[Aetiologies of lithium overdose: 10-year experience of Marseille poison centre]. / Circonstances d'intoxication par sels de lithium: expérience du centre antipoison de Marseille sur 10 ans.

OBJECTIVE: Lithium is used for control of bipolar disorders. In order to precise the different circumstances at the origin of poisonings, the authors present the cases of lithium intoxication observed in the Marseille poison centre between January 1991 and December 2000. STUDY DESIGN: Retrospective study. METHODS: Three hundred and four cases were observed during the studied period (1 patient a case), concerning 6 different circumstances. For 3 of them, the symptoms were mild: accidental ingestion with children (13 cases); mistakes on the quantities of ingested tablets (43 cases); elevation of lithium blood level due to diuretic therapy (8 cases). For 2 other circumstances, the clinical signs were more severe: treated patients who developed renal failure (15 cases, 6 patients managed in intensive care unit [ICU], 1 death) or dehydration (35 cases, 8 patients treated in ICU and 1 death). Finally, the most severe cases were collected with suicide attempts. Fifty-six percent of the patients were managed in ICU, 5% needed haemodialysis, 10% had cardiac (repolarization disturbances) or neurological (seizures) complications, 2% died. CONCLUSION: The severity of lithium poisonings depends of the circumstances. Ingestion of high quantities of sustained released tablets is the most dangerous situation. Accidental ingestion, even with children, must be considered as less severe situations.

[Ketamine--dreams and realities]. / Kétamine--Rèves et réalités.

Ketamine is an anaesthetic used in human medicine and veterinary practice, synthesised on 1962 and marketed on 1970 in France. Recreational uses were described during 1992 in the medical community and in 1996 in the dance settings. The chemical name of ketamine is 2--(2chlorophenyl)2-(methylamine)-cyclohexanone, an aryl cyclohexylamine, structurally related to phencyclidine. Ketamine is known under the following street names: Keta K, Kate, Special K, Vitamin K, la Golden, la Vétérinaire. Ketamine is used intranasally, orally and intramusculary in recreational use. Ketamine is manufactured by the chemical industry. Due to the complicated synthesis, it is sold illicitly for recreational use. Ketamine is a dissociative drug, and the user enters in a psychedelic dream with hallucinations, floating sensation, feeling of dissociation of the mind from the body. The dream is forgotten, the user full in reality with loss of self control, risk of acute intoxication. In long-term exposure, tolerance, dependence, withdrawal signs and flash back are described. Ketamine trademarks are subject to control in France through medicine legislation Ketamine and its salts are subject to control under the national legislation on narcotics and psychotropics substance. From September 2001, the theft of medical and veterinary trademarks have to be declared to police, care health authority Pharmacy control authority and French Health Products Safety Agency.

[Ma Huang, from dietary supplement to abuse]. / Ma Huang, du complement alimentaire à l'abus.

Dietary supplements containing Ma Huang (chinease ephedra) are available on the web sites and dietary shops in USA. They are widely promoted and used as a mean of weight reduction and energy enhancement. They contain Ma Huang alone or combined with Guarana (caffeine), creatine, St John's wort, carnitine and are proposed with different labels. Numerous reports of adverse reactions and acute intoxication related to these products use were described in the medical literature. In the light of the severity of these cases, some of which resulted in permanent injury and death, the Food and Drug Administration has proposed limits on the dose and duration of use of such supplements. A review of 140 reports submitted to the FDA between June 1997 and March 1999, 47% involved cardiovascular symptoms, 18% neurological symptoms. Severe hypertension was the single most frequent adverse effect followed by tachycardia, myocardial infarction, stroke, seizure. Ten events resulted in death and 13 produced permanent impairment. In France, ampleness of the use of dietary supplements containing ephedra alkaloids is unknown. Two French recent severe poisonings (one with "ripped Fuel" for losing weight and the other with "Energy pills" in a body builder) show that there is serious health risks for the chronic users. Dietary supplements are not subject to control under "la Direction Générale de la Santé". Informations for general public, medical community and health-care authorities are necessary to be aware of potential health hazards of these products use.

Ketamine - reves et realites.

