Carbon nanotubes functionalized with folic acid attached via biomimetic peptide linker.

AIM: Anchoring folic acid (FA) with a biomimetic peptidic linker resistant to proteolytic degradation to act as a homing device on functionalized carbon nanotubes. MATERIALS & METHODS: Ethylenediamine was attached to oxidized multiwalled carbon nanotubes (MWNTs) using 4-(4,6-dimethoxy-[1,3,5]triazin-2-yl)-4-methylmorpholinium tetrafluoroborate. FA was coupled with 6-aminohexanoic acid and derivatives of ß-alanine, affording four intermediates, which connected to the MWNTs via peptidic linkers of various lengths. RESULTS: Biomimetic nanomaterials were produced with FA as a homing molecule. The structure and properties of the nanomaterials were analyzed, confirming the versatility of the peptides used as linkers. CONCLUSION: Conjugates of FA attached to MWNTs via peptide linkers prepared from ß-alanine residues are resistant to proteolytic degradation. Viability in colon cancer cells and normal colonocytes confirmed their lack of cytotoxicity.

Synthesis of Carbon Nanotubes in Thermal Plasma Reactor at Atmospheric Pressure.

In this paper, a novel approach to the synthesis of the carbon nanotubes (CNTs) in reactors operating at atmospheric pressure is presented. Based on the literature and our own research results, the most effective methods of CNT synthesis are investigated. Then, careful selection of reagents for the synthesis process is shown. Thanks to the performed calculations, an optimum composition of gases and the temperature for successful CNT synthesis in the CVD (chemical vapor deposition) process can be chosen. The results, having practical significance, may lead to an improvement of nanomaterials synthesis technology. The study can be used to produce CNTs for electrical and electronic equipment (i.e., supercapacitors or cooling radiators). There is also a possibility of using them in medicine for cancer diagnostics and therapy.

Influence of Plasma Jet Temperature Profiles in Arc Discharge Methods of Carbon Nanotubes Synthesis.

One of the most common methods of carbon nanotubes (CNTs) synthesis is application of an electric-arc plasma. However, the final product in the form of cathode deposit is composed of carbon nanotubes and a variety of carbon impurities. An assay of carbon nanotubes produced in arc discharge systems available on the market shows that commercial cathode deposits contain about 10% CNTs. Given that the quality of the final product depends on carbon-plasma jet parameters, it is possible to increase the yield of the synthesis by plasma jet control. Most of the carbon nanotubes are multiwall carbon nanotubes (MWCNTs). It was observed that the addition of catalysts significantly changes the plasma composition, effective ionization potential, the arc channel conductance, and in effect temperature of the arc and carbon elements flux. This paper focuses on the influence of metal components on plasma-jet forming containing carbon nanotubes cathode deposit. The plasma jet temperature control system is presented.

Optimization of magnetic field-assisted synthesis of carbon nanotubes for sensing applications.

One of the most effective ways of synthesizing carbon nanotubes is the arc discharge method. This paper describes a system supported by a magnetic field which can be generated by an external coil. An electric arc between two electrodes is stabilized by the magnetic field following mass flux stabilization from the anode to the cathode. In this work four constructions are compared. Different configurations of cathode and coils are calculated and presented. Exemplary results are discussed. The paper describes attempts of magnetic field optimization for different configurations of electrodes.

[Acute ethylene glycol poisoning among patients of Nofer Institute of Occupational Medicine in Lódz, Toxicology Unit, hospitalized in the years 2000-2009]. / Ostre zatrucia glikolem etylenowym wsród pacjentów oddzialu Toksykologii Instytutu Medycyny Pracy im. Nofera w Lodzi, hospitalizowanych w latach 2000-2009.

