BVT, Bidirectional ventricular tachycardia in poisoning

 

Bidirectional ventricular tachycardia in poisoning – recent nine articles

-        QRS axis shifts 180 degrees from left to right with each alternate beat

-        Causes: severe digoxin toxicity; or familial catecholaminergic polymorphic ventricular tachycardia (CPVT), herbal aconite poisoning. Caffeine poisoning.

 

Year	Country	age	gender	Substance	References
2021	USA	78	F	Dogoxin	1
2019	Japan	27	F	Caffeine	2
2016	China	45	F	Aconitine	3
2014	Italy	83	F	Digoxin	4
2012	Japan	43	F	Aconitine	5
2009	Belgium	54	M	Digoxin	6
2005	France	86	F	Digoxin	7
2005	USA	59	F	Aconite	8
1992	Japan	69	M	Aconite	9

 

References

 

1.     https://pubmed.ncbi.nlm.nih.gov/34159036/

2.     https://pubmed.ncbi.nlm.nih.gov/31623982/

3.     https://pubmed.ncbi.nlm.nih.gov/26604120/

4.     https://pubmed.ncbi.nlm.nih.gov/25221680/

5.     https://pubmed.ncbi.nlm.nih.gov/30533117/

6.     https://pubmed.ncbi.nlm.nih.gov/19761942/

7.     https://pubmed.ncbi.nlm.nih.gov/16050845/

8.     https://pubmed.ncbi.nlm.nih.gov/15635326/

9.     https://pubmed.ncbi.nlm.nih.gov/1439251/ 

 

Edited by Yu-Jang Su  March 25, 2023

Dry bite of Snake venom

 

Dry bite Snake venom	Comment	Country	References
Definition	Failure to inject venom while biting	Denmark and Brazil.	1
Cause	[1] viral infections, [2] physical agents, [3] traumas during defense,  [4] excessive pressure on the venom glands (i.e., during manual extraction in captivity) [5] any other inflammatory response. [6] venom gland tissue damage will result in empty venom glands and, consequently, in dry bites.  [7]. Calcification of fangs and obstruction of the secondary venom ducts. [8]. Aged snakes often present these alterations	Denmark and Brazil.	1
Rate	18%	India	2
	Viperids (14.7%)    Elapids (14.5%)	Denmark and Brazil.	1
	19%	Turkey	3
	Rattlesnake 42.9%	Brazil.	4
	25—50%	Denmark and Brazil.	1
Diagnosis	The diagnosis of a dry bite is generally made retrospectively, once it has been confirmed that the bite was sustained from a venomous snake and that no envenoming occurred.	Denmark and Brazil.	1
Observe	Some toxins may exert their effects within minutes, while others may require several hours to take effect. Therefore, it is crucial to observe the patient long enough to enable differentiation between delayed onset of toxicity and a dry bite. Usually, clinical manifestations present within 12–24 h (or less) of the bite incident	Costa Rica; Spain, UK, Papua New Guinea, and Australia.	5

 

1.      https://pubmed.ncbi.nlm.nih.gov/33105644/

2.      https://pubmed.ncbi.nlm.nih.gov/33311806/

3.      https://pubmed.ncbi.nlm.nih.gov/17978913/

4.      https://pubmed.ncbi.nlm.nih.gov/8592769/

5.      https://pubmed.ncbi.nlm.nih.gov/28905944/

 Edited by Yu-Jang Su   Feb, 7, 2023

Current 10 articles related to New Psychoactive Substance

 

