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Beware of the serious harm of veterinary drug poisoning:a case report

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World Journal of emergency Medicine 2024年第2期15卷 153-155页

作者： Ping Dai Jin Sun Tongyue Zhang Zhiqiang Zhou Zixi Wen Tianzi Jian Aerbusili Genjiafu Baotian Kan Xiangdong Jian department of poisoning and occupational Diseases Emergency MedicineQilu HospitalCheeloo College of MedicineShandong UniversityJinan 250012China emergency department Affiliated the Jianhu Clinical Medical College of Yangzhou UniversityYancheng 224700China department of occupational and Environmental Health School of Public HealthCheeloo College of MedicineShandong UniversityJinan 250012China School of Nursing and Rehabilitation Cheeloo College of MedicineShandong UniversityNursing Theory&Practice Innovation Research Center of Shandong UniversityJinan 250012China department of Geriatric Medicine Qilu HospitalNursing Theory Innovation and Research Center of Shandong UniversityCheeloo College of MedicineShandong UniversityJinan 250012China

Veterinary drugs are substances(including pharmaceutical feed additives)used to prevent,treat,and diagnose diseases or regulate the physiological functions of animals.Veterinary drug poisoning in humans is relatively rare both in China and the rest of the world.Here,we report a case of death from veterinary drug poisoning from avermectin-closantel.Avermectin-closantel is a broad-spectrum antiparasitic drug,which has high efficacy against a variety of trematodes and nematodes.

关键词： drug drugs diseases

The value of toxicological analysis in acute poisoning patients with uncertain exposure histories:a retrospective and descriptive study from an institute of poisoning

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World Journal of emergency Medicine 2024年第2期15卷 98-104页

作者： Qifang Shi Gen Ba Zhenyu Xia Zhengsheng Mao Hao Sun Jinsong Zhang Institute of poisoning Nanjing Medical UniversityNanjing 211100China department of emergency Medicine the First Affiliated Hospital of Nanjing Medical UniversityNanjing 210029China department of Forensic Medicine Nanjing Medical UniversityNanjing 211166China The Key Laboratory of Modern Toxicology of Ministry of Education Nanjing Medical UniversityNanjing 211166China

BACKGROUND:In clinical practice,some patients might not be able or unwilling to provide a thorough history of medication and poison exposure.The aim of this study was to use toxicological analysis to examine the clinical characteristics of patients with acute poisoning whose exposure history was uncertain from a toxicological analysis perspective.METHODS:This was a retrospective and descriptive study from an institute of poisoning.Patient registration information and test reports spanning the period from April 1,2020 to March 31,2022,were obtained.Patients with uncertain exposure histories and who underwent toxicological analysis were included.Clinical manifestations and categories of toxics were analyzed.RESULTS:Among the 195 patients with positive toxicological analysis results,the main causes of uncertain exposure history was disturbance of consciousness(62.6%),unawareness(23.6%)and unwillingness or lack of cooperation(13.8%).The predominant clinical manifestations were disturbed consciousness(62.6%),followed by vomiting and nausea(14.4%)and liver function abnormalities(8.7%).A comparison of clinical manifestations between patients with positive and negative(n=99)toxicological analyses results revealed significantly different proportions of disturbances in consciousness(63%vs.21%),dizziness(1.5%vs.5.1%),multi-organ failure(1.5%vs.7.1%),and local pain(0 vs 4%).The main categories of substances involved were psychiatric medications(23.1%),sedatives(20.5%),insecticides(13.8%),and herbicides(12.8%).CONCLUSION:The clinical manifestations of acute poisoning in patients with an uncertain exposure history are diverse and nonspecific,and toxicological analysis plays a pivotal role in the diagnosis and differential diagnosis of such patients.