Acute poisonings with ethylene glycol pose real challenge in the clinical toxicology. The main objective of this study is an analysis of clinical features and identification of prognostic factors in poisoning with ethylene glycol of patients hospitalized in the Toxicology Unit in the years 2000-2009. The medical records of the patients were identified and separated. In the years 2000-2009, 102 patients were hospitalized due to ethylene glycol poisoning, what accounted for 0.38% of total admissions to the unit (26.801 hospitalized people). The mean age of patients amounted 48.05 +/- 12.55 years, the history positive for chronic alcohol abuse was present in 63 (61.76%) cases. Mean values of ethylene glycol concentration were as: in serum 173.14 mg/dl, in urine 6576.46 mg/l. Patients condition on admission varied, with 63 (61.76%) cases described as the severe state. The most frequently noted pathologies were consciousness disturbances and tachycardia. 14 patients died within the analysed group and 63 (61.76%) developed single or multiorgan complications in the course of disease. The most commonly encountered complication were: acute renal failure, anaemia, pneumonia and central nervous system damage. Such parameters as: BE and HCO3 measured on admission should be considered as the prognostic factors, determining the course of the disease and the outcomes of treatment. Poor prognosis may be associated with such clinical features on admission, as: respiratory and circulatory disturbances and cerebral sequelae. The importance of acute poisoning of ethylene glycol is determined both by high frequency of immediate life threatening conditions and by the risk of complications leading to permanent organs damage.

[Acute novel drugs poisoning among patients of Nofer Institute of Occupational Medicine in Lodz, Toxicology Unit, hospitalized in the years 2008-2012--epidemiology, clinical state]. / Ostre zatrucia nowymi srodkami psychoaktywnymi wsród pacjentów oddzialu Toksykologii Instytutu Medycyny Pracy w Lodzi w latach 2008-2012-- rozpowszechnienie, obraz kliniczny zatrucia.

UNLABELLED: Intoxication with novel recreational drugs poses significant challenge for medical staff due to diagnostic difficulties, complex clinical pattern, resulting from polyethiology of poisoning and potential risk of life threatening complications. OBJECTIVES: Description of clinical pattern novel drug intoxication. METHODS: retrospective review of medical records patients hospitalized in the Toxicology Unit (TU) with diagnosis of intoxication with novel recreational drugs. RESULTS: During the period from 2008-2010--431 patients were admitted to TU with mentioned above diagnosis. 159 (36.9%) patients were positive for ethanol with its average concentration in blood 150 mg%. Presence of other substances like amphetamine, cannabinoids, atropine, ephedrine, carbamazepine, benzodiazepines and dextrometorphan was confirmed. The most frequent clinical symptoms observed on admission were: anxiety, agitation, complaints associated with circulatory system and vertigo Average pulse rate and both: diastolic and systolic pressure were within normal limits, however authors noted slight tendency toward tachycardia. One patients died due to multiorgan failure. Average period of hospitalization amounted 2.24 days. Co-poisoning with ethanol was associated with higher frequency of circulatory system disturbances. RESULTS: Clinical pattern of poisoning with novel drugs could partially correspond with mild sympathomime. tic syndrome.

[Kidney transplants from donors burdened metabolic acidosis in the course of poisoning with methanol and carbon monoxide]. / Transplantacje nerek od dawców obciazonych kwasica metaboliczna w przebiegu zatruc metanolem i tlenkiem wegla.

The question of obtaining organs from donors who died of methanol poisoning has been discussed in the medical literature for many years. The results of such transplants published so far are very optimistic. However, the possibility of permanent and significant injury to transplanted organs caused by poisons or its metabolites raises serious concerns regarding the procedure. The long-term effects of intensive treatment of poisoning need to be considered as well. Metabolic acidosis and high blood osmolality are agents with recognized damaging potential impairing organ function at cellular level. The study traced the fate of kidney transplants from 13 donors who died of methanol poisoning and one isoned with carbon monoxide. The donors group consisted of 12 men and 2 women, of mean age 49 years (SD +/- 7.93). The kidneys were transplanted 20 men and 8 women. The mean age of recipients was 50.29 years (SD +/- 12.9). At the time of admission to the Department of Toxicology all donors presented with profound metabolic acidosis and high plasma osmolality (mean 434.71 mOsm/kg H2O (SD +/- 73.29). Metabolic acidosis was treated high doses of sodium bicarbonate (mean infusion volume of was 409 ml) before the HD procedure. Blood methanol levels were between 125 and 470 mg% (mean 317.23 SD +/- 136.83). The carboxyhaemoglobin concentration of in the donor poisoned with carbon monoxide was 47.2%. Transplantation was performed after confirmation of the brain death, the period of cold ischemia (CIT) ranged from 6 to 22 hours (mean 16.06 hours; SD +/- 3.99). Kidneys have taken function immediately after transplantation in 21 recipients. In seven cases, patients required two or three HD procedures. A total of 16 dialysis were performed post-transplants. In the group of patients, the mean glomerular filtration rate (GFR) at 3 months after transplantation was 46.71 ml/min/1.73m2 (SD +/- 10.89). During the 18 months follow-up a constant upward trend to the mean GFR 50.55 was noticed. In the group of donors, the mean blood urea concentration (BUN) 3 months after transplantation was 61.43 mg/dL, including 7 patients with BUN within the range of 80-100 mg/dL. At 18 months post transplant, the average concentration was 42.36 mg/dL, with no cases exceeding 55 mg/dL. Similarly, serum creatinine level normalized with the mean value of 3.01 mg/dL at 3 months and 1.68 mg/dL at 18 months post the procedure. There was no case exceeding 2 mg/dL. One recipient died of a heart attack after a period of more than 18 months after transplantation. However, the transplant was efficiently active at all times (GFR 56-60 ml).

