Clinical Laboratory Tests in Some Acute Exogenous Poisonings.

BACKGROUND: There is no specific toxicological screening of clinical laboratory parameters in clinical toxicology when it comes to acute exogenous poisoning. AIM: To determine routine clinical laboratory parameters and indicators for assessment of vital functions in patients with acute intoxications. MATERIALS AND METHODS: One hundred and fifty-three patients were included in the present study. They were hospitalized in the Department of Clinical Toxicology at St. George University Hospital, Plovdiv for cerebral toxicity inducing medication (n = 45), alcohol (n = 40), heroin abuse (n = 33). The controls were 35. The laboratory tests were conducted in compliance with the standards of the clinical laboratory. We used the following statistical analyses: analysis of variance (the ucriterion of normal distribution, the Student's t-test, dispersion analysis based on ANOVA) and non-parametric analysis. RESULTS AND DISCUSSION: Based on the routine hematological parameters with statistically significant changes in three groups of poisoning are: red blood cells, hematocrit, hemoglobin (except alcohol intoxication) and leukocytes. We found statistically significant changes in serum total protein, sodium and bilirubin. The highest statistical significance is the increased activity of AST and ALT. CONCLUSION: We present a model for selection of clinical laboratory tests for severe acute poisoning with modern equipment under standardized conditions. The results of the study suggest that the clinical laboratory constellation we used can be used as a mandatory element in the diagnosis of moderate and severe intoxication with the mentioned toxic substances.

Snake venom poisoning in the Plovdiv region from 2004 to 2012.

INTRODUCTION: Envenomation by poisons of biological origin is very common globally in the tropical and subtropical areas mainly, where the biological diversity of the species clearly leads to evolution of highly toxic species. The weather warming trend in Bulgaria, whether cyclic or permanent, allows for a change in the biological response of reptiles and insects inhabiting the temperate zone by a possible migration of biological species from the subtropical zone towards the temperate zone because of the new environmental conditions. There are very few studies on snake bite envenoming in Bulgaria. The AIM of the study was to find the incidence of the acute accidental intoxication (AAI) caused by snake venom in adult individuals in a large region of Bulgaria between 2004 and 2012 and characterises it by number, type, main clinical features, course and socio-demographic parameters of the victims so that preventive measures can be taken, wherever necessary. MATERIALS AND METHODS: We studied retrospectively all 68 cases of AAI caused by snake venom in adult individuals (> 18 years old) hospitalized in the Clinic of Toxicology in St. George University Hospital, Plovdiv over the period from 2004 to 2012 by 23 quantitative and qualitative parameters. RESULTS: We found that the average annual incidence of snake venom AAI in adult population in the region of Plovdiv was relatively low for the specified period (9.5 per 100000 residents); the snake venom AAI increases or decreases every other year, with no clearly delineated trend for now. The prevalence of envenomation by poisons of biological origin increased from 2.3% in 1990-1998 to 9.5-10.33% between 2007 and 2012. The main sociodemographic characteristics of snake bite victims are similar to those in other Balkan and Central European countries. The clinical response to poisons of biological origin is generally identical with the response to the viper (Vipera ammodytes)--mild to medium intensity with predominantly local toxic syndrome. CONCLUSIONS: The algorithm of Clinical Pathway 293 (CP) is effective and conducive to the reduction of duration of the morbid condition. There are, however, still aspects of it that can be optimised.

Severe hypotension and ischemic stroke after disulfiram-ethanol reaction.

Disulfiram (tetraethylthiuram disulfide) has been used for almost 60 years in the treatment of alcohol addiction. It causes aversive behavior due to disulfiram-ethanol reaction (DER). The classical DER includes flush, sweating, tremor, nausea, vomiting, tachycardia, moderate decrease in blood pressure and restlessness. Complete recovery is the usual outcome in clinical settings. Life-threatening reactions are rare but sometimes occur. We present a case of a 53-year-old man developing severe hypotension and ischemic stroke as a result of disulfiram treatment and ethanol intake. Use of adrenalin as a drug of choice in this critical condition, together with other therapeutic approaches led to stabilization of hemodynamics and reversal of neurological symptoms. Our case had a favorable outcome, but it should be remembered that patients unable to comply to the strong restrictions in treatment for alcohol rejection are not eligible for this therapeutic modality used in the management of alcohol dependency.

A rare case of severe intoxication from multiple bee stings with a favorable outcome.

A 73-year old female of no allergic diathesis was attacked by bees and stung all over her body accidentally sustaining more than 518 stings for a very short time. Severe acute poisoning developed from the bee venom, manifested by coma, rhabdomyolysis, toxic hepatitis, acute renal failure, gastric hemorrhage and anemia. Following an active treatment the patient recovered. Literature search shows this to be a rare case of survival after multiple bee stings.