关键词： Acute poisoning Toxic exposure Toxicological analysis Clinical manifestation

Chlorfenapyr poisoning:mechanisms,clinical presentations,and treatment strategies

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World Journal of emergency Medicine 2024年第3期15卷 214-219页

作者： Ji Cheng Yulu Chen Weidong Wang Xueqi Zhu Zhenluo Jiang Peng Liu Liwen Du emergency department Ningbo No.2 HospitalNingbo 315010China

BACKGROUND:Chlorfenapyr is used to kill insects that are resistant to organophosphorus insecticides.Chlorfenapyr poisoning has a high mortality rate and is difficult to treat.This article aims to review the mechanisms,clinical presentations,and treatment strategies for chlorfenapyr poisoning.DATA RESOURCES:We conducted a review of the literature using PubMed,Web of Science,and SpringerLink from their beginnings to the end of October 2023.The inclusion criteria were systematic reviews,clinical guidelines,retrospective studies,and case reports on chlorfenapyr poisoning that focused on its mechanisms,clinical presentations,and treatment strategies.The references in the included studies were also examined to identify additional sources.RESULTS:We included 57 studies in this review.Chlorfenapyr can be degraded into tralopyril,which is more toxic and reduces energy production by inhibiting the conversion of adenosine diphosphate to adenosine triphosphate.High fever and altered mental status are characteristic clinical presentations of chlorfenapyr poisoning.Once it occurs,respiratory failure occurs immediately,ultimately leading to cardiac arrest and death.Chlorfenapyr poisoning is diflcult to treat,and there is no specific antidote.CONCLUSION:Chlorfenapyr is a new pyrrole pesticide.Although it has been identified as a moderately toxic pesticide by the World Health Organization(WHO),the mortality rate of poisoned patients is extremely high.There is no specific antidote for chlorfenapyr poisoning.Therefore,based on the literature review,future efforts to explore rapid and effective detoxification methods,reconstitute intracellular oxidative phosphorylation couplings,identify early biomarkers of chlorfenapyr poisoning,and block the conversion of chlorfenapyr to tralopyril may be helpful for emergency physicians in the diagnosis and treatment of this disease.

关键词： Chlorfenapyr poisoning Mechanism Clinical presentation Treatment

Food-Borne poisoning Accident from Amanitin Toxin in Wild Mushrooms—Xingtai City,Hebei Province,China,2023

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China CDC weekly 2024年第3期6卷 56-59页

作者： Baopu Lv Liang Liu Hao Xiao Qingbing Meng Rui Zhang Yaqing An Yingli Jin Yu Ma Hengbo Gao Yongkai Li Qian He Yutao Zhang Changqing Liu Xiaoyan Luo Xiaomin Xu Fenshuang Zheng Yingping Tian Hongshun Zhang Dongqi Yao emergency department The Second Hospital of Hebei Medical UniversityShijiazhuang CityHebei ProvinceChina National Institute of occupational Health and Poison Control Chinese Centre for Disease Control and PreventionBeijingChina Hebei Provincial Center for Disease Control and Prevention Shijiazhuang CityHebei ProvinceChina Zhejiang Provincial Center for Disease Control and Prevention Hangzhou CityZhejiang ProvinceChina emergency department The Affiliated Hospital of Yunnan UniversityKunming CityYunnan ProvinceChina

What is already known about this topic?Fatal poisonings caused by wild mushrooms containing amanita toxins pose a significant threat in the southern regions of China.These toxins primarily induce gastrointestinal symptoms initially,which are then followed by potentially life-threatening acute liver damage.What is added by this report?This report contributes to the existing knowledge on these cases of poisoning by documenting the second occurrences in Hebei Province and the first occurrences in Xingtai City.Five individuals reported consuming wild mushrooms from the same origin,and laboratory tests confirmed the presence ofα-amanitin in their blood samples.What are the implications for public health practice?This underscores the risk associated with the collection and consumption of amanita toxin-containing mushrooms in Hebei.It is important to note that the identification of toxic and non-toxic mushrooms should not solely rely on personal experience or appearance.