[Metformin poisoning--clinical features, diagnostics and treatment--case presentations]. / Zatrucie metformina--symptomatologia, diagnostyka i leczenie--prezentacja przypadków klinicznych.

Metformin has been used for many years as oral anti-hyperglycaemic agent in the treatment of type 2 diabetes mellitus either in Poland or in the world. Metformin is the most commonly prescribed agent, but acute poisonings of this agent are rare. A review of our experience indicates, that poisoning with this agent may lead to life-threatening or fatal metformin toxicity. The authors of this publication postulate, that each patient with metformin exposure should be hospitalized. Physician must be vigilant to recognize anti-hyperglycaemic agent poisonings like biguanides when hypoglycaemia and acidosis are present in laboratory results. We present patients with metformin toxicity, some of them with fatal course.

[Intoxication or false-positive acetaminophen result of toxicological determinations? Two case reports]. / Zatrucie paracetamolem czy falszywie dodatni wynik analizy toksykologicznej? Opis 2 przypadków.

The aim of this study was to show the diagnostic procedure used in the two cases with false-positive serum acetaminophen results in suspected acetaminophen poisoning. The determination of serum acetaminophen were carried out using a UV/VIS spectrophotometer (Specord 40 Analytik Jena), coupled with an analytic computer station WinASPECT. The employed method of determination was based on the acetaminophen reaction with sodium nitrite, which yields yellow colour of solution in the presence of sodium hydrate. The intensity of the yellow colour depends on the concentration of acetaminophen in serum. The relationship between absorbance and concentration was linear at concentrations in the range 50-600 microg/mL, with relative standard deviation of +/- 2.1% and detection limit of 30 microg/mL. To confirm or reject the doubtful results of colorimetric assays, the serums of patients were measured with high performance liquid chromatography with mass spectrometry detection and gas chromatography with mass spectrometry detection. The analysis of presented cases leads to a conclusion that acetaminophen results should be confirmed either by scanning urine for p-aminophenol presence (which is a routine procedure in our laboratory) or by using a different method of measuring acetaminophen serum levels.

[Acute poisonings with carbon monoxide among the patients hospitalized in the Toxicology Unit during the period of 2006-2010]. / Zatrucia tlenkiem wegla w materiale Oddzialu Toksykologii Instytutu Medycyny Pracy w Lodzi w latach 2006-2010.

Acute poisonings with carbon monoxide pose real challenge in the clinical toxicology. Its importance is determined both by high frequency of immediate life threatening conditions and by the risk of complications leading to permanent organs damage. The main objective of this study is an identification of prognostic factors on the base of analysis the cohort of patients hospitalized due to intoxication with these agents in the Toxicology Unit during the period 2006-2010. During the search process 571 patients hospitalized due to carbon monoxide poisoning during the period 2006-2010 were identified within total number of 21 400 subjects hospitalized during studied period. Therefore intoxications with carbon monoxide accounted for 2.66% of total admissions to the unit. The main sources of exposure were faulty gas heaters. Patients condition on admission varied, with most cases described as the moderate and severe state. At the moment of admission to hospital, the most frequently noted pathologies were: vertigo, headeache and complains from the respiratory tract. The most commonly encountered complication were labyrinths' injuries, neurological abnormalities and pneumonia. Mean concentration of COHb measured on admission in this group was in the blood 21.50 +/- 10.96%. Poor prognosis may be associated with such clinical features on admission, as: respiratory and circulatory disturbances, cerebral sequelae and reported sequelae from labyrinths. Such parameters as: COHb level, lactate and troponine concentrations and BE values measured on admission should be considered as the prognostic factors, determining the course of the disease and the outcomes of treatment.

