Three fatal intoxications due to methylone

We present three fatal intoxications of methylone, a cathinone derivative. Blood was analyzed with a routine alkaline liquid-liquid extraction and analyzed by gas chromatography coupled with a mass spectrometer (GC-MS). Methylone was identified by a full scan mass spectral comparison to an analytical standard of methylone. For a definitive and conclusive confirmation and quantitation, methylone was also derivatized with heptafluorobutyric anhydride and analyzed by GC-MS. In all three fatalities, the deceased exhibited seizure-like activity and elevated body temperatures (103.9, 105.9 and 107°F) before death. Two of the three cases also exhibited metabolic acidosis. One of the three cases had prolonged treatment and hospitalization before death with symptoms similar to sympathomimetic toxicity, including metabolic acidosis, rhabdomyolysis, acute renal failure and disseminated intravascular coagulation. The laboratory results for this patient over the 24 h period of hospitalization were significant for increased lactate, liver transaminases, creatinine, myoglobin, creatine kinase and clotting times, and decreased pH, glucose and calcium. Peripheral blood methylone concentrations in the three fatal cases were 0.84, 3.3 and 0.56 mg/L. In conlusion, peripheral blood methylone concentrations in excess of 0.5 mg/L may result in death due to its toxic properties, which can include elevated body temperature and other sympathomimetic-like symptoms.     

Massive ibuprofen ingestion with survival

OBJECTIVE: To report a massive, 100 g ibuprofen ingestion in an adolescent, with survival. CASE REPORT: The patient developed coma, metabolic acidosis, and mild thrombocytopenia, but improved rapidly with supportive care. Renal function remained normal and no gastrointestinal bleeding occurred. CONCLUSIONS: Massive ingestion of ibuprofen may result in a variable picture with some elements of significant toxicity, but supportive care usually results in survival without sequelae.     

Sudden death due to ingestion of cocaine

A 27-year-old male died as the result of swallowing a bag of cocaine. Using gas chromatography and ultraviolet spectrophotometry, the concentration of cocaine was determined on all specimens submitted for analysis. These analyses revealed what may possibly be the highest concentrations of cocaine ever reported in the toxicology literature. These values were confirmed by another medical examiner toxicology laboratory.     

A fatality due to accidental PineSol ingestion

The case history and toxicological findings of a fatal PineSol intoxication are presented. An 89-year-old white female with Alzheimer's disease accidentally drank PineSol and was subsequently brought to the hospital where she was pronounced dead on arrival. Significant autopsy findings included acute erosive gastritis. There appeared to be no aspiration of PineSol into the lungs. Isopropanol along with 1-alpha-terpineol are the two major toxic ingredients of PineSol. The toxicological screening and quantitiation of 1-alpha-terpineol in postmortem fluids was performed by gas chromatography-mass spectrometry using a simple one-step extraction. Postmortem blood, urine, and gastric levels of 1-alpha-terpineol were 11.2 mg/L, 5.76 mg/L, and 15.3 g/L, respectively. Postmortem blood, vitreous humor, urine, and gastric acetone concentrations were 25, 31, 33, and 28 mg/dL. Postmortem concentrations of isopropanol were less than 10 mg/dL in the blood, vitreous humor, urine, and gastric contents. The cause of death was ruled acute 1-alpha-terpineol intoxication due to accidental ingestion of PineSol, presumably caused by confusion related to Alzheimer's disease.     

Severe hepatitis due to Atrium

(1) Atrium, a combination of difebarbamate, febarbamate and phenobarbital first marketed in France more than 30 years ago, carries a risk of hepatitis. (2) Despite restrictions on its indications and treatment duration introduced in 1997, cases of severe liver damage have continued to be notified in France. (3) Benzodiazepines are the reference drugs for alcohol withdrawal. Carbamates and barbiturates are no more effective than benzodiazepines, and carry a higher risk of adverse effects. (4) The recent decision to withdraw Atrium from the market was long awaited.     

