Severe aconite poisoning successfully treated with veno-arterial extracorporeal membrane oxygenation:A case report

BACKGROUND Most species of aconite contain highly toxic aconitines,the oral ingestion of which can be fatal,primarily because they cause ventricular arrhythmias.We describe a case of severe aconite poisoning that was successfully treated through venoarterial extracorporeal membrane oxygenation(VA-ECMO)and in which detailed toxicological analyses of the aconite roots and biological samples were performed using liquid chromatography-tandem mass spectrometry(LC-MS/MS).CASE SUMMARY A 23-year-old male presented to the emergency room with circulatory collapse and ventricular arrhythmia after ingesting approximately half of a root labeled,“Aconitum japonicum Thunb”.Two hours after arrival,VA-ECMO was initiated as circulatory collapse became refractory to antiarrhythmics and vasopressors.Nine hours after arrival,an electrocardiogram revealed a return to sinus rhythm.The patient was weaned off VA-ECMO and the ventilator on hospital days 3 and 5,respectively.On hospital day 15,he was transferred to a psychiatric hospital.The other half of the root and his biological samples were toxicologically analyzed using LC-MS/MS,revealing 244.3 mg/kg of aconitine and 24.7 mg/kg of mesaconitine in the root.Serum on admission contained 1.50 ng/mL of aconitine.Beyond hospital day 2,neither were detected.Urine on admission showed 149.09 ng/mL of aconitine and 3.59 ng/mL of mesaconitine,but these rapidly decreased after hospital day 3.CONCLUSION The key to saving the life of a patient with severe aconite poisoning is to introduce VA-ECMO as soon as possible.

Treatment of a patient with aconitine poisoning using veno-arterial membrane oxygenation:A case report

BACKGROUND Aconitine poisoning is highly prone to causing malignant arrhythmias.The elimination of aconitine from the body takes a considerable amount of time,and during this period,patients are at a significant risk of death due to malignant arrhythmias associated with aconitine poisoning.CASE SUMMARY A 30-year-old male patient was admitted due to accidental ingestion of aconitinecontaining drugs.Upon arrival at the emergency department,the patient intermittently experienced malignant arrhythmias including ventricular tachycardia,ventricular fibrillation,ventricular premature beats,and cardiac arrest.Emergency interventions such as cardiopulmonary resuscitation and defibrillation were promptly administered.Additionally,veno-arterial extracorporeal membrane oxygenation(VA-ECMO)therapy was initiated.Successful resuscitation was achieved before ECMO placement,but upon initiation of ECMO,the patient experienced recurrent malignant arrhythmias.ECMO was utilized to maintain hemodynamics and respiration,while continuous blood purification therapy for toxin clearance,mechanical ventilation,and hypothermic brain protection therapy were concurrently administered.On the third day of VA-ECMO support,the patient’s respiratory and hemodynamic status stabilized,with only frequent ventricular premature beats observed on electrocardiographic monitoring,and echocardiography indicated recovery of cardiac contractile function.On the fourth day,a significant reduction in toxin levels was observed,along with stable hemodynamic and respiratory functions.Following a successful pump-controlled retrograde trial occlusion test,ECMO assistance was terminated.The patient gradually improved postoperatively and achieved recovery.He was discharged 11 days later.CONCLUSION VA-ECMO can serve as a bridging resuscitation technique for patients with reversible malignant arrhythmias.

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

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.

