade da substância e as contraindicações para o procedimento. Resultados: Dos 587 casos atendidos, 338 (57,6%) foram submetidos à lavagem gástrica. Dentre esses casos, constatou-se a realização equivocada do procedimento em 95,8% casos. Conclusão: O número de pacientes submetidos à lavagem gástrica neste trabalho foi considerado elevado, mesmo quando orientado pelo centro de atendimento. Apesar da falta de evidências de que a lavagem gástrica traga benefícios nos casos de intoxicação, ela é largamente utilizada em virtude do desconhecimento das indicações e contraindicações desse procedimento por parte dos profissionais de saúde

Objective: To evaluate the indication of gastric lavage in the treatment of poisoning caused by ingestion. Methods: All cases of poisoning caused by ingestion that were treated in two hospitals in inland cities of São Paulo and subjected to gastric lavage from January 1, 2011 to December 31, 2015 were retrospectively assessed as for the indication of the procedure, considering the time between ingestion and care, substance toxicity, and procedure contraindications. Results: Of the 587 cases treated, 338 (57.6%) underwent gastric lavage. The procedure was considered incorrect in 95.8% of cases. Conclusion: The number of patients undergoing gastric lavage in this study was considered high, even when instructed by the center of attendance. Despite the lack of evidence that gastric lavage brings benefits in cases of poisoning, it is widely used due to the lack of knowledge by health professionals of the indications and contraindications of this procedure.

Actualización en el manejo de intoxicación sistémica por anestésicos locales / Local anesthetics systemic toxicity: update in management

Systemic toxicity by local anesthetics an adverse reaction that occurs when local anesthetics (AL) reach significant systemic levels, primarily affects the central and cardiovascular nervous system, and while it is an infrequent event, it can be potentially fatal. The main determinant of the toxicity is the plasma concentration of LA, especially the free fraction. The most serious symptoms are seizures and cardiac arrest, which can occur with the administration of any LA. Bupivacaine is the most cardiotoxic of the commonly used LAs, followed in decreasing order by levobupivacaine, ropivacaine and lidocaine.

La intoxicación sistémica por anestésicos locales (ISAL), una reacción adversa que ocurre cuando los anestésicos locales (AL) alcanzan niveles sistémicos significativos, afecta principalmente al sistema nervioso central y cardiovascular, y si bien, es un evento infrecuente, puede ser potencialmente fatal. El principal determinante de la ISAL es la concentración plasmática de AL, en especial la fracción libre. Los síntomas más graves son las convulsiones y paro cardíaco, los cuales pueden ocurrir con la administración de cualquier AL. La bupivacaína es el más cardiotóxico de los AL comúnmente utilizados, seguido en orden decreciente por levobupivacaína, ropivacaína y lidocaína.

Antibiotic therapy for snakebite envenoming

There are numerous conflicting recommendations available on the use of antibiotics following snakebite. The present letter to the editor presents some recommendations based on recent studies, and aims to stimulate debate on this topic.(AU)

Intoxicación por etilenglicol, fisiopatología y enfrentamiento clínico / Ethylene glycol poisonin: an update

Toxic alcohols can produce severe poisoning with multiple organic involvement and even death. The most common form is ethylene glycol. The diagnosis can be extremely difficult if there is no history of its consumption. Its clinical presentation can simulate other conditions. Ethylene glycol poisoning is characterized by an initial rise in plasma osmolal gap that decreases during the evolution, while alcohol is metabolized to acids. This last condition causes a metabolic acidosis with elevated anion gap. The clinical manifestations are diffuse neurological involvement initially, followed by hemodynamic alterations due to myocardial damage associated with hypocalcemia and acidemia. Subsequently, severe tubular renal damage appears, which may require renal replacement therapy, and finally, focal neurological alterations. To treat this poisoning, it is necessary to inhibit the transformation of alcohol into acids, increase the metabolism of the latter or withdraw them directly with hemodialysis.

