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Alanine transaminase and prothrombin time abnormalities following mushroom poisoning
Abstracts / Toxicology Letters 164S (2006) S1–S324
be produced by multiple dosing of Formate dehydrogenase and to prolong the serum half life of the enzyme, the N-hydroxysuccinimidyl ester of methoxy polyethylene glycol propionic acid (mPEG-SPA 5000) was conjugated to native Formate dehydrogenase. PEGylation reactions were run at 20 ◦ C for 30 min in a reaction buffer (0.2 M sodium phosphate buffer, pH 8.3). The PEGylated molecules were purified from unreacted PEG with Amicon Ultra—4 (10 kDa) and by Sephacryl S300 HR gel-filtration chromatography. Unreacted Formate dehydrogenase molecules were removed by DEAE Sepharose FF anion-exchange chromatography. PEGFD enzyme molecules obtained from reacting ratio of FD/PEG of 1/40 had an enzyme activity of 68% of unmodified enzyme. Immunogenicity of PEGylated and native enzyme was evaluated by ELISA. Plasma half life based on biological activity was also evaluated. In vivo efficacy of PEG-FD or native FD was comparatively evaluated by single intravenous administration of PEG-FD or native FD in folate deficient methanol intoxicated albino rats along with carbicarb buffer infusion. Methanol and formate were estimated at specific time points, respectively, with HPLC and Fluorescence spectrophotometer. PEG-FD had comparatively longer plasma half life, lower immunogenicity and lesser allergenicity than native FD. PEG-FD had better in vivo efficacy than native FD in eliminating the formate in methanol poisoning. doi:10.1016/j.toxlet.2006.06.207 P2-67 Monitoring of the heroine addict patients during methadone substitution therapy Daniela Luiza Baconi, Anne Marie Ciobanu, Maria Barca, Dan Balalau, Cristina Hudita, Gina Manda 2 , Mihaela Ilie 1 , Mihai Ionica 3 1 “Carol
Davila” University of Medicine and Pharmacy, faculty of Pharmacy, Bukharest, Romania; 2 “Victor Babes” National Institute, Bucharest, Roma3 Clinical Emergency Hospital, Bucharest, nia; Romania The drug addiction treatment is a long-term process that implies multiple interventions and has as final aim the abstinence. Addiction treatment, including diagnosis, medical assistance, and social reintegration of addicts, has the purpose of improving the health state and the quality of life, by diminishing the drug usage, the morbidity and mortality due to the addiction, by facilitating the access to public services and full social reintegration.
S99
The study aims at a complex evaluation (clinic, paraclinic, and psychologic) of the heroin addict patients during methadone substitution treatment conducted at Sf. Stelian Center for Evaluation and Treatment of Addictions, Bucharest. This study presents evaluation of 32 cases (29 men and 3 women) during methadone detoxication treatment; these patients fulfilled the inclusion criteria and were eligible for the study. Socio-demographic, toxicological, and clinical characteristics of the patients included in the study are presented. Complete hematological and biochemical analyses are performed for each patient; the psychologic profile of the patients is evaluated and the prevalence and the type of psychiatric morbidity at the heroin addicts are identified. The analytic diagnostic of drug abuse is provided by using GC-MS chromatographic methods and the methadone plasma levels are determined by HPLC and GC-MS methods. The presented methodology is continued during methadone maintenance therapy. In the study group the mean age is 24.53 years (range 16–32) and the mean length of i.v. heroin use is 4.78 years (range 1–9); the mean levels of heroine metabolites in urine was 9940.1 ng/mL (in 6 cases the levels was higher than 30,000 ng/mL) and the mean methadone dose was 17.41 mg (range 7.5–40 mg). HVC infection was present in 75% of patients. Cocaine use has been reported in 25% of patients, marijuana or hashish use in 50% of patients and ecstasy use in 28% of patients. The results of the study identified some of the factors associated with enrolment into methadone treatment and give an insight into profiles of the patients who enter in the treatment. doi:10.1016/j.toxlet.2006.06.208 P2-68 Alanine transaminase and prothrombin time abnormalities following mushroom poisoning Daniela Chaparroska, Niko Babulovska
Becaroski, Aleksandra
Department of Urgent Internal Medicine and Toxicology, University Clinical Centre, Skopje, The Former Yugolav Republic of Macedonia Aims: Toxic mushroom poisoning leads to a variety of clinical outcomes ranging from self-limited gastrointestinal symptoms to fulminant hepatic failure requiring orthotopic liver transplantation. We reviewed the outcomes of patients with severe acute hepatitis secondary
S100
