Asia Pacific Journal of Medical Toxicology
Volume:12 Issue: 1, Winter 2023

A common poisoning in tropical and subtropical areas is snake and scorpion poisoning. A massive scorpion swarm on in southern Egypt left three dead and five hundred hospitalized after heavy storms on 13 November 2021. The morbidity from scorpion sting and snake bite is a medical problem through all seasons of the year. This study was conducted to assess the clinicalepidemiological profile of snake bites and scorpion stings cases admitted to Alexandria poison center, Egypt. In addition, it compared snake bites and scorpion stings’ presentation, management, prognosis, and the effect of the polyvalent antivenom, locally produced by (VACSERA).Subjects and A prospective observational study was conducted at Alexandria poison center (APC), Alexandria, Egypt. All cases admitted to the hospitals from 1st March 2019 to 29th February 2020 were included. The study included 130 cases of snake bites (94) and scorpion stings (36). 51.1% of patients with snake bites and 44.4% of patients with scorpion stings were in the age group <30 years. There was seasonal variation of snake bites, and scorpion stings with a reported statistically significant difference (P= 0.008). There was a significant difference between the two study groups regarding the local manifestations. 55.3 % of the cases received supportive measurements and 44.7 % received the polyvalent antivenom. Recovery was the main outcome in 95.4% of patients.  There was a significant difference between the two studied groups regarding the local manifestations. The antivenom was not given to all cases. Recovery was the main outcome in 95.4% of patients.

Little evidence supports intravenous ethanol (IVE) as an alternative alcohol withdrawal syndrome (AWS) prophylactic agent. This study characterized the use of IVE in alcohol dependent patients and described clinically relevant efficacy and safety outcomes. Retrospective descriptive study of IVE use between January 1st, 2011 and September 15th, 2018 was carried out in this study. Patient characteristics, infusion parameters, and outcomes were recorded.                                  In this study, 69 patients received IVE; 24 (34.8%) received IVE for AWS treatment. Percent infusion time outside goal Sedation-Agitation Scale (SAS) and Clinical Institute Withdrawal Assessment (CIWA) ranges were 4.8% (IQR 0 – 17.4) and 3.8% (IQR 0 – 9.8), respectively. Forty-two (60.9%) patients received a benzodiazepine with a median daily requirement of 0.72 mg (IQR 0 – 3.12) of lorazepam equivalent. Mechanical ventilation was associated with increased benzodiazepine dose (p = 0.002) and a higher percentage of time spent outside goal SAS (p < 0.001) range. Treatment patients required higher daily doses of IVE (p = 0.05) and spent more time outside of goal CIWA range (p < 0.001). Higher initial infusion rate was associated with intubation during infusion.  Patients spent a majority of infusion time within goal SAS and CIWA ranges and required low doses of benzodiazepines. Mechanical ventilation and indication were associated with significant differences in patient outcomes and are likely to be confounders for any future investigation utilizing benzodiazepine requirements or sedation or withdrawal scales as endpoints. Further study is required to elucidate the potential benefits and risks of IVE.

Methanol is the simplest yet toxic alcohol found in many households and industrial materials. Exposure to methanol can be hazardous, and if left untreated, can result in mortality or severe morbidity. Methanol poisoning is mostly accidental, but it can result in mortality and severe morbidity. Due to the high prevalence of ECG changes in patients with methanol poisoning, this study aimed to evaluate the relationship of these ECG changes with methanol poisoning in determining the prognosis of the patients. This cross-sectional study was conducted on 114 patients with acute methanol poisoning at the Shahid Rajaei Hospital in Karaj, Alborz Province, Iran. Clinical, laboratory and ECG variables were evaluated. Furthermore, the gathered data were analyzed with SPSS software. 1.8% of patients had a PR interval of less than 121ms, and 3.5% had more than 200ms. Among various ECG changes, only PR intervals of more than were significantly associated with mortality. Patients with short QT intervals had the highest PCO2, PH, and HCO3. On the other hand, people with long QT had the lowest amount of PCO2, PH, and HCO3, which was statistically significant. Laboratory tests showed significant differences in serum potassium level and blood PH between died and survived patients.Discussion and In our study, the most common finding in ECG was sinus tachycardia, and short QT was the second most common finding, which is consistent with other studies. Our study found that in ECGs, only PR intervals more than 200 have a significant relationship with mortality, which supports previous studies. Finally, it was that mortality in patients with methanol poisoning is significantly associated with PR interval prolongation, acidosis, and hyperkalemia.

The present study was conducted to determine the prevalence of acute iron poisoning among patients in a referral poison control center located in Tehran. It also studied their clinical profile, treatment, and outcome. This retrospective cross-sectional study was conducted on acute iron poisoned patients, who were admitted to the poison center from March 21, 2015 to March 19, 2020. Some background variables such as age, gender, ingested dose, time interval between onset of poisoning to hospital admission, the need for antidote, clinical presentations, paraclinical findings and outcome of poisoning were extracted from patients’ medical records. Data analysis was carried out using SPSS software.  A total of 74 patients with acute iron poisoning with a mean age of 16.85 ± 11.97 years included in this study. Sixty-one (82.4%) patients were female and the most affected age group was 19-30 years (35.1%). The ingestion dose median in patients under 18 years old was 2450 (IQR=5600, Min= 120, Max= 30000) mg and in the group over 18 years old it was 9000 (IQR= 11125, Min= 600, Max= 30000) mg. Vomiting (66.2%) and lethargy (24.3%) were the most common clinical presentations on admission. Metabolic acidosis was the most common abnormality in blood gas analysis (43.2%). Positive findings in abdominal radiography have been observed in 4 (5.4%) cases. The serum iron concentration in the patients were 259.54 ± 153.96 μg/dL. Moreover, mortality was reported in one case (1.3%). There was a significant difference between the age of the patients whom received deferoxamine and more patients under 18 years of age received the antidotal therapy (p=0.003). The present study showed a low mortality rate among the acute iron poisoning patients. From this view, it can be concluded that adults have lower mortality rates than children.

