Fatal water intoxication of an Army trainee during urine drug testing

An Army trainee developed acute water intoxication, hyponatremia, pulmonary edema, and fatal cerebral edema. This is the first report of a fatality related to urine drug testing. This resulted from supervised excessive water ingestion in an attempt to induce a sufficient urine specimen for substance abuse testing. To avoid a similar preventable death in the future, we make several recommendations. These include limiting the volume of ingested fluid to eight ounces every 30 to 45 minutes, not to exceed 40 ounces, and providing a relaxed, reassuring environment when obtaining urine specimens for substance abuse detection.     

Immunoassays for drug screening in urine

Immunoassays are presently used worldwide for the rapid screening of drugs. Despite the fact that they are a highly valuable tool for the testing of legal and illicit drugs, there is a real risk of false-positive and false-negative findings and many pitfalls must be taken into account when these tests are used in an uncritical manner and without valid confirmation procedures. In a long-standing successful cooperation with a large psychiatric hospital, we checked doubtful and nonplausible immunochemical findings in urine with gas chromatography-mass spectrometry (GC-MS) confirmation methods. The reported case histories demonstrate typical pitfalls, for example, influence of changing nutritional habits, use of sweeteners (cyclamate), uncritical creatinine correction, impaired elimination, or cross-reactivities of simultaneous therapeutic medication. In accordance with national and international associations, immunoassays are recommended as a useful tool for screening. However, confirmation analysis with conclusive methods (GC-MS or liquid chromatography-MS) is unavoidable for valid substance identification, discrimination between active and inactive metabolites, detection of congeners, and accurate determination of concentrations in body fluids.     

Fatal water intoxication during olanzapine treatment: A case report

A man in his twenties was diagnosed with schizophrenia in his late teens. The night before his death, his family reported he drank a large amount of water, vomited, collapsed, and snored loudly while sleeping, but they did not view the event seriously as he did it routinely. The following morning, he was found dead. Autopsy revealed hyponatremia by water intoxication as the cause of death. Water intoxication has various causes. In this case, 610 ng/mL olanzapine was detected in serum samples. Although this concentration is not as high as the fatal concentrations reported in past studies, it might have caused some adverse effects. Furthermore, the observation that excessive drinking behavior started after the dose of olanzapine was increased suggests a possibility that olanzapine aggravated water intoxication.     

A modified direct-heating headspace solid-phase microextraction method for drug screening with urine samples

Forensic Toxicology -     

Death by water intoxication

With recent emphasis on increased water intake during exercise for the prevention of dehydration and exertional heat illness, there has been an increase in cases of hyponatremia related to excessive water intake. This article reviews several recent military cases and three deaths that have occurred as a result of overhydration, with resultant hyponatremia and cerebral edema. All of these cases are associated with more than 5 L (usually 10-20 L) of water intake during a period of a few hours. The importance of maintaining adequate hydration in exertional heat illness prevention cannot be overemphasized, but excessive fluid intake may lead to life-threatening hyponatremia. Current guidelines provide safety by limiting fluid intake during times of heavy sweating to 1 to 1.5 L per hour.     

Acute pancreatitis in a military hospital

This is a retrospective review of 139 patients who had 152 admissions for acute pancreatitis. Mean patient age was 40 years (range, 1 to 83 years), although the largest percentage (56%) fell between ages 20 and 39 years. There were 92 males and 47 females. Abdominal pain was universal and typically epigastric (88%). Radiologic ultrasound study was used in 80% of patients, which demonstrated pancreatic abnormalities in 37% and gallstones in 16%. Alcohol was the most common cause of acute pancreatitis, accounting for 37% of first attacks and 52% of recurrent attacks. About 15% of patients required intensive care unit management and 23% required operations. Only one patient died (mortality = 0.6%). Among our patients, 58% had at least one of 11 risk factors according to Ranson's criteria, although no one had more than four. Presence of Ranson's risk factors was predictive of need for intensive care unit management (p less than 0.001) and for the need of operation in general (p less than 0.05). Compared to other series reported in the literature, our patients appear to have been diagnosed and admitted earlier.     

Cost-effective syphilis screening in military recruit applicants.

A cost-effectiveness analysis of syphilis screening was performed. Strategies included no screening, universal testing at military entrance processing stations, universal testing at basic training centers, and contracting centralized screening. Probabilities derived from data retained on recruit applicants from 1989 through 1991 (N = 1,588,143) and from the published literature were used. Cost estimates were derived from costs incurred by the military and costs projected from implementing new strategies. Sensitivity analyses were performed. Modifying the existing contract for human immunodeficiency virus screening to include syphilis screening would maximize the effectiveness of screening at a cost to the Department of Defense of $9.52 per additional year of service received. The no-screening option was significantly more cost-saving than the current method of testing. Syphilis is rare and treatable, and individuals with syphilis will be identified by other means in many cases. Syphilis screening of recruit applicants at the military entrance processing stations should cease, saving the military $2,541,000 per year.     