关键词： Hebei consuming initially

Severe liver injury and clinical characteristics of occupational exposure to 2-amino-5-chloro-N,3-dimethylbenzamide: A case series

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Hepatobiliary & Pancreatic Diseases International 2024年第2期23卷 186-194页

作者： Meng-Xiao Feng Hua Zou Yuan-Qiang Lu department of emergency Medicine The First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases of Zhejiang Province Hangzhou 310003China occupational Health and Radiation Protection Institute Zhejiang Provincial Center for Disease Control and PreventionHangzhou 310051China

Background:The 2-amino-5-chloro-N,3-dimethylbenzamide is a key intermediate in the synthesis of pesticides and pharmaceuticals.However,no literature currently exists on 2-amino-5-chloro-N,3-dimethylbenzamide poisoning in humans.This study aimed to reveal the health hazard of this chemical for humans and summarize the clinical characteristics of patients with occupational 2-amino-5-chloro-N,3-dimethylbenzamide poisoning.Methods:This observational study included four patients with 2-amino-5-chloro-N,3-dimethylbenzamide poisoning from June 2022 to July 2022.The entire course of the incidents was described in detail.Blood 2-amino-5-chloro-N,3-dimethylbenzamide concentrations were detected by a mass spectrometer.Hema-toxylin and eosin staining was performed to assess liver injury,and immunofluorescence was used to evaluate hepatic mitophagy.Results:The 2-amino-5-chloro-N,3-dimethylbenzamide powder(99%purity)entered the human body mainly via the skin and respiratory tract due to poor personal protective measures.The typical course of 2-amino-5-chloro-N,3-dimethylbenzamide poisoning was divided into latency,rash,fever,organic dam-age,and recovery phases in accordance with the clinical evolution.Rash and fever may be the important premonitory symptoms for further organ injuries.The chemical was detected in the blood of all patients and caused multiple organ injuries,predominantly liver injury,including kidney,myocardium,and micro-circulation.Three patients recovered smoothly after comprehensive treatments,including artificial liver therapy,continuous renal replacement therapy,glucocorticoids,and other symptomatic and supportive treatments.One patient survived by liver transplantation.The postoperative pathological findings of the removed liver showed acute liver failure,and immunofluorescence staining confirmed the abundance of mitophagy in residual hepatocytes.Conclusions:This study is the first to elaborate the clinical characteristics of patients with 2-amino-5-chloro-N,3-dimethylbenzamide poisoning.The chemical enter

关键词： 2-amino-5-chloro-N,3-dimethylbenzamide poisoning Clinical characteristics Liver injury

Multiorgan dysfunction syndrome due to high-dose cantharidin poisoning:A case report

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World Journal of Clinical Cases 2024年第12期12卷 2074-2078页

作者： Wan-Ling Xu Wen-Jing Tang Wei-Ying Yang Li-Chao Sun Ze-Qun Zhang Wei Li Xiu-Xian Zang department of emergency Medicine First Hospital of Jilin UniversityChangchun 130021Jilin ProvinceChina department of Chinese Traditional Medicine First Hospital of Jilin UniversityChangchun 130021Jilin ProvinceChina

BACKGROUND This report delves into the diagnostic and therapeutic journey undertaken by a patient with high-dose cantharidin poisoning and multiorgan dysfunction syndrome(MODS).Particular emphasis is placed on the comprehensive elucidation of the clinical manifestations of high-dose cantharidin poisoning,the intricate path to diagnosis,and the exploration of potential underlying mechanisms.CASE SUMMARY A patient taking 10 g of cantharidin powder orally subsequently developed MODS.The patient was treated with supportive care,fluid hydration and antibiotics,and hemoperfusion and hemofiltration therapy for 24 h and successfully recovered 8 d after hospital admission.Cantharidin poisoning can cause lifethreatening MODS and is rare clinically.This case underscores the challenge in diagnosis and highlights the need for early clinical differentiation to facilitate accurate assessment and prompt intervention.CONCLUSION This article has reported and analyzed the clinical data,diagnosis,treatment,and prognosis of a case of high-dose cantharidin poisoning resulting in MODS and reviewed the relevant literature to improve the clinical understanding of this rare condition.

