Significance of toxic interactions in medicolegal evidence. Complex fatal poisoning with drugs of abuse in the material of the Chair of Forensic Medicine, Collegium Medicum, Jagiellonian University in Krakow.
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The subject of the study was fatal complex poisonings with drugs of abuse in two young men. In the first case, postmortem investigation revealed cardiotoxic death as the result of an interaction between opiates, amphetamine derivatives and oxazepam. In the second case, death followed the administration of amphetamine derivatives and cocaine (xenobiotics known on the illicit drug market as "UFO"). Based on the toxicological postmortem analysis the authors discuss the interpretation of the results in the light of general problems of interactions taking place in toxicokinetic and toxicodynamic phases of intoxication processes. (+info)
Concomitant overdosing of other drugs in patients with paracetamol poisoning.
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AIMS: Paracetamol is frequently involved in intended self-poisoning, and concomitant overdosing of other drugs is commonly reported. The purpose of the study was to investigate further concomitant drug overdose in patients with paracetamol poisoning and to evaluate its effects on the outcome of the paracetamol intoxication. METHODS: Six hundred and seventy-one consecutive patients admitted with paracetamol poisoning were studied and concomitant drug intake was recorded. The relative risk of hepatic encephalopathy, death or liver transplantation, hepatic dysfunction, liver cell damage, and renal dysfunction associated with concomitant overdosing of other drugs was evaluated by multivariate analysis. RESULTS: Concomitant drug overdose was found in 207 patients (31%, 95% confidence interval [CI] 27, 34%). Concomitant overdosing of benzodiazepines (99 cases), opioid analgesics (38 cases), acetylsalicylic acid (33 cases), and NSAID (32 cases) predominated. Concomitant benzodiazepine overdose was an independent risk factor in the development of hepatic encephalopathy (odds ratio [OR] 1.91; CI 1.00, 3.65) and renal dysfunction (OR 1.81; CI 1.00, 3.22). Concomitant overdosing of opioid analgesics was a protective factor in the development of hepatic encephalopathy (OR 0.26; CI 0.07, 0.96). Concomitant acetylsalicylic acid overdose was a risk factor in the development of hepatic encephalopathy (OR 4.87; CI 1.52, 15.7) and death or liver transplantation (OR 6.04; CI 1.69, 21.6). A tendency towards a more favourable outcome was observed in patients with concomitant NSAID overdose. CONCLUSIONS: Concomitant overdosing of benzodiazepines or analgesics is frequent in patients admitted with paracetamol poisoning. Concomitant benzodiazepine or acetylsalicylic acid overdose was associated with more severe toxicity, whereas concomitant overdosing of opioid analgesics was associated with less toxicity. (+info)
Adverse event associated with methionine loading test: a case report.
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The death of a control subject after an oral load of methionine for a study of the possible relationship between homocysteine and Alzheimer's disease is reported. The subject developed postload plasma concentrations of methionine far beyond those reported previously in humans given the usual oral loading dose of methionine (100 mg/kg body wt). Her preload plasma metabolite values rule out known genetic diseases that might predispose one to unusually high methionine concentrations. The most likely explanation for these events is that the subject received a substantial overdose of methionine. The possibility that extremely high methionine concentrations may lead to severe cerebral effects is discussed, and it is recommended that any move to increase the sensitivity of the usual methionine loading test by increasing the dose of methionine either not be undertaken or be taken only with extreme care. (+info)
Sudden death and suicide: a comparison of brain weight.
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BACKGROUND: Recent evidence suggests that the brain weight of individuals over the age of 60 who commit suicide is significantly higher than in those who die of natural causes. AIMS: To ascertain whether brain weight is different in people of a younger age who commit suicide than in those who die accidentally. METHOD: A retrospective review of post-mortem reports collecting height, weight and brain weight in 100 suicide victims (87 males, mean age 38.5 years) and 100 age/gender-matched controls who died accidentally or of natural causes (87 males, mean age 38.7 years). Comparison by t-test was made of brain weight in isolation as well as brain weight corrected for height, weight and body mass index. RESULTS: These results reveal no significant difference in brain weight in suicide cases compared to the general population (P > 0.05). The brain weight of those who died by hanging was significantly higher than of those who died by overdose. CONCLUSIONS: Whatever the significant neuropsychiatric elements are that influence suicidal behaviour, they do not consistently affect brain weight in the population studied. (+info)
Delayed asystolic cardiac arrest after diltiazem overdose; resuscitation with high dose intravenous calcium.
