Poisoning deaths in Poland: Types and frequencies reported in Lódz, Kraków, Sosnowiec, Gdansk, Wroclaw and Poznan during 2009-2013.

OBJECTIVES: The aim of this study has been to assess the characteristics of acute poisoning deaths in Poland over a period of time 2009-2013. MATERIAL AND METHODS: The analysis was based on the data obtained from the patient records stored in toxicology departments in 6 cities - Lódz, Kraków, Sosnowiec, Gdansk, Wroclaw and Poznan. Toxicological analyses were routinely performed in blood and/or urine. Major toxic substances were classified to one of the following categories: pharmaceuticals, alcohol group poisonings (ethanol and other alcohols), gases, solvents, drugs of abuse, pesticides, metals, mushrooms, others. Cases were analyzed according to the following criteria: year, age and gender of analyzed patients, toxic substance category and type of poisoning. The recorded fatal poisonings were classified according to the International Classification of Diseases. RESULTS: The record of 261 deaths were retrospectively reviewed. There were 187 males (71.64%) and 74 females (28.36%) and the male to female ratio was 2.52. Alcohol group poisonings were more frequently responsible for deaths in men compared to all poisonings, 91.1% vs. 71.6%, respectively (p < 0.05), and pharmaceutical agents were more frequently responsible for deaths in women, 47.4% vs. 28.4%, (p < 0.05). Methanol was the most common agent in the alcohol group poisonings, accounting for 43.75% (N = 49), followed by ethylene glycol, 39.29% (N = 44), and ethanol, 16.96% (N = 19). CONCLUSIONS: Epidemiological profile data from investigation of poisoning deaths in Poland may be very useful for the development of preventive programs. Int J Occup Med Environ Health 2017;30(6):897-908.

Nonfatal and fatal intoxications with pure caffeine - report of three different cases.

Caffeine is not usually perceived as a drug by most people because it is found in many foods and drinks, including caffeinated energy drinks, as well as in over the counter analgesics and cold preparations. Recently in Poland it has become increasingly common to take pure caffeine, bought through online stores, as a psychoanaleptic. This creates a much higher risk of severe and even fatal poisoning in comparison with the risk associated with the abuse of food products and non-prescription medicines containing low doses of caffeine. This paper presents three different cases of poisoning that occurred when pure caffeine was taken as psychostimulant; in cases 1 and 2 poisoning was the result of a single overdose, while in the case 3 poisoning resulted from a cumulative overdose. In the case 1 there was a severe intoxication (persistent vomiting, hypotension, tremor), and the concentration of caffeine in the blood was found to be 80.16 µg/mL. The patient was treated using hemodialysis, which caused a rapid decrease in blood levels of caffeine and relief of the clinical symptoms of poisoning. Cases 2 and 3 were fatal poisonings, and recorded levels of caffeine in post mortem blood samples were 140.64 µg/mL and 613.0 µg/mL. In case 2 the patient died 10 min after admission to hospital as a result of sudden cardiac arrest, which was preceded by an attack of convulsions, and in case 3 death occurred in home and was also sudden in nature. Taking pure caffeine as a stimulant is associated with a high risk of overdose and the development of serious and even fatal poisoning, and those using pure caffeine are generally completely unaware of these risks. In such cases, death is usually sudden due to functional mechanisms.

[Severe bencyctane intoxication--a case report]. / Ciezkie zatrucie bencyklanem--opis przypadku.

Bencyclane relaxes smooth muscles of vasculature and has been used in the treatment of peripheral and cerebral circulation disorders. Bencyclane penetrates the blood brain barrier and may evoke various adverse central effects, such as psychotic episodes, coma, and convulsions. It also decreases arterial pressure by vasodilatation and has negative inotropic action. The cardiodepressive action of bencyclane is caused probably by a direct calcium-channel antagonistic mechanism. The case of a 23-year old man, addict on amphetamine, who ingested 5 g of bencyclane (Halidor) is presented. The patient developed coma, convulsions, shock and cardiogenic pulmonary edema. He required mechanical ventilation, treatment with pressure amines (dopamine and dobutamine) and calcium. The circulatory and respiratory insufficiency persisted to the seventh day of hospitalization, then the patient was completely recovered and confirmed suicidal ingestion of 50 tablets a 100 mg of Halidor. In cases of severe bencyclane intoxications most important is an intensive symptomatic treatment. In these cases extracorporeal methods of toxin elimination from the blood are probably completely inutile, because of large bencyclane volume of distribution.

[Two different clinical cases of acute arsenic trioxide intoxication]. / Dwa przypadki ostrego zatrucia arszenikiem o róznym przebiegu klinicznym.