Toxicidad por ácido fluorhídrico: reporte de casos / HYdrofluoric acid toxicity

Los accidentes con ácido fluorhídrico en Argentina son un motivo de consulta infrecuente, a pesar de ser utilizado en varias actividades laborales. Es uno de los pocos cáusticos con tratamiento específico que se debe tener en cuenta. Reportamos el caso de un paciente de 35 años que estuvo en contacto con esta sustancia con posterior compromiso de miembro superior, presentando placa eritematosa en región palmar derecha y lesión ampollar con descamación posterior y sangrado en lecho ungueal. Recibió tratamiento local con gluconato de calcio al 20% en toda la extensión de la zona afectada durante 48 hs con recuperación completa a los quince días. La sospecha clínica temprana y la administración adecuada de gluconato de calcio evitan lesiones de mayor grado y extensión

In Argentina, hydrofluoric acid accidents are a rare reason for consultation, despite being a commonly used substance in laboral activities. It is one of the few caustics with a specific treatment that must be taken into account. We report the case of a 35 year old patient affected by said substance, in which we observe an impairment of the upper limb, presenting on the right palmar region, an erythematous plaque with a blister lesion with posterior scaling and bleeding of the nail bed. The importance of the early clinical suspicion and the proper administration of calcium gluconate would avoid bigger and more extensive lesions

Epidemiología de las intoxicaciones agudas por drogas de abuso en las urgencias de un hospital del Centro de España basada en datos de análisis toxicológico de orina / Epidemiology of acute poisonings for drugs of abuse in the emergency room of a hospital from the Center of Spain based on analysis data toxicological urine

Introducción: las intoxicaciones agudas son motivo de consulta cada vez más frecuente en los Servicios de Urgencia hospitalarios (SUH) debido a la mayor disponibilidad y acceso a productos químicos tóxicos. Se observan diferentes patrones en cada área sanitaria según el tipo de población, geografía y perfil epidemiológico de consumo. Material y métodos: el objetivo de nuestro estudio es realizar un perfil epidemiológico y describir el manejo del paciente que acude por clínica compatible con intoxicación aguda por drogas de abuso (IA) basado en la determinación de tóxicos en orina para seis sustancias (cannabis, opiáceos, cocaína, anfetaminas, benzodiazepinas y éxtasis) solicitados en el período de estudio 2010-2012. Resultados: se solicitaron 2755 peticiones, de las cuales fueron positivas 1429, y se estudiaron al azar 661 historias clínicas. El perfil de paciente intoxicado de nuestra área es el de varón de entre 30 y 40 años, consumidor preferentemente de cannabis y cocaína; las benzodiazepinas son el tóxico más frecuente en las mujeres, con clínica mayoritariamente neurológica, sin diferencias en cuanto a la franja horaria o el mes del año en que recibió el alta desde el propio SUH en casi el 60% de los casos. Discusión: las IA en los SUH representan casi el 1% de las consultas y tienen una escasa mortalidad. En algunos casos, el médico de urgencias comienza el tratamiento antes de conocer el resultado toxicológico, lo que nos hace plantearnos la utilidad real y el coste-efectividad de estas determinaciones en todos los pacientes con alteración del nivel de conciencia. (AU)

Introduction: acute intoxications are a rising and common query demand on the emergency rooms because of the easy access and disponibility to toxic substances, where we can observe different patterns attending to type of population, geography and epidemiologic consume profile. Material and methods: our objective is to analyze the epidemiology and patient handling coming to the Emergency Room (ER) with compatible symptoms of street drugs abuse, based on the determination of cannabis, cocaine, amphetamine, benzodiazepine, opiates and ectasy urine levels in the period 2010-2012. Results: the ER requested 2755 determinations being positive 1429 and randomly examined 661 clinical histories. The profile of intoxicated patient was male, 30 to 40 years old, preferently cannabis and cocaine consumer (benzodiazepine in women), mostly with neurological symptoms when arrive, without differences between months or day time and, almost 60% of them, discharged directly from the ER. Conclusions: acute intoxications barely represent 1% of ER demands and produce poor or scarce mortality. Sometimes, doctors in charge start with therapeutic measures before knowing the results of toxicology, what leads us to ask about actual usefulness and cost-efficiency of the toxicology assay to every patient with low conscious level. (AU)