Abstracts / Toxicology Letters 164S (2006) S1–S324
to amanita phalloides poisoning, treated with contemporary modalities. Methods: We retrospectively reviewed patients admitted to our institution over a 5-year period (2000–2005) with elevated transaminase levels (>1000 IU/L) attributed to recent mushroom ingestion. The patient’s clinical course, laboratory data, and treatment regimen were recorded and analyzed. Results: The mean peak serum levels were: aspirate transaminase 6520 IU/L, alanine transaminase 8860 IU/L, total bilirubin 11.5 mg/dL, creatinine 535 Mmol/L, and prothrombin time- international normalized ratio (PT-INR) >10. Three patients developed acute renal failure requiring hemodialysis and hemoperfusion. The other 17 patients survived without significant morbidity. Conclusions: Patients with severe hepatitis from amanita phalloides poisoning are thought to have a poor prognosis and frequently need liver transplantation for survival. We suggest that with early and aggressive multidisciplinary care, such patients recovered from severe hepatitis caused by amanita phalloides poisoning, without liver transplantation. doi:10.1016/j.toxlet.2006.06.209 P2-69 Acute intoxications in the ICU—What has changed in a 5 years period? Marijan Merkler, Marijana Grgi´c Medi´c, Radovan Radoni´c, Vladimir Gaˇsparovi´c Clinical hospital center Zagreb, Zagreb, Croatia Acute intoxication is a condition characterized by the distress of one or more organ systems due to the toxin or its metabolites. Patients with severe and life threatening intoxications, requiring intensive treatment and surveillance, are admitted to the Intensive care Unit at of the Clinical hospital center Zagreb. The aim of this study was to analyze the acute intoxicated patients admitted to the ICU in the year 2005 and to assess the changes in the structure of acute intoxication in the 5 years period, by comparing these data with the data from the year 2000. During the year 2005 (1st January–December 31st 2005), 44 patients (23 male and 21 female) with severe intoxications were admitted to the ICU. The median age was 40.6 years (range 17–86 years). Thirty-nine (88.6%) patients survived and 5 (11.4%) patients died. The intoxication occurred most frequently in the suicidal attempt, in 32 (72.7%) patients, overdose was registered in 10 (22.7%) patients, and accidental poisoning in 2 (4.6%) patients. Toxic agents were in most cases (18 patients,
40.9%) drugs, narcotics were detected in 10 (22.7%) patients, alcohol in 5 (11.4%), corrosive agents in 5 (11.4%) and other agents in 6 (13.6%) cases (pesticides, carbon monoxide, ethylene-glycol, etc.). The most frequent indications for admissions into the ICU were acute confusional states (21 patients, 45.4%), and 17 (38.6%) patients were comatose at admission. The median duration of treatment in the CU was 2.95 days (range 1–9 days). The most frequent complications were respiratory insufficiency, and pneumonia was registered in eight (18.2%) patients. Twenty patients (45.4%) continued the treatment in the psychiatric ward following the dismissal from the ICU. These data were compared with our data from the year 2000. The proportion of patients with acute drug intoxications remained unchanged (40.2% in 2000 versus 40.9% in 2005) and was the highest in both years. The increase in the proportion of patients with acute narcotic intoxications increased from 15.1% to 22.7% whereas the proportion of acute alcohol intoxication decreased from 22.6% to 11.4%. The median duration of treatment did not change significantly (3.1 days versus 2.9 days). The significant increase of patients admitted due to narcotic abuse was detected. Nearly half of all intoxications are caused by drugs. The most common complications of acute intoxications in human are observed on respiratory tract. doi:10.1016/j.toxlet.2006.06.210 P2-70 National antidotes stockpile for chemical emergencies in Italy Valeria Petrolini 1 , Carlo Locatelli 1 , C. Lonati 1 , L. Mela 1 , Andrea Giampreti 1 , Raffaela Butera 1 , A. 2 1 Volpini , Luigi Manzo 1 Pavia
Poison Centre and National Toxicology Information Centre, Toxicology Unit, IRCCS Maugeri Foundation Hospital and University of Pavia, Italy; 2 Department of Civil Protection, Rome, Italy In the last 5 years concern about health risks of hazardous accidents has increased: the existing plans to face an industrial chemical disaster has been reviewed and extended worldwide to counteract potential terrorist attacks involving chemical agents. In Italy, within the context of an agreement between the Italian Department of Civil Protection and the Pavia Poison Center, a system for antidote stoking, supply, and use in chemical (conventional and/or non conventional) emergencies has been set up. Sixteen different antidotes, unavailable in appropriate quantity in the Italian emergency depart-
