A Retrospective Analysis of Intoxicated Patients Admitted to the Intensive Care Unit: A Single-Institution Assessment in the Post-Pandemic Period

Background: The aim of this study was to evaluate the clinical and epidemiological characteristics of patients with acute intoxication admitted to the Intensive Care Unit (ICU). Material and Methods: An observational retrospective study was conducted on intoxicated patients who admitted to ICU between January 2022 and January 2024. Data were collected from the patients medical records. The demographic characteristics, causes of intoxications, clinical parameters, the mean stay in the ICU, treatment modalities and prognosis were recorded. Results: A total of 2875 critically ill patients were admitted during the study period, and 109 (3.79%) of them were acute intoxications. Their mean of ages was 38.09 ± 12.29. The female-to-male ratio was 1.37/1. Drugs were found to be the primary cause (62.39%) of intoxications, and analgesics, antidepressants, and antibiotics were the most frequent agents. Suicidal attempts were present in 66 patients, most of them were female (62.13%) and between 17 - 24 years (40.91%). The other common causes of intoxications were carbon monoxide (CO) (22.02%), methyl/ethyl alcohol (8.26%) and mushroom (5.50%). The mean stay in the ICU was 2.69 ± 0.89 days. Mechanical ventilation was applied to 10 of our patients. Renal replacement therapy was required in 6 patients. Despite all treatments, 6 of our patients died, and we found the mortality rate to be 5.50%. Conclusion: Intoxications were more frequent in young female patients and drugs were the most common cause with suicidal intent. Unfortunately, CO poisoning continues to be a very important problem in our city. These findings provided significant information about the characteristics of intoxications in Karabuk.

Intoxication Induced by Urea Containing Diets in Broiler Chickens: Effect on Weight Gain, Feed Conversion Ratio, Hematological and Biochemical Profiles

Urea as a source of cheap non-protein nitrogen is used to adulterate fish and meat meals which are basic components of broiler diets. The present study was carried out to elucidate the effects of urea on weight gain, and hematological and biochemical profiles. A total of 48 broiler chicks were randomly allotted into 4 groups, designated Groups 1, 2, 3 and 4 of 12 birds each. Birds in Groups 2, 3 and 4 were fed on diets containing urea at the levels of 1%, 2.5% and 4%, respectively. Birds in Group 1 served as control and were not exposed to urea. Experimentation period was for 3 weeks and experiment was terminated when birds were 42 days of age. Body weight of all intoxicated birds at the various intervals was significantly decreased in comparison with that of the untreated control. Compared with control, all intoxicated broilers manifested significant (P ≤ 0.05) decrease in all hematological parameters involving erythrocytic and total leucocytic counts, Hemoglobin (Hb) and Packed Cell Volume (PCV) on a dose- and time-pattern. In comparison with the control levels, biochemical profile of the intoxicated birds disclosed significant decrease in blood glucose level and significant increase in serum uric acid, urea, Alkaline Phosphatase (ALP) and Lactate Dehydrogenase (LDH) levels. Based upon the present data, it was concluded that the addition of urea to broiler diets bears serious sequences concerning the general health condition, performance, weight gain, and hematological and biochemical profiles.

Association of carbon monoxide poisonings and carboxyhemoglobin levels with COVID-19 and clinical severity