Severe hypercalcemia due to teriparatide

Osteoporosis that is by far the most common metabolic bone disease, has been defined as a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. Anabolic therapy with teriparatide, recombinant human parathyroid hormone (PTH 1-34), stimulates bone formation and resorption and improves trabecular and cortical microarchitecture. Teriparatide is indicated for the treatment of men and postmenopausal women with osteoporosis who are at high risk for fracture, including those who have failed or are intolerant of previous osteoporosis therapy. In conclusion, although teriparatide seems quite effective in the treatment of osteoporosis, it may cause life-threatening hypercalcemia. Therefore, patients should be closely monitored if symptoms of hypercalcemia are present during teriparatide treatment. Sustained hypercalcemia due to teriparatide treatment can not be seen in literature so we wanted to emphasize that severe hypercalcemia may develop due to teriperatide.     

甲巯咪唑致严重粒细胞缺乏

患者女,35岁。因“咽痛、发热1d”于2004年5月4日入院。患者确诊为甲状腺功能亢进3个月,给予甲巯咪唑30mg,3次/d口服。入院前1d出现咽部疼痛、发热(体温39.5℃),全身乏力。血常规显示:WBC0.8×109/L,N0.07,L0.78,M0.15,Hb124g/L,PLT90×109/L。中性粒细胞<0.5×109/L,淋巴细胞相对增多。入院后,查体:咽部有黏膜白斑及红肿,悬雍垂出现溃疡,T39.7℃。给予粒细胞集落刺激因子(特尔津)150μg,皮下注射,1次/d。同时给予左氧氟沙星0.4g,1次/d;氯唑西林3.0g,2次/d,静滴。4d后因体温未下降,血培养示阴性,停用氯唑西林换用头孢他啶,但体温仍高…     

Death due to inhalation of industrial acetylene

CASE REPORT: Acetylene is a commonly found industrial agent that, when mixed with oxygen, is used for welding. This report outlines circumstances surrounding the death of a 40-year-old male with presumptive evidence of abuse of the substance and subsequent death. The article covers the uses of acetylene, the toxic effects attributed to the gas, and the circumstances of the incident.     

Aroclor 1242 inhalation and ingestion by Sprague-Dawley rats

PCBs have been considered to be almost nonvolatile and insoluble in water. However, recent studies have shown the importance of their slight solubility in water and capability to enter the atmosphere and disperse throughout the global environment. This preliminary study was designed to measure uptake and observe any physiological changes in Sprague-Dawley rats. The PCB product Aroclor 1242 is the major pollutant of the Hudson River, NY, and New Bedford Harbor, MA. The rats were exposed for 30 d to 0.9 microg/m3 via inhalation and 0.436 microg/g (ppm) in the food. The inhalation of PCBs gave a greater PCB uptake than ingestion. Both routes of administration caused significant serum thyroid hormone elevations. Histopathologic changes were observed in the urinary bladder, thymus, and the thyroid after both exposure regiments. Rearing and ambulation were significantly decreased in both exposure regiments in an open field behavior test.     

Acute hepatic failure due to yellow phosphorus ingestion

We report a case of three year old girl, who was brought to hospital for accidental consumption of rat-poison (3% phosphorus). The patient was asymptomatic for first 48 hours. Later on she developed the symptoms of hepatic failure. She was managed conservatively and was discharged after 14 days.     

A fatality due to ingestion of hydrofluoric acid

We report a fatal case of hydrofluoric acid (HF) ingestion with suicidal intent. Quantitation using an ion-selective electrode for fluoride in fresh bile, gastric contents, kidney, liver, skeletal muscle, urine, and vitreous humor yielded 6.5, 39.0, 10.0, 6.0, 4.5, 5.0, and 4.5 ppm, respectively. In addition to the unfixed specimens, fluoride ion was measured in the following fixed tissue: brain, heart, kidney, liver, pancreas, stomach, and heart. Tissues were measured directly and/or by using the technique of standard addition. Fluoride concentrations using either method were found to be comparable. Fluoride concentration in fresh tissue was consistent with toxicity, although the urine fluoride concentration was in the range observed for asymptomatic workers exposed to fluoride in air. Fixed tissue preparations revealed fluoride concentrations consistent with nonexposure, whereas examination of the formalin fixative revealed fluoride concentrations only slightly higher than negative control formalin. We conclude that fixed tissues are inappropriate for fluoride determination. This is the first case we are aware of that provides fluoride concentrations in skeletal muscle in a fatality involving HF ingestion.     

