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NMR spectroscopy as a tool for diagnosis of acute poisonings
80
Poster Session IF. Human Toxicology
go unrecognized by physicians. Suspicion of such events require the identification, in as precise a manner as possible, of the responsible molecule. This may be accomplished a posteriori if a specimen of serum is obtained and frozen for safekeeping systematically in the case of any anomaly of memory, mental or motor function not otherwise explained. Where the suspicion is correct, toxin identification often permits a diminution in the hospital stay and costly adjunctive examinations among patients admitted for acute behavioral changes which may sometimes suggest an organic pathology.'Mass spectrometry is the most efficient analysis for the detection of the implied product. These incidents are rapidly growing in frequency, in the U.S. ("date-rapes"), as well as in the European Union or South America, and pose multiple problems: (a) May these cases be compared with syndromes already described among "chemically-battered children", and/or with the testimonies obtained by police, the military or psychiatries, when persons are under the influence of psychotropic substances. (b) The substances responsible have been essentially benzodiazepines, but may extend to other recently released hypnotics or to drugs of the amphetamine type. The use of scopolamine has been denounced in South America. Bromides and gamma-hydroxybutyric acid have also been incriminated. (c) Can legislative control of these substances prevent their misuse or will other substances take their place? (d) How should the violence committed on the victims be viewed from a judiciary standpoint? Offence or crime? The elucidation of these phenomena of chemical submission is only in its beginning stages in human toxicology.
IP1F17S1
SILICOSIS RELATED CHANGES IN SERUM COPPER
M. Cojocaru, Elena Dinu, Mirela Mitrea. Clinical Hospital "N. Gh. Lupu", Dept. Clinical Immunology, Bucharest, Romania To ascertain the diagnostic and prognostic value of serum copper in silicosis, this trace element was determined in 68 patients (all males), aged varied between 20 and 60 years (mean age 44 ± 2.3 years). The same determination was carried out in a control group of 35 healthy subjects. The patients were distributed into three subgroups according to the evolutive stage of disease. The mean value of serum copper increased gradually from stage to stage reaching in stage 1lI the highest copper mean value (p < 0.01). Serum copper concentrations also increased with the severity of disease. These changes suggest that copper is directly responsible for the lung changes in silicosis and can be used as a indicator of the severity of the inflammatory reaction.
IP1F1761
Moreover, spectral assignments were performed relatively to control biological samples, and confirmed by two-dimensional J-resolved analysis. Identification and quantitation procedures were tested in a case of acute salicylate poisoning. Results were in agreement with that from classical biochemical methods, and NMR investigations were therefore applied to other acute clinical cases, such as chloroquine, methanol, and ethyleneglycol, glyphosate, and paraquat poisonings High resolution NMR spectroscopy could thus provide a valuable tool to assess several compouds in one analysis, without preselection of the analytes.
IP1F1771 ACCIDENTAL EMERGENCY PREPAREDNESS FACING RELEASES OF TOXIC GASES A. Baert, J. Y. Breurec, B. James, J.P. Curtes. Centre Antipoisons de Rennes CHR Pontchaillou 35033 RENNES Cedex 9, France Many reviews.have emphasized the need for the emergency community to minimize the adverse consequences of hazardous materials' release. Decisions that are needed to protect rapidly the public during a toxic vapour cloud emergency can be factored in two questions: will in place protection provide adequate protection? Is there sufficient time to evacuate? The choice of acceptable levels for a once-in-a-lifetime exposure significantly affects the size of the vunerable zone. To help local officials in the ultimate hasty decision between in place protection and evacuation, we propose to determine several zones of vulnerability. Each zone is determined as an area where a specified level of concern of chemical, the Emergency Response Planning Guideline [ERPGJ (developped under the auspices of the American Industrial Hygiene Association) may potentially be exceeded. Using dispersion modelling techniques, if the estimate concentration in a zone is expected to be for one hour above the critical level 2, 5 ERPG2, the incident commander must consider evacuation. In other risk zones, protective actions are: public information, simple sheltering in place (go indoors, chose a room on the leeward side, close windows and doors, turn off the ventilation system, tune to a designated radio station), strengthenings sheltering in place (gaps around door and windows are sealed with paper and tape). Nevertheless, it might be more effective to undertake an expedited evacuation of the most vulnerable shelters instead of relying on the use of extra precautions while using in place protection. In all cases, incident commander should clearly justify the choice of vulnerability level and protective actions.
