硼砂Na2B4O5(OH)4·8H2O中毒; 硼酸 H3BO3中毒

 Substance

-       Na2B4O5(OH)4·8H2O

-       A hydrated borate of sodium

-       Alkaline after soluble in water

 

Common name/ Trade name

-       Borax

-       Boric acid, H3BO3, prepared from borax. [1]

 

Involving system [2]

-       Respiratory system: acute poisoning via inhalation exposure

-       GI system: acute poisoning after oral exposure

-       Skin: could be affected by oral or dermal exposure

-       CV system and CNS system: could be affected under chronic exposure

 

Presentation

-       Respiratory system: nose and throat irritation, causing coughing or dyspnea

-       GI system: diarrhea or vomiting, frequently confused with acute gastroenteritis [1]

-       Skin: eye irritation, skin lesions, hair loss, exfoliation, desquamation of the skin ("boiled lobster" rash) [1, 3, 4]

-       CV system: Arrhythmia

-       CNS system: Seizure, delirium, coma [1, 5]

-       a Large amount of borax ingestion may cause death [2]

 

Antidote/Treatment

-       No specific antidote

-       NG irrigation and usage of activated charcoal or laxatives are  NOT recommended due to poor adsorptive capacity [1]

-       Exchange transfusion, Dialysis may be a possible method for preventing deterioration [1]

 

Disposition

-       Alkaline ingestion should be treated according to the Zargar grading of esophagogastroduodenoscopy

-       Lethal dose is 2-3 grams for infants, 5-6 grams for children, and 15-20 grams for adults

 

References

[1]   Goldfrank’s Toxicologic Emergencies 11th ed. Ch.101: 1375.

[2]  Hadrup N, Frederiksen M, Sharma AK. Toxicity of boric acid, borax and other boron containing compounds: A review. Regul Toxicol Pharmacol. 2021 Apr;121:104873. doi: 10.1016/j.yrtph.2021.104873. Epub 2021 Jan 22. PMID: 33485927

[3]  Hubbard SA. Comparative toxicology of borates. Biol Trace Elem Res. 1998 Winter;66(1-3):343-57. doi: 10.1007/BF02783147. PMID: 10050929.

[4]  Beckett WS, Oskvig R, Gaynor ME, Goldgeier MH. Association of reversible alopecia with occupational topical exposure to common borax-containing solutions. J Am Acad Dermatol. 2001 Apr;44(4):599-602. doi: 10.1067/mjd.2001.112223. PMID: 11260532.

[5]  Gordon AS, Prichard JS, Freedman MH. Seizure disorders and anemia associated with chronic borax intoxication. Can Med Assoc J. 1973 Mar 17;108(6):719-21 passim. PMID: 4691106; PMCID: PMC1941259.

 

- edited by Chun Chen and Yu-Jang Su  Dec 21, 2022.

 

 

Poisoning / Intoxicated Related Jaundice

 