Acquired methemoglobinemia in a third trimester puerpera and her premature infant with sodium nitrite poisoning:A case report

BACKGROUND The common cause of sodium nitrite poisoning has shifted from previous accidental intoxication by exposure or ingestion of contaminated water and food to recent alarming intentional intoxication as an employed method of suicide/exit.The subsequent formation of methemoglobin(MetHb)restricts oxygen transport and utilization in the body,resulting in functional hypoxia at the tissue level.In clinical practice,a mismatch of cyanotic appearance and oxygen partial pressure usually contributes to the identification of methemoglobinemia.Prompt recognition of characteristic mismatch and accurate diagnosis of sodium nitrite poisoning are prerequisites for the implementation of standardized systemic interventions.CASE SUMMARY A pregnant woman was admitted to the Department of Critical Care Medicine at the First Affiliated Hospital of Harbin Medical University due to consciousness disorders and drowsiness 2 h before admission.Subsequently,she developed vomiting and cyanotic skin.The woman underwent orotracheal intubation,invasive mechanical ventilation(IMV),and correction of internal environment disturbance in the ICU.Her premature infant was born with a higher-than-normal MetHb level of 3.3%,and received detoxification with methylene blue and vitamin C,supplemental vitamin K1,an infusion of fresh frozen plasma,as well as respiratory support via orotracheal intubation and IMV.On day 3 after admission,the puerpera regained consciousness,evacuated the IMV,and resumed enteral nutrition.She was then transferred to the maternity ward 24 h later.On day 7 after admission,the woman recovered and was discharged without any sequelae.CONCLUSION MetHb can cross through the placental barrier.Level of MetHb both reflects severity of the sodium nitrite poisoning and serves as feedback on therapeutic effectiveness.

Acute diquat poisoning case with multiorgan failure and a literature review:A case report

BACKGROUND With the withdrawal of paraquat from the market,diquat is widely used,so the treatment of diquat poisoning has become one of the focuses of emergency poisoning diagnosis and treatment.CASE SUMMARY We studied the case of a 17-year-old male patient who drank 200 mL(20 g/100 mL)of diquat solution two hours before arriving at the hospital.Despite the use of treatments such as gastric lavage,hemoperfusion,continuous hemodialysis,glucocorticoids,and organ support,the patient’s condition rapidly progressed to multiorgan failure,and he died 23.5 h after admission.CONCLUSION We summarized the clinical characteristics and treatment strategies of diquat poisoning through this case and performed a literature review to provide a basis and direction for clinical treatment.

Repeated atrial arrhythmia induced by cochineal red poisoning:A case report

BACKGROUND Cochineal red is an organic compound widely used in food,cosmetics,pharmaceuticals,textiles,and other fields due to its excellent safety profile.Poisoning caused by eating foods containing cochineal red is rare,and repeated atrial arrhythmia due to cochineal red poisoning is even rarer.CASE SUMMARY An 88-year-old Asian female patient was admitted to hospital due to a disturbance of consciousness.Twelve hours prior to presentation,the patient consumed 12 eggs containing cochineal red over a period of 2 h.At presentation,the patient was in a coma and had a score of 6 on the Glasgow Coma Scale(E2+VT+M4).The patient’s skin and mucous membranes were pink.Electrocardiography(ECG)revealed rapid atrial fibrillation without any signs of ischemia.We prescribed cedilan and fluid replacement for arrhythmia correction.Shortly after admission,the atrial fibrillation corrected to a normal sinus rhythm.On the day 2 of admission,the patient had a sudden atrial flutter accompanied by hemodynamic instability and rapidly declining arterial oxygen saturation between 85%and 90%.The sinus rhythm returned to normal after two electrical cardioversions.Six days after admission,the skin color of the patient returned to normal,and the ECG results were normal.The patient was transferred out of the intensive care unit and eventually discharged after 12 d in hospital.At the 2-mo follow-up visit,the patient was in good health with no recurrence of arrhythmia.CONCLUSION Although cochineal red is a safe,natural food additive,excessive consumption or occupational exposure can induce cardiac arrhythmias.

