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The oxidative stress and antioxidant therapy in patients with acute and chronic poisoning by pesticides
Abstracts / Toxicology Letters 258S (2016) S62–S324
P04-005 Poisoning in Chile: A 10-year report from the Catholic University Poison Center J.C. Rios 1,∗ , J.J. Mieres 1 , P. Cerda 1 , L. Silva 1 , P. Olivares 1 , P. Medel 1 , S. Solari 2 , E. Paris 1 1
Centro de Información toxicológica (CITUC), Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile 2 Department of Clinical Laboratory, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
Epidemiologic information about poisoning allows tracking the local situation and establishing effective prevention strategies. In this regard, poison centers play a fundamental role in toxicovigilance. This study describes and analyzes poisoning cases received at the Poison Center of the Catholic University between 2006 and 2015. Variables analyzed were: number of cases, age, gender, exposure, circumstance, route of exposure and causal agent. During the studied period there were 267,221 cases of human poisonings, 56% involved females and 44% males. Half of the calls (49%) were made from healthcare facilities. The most frequent route of exposure was ingestion (82%), followed by bite/stings (6%) and inhalation (4%). Main causal agents were pharmaceutical products (58%), followed by household products (15%) and pesticides (12%). Most frequent type of medication involved were neurological agents (53%). 59% of cases were accidental and 29% were intentional (of this 93% were suicides). In suicide intents the main agents involved were pharmaceutical products (86%). Female had a risk of ingesting substances with suicidal intent 3.3 times larger than male sex (OR: 3.3; IC 95%: 3.2–3.4; p < 0.001). In females, the risk of suicide intent with pharmaceutical products was 3.4 higher than males (OR: 3.4; IC 95%: 3.3–3.5; p < 0.001). Toddler and children accounted for 50% of all cases, while adolescent 14%, being 86% of those, suicidal cases. In conclusion, most poisoning cases involved females and the main agent reported were pharmaceutical products. In children, accidental exposure by ingestion was the main cause of the reports while in adolescents prevailed suicide exposures. http://dx.doi.org/10.1016/j.toxlet.2016.06.1430 P04-006 The oxidative stress and antioxidant therapy in patients with acute and chronic poisoning by pesticides G.M. Balan ∗ , N. Bubalo, O. Harchenko, V. Babich, O. Vasetskya, V. Bubalo L.I. Medved’s Research Center of Toxicology MH, Kyiv, Ukraine We have studied the causes of the development, distribution, clinical manifestations, state of biomarkers of antioxidant system in the current dynamics of the acute and chronic poisoning by pesticides among agriculture workers. Among the examined patients had been: 60 with an acute poisoning of organophosphorus pesticides (OP), 236 with acute poisoning by herbicides based on 2,4-dichlorophenoxyacetic acid (2,4-D), 14 with acute poisoning by synthetic pyrethroids, 70 with chronic intoxications of several pesticides. The clinical presentation which are represented by 60 cases of acute poisoning OP in all cases observed cholinergic crisis (100%), intermediate syndrome (16.7%), vegetative dysfunction syndrome and asthenic syndrome (85%), vegetative sensory polyneuropathy (20%), rarely observed toxic liver damage, peripheral neuropathy, cardiomyopathy and organophosphate-induced delayed polyneuropathy. The description of symptoms which are
S101
represented by 236 cases of acute poisoning by herbicides based on 2,4-D, synthetic pyrethroids predominated disorder of the nervous and hepatobiliary system. With increasing degree of severity poisoning by pesticides and their progredient course noted the increase of oxidative stress with increase in plasma level of malone dialdehyde against the background of oppression indicators of the antioxidant system, especially in the development of toxic liver damage. Adding into a complex detoxification therapy in patients with poisoning by pesticides of antioxidants such as emoxypine, alpha lipoic acid and ursodeoxycholic acid increased the efficacy of treatment, accelerated the regression of clinical, especially hepatobiliary system. Substantiated the usage of emoxypine in case toxic liver damage with the cytolytic syndrome and the ursodeoxycholic acid in same damage with cholestasis syndrome. http://dx.doi.org/10.1016/j.toxlet.2016.06.1431 P04-007 Blood manganese concentrations in patients exposed to mercury M. Barbaro 1,∗ , A. Soldarini 1 , A. Ronchi 2 , P.D. Pigatto 3 , I. Bolengo 4 , G. Guzzi 4 1
