Asia Pacific Journal of Medical Toxicology
Volume:11 Issue: 3, Summer 2022

Methanol poisoning is associated with high morbidity and mortality, due to its toxic metabolites namely formaldehyde and formic acid. Though explicit treatment guidelines exist but management becomes an arduous task when a cluster of cases present in resource limited settings. We describe here an outbreak of methanol poisoning during COVID 19 pandemic, the challenges faced and the outcome. To review the clinical manifestations, biochemical parameters, management and outcome of patients of methanol poisoning A retrospective analysis of methanol poisoning patients presenting to our hospital during an outbreak. A total of 108 patients presented to our center over a span of 13 days. All had allegedly consumed adulterated alcohol 12 to 96 hours prior to admission. 41had expired en-route to hospital, 20 expired within 6 hours of presentation and 8 were intubated. Among survivors, the most common complaint was visual blurring (n=31) followed by neurological symptoms (n=27). The mean pH and anion gap were 7.06 and 27.2 respectively at presentation and 7.38 and 8.0 respectively on discharge. 30 patients underwent hemodialysis to remove the toxic alcohol and its metabolites. All patients with ocular involvement received injection methylprednisolone 500 mg for 3 days. The overall mortality was 67.5%. Methanol poisoning needs to be recognized early and managed emergently. Delay in seeking medical care substantially increases mortality. In case of inaccessibility to fomepizole and ethanol, dialysis has a pivotal role in management. Methylprednisolone therapy should be considered in all patients with visual complaints to reduce complications.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a family of drugs that are among the most commonly prescribed drugs worldwide. Due to the ease of access and widespread use of these drugs, many cases of intentional and accidental poisoning of these compounds have been reported.The aim of this study was to determine the prevalence of the clinical signs of drug toxicity with aspirin and NSAIDs in patients referred to Razi Hospital in Ahwaz. In this study, patients suffering from aspirin and NSAIDs poisoning referred to Razi Hospital during 2013-2015 were included in the study. Information