be produced by multiple dosing of Formate dehydrogenase and to prolong the serum half life of the enzyme, the N-hydroxysuccinimidyl ester of methoxy polyethylene glycol propionic acid (mPEG-SPA 5000) was conjugated to native Formate dehydrogenase. PEGylation reactions were run at 20 ◦ C for 30 min in a reaction buffer (0.2 M sodium phosphate buffer, pH 8.3). The PEGylated molecules were purified from unreacted PEG with Amicon Ultra—4 (10 kDa) and by Sephacryl S300 HR gel-filtration chromatography. Unreacted Formate dehydrogenase molecules were removed by DEAE Sepharose FF anion-exchange chromatography. PEGFD enzyme molecules obtained from reacting ratio of FD/PEG of 1/40 had an enzyme activity of 68% of unmodified enzyme. Immunogenicity of PEGylated and native enzyme was evaluated by ELISA. Plasma half life based on biological activity was also evaluated. In vivo efficacy of PEG-FD or native FD was comparatively evaluated by single intravenous administration of PEG-FD or native FD in folate deficient methanol intoxicated albino rats along with carbicarb buffer infusion. Methanol and formate were estimated at specific time points, respectively, with HPLC and Fluorescence spectrophotometer. PEG-FD had comparatively longer plasma half life, lower immunogenicity and lesser allergenicity than native FD. PEG-FD had better in vivo efficacy than native FD in eliminating the formate in methanol poisoning. doi:10.1016/j.toxlet.2006.06.207 P2-67 Monitoring of the heroine addict patients during methadone substitution therapy Daniela Luiza Baconi, Anne Marie Ciobanu, Maria Barca, Dan Balalau, Cristina Hudita, Gina Manda 2 , Mihaela Ilie 1 , Mihai Ionica 3 1 “Carol
Davila” University of Medicine and Pharmacy, faculty of Pharmacy, Bukharest, Romania; 2 “Victor Babes” National Institute, Bucharest, Roma3 Clinical Emergency Hospital, Bucharest, nia; Romania The drug addiction treatment is a long-term process that implies multiple interventions and has as final aim the abstinence. Addiction treatment, including diagnosis, medical assistance, and social reintegration of addicts, has the purpose of improving the health state and the quality of life, by diminishing the drug usage, the morbidity and mortality due to the addiction, by facilitating the access to public services and full social reintegration.
S99
The study aims at a complex evaluation (clinic, paraclinic, and psychologic) of the heroin addict patients during methadone substitution treatment conducted at Sf. Stelian Center for Evaluation and Treatment of Addictions, Bucharest. This study presents evaluation of 32 cases (29 men and 3 women) during methadone detoxication treatment; these patients fulfilled the inclusion criteria and were eligible for the study. Socio-demographic, toxicological, and clinical characteristics of the patients included in the study are presented. Complete hematological and biochemical analyses are performed for each patient; the psychologic profile of the patients is evaluated and the prevalence and the type of psychiatric morbidity at the heroin addicts are identified. The analytic diagnostic of drug abuse is provided by using GC-MS chromatographic methods and the methadone plasma levels are determined by HPLC and GC-MS methods. The presented methodology is continued during methadone maintenance therapy. In the study group the mean age is 24.53 years (range 16–32) and the mean length of i.v. heroin use is 4.78 years (range 1–9); the mean levels of heroine metabolites in urine was 9940.1 ng/mL (in 6 cases the levels was higher than 30,000 ng/mL) and the mean methadone dose was 17.41 mg (range 7.5–40 mg). HVC infection was present in 75% of patients. Cocaine use has been reported in 25% of patients, marijuana or hashish use in 50% of patients and ecstasy use in 28% of patients. The results of the study identified some of the factors associated with enrolment into methadone treatment and give an insight into profiles of the patients who enter in the treatment. doi:10.1016/j.toxlet.2006.06.208 P2-68 Alanine transaminase and prothrombin time abnormalities following mushroom poisoning Daniela Chaparroska, Niko Babulovska
Becaroski, Aleksandra
Department of Urgent Internal Medicine and Toxicology, University Clinical Centre, Skopje, The Former Yugolav Republic of Macedonia Aims: Toxic mushroom poisoning leads to a variety of clinical outcomes ranging from self-limited gastrointestinal symptoms to fulminant hepatic failure requiring orthotopic liver transplantation. We reviewed the outcomes of patients with severe acute hepatitis secondary
S100
Abstracts / Toxicology Letters 164S (2006) S1–S324