BACKGROUND Coronavirus disease 2019(COVID-19),which recently spread throughout the entire world,is still a significant health issue.Additionally,the most common cause of risky poisoning in emergency services is carbon monoxide(CO)poisoning.Both disorders seem to merit more research as they have an impact on all bodily systems via the lungs.AIM To determine how arterial blood gas and carboxyhemoglobin(COHb)levels affect the clinical and prognostic results of individuals requiring emergency treatment who have both COVID-19 and CO poisoning.METHODS Between January 2018 and December 2021,479 CO-poisoning patients participated in this single-center,retrospective study.Patients were primarily divided into two groups for analysis:Pre-pandemic and pandemic periods.Additionally,the pandemic era was divided into categories based on the presence of COVID-19 and,if present,the clinical severity of the infection.The hospital information system was used to extract patient demographic,clinical,arterial blood gas,COVID-19 polymerase chain reaction,and other laboratory data.RESULTS The mean age of the 479 patients was 54.93±11.51 years,and 187(39%)were female.226(47%)patients were in the pandemic group and 143(30%)of them had a history of COVID-19.While the mean potential of hydrogen(pH)in arterial blood gas of all patients was 7.28±0.15,it was 7.35±0.10 in the pre-pandemic group and 7.05±0.16 in the severe group during the pandemic period(P<0.001).COHb was 23.98±4.19%in the outpatients and 45.26%±3.19%in the mortality group(P<0.001).Partial arterial oxygen pressure(PaO2)was 89.63±7.62 mmHg in the pre-pandemic group,and 79.50±7.18 mmHg in the severe group during the pandemic period(P<0.001).Despite the fact that mortality occurred in 35(7%)of all cases,pandemic cases accounted for 30 of these deaths(85.7%)(P<0.001).The association between COHb,troponin,lactate,partial arterial pressure of carbon dioxide,HCO3,calcium,glucose,age,pH,PaO2,potassium,sodium,and base excess levels in the pre-pandemic and pandemic groups was statistically significant in univariate linear analysis.CONCLUSION Air exchange barrier disruption caused by COVID-19 may have pulmonary consequences.In patients with a history of pandemic COVID-19,clinical results and survival are considerably unfavorable in cases of CO poisoning.

Assessment of Acute Poisoning Cases in Emergency Department of the Provincial General Reference Hospital in Bukavu, DR-Congo

Background: Acute intoxications result from intentionally or accidentally taking a relatively significant amount of a chemical substance which triggers disturbances in the level of psychophysiological functions, the complications of which may lead to mental disorders, physical causalities, and death. Any acute intoxication mostly requires emergency care. Objective: To highlight the prevalence, history, clinical features, emergency treatment, and prediction of acute intoxication cases referred to the emergency services at the Provincial General Reference Hospital in Bukavu, DR-Congo. Methods: A retrospective cross-sectional study was conducted from January 2021 to October 2022 based on an analysis of patients’ medical files. Triage was performed among all-type of patient files recorded in the computerized hospital database Ebale-Sante to sort cases of intoxication. Results: During the observational period, 3966 emergency admissions were counted, of which 321 (8.09%) patients were identified as having acute intoxication. Among these, 100 files that containing sufficient information fit the quality criteria for this study’s analysis. The victims were infants, adolescents and adults aged 1 - 45 years, and 52% were female and 48% were male. Most cases were accidental and, occurred at home, and the victims were driven to the hospital within 2 - 24 hours. The substances consumed included household products, drugs, and herbs. Resuscitation care, antidotes and supportive symptomatic medications ensured that 85% were healed and 10% experienced sequelae;however, 5% died. Conclusion: Acute intoxication occurs in infants mostly accidentally though the ingestion of household products and medicines. Furthermore, suicide cases may occur in traumatized adolescents and discordant couples. People should be informed about how to store hazardous products (e.g.: drugs, household products and pesticides), which should not be available to children, to avoid unintentional poisoning. Special training in clinical toxicology is required to reduce treatment failure.

Suicide Attempts in a General Hospital: A Case-Control

Objective: This study aims is to conduct a comparative analysis of the clinical and sociodemographic profiles of individuals referred to Consultation-Liaison Psychiatry (CLP) at a tertiary general hospital, specifically focusing on those seeking assistance due to suicide attempts (TS) versus CLP requests for other reasons (non-TS) between the years 2010 and 2020. Additionally, we aim to assess factors associated with suicide attempts. Method: This retrospective controlled study involves a thorough examination of medical records encompassing 3913 patients who received CLP services at the Hospital de Base (HB) and the Children and Maternity Hospital (HCM) of São José do Rio Preto Medical School Foundation (Funfarme) from June 2010 to June 2020. The patient cohort is categorized into two groups: those with requests for SA (n = 677) and those with requests for other reasons. Results: In the SA group, as opposed to the non SA group, statistically significant differences were observed for gender (predominantly female), employment status (employed), marital status (single), and age (younger). Notably, a higher prevalence of psychiatric antecedents (88.7%, n = 555 vs. 73.6% n = 2018) was found in the SA group, indicating a significant association. The frequency of SA requests remained stable over the years. Among the SA group, mood disorders were the most prevalent (39%, n = 372), followed by disorders related to substance use (21.2%, n = 202), and personality disorders (16%, n = 152). A history of previous suicide attempts emerged as a crucial factor for the recurrence of SA (p-value ≤ 0.001). Exogenous intoxication emerged as the most frequently employed method in attempts (79.6%, n = 539), particularly prevalent among patients diagnosed with mood disorders (41%, n = 314). A significant association was observed between the method of attempt and the nosological psychiatric diagnosis (χ2 = 42.277;p ≤ 0.001). Regarding outcomes, the majority of patients were referred for outpatient follow-up (23%, n = 336) in specialized mental health services or at the Primary Healthcare Unit, highlighting the general hospital’s pivotal role in integrating patients into the broader healthcare network. Conclusion: Variables such as gender (female), age group (young adults), and psychiatric history exhibited stronger associations with suicide attempts compared to the group assisted by CLP for other reasons. Furthermore, a noteworthy correlation between the method employed and the psychiatric diagnosis was identified.