IP1F222 I PROSPECTIVE STUDY ON THE INTOXICATIONS IN NMRSPECTROSCOPY AS A TOOLFOR DIAGNOSIS OF ACUTE POISONINGS
M. Imbenotte *, N. Azaroual, S. Maschke, D. Mathieu, F. Leclerc, G. Vermeersch, M. Lhermitte. Toxicology Laboratory, NMR Application Laboratory, Lille 2 University; Adult and Paediatric Reanimation Units; Biochemistry and Molecular Biology Laboratory, CHRU Lille, France NMR spectroscopy can be used for the analysis of a wide range of endogenous compounds, xenobiotics and their metabolites present in biological fluids, such as urine and plasma. Unlike classical determination techniques, no pretreatment for extraction or derivatization is required. Nevertheless, two problems arose for the analysis with I H NMR of biological specimens: the high content of water and the possible presence of macromolecules. In order to fix these problems, specific irradiation sequences had to be elaborated and optimized. It included selective presaturation, T2-based, and TOCSY experiments.
CARBON MONOXIDE IN FES CITY-WINTER 97/98
A. Moubarik *, M.M. Mikou, R. Soulaymani. Poison Control Center Rabat, Morocco During 97/98 winter, a prospective study on the intoxications at the carbon monoxide has been undertaken at Ibn EI Khatib hospital and EI Ghassani hospital in Fes; a city with a dry weather, extremely cold in winter repuring the daily use of heding means and sources of CO. The number of cases retained up to this day is of 60, six of which are dead. The intoxication often collective is frequently caused by gaz heater services. The consultation timing doesn't exceed I hour with the use of products such as milk, lemon etc... on the accident places by people victims of intoxications. The symptoms are frequently made of general signs with headaches, tachycardia, asthenia, digestive signs, without cardio-
Poster Session IF. Human Toxicology
go unrecognized by physicians. Suspicion of such events require the identification, in as precise a manner as possible, of the responsible molecule. This may be accomplished a posteriori if a specimen of serum is obtained and frozen for safekeeping systematically in the case of any anomaly of memory, mental or motor function not otherwise explained. Where the suspicion is correct, toxin identification often permits a diminution in the hospital stay and costly adjunctive examinations among patients admitted for acute behavioral changes which may sometimes suggest an organic pathology.'Mass spectrometry is the most efficient analysis for the detection of the implied product. These incidents are rapidly growing in frequency, in the U.S. ("date-rapes"), as well as in the European Union or South America, and pose multiple problems: (a) May these cases be compared with syndromes already described among "chemically-battered children", and/or with the testimonies obtained by police, the military or psychiatries, when persons are under the influence of psychotropic substances. (b) The substances responsible have been essentially benzodiazepines, but may extend to other recently released hypnotics or to drugs of the amphetamine type. The use of scopolamine has been denounced in South America. Bromides and gamma-hydroxybutyric acid have also been incriminated. (c) Can legislative control of these substances prevent their misuse or will other substances take their place? (d) How should the violence committed on the victims be viewed from a judiciary standpoint? Offence or crime? The elucidation of these phenomena of chemical submission is only in its beginning stages in human toxicology.
IP1F17S1
SILICOSIS RELATED CHANGES IN SERUM COPPER
M. Cojocaru, Elena Dinu, Mirela Mitrea. Clinical Hospital "N. Gh. Lupu", Dept. Clinical Immunology, Bucharest, Romania To ascertain the diagnostic and prognostic value of serum copper in silicosis, this trace element was determined in 68 patients (all males), aged varied between 20 and 60 years (mean age 44 ± 2.3 years). The same determination was carried out in a control group of 35 healthy subjects. The patients were distributed into three subgroups according to the evolutive stage of disease. The mean value of serum copper increased gradually from stage to stage reaching in stage 1lI the highest copper mean value (p < 0.01). Serum copper concentrations also increased with the severity of disease. These changes suggest that copper is directly responsible for the lung changes in silicosis and can be used as a indicator of the severity of the inflammatory reaction.
