Cardiovascular depression resulting from atenolol intoxication.

A case of massive atenolol ingestion leading to hypotension in association with PR and QRS interval prolongation on the electrocardiogram is presented. These clinical findings are identical to those attributed to the membrane-stabilizing activity of propranolol and other lipophilic beta-blockers. It is commonly believed that hydrophilic agents such as atenolol lack this activity. A review of the literature reveals that hydrophilic beta-blockers may have membrane-stabilizing activity, though much higher concentrations are required to produce this action in comparison with lipophilic agents. This case and a review of the literature provides a potential pathophysiological basis for atenolol-induced haemodynamic depression.     

Skeletal muscle weakness resulting from quinidine ingestion

We have described a patient with muscle weakness caused by ingestion of quinidine sulfate. Intrafascicular perivasculitis and rare muscle fiber regeneration were present in the muscle at biopsy. A similar clinical picture has previously been reported in patients taking other medications, but not quinidine.     

Increased urinary riboflavin excretion resulting from boric acid ingestion

The urinary excretion of riboflavin (vitamin B2) was determined in 14 patients, both children and adults, after the ingestion of boric acid. These patients reported to the New York City Poison Control Center during a 2 1/2 year period. Riboflavin was determined by a modification of a previously described method which is based upon competitive protein binding. Boric acid ingestion was associated with greatly increased urinary riboflavin excretion in approximately two thirds of the patients. Most of the riboflavin appeared to be excreted within the first 24 hr after ingestion of boric acid. These data provide evidence of a previously unrecognized hazard of boric acid ingestion in patients.     

Severe systemic intoxication following triclopyr-TEA ingestion

We report a case of triclopyr ingestion, a herbicide that acts via the auxin system in plants. It is classified as low-toxicity herbicide. The patient ingested this product and developed metabolic acidosis and coma with cardiovascular impairment. Echocardiography and elevated Troponin T and CK MB with prolongation of QTc suggested direct myocardial toxicity. The patient was extubated 57?h after ingestion, and he recovered completely. This case illustrates the potential acute toxicity of this agent in humans.     

Severe systemic intoxication following triclopyr-TEA ingestion

We report a case of triclopyr ingestion, a herbicide that acts via the auxin system in plants. It is classified as low-toxicity herbicide. The patient ingested this product and developed metabolic acidosis and coma with cardiovascular impairment. Echocardiography and elevated Troponin T and CK MB with prolongation of QTc suggested direct myocardial toxicity. The patient was extubated 57 h after ingestion, and he recovered completely. This case illustrates the potential acute toxicity of this agent in humans.     

Botulisme: pas toujours une intoxication par ingestion

Botulism is a rare but paralyzing disease caused by a neurotoxin produced by the anaerobic, spore-forming Gram-positive bacterium. Clostridium botulinum. Temperatures of over 120° C are required to kill the spores, while a one-minute exposure to 85° C is sufficient to inactivate the toxin. Although in most cases botulism is caused by eating contaminated food, experimental data and documented cases of botulism in laboratory workers clearly indicate that an aerosolized form of the toxin may also provoke botulism, i.e., that the bacterium can be inhaled. Moreover, according to experts, the use of aerosolized botullinum toxin could be one of the most frightening weapons in the context of biological warfare. We report one case of documented botulism probably secondary to the inhalation of serotype B toxin from contaminated food. This observation emphasizes that although the clinical diagnosis of botulism is fairly straighforward as it is based on highly indicative symptoms (multiple paralysis of the cranial nerves and atropinic signs), the route of acquisition is not always easy to determine.     

Acute intoxication due to ingestion of vegetables contaminated with aldicarb

Three members of the same family ingested vegetables treated with aldicarb. All three developed signs and symptoms of acetylcholinesterase inhibition and all recovered a few hours after the ingestion. Reports of toxicity from the ingestion of aldicarb-contaminated food are uncommon. Aldicarb is a potent pesticide which can only be used safely if governmental and industry regulations are followed carefully.     

