Glufosinate

 Substance

 

Glufosinate-Ammonium 13.5%SL

 

Common name / Trade name

 

強手(固殺草); 草銨膦

 

Involving system

-          Mechanism: glutamine synthetase-inhibiting [1]

-          Interferes with glutamate synthetase activity [2]

-          Neurotoxicity.

-          Mental disturbances [3]

-          Hematological changes

-          Gastrointestinal effects [3], nausea.

 

Presentation

-          Altered mental status [4] amnesia [2]

-          Fever [2]

-          Arrhythmia, [2]

-          Seizure, 31.5% [5]

-          higher initial ammonia levels. [6]

-          respiratory failure. [7]

-          Vasogenic edema in striatum [8]

-          Shock [2]

 

Antidote and Treatment

-          Activated charcoal, Carbomix [2].

-          IVF, monitoring urine output.

-          Intubation if respiratory failure

-          Monitoring.

-           supportive care.

-           benzodiazepine for seizure

-          Without antidote.

-          Hemodialysis [2]

 

Disposition

-          Observe 48 hours, [2]

-          Age > 70 years and GCS score < 9 at triage could be predictors of mortality in patients. [4]

-          An initial serum ammonia level >151 µg/dL was an independent early predictor of in-hospital mortality [9]

-          Older age (≥ 61 years; adjusted OR 4.9) and larger amount of glufosinate ingestion (≥ 13.9 grams; adjusted OR 25.2) were positively associated with the development of severe toxicity [10].

-          6.1% to 17.7% died following deliberate glufosinate ingestion. [2, 10]

 

References

 

[1]. https://pubmed.ncbi.nlm.nih.gov/36963955/

[2].Goldfrank’s Toxicology Emergencies p1478—79. 11^th ed.

[3] https://pubmed.ncbi.nlm.nih.gov/9491336/

[4] https://pubmed.ncbi.nlm.nih.gov/34392143/

[5]. https://pubmed.ncbi.nlm.nih.gov/28421825/

[6] https://pubmed.ncbi.nlm.nih.gov/36399183/

[7]. https://pubmed.ncbi.nlm.nih.gov/24044532/

[8] https://pubmed.ncbi.nlm.nih.gov/19581091/

[9]. https://pubmed.ncbi.nlm.nih.gov/31146590/

[10] https://pubmed.ncbi.nlm.nih.gov/22480254/

 

Edited by Yu-Jang Su May 1st, 2023. 

Inoxicated / Poisoning-Related Coma Blister

 

Inoxicated / Poisoning-Related Coma Blister
Year	Country	Age	Gender	Substance	References
2022	US	82	F	lorazepam for insomnia	1
2012	Brazil	45	F	clonazepam, promethazine, oxcarbazepine and quetiapine	2
2009	UK			barbiturate	3
2007	UK	53	F	Acetaminophen 500mg, codeine 30mg	4
2002	Germany			theophylline toxicity	5
2002	Canada			amitriptyline overdose	6
1991	Australia	25	M	carbon monoxide	7
1990	Ichilov	75		200 mg oxazepam	8
1972				BARBITURATE	9

1.      https://pubmed.ncbi.nlm.nih.gov/35180064/

2.      https://pubmed.ncbi.nlm.nih.gov/22892778/

3.      https://pubmed.ncbi.nlm.nih.gov/19359256/

4.      https://pubmed.ncbi.nlm.nih.gov/17952753/

5.      https://pubmed.ncbi.nlm.nih.gov/12198361/

6.      https://pubmed.ncbi.nlm.nih.gov/12447625/

7.      https://pubmed.ncbi.nlm.nih.gov/1743385/

8.      https://pubmed.ncbi.nlm.nih.gov/2231838/

9.      https://pubmed.ncbi.nlm.nih.gov/4116178/

 edited by Yu-Jang Su  April 12, 2023. 

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