关键词： Cantharidin poisoning Multiorgan dysfunction syndrome Clinical treatment and management Case report

Seizure as the main presenting manifestation of three patients with acute glufosinate-ammonium poisoning

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2024年第4期25卷 354-358页

作者： Ping WANG Congying SONG Xuan LU Yuanqiang LU department of emergency Medicine the First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhou 3100030 China Zhejiang Key Laboratory for Diagnosis and Treatment of Physic chemical and Aging related Injuries Hangzhou 310003China department of Geriatric Medicine the First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhou 310003China

Glufosinate-ammonium herbicides are the most widely used broad-spectrum,non-selective herbicides in the world.Glufosinate-ammonium is a structural analogue of glutamate(Glu)which can irreversibly inhibit the activity of glutamine synthetase(GS)and Glu decarboxylase in plants,thereby blocking the synthesis of glutamine(Gln)from Glu and ammonia(Hoerlein,1994).This causes the plants to die because of the nitrogen metabolism disorder and subsequent intracellular accumulation of ammonia.In humans,the characteristic features of glufosinate-ammonium herbicide poisoning include gastrointestinal symptoms and neurotoxicity(Watanabe and Sano,1998).

关键词： ammonium ammonia thereby

Death from caustic ingestion:A case report

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Journal of Acute Disease 2024年第2期13卷 81-84页

作者： Shao Hui Koh Jacqueline C.L.Tan department of emergency Medicine Sengkang General HospitalSingapore

Rationale:Acute caustic ingestion from suicidal intent is not usual in emergency departments in developed countries.One of the substances commonly ingested by suicidal patients,phosphoric acid,tends to cause multi-system derangements.Patient’s Concern:A 41-year-old male patient presented with complaints of throat discomfort,severe generalized abdominal pain,and multiple episodes of hematemesis after ingesting a restroom cleaning solution.Diagnosis:poisoning by acute caustic ingestion(containing<30%phosphoric acid and<4%ethylene glycol).Interventions:The patient was administered 50 mL of 8.4%sodium bicarbonate solution followed by an isotonic sodium bicarbonate solution running at 500 mL/h,a hyperkalemia kit,ceftriaxone,metronidazole,omeprazole,and atropine.The patient then underwent urgent hemodialysis.Outcomes:The patient suffered gastrointestinal bleeding as a result of local caustic injury.In addition,his course of illness was complicated by severe acidemia from high anion gap metabolic acidosis and deranged electrolytes(hyperphosphatemia,hyperkalemia,and hypocalcemia).He developed multi-organ failure and eventually demised.Lessons:The clinician needs to be mindful of the multi-system complications arising from such a caustic ingestion.These patients need to be monitored closely for deterioration,and have prompt management of the various arising complications,to reduce the high morbidity and mortality associated with this condition.

关键词： Phosphoric acid poisoning Caustic ingestion Acid ingestion Cleaner ingestion Corrosive ingestion

The Role of Abdominal CT in the Assessment of the Effectiveness of Gastric Lavage after Pesticide poisoning

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Journal of Biosciences and Medicines 2024年第5期12卷 293-299页

作者： Minghui Gong Zhengdong Wan emergency department First Affiliated Hospital of Yangtze University Jingzhou China

Pesticide poisoning is one of the most common diseases in the emergency department, characterized by rapid changes in condition, a high misdiagnosis rate, and a poor prognosis. Measures for early removal of poisons are crucial, and gastric lavage is one of the important measures. Regarding the post-gastric lavage effect, abdominal CT scanning has an important application value in the assessment of the gastric lavage effect after pesticide poisoning.

关键词： Abdominal CT Gastric Lavage Pesticide poisoning Assessment