Muertes asociadas a la toxicidad de los anes-tésicos locales: estudio clínico, patológico, analítico y toxicológico de siete casos mortales asociados a la administración de mepivacaína, lidocaína y bupivacaína / Deaths related to toxicity of local anaesthetics: clinical, pathological, analytical and toxicological evaluation of seven fatal cases associated with the administration of mepivacaine, lidocaine and bupivacaine

La anestesia local ha sido considerada, desde siempre, como intrínsecamente más segura que la anestesia general. Sin embargo, los anestésicos locales pueden generar problemas tóxicos agudos, tan graves, que terminen con la vida. Los anestésicos locales son los responsables de un 5 a 10 por ciento de todos los casos de reacciones adversas a medicamentos. En este trabajo, consideramos muertes asociadas a la toxicidad de anestésicos locales (intoxicaciones fatales) a todas aquellas muertes que tuvieron lugar en el transcurso de la primera hora de la administración de un anestésico de tipo amida. Describimos los hallazgos clínico patológicos y químico toxicológicos de siete casos mortales que tuvieron lugar: tres en la silla del dentista, otro durante la extirpación de dos pequeños tumores nasales, dos muertes en el quirófano (intervención de plastia reductora de mama; prostatectomía) y la séptima paciente fue hallada cadáver en su domicilio, 1-2 horas después de un lifting cérvicofacial. Las muertes fueron atribuidas a sobredosis de anesté-sicos locales, seguida de intoxicación aguda del SNC (un caso) o intoxicación cardiovascular (cinco casos). El caso séptimo fue una muerte sin testigos. En dos de los casos que murieron en la silla del dentista, la sobredosis se debió, probablemente, a la no utilización de vasoconstrictores (pacientes hipertensas) (AU)

Concentrations in human fluids: 101 drugs affecting the digestive system and metabolism.

BACKGROUND: The toxicological interpretation of blood and urine concentrations of drugs affecting the digestive system and metabolism, as with other groups of pharmaceutical specialties, is complicated. METHODS: As a continuation of our published studies on the concentrations of drugs of abuse, drugs affecting cardiovascular and hematopoietic systems, and respiratory system, we have reviewed the published data relating to the concentrations of drugs affecting the digestive system and metabolism in clinical and forensic cases. We have selected them on the basis of conservative criteria and our own experience. RESULTS: A table with concentrations of 101 drugs in whole blood, serum/plasma, and urine, corresponding to therapeutic, toxic, or lethal concentrations, is presented. CONCLUSIONS: The data can help interpret analytical results of patient or postmortem samples when there is a suspicion of poisoning with this group of drugs.

Therapeutic, toxic, and lethal concentrations of 73 drugs affecting respiratory system in human fluids.

BACKGROUND: Drugs affecting the respiratory system are an important group of pharmaceutical specialties in poisoning with relatively high frequency. METHODS: As a continuation of our published studies on the concentrations of drugs of abuse and drugs affecting cardiovascular and hematopoietic systems, we have reviewed the published data to select respiratory drugs on the basis of conservative criteria and our own experience. RESULTS: A compilation of the concentrations of 73 drugs affecting the respiratory system--in whole blood, serum/plasma, and urine, and corresponding to therapeutic, toxic, or lethal concentrations--is given. CONCLUSIONS: The table presented can be helpful in interpretation of the concentrations of this group of medicines encountered in clinical, toxicologic, and forensic cases.

Epidemiology of poisoning due to pharmaceutical products, Poison Control Centre, Seville, Spain.

A retrospective study of telephone calls concerning poisoning due to pharmaceutical products, attended by the Toxicological Information Service in Seville (Spain), is presented. The years 1993 and 1994 were analized. Demographic data including the age and sex of the patient, route of exposure, cause, type of poisoning and the therapeutic group, was obtained. The great majority were cases of acute poisoning due to domestic accident, attempted suicide took second place. Ingestion was the principal route of entry, and more males than females were affected. 35.2% were children under two. In general, the medicines most frequently involved were those affecting the nervous system (28.1%)--principally analgesics, anxiolytics and antidepressants--followed by dermatological agents (13.7%)--such as antiseptics and disinfectants-and those affecting the respiratory (medicines to treat common cold, bronchodilators, antitussives) and digestive systems (laxatives, antiacids). It is hoped that with knowledge of data from as many poisons centres as possible, an improvement may gradually be seen in the prevention of the such poisoning in the future.

Therapeutic, toxic, and lethal concentrations in human fluids of 90 drugs affecting the cardiovascular and hematopoietic systems.

BACKGROUND: Drugs affecting the cardiovascular and hematopoietic systems are frequently involved in poisoning. As a continuation of our previously published study about the concentrations of drugs of abuse, we have compiled published data about these drugs and subjected them to selection and unification on the basis of conservative criteria and our own experience. RESULTS: A compilation of the concentrations of 90 drugs affecting heart, circulation, blood or hematopoietic organs, in whole blood, serum/plasma, and urine, corresponding to therapeutic, toxic or lethal concentrations is given. Although the interpretation of the concentrations is a complex and difficult problem, the presented table can be helpful in interpretation from the actual concentrations of this group of drugs encountered in clinical, toxicological and forensic cases.

Habitual, toxic, and lethal concentrations of 103 drugs of abuse in humans.

BACKGROUND: Poisoning caused by drugs of abuse or commonly used addictive medicines occurs with relative frequency and often leads, either directly or indirectly, to death. The interpretation of the blood and urine concentrations is, however, a complex and difficult problem. METHODS: We have reviewed the published data and subjected them to selection and unification on the basis of conservative criteria and our own experience. RESULTS: A compilation of the concentrations of 103 drugs of abuse in whole blood, serum/plasma, and urine, during habitual or therapeutic use and as found in toxic or lethal poisoning is given. CONCLUSIONS: The table presented can be helpful in interpretation of the drug concentrations encountered in clinical, toxicological, and forensic cases.

Pediatric poisonings due to cleansing agents reported in 1994 to the Toxicological Information Service of Seville, Spain.

A retrospective study of 46 poisonings in children due to detergents, cleansing agents and bleach in 1994 and reported to the Toxicological Information Service in Seville (Spain) is presented. Most children affected were under the age of 4. The most frequent products implicated were dishwashing liquids, degreasers and bleach, and then glass cleaners and general household cleansing agent. In children under 2-y-of-age the principal agents of poisoning were dishwashing liquids, glass cleaners and degreasers; from 3 to 7-y-old they were bleach and general household cleaning agents; and from 8 to 14-y-of-age floor cleaners and clothes softeners were most frequent. The accidental poisonings occurred at home in all cases with a greater number of boys affected (63.0%) than girls (37.0%). The principal route of exposure was ingestion (91.5%) followed by absorption from the skin (4.3%) and conjunctiva (4.3%).