IP1F1761
Moreover, spectral assignments were performed relatively to control biological samples, and confirmed by two-dimensional J-resolved analysis. Identification and quantitation procedures were tested in a case of acute salicylate poisoning. Results were in agreement with that from classical biochemical methods, and NMR investigations were therefore applied to other acute clinical cases, such as chloroquine, methanol, and ethyleneglycol, glyphosate, and paraquat poisonings High resolution NMR spectroscopy could thus provide a valuable tool to assess several compouds in one analysis, without preselection of the analytes.
IP1F1771 ACCIDENTAL EMERGENCY PREPAREDNESS FACING RELEASES OF TOXIC GASES A. Baert, J. Y. Breurec, B. James, J.P. Curtes. Centre Antipoisons de Rennes CHR Pontchaillou 35033 RENNES Cedex 9, France Many reviews.have emphasized the need for the emergency community to minimize the adverse consequences of hazardous materials' release. Decisions that are needed to protect rapidly the public during a toxic vapour cloud emergency can be factored in two questions: will in place protection provide adequate protection? Is there sufficient time to evacuate? The choice of acceptable levels for a once-in-a-lifetime exposure significantly affects the size of the vunerable zone. To help local officials in the ultimate hasty decision between in place protection and evacuation, we propose to determine several zones of vulnerability. Each zone is determined as an area where a specified level of concern of chemical, the Emergency Response Planning Guideline [ERPGJ (developped under the auspices of the American Industrial Hygiene Association) may potentially be exceeded. Using dispersion modelling techniques, if the estimate concentration in a zone is expected to be for one hour above the critical level 2, 5 ERPG2, the incident commander must consider evacuation. In other risk zones, protective actions are: public information, simple sheltering in place (go indoors, chose a room on the leeward side, close windows and doors, turn off the ventilation system, tune to a designated radio station), strengthenings sheltering in place (gaps around door and windows are sealed with paper and tape). Nevertheless, it might be more effective to undertake an expedited evacuation of the most vulnerable shelters instead of relying on the use of extra precautions while using in place protection. In all cases, incident commander should clearly justify the choice of vulnerability level and protective actions.
IP1F222 I PROSPECTIVE STUDY ON THE INTOXICATIONS IN NMRSPECTROSCOPY AS A TOOLFOR DIAGNOSIS OF ACUTE POISONINGS
M. Imbenotte *, N. Azaroual, S. Maschke, D. Mathieu, F. Leclerc, G. Vermeersch, M. Lhermitte. Toxicology Laboratory, NMR Application Laboratory, Lille 2 University; Adult and Paediatric Reanimation Units; Biochemistry and Molecular Biology Laboratory, CHRU Lille, France NMR spectroscopy can be used for the analysis of a wide range of endogenous compounds, xenobiotics and their metabolites present in biological fluids, such as urine and plasma. Unlike classical determination techniques, no pretreatment for extraction or derivatization is required. Nevertheless, two problems arose for the analysis with I H NMR of biological specimens: the high content of water and the possible presence of macromolecules. In order to fix these problems, specific irradiation sequences had to be elaborated and optimized. It included selective presaturation, T2-based, and TOCSY experiments.
CARBON MONOXIDE IN FES CITY-WINTER 97/98
A. Moubarik *, M.M. Mikou, R. Soulaymani. Poison Control Center Rabat, Morocco During 97/98 winter, a prospective study on the intoxications at the carbon monoxide has been undertaken at Ibn EI Khatib hospital and EI Ghassani hospital in Fes; a city with a dry weather, extremely cold in winter repuring the daily use of heding means and sources of CO. The number of cases retained up to this day is of 60, six of which are dead. The intoxication often collective is frequently caused by gaz heater services. The consultation timing doesn't exceed I hour with the use of products such as milk, lemon etc... on the accident places by people victims of intoxications. The symptoms are frequently made of general signs with headaches, tachycardia, asthenia, digestive signs, without cardio-