[Acute methanol poisoning among patients of Toxicology Unit, Nofer Institute of Occupational Medicine in Lódz, during the period 2000-2009]. / Ostre zatrucia alkoholem metylowym wsród pacjentów Oddzialu Toksykologii Instytutu Medycyny Pracy im. Nofera w Lodzi, hospitalizowanych w latach 2000-2009.

The main objective of this study was an analysis of the cohort of patients hospitalized due to intoxication with this agent during the period 2000-2009 and investigate factors, which determined the course of poisoning. During the search process, 288 (1.07%) patients were identified within total number of 26801 patients hospitalized. Within analysed cohort male patients formed majority with 227 males, whereas only 61 females were found within this group. The mean methanol blood concentration was 50.09 mg/dl and ethanol - 292.90 mg/dl. Patients condition on admission varied, the most frequently noted pathologies were consciousseness disturbances and tachycardia, namely the former was recorded in 171 cases (59.4%) whereas the latter in 89 patients (30.90%). 11 patients died within the analysed group and 72 developed single or multiorgan complications in the course of poisoning. The most commonly encountered complication was pneumonia. Features of central nervous system (CNS) damage were found in 20 cases (6.94%). Average concentrations of methanol in the group of the 11 deceased patients were: 158.73 mg/ dl, 20.91 mg/dl for ethanol. The average values of arterial blood gases parameters in this group were pH= 6.98; BE=(-) 22.482; HCO3=9.67 mmol/l. Within the non survivors group such complications as CNS damage, seizures, pneumonia, liver injury and pancreatitis were noted more frequently, with statistical significance. The concentrations of methanol and ethanol in the blood on admission and such ABG parameters as pH, BE, HCO3, pCO2 i pO2 also measured on admission should be considered as the prognostic factors, determining the course of the disease and the outcomes of treatment. Poor prognosis may be associated with such clinical features on admission, as: respiratory and circulatory disturbances and cerebral sequelae.

[Management of acute carbon monoxide poisoning--Polish Medical Society, Section of Clinical Toxicology position statement]. / Postepowanie w ostrych zatruciach tlenkiem wegla--stanowisko Sekcji Toksykologii Klinicznej Polskiego Towarzystwa Lekarskiego.

Paper presents Polish Medical Society, Section of Clinical Toxicology position statement on the prehospital and hospital management of carbon monoxide poisoning.

[Suicidal intoxication with digoxin--still actual problem in clinical toxicology--case report]. / Samobójcze zatrucie digoksyna--nadal aktualny problem toksykologii klinicznej --opis przypadku.

We present case a male patient who attempted suicide by ingestion of 90 tablets of digoxin in total dose of 22.5 mg. A measured peak level of digoxin was 6,75 ng/ml. Temporary invasive cardiac pacing with single chamber ventricular pacer was performed for treatment of the life-threatening rhythm and conduction disturbances that revealed within few hours after admission. According to the authors, presented method of therapy should always be taken into consideration in case development of cardiovascular disturbances in acute poisoning with digoxin.

[Management of acute cyanide poisoning--Polish Medical Society, Section of Clinical Toxicology position statement]. / Postepowanie w ostrych zatruciach cyjankami - stanowisko Sekcji Toksykologii Klinicznej Polskiego Towarzystwa Lekarskiego.

Paper presents Polish Medical Society, Section of Clinical Toxicology position statement on the prehospital and hospital management of cyanide poisoning.

[The application of 4-aminopyridine in calcium channel inhibitors acute poisoning]. / Zastosowanie 4-aminopirydyny w ostrych zatruciach lekami z grupy inhibitorów kanalu wapniowego.