部队高原驻训的饮食饮水卫生安全保障能力调查

目的：了解部队高原驻训的饮食饮水卫生安全需求,探索提升部队卫生保障能力的途径。方法随机抽取7家单位,通过实地查看和现场检测相结合的方法,调查某地域宿舍内外环境变化以及部队的饮食、饮水卫生安全状况。利用内标和外标校准方法对仪器测量的稳定性进行测试。结果该地域宿舍内外环境的昼夜温差以及湿度变化大。2家野战部队单位的食品原料均为统一采购,采购点固定,但5家卫勤保障单位则是独立采购,并且7家单位均缺少食品储运的保藏设施设备。在抽检的53份食品样品中,1份样品的农药残留不合格。3份水样的浑浊度、氨氮、硝酸盐氮3项指标符合卫生要求,未检测出游离余氯和总氯。高原环境下对分光光度计测量无显著影响,但对酶联免疫检测仪有显著影响。结论部队高原作训存在饮食饮水卫生安全隐患,应完善管理流程以及强化装备适应性以提升野外卫生保障效能。     

Sleep disturbance during military deployment

This preliminary investigation evaluated symptoms of sleep disturbance and insomnia in a group of 156 deployed military personnel. A 21-item Military Deployment Survey of Sleep was administered to provide self-reported estimates of a variety of sleep parameters. The results indicated that 74% of participants rated their quality of sleep as significantly worse in the deployed environment, 40% had a sleep efficiency of < 85%, and 42% had a sleep onset latency of > 30 minutes. Night-shift workers had significantly worse sleep efficiency and more problems getting to sleep and staying asleep as compared to day-shift workers. The results of the study indicate the need for programs to help deployed military members get more and better sleep.     

百草枯中毒的药物治疗研究进展

农药百草枯属剧毒除草剂,重度中毒患者可在短时间内死于多脏器功能衰竭;中度中毒时主要损害肺脏,患者发生急性呼吸窘迫综合征,后期多死于肺纤维化。因尚无特效解毒药,临床救治多以对症和支持治疗为主,病死率极高。寻求有效的治疗药物已成为百草枯中毒的研究热点。本文对临床救治中常用的及近年来新发现的对百草枯中毒有治疗作用的药物作一综述。     

某地区军校考生毒品检测结果分析

目的：回顾性分析某地军校考生毒品检测结果。方法：采用竞争胶法金试剂盒对2256名考生尿样,进行吗啡、甲基安非他明（冰毒）检测。结果：2256名中,吗啡初检阳性19名,复检阳性8名;冰毒初检阳性1名,复检阳性1名。结论：经分析和询问,假阳性结果可能与食物或药物中含有鸦片类成分有关,应认真鉴别,对考生负责。     

Assessing chemical exposures during military deployments

Before the first Persian Gulf War, military chemical concerns were focused on life-threatening/performance-impairing effects from exposures to chemical warfare agents. Now, hazards of concern include both high and low levels of chemical warfare agents and toxic industrial chemicals in air, soil, and water. The types of health effects considered have expanded to include both immediate, acute effects (mild and severe), and delayed or chronic outcomes. Because federal exposure standards are not applicable to deployed personnel, the U.S. Army Center for Health Promotion and Preventive Medicine established military-specific exposure guidelines in Technical Guide 230, Chemical Exposure Guidelines for Deployed Military Personnel. Methods used to develop the guidelines address toxicological data limitations, uniqueness of military populations and exposure scenarios, and a risk assessment process compatible with existing military operational risk management doctrine. The Technical Guide 230 helps ensure chemical hazards are addressed in various deployment scenarios.     

The influence of water versus carbohydrate-electrolyte hydration on blood components during a 16-km military march

The purpose of this study was to identify and to compare the effects of ingesting liquids during a 16-km military march under moderate environmental conditions. Twenty-six volunteer male subjects were randomly divided into two groups. Group GW received water (n=12), and group GP received an electrolytic carbohydrate solution (n=14). Blood and urine samples were obtained immediately before and after the march. No significant differences between the drinks were found for any of the measured variables. However, important results (p < 0.05) were observed by comparing variables before and after exercise. The variables included sodium, hematocrit, red blood cell, hemoglobin, and lactic acid levels and body weight (group GW) and sodium, potassium, hematocrit, red blood cell, hemoglobin, and lactic acid levels (group GP). Under the environmental conditions and hydration procedures applied, the results of this study showed similarities in the behavior of the variables, regardless of the kind of beverage consumed.     

急性砷中毒样品的剖析及尿中砷排泄的观察

报道了对某单位食堂早餐食物中毒原因的调查以及有关中毒样品的剖析。通过对中毒现场样品采集和对样品进行系统分析，迅速确证馒头中污染的亚砷酸盐是导致中毒的直接原因。对中毒者血、尿样品进行检测，发现血、尿样品中Ａｓ＾３＋的含量均达到１．０μｇ／ｍｌ（中毒第３ｄ的血尿样品），高于同一食堂就餐的未中毒者。同时对中毒病人尿中砷排泄的情况进行了观察，其尿砷排泄符合一级动力学过程，Ｋ＝０．０７ｄ＾－１，消除半衰期为