Lead poisoning is a problem in Iranian society. The most common symptoms of chronic lead poisoning are abdominal pain, constipation, and dysphagia. In this study, the blood lead level (BLL) of the patients, who referred to Besat Hospital, Hamadan, Iran with non-traumatic abdominal pain was evaluated. This is a case-control study in which 120 patients with abdominal pain, who referred to ED were divided into two groups. The first group of patients without exposure to lead (control) and the second group with exposure to lead (case), and then BLL were measured. Of 120 patients, 74 patients were male and 46 patients were female. The patients` mean age was 48.76 ± 17.12 years. The average BLL in the control group was 0.67 ± 1.38 μg/dL and in the case group was 1.61 ± 3.02 μg/dL (p<0.001). In the case group, 59 patients had a history of opium consumption and one was a building painter, whose average BLL was 1.63 ± 0.4 and 0 ± 0.3 μg/dL respectively. One patient from the control group and five patients from the case group had BLL higher than normal, but there was no statistical difference observed in both groups (p=0.207). lead poisoning among patients with abdominal pain, especially in opium addicts, should always be considered as a differential diagnosis.

Due to the diversity of snakes in Iran, understanding the demographic characteristics of patients can be effective in better treatment. The aim of this study was to determine the clinical symptoms of snakebites in children admitted to Abuzar Hospital of south of Iran from 2018-2020. The present study was descriptive-analytical and retrospective. A number of 145 snakebites children referred to Abuzar Hospital of south of Iran from 2018-2020 were selected by census and examined. The clarified was extracted from the analysis using SPSS software version 22.  The mean age of snakebite children was 10.73±3.41 years, 92 (63.4%) were male children. The mean of anti -venom intake in bitten children was 4.93±1.44, the mean BUN (Blood Urea Nitrogen) 13.70±4.01, and the mean creatinine 0.68±0.14. The mean duration of hospitalization 4.05±2.13 days and the mean duration of onset of symptoms after the bite in patients was 94.34±109.31 hours. The mean of coagulation problems in the first stage in patients was 2.76±1.91 and 82 (56.6%) of snake bred children received FFP blood product. The first symptom after a bite in 60 snakebite children (41.4%) was pain. Four patients (2.8%) were hospitalized for two days and two patients (1.4%) were admitted to the intensive care unit (ICU) for three days. The location of 49 of the snakebite children was Ahvaz (33.8%) and none of the snakebite children died.  According to the results of this study and understanding the epidemiology of snakebite in the Khozestan province, it is possible to play an effective role in preventing snakebites and other causes by educating all health care workers and physicians as well as raising public awareness in the community.

Most household cleaners contain chlorine, an irritating chemical commonly used to purify water. The inhalation of chlorine causes chemical pneumonitis and the treatment of inhalation injuries from this chemical is difficult due to the lack of evidence and human studies. We will discuss a case of a man, who developed chemical pneumonitis after being exposed to chlorine fumes while cleaning swimming pool.

A 30-year-old man showed up after being exposed to 33% hydrochloric fumes at work and developed coughing, sore throat, and dyspnea immediately. He received initial treatment at nearby clinic and referred to the emergency department (ED). In ED, he was in respiratory distress. His respiratory rate (RR) was 28 breaths per minute and oxygen saturation was 81% with a 15 L/min non-rebreathing mask. Lung auscultation showed crepitation in both lower zones with expiratory rhonchi. Noninvasive ventilation (NIV) support was initiated with continuous nebulization of salbutamol, ipratropium bromide, and sodium bicarbonate. His initial blood gases showed type 1 respiratory failure. He was then intubated for severe acute respiratory distress syndrome (ARDS). The patient was then admitted to the intensive care unit (ICU) for further treatment and discharged after 18 days of hospitalization.

Acute exposure to chemical irritants can cause asthma exacerbation, chronic bronchitis, bronchial hypersensitivity, and ARDS. There are no biomarkers for the inhalation of HCL gas. Medical history, clinical symptoms, and radiographic findings are decisive factors in the diagnosis. Treatment usually focuses on supportive care such as oxygen therapy, broncholytic therapy, and sodium bicarbonate, inhaled or systemic corticosteroids.

Metformin-associated lactic acidosis is a rare, yet fatal condition, especially in the presence of risk factors. Therapeutic use of metformin may induce lactic acidosis. Gastrointestinal bleeding, dehydration, acute renal failure, and drugs are major risk factors that increase the mortality risk associated with metformin-associated lactic acidosis. In this regard, this case study aimed to present a patient, who died due to metformin-associated lactic acidosis despite treatment.

This case study featured a 45-year-old diabetic patient with metformin use, who presented to the emergency department with the complaint of low back pain. He had acute renal failure, severe lactic acidosis, and shock findings. 

The primary purpose of metformin-associated lactic acidosis treatment is to restore acid-base balance and provide hemodynamic support. Hemodialysis reduces the mortality due to metformin-associated lactic acidosis by decreasing lactate clearance. Supportive therapies should be used. Nevertheless, mortality still occurs in approximately 50% of the cases.

Metformin overdose or even therapeutic levels of metformin use can cause MALA in the presence of various risk factors. MALA, a rare clinical condition, is associated with mortality rates of up to 50%. The most crucial step in treating MALA is hemodialysis/venous hemofiltration. Given that metformin is a frequently used medication, care should be taken in the follow-up of patients using metformin, considering MALA.