Successful treatment of an adult with Amanita phalloides-induced fulminant liver failure with molecular adsorbent recirculating system (MARS)

Despite significant advances in intensive care management of Amanita phalloides-induced fulminant liver failure (FLF), patients with this condition still have a high mortality rate in the absence of orthotopic liver transplantation. Molecular Adsorbent Recirculating System (MARS) is a new, cell-free, extracorporeal liver assistance method utilizing an albumin dialysate for the removal of albumin-bound toxins, and a highly effective depurative therapy in adults with wild mushroom-induced FLF. We report the case of a 39 year old woman with Amanita phalloides-induced FLF, admitted to our intensive care unit (ICU) and treated with MARS. Our patient had severe hepatic dysfunction: hepatic encephalopathy (grade II), ALT = 5022 (2475-10098) IU/L, bilirubin = 7.18 (4.8-10.1) mg/dL, prothrombin time (PT) = 90.4 (29.3-140.4) s. MARS sessions had an immediate impact on liver tests: statistically significant decrease in ammonia, ALT and PT. Hepatic encephalopathy was successfully reduced. The patient survived and the hepatic function completely recovered. MARS appears to be a safe and highly effective depurative therapy in adults with Amanita phalloides-induced FLF.     

A rare cause of non-Q myocardial infarction--acute carbon monoxide poisoning

Myocardial infarction is a rarely reported complication of acute carbon monoxide (CO) poisoning. We report the case of a 77 years old woman who presented to our emergency department with altered consciousness as a consequence of exposure to CO. The patient didn't experience any chest pain, but the electrocardiogram showed a non-Q-wave antero-septal acute myocardial infarction, with typical elevation in troponin T and creatine-phosphokinase MB levels. The patient recovered completely after specific treatment of poisoning with no major cardiac complication. We consider that careful electrocardiographic and enzymatic monitoring of all patients, especially elderly patients, in the first hours after CO exposure is important for early diagnosis and treatment of this rare complication of CO poisoning, and can improve the outcome of these patients.     

Electrocardiographic changes in acute organophosphate poisoning

Cardiac complications often accompany poisoning with organophosphates. These may be serious and often fatal, being represented by cardiac arrhythmias, electrocardiographic abnormalities and conduction defects, as well as myocardial infarction, a rarely reported complication of acute pesticide poisoning. The extent and pathogenesis of cardiac toxicity from these compounds is not yet clearly defined. We report the case of a 57-year-old woman who presented to our emergency department with coma and acute non-cardiogenic pulmonary edema, as a result of organophosphates ingestion. She was resuscitated for asystole presented shortly after admission; prolonged QTc interval, ST-T changes, right bundle branch block, ventricular tachycardia were recorded. Finally she developed acute anteroseptal myocardial infarction and died despite serum cholinesterase normalization. We believe that admission in an intensive care unit, careful electrocardiographic and enzymatic monitoring of all patients is important for the diagnosis and treatment of cardiac complications of organophosphates poisoning.     

Diagnostic problems in a case of chronic expanding hematoma

We present a case of chronic expanding hematoma occurring in the right medial thigh. The patient was an 86 year-old woman who had this mass with slowly growth 3 years before. Ultrasonography showed a multilocular cyst and computed tomography an image of heterogeneous mass with capsule formation. A diagnose was unable to perform through both methods, which was confirmed by histopathological exam after successful surgical treatment. Microscopically, a fibrous pseudocapsule and in the central cavities blood clot, fibrin and necrotic debris were described.     

Respiratory syndromes in acute poisoning

Respiratory syndromes in acute poisoning can refer to a wide range of specific clinical syndromes, from acute tracheobronchitis to acute pulmonary edema, chemical pneumonia, acute respiratory distress syndrome and respiratory failure, that occur as a result of direct or indirect effect of chemical substances, drugs and toxins on lungs and airways. Our study attempt to identify, during one-year retrospective study on patients diagnosed with acute poisoning, addressed to Medical Clinic of Emergency Clinic Hospital of Iasi, the respiratory syndromes commonly associated with acute poisoning. We found that the association of toxins, inhalation of gases or volatile substances have a high risk for appearance of respiratory syndromes. The outcome of these patients is influenced by the duration of exposure or the delay of presentation to the hospital after ingestion, and depends on the rapid and aggressive measures for basic life support and intensive care.     

Self-administration of intravenous drugs--a rare cause of respiratory arrest in medical practice

Respiratory arrest is a major emergency in medical practice, which implies prompt intervention from the physician assisting such case. Respiratory arrest can be classified into primary respiratory arrest, caused by airway obstruction, decreased respiratory drive, or respiratory muscle weakness and secondary respiratory arrest, as a result of circulatory insufficiency. Among important causes of respiratory arrest, acute poisonings are to remember. We present a case of respiratory arrest following intravenously self-administration of opiates in attempted suicide. Patient required rapidly orientated etiologic diagnostic, and had a favorable outcome, with complete recovery, after applying CPR protocol, as well as antidote.