Year	Country	Substance	Content	Reference
2020	Pakistan	Paracetamol	Presented with pain in the abdomen, vomiting, and jaundice	https://pubmed.ncbi.nlm.nih.gov/32703356/
2019	Romania	Mushroom poisoning	ALF, acute liver failure	https://pubmed.ncbi.nlm.nih.gov/35154529/
2021	Portugal	Chronic Copper Sulfate	Dysphagia to solids and liquids, anemia, acute kidney injury, liver cytolysis, and hypocalcemia.	https://pubmed.ncbi.nlm.nih.gov/33768078/
2014	France	Naphthalene, 萘	Delirium, fever and jaundice, three days after ritual ingestion of naphthalene	https://pubmed.ncbi.nlm.nih.gov/24909442/
2015	Sweden	Amanita phalloides	Gastrointestinal disorders followed by jaundice, seizures, and coma, culminating in death	https://pubmed.ncbi.nlm.nih.gov/26375431/
2008	South Korea	Chloroform and dichloromethane	Abnormal liver enzymes were noted on postingestion day 2, and jaundice occurred on postingestion day 3	https://pubmed.ncbi.nlm.nih.gov/19091298/
2005	Mexico	Arsenic	Alterations of consciousness, from confusion until delirium, crash, hematuria, jaundice and renal insufficiency.	https://pubmed.ncbi.nlm.nih.gov/15998481/
2004	Poland	Acetaminophen	Liver injury (progressive encephalopathy and jaundice, decreased prothrombin activity) developed	https://pubmed.ncbi.nlm.nih.gov/15521608/
2002	Germany	MDMA	nausea, vomiting, abdominal pain and jaundice	https://pubmed.ncbi.nlm.nih.gov/12297982/
1997	Germany	Methylenedianiline, 工業製造的化學物質，並不會自然產生，也稱為 MDA。它也被用來製造塗層材料、膠水、 纖維、染料和橡膠。 會存在空氣中的微小粒子。	Acute jaundice developed within 2 days after ingestion	https://pubmed.ncbi.nlm.nih.gov/9022650/
1985	Germany	Vitamin A	prehepatic and hepatic icterus and hypersplenism with hemolytic anemia.	https://pubmed.ncbi.nlm.nih.gov/3992236/
1989	France	Geromitra esculenta, 鹿花菌 又名鹿花蕈或河豚菌	vomiting and diarrhoea, and, afterwhile, by jaundice, convulsions and coma.	https://pubmed.ncbi.nlm.nih.gov/2681713/
1983	Australia	Phenylbutazone (NSAIDS)	coma, convulsions, diarrhoea, and of cholestatic jaundice which evolved over the succeeding 10 days.	https://pubmed.ncbi.nlm.nih.gov/6843432/

(Excluding experimental and animal studies)

 

Edited by Yu-Jang Su  Nov 29, 2022 

Acute Poisoning / Intoxication Related Acute Hepatitis

 

Year	Country / Language	Substance	References
1978	France	Gyromitra esculenta鹿花菌	https://pubmed.ncbi.nlm.nih.gov/754347/
1982	France	Paracetamol	https://pubmed.ncbi.nlm.nih.gov/6280319/
1985	France	Maprotiline (TCA)	https://pubmed.ncbi.nlm.nih.gov/3880282/
1985	Germany	Lead Picture of Lead Poisoning	https://pubmed.ncbi.nlm.nih.gov/4007894/
1989	Japan	Bromovalerylurea (止痛鎮靜藥)	https://pubmed.ncbi.nlm.nih.gov/2794681/
1990	France	Isoniazid	https://pubmed.ncbi.nlm.nih.gov/2328884/
1991	France	Methotrexate	https://pubmed.ncbi.nlm.nih.gov/1836586/
1992	Belgique	Amanita phalloides毒鵝膏	https://pubmed.ncbi.nlm.nih.gov/1462748/
1997	Germany	Methylene dianiline p,p'-diaminodiphenylmethane塗層材料、膠水、氨綸纖維、染料和橡膠	https://pubmed.ncbi.nlm.nih.gov/9022650/
2002	Germany	Ecstasy (MDMA)	https://pubmed.ncbi.nlm.nih.gov/12297982/
2008	Korea	Chloroform and dichloromethane	https://pubmed.ncbi.nlm.nih.gov/19091298/
2009	Colombia	White phosphorus	https://pubmed.ncbi.nlm.nih.gov/19502664/
2009	Poland	Amanita phalloides	https://pubmed.ncbi.nlm.nih.gov/19999046/
2013	France	Ecstasy and cocaine	https://pubmed.ncbi.nlm.nih.gov/23910059/
2016	Turkey	Mad honey	https://pubmed.ncbi.nlm.nih.gov/27239626/
2017	Pakistan	Paraphenylene Diamine 染髮劑	https://pubmed.ncbi.nlm.nih.gov/28534001/
2018	Belgium	Cresol	https://pubmed.ncbi.nlm.nih.gov/29869478/
2020	Pakistan	Paraphenylenediamine	https://pubmed.ncbi.nlm.nih.gov/32617225/
2020	Algeria	Paracetamol	https://pubmed.ncbi.nlm.nih.gov/32983905/
2021	Portugal	Cooper	https://pubmed.ncbi.nlm.nih.gov/34671575/
2022	Pakistan	Paraphenylenediamine (Hair Dye)	https://pubmed.ncbi.nlm.nih.gov/36258948/

 

Edited by Yu-Jang Su  Oct 29, 2022

Chlorfenapyr Poisoning

 SUBSTANCE

-          C₁₅H₁₁BrClF₃N₂O (https://pubchem.ncbi.nlm.nih.gov/compound/Chlorfenapyr

-          a pyrrole insecticide

           

Common name / Trade name

-          Chlorfenapyr

 

Involving SYSTEM [1]

- CV: on the respiratory or cardiovascular systems

- ANS: autonomic nervous system and prominent neurotoxicity, dose-dependent.

