[Cardiovascular disturbances in acute poisoning--mechanisms and management]. / Zaburzenia sercowo-naczyniowe w ostrych zatruciach--mechanizm i postepowanie.

The authors present the most common in clinical toxicology cardiovascular disturbances and mechanism of action the selected drugs (tricyclic antidepressants, cardiac glycosides, beta-blocking agents and calcium channel blockers). General management in acute poisoning with these drugs is also presented, concerning their toxicodynamics.

[Severe carbon monoxide poisoning: different clinical course--the same source of exposure]. / Ciezkie zatrucie tlenkiem wegla: rózny przebieg kliniczny--to samo zródlo narazenia.

The different course of acute carbon monoxide poisoning in two young people exposed to the same Carbon monoxide source are reported in the study. The pulmonary edema was diagnosed in the man, but not in the woman. The brain morphological changes revealed by MRI were significantly marked in the women compared to the intoxicated man. MRI detected the brain changes invisible in CT scans and seems be more useful for evaluation CNS abnormalities. The neuropsychological examination, of the brain functional changes is also necessary for proper evaluation of the CNS damage.

[Preliminary evaluation of methadone program in Kraków]. / Wstepna ocena programu metadonowego w Krakowie.

Methadone maintenance programs have effectively reduced opiate dependency and are available in many countries, also in Poland. In Kraków 50 persons were qualified to methadone maintenance treatment. Their age varied from 21 to 46 years, mean 27.8 years. Participants of the programme were mainly educated on basic technical level, unemployed, after 3 to 30 attempts of detoxification treatment. After initial observation at the Detoxification Unit of the Department of Clinical Toxicology and establishing effective daily oral dose of methadone, all patients in Outpatient Clinic of Abuse receive daily adequate dose of methadone, where in parallel, individual and group psychotherapy is used. Methadone programme which was applied seems to prove the fact, that it can significantly improve life quality of addicted patients as well as increase the level of public safety.

[Nutrition disorders in persons qualified for the methadone treatment. Part II. Food choice and intake in diets of opiate addicts]. / Problemy zywieniowe osób zakwalifikowanych do leczenia substytucyjnego metadonem. Czesc II. Sposób zywienia osób uzaleznionych od opiatów.

The aim of the study is to establish the composition and nutritional value of daily food in the group of opiate addicted patients qualified to methadone therapy. The presented data show the results of the survey carried out at the start of the treatment in the group of 42 patients (13 women aged from 21-33 years and 29 men aged from 21-46 years). For the dietary survey the method of 24 hour recall was used: nutrients of daily individual diets and mean values with standard deviations for examined groups were calculated with use of own computer programme and polish food composition data. The proportion of energy covered by groups of food products was also calculated. The results show wide distribution of food consumption: the mean level of the daily energy intake was 2438 kcal (SD +/- 976, range 492 kcal to 4193 kcal.) in the group of men, and 2039 kcal (SD +/- 925, range 561-3860 kcal) in the group of women. The mean protein intake was 82 g (13.4 E%) for men and 63 g (12.4 E%) for women. In the diet of 5 men and 6 women carbohydrate energy exceeded 70% of the total energy intake, indicating high consumption of food items containing considerable amounts of sugar (bonbons, confectionery, cakes, sweets, chocolate, sweet drinks and similar).

[Self-poisoning with Datura stramonium]. / Samozatrucie Datura stramonium.

During last 5 years only single cases of poisoning with plants containing psychoactive substances, especially Datura stramonium, were treated in the Department of Clinical Toxicology in Kraków. In autumn 1999, during 1 month, 7 patients, aged from 14 to 27 years (mean 18 years) poisoned with Datura stramonium were treated. On admission in all patients central and peripheral anticholinergic symptoms were stated. Four of them ingested seeds, three of them chewed seeds and leaves. Only one ingested Datura seeds in suicidal attempts. In the group, only one--20-years-old--previously abused amphetamine and smoked marihuana. For the remaining 5 boys (14-18 years-old), it was the first experience with psychoactive substances. All were successfully treated, in 5 patients physostigmine was used, in dose ranged from 2 to 6 mg, with no adverse effects. Seasonal accessibility of natural psychoactive products may be the first, easy, free step of addiction.