Clinical outcome of acute intoxication due to ingestion of auxin-like herbicides

Background. The human toxicity of synthetic auxin analogue herbicides has not been extensively studied. Methods. Clinical outcome was assessed from medical records of 17 patients who had intentionally ingested auxin pesticides with active ingredients like dicamba, triclopyr, MCPA or mecoprop. The patients were interviewed after discharge to follow outcome (interval 2 to 56 months). Result. One patient who had ingested 500 mL of a mecoprop product died of hypotension and respiratory failure 36 hours after hospital admission. The other 16 patients recovered and were discharged by hospital day 28. After discharge, four patients died from causes not related to herbicide intoxication. In the 12 surviving patients, no long-term effects were reported. Conclusion. Human toxicity of synthetic auxins appears relatively benign with conservative treatment. However, when the amount ingested is above several hundred milliliters of commercial product, especially in combination of mecoprop with other intoxicants (e.g. alcohol), shock with respiratory failure may develop and lead to death.     

Antimuscarinic management of overactive bladder

The symptoms of an overactive bladder (OAB) has a negative effect on the health-related quality of life of a sufferer. Many do not seek help and up to 73% of those of who are assessed do not take medication to relieve their symptoms. The key to managing this condition is a multidisciplinary approach to conservative behaviour therapy in the form of bladder training. This management is more effective when combined with antimuscarinic medication.     

Acute oral selenium intoxication with ten times the lethal dose resulting in deep gastric ulcer

A 48-year-old woman presented after taking 2000 mg of selenium dioxide, corresponding to 10 times the experimental lethal dose in animals. She presented with mildly altered consciousness and hematemesis. Endoscopy revealed mucosal damage throughout the oral cavity, esophagus, and stomach. There was no evidence of perforation. After intubation and gastric lavage, hemodialysis was performed. The patient was discharged uneventfully on the 16(th) day. This case highlights a very rare acute selenium intoxication. Serum and urinary selenium levels and serum glutathione peroxidase activities during the patient's course were followed, as well as the mucosal corrosive damage caused by the selenium.     

Concentrations of morphine and codeine in serum and urine after ingestion of poppy seeds

We measured morphine and codeine in commercially available poppy seeds and in serum and urine samples from healthy adults who had ingested these poppy seeds. Four brands of black poppy seeds, examined by gas chromatography-mass spectroscopy (GC-MS) with deuterated internal standards, contained from 17 to 294 micrograms of morphine and 3 to 14 micrograms of codeine per gram of seeds. Morphine was detected by GC-MS in hydrolysates of serum as late as 24 h after ingestion, with a maximum mean concentration of 100 ng/mL (range 82-131) measured 2 h after the subjects ingested 25 g of seeds. Opiates were detectable (greater than 300 micrograms/L) in urine by enzyme-multiplied immunoassay (EMIT; Syva Co.) and by radioimmunoassay screening procedures for as long as 48 h after ingestion. The identity and quantities of morphine and codeine in poppy seed extracts and in hydrolysates of serum and urine were confirmed by GC-MS. Therefore a positive finding of morphine or codeine in blood and urine may sometimes be due to ingestion of poppy seeds.     

Antimuscarinic syndrome after propofol administration in the emergency department

Antimuscarinic syndrome (AS), a rare but serious adverse event associated with propofol should be included in the differential diagnosis of patients who develop agitation after its administration. We report a case of antimuscarinic syndrome that developed in an emergency department patient immediately after receiving propofol for the reduction of an elbow dislocation. The patient had received therapeutic doses of meperidine and promethazie several hours before the administration of propofol, and had an estimated serum ethanol level of 64 mg/dL about 1 h before sedation. The patient was successfully treated with physostigmine. Administration of propofol in conjunction with other substances known to have antimuscarinic effects may increase the risk of developing AS.     

A case of mixed intoxication with isopropyl alcohol and propanol-1 after ingestion of a topical antiseptic solution

We report a mixed intoxication with isopropyl alcohol and propanol-1 in a hospitalized patient who ingested, on two separate days, two 100 ml bottles of a topical antiseptic solution containing isopropyl alcohol and propanol-1. Eight hours after the second ingestion, plasma concentrations of isopropanol, propanol-1 and acetone were 37 mg/dL, <10 mg/dL, and 227 mg/dl, respectively. Despite a lack of severe toxicity, 4-methylpyrazole (fomepizole) was initiated. This case points out the need to limit access to alcohol-containing antiseptic solutions on wards where alcoholic and psychotic patients are hospitalized.