This paper describes two different cases of acute suicidal arsenic trioxide intoxication. Case no 1. A 38-year-old man, alcohol abuser, who ingested 4-5 g dental paste, which corresponds to 2.2-2.7 g of pure arsenic trioxide, developed gastritis with vomiting and abdominal pain, but without diarrhea. No cardiovascular collapse or renal failure were observed. The patient developed also symptoms of central nervous system injury (minor left paresis) and transient hepatic impairment. A head CT revealed no pathological changes in the brain. Hepatic disturbance recovered in a few days and the patient could be discharged on the 12 day. Case no 2. A 57-year-old man, who ingested few grams of pure arsenic developed vomiting, abdominal pain and severe diarrhea. Cardiovascular collapse as a result of intravascular volume depletion, vasodilatation and myocardial dysfunction was observed. The patient died on the first day of hospitalization. In both cases treatment included gastric lavage, BAL therapy, haemodialysis and supportive measures.

Poisoning or primary nervous system disease?--difficulties of the differential diagnosis exemplified by four different clinical cases.

Acute or chronic injury of the nervous system caused by xenobiotics can resemble primary disorders of the nervous system. In this study, four different cases that are characterized by unclear clinical presentation have been discussed; they required a detailed differential diagnostics using modern radiologic and electrophysiologic studies. Case 1. A young alcohol abuser was referred to the Acute Poisonings Unit at Wroclaw with a presumptive diagnosis of methanol poisoning. Neither methanol nor ethylene glycol were detected in patient's serum and urine. During hospitalization in our ward he lost vision completely, and neurologic examination was consistent with a transverse spinal cord injury. Traumatic spinal cord injury coexisting with methanol poisoning, or even Devic's syndrome were considered in differential diagnosis. The MRI did not reveal a spinal cord injury, and the EMG showed severe demyelinating-axonal polyneuropathy. Finally the patient was diagnosed with methanol poisoning complicated by both loss of vision and severe alcoholic polyneuropathy. Case 2. A 27-year-old man was found unconscious in a street. A head CT revealed numerous small intracerebral hemorrhages, and patient's urine contained high concentration of amphetamine. A presumptive diagnosis of amphetamine poisoning complicated by intracranial hemorrhage was proposed. The repeat head CT revealed traumatic injury of the skull in a form of depression. Based on this result, the patient was diagnosed with a posttraumatic intracranial hemorrhage. Case 3. A young man with history of schizophrenia was transferred to our ward from a psychiatric hospital with a presumptive diagnosis of neuroleptic malignant syndrome complicated by rhabdomyolysis. Infection of the nervous system and focal lesions in the brain were ruled out with help of lumbar puncture and a brain MRI. After having obtained additional details of patient's history, it appeared that the patient had not been taking neuroleptics, and therefore it was assumed that patient's condition be connected with a catatonic type of schizophrenia exacerbation. Case 4. A 17-year-old woman, who returned from a disco club, presented with a bizarre behavior, she spoke incoherently, and she saw everything in bright and intense colors. Then she experienced a severe seizure attack with loss of consciousness and apnea. Toxicologic tests were negative. The patient was referred to neurology where she was finally diagnosed with epilepsy, and the attack was induced by strobe lights in a disco club.

[Intoxications with atypical antipsychotic drugs--data of the Acute Intoxication Unit in Wroclaw]. / Zatrucia atypowymi lekami przeciwpsychotycznymi w materiale Oddzialu Ostrych Zatruc we Wroclawiu.

Recently, atypical antipsychotic agents have largely replaced traditional agents as first-line drugs for the treatment of schizophrenia and psychotic mood disorders. Considering the increase in atypical antipsychotics prescriptions and the increased risk of suicide in this patient population, the number of reported cases of antipsychotic drugs may be expected to increase. This paper describes the clinical course of atypical antipsychotic agents intoxication, chiefly clozapine, risperidone and olanzapine. Clozapine was the ingestant in 11 cases of atypical antipsychotics overdose in our material. The major observed effects in this group included deep coma, tachycardia, hypersalivation, delirium and shock. Clozapine has a small therapeutic index; in our patients the mortality rate was 27%. Ten patients with risperidone overdose were identified. Our data show that risperidone toxicity manifests mainly as mild central nervous system effects: somnolence, vertigo and tardive dyskinesia. Olanzapine has been considered to be similar to clozapine, but olanzapine intoxication appeared to have a relatively benign clinical course as compared with clozapine intoxication. In olanzapine intoxications deep coma, myosis and mild cardiovascular effects (hypotonia) were observed.

[Benzodiazepine poisonings among elderly patients of Acute Poisoning Department of the Marciniak Memorial Hospital in Wroclaw in the years 2000-2001]. / Zatrucia benzodiazepinami u osób w wieku podeszlym w materiale Oddzialu Ostrych Zatruc Szpitala im. T. Marciniaka we Wroclawiu w latach 2000-2001.

Acute benzodiazepines poisonings in the group of 27 elderly patients is discussed. Majority of patients suffer from depression and cognitive impairment. Compared this special group of patients with younger the prognosis is worse what is expressed in greater number of deaths.