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A 51 year old man took a mixed overdose including 1.8-3.6 g of diltiazem, paracetamol, aspirin, isosorbide nitrate, and alcohol. He initially presented to hospital after six hours with mild hypotension and was treated with activated charcoal and intravenous fluids. Eighteen hours after the overdose he had two generalised tonic-clonic seizures. The patient remained unresponsive with junctional bradycardia, unrecordable blood pressure, and then became asystolic. He was resuscitated with high dose (13.5 g) intravenous calcium and adrenaline (epinephrine). He required inotropic support and temporary pacing over the next 48 hours. This case suggests there is a role for aggressive high dose intravenous calcium therapy in severe diltiazem overdose, particularly with the onset of asystole. It should be considered early in cases of cardiac arrest after diltiazem overdose. The case also highlights the problems with delayed toxicity when whole bowel irrigation is not administered. (+info)
LC-MS determination of oxydemeton-methyl and its main metabolite demeton-S-methylsulfon in biological specimens--application to a forensic case.
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A sensitive method for the identification and quantitation of the organophosphate insecticide oxydemeton-methyl and its metabolite demeton-S-methylsulfon from human blood and various tissue samples has been established. After solid-phase extraction using C18 cartridges the extracts were analyzed by high-performance liquid chromatography with mass selective detection (Finnigan MAT LCQ). The method was completely validated. The limit of detection is 1 ng/g blood for the parent substance oxydemeton-methyl and 2 ng/g blood for the metabolite demeton-S-methylsulfon. This method was applied for the analysis of blood and tissue samples of a 58-year-old man who died after the intake of Metasystox R-Spezial, a product from Bayer containing oxydemeton-methyl. Because of a prolonged interval between the ingestion and death, the concentrations of oxydemeton-methyl and demeton-S-methylsulfon were very low. Although the body was already putrefied when the autopsy was performed, the chromatograms of blood and tissue samples were free of interfering peaks. (+info)
The effect of regular medication on the outcome of paracetamol poisoning.
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BACKGROUND: Patients admitted with paracetamol overdose frequently receive one or more types of regular medication that may affect the outcome of the paracetamol intoxication. AIM: To describe the use of regular medication in patients with paracetamol poisoning and to evaluate its effects on morbidity and mortality. METHODS: Seven hundred and thirty-seven consecutive patients admitted with paracetamol poisoning were studied and the use of regular medication was recorded. The relative risk of hepatic encephalopathy, death or liver transplantation, severe hepatic dysfunction and severe hepatocellular injury was evaluated by multivariate analysis. RESULTS: Regular medication was received by 332 patients (45%). Medication with benzodiazepines (105 cases), antidepressants (100 cases), neuroleptics (75 cases), paracetamol (58 cases), oral contraceptives (51 cases), beta-agonists (40 cases), opioid analgesics (32 cases) and anticonvulsants (27 cases) predominated. Regular medication with opioid analgesics was associated with a high incidence of hepatic dysfunction (odds ratio, 5.39; 95% confidence interval, 1.13-25.8). No significant findings were demonstrated for benzodiazepines, antidepressants, neuroleptics, paracetamol, oral contraceptives, beta-agonists or anticonvulsants in the multivariate analysis. CONCLUSIONS: Regular medication with psychotropic medication, analgesics, oral contraceptives, beta-agonists or anticonvulsants was frequent in patients admitted with paracetamol poisoning. Medication with opioid analgesics was associated with a significantly increased incidence of hepatic dysfunction, whereas the other medications did not appear to affect the outcome of the paracetamol intoxication. (+info)
Measuring plasma paracetamol concentrations in all patients with drug overdoses; development of a clinical decision rule and clinicians willingness to use it.
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OBJECTIVES: The study proposed a clinical decision rule: In patients who have taken a deliberate overdose, but deny taking paracetamol or paracetamol containing compounds, who have a GCS of 15, understand English well, and have not taken excessive alcohol, there is no need to take blood for paracetamol estimation. METHODS: 307 consecutive emergency department patients were followed up, and the history of their overdose was correlated to blood paracetamol concentrations. In addition, clinicians were asked what level of confidence they required from such a clinical decision rule before they would use it. RESULTS: 152 admitted paracetamol and 155 denied it. Of the 155 that denied it, 13 had concentrations detected in the blood, but needed no treatment with antidote. Eighty three per cent of clinicians require a false negative rate of less than 1%. CONCLUSIONS: Using this decision rule, only 46 of 307 patients would not have required paracetamol concentrations to be measured. To show a negative rate of less than 1% a sample size of 20,000 patients would be needed. BOTTOM LINE: All patients who allege taking an overdose need paracetamol concentrations checking. (+info)