Laboratory Medicine, “San Raffaele” Hospital Scientific Institute, Milano, Italy 2 Pavia Poison Control Center and National Toxicology Information Centre, Toxicology Unit, IRCCS Maugeri Foundation and University of Pavia, Italy 3 Department of Biomedical, Surgical and Dental Sciences, Unit of Oral Pathology and Medicine, IRCCS Galeazzi Hospital, University of Milan, Milan, Italy 4 Italian Association for Metals and Biocompatibility Research – A.I.R.M.E.B., Milan, Italy
Question: We hypothesize that mercury exposure may affect the retention toxicity of manganese in humans. We tested the hypothesis that persons exposed to mercury may have increased levels of blood manganese. Methods: We performed measurements of whole-blood manganese levels by ICP-MS. Reference range for manganese is <7.7 g/l. Results: The average (±SD) manganese concentration was 8.46 ± 3.4 g/l among 53 patients exposed to dental materials. In a subgroup analysis of 53 patients, mean (±SD) manganese concentration was 8.8 ± 3.4 g/l in 37 women and 7.66 ± 3.4 g/l in 16 men. At least 62.2% (23 of 37) of women had mildly elevated manganese concentrations (mean 10.16 ± 2.8), ranged from 3.6 to 15.7. In men, 7 of 16 (43.7%) had slightly elevated manganese concentrations (mean 10.06 ± 3.1), ranged from 2.2 to 15.8. 10 patients of 53 (18.9%) with manganese values above 11.9 g/l (range 11.9–15.8) were associated with severe neurological disorders (Parkinson’s disease, oral dystonia, epilepsy, Tourette’s syndrome, and craniofacial neuralgia). Biological indices of manganese may be: serum alanine/aspartate aminotransferases, serum bilirubin, serum alkaline phosphatase, gamma-glutamyltransferase, serum amylase, serum copper and zinc, serum ceruloplasmin, serum iron, serum albumin, prothrombin levels. Serum prolactin (PRL) concentration can be used as a reliable marker of exposure to manganese. A mean of 8.46 ± 3.39 g/l of total mercury in whole-blood (limit, <2) was found in 53 patients and had mercury, like iron, potential effect on the neurotoxicity of manganese. Conclusions: Manganese seems to be affected by mercury levels. http://dx.doi.org/10.1016/j.toxlet.2016.06.1432
P04-005 Poisoning in Chile: A 10-year report from the Catholic University Poison Center J.C. Rios 1,∗ , J.J. Mieres 1 , P. Cerda 1 , L. Silva 1 , P. Olivares 1 , P. Medel 1 , S. Solari 2 , E. Paris 1 1
Centro de Información toxicológica (CITUC), Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile 2 Department of Clinical Laboratory, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
Epidemiologic information about poisoning allows tracking the local situation and establishing effective prevention strategies. In this regard, poison centers play a fundamental role in toxicovigilance. This study describes and analyzes poisoning cases received at the Poison Center of the Catholic University between 2006 and 2015. Variables analyzed were: number of cases, age, gender, exposure, circumstance, route of exposure and causal agent. During the studied period there were 267,221 cases of human poisonings, 56% involved females and 44% males. Half of the calls (49%) were made from healthcare facilities. The most frequent route of exposure was ingestion (82%), followed by bite/stings (6%) and inhalation (4%). Main causal agents were pharmaceutical products (58%), followed by household products (15%) and pesticides (12%). Most frequent type of medication involved were neurological agents (53%). 59% of cases were accidental and 29% were intentional (of this 93% were suicides). In suicide intents the main agents involved were pharmaceutical products (86%). Female had a risk of ingesting substances with suicidal intent 3.3 times larger than male sex (OR: 3.3; IC 95%: 3.2–3.4; p < 0.001). In females, the risk of suicide intent with pharmaceutical products was 3.4 higher than males (OR: 3.4; IC 95%: 3.3–3.5; p < 0.001). Toddler and children accounted for 50% of all cases, while adolescent 14%, being 86% of those, suicidal cases. In conclusion, most poisoning cases involved females and the main agent reported were pharmaceutical products. In children, accidental exposure by ingestion was the main cause of the reports while in adolescents prevailed suicide exposures. http://dx.doi.org/10.1016/j.toxlet.2016.06.1430 