[Comparison between the poisoning severity score and specific grading scales used at the Department of Clinical Toxicology in Krakow]. / Porównanie skali Poisoning Severity Score i specyficznych skal ciezkosci zatrucia uzywanych w Klinice Toksykologii Collegium Medicum UJ.

The aim of the present study has been to assess the concordance in severity grading when using the Poisoning Severity Score (PSS), proposed by IPCS/EC/EAPCCT vs. some specific grading scales. Cases of acute poisoning admitted to the Department of Clinical Toxicology in Kraków during months January, March, May, July, August and October 1998 (n = 820) were evaluated. Severity grading was performed in all cases using both the PSS and special grading scales developed by the poisons centre in Kraków. The PSS is assessing severity on the basis of observed clinical signs and symptoms (at their maximum), but does not take into account potential risks or plasma/serum concentrations. The Kraków scales include both clinical symptoms on admission and results of toxicological analyses. Ethanol (39.4%), drugs (36.2%) and carbon monoxide (7.9%) were the most commonly involved toxic agents. Overall concordance between the PSS and the Kraków scales was at hand in 596 cases (72.7%). The lack of concordance was most evident for ethanol and carbon monoxide cases--the PSS generally giving a lower grade. The discordance was less pronounced for grade 3 (life-threatening) poisonings. Significant number of ethanol poisoning in Kraków centre require medicolegal certification thus ethanol concentration (blood or expired air) is considered while evaluating the poisoning severity. Moreover majority (more than 70%) of acutely ethanol poisoned patients treated at the Department are chronic alcoholics so clinical evidence of intoxication may be minimal at blood ethanol levels higher than 3.0 g/L. For ethanol intoxication the blood ethanol concentration was considered in the Kraków scale but not in the PSS, and when the blood concentrations were disregarded and clinical symptoms only were evaluated the concordance improved between the different systems from 72.7% to 92.3%. Thereby also the overall concordance in the study increased to 82.9%. The less satisfying concordance for carbon monoxide cases was mainly caused by discrepancies in the evaluation of neurological symptoms. Also the blood lactate concentration, COHb level, duration of exposure and patient's age are considered in the Kraków scale but not in PSS. The PSS is intended as a general scheme for grading severity of acute poisoning. In this study an acceptable concordance between the PSS and some locally developed grading scales was at hand in the majority of cases, but it seems that for specific poisons, like carbon monoxide, some modifications and additional criteria may be justified. Further studies to test the reliability of the PSS are encouraged.

The comparison of respiratory resistance and occlusion pressure in alcohol dependent patients who complain or not of the respiratory system disorders.

Alcohol abusers often complain of respiratory symptoms. The aim of the study was to analyse the respiratory pattern parameters and occlusion pressure in chronic alcoholics who complained of respiratory symptoms vs. those who did not suffer from any symptoms before the admission. Also dynamics in changes of spirometry parameters and respiratory pattern parameters during controlled, absolute abstinence while hospitalisation in the Detoxification Unit of the Department of Clinical Toxicology was evaluated. There were 124 study patients: 84 ethanol dependent patients and 40 healthy subject not dependent on ethanol (control group). Ethanol dependency was diagnosed using ICD-10 criteria. The questionnaire according to Fletcher was gathered for each of the subject. The positive results of Fletcher questionnaire (chronic cough + chronic expectoration) was obtained in 43 of the ethanol abusers-group I. The rest of abusers who did not complain of any respiratory symptoms was included to the group II. Respiratory tract resistance was significant the differential factor between the patients with positive results of Fletcher questionnaire and patients who did not suffer any symptoms before admission. Significant differences in occlusion pressure values, were noted between the group of abusers with and without the respiratory symptoms both in the first and control examination.