Ketamine is an anaesthetic used in human medicine and veterinary practice, synthesised on 1962 and marketed on 1970 in France. Recreational uses were described during 1992 in the medical communauty and in 1996 in the dance settings. The chemical name of ketamine is 2 - (2chlorophenyl) 2-(methylamine)-cyclohexanone, an aryl cyclohexylamine, structurally related to phencyclidine. Ketamine is known under the following street names : Keta K, Kate, Special K, Vitamine K, la Golden, la Vétérinaire. Ketamine is used intranasally, orally and intramusculary in recreational use. Ketamine is manufactured by the chemical industry. Due to the complicated synthesis, it is sold illicitly for recreational use. Ketamine is a dissociative drug, and the user enters in a psychedelic dream with hallucinations, floating sensation, feeling of dissociation of the mind from the body. The dream is forgotten, the user fulls in reality with loss of self control, risk of acute intoxication. In long term exposure, tolerance, dependence, withdrawal signs and flash back are described. Ketamine trademarks are subject to control in France through medicine legislation Ketamine and its salts are subject to control under the national legislation on narcotics and psychotropics substance. From September 2001, the theft of medical and veterinary trademarks have to be declared to police, care health authority Pharmacy control authority and French Health Products Safety Agency.

Ma Huang, du complement alimentaire a l'abus.

Dietary supplements containing Ma Huang (chinease ephedra) are available on the web sites and dietary shops in USA. They are widely promoted and used as a mean of weight reduction and energy enhancement. They contain Ma Huang alone or combined with Guarana (caffeine), creatine, St Jonh's wort, carnitine and are proposed with different labels. Numerous reports of adverse reactions and acute intoxication related to these products use were described in the medical literature. In the light of the severity of these cases, some of which resulted in permanent injury and death, the Food and Drug Administration has proposed limits on the dose and duration of use of such supplements. A review of 140 reports submitted to the FDA between June 1997 and March 1999, 47 % involved cardiovascular symptoms, 18 % neurological symptoms. Severe hypertension was the single most frequent adverse effect followed by tachycardia, myocardial infarction, stroke, seizure. Ten events resulted in death and 13 produced permanent impairment. In France, ampleness of the use of dietary supplements containing ephedra alkaloids is unknown. Two French recent severe poisonings (one with "ripped Fuel" for losing weight and the other with "Energy pills" in a body builder) show that there is serious health risks for the chronic users. Dietary supplements are not subject to control under "la Direction Générale de la Santé". Informations for general public, medical community and health-care authorities are necessary to be aware of potential health hazards of these products use.

Diazepam poisoning with one-month monitoring of diazepam and nordiazepam blood levels.

A 54-y-old man ingested 2 g of bulk laboratory diazepam and was treated with activated charcoal, enhanced diuresis and flumazenil infusion. The treatment resulted in awakening, but the patient had drowsiness, dysarthria, diplopia, and dizziness for 9 d. Blood levels of diazepam and its main metabolite, nordiazepam, were obtained for 1 mo. The half-lives in this benzodiazepine overdose were longer than those seen with therapeutic doses. Benzodiazepines should not be readministrated when patients awake after suicide attempts.

Phase I trial and pharmacological study of a 3-hour paclitaxel infusion in children with refractory solid tumours: a SFOP study.

The maximum tolerated dose of paclitaxel administered by 24-hour continuous infusion in children is known. Short infusion might offer equivalent antitumour efficacy and reduced haematological toxicity, without increasing the allergic risk. Our aims were to determine the maximum tolerated dose and the pharmacokinetics of paclitaxel in children when administered in 3-h infusion every 3 weeks. Patients older than 6 months, younger than 20 years with refractory malignant solid tumours were eligible when they satisfied standard haematological, renal, hepatic and cardiologic inclusion criteria with life expectancy exceeding 8 weeks. Paclitaxel was administered as a 3-hour infusion after premedication (dexamethasone, dexchlorpheniramine). Pharmacokinetic analysis and solvent assays (ethanol, cremophor) were performed during the first course. 20 courses were studied in 17 patients; 4 dosage levels were investigated (240 to 420 mg/m(2)). No dose-limiting haematological toxicity was observed. Severe acute neurological and allergic toxicity was encountered. One treatment-related death occurred just after the infusion at the highest dosage. Delayed peripheral neurotoxicity and moderate allergic reactions were also encountered. Pharmacokinetic analysis showed dose-dependent clearance of paclitaxel and elevated blood ethanol and Cremophor EL levels. Although no limiting haematological toxicity was reached, we do not recommend this paclitaxel schedule in children because of its acute neurological toxicity.