- Muscle: skeletal muscle system, elevated CK.

- GI: gastrointestinal system: upset.

- blood coagulopathy. 

- Renal: elevated levels of blood urea nitrogen (BUN) and total protein.

- Deposited concentration ranked: 

  Fat, Large intestine, Blood, Liver, Muscle, Kidney, bone, brain, and lung. [2]. 

 

Presentation [1]

- Epidemiology: Age is 52.2±15.6 years old     

- Fever: the highest body temperature was 40.8±1.1 degrees Celsius.

- Consciousness: decrease in spontaneous motor activity, gait abnormality, and abnormal arousal.   

– Vital signs: Hyperthermia

- Neuro: salivation, convulsion, and death in large dose intoxication, bilateral leg weakness, and urinary incontinence.

- Rhabdomyolysis: the elevated CK level (4966±5978.4 IU/L)   

  - Metabolic acidosis

- Pancreatitis.    

 

Antidote / Treatment [1]

-          No specific antidote.

-          Early gastric decontamination 

-          Prolonged dialysis may be a possible method for preventing deterioration.

-          Effective supportive care.

 

Disposition

 

- The length of stay was 10.3±6.1 days.

- Initiation of fever and a deteriorating consciousness is the warning sign of a sudden fatal outcome.

- The mortality rate was up to 80%.        

 

REFERENCES

[1] Chien SC, Chien SC, Su YJ. A fatal case of chlorfenapyr poisoning and a review of the literature. J Int Med Res. 2022 Sep;50(9):3000605221121965. doi: 10.1177/03000605221121965. PMID: 36112969; PMCID: PMC9483958.

 [2]. https://pmc.ncbi.nlm.nih.gov/articles/PMC11153369/

 

Edited by Yu-Jang Su Sep 26, 2022. 

Revised. Feb 2, 2025.

Naloxone

 

Naloxone	Situation	Concern	References
Pregnancy	Category C		[1] [2]
Contraindicated	Allergy
controversial	Seizure	Naloxone alone reduced the number and duration of seizures but increased the number of mild seizures	[3 [4][5][6]
controversial	Alcohol intoxicated	Lacks effectiveness in ethylic coma	[7]
Precautions	Bronchospasm	Hypoxia risk	[8]
Precautions	COPD	Hypoxia risk	[2]
Precautions	Respiratory failure/ distress	Hypoxia risk	[2]
Precautions	Lung edema, non-cardiogenic	Hypoxia risk	[2]
Adverse effect	BPH	Acute urinary retention. (AUR)	[9]
Adverse effect	Acute abdomen, pancreatitis	Induced.	[10]
Treatment	Acute abdomen, IBD	Efective and safe, and could be considered for the treatment of therapy refractory IBD patients	[11]
Precautions	Liver, renal impaired function	Hepatitis	[2]
Contraindicated	hypothyroidism	Increment oxygen consumption, but not ventilation.	[12]

 

References

[1] Goldfrank’s p.541, 11th ed.

[2] https://www.ncbi.nlm.nih.gov/books/NBK534811/

[3] https://pubmed.ncbi.nlm.nih.gov/32133101/

[4] https://pubmed.ncbi.nlm.nih.gov/30676832/

[5] https://pubmed.ncbi.nlm.nih.gov/34051813/

[6] https://pubmed.ncbi.nlm.nih.gov/15167188/

[7] https://pubmed.ncbi.nlm.nih.gov/8115696/

[8] https://pubmed.ncbi.nlm.nih.gov/23380114/

[9] https://pubmed.ncbi.nlm.nih.gov/31975924/

[10] https://pubmed.ncbi.nlm.nih.gov/27922226/

[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845217/

[12] https://pubmed.ncbi.nlm.nih.gov/7800724/

Edited by Yu-Jang Su    Aug 13, 2022