[Methods of poison elimination--controversies and actual views about their use]. / Metody eliminacji trucizn--kontrowersje i aktualne poglady na ich stosowanie.

This paper presents controversies and current ideas about application of poison elimination methods in acute poisonings. Indications and contra-indications for single dose of activated charcoal, gastric lavage, cathartics and whole bowel irrigation are discussed. Rationale and indications for forced diuresis, repeated doses of activated charcoal, hemodialysis and hemoperfusion, enhanced elimination methods, are described.

[Acute, oral poisoning with hydrogen peroxide (concentrated peracetic acid) with neurologic sequelae]. / Ostre, doustne zatrucie perhydrolem (stezonym nadtlenkiem wodoru) z nastepstwami neurologicznymi.

The case of accidental, acute oral poisoning with concentrated hydrogen peroxide with peracetic acid components of disinfectant using in food industry (Steridial P) is presented. Neurological sequelae as a result of gas embolisation and supportive and symptomatic treatment are described.

[Suicidal self poisoning with disulfiram in a 15-year old boy with resulting encephalopathy]. / Samobójcze ostre zatrucie disulfiramem u 15-letniego chlopca z nastepowa encefalopatia.

Acute intentional overdoses of disulfiram (app. 30 g) is reported in 15-years-old boy. The neurological disturbances as nystagmus, coma, seizures and than impairment of memory and perception were dominated in the clinical picture. During MRI examination the areas of different signal from corpus callosum were detected which can be referred to focus of demyelinisation. The patient recovered and was discharged from the hospital after 30 days. Neuropsychological examinations have suggested dysfunction of CNS. The control MRI examination 90 days later, did not reveal any pathological changes in the brain.

[Neurologic sequelae in severe carbon monoxide poisoning--case report]. / Nastepstwa neurologiczne ciezkiego zatrucia tlenkiem wegla--opis przypadku.

The symptoms and clinical course of severe acute poisoning with carbon monoxide in 22-years-old man is described. To evaluate neurological sequelae, magnetic resonance imaging (MRI) repeatedly was performed. In initial examination, at week 7 after intoxication, MRI showed bilateral abnormalities of the amygdaloid nucleus, caudate nucleus and in globus pallidus at right. Haemorrhagic lesion of internal capsule was shown 10 days later. In the next examinations regression in basal ganglia was observed, but slight atrophy of brain was stated. Neuropsychological examinations performed simultaneously, allowed to evaluate the dynamics of central nervous system disfunction.

[Use of naloxone in acute poisoning with opiates in substance dependent persons]. / Zastosowanie naloksonu w ostrych zatruciach opiatami u osób uzaleznionych.

Acute poisonings with drugs of abuse in Poland in 1995 made up 3-4% of all cases of intoxications. In Kraków the most common cause of drug addiction resulting in life threatening states is the use and abuse of opiates derivatives produced by drug addicted people themselves. This domestic product, so called "kompot" or Polish heroin is produced from poppy straw or juice of poppy head (Papaver somniferum). "Kompot" shows the variable contents of heroin, 6-MAM, 3-MAM, morphine, acetylocodeine and codeine. Papaverine, thebaine and narcotine were also detected. The aim of the study was to investigate the frequency of application and the efficiency of naloxone in the treatment of acute poisonings with "kompot" in the subculture of Kraków drug abusers. 91 patients were treated in the Department of Toxicology in 1996 from the acute poisoning with "kompot". There were 24% of women and 76% of men. The age average was 25.2 years. In 61.5% of cases patients intake only "kompot", in 27.5% "kompot", benzodiazepines and barbiturates, in 6.6% "kompot" and amphetamine and only in 4.4% "kompot" with ethanol. In 10% of poisoned naloxone was applied only at the place of accident. In 58% only in the Department of Toxicology. 32% were treated with naloxone both at the place of accident and in the Department of Toxicology. At the place of accident in most cases the single dose was usually applied (mean dose 0.48 mg) and 76% of patients required the additional treatment with naloxone after the admission (mean dose 1.92 mg). Only 5.5% of acute intoxicated with kompot" drug abusers needed intensive care treatment. Complications in the form of vomiting and excitement were a rare case-5.5%.