to amanita phalloides poisoning, treated with contemporary modalities. Methods: We retrospectively reviewed patients admitted to our institution over a 5-year period (2000–2005) with elevated transaminase levels (>1000 IU/L) attributed to recent mushroom ingestion. The patient’s clinical course, laboratory data, and treatment regimen were recorded and analyzed. Results: The mean peak serum levels were: aspirate transaminase 6520 IU/L, alanine transaminase 8860 IU/L, total bilirubin 11.5 mg/dL, creatinine 535 Mmol/L, and prothrombin time- international normalized ratio (PT-INR) >10. Three patients developed acute renal failure requiring hemodialysis and hemoperfusion. The other 17 patients survived without significant morbidity. Conclusions: Patients with severe hepatitis from amanita phalloides poisoning are thought to have a poor prognosis and frequently need liver transplantation for survival. We suggest that with early and aggressive multidisciplinary care, such patients recovered from severe hepatitis caused by amanita phalloides poisoning, without liver transplantation. doi:10.1016/j.toxlet.2006.06.209 P2-69 Acute intoxications in the ICU—What has changed in a 5 years period? Marijan Merkler, Marijana Grgi´c Medi´c, Radovan Radoni´c, Vladimir Gaˇsparovi´c Clinical hospital center Zagreb, Zagreb, Croatia Acute intoxication is a condition characterized by the distress of one or more organ systems due to the toxin or its metabolites. Patients with severe and life threatening intoxications, requiring intensive treatment and surveillance, are admitted to the Intensive care Unit at of the Clinical hospital center Zagreb. The aim of this study was to analyze the acute intoxicated patients admitted to the ICU in the year 2005 and to assess the changes in the structure of acute intoxication in the 5 years period, by comparing these data with the data from the year 2000. During the year 2005 (1st January–December 31st 2005), 44 patients (23 male and 21 female) with severe intoxications were admitted to the ICU. The median age was 40.6 years (range 17–86 years). Thirty-nine (88.6%) patients survived and 5 (11.4%) patients died. The intoxication occurred most frequently in the suicidal attempt, in 32 (72.7%) patients, overdose was registered in 10 (22.7%) patients, and accidental poisoning in 2 (4.6%) patients. Toxic agents were in most cases (18 patients,
40.9%) drugs, narcotics were detected in 10 (22.7%) patients, alcohol in 5 (11.4%), corrosive agents in 5 (11.4%) and other agents in 6 (13.6%) cases (pesticides, carbon monoxide, ethylene-glycol, etc.). The most frequent indications for admissions into the ICU were acute confusional states (21 patients, 45.4%), and 17 (38.6%) patients were comatose at admission. The median duration of treatment in the CU was 2.95 days (range 1–9 days). The most frequent complications were respiratory insufficiency, and pneumonia was registered in eight (18.2%) patients. Twenty patients (45.4%) continued the treatment in the psychiatric ward following the dismissal from the ICU. These data were compared with our data from the year 2000. The proportion of patients with acute drug intoxications remained unchanged (40.2% in 2000 versus 40.9% in 2005) and was the highest in both years. The increase in the proportion of patients with acute narcotic intoxications increased from 15.1% to 22.7% whereas the proportion of acute alcohol intoxication decreased from 22.6% to 11.4%. The median duration of treatment did not change significantly (3.1 days versus 2.9 days). The significant increase of patients admitted due to narcotic abuse was detected. Nearly half of all intoxications are caused by drugs. The most common complications of acute intoxications in human are observed on respiratory tract. doi:10.1016/j.toxlet.2006.06.210 P2-70 National antidotes stockpile for chemical emergencies in Italy Valeria Petrolini 1 , Carlo Locatelli 1 , C. Lonati 1 , L. Mela 1 , Andrea Giampreti 1 , Raffaela Butera 1 , A. 2 1 Volpini , Luigi Manzo 1 Pavia
Poison Centre and National Toxicology Information Centre, Toxicology Unit, IRCCS Maugeri Foundation Hospital and University of Pavia, Italy; 2 Department of Civil Protection, Rome, Italy In the last 5 years concern about health risks of hazardous accidents has increased: the existing plans to face an industrial chemical disaster has been reviewed and extended worldwide to counteract potential terrorist attacks involving chemical agents. In Italy, within the context of an agreement between the Italian Department of Civil Protection and the Pavia Poison Center, a system for antidote stoking, supply, and use in chemical (conventional and/or non conventional) emergencies has been set up. Sixteen different antidotes, unavailable in appropriate quantity in the Italian emergency depart-