Neuropatia óptica tóxica por inalação de metanol / Optic neuropathy toxic after methanol inhalation

Resumo A intoxicação por metanol é um evento considerado raro, principalmente quando feita por via inalatória. Retratou-se neste presente estudo um relato de caso de um paciente que desenvolveu neurite óptica tóxica após exposição ao metanol e ácido acético por via inalatória em seu ambiente de trabalho. Foi descrito sobre as terapias obtidas na literatura, bem como as manifestações clínicas e o manejo a este paciente.

Abstract The methanol toxicity is considered rare event , especially when taken by inhalation . It was portrayed in the present study a case report of a patient who developed toxic optic neuritis after exposure to methanol and acetic acid by inhalation in the workplace . It was described for the therapies from the literature as well as the clinical manifestations and management in this patient.

True or false coral snake: is it worth the risk? A Micrurus corallinus case report

Bites provoked by the genus Micrurus represent less than 1% of snakebite cases notified in Brazil, a tiny fraction compared with other genus such as Bothrops and Crotalus, which together represent almost 80% of accidents. In addition to their less aggressive behavior, habits and morphology of coral snakes are determinant factors for such low incidence of accidents. Although Micrurus bites are rare, victims must be rescued and hospitalized in a short period of time, because this type of envenoming may evolve to a progressive muscle weakness and acute respiratory failure. Case Presentation We report an accident caused by Micrurus corallinus involving a 28-year-old Caucasian sailor man bitten on the hand. The accident occurred in a recreational camp because people believed the snake was not venomous. The victim presented neurological symptoms 2 h after the accident and was taken to the hospital, where he received antielapidic serum 10 h after the bite. After the antivenom treatment, the patient presented clinical evolution without complications and was discharged 4 days later. Conclusions: We reinforce that it is essential to have a health care structure suitable for the treatment of snakebite. Besides, the manipulation of these animals should only be carried out by a team of well-equipped and trained professionals, and even so with special attention.(AU)

Hidroxocobalamina no tratamento de intoxicações por cianeto / Hydroxocobalamin in the treatment of cyanide poisoning