P04-006 The oxidative stress and antioxidant therapy in patients with acute and chronic poisoning by pesticides G.M. Balan ∗ , N. Bubalo, O. Harchenko, V. Babich, O. Vasetskya, V. Bubalo L.I. Medved’s Research Center of Toxicology MH, Kyiv, Ukraine We have studied the causes of the development, distribution, clinical manifestations, state of biomarkers of antioxidant system in the current dynamics of the acute and chronic poisoning by pesticides among agriculture workers. Among the examined patients had been: 60 with an acute poisoning of organophosphorus pesticides (OP), 236 with acute poisoning by herbicides based on 2,4-dichlorophenoxyacetic acid (2,4-D), 14 with acute poisoning by synthetic pyrethroids, 70 with chronic intoxications of several pesticides. The clinical presentation which are represented by 60 cases of acute poisoning OP in all cases observed cholinergic crisis (100%), intermediate syndrome (16.7%), vegetative dysfunction syndrome and asthenic syndrome (85%), vegetative sensory polyneuropathy (20%), rarely observed toxic liver damage, peripheral neuropathy, cardiomyopathy and organophosphate-induced delayed polyneuropathy. The description of symptoms which are
S101
represented by 236 cases of acute poisoning by herbicides based on 2,4-D, synthetic pyrethroids predominated disorder of the nervous and hepatobiliary system. With increasing degree of severity poisoning by pesticides and their progredient course noted the increase of oxidative stress with increase in plasma level of malone dialdehyde against the background of oppression indicators of the antioxidant system, especially in the development of toxic liver damage. Adding into a complex detoxification therapy in patients with poisoning by pesticides of antioxidants such as emoxypine, alpha lipoic acid and ursodeoxycholic acid increased the efficacy of treatment, accelerated the regression of clinical, especially hepatobiliary system. Substantiated the usage of emoxypine in case toxic liver damage with the cytolytic syndrome and the ursodeoxycholic acid in same damage with cholestasis syndrome. http://dx.doi.org/10.1016/j.toxlet.2016.06.1431 P04-007 Blood manganese concentrations in patients exposed to mercury M. Barbaro 1,∗ , A. Soldarini 1 , A. Ronchi 2 , P.D. Pigatto 3 , I. Bolengo 4 , G. Guzzi 4 1
Laboratory Medicine, “San Raffaele” Hospital Scientific Institute, Milano, Italy 2 Pavia Poison Control Center and National Toxicology Information Centre, Toxicology Unit, IRCCS Maugeri Foundation and University of Pavia, Italy 3 Department of Biomedical, Surgical and Dental Sciences, Unit of Oral Pathology and Medicine, IRCCS Galeazzi Hospital, University of Milan, Milan, Italy 4 Italian Association for Metals and Biocompatibility Research – A.I.R.M.E.B., Milan, Italy
Question: We hypothesize that mercury exposure may affect the retention toxicity of manganese in humans. We tested the hypothesis that persons exposed to mercury may have increased levels of blood manganese. Methods: We performed measurements of whole-blood manganese levels by ICP-MS. Reference range for manganese is <7.7 g/l. Results: The average (±SD) manganese concentration was 8.46 ± 3.4 g/l among 53 patients exposed to dental materials. In a subgroup analysis of 53 patients, mean (±SD) manganese concentration was 8.8 ± 3.4 g/l in 37 women and 7.66 ± 3.4 g/l in 16 men. At least 62.2% (23 of 37) of women had mildly elevated manganese concentrations (mean 10.16 ± 2.8), ranged from 3.6 to 15.7. In men, 7 of 16 (43.7%) had slightly elevated manganese concentrations (mean 10.06 ± 3.1), ranged from 2.2 to 15.8. 10 patients of 53 (18.9%) with manganese values above 11.9 g/l (range 11.9–15.8) were associated with severe neurological disorders (Parkinson’s disease, oral dystonia, epilepsy, Tourette’s syndrome, and craniofacial neuralgia). Biological indices of manganese may be: serum alanine/aspartate aminotransferases, serum bilirubin, serum alkaline phosphatase, gamma-glutamyltransferase, serum amylase, serum copper and zinc, serum ceruloplasmin, serum iron, serum albumin, prothrombin levels. Serum prolactin (PRL) concentration can be used as a reliable marker of exposure to manganese. A mean of 8.46 ± 3.39 g/l of total mercury in whole-blood (limit, <2) was found in 53 patients and had mercury, like iron, potential effect on the neurotoxicity of manganese. Conclusions: Manganese seems to be affected by mercury levels. http://dx.doi.org/10.1016/j.toxlet.2016.06.1432