荷丹片致重症腹泻

患者女,56岁。因患高血脂、高血压病1.5年左右,于2006年5月12日来我院门诊检查。查体:T36.5℃,BP150/100mmH(g1mmHg=0.133kPa),心肺未见异常,腹软,肝脏肋下可及1cm,脾不大,腹部未触及异常包块,下肢无水肿。生化检查示:甘油三酯(TG)10.8mmol/L,总胆固醇(TC)11.2mmol/L,低密度脂蛋白胆固醇(LDL-C)4.2mmol/L,高密度脂蛋白胆固醇(HDL-C)0.84mmol/L。尿常规呈阴性。给予口服荷丹片2片,3次/d;卡托普利片25mg,3次/d;尼群地平片10mg,3次/d;肠溶阿司匹林片25mg,3次/d。患者在服药第7d,出现严重腹泻,日大便次数达10多次,呈稀溏状,伴全身无力…     

Polymer fume fever-like syndrome due to hairspray inhalation

Inhalation of fluoropolymer pyrolysis products causes a self-limited illness termed polymer fume fever; symptoms include fever, chills, myalgias and non-productive cough, and are easily mistaken for an acute viral illness. We report a 29-y-old male who developed fever and pneumonitis shortly after the inhalation of pyrolyzed hairspray. Chest x-rays showed pictures consistent with pneumonitis. The patient was treated solely with supplemental oxgen, and his symptoms resolved over 24 h. Inhalation of pyrolyzed hairspray may cause a syndrome resembling polymer fume fever.     

复方甘草酸苷致严重低血钾与横纹肌溶解

1例37岁男性因乙型肝炎表面抗原（HBsAg）、e抗体（HBeAb）、核心抗体（HBcAb）阳性和转氨酶升高服用复方甘草酸苷25 mg,3次/d,共1个月.1个月后出现双下肢酸痛、乏力,实验室检查示血钾1.8 mmol/L,肌酸激酶8 378 U/L,考虑是复方甘草酸苷所致低血钾与横纹肌溶解.停用复方甘草酸苷并给予补钾、补液治疗10 d后,血钾升至5.1 mmol/L,肌酸激酶降至450 U/L,肌痛、乏力消失.     

伊立替康致重度迟发性腹泻与骨髓抑制

1例63岁女性结肠癌患者术后采用伊立替康﹢奥沙利铂化疗方案：首日给予伊立替康200 mg﹢奥沙利铂200 mg,第8天给予伊立替康160 mg。化疗第7天患者出现黄色稀便,遂停止化疗,给予保护肠黏膜和止泻药。第8天夜间患者发热（体温38.0℃）,外周血白细胞计数0.27×10^9/L,血小板计数117×10^9/L,给予抗感染和升白细胞治疗。第14天再次出现严重水样便,当日血钾2.3 mmol/L、钠126 mmol/L,给予抗感染和纠正电解质紊乱治疗。第16天患者出现持续发热、严重腹胀合并肠麻痹,外周血白细胞计数0.25×10^9/L,血小板计数25×10^9/L,给予亚胺培南/西司他丁钠与奥曲肽。第18天患者血压降至70/40 mmHg（1 mmHg＝0.133 kPa）,血氧饱和度测不到,呈昏迷状态。第19天患者经抢救无效死亡。     

Lead poisoning due to ingestion of Indian herbal remedies

A case of lead poisoning is presented. The patient had recently returned to New Zealand from the Indian subcontinent. This prompted a search that identified lead contamination of ingested medicinal products that had been prescribed in India. There have been several case reports of lead toxicity due to contamination of Indian herbal medicines, though none, to our knowledge, previously reported from New Zealand.     

6-氨基己酸致严重头痛

1例17岁女性患者确诊为Ⅰ型遗传性血管性水肿后给予6-氨基己酸4 g/d静脉滴注。第1次用药约1h时患者出现头痛、恶心,逐渐发展为双颞侧剧烈跳痛,伴全身乏力、精神萎靡、行动困难等症状,静脉滴注结束后约1h上述症状消失。第1~8天静脉滴注6-氨基己酸后上述症状复现,且逐日加重,均在用药结束后约1h症状消失。