[Doping in sports. Cases reported to the Poison Control Center of Marseille from 1992 to 2000]. / Produits dopants en pratique sportive. Cas notifiés au centre antipoison de Marseille de 1992 à 2000.

OBJECTIVE: To study the doping substances used in sport and their toxicity. METHODS: Retrospective analysis from January 1992 to December 2000 of the cases of use of doping substances in sport reported by telephone to the anti-poison center in Marseilles. RESULTS: Fifty-one cases were reported concerning 48 men and 3 women with a mean age of 30, ranging from 10 to 55 years. Sixty-three percent of cases were reported over the last four years. The sport practiced was bodybuilding, except in 2 cases (cycling in one case and running in the other). The products used were mainly anabolizing hormones (15 times), clenbuterol (14 times) and creatine (7 times). A third of cases concerned associations of substances and 19 cases presented with symptomatology. CONCLUSION: The diversity in nature and status of the substances mentioned and their association requires enhanced vigilance with regard to the use of drugs in sport. The recent measures voted within the framework of the anti-doping law dated 23/3/99 are aimed at increasing surveillance with the development of anti-doping antennae.

[Lead poisoning in adults. Experience of the Poison Control Center of Marseille from 1993 to 2000]. / Le saturnisme des adultes. Expérience du Centre antipoison de Marseille de 1993 à 2000.

OBJECTIVE: Report the experience of the Marseille's anti-poison center with lead poisoning adults. PATIENTS AND METHODS: Between 1993 and 2000, 45 adults patients consulted the poison Centre of Marseille for a history of lead exposure (9 women, 36 men, average age 44 YO, between 22 an 76 YO). The lead sources were mostly occupational (welding, heavy metal industries...), but some were environmental (shooting as a hobby, hunting,...). RESULTS: Ninety-one percent of the patients presented with a clinical feature of possible lead intoxication (asthenia, abdominal pain, anaemia, seizures,...). For 22 patients, calcitetracemate provocation test was negative. 6 patients with a positive test refused to be treated. 16 patients with a positive test were treated with chelation therapy (average lead blood level 566 micrograms/l--mini 320 micrograms/l, maxi 943 micrograms/l--and average lead urine elimination 3,011 micrograms/24 H--mini 789 micrograms/24 H, maxi 7,229 micrograms/24 H. 58 cures were done (1 to 12 cures for each patient). The average quantities of lead eliminated in the urine during the chelation therapy was 30,912 micrograms +/- 29,059 micrograms by case. For 12 patients who stopped the lead exposure after the diagnosis of lead poisoning, the chelaion therapy permitted to decrease the lead blood level of 69%. For 4 patients still exposed during the treatment, the lead blood level decrease of 7% only. For the 16 treated patiEnts, a clinical improvement was noted, and no adverse effects of chelation therapy was observed during the 58 cures.

[Accidental narcotic and buprenorphine poisoning in children notified at the Marseille Poison Center between 1993 and 1999]. / Intoxications accidentelles par stupéfiants et buprénorphine chez les enfants notifiées au Centre Antipoison de Marseille de 1993 à 1999.

To evaluate the frequency and severity of accidental poisoning in children by narcotics or buprenorphine, a retrospective study was carried out: 75 cases were collected by the Marseille Poison Centre between 1993 and 1999. Most of the patients were between 1 and 3 years old and the drugs involved were cannabis and, more recently, Subutex (buprenorphine). These two drugs were responsible for the most severe cases of poisoning, most of which occurred at home.

[Accidental ingestion of paracetamol in the for of the pediatric syrup EFFERALGAN: case studies during the six months following the institution of the child-proof top]. / Ingestions accidentelles de paracétamol sous la forme de sirop EFFERALGAN pédiatrique: étude des observations au cours des six mois qui ont suivi la mise en place d'un bouchon de sécurité.

During the 6 months following the child-proof top commercialisation for the paediatric syrup EFFERALGAN in France, 51 cases of accidental ingestion were collected by the Marseilles Poison Centre. For 21 pour cent of them, the alleged dose taken was greater than the toxic dose. For 2 cases only, the responsible bottle had a child-proof top and was open on the table. For all other cases, it was simple-opening bottles (old bottles still present in houses, or bottles without a special top but sold in order to get rid of stocks). This study proves that such a preventive measure (modification of the top of the syrup bottles) is only fully effective if additional measures are undertaken such as return of unsold stocks or the provision of information to pharmacists and physicians.

