Imidacloprid Poisoning

 

SUBSTANCE

imidacloprid poisoning 

 

Common name / Trade name

-       One kind of Neonicotinoid

 -益達胺; 霹靂掌; 金剛棒; 一帖靈; 勁厲害

-First-generation compounds appear to have significantly worse toxicity than second generation compounds despite both being classified as class II compounds (moderately hazardous) according to the WHO classification [1]

-Most were exposed by ingestion (93.3%) [2]

Involving SYSTEM

-Nervous system: nausea or vomiting with nervous system involvement [1] neurological effects (14.2%) [2]

- competitive inhibitor at the nicotinic acetylcholine receptors interfering with the transmission of impulses leading to fatigue and paralysis. [3]

-Renal: rhabdomyolysis resulting in acute kidney injury [4]

-GI: gastrointestinal symptoms (63.8%) with no corrosive injuries [2]

- other: ischemic and metabolic encephalopathy, multiorgan failure [4]

- arrhythmia: ventricular fibrillation [4]

-       neuropsychiatric sequelae [4]

 

Presentation

-       altered consciousness (32.1%) or muscle weakness (21.4%) [1]

-       drowsy but arousable, dyspnoeic, and profusely sweating [3]

-       Autonomic nervous system: stimulation causes sweating, dilated pupils, tachycardia, and hypertension [3]

-       nausea or vomiting, abdominal pain, drowsiness, headache, or dizziness, but some cases may be asymptomatic [4]

-        

Antidote / Treatment

-       GI decontamination. [3]

-       activated charcoal [4]

-       Intubation if unconscious [3]

-       No antidote, supportive care.

 

Disposition

-       predominantly male (60.7%) [1] no (18.4%) to mild (76.1%) toxicity [2]

-       A minority of patients required invasive care (28.6%) or invasive ventilation (25.0%) [1]

-       ICU care: in high lactate, RR> 24.7/min, GCS<11, SOFA score >3.4 [1]

-       cardiovascular effects (especially tachycardia and cardiac arrest), central nervous system effects (especially coma), dyspnea, and diaphoresis were significantly associated with mortality [2]

-       Mortality rate: 3.1% [2]

 

REFERENCES

1.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10949290/

2.https://pubmed.ncbi.nlm.nih.gov/33204096/

3.https://pubmed.ncbi.nlm.nih.gov/36987471/

4.    https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-022-03742-8

edited by Yu-Jang Su                  5 June 2024

 

Lophophora williamsii Poisoning

 

 Substance

Lophophora williamsii, contains active alkaloids—such as pellotine, anhalonidine, hordenine and mescaline [1].

Plant: peyote [2]

less potent than LSD. [3, 4]

 

Common name or Trade name 

烏羽玉

 

Involving system

-       a serotonin agonist. [3]

-       serotonin 5HT2A/2C receptor agonist [4]

-       α1A/2A noradrenaline and D1/2/3 dopamine receptors.[4]

-       Toxidrome of a sympathomimetic effect. [5]

 

Presentation

Onset 30-60 minutes, lasts 5-12 hours (though wide individual variability) [3]

Psycho- Hallucination, agitation, euphoria, altered sensorium, altered sense of time, extreme focus or distractibility, hallucinations, Dizziness, headache. [3, 4] depersonalization and psychoses.[5]

CV- tachycardia, hypertension and vomiting. [3]

Abdomen - Nausea/vomiting, abdominal pain. [3]

Pupil - mydriasis [3]

Other - energy, esoteric/spiritual experiences. [3].

 

Antidote and Treatment

No antidote, standardly supportive treatment. [3]

Supportive care. [3]

Not usually associated with significant morbidity/mortality. [3]

 

Disposition

 Treat and observe.

 

References

[1]: Doesburg-van Kleffens M, Zimmermann-Klemd AM, Gründemann C. An Overview on the Hallucinogenic Peyote and Its Alkaloid Mescaline: The Importance of Context, Ceremony and Culture. Molecules. 2023 Dec 5;28(24):7942.

[2]:  Kapadia GJ, Highet RJ. Peyote alkaloids. IV. Structure of peyonine, novel beta-phenethylpyrrole from Lophophora williamsii. J Pharm Sci. 1968 Jan;57(1):191-2.

[3]. https://wikem.org/wiki/Mescaline_toxicity

[4]. Vamvakopoulou IA, Narine KAD, Campbell I, Dyck JRB, Nutt DJ. Mescaline: The forgotten psychedelic. Neuropharmacology. 2023 Jan 1;222:109294.