CONTEXTO: A intoxicação por cianeto pode ser considerada uma intoxicação rara porém de extrema gravidade. A causa mais comum de exposição aguda ao cianeto é a inalação de fumaça em incêndios. Nos casos de intoxicação, além das medidas de suporte clínico, como suplementação de oxigênio, a terapia com antídotos deve ser realizada. Dentre os antídotos disponíveis (hidroxocobalamina, nitrito de amila, nitrito de sódio, tiossulfato de sódio, 4-dimetilaminofenol e edetato de dicobalto), a hidroxocobalamina é apontada como o antídoto de primeira linha. Atualmente, tais medicamentos não estão disponíveis no Brasil. EVIDÊNCIAS CIENTÍFICAS: Dentre as melhores evidências recuperadas, após buscas por revisões sistemáticas, encontram-se 4 estudos observacionais realizados na França, sendo um de delineamento prospectivo e os demais retrospectivos (um total de 345 pacientes estudados). A maioria dos pacientes foi exposta ao cianeto por inalação de fumaça em incêndios domésticos, exceto por um estudo que avaliou principalmente tentativas de suicídio com ingestão de cianeto. Como intervenção, os estudos preconizaram uma dose inicial de 5g de hidroxocobalamina em infusão de 15-30 min, a qual foi administrada em aproximadamente 20 min após o contato com o serviço de emergência ainda em âmbito pré-hospitalar, com a possibilidade de doses adicionais em pacientes não responsivos (até um total de 15g). Como resultados, a mortalidade variou de 28-42% considerando todos os indivíduos que receberam a hidroxocobalamina. Entre os indivíduos com intoxicação confirmada laboratorialmente, 33-36% vieram a falecer, sendo poupados até mesmo indivíduos com níveis plasmáticos potencialmente letais, nestes a morte ocorreu em 36-39% dos casos. A parada cardíaca se apresentou como uma complicação comum (38%). A presença de sequelas no momento da alta hospitalar foi de 10-14%, sendo confusão, perda de memória e síndrome cerebelar as mais comuns. A hidroxocobalamina apresentou um perfil de segurança favorável, apenas com incidência de efeitos adversos leves. Dentre eles, o mais comum foi a apresentação de coloração vermelho-rosa na pele e urina e, mais raramente, aumento da pressão arterial. Após a avaliação crítica com a proposta do sistema GRADE, as evidências de eficácia atualmente disponíveis foram classificadas com qualidade muito baixa e as evidências de segurança com qualidade moderada. DISCUSSÃO: A hidroxocobalamina se apresenta como um agente potencialmente efetivo no tratamento de intoxicações por cianeto. Suas evidências devem ser interpretadas com cautela devido às limitações de suas fontes. O delineamento descritivo não permite o testes das variadas hipóteses, sem, portanto, ser quantificada a influência do acaso sobre os resultados obtidos. Da mesma forma, a ausência de controles e ajustes estatísticos não afasta a influência de fatores de confusão, sendo esses, importantes fontes de viés nos estudos observacionais. Com os custos considerados nas análises econômicas, ela se apresenta também como uma opção potencialmente custo-efetiva e com baixo impacto orçamentário. Todavia, outros fatores além da qualidade das evidências, como as barreiras para a sua devida implementação, devem ser considerados na elaboração de uma recomendação sobre seu uso. DECISÃO FINAL: Após as considerações provenientes da Consulta Pública, os membros da CONITEC presentes na 40ª reunião do plenário do dia 08/09/2015 deliberaram, por unanimidade, recomendar a incorporação do Cloridrato de hidroxocobalamina na concentração de 5 g injetável no tratamento de intoxicações por cianeto. Foi assinado o Registro de Deliberação nº 149/2015. DECISÃO: Incorporar a hidroxocobalamina no tratamento de intoxicações por cianeto, no âmbito do Sistema Único de Saúde ­ SUS, dada pela Portaria nº 9 de 28 de janeiro de 2016 publicado no DOU nº 20 de 29 de janeiro de 2016.

Intoxicación aguda por cocaína en un lactante no asociada a lactancia materna. A propósito de un caso clínico / Acute cocaine intoxication in an infant that is not associated to maternal breastfeeding. A clinical case

La intoxicación aguda por cocaína es infrecuente en lactantes y niños. Las formas más frecuentes de presentación clínica son las convulsiones tónico-clónicas en apirexia, alteraciones motoras y la excitación psicomotriz. Se presenta el caso de un lactante de 1 mes que ingresó a la Unidad de Cuidados Intensivos de Niños del Centro Hospitalario Pereira Rossell por una intoxicación aguda por cocaína. El cuadro clínico consistió en manifestaciones secundarias a un estado hiperadrenérgico generalizado, con lesión miocárdica, excitación psicomotriz, distonías cervicales, convulsiones y acidosis metabólica persistente. Presentó el test de detección de benzoilecgonina en orina positivo al momento del ingreso a la emergencia. No se pudo establecer con exactitud cuál fue la vía de ingreso de la cocaína. Es necesario un alto índice de sospecha para llegar al diagnóstico de intoxicación por cocaína en lactantes.

Acute intoxication with cocaine is infrequent in children. Generalized tonic-clonic seizures, movement disorders and agitation are the most frequently observed clinical features in cocaine intoxication. We present the case of acute cocaine intoxication in a 1 month old boy who was hospitalized in the Pediatric Critical Care Unit of Pereira Rossell Hospital Center. Clinical features were secondary to generalized adrenergic stimulation. Clinical features were myocardial damage, cervical dystonic movements, agitation and metabolic acidosis. Urine toxicology screening proved positive for benzoylecgonine upon arrival at the Emergency Unit. Cocaine´s entry into the infant was not clearly established, although it was likely to be passive exposure to coca paste smoke. A high level of suspicion is needed in order to diagnose diagnosis acute cocaine intoxication in children.