CLINICAL AND BIOCHEMICAL FINDINGS OF RHABDOMYOLYSIS IN ACUTE INTOXICATIONS WITH PSYCHOACTIVE AND CHEMICAL SUBSTANCES.

The aim of the study is to identify possible differences in demographic, laboratory and clinical characteristics between patients with rhabdomyolysis due to intoxication with psychoactive and chemical substances. The study is a cross-sectional study conducted between 1 January and 30 June 2019. All the patients included during this period were treated due to intoxication (outpatient or hospitalized) at the University Clinic of Toxicology in Skopje. The patients with rhabdomyolysis were divided in two groups according to the nature of the substance used for intoxication: a) psychoactive substances and b) a chemical substance. Rhabdomyolysis was determined with a value of CPK (creatinine phosphate kinase) >250 U/L. Patients with rhabdomyolysis due to intoxication with chemical substances were significantly older than patients with rhabdomyolysis due to intoxication with psychoactive substances. There is a significant difference between the two groups of patients with rhabdomyolysis in terms of CPK, urea, hemoglobin values during the first day with regards to significantly higher values in the group where intoxication occurred with psychoactive substances. Five patients with rhabdomyolysis due to intoxication with psychoactive substances experienced muscle pain (10.9%), and one patient (3.8%) of those with rhabdomyolysis due to intoxication with chemicals, without any significant association between muscle pain and type of intoxication (Fisher exact test: p=0.3003). Muscle weakness and pigmented urine were identified consequently in six patients (13.0%) vs. five (10.9%) of patients with psychoactive intoxication and none with chemical. Rhabdomyolysis caused by psychoactive and chemical substances is associated with clinical manifestations and biochemical abnormalities. The values of CPK, myoglobin, AST, ALT, LDH, urea and creatinine were higher in favor of the group of intoxicated patients with rhabdomyolysis with psychoactive substances. The clinical symptoms of rhabdomyolysis are not present in all intoxicated patients, but are more present in the group intoxicated with psychoactive substances. Biochemical findings are crucial in establishing the diagnosis of rhabdomyolysis. Abnormalities of biochemical findings need to be identified in order to initiate appropriate treatment immediately to prevent mortality and morbidity.

Conservative therapeutic approach to corrosive poisonings in adults.

INTRODUCTION: In this study, we assess the effectiveness of a conservative therapeutic treatment of acute corrosive poisonings in adults, and we define therapeutic protocols based on clinical and endoscopic criteria. METHODS: We analyzed clinical records of patients with acute corrosive poisonings who were hospitalized and treated at the Toxicology Clinic at the University of Skopje, Republic of Macedonia, during a 5-year period (2006-2010). A total of 481 patients' records with cases of acute corrosive poisonings were analyzed. There were 317 female (65.9 %) and 164 male (34.1 %) patients. The purpose of the therapy in the cases of acute corrosive poisonings is to prevent perforation as well as progressive fibrosis and stenosis of the esophagus and stomach. Therapeutic approach mainly consists of proton pump inhibitors, H(2) blockers, antibiotics, and intensive hyperalimentation. There are different opinions regarding conservative treatment of acute corrosive poisonings in adults. CONCLUSION: Based on our study of corrosive poisonings of adults, we propose a list of optimal treatment recommendations.

Prooxidative/antioxidative homeostasis in heroin addiction and detoxification.

BACKGROUND: Long-term heroin abuse is related to pathological changes in many organs mediated by oxidative stress (OS). OBJECTIVES: Estimation of systemic OS and antioxidant capacity in heroin addiction and detoxification provides information about prooxidant/antioxidant homeostasis in heroin misuse and need for antioxidant supplementation. METHODS: OS was evaluated by the measurement of plasma reactive oxygen metabolites using spectrophotometric method and plasma lipid peroxidation by its end product--malondyaldehyd using Tiobarbituric Acid Reactions Substances method. The extracellular antioxidant capacity was estimated using OXY-adsorbent test. RESULTS: This cross-sectional study includes 68 patients: 46 heroin addicts (20 patients on chronic heroin abuse, 19 patients on conventional method of detoxification and 7 patients on opioid antagonist--naltrexone (and 22 patients as a control) group. Increased OS was found in the heroin group (d-ROMs 349.3 +/- 102.2 UCarr, MDA 4.0 +/- 0.4 micromol/L) compared to the group on detoxification (d-ROMs 230.2 +/- 96.4 UCarr; MDA 3.6 +/- 0.3 micromol/L) and control group (d-ROMs 264.1 +/- 30.9 UCarr; MDA 3.7 +/- 0.2 micromol/L). TAC was decreased in the heroin group (324.5 +/- 75.0 micromol HClO/ml) and restored during conventional detoxification (371.8 +/- 25.1 micromol HClO/ml), but not completely in the group with naltrexone treatment (335.6 +/- 16.9 micromol HClO/ml) compared with controls (395.4 +/- 35.6 micromol HClO/ml). CONCLUSION: Long-term heroin abuse stimulates a progressive systemic oxidative stress which increases the extracellular antioxidants consumption and develops conditions for chronic heroin toxicity (Fig. 1, Tab. 4, Ref. 35). Full Text (Free, PDF) www.bmj.sk.