Asia Pacific Journal of Medical Toxicology
Volume:10 Issue: 4, Autumn 2021

Bipolar disorder (BD) is considered as a severe mental disease. Lithium, which is widely used to treat BD, has a limited therapeutic index, and its toxicity is common in people who use it. Lithium poisoning can occur intentionally or accidentally. In this cross-sectional study, we assembled data from 21 profiles of patients with lithium poisoning that referred to Razi Hospital in Ahvaz from 2015 to 2018. After studying the records of lithium poisoning patients, the checklist was adjusted based on demographic characteristics (age, gender, and cause of poisoning) and clinical information (need for dialysis, duration of hospitalization, clinical signs, and …). The data were analyzed using the SPSS software. Finding shows that among 21 subjects, 10 patients (47.6%) were men and 11 (52.4%) were women. In addition, most of the patients poisoned with lithium (47.6%) were in the age range of 20-29 years. Among all patients younger than 50 years, poisoning was caused by suicide. Also, decreased consciousness (47.6%) was the most common symptom of poisoning, and 16 patients (76.2%) were hospitalized in the ICU. 71.4% of lithium poisoning patients were associated with concomitant use of other drugs, and one person died in this study. Considering the use of lithium with the intention of suicide in 90.5% of cases with lithium poisoning and also the significant simultaneous use of lithium with antidepressants and hypnotic drugs, further research should be seemingly performed in the psychological and social fields for preventive measures, as well as planning to reduce committing suicide and poisoning.

Hemodialysis is one of the most common extracorporeal procedures that is used for treatment in some intoxicated patients. Therefore, epidemiology and prognostic factors in hemodialysis intoxicated patients were evaluated. In this cross-sectional study, all hospitalized patients, who underwent hemodialysis admitted to the poisoning center at Taleghani Hospital, Urmia, Iran, from 2016-2020 were evaluated. The demographic data, clinical and some laboratory findings in survivor and non-survivor group were studied retrospectively and evaluated in relation to outcome of the patients. Then, the data were analyzed by descriptive and analytical statistics using SPSS v 16. In this study, 200 (158 males, 42 females) patients were evaluated. The mortality rate was 31.5% (79% males, 21% females). Toxic Alcohol (methanol, ethylene glycol) 86 (43%) and paraquat 58 (29%) were the main causes of poisoning among the patients treated with hemodialysis. Loss of consciousness 82 (41%) and Gastrointestinal discomforts (nausea, vomiting, and epigastric pain) 68 (34%) were the most signs and symptoms in patients. Statistically significant relationships (p value < 0.05) were found between the acute renal failure and causes of poisoning. Finally, 137 patients (68.5%) were discharged with full recovery and 63 cases (31.5%) were died. Because extracorporeal therapies such as hemodialysis are one of the main procedures in the treatment of poisoning and there are limited studies on the prevalence of hemodialysis in poisoned patients, this study was carried out to evaluate hemodialysis in intoxicated patients whose data can be used more widely in the future. However, more studies are required to explore the prevalence of hemodialysis in poisoned patients.

Despite the efficiency, many side effects have been reported for cisplatin, which is a well-known anti-cancer agent. Among them we can point to ototoxicity, which seriously reduces the quality of life in cisplatin-receiving patients. Since the approach of using natural ingredients in clinic has been growing in recent years, herein, we intend to gather delegated documentations of the presented scientific reports regarding various aspects of cisplatin-induced ototoxicity (CIO) focusing on some effective natural remedies.

Well-known scientific databases such as Google Scholar, Scopus, and PubMed were employed to search the target keywords. Then, to prepare the literature, the selected contents were reviewed, analyzed, and modified at several stages.

Recent studies have shown that the prevalence of CIO is very high and most cisplatin-receiving patients suffer from this complication to a certain degree. Along with other underlying factors, the roles for reactive oxygen species (ROS) and apoptotic factors have been found very significant in forming the process of CIO. In order to alleviate the complication, various pharmacological and non-pharmacological treatments have been introduced and suggested. Particularly, special attention has been paid to natural products in recent decades. In this regard, many of these compounds were found efficacious and safe.

This review showed that, many natural products are able to attenuate CIO through various mechanisms, among which anti-oxidative and anti-apoptotic pathways would be the most important ones. Therefore, as a novel pharmacological approach, they have the potential to be focused in future mechanistic studies.

Bread is a staple food across the world, especially in Nigeria. Potassium bromate is widely used by bakers to enhance bread elasticity, functionality, and quality. Due to its toxicity, the use of potassium bromate in bread production in Nigeria was banned by the National Agency for Food and Drug Administration and Control (NAFDAC); the regulatory agency for food and pharmaceutical products in 2003. This review aims to assess the compliance levels of potassium bromate used in the production of low and high-cost bread consumed across Nigeria. 17 selected articles across the six geopolitical zones were evaluated. This review identified that most of the bread sold and consumed in Nigeria contained potassium bromate in quantities above the permissible limit. Surprisingly, even bread labeled as “bromate-free”, “with NAFDAC registration number” and sold at high-costs also contained potassium bromate in excess concentration. This implies that many bread sold in Nigeria are unsafe for human consumption. Due to the deleterious effects of potassium bromate, its continual usage and consumption above the safe limit is a threat to the total well-being of the consumers. Its use in the bread-making industry also poses a serious health occupational hazard to bakers. Bread makers should opt for other alternative dough conditioners such as ascorbic acid, glucose oxidase, and potassium iodate for bread production. NAFDAC should put in more proactive measures to ensure constant monitoring of food products pre-and post-production to guarantee adherence to its regulatory standards and the safety of human life.