Toxicity assessment and screening of tetrodotoxin in the oblong blowfish(Takifugu oblongus)from the Tamil Nadu Coast of Bay of Bengal,India

Objective:To assess the toxicity of the pufferfish Takifugu oblongus,from Chennai coast,Tamil Nadu,India and to detect the presence of Tetrodotoxin(TTX).Methods:The toxicity was evaluated by mouse bioassay using Swiss Albino mice which were expressed in mouse units(MU).Gross anatomical features were observed which is followed by histopathology of the dead mice tissues to establish the toxicity.Instrumental analysis for the presence of tetrodotoxin was also performed through GC-MS and HPLC.Results:The toxicity of ovary was the maximum with 163 MU/g and lowest toxicity was observed in skin with 75.88 MU/g.Histopathological analyses of the dead mice showed various cellular degenerations and inflammations.The amount of Tetrodotoxin detected through GC-MS and HPLC was more reliable and sensitive than the customary mouse bioassay as instrumental analyses were able to detect even nanograms of the toxin.Conclusions:The present study evidently proved that Takifugu oblongus is highly toxic and consumption of the same can pose serious threat for health and possible lethality to humans.

Analysis of Paraquat Intoxication Epidemic (2002-2011) within China

Paraquat, is a Bipy herbicide have been widely used in last decade in China. Because of its high human toxicity and mortality characteristics, paraquat has been gained considerable attention in recent years. In order to evaluate the epidemic status of paraquat harm to human health in China, 24 h hotline information about paraquat intoxication consultation from January Ist, 2002 to December 31st, 2011 was collected by experienced practitioners in the Poison Control Center （National Poison Control Center, NPCC）

Changes in Tissue Metals After Cadmium Intoxication and Intervention With Chlorpromazine in Male Rats

Cadmium (Cd), one of the most dangerous heavy metals, has a very similar ionic radius to calcium (Ca). The interference of cadmium in calcium homeostasis may play an important role in cadmium toxicity. Recent reports indicate that calmodulin (CaM) inhibitors such as trifluoperazine and chlorpromazine (CPZ) could protect rodents against cadmium toxicity. It was also reported that pretreatment of mice with zinc (Zn) could reduce the adverse effects induced by cadmium. The aim of this study is to determine whether Cd changes the balance of other essential metals such as Zn and copper (Cu) in rat tissues, and whether CPZ can reverse these changes which are induced by cadmium intoxication. Adult male Sprague Dawley (SD) rats were injected intraperitoneally (ip) with cadmium chloride (CdCl 2) (0.2, 0.4, 0.8 mg Cd/kg body weight) alone and 0.4mg Cd/kg in association with CPZ (5 mg/kg) daily for a week. The control animals were injected with normal saline only. The results showed that the cadmium content in the liver, kidney and testis increased significantly with a dose response relationship. Cadmium treatment markedly increased the Zn and Ca content in some of the tissues. Hepatic and renal metallothionein (MT) increased significantly after cadmium intoxication. CPZ treatment, however, reduced cadmium content in liver, but not blood and kidney. CPZ seemed to decrease the content of MT in liver and significantly increase the amounts of MT in kidney. These data suggest that the intervention of cadmium with tissue essential metals may play a role in cadmium toxicity in rats, and calmodulin inhibitors to some extent can reduce the adverse effect of cadmium by decreasing the cadmium load in tissues and reversing the unbalance of essential metals.

Cyanide Intoxication in Mice Through Different Routes and its Prophylaxis by α-Ketoglutarate

Antagonising effects of α-ketoglutarate (α-KG) could be attributed to complexing of the reactive nucleophile (CN-) to form cyanohydrin in cyanide intoxication. However, an enormous protection obtained could not be delineated on account of possible in situ binding of α-KG given intraperitoneally (i.p.) in mice to cyanide administered through the same route. The present study was designed to see the efficacy of a-KG alone or in combination with sodium nitrite (SN) and/or sodium thiosulfate (STS) in male mice exposed to cyanide administered through subcutaneous (s.c.) or inhalation route. A technique for generation of hydrogen cyanide (HCN) is also discussed. On the basis of protection index (PI), defined here as the LD50 of cyanide in protected mice/LD50 of cyanide in unprotected mice and survival time, STS + α-KG regimen was equipotent to the conventional SN + STS regimen. This is further substantiated by effect of α-KG in reducing plasma cyanide levels. The efficacy of α-KG remains undeterred irrespective of the route of cyanide intoxication, while the magnitude of protection varies.

Effect of lead acetate toxicity on experimental male albino rat

Objective:To evaluate the effect of different doses of lead acetate(1/20,1/40 and 1/60 of LD_(50))on body weight gain,blood picture,plasma prolein profile and the function of liver,kidney and thyroid gland.Methods:Male albino rats were divided into four groups,the first group represented the health control animals,while the second,third and fourth groups were ingested orally with sub lethal doses of load acetate(1/20,1/40 and 1/60)of the oral LD_(50),respectively.One dose was ingested every two days during the experimental period(14 weeks)including the adaptation time.Blood was collected and used for all analysis.Results:The results showed that,the ingestion of Pb^(2+)induced significant stimulation in glutamic-pyruvic transaminase(ALT)and glutamic-oxalacetic transaminease(AST)activity.Also,total soluble protein and albumin contents of plasma were significantly decreased,while the content of globulin was changed by the Pb^(2+)treatments.The cholinesteiase activity was inhibited,but the activities of alkaline and acid phosphates and lactate dehydrogenase were stimulated,while plasma glucose level was elevated as a result of lead acetate intoxication.In case of blood picture,Pb^(2+)ingestion reduced the contents of hemoglobin and RBCs count of intoxicated rat's blood and the plasma levels of T3,T4 and blood WBCs count were decreased.Conclusions:It can be concluded that lead acetate has harmful effect on experimental male albino rats.Therefore,the present work advises people to prevent exposure to the lead compound to avoid injurious hazard risk.

The New Approach to the Diagnostics and Treatment of Endogenous Intoxication in Patients with Burn Injury

Background: The main causes of mortality in patients with burn injury are the development of systemic inflammatory process, multiple organ failure and septic complications. The aim of the research: Improvement of diagnostic and therapeutic approaches to the detection and elimination of endogenous intoxication in patients with burn injury. Materials and methods: The main study group consisted of 19 patients and the comparison group—of 10 patients with burn injury. 92 blood serum (BS) samples of the patients of the main group were tested, using the method of fluorescence spectroscopy (MFS). The advanced therapeutic tactics were proposed for the patients of both groups. The control group consisted of 40 healthy individuals (donors). BS of these patients was also tested using MFS. Results: Patients with burn injury have endogenous intoxication in their blood. The effective concentration of albumin is reduced in patients with burn injury due to the blockage of albumin binding centers by bacterial metabolism products. Fluorescence spectra (FS) of BS in patients with burn trauma and donors were obtained and investigated. Based on MFS results, an improved treatment regimen using infusion of albumin solution was proposed. Conclusions: An improved technique for the management of patients with burn injury is based on the use of MFS for the diagnostic evaluation of endogenous intoxication in them. The idea of pathological changes in albumin molecules in patients with burn injury is pathogenetically substantiated by the successful use of infusion of albumin solution in these patients on the basis of the MFS.

Study on pulmonary injury due to acute H_2S inhalation and its therapeutic scheme

Pulmonary injury after acute H2S inhalation was studied with bronchoalveolar lavage（BAL）,ultracentrifuge,and optical and electron microscopy.The changes of the activities oflactate dehydrogenase,alkaline and acid phosphatase,and angiotension converting enzymes inBAL fluid were used as the indicator of cellular damages,those of leucocytic count and the indi-cator of inflammatory response,and those of the concentration of protein and Evans blue as theindicator of vascular permeability.In addition the effects of H2S on lipid peroxidation,naturalantioxidative system and energy substances and the changes of phospholipid concentration inBAL fluid were also observed.The results were as follows:1.Inhalation of H2S exerted a severe cytotoxic effect on the lung tissues resulting in dam-ages on various types of cells and a severe edematogenic effect on lung parenchyma.2.The development of pulmonary edema in H2S intoxication resulted from a combination ofdifferent pathogenic factors.3.The biochemical changes and their recovery occurred earlier than the pathologicalchanges and their recovery.The efficacy of 6 categories of drugs including 25 medicaments against H2S intoxication wasevaluated in mice,and 10 drugs were found to be prophylactically effective.The effects of vari-ous methemoglobin-forming agents and some other drugs were also studied in their treatment ofH2S intoxication in rabbits and dogs.It was concluded that methemoglobin-forming agentscould be used as specific antidotes but could not provent or alleviate the lung damages due toH2S inhalation unless they were administered in association with dexamethasone,vitamin E oranisodamine.A scheme of the medical treatment for H2S intoxication was presented.

Catechol-Bisphosphonate Conjugates: New Potential Chelating Agents for Metal Intoxication Therapy

In a quest for better chelating therapy drugs for the treatment of intoxication by Fe, Al, oractinides, two new series of mixed catechol-bisphosphonate through amide linkage were synthesized.Benzyl group was used as protecting group to avoid the breakage of amide by acid hydrolysis orimcomplete reaction in silylation-dealkylation using bromotrimethylsilane.

Antidotal administration of 4—dimethylaminophenol in cyanide intoxication and acute hemorrhage in dogs

Thirty-two mongrel dogs were divided into 4 groups.24 dogs of the 3 therapeutic groupswere inflicted with mild,medium,and severe hemorrhage through right femoral artery bleeding untilthe arterial systolic pressure dropped to 9.33,6.67 and 5.33 kPa,respectively,and then intoxicatedby intravenous NaCN 2.5mg/kg 3min after intoxication,intravenous 4-dimethylaminophenol(DMAP) 2 mg/kg was given.8 dogs of the control were inflicted with mild hemorrhage and similar-ly intoxicated,but no treatment was given.The changes of hemodynamics,blood gases andmethemoglobin were observed in the dogs.It was found that all the dogs of the control died with-in 5 min after administration of NaCN.DMAP could exert an excitatory effect on hemodynamicsand rescue the animals from death.The excitatory effect of DMAP became weaker whilehemorrhage became more severe.DMAP could further disturb the oxygen-caring capacity ofhemoglobin because of the formation of large amounts of methemoglobin when it was used as an anti-dote for cyanide intoxidation accompanied with acute hemorrhage.

Acute ethanol-related nervous system injuries

Acute ethanol intoxication has a diversity of clinical pictures that extend from mere euphoria to severe neurological impairment culminating in coma. Although the majority of cases have a reversible and benign course, the situation needs a careful medical monitoring. Authors describe pharmacological aspects of the acute ethanol intoxication, with organs and systems affected during the consumption of exaggerated quantities. Correlations between blood alcohol concentration and neurological symptomatology are given, and a brief discussion of the criteria for the acute intoxication is made. The fact that this occurrence has been of little attention is due not only to the reversibility of the majority of symptoms, but also because that medical research has been ever since focused more on chronic diseases related to alcohol abuse, withdrawal syndrome and recently with hangover as an independent situation. With no specific antidote actually at hand, treatment is symptom-oriented and the pharmacological armamentarium is richer when it comes to dealing with withdrawal, abstinence and other chronic complications of ethanol abuse.

A severe case of levothyroxine intoxication successfully treated in intensive care unit

Levothyroxine intoxication is a rare clinical entity which is usually asymptomatic. However, severe symptoms such as respiratory failure, malignant hyperthermia, seizures, arrhythmia, and coma have been reported. In this case report, a patient who ingested high dose (15 mg) levothyroxine for suicide and admitted to intensive care unit was presented. There was a decrease in Glasgow coma score in the follow-up. The patient was intubated due to acute respiratory failure. Gastric lavage, activated charcoal, methylprednisolone, cholestyramine and therapeuthic plasma exchange were administered. Despite ingestion of high dose of levothyroxine, thyrotoxicosis symptoms resolved with appropriate treatment and the patient was discharged from the intensive care unit.

Epidemiological and clinical data of patients with stings and bites at a medical center of Turkey

Objective: To analyze the epidemiological and clinical data of patients who were admitted to ?n?nü University Turgut ?zal Medical Center Emergency Department with bites and stings between 2013 and 2015. Methods: Patients with bites and stingings who were admitted to ?n?nü University Turgut ?zal Medical Center during 2013-2015 were selected for this retrospective evaluation. We retrived the following information including age, gender, anatomic localization of the sting or bite, admission time, complaints, vital signs, length of stay, laboratory findings and hospitalization department. Pearson's chi-square test, Fisher's exact test, One-way ANOVA test and the Bonferroni correction as post hoc were used for statistical analysis. Results: The mean age of the patients was (43.51±16.90) years, and 55% were male. The most common admission reason was pain (34.7%), followed by rash (19.1%) and panic (11.6%). A total of 16.8% of the admissions occurred in July, 16.8% in August and 16.5% in June while the occurrence was the lowest in November with 1.5%. The most prevalent bites or stinging animals were scorpions (34.6%), followed by ticks (19.7%) and bees (12.9%). Antihistaminic-steroid-tetanus and analgesic-antihistaminic-steroid combinations were administered, respectively to 59.6% and 25% of the patients. The longest length of stay was (48.56±26.92) h due to snake bites. Conclusions: The community should be educated about the living areas of these animals, the seasons and hours in which they are active. Since individuals living and working in rural areas are at risk, more education should be given to them.

Chelation in Metal Intoxication XLIV: Efficacy of α-Mercapto β-(5-Substituted, 2-Furyl) Acrylic Acids in Mobilizing Intracellularly Bound Cadmium in Rat

The efficacy of α mercapto β (2_furyl) acrylic acid (MFA), α mercapto β (5_sodiumsulfonate, 2_furyl) acrylic acid (MSFA) and α mercapto β (5_acetoxymethyl, 2_furyl) acrylic acid (MAFA) to mobilize intracellularly bound cadmium in liver and kidney was investigated in rats pre_exposed to cadmium. MFA was effective in reducing cadmium levels of hepatic and renal supernatant cytosolic fraction (SCF) while MSFA and MAFA were effective in lowering cadmium levels of renal SCF and hepatic SCF respectively. All the chelating agents also enhanced the excretion of cadmium more in feces than in urine. However, substitution on the furan ring lowered cadmium mobilizing efficacy of the parent compound, MFA. The treatment with MFA did not affect the status of endogenous zinc and copper while the treatment with MSFA and MAFA enhanced their excretion. MSFA increased hepatic and renal zinc and renal copper while MAFA increased their copper levels.

Synergistic Effects of Fumonisins B1 and B2 in Pigs:A Review

The productivity of swine farming depends on the large amount of nutrients that may contain mycotoxins.This review addresses the main smoke functions in food,its physical-chemical characteristics,metabolization,immunological factors and preventive measures.Fungal contamination can occur during virtually all stages of the development of the plant organism.The clinical results in animals are dependent on the amount of mycotoxins in their organism associated with the mycotoxin type,leading to pulmonary edema,decreased food intake and weight gain,and reduced ability to move.Pulmonary edema caused by fumonisin(FUMO)is the cause of the disease,but the definitive diagnosis is based on the observation of the lesions and the presence of FUMO in the raw materials of the diet.Prevention can be by use of additives as an adsorbent that can decrease or control existing toxins in the identified diet.It is necessary to have a careful assessment of the benefits of the more stringent prevention standards on the contamination of fumes,as well as their economic losses in the food chain.

Suicide attempt of an overt hypothyroid patient with levothyroxine:A case report

Rationale: Levothyroxine is the most commonly used agent in thyroid hormone replacement therapy. Although there are many hypothyroid patients who use levothyroxine as a treatment, high level of thyroid stimulating hormone is found in a limited number of levothyroxine overdose cases worldwide.Patient concern: A 34-year-old male patient taking 4.5 mg levothyroxine for suicide. Diagnosis: Overdose of levothyroxine. Interventions: The patient was admitted to the intensive care unit for follow-up treatment. Cardiac rithym and vital parameters of patient were closely monitored. Outcomes: The patient discharged without any life-threatening complications. Lessons: Patient with initial high thyroid stimulating hormone levels may not be in hyperthyroidism crisis by levothyroxine poisoning.