Calcium channel inhibitors have been extensively used to treat arterial hypertension, ischaemic heart disease and supraventricular rhythm irregularities. The poisonings by that category of drugs are extremely dangerous, particularly when accompanied by intoxication with other drugs affecting the circulatory function. This paper reports 3 cases of poisonings with calcium channel inhibitors (verapamil and diltiazem) in combination with angiotensin convertase inhibitors and nonselective beta-adrenolytics. Circulatory insufficiency and cardiac rhythm abnormalities were noted in all reported cases, in one in the form of ventricular bigeminy and two episodes of ventricular fibrillation, while in the two other cases in the form of 1 degree atrioventricular block. The persisting hypotonia combined with heart rhythm disturbances could not be prevented by the typical conservative treatment involving intravenous administration of infusion fluids, calcium formulations, catecholamines and atropin. The application of 4-amino-pyridine (Pymadin) caused that arterial tension and heart rate were higher, and the heart rhythm disturbances disappeared. The reported cases suggest a beneficial effect of 4-aminopyridine used to treat cases of poisonings by calcium channel inhibitors; however, up to the present time, no detailed procedures have been determined for 4-aminopyridine administration in cases like those reported above. 4-aminopyridine has not been included in the list of the antidotes approved by the WHO and, therefore, broader tests and more clinical observations are required to confirm its therapeutic value.

[Sodium azide--clinical course of the poisoning and treatment]. / Azydek sodu--przebieg kliniczny zatrucia i leczenie.

Sodium azide poisonings occur very rarely. The mechanism of sodium azide toxic effect has not yet been fully explained. Despite the lack of an explicit procedure for the cases of sodium azide poisonings, in vitro tests and rare case reports suggest that treatment with antidotes for cyanide poisoning victims can be effective. This study describes two cases of suicidal sodium azide ingestion. Case 1. 30-year-old male ingested ca. 180 mg of sodium azide. On admission to hospital, within 4 hours from poisoning, the man complained of dizziness and anxiety. Physical examination revealed horizontal nystagmus, flapping tremor, HR 135/min. In laboratory tests, higher blood concentration of lactates (3 mmol/l) was detected, as well as lower potassium concentration (3.4 mmol/L) and increased transaminase activity (ALT 74 U/l, AST 90 U/l). Electrocardiographic tests showed a negative T wave in limb lead III. Other results were within normal. As the patient ingested a toxic dose of sodium azide, he was treated according to the therapy prescription for cyanide poisoning (amyl nitrite inhalation followed by intravenous administration of sodium nitrite and sodium thiosulphate). ECG record of the last day of hospitalization (7th day of treatment) showed negative T waves in lead III, V4-V6. He was discharged from hospital in good condition. Case 2.23-year-old male ingested 10 g of sodium azide 1.5 hours prior to admission to hospital. At the beginning, the patient's condition was good, but it changed to critical state within the first hours of hospitalization. He developed a deep coma, respiratory and circulatory insufficiency, metabolic acidosis, cardiac dysrrhythmias and anuria. Cardiac activity monitoring showed alternating tachycardia (140 beats per minute) and bradycardia (48 beats per minute), numerous additional supraventricular and ventricular extrasystoles and sinus dysrrhythmia. Cardiac arrest (asystolia) occurred twice, the second incident with fatal outcome. The patient received supportive therapy, he was also treated according to the therapy prescription for cyanide poisoning. Circulatory disturbances observed in both cases have been described in literature as symptoms of sodium azide poisoning. However, available literature data are scarce and lack systematization, most of them coming from several decades ago. The lack of patient's consent for detailed examination of circulatory system and liver made it impossible to gather further knowledge on the subject. The efficacy of treatment with antidotes for cyanide poisoning has not been unequivocally determined for this kind of intoxication.

[Clinical presentation of ST-elevation acute coronary syndrome in the course of intoxication with megadose of rifampicin. A case report]. / Obraz ostrego zespolu wiencowego z uniesieniem odcinka ST w przebiegu zatrucia megadawka rifampicyny. Opis przypadku.

We present a case of 29-year-old male, with coronary artery disease in mother's history, after suicidal poisoning with 30 g of rifampicin, who presented severe chest pain, ST elevations in ECG, low values of blood pressure and elevated troponin I. Echocardiography revealed generalised hypokinesia, and depressed contractility--left ventricle ejection fraction was 7%. Urgent coronary angiography has shown normal epicardial arteries with slow contrast inflow. The toxic properties of rifampicin as well as hypotension due to dehydration are considered reasons of symptoms in the presented case.

The Leiden mutation and activated protein C resistance as risk factors for disseminated intravascular coagulation in acutely poisoned patients.