The results of the brain computer tomography and clinical picture in acute cholinesterase inhibitors poisoning.

The aim of this study was to evaluate a morphological and functional status of the CNS in acute cholinesterase inhibitors (ChI) poisonings using the brain computer tomography (CT) and complex psychiatric examination. Under examination there were 59 cholinesterase inhibitors orally poisoned patients, treated at the Department of Clinical Toxicology in years 1984-1997, aged from 14 to 68 (mean 34.7 +/- 12.8) years. The examined group comprised 9 women (15.3%) and 50 men (84.7%). Between the 3rd and 7th day of hospitalisation a complex psychiatric examination was performed. The CNS damage was diagnosed when the point score from complex psychiatric examination was minimum 5 points. CT was performed between the 3rd and 10th day after the intoxication. Incorrect CT scans were found in 78% of poisoned patients. The most common lesion was generalised cortex atrophy and subcortex atrophy of the brain (73.9%), followed by isolated cortex (17.4%) and subcortex atrophy with simultaneous areas of low density in the subcortical nuclei (8.7%). The frequency of incorrect CT scans was statistically higher (p < 0.01) in the group of organophosphorous compounds poisoned patients compared to those poisoned with carbamates. The complex psychiatric examination revealed in 24 patients (40.7%) the differently intensified alterations, but the point score was not higher than 4. Unquestionable damage of the CNS was recognised in 34 patients (57.6%) of the ChI poisoned patients. The frequency of CNS changes detected in complex psychiatric examination was statistically higher (p < 0.01) in the group of the severely poisoned patients. The significantly higher frequency of pathological changes revealed by the brain CT was found in the group of patients with higher than 5 point score obtained from the complex psychiatric evaluation compared to those with score lower than 5 (p < 0.001).

Pesticides poisonings in clinical and medicolegal aspect.

In the course of time, progress in knowledge, after many years of a widespread use of pesticides, it is necessary to evaluate negative results they cause. Poisonings with these xenobiotics have claimed new tasks and problems for toxicology. The present study comprises some complex problems of pesticides poisonings on the basis of examinations referring to non-fatal and fatal cases of poisonings in clinical and medicolegal aspects. They include cholinesterase inhibitor poisonings, dipyridil herbicides and chlorphenoxyacetate as well. On the basis of quantitative determinations of cholinesterase inhibitors relations between blood concentration and toxic effects were considered. Moreover, an elimination of inhibitors from blood in relation to the method of treatment and kind of pesticide was observed. In fatal cases of intoxication morphological changes in tissues, pesticides distribution and antemortem-postmortem relations were discussed. Toxicological findings in the cases examined constitute a data library for complex clinical and medicolegal purposes.

Acute pesticides poisonings in pregnant women.

44 pregnant women were treated at the Department of Clinical Toxicology in years 1986-1996 as a result of acute poisonings with different xenobiotics. Acute pesticide poisoning that involved 4 cases were always severe and had dramatic clinical course. Carbofuran intoxication stated in a 17-year-old woman (18 weeks of pregnancy) resulted in fetus death. Toxicological findings revealed that the level of the poison in the mothers blood was comparable to that in the fetus. Carbofuran evidently passed the placental barrier in concentration which was sufficient to cause the fetus death. In the second woman (20-year-old, 12 weeks pregnant) who was classified as severely poisoned on admission to the clinic a spontaneous abortion was stated on 27th day after poisoning. The highest level of carbofuran in the blood of the mother was 9.71 micrograms/g. A 30-year-old woman, 10 weeks pregnant took formothion (50 ml) per vaginam in order to provoke abortion. She was classified as moderately poisoned. Gynecological examination and ultrasonography confirmed the pregnancy. The fetus heart tones were audible. The patient was discharged from hospital after 3 days at her own request in a good general condition. The concentration of formothion in washings from vagina was similar to the levels observed in blood serum on the patient admission to the Clinic, and 24 hour later. A 21-year-old woman, 5 month pregnant ingested an unknown amount of endosulfan to provoke abortion. Gynecological examination and abdominal ultrasonography revealed longitudinal pelvic presentation of fetus. Neither fetal movement nor heart tones were audible as early as four hours after the clinical symptoms occurred. Such low concentration of endosulfan in the blood of the mother as 0.47 microgram/g of the poison caused relatively quick fetus death. The highest levels of endosulfan were found in the liver and in the fetus kidneys.

