[Immunosuppressive treatment due to paraquat poisoning]. / Tratamiento inmunosupresor en las intoxicaciones por paraquat.

Paraquat is the most important member of the bipyridyl compound. It is directly caustic in nature and it exerts its herbicidal activity by inhibiting the reduction of NADP to NADPH during photosynthesis, a process in which superoxide, singlet oxygen, hydroxyl, and peroxide radicals are formed. Human tissue toxicity likely results from a similar oxidative mechanism. After oxidative destruction, recruitment of inflammatory cells leads to late onset and irreversible pulmonary fibrosis. Ingestion greater than 20-40 mg/kg of paraquat concentrate should be aggressively managed with the administration of intestinal decontaminants and hemoperfusion. Low-inspired oxygen therapy should be given until it becomes impractical in the face of hypoxemia. Administration of immunodepressive therapy, steroids and cyclophosphamide, should be considered. In addition, there should be intermittent assessment of pulmonary function and of plasma and urinary concentrations of paraquat.

Tratamiento inmunosupresor en las intoxicaciones por paraquat / Immunosuppressive treatment due to paraquat poisoning

El paraquat es el agente más importante de la familia de los biperidilos. Es directamente cáustico en la naturaleza, su actividad es herbicida mediante la reducción del NADP a NADPH durante la fotosíntesis, un proceso de superoxidación que genera radicales oxi, hidroxil y radicales peróxidos. La toxicidad en tejidos humanos resulta de forma parecida por la alteración del proceso oxidativo. Tras la destrucción oxidativa, el reclutamiento de las células inflamatorias conducen a un proceso tardío de fibrosis pulmonar. La ingesta mayor de 20-40 mg/kg de concentrado de paraquat requiere de un tratamiento agresivo con descontaminación intestinal y hemoperfusión. Igualmente, la limitación del aporte de oxígeno a bajo flujo según la hipoxemia tolerable. La administración de terapia inmunosupresora con esteroides y ciclofosfamida debe ser considerada. Igualmente debe ser controlada de forma intermitente la función pulmonar y los niveles de paraquat en plasma y orina

Paraquat is the most important member of the bipyridyl compound. It is directly caustic in nature and it exerts its herbicidal activity by inhibiting the reduction of NADP to NADPH during photosynthesis, a process in which superoxide, singlet oxygen, hydroxyl, and peroxide radicals are formed. Human tissue toxicity likely results from a similar oxidative mechanism. After oxidative destruction, recruitment of inflammatory cells leads to late onset and irreversible pulmonary fibrosis. Ingestion greater than 20-40 mg/kg of paraquat concentrate should be aggressively managed with the administration of intestinal decontaminants and hemoperfusion. Low-inspired oxygen therapy should be given until it becomes impractical in the face of hypoxemia. Administration of immunodepressive therapy, steroids and cyclophosphamide, should be considered. In addition, there should be intermittent assessment of pulmonary function and of plasma and urinary concentrations of paraquat

Uso de oximas en la intoxicación por organofosforados / Use of oximes in organophosphorate poisoning

No disponible

[Poisoning caused by organophosphate insecticides. Study of 506 cases]. / Intoxicaciones por insecticidas organofosforados. Estudio de 506 casos.

A total of 506 cases of acute poisoning with organophosphorus insecticides attended at Hospital Torrecárdenas, Almería, from 1981 to 1992 were prospectively studied. In all cases a predetermined clinical and therapeutical protocol was followed. Eighty per cent of poisoning events were accidental in nature, most occurred in males, greenhouse workers, and the toxic agents was most commonly absorbed through the skin and airways. All patients presented initially with overt cholinergic symptoms. The presence of bronchorrhea, tremor-fasciculations, respiratory depression and a lower level of consciousness was associated with severe poisonings. Uncommon and exceptional complications included: 5 cases with complete atrio-ventricular block, 3 cases with pancreatitis, 17 cases with endogenous re-intoxications and 3 patients with central diabetes insipidus.

Clinical and pathological findings in fatal 1,3-dichloropropene intoxication.

1. A 27-year-old, previously healthy, worker accidentally drank a solution containing 1,3-dichloropropene. 2. He developed gastrointestinal distress, adult respiratory distress syndrome, haematological and hepatorenal functional impairment and died after 40 h. 3. Damage to the pancreas was also thought to have been caused by the chemical as part of a multiorgan disorder.

Assessment of total pulmonary airway resistance under mechanical ventilation.

We propose a procedure for assessing the pulmonary airway resistance of patients under mechanical ventilation with a volume-cycled respirator having a sine-wave flow curve and inspiration/expiration (I/E) ratio of 1/2. This simplified procedure requires only the respirator's manometer and spirometer. The method is based on Ohm's Law, dividing the pressure difference (as shown on the manometer) between the peak value and that obtained by occluding the expiratory outlet by one-tenth of the minute volume (Vm). The relationship between the Vm and flow is obtained by calculating the height of the triangle formed by the sine wave, given that the area approximates total volume and the base is derived from the frequency and I/E ratio. This method was tested in 296 measurements on 106 patients using as a control the determination of resistance with a pneumotachograph and differential manometer placed between the patient and respirator. There was a high correlation (r = 0.96) between both procedures. To further facilitate bedside use, we have prepared a graph relating common values of Vm and pressure to resistance.