The aim of this work was to assess the prevalence of a genetic predisposition to disseminated intravascular coagulation (DIC) among acutely poisoned patients. Activated protein C resistence (APCR) is a genetically determined cause of thrombophilia and DIC development. One hundred seventy-six subjects were divided into three groups: one consisted of 83 acutely poisoned patients with DIC; a second consisted of 57 acutely poisoned patients without DIC; the third group consisted of 91 healthy controls. Abnormal results of APCR testing were found in 24.1% of the poisoned DIC group, 5.3% of the poisoned nonDIC group, and 3.3% of the control group. Genetic tests were performed in 37 selected patients. Factor V Leiden mutation (G/A genotype) was determined to be present in people whose R index value was below 1.9. These results raise the possibility that outcomes of acute poisonings may be influenced by genetic predisposition.

[MMPI- and BDI-scale-based self-assessment of the psychic condition of patients after a suicidal attempt]. / Samoocena stanu psychicznego pacjenta po próbie samobójczej na podstawie podskali MMPI i Kwestionariusza Becka.

UNLABELLED: Parasuicide (suicidal attempt) is an intentional, self-aggressive behaviour intended to damage the body rather than cause death. About 75% of suicidal attempts are those committed for the first time. The majority of suicidal attempts are impulsive. About 66% of the parasuicide patients said that they had thought about the act for less than an hour beforehand. Only 30% of the patients had been psychiatrically diagnosed before they were admitted to the hospital. After prompt re-diagnosing, the percentage was considerably lower. The aim of the work is to analyse, using Minnesota Multiphasic Personality Inventory (MMPI-DMS subscale) and Beck Depression Inventory (BDI), the self-assessment of the psychical condition of patients hospitalised at the Acute Poisonings Clinic, Nofer Institute of Occupational Medicine, Lodz, Poland, for attempted suicide. The study subjects included 222 patients (148 women and 74 men) treated in 2003. The control comprised 137 volunteers random-selected from among patients visiting Institute's Outpatient Clinic of Occupational Diseases. The psychiatric testing revealed mood and personality disorders, and acute stress disorders. Depression or other psychotic reactions were not diagnosed in any of the cases. Mean MMPI subscale scoring for the women was 10.7 (subjects) and 3.5 (control). The MMPI rating after 6 months since the attempted suicide was 6.03, i.e. by 4.3 scores lower. The corresponding values for the men were 10.1 (subjects) and 3.06 (control), and after 6 months the value was 4.64, by 5.46 scores lower. Mean BDI scale scoring for the women was 10.56 (subjects) and 7.9 (control). The BDI score after 6 months since the poisoning was 7.74, i.e. by 2.83 scores lower. The corresponding values for the men were 10.77 (subjects) and 5.27 (control), and after 6 months the value was by 2.86 scores lower. The results are statistically significant (p<0.001). CONCLUSION: The results show that 6 months after the suicidal attempt, the self-assessment of patients' psychical condition improves, the mood normalises. The suicidal attempt is often an impulsive act intended to relieve the rapidly growing stress.

[Biological and toxic effects of ethanol: diagnostics and treatment of acute poisonings]. / Dzialanie biologiczne i toksyczne etanolu, diagnostyka i leczenie zatruc.

Ethyl alcohol (ethanol) is readily absorbed from all parts of the gastrointestinal tract due to its hydrophilic potential. The biological effects in humans refer to practically every organ and system. The basic enzyme involved in its oxidation is alcohol dehydrogenase. Another important metabolic pathway is the Microsomal Ethanol-Oxidizing System (MEOS). Toxic effect on basic cell functions is produced both by ethanol and acetic aldehyde, its oxidation product which accounts for most of the acute and delayed effects of ethanol toxicity. In acute ethanol intoxication's the CNS symptoms are the first to manifest. Ethanol affects the CNS functions mainly through stimulating opiate and benzodiazepine receptors and a number of neurotransmitters. However, the attempts to diminish the toxic effects of ethanol on CNS by blocking the affected receptors have proved to be ineffective. In acute poisoning a basic essential is to sustain vital functions by following the principles of intensive care. Each case of acute ethanol intoxication must be subject to neurological examination for possible cerebro-cranial traumas. The diagnostics and treatment procedures should take account of the possible symptoms: convulsions, respiratory and cardiac failure, hypoglycemia, hypothermia, and severe gastric dysfunction. Vital signs monitoring and control of acid-base and water-electrolyte balance are a must. The toxic properties of ethanol metabolites can be particularly hazardous to patients treated with disulfiram. The patients who develop "antabuse response" should be given immediately iron and vitamin C intravenously.