[Selected chemical compounds as potential sources of massive poisoning. Physicochemical properties, poisoning symptoms, treatment]. / Wybrane zwiazki chemiczne stanowiace potencjalne zródlo zatruc masowych. Wlasciwosci fizyko-chemiczne, objawy zatrucia, postepowanie lecznicze.

Characteristics of 42 chemical compounds (17 gases and 24 liquids) sustaining potential danger of massive poisonings in case of accident or chemical disaster is presented. Description of each substance includes: physiocochemical properties, pathophysiology and symptoms of acute poisonings with those chemicals. Rules and procedures of treatment are presented including premedical first aid and medical treatment.

Acute poisonings in the course of drug addiction: chemicotoxicological diagnostics.

A demand for a quick and reliable diagnostics of acute and chronic poisonings with drugs of abuse, monitoring of the treatment of drug abusers and controlling their abstinence lead to a search for the most useful diagnostic methods for clinical aims and certification. Our observations concerning the importance of toxicological investigation, particularly the use of Triage rapid immunoassay, in the diagnostics of acute poisonings and the abstinence control of dependent people were presented. Urine of 418 poisoned people and 7 "detoxificated' patients treated at the Department of Toxicology in Kraków in the years 1991-1995 was examined, and in 54 cases Triage method was used (seven drugs of abuse were determined: amphetamine, barbiturates, benzodiazepines, cocaine, methadone, opiates and tetrahydrocannabinoids), which was later confirmed using the Fluorescence Polarisation immunoassay, measured with the Vitalab Eclair. An increase in number of admitted patients to the Department of Toxicology was noted and the need for reliable diagnostics concerning the increasing number of cases in which inconsistency of the drug declared in the interview with the toxicological findings was stated. Triage method used in the examinations proved to be very useful for clinical diagnostics in quick determination of drugs of abuse in urine. The result should be confirmed using another, preferential method for the poison found in biological material.

The usefulness of carboxyhemoglobin, methemoglobin and blood lactate concentration in evaluating the health condition of Kraków inhabitants exposed to primary pollutants.

Determination of the carboxyhemoglobin (COHb), methemoglobin (MetHb), and blood lactate concentrations is known as important contributive in evaluation of oxygen deficiency in people from urban populations. The methemoglobinemia is usually caused by unfavourable impact of NOx. A quantification of COHb allows, to some extend, to evaluate the threat of population with carbon monoxide (CO). An elevation in the blood lactate concentration indicate the oxygen insufficiency of the examined patients. The aim of this study was to evaluate the concentrations of the mentioned parameters in the three groups Kraków's population differently exposed to CO produced by incomplete combustion of carbon-containing materials. The group I consisted of 53 patients treated at the Toxicological Department for acute CO poisoning. The group II comprised 31 subjects professionally exposed to CO. The group III comprised 99 adult Kraków's inhabitants who started education in the technical school and had never been professionally exposed to CO (control group). The elevation in methemoglobin concentration was not found in any of the examined group. The highest COHb level was noted in the group of the acute CO poisoned patients. No significant difference between COHb levels was found in the chronically exposed group (II) and in the control one. The increased blood lactate concentrations were found in both the acutely CO poisoned and in the group of chronically, by occupation, exposed to CO. No unfavourable impact of Nox reflected in methemoglobinemia was noted in any examined population. The determination of COHb levels is helpful in diagnosis of acute CO poisoning. The measuring of the blood lactate concentration allows to detect the oxygen insufficiency in acute CO poisoning and in states of long-term exposure to CO.