Country	Journal	Date	Important information	References
Spain	Anal Methods	2023 Jan 3	Using Membrane-assisted solvent extraction followed by liquid chromatography-tandem mass spectrometry for urine testing	[1]
Canada	Nicotine Tob Res.	2023 Jan 2	Compassion clubs are a model for the distribution of psychoactive substances that are focused on harm reduction and social support rather than profit.	[2]
Australia	Front Psychiatry.	2022 Dec 15	Synthetic cannabinoid receptor agonists (SCRAs) are a diverse class of new psychoactive substances that have been associated with multiple instances and types of toxicity. Some "off-targets" could possibly contribute to the SCRA toxidrome, particularly at high concentrations, CB1-mediated cellular dysfunction provides support for hypotheses concerning on-target, rather than off-target, toxicity.	[3]
UK	Drug Test Anal.	2022 Dec 29.	Higher drug levels were detected in leg hair for cannabinol, THC, methadone, and EtG and in beard hair for THC, THC-COOH, and 6-acetylmorphine. In contrast, significantly lower levels were detected in axilla hair for cannabinol, THC and for EDDP, but median levels of mephedrone and DHEA were higher.	[4]
France	Rev Epidemiol Sante Publique.	2022 Dec 24	Drug consumption rooms (DCR) are devices that target people who inject drugs (PWID) exposed to high sanitary or social risks, i.e. people living in precarious conditions, who have to inject in public spaces, in deleterious sanitary environments and with rapid gestures in order not to be seen. These analyzes highlight that the people who most want to attend a DCR are aware of the harms associated with their practices and show a desire to seek protection from street-based drug scenes.	[5]
Taiwan	J Forensic Leg Med.	2022 Dec 22	NPS users were 5.7 years younger than non-NPS drug users (37 vs. 42.7 years, p = 0.022). NPS users had a 2.6-fold higher rate of suicide and a 2.9-fold greater possibility of violence than non-NPS drug users. Moreover, NPS users experienced a 4.3-fold greater feeling of palpitation (p = 0.024) and had an 8.1-fold higher chance of presenting facial flush (p = 0.032) than non-NPS drug users.	[6]
Czech Republic	Pharmaceuticals (Basel).	2022 Nov 30	Find a synthetic pathway for a novel synthetic cathinone, namely 4-isobutylmethcathinone, and describe its spectroscopic properties and biological activity in vitro. Higher cytotoxicity in comparison with other synthetic cathinones. In the receptor binding studies, a significant difference in the agonistic effect on dopamine and adrenergic receptors of individual enantiomers was observed. The lack of binding affinity towards the serotonin receptors then relates 4-isobutylmethcathinone to the family of monoamine drugs, such as 3,4-methylenedioxymathamphetamine (ecstasy, MDMA).	[7]
Germany	Metabolites.	2022 Dec 2	In Vitro and In Vivo Toxicometabolomics of the Synthetic Cathinone PCYP Studied by Means of LC-HRMS/MS	[8]
France	Int J Mol Sci.	2022 Dec 8	Arylcyclohexylamine (ACH) compounds such as ketamine, phencyclidine and eticyclidine derivatives are rapidly increasing use and the absence of detailed toxicity data. First used mainly for their pharmacological properties in anesthesia, their recreational use is increasing. ACH derivatives have an antagonistic activity against the N-methyl-D-aspartate receptor, which leads to dissociative effects (dissociation of body and mind). Synthetic ketamine derivatives produced in Asia are now arriving in Europe, where most are not listed as narcotics and are, thus, legal. These structural derivatives have pharmacokinetic and pharmacodynamic properties that are sometimes very different from ketamine.	[9]
Sweden. Netherlands. USA. UK.	Basic Clin Pharmacol Toxicol.	2022 Dec 21	4'Cl-cumyl-PINACA (SGT-157), 4'F-cumyl-5F-PINACA (4F-cumyl-5F-PINACA, SGT-65) and 4'F-cumyl-5F-PICA (4F-cumyl-5F-PICA, SGT-64) are a series of new halogenated cumyl synthetic cannabinoid receptor agonists (SCRAs). Many metabolites retained halogen groups at the cumyl moieties which, in various combinations, may be suitable as analytical biomarkers.	[10]

 

[1] https://pubmed.ncbi.nlm.nih.gov/36594640/

[2] https://pubmed.ncbi.nlm.nih.gov/36591922/

[3] https://pubmed.ncbi.nlm.nih.gov/36590635/

[4] https://pubmed.ncbi.nlm.nih.gov/36581323/

[5] https://pubmed.ncbi.nlm.nih.gov/36571957/

[6] https://pubmed.ncbi.nlm.nih.gov/36571928/

[7] https://pubmed.ncbi.nlm.nih.gov/36558946/

[8] https://pubmed.ncbi.nlm.nih.gov/36557246/

[9] https://pubmed.ncbi.nlm.nih.gov/36555217/

[10] https://pubmed.ncbi.nlm.nih.gov/36544361/

edited by Yu-Jang Su  Jan 4, 2023

 

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.