Methanol intoxication causes high anion gap metabolic acidosis in addition to Central Nervous System (CNS) depression. Benzodiazepines in co-ingestion with other CNS depressants as alcohol can cause significant respiratory depression. Liraglutide is a novel antidiabetic agent whose acute overdose is not well studied. This case report aimed to present a case with combined intake of the three above-mentioned chemicals.

A case of 43-year-old male not diabetic, not an alcohol consumer, uses benzodiazepines regularly for sleep disorders. The patient unintentionally took 10 tablets of benzodiazepines over a period of 24 hours, aiming to sleep. He also consumed one glass of ethanol containing methanol (used for disinfection). The patient was on liraglutide subcutaneous injections for weight loss, with one injection 2 days before admission.The night before admission, the patient first felt light headed and complained of blurring of vision. The condition progressed and the patient was taken to the emergency department where he presented with coma, apnea, and shock.On the arrival of the patient, he was intubated and mechanically ventilated for having a disturbed conscious level and apnea.Laboratory testing identified severe persistent mixed type acidosis, hypoglycemia, and urinary toxicology screen was positive for benzodiazepine. IV fluids, vasopressors, Dextrose, bicarbonate, flumazenil, vitamin B, and folinic acid were given. Although urgent haemodialysis was undertaken, acidosis continued. The patient passed away after 37 hours of intensive care unit admission.

Combined exposure to alcohol and benzodiazepines can cause significant mixed type acidosis. CNS depression can result from combined alcohol, benzodiazepines, and prolonged hypoglycemia.

Botulism is a rare but lethal disease and atypical clinical presentations of this disease are difficult to diagnose. We report a case of iatrogenic botulism who presented withasymmetric cranial nerve involvement.

An eighteen year old female with cerebral palsy, congenital hydrocephalus and left upper/lower limb spasticity accidentally received double the normal dose of Botulinum neurotoxin A (BoNTA) which was equal to 800 Units, administered intramuscularly in the aforementioned muscle groups, leading to left eyelid drooping without no additional cranial nerve palsy or sensory/motor limb deficit. Patient was hospitalized for 3 days of clinical observation during which there was no progression of symptoms to the contralateral side, and the patient was uneventfully discharged. On follow up, the patient continued to make a steady recovery.

Asymmetric muscle weakness is unusual for botulism confounded further in a patient with underlying spastic disorder. In our case, BoNTA was administered unilaterally in muscle groups, yet symptoms developed remotely from the injection site. Factors causing this could be large anteroand retrograde axonal transport or from systemic uptake from nearby capillary beds. There is no current consensus on an optimal therapeutic injection dose for BoNTA in children or adults.

Physicians should be aware that asymmetric iatrogenic botulism of the cranial nerves may occur from a botulinum toxin injection into a site that is anatomically remote from the face.

In remote areas of India, folk medicine by local unregistered practitioners is quite common. Such practitioners use Sindoor or Vermillion, or Kumkum in their medicinal preparations to cure chronic ailments like joint pain, infertility, asthenia, impotence, and immunological disorders. Traditional Indian Vermillion is prepared using lime (calcium component) mixed with various natural ingredients like camphor, oil, agaru, sandalwood paste, and turmeric. However, modern-day commercial Vermillion contains Lead tetroxide. The use of such lustrous synthetic Vermillion that contains Lead salts in folk medicine may cause Lead intoxication among the consumer tribal population.

 The case of a 51-year-old male admitted to our tertiary care institute with colicky abdominal pain and quadriparesis and a history of chronic tea intake containing synthetic Vermillion and turmeric as prescribed by local folk medicine practitioners is presented.

People in remote areas of the tribal-state of Chhattisgarh (India) often consult a local traditional healer first and report to a modern health facility when things go out of hand. The instant case presented after development of quadriparesis, dysphagia, and dysphonia. He was diagnosed as a case of Lead toxicity based on clinical suspicion corroborated by blood Lead levels and was conservatively managed with BAL leading to satisfactory recovery.

In the case of Lead toxicity, early diagnosis, careful evaluation of complications, and immediate treatment are very important. As a preventive measure, medical systems need to educate and collaborate with traditional practitioners in the best interest of tribal people residing in remote areas of India.

Drug abuses have become an important part of the emergency service admissions. As a result of MDMA (3,4-methylenedioxy-methamphetamine) intake, various side effects may occur; from minor to major conditions. After using cannabis alone is cardiovascular symptoms, respiratory symptoms, nausea/vomiting and neurological symptoms. We presented the MDMA and cannabis intake case which resulted in multiple major adverse events and death in the emergency department.

 A nineteen-year-old male patient was brought to the emergency department with generalized tonic-clonic seizure. On admission, the patient had hypoglycemia and his urine was positive for cannabis and amphetamine. Liver, renal failure, DIC and methemoglobinemia developed. Although he received noradrenaline and dopamine infusion due to hypotension, his hypotension deepened. During the follow-up, cardiac arrest developed and after 30 minutes of cardiopulmonary resuscitation, death was accepted.

It is a phenomenon in which severe side effects occur after intake of MDMA and cannabis and result in death. MDMA is inhibited by the CYP2D6 enzyme and is excreted renally. The presence of drugs that inhibit this enzyme, the development of kidney failure, and the genetic polymorphism of the enzyme may cause these effects.

The use of street drugs can cause death with many serious side effects.