[5] Dinis-Oliveira RJ, Pereira CL, da Silva DD. Pharmacokinetic and Pharmacodynamic Aspects of Peyote and Mescaline: Clinical and Forensic Repercussions. Curr Mol Pharmacol. 2019;12(3):184-194.

Edited by Yu-Jang Su 

 21 May 2024

 

Bongkrekic Acid Poisoning

 

SUBSTANCE

  Bongkrekic acid

-          molecular weight of 486 kDa [1]    

-          ever been reported from Indonesia, China, and more recently in Mozambique.[1]

-          test liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) using blood samples. [2].

-          B. cocovenenans is often called Pseudomonas cocovenenans subsp. farinofermentans. [3].

 

 

Common name / Trade name

-          Pathogenic bacteria Burkholderia gladiolus (B. gladiolus) foodborne. Burkholderia cocovenenans [4, 5]

-          Possible related food not well- reserved : wet rice and starch products, Tremella, and Auricularia auricula [6]    

-          Wet rice noodles with 4% soybean oil had a BA concentration of 31.72 ± 9.41 mg/kg, 5.74 times higher than those without soybean oil (5.53 ± 1.23 mg/kg). [6]

-          Mitochondrial toxins: it inhibits adenine nucleotide translocase (ANT)[1]

-          Not-well reserved coconut- or corn-based foods [1]

 

 

Involving SYSTEM

-          Liver :progressive dysfunction of liver function and coagulation function [3]

-      Kidney: Acute kidney injury.  [3]

-          Diffuse changes in the liver, hepatic failure. [3]

-          Brain, CNS.: Collapse and altered mental status.

 

Presentation

-          Altered mental status.

-          Hepatic failure.

-          Acute kidney injury

-          Shock presentation.

-          Collapse, sudden.

-          OHCA, (Out of Hospital Cardiac Arrest).

-          Respiratory failure.

-          Abdominal pain, diarrhea, vomiting, and generalized malaise. [7]

-          Death was preceded by psycho-motor agitation and abnormal posturing.[7]

 

 

Antidote / Treatment

- No specific antidote.

- Fresh frozen plasma.

- Plasma exchange was suggested. [8]

- Molecular Adsorbent Recirculating System (MARS) [9]

- Continuous veno-venous hemodiafiltration (CVVHDF)

- aggressive supportive care.

- ICU, intensive care is mandatory.

 

 

Disposition

 

-          mortality rate of up to 40 % or more [4]

-          The reported case fatality rates averaged 60%, 32%, and 26.5% [3]

-          The median course of disease in 9 cases was 53 hours (range: 20–341 hours).

-          In China a patient had the longest latency period, and he returned home after receiving prescription medication from the OPD. He then died at home with the shortest course of illness, which was only 20 hours. [3]

 

 

REFERENCES

 

[1] Anwar M, Kasper A, Steck AR, Schier JG. Bongkrekic Acid-a Review of a Lesser-Known Mitochondrial Toxin. J Med Toxicol. 2017 Jun;13(2):173-179. doi: 10.1007/s13181-016-0577-1.

 

[2]. Zhou B, Li HL, Ma J, Dong F, Yu Y. [Fast determination of bongkrekic acid in plasma by high performance liquid chromatography-tandem mass spectrometry]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2022 Mar 20;40(3):219-221.

 

[3]. Yuan Y, Gao R, Liang Q, Song L, Huang J, Lang N, Zhou J. A Foodborne Bongkrekic Acid Poisoning Incident - Heilongjiang Province, 2020. China CDC Wkly. 2020 Dec 18;2(51):975-978.

 

[4] Wang T, Cheng B, Jiao R, Zhang X, Zhang D, Cheng X, Ling N, Ye Y. Characterization of a novel high-efficiency cracking Burkholderia gladiolus phage vB_BglM_WTB and its application in black fungus. Int J Food Microbiol. 2024 Apr 2;414:110615. doi: 10.1016/j.ijfoodmicro.2024.110615. Epub 2024 Feb 3. PMID: 38325260.

 

[5] Jiao Z, Kawamura Y, Mishima N, Yang R, Li N, Liu X, Ezaki T. Need to differentiate lethal toxin-producing strains of Burkholderia gladioli, which cause severe food poisoning: description of B. gladioli pathovar cocovenenans and an emended description of B. gladioli. Microbiol Immunol. 2003;47(12):915-25.

 

[6]. Yao Y, Zhong X, Zhou Y, Zhang H, Zhao D, Zhang W, Liu Y, Xu J, Xie C, Yu C, Wang Y, Chen Z, Chen K, Yuan J. Exploring the characteristics of Burkholderia gladioli pathovar cocovenenans: Growth, bongkrekic acid production, and potential risks of food contamination in wet rice noodles and vermicelli. Food Microbiol. 2024 Jun;120:104449.

 

[7]. Gudo ES, Cook K, Kasper AM, Vergara A, Salomão C, Oliveira F, Ismael H, Saeze C, Mosse C, Fernandes Q, Viegas SO, Baltazar CS, Doyle TJ, Yard E, Steck A, Serret M, Falconer TM, Kern SE, Brzezinski JL, Turner JA, Boyd BL, Jani IV; Chitima Investigation Group. Description of a Mass Poisoning in a Rural District in Mozambique: The First Documented Bongkrekic Acid Poisoning in Africa. Clin Infect Dis. 2018 Apr 17;66(9):1400-1406.

 

[8] Lv R, Zeng W, Zhang P, Chen X, Yuan K, Shen H, Tian J, Li D, Zhao L, Liu Y. The toxicokinetic and extracorporeal removal of bongkrekic acid during blood purification therapies: A case report. Toxicon. 2023 Sep;233:107275.

 

[9]. Saliba F. The Molecular Adsorbent Recirculating System (MARS) in the intensive care unit: a rescue therapy for patients with hepatic failure. Crit Care. 2006 Feb;10(1):118.

 

 

Edited by Yu-Jang Su         April 4, 2024

Sudan Dyes

 

Substance

  Sudan dyes. [1]

 

Common name

  蘇丹紅

  Sudan I [1-(phenylazo)-2-naphthol, C.I. Solvent Yellow 14] is an industrial dye [2]

  Azo(含氮的) dye.

 

Involving system

Sudan I induces the malignancies in the liver and urinary bladder of rats and mice [2].

Bronchial asthma. [3]

Bladder cancer. [4].

 

Presentation

-          Allergic reaction is possible.

-          Long-term: leading to cancer was suspected.

 

Antidote

  None.

 

Disposition

-          Japan report: consider to be illegal use of Sudan red as a food coloring agent [5].

-          Non-permitted: In Hong Kong, Mainland China, and in countries including the European Union, Australia and Canada.[6]

 

References

1.      https://www.cfs.gov.hk/english/multimedia/multimedia_pub/multimedia_pub_fsf_05_01.html

2.      https://pubmed.ncbi.nlm.nih.gov/25658126/

3.      https://pubmed.ncbi.nlm.nih.gov/32021623/

4.      https://pubmed.ncbi.nlm.nih.gov/22686317/

5.      https://pubmed.ncbi.nlm.nih.gov/17058355/

6.      https://www.cfs.gov.hk/english/programme/programme_rafs/programme_rafs_fc_02_01.html

Edited by Yu-Jang Su  March 17, 2024. 

 

Recent 10 Substances Causing Methemoglobinemia in Scientific Articles

 

Recent 10 substances causing Methemoglobinemia in scientific articles
Year	Month	Country	Substance	Antidote	reference
2024	Feb	Australia	Primaquine	methylene blue.	[1]
2024	Jan	USA	Dapsone	3% Methylene blue	[2]
2024	Jan	India	Phenazopyridine200 mg three times a day for 14 days	methylene blue and oxygen	[3]
2023	Oct	China	sodium nitrite	100 mg of methylene blue	[4]
2023	July	Haifa, Israel	Anesthetic Cream lidocaine 2.5% and prilocaine 2.5%, applying it excessively every few hours daily for 2 weeks.	intravenous methylene blue 72 mg (1 mg/kg)	[5]
2023	May	UK	Alkyl nitrites ('poppers')	Methylthioninium chloride	[6]
2023	Feb	China	Nitrobenzene	methylene blue	[7]
2022	Dec	USA	Nail Polish Remover isobutyl nitrite-containing	methylene blue at a rate of 1 mg/kg	[8]
2022	Nov	India	100 mL of a herbicide marketed as FIRE-007	methylene blue 50 mg in 100 mL NS was given over 10 min	[9].
2022	Sep	USA	Presumed ingestion of lava lamp contents	Three doses of  ascorbic acid 5 g	[10].

References

[1]. https://pubmed.ncbi.nlm.nih.gov/38336484/

[2]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10847900/

[3]. https://pubmed.ncbi.nlm.nih.gov/38167589/

[4]. https://pubmed.ncbi.nlm.nih.gov/38028640/

[5]. https://pubmed.ncbi.nlm.nih.gov/37611308/

[6]. https://pubmed.ncbi.nlm.nih.gov/37247947/

[7]. https://pubmed.ncbi.nlm.nih.gov/36895721/

[8]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9805361/

[9]. https://casereports.bmj.com/content/15/11/e253407.long

[10]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9603889/

Edited by Yu-Jang Su   Feb 15, 2024