[Dependence on psychotropic drugs and substitution treatment: recent trends. The OPPIDUM study of the Centers for Evaluation and Information on Drug Dependence (CEIP), October 1997]. / Dépendance aux psychotropes et traitements de substitution: tendances récentes a propos de l'enquête OPPIDUM des Centres d'Evaluation et d'Information sur les Pharmacodépendances (CEIP) d'octobre 1997.

The aim of this study was to identify the latest trends in psychotropic drug use and the effect of the increase of maintenance treatments for serious opioid addiction. The results are based on data from OPPIDUM, an annual survey primarily concerned with the consumption of licit and illicit drugs. The study involved 1066 drug addicts recruited during the month of October 1997 from 38 French health centres connected with the Centres for Evaluation and Information on Drug Addiction (CEIP). The most frequently reported drugs were benzodiazepines (n = 323), some of which, especially flunitrazepam (Rohypnol, n = 123), are extremely addictive. The data showed a slight decrease in heroin consumption as well as a marked increase in the use of maintenance treatments. The association between benzodiazepines and buprenorphine (Subutex) should consequently be studied, whether buprenorphine is being used illicitly or prescribed as a maintenance treatment.

[Methamidophos intoxication: immediate and late neurological toxicity; two case reports]. / Intoxication au méthamidophos: toxicité neurologique immédiate et retardée; à propos de deux observations.

Méthamidophos is an organophosphorus insecticide which delayed neurotoxicity is more frequent than with other organophosphates. Authors present a case report concerning a collective poisoning after cutaneous contact: two farm labourers presented moderate cholinergic signs quickly followed by proximal neurological signs (retrobulbar ocular neuritis for one patient, thight paresthesias for the second one). These signs decreased meanwhile new neurological symptoms appeared: sensory and motor peripheral neuropathy in both patients, with a clinical aspect of OrganoPhosphorus Induced Delayed Neuropathy (OPIDN). This unusual chronology and the disappearence of all signs at the 18th month, lead the authors to diagnose a collective methamidophos poisoning in three phases: first, anticholinesterasic acute syndrome; second, an intermediate syndrome and third an OPIDN.

The management of extreme hypernatraemia secondary to salt poisoning in an infant.

We describe a five-week-old boy who had seizures and extreme hypernatraemia secondary to ingesting an improper home-made formula. Initial sodium concentration was 211 mmol.l-1. Other clinical and biological features were moderate dehydration and renal insufficiency with generous urine output and high urinary sodium concentration. Fluid therapy with hypotonic dextrose solution corrected the volume deficit in 48 h and progressively decreased the serum sodium concentration. During ICU stay the patient developed recurrent episodes of seizures and pulmonary oedema requiring mechanical ventilation for five days. Recovery was complete with no abnormal sequelae after a ten-month follow-up. Salt poisoning is in unusual cause of extreme hypernatraemia. It can be safely managed with fluid therapy alone if urine output is preserved, with progressive decrease of serum sodium as target. If this condition is recognized, outcome should be favourable.

Change, disengagement, and renewal: relationship dynamics between young adults and their fathers after divorce.

Little is known about children's perceptions of their parents' divorce or how children construct meaning around the divorce and their subsequent relationships with their parents. The focus of this study was to learn about the experiences and the meanings young adults had constructed about the divorce process and their relationships with their fathers in the years after the divorce. The findings revealed a broad spectrum of experiences and several key issues that gave meaning to both the disengagement and the reengagement with their fathers. Loss, trust, acceptance, availability, and support are a few of the vital issues addressed. Implications for family therapists are discussed.

[Accidental ingestions of paracetamol in the form of EFFERALGAN pediatric syrup: experience of the Marseille Anti-poison Center during 1998]. / Ingestions accidentelles de paracétamol sous la forme de sirop EFFERALGAN pédiatrique: expérience du Centre Antipoison de Marseille au cours de l'année 1998.

In 1998, 77 cases of accidental ingestion of paracetamol paediatric syrup (Efferalgan) in children were notified to the Marseille Poison Centre. In a quarter of them, the alleged dose taken was greater than the toxic dose. Ingestion was mainly due to the child opening the bottle. The proximate marketing of a product with a child-proof top, which should allow the number of accidents to be reduced. Doctors and pharmacists should be informed rapidly, so that they can warn the families who still have the old type of bottle.