Cade Oil Poisoning: A Case Series

Objectives and Study: Cade oil is aromatic oil obtained from the branches and wood of Juniperus oxycedrus, common in the Mediterranean region and widely used in traditional medicine. This oil contains many chemical compounds with neurological, cardiac, renal, respiratory, hepatic, and gastrointestinal toxicity. Cade oil poisoning often requires intensive care admission due to the severity of the clinical picture. The objective of this study is to highlight the multiple manifestations found in the pediatric population due to cade oil exposure objectifying its significant toxicity. Methods: The authors report during this article a series of five cases of cade oil poisoning on pediatric patients hospitalized in the pediatric intensive care unit of El HARROUCHI hospital at the CHU Ibn Rochd in Casablanca during the period from 11/01/2022 to 12/07/2022. The patients have been exposed, a few hours before their admission, to an external cade oil application used by parents for therapeutic purposes. Main Findings: Our patients were aged from 1 month to 4 years, the average age was 1.5 years with a female predominance and a sex ratio of 1.5:1. The patients had no prior medical history, and the cade oil application was spontaneously declared by the parents of only 2 patients, 3 of them reported the use of it after the detection of the substance by the clinician. For all the cases, cade oil was applied to treat fever. All five (5) patients presented initial neurological signs. 3 of them were admitted to an acute consciousness disorder and the 2 other patients presented respectively a convulsive status epilepticus and generalized-onset seizure. We report respiratory symptoms in 4 cases ranging from a simple caught, rhinorrhea to severe respiratory distress. Three patients presented acute liver failure with very high transaminase levels associated with acute kidney failure. Two of them presented digestive symptoms such as abundant hematemesis, vomiting, and watery diarrhea. All patients received high doses of N acetylcysteine in their initial treatments. The evolution was unfavorable for 4 patients who developed a multiorgan failure, 3 of them died, with a good clinical improvement in the fifth patient after supportive and symptomatic treatment. Conclusion: Cade oil poisoning remains a very frequent situation in our context. Its toxicity is widely described in the literature. The increasing number of cases admitted, and the seriousness of the clinical picture require mass awareness among the population and the scientific community toward the use of medicinal plants.

Multiple organ dysfunction and rhabdomyolysis associated with moonwort poisoning: Report of four cases

BACKGROUND Moonwort is a widely used Chinese herbal medicine. It has various pharmacological effects, such as relieving cough and preventing asthma. To date,multiple organ dysfunction and rhabdomyolysis caused by moonwort poisoning have not been reported.CASE SUMMARY Here we report four cases of moonwort poisoning that presented with multiple organ dysfunction and rhabdomyolysis accompanied by vomiting, fatigue, and muscle aches. One patient was an adult male, two were adult females, and one was a boy, with an age range of 7–64 years. The adults were treated with hemoperfusion and symptomatic therapies, while the child was treated with plasma exchange and symptomatic therapies. All four patients recovered.CONCLUSION Blood purification combined with symptomatic treatment may be an effective method for managing multiple organ dysfunction and rhabdomyolysis caused by acute moonwort poisoning.

Cardiac arrhythmias and cardiac arrest related to mushroom poisoning: A case report

BACKGROUND Mushroom exposure is a global health issue.The manifestations of mushroom poisoning (MP) may vary.Some species have been reported as rhabdomyolytic,hallucinogenic,or gastrointestinal poisons.Critical or even fatal MPs are mostly attributable to Amanita phalloides,with the development of severe liver or renal failure.Myocardial injury and even cases mimicking ST-segment elevation myocardial infarction (STEMI) have been previously reported,while cardiac arrhythmia or cardiac arrest is not commonly seen.CASE SUMMARY We report a 68-year-old woman with MP who suffered from delirium,seizure,long QT syndrome on electrocardiogram (ECG),severe cardiac arrhythmias of multiple origins,and cardiac arrest.She was intubated and put on blood perfusion.Her kidney and liver functions were intact;creatine kinase-MB was mildly elevated,and then fell within normal range during her hospital stay.We sent the mushrooms she left for translation elongation factor subunit 1α,ribosomal RNA gene sequence,and internal transcribed spacer sequence analyses.There were four kinds of mushrooms identified,two of which were found to be toxic.CONCLUSION This is the first time that we found cardiac toxicity caused by Panaeolus subbalteatus and Conocybe lactea,which were believed to be toxic to the liver,kidney,and brain.We suggest that intensive monitoring and ECG follow-up are essential to diagnose prolonged QT interval and different forms of tachycardia in MP patients,even without the development of severe liver or renal failure.The mechanisms need to be further investigated and clarified based on animal experiments and molecular signal pathways.

Duodenal perforation after organophosphorus poisoning: A case report

BACKGROUND Organophosphorus poisoning(OP)is one of the common critical conditions in emergency departments in China,which is usually caused by suicide by taking oral drugs.Patients with severe OP have disturbance of consciousness,respiratory failure,toxic shock,gastrointestinal dysfunction,and so on.As far as we know,the perforation of the duodenum caused by OP has not been reported yet.CASE SUMMARY A 33-year-old male patient suffered from acute severe OP,associated with abdominal pain.Multiple computed tomography scans of the upper abdomen showed no evidence of intestinal perforation.However,retrograde digital subtraction angiography,performed via an abdominal drainage tube,revealed duodenal perforation.After conservative treatment,the symptoms eased and the patient was discharged from hospital.CONCLUSION Clinicians should pay close attention to gastrointestinal dysfunction and abdominal signs in patients with severe OP.If clinical manifestation and vital signs cannot be explained by common complications,stress duodenal ulcer or perforation should be highly suspected.

Can kissing cause paraquat poisoning: A case report and review of literature

BACKGROUND Paraquat is an effective,broad-spectrum,highly toxic quaternary ammonium herbicide.Paraquat poisoning has been reported frequently in recent years.It has severe lung,kidney,liver,and nervous system toxicity,and there is currently no specific antidote.Paraquat poisoning may follow ingestion,inhalation,and skin contact.There have been no previous reports of paraquat poisoning that resulted from kissing.This rare case provides a new reference for the prevention of paraquat poisoning.CASE SUMMARY A 27-year-old man came to the emergency department complaining that he had come into contact with paraquat by kissing his girlfriend,who had taken 80-120 mL 20%paraquat.After admission,his lung computed tomography(CT)showed increased lung markings.Redness and a burning sensation developed on his tongue,which progressed to painful erosions and coalescent ulcers.The final diagnosis was mild paraquat poisoning.Anti-inflammatory,antioxidant,and symptomatic treatment were initiated and continued for 7 d.Dyspnea did not occur,subsequent lung CT showed no significant changes,and the tongue pain was slightly improved.One month after discharge,the tongue injury was resolved.CONCLUSION This case indicated that the tongue and lung tissues are particularly vulnerable to paraquat toxicity,even after a limited exposure.

Acute Poisoning among Farmers by Chlorpyrifos: Case Report from Gaza Strip

Spraying of organophosphorus insecticides (OPI) using high volume technique may result in poisoning cases among farmers or inhabitants in the spraying zone. This study reported a case among farmers in Gaza Strip, Palestine and discussed the follow up treatments. Results showed sever fasciculation of tongue and all muscle, pinpoint pupils not reacting to light, losing consciousness and disoriented, irritability, followed by diarrhea, vomiting, and severe inhibition of acetyl choline esterase (ACHE). Irritability and low level of ACHE activity were the unique syndromes of this case. Management of the poisoning with Atropine injection was not successful treatment to cure the case. Treatment with Toxogonin as intravenous injection resulted in relieved the irritability of the poisoned case and cure the patient at the end point. During the six weeks of follow up period, the case was severely poisoned in the 1st week, moderate poisoned in the 2nd week and slightly poisoned at the 3rd week. A medical decision to release the patient was made after ACHE activity level reached 4750 U/L, which very close to the normal range. The farmers left the hospital after three weeks of medical treatments and follow up. It is recommended to use Toxogonin in the management of poisoned cases with OPI immediately on arrival of cases with losing consciousness.

Acute methanol poisoning with bilateral diffuse cerebral hemorrhage:A case report

BACKGROUND Acute methanol poisoning(AMP)is a systemic disease that mainly affects the central nervous system and is characterized by ocular damage and metabolic acidosis.If appropriate treatments are inadequate or delayed,the mortality can exceed 40%.As the most serious complication,cerebral hemorrhage is rare with reported prevalence of 7%-19%.CASE SUMMARY A 62-year-old man drank liquor mixed with 45%methanol and 35%alcohol.His vision blurred 10 h later and he fell into coma in another 9 h.Serum toxicological tests were performed immediately,and continuous renal replacement therapy(CRRT)was carried out as the lactic acid exceeded 15 mmol/L and blood pH was 6.78.In addition,the toxicological report revealed 1300.5μg/mL of methanol in serum and 1500.2μg/mL in urine.After 59 h of CRRT,the methanol level decreased to 126.0μg/mL in serum and 151.0μg/mL in urine.However,the patient was still unconscious and his pupillary light reflex was slow.Computed tomography showed hemorrhage in the left putamen.After 16 d of life support treatment,putamen hemorrhage developed into diffuse symmetric intracerebral hemorrhage.In the end,his family gave up and the patient was discharged,and died in a local hospital.CONCLUSION Cerebral hemorrhage requires constant vigilance during the full course of treatment for severe cases of AMP.

Successful Management of Carbamate Poisoning among Children: Case Report from Gaza Strip

A bad management of pesticide marketing and use resulted in using extreme toxic pesticides inside houses for controlling public health insects such as cockroaches. A child of two years old was poisoned with pesticide residues after application of pesticides at home for cockroach control. The child with a semi-conscious status was brought to the European hospital in south Gaza with his father along with the empty container of pesticide which was used at home. It appeared that Carbaryl (a carbamate insecticide) was the reason for poisoning. In the intensive care unite the child was washed out with clean water and his cloths were removed to reduced the possible hazards. Blood analysis showed that moderate inhibition of acetylcholinesterase (AChE) on addition became more sever on due time. Then the child was given several doses of atropine but without any improvement in AChE activity. Then the child was given Obedoxim as an antidote. This resulted in significant improvement of AChE activity. The child continued to receive Obedoxim every day until AChE activity reached the normal range. Blood analysis did not show any traces of Carbaryl. It is recommended to give Obedoxim to the carbamate immediately when someone is poisoned instead of atropine for successful management of the poisoned case.

Chronic colchicine poisoning with neuromyopathy,gastric ulcers and myelosuppression in a gout patient:A case report

Colchicine has been widely used as an anti-gout medication over the past decades.However,it is less commonly used due to its narrow therapeutic range,meaning that its lethal dose is close to its therapeutic dose.The lethal dose of colchicine is considered to be 0.8 mg/kg.As chronic colchicine poisoning has multiple manifestations,it poses a challenge in the clinician’s differential diagnosis.Historically,the drug was important in treating gout;however,clinical studies are currently underway regarding the use of colchicine in patients with coronavirus disease 2019 as well as its use in coronary artery disease,making this drug more important in clinical practice.CASE SUMMARY A 61-year-old male with a history of gout and chronic colchicine intake was admitted to our Emergency Department due to numbness and weakness of the lower limbs.The patient reported a history of colchicine intake for 23 years.After thorough examination,he was diagnosed with colchicine poisoning,manifesting as neuromyopathy,multiple gastric ulcers and myelosuppression.We advised him to stop taking colchicine and drinking alcohol.We also provided a prescription of lansoprazole and mecobalamin,and then asked him to return to the clinic for re-examination.The patient was followed up for 3-mo during which time his gout symptoms were controlled to the point where he was asymptomatic.CONCLUSION Colchicine overdose can mimic the clinical manifestations of several conditions.Physicians easily pay attention to the disease while ignoring the cause of the disease.Thus,the patient’s medication history should never be ignored.

Clinical analysis of pipeline dredging agent poisoning:A case report

BACKGROUND Pipeline dredging agents are new household deep cleaning products used to dredge blockages in kitchen and bathroom pipeline caused by grease,hair,vegetable residue,paper cotton fibre,and other organic substances.Pipeline dredging agents are corrosive chemicals that can cause poisoning through corrosive damage to the digestive tract;however,this has not been reported clinically.Therefore,this report emphasises that oral pipeline dredging agent poisoning can cause corrosive damage to the digestive tract and may have serious health consequences.CASE SUMMARY A 68-year-old man consumed liquor(200 m L) at approximately 13:00 on April 22,2021.At approximately 16:00,his family found him unresponsive with blackened lips,blood spots in the corners of the mouth,and blood stains on the ground,as well as an empty bottle of a pipeline dredging agent.One hour later,he was admitted to the emergency department of a local hospital.Considering the empty bottle,he was suspected to have sustained severe corrosive damage to the digestive tract and was transferred to our department at 23:15 on April 22,2021.He developed dysphagia and intermittent fever and experienced difficulty in opening his mouth throughout his hospital stay.The patient’s condition gradually stabilised.However,he suddenly developed respiratory failure on day 12,and endotracheal intubation and ventilator-assisted ventilation were performed.However,the patient died after 1.5 h despite emergency rescue efforts.CONCLUSION Pipeline dredging agents are highly corrosive and may cause corrosive damage to the digestive tract and asphyxia upon consumption.

Acute kidney injury due to intravenous detergent poisoning:A case report

BACKGROUND Detergent poisoning mostly occurs through oral ingestion(>85%),ocular exposure(<15%),or dermal exposure(<8%).Reports of detergent poisoning through an intravenous injection are extremely rare.In addition,there are very few cases of renal toxicity directly caused by detergents.Here,we report a unique case of acute kidney injury caused by detergent poisoning through an accidental intravenous injection.CASE SUMMARY A 61-year-old man was intravenously injected with 20 mL of detergent by another patient in the same room of a local hospital.The surfactant and calcium carbonate accounted for the largest proportion of the detergent.The patient complained of vascular pain,chest discomfort,and nausea,and was transferred to our institution.After hospitalization,the patient’s serum creatinine level increased to 5.42 mg/dL,and his daily urine output decreased to approximately 300 mL.Renal biopsy findings noted that the glomeruli were relatively intact;however,diffuse acute tubular injury was observed.Generalized edema was also noted,and the patient underwent a total of four hemodiafiltration sessions.Afterward,the patient’s urine output gradually increased whereas the serum creatinine level decreased.The patient was discharged in a stable status without any sequelae.CONCLUSION Detergents appear to directly cause renal tubular injury by systemic absorption.In treating a patient with detergent poisoning,physicians should be aware that the renal function may also deteriorate.In addition,timely renal replacement therapy may help improve the patient’s prognosis.

Lessons from a methanol poisoning outbreak in Egypt: Six case reports

BACKGROUND Mass methanol poisonings are challenging,especially in regions with no preparedness,management guidelines and available antidotes.CASE SUMMARY Six Ukrainian patients were referred to our emergency department in Cairo,Egypt several hours after drinking an alcoholic beverage made of 70%-ethanol disinfectant bought from a local pharmacy.All patients presented with severe metabolic acidosis and visual impairments.Two were comatose.Management was based on the clinical features and chemistry tests due to deficient resources for methanol leveling.No antidote was administered due to fomepizole unavailability and the difficulties expected to obtain ethanol and safely administer it without concentration monitoring.One patient died from multiorgan failure,another developed blindness and the four other patients rapidly improved.CONCLUSION This methanol poisoning outbreak strongly highlights the lack of safety from hazardous pharmaceuticals sold in pharmacies and limitations due to the lack of diagnostic testing,antidote availability and staff training in countries with limited-resources such as Egypt.

Characteristics of Poisoning Cases Admitted to Outpatient and Emergency Department—China,2019

Summary What is already known about this topic?Poisoning constitutes a significant cause of mortality among individuals aged 1 to 44 in China.Nonetheless,the epidemiological understanding of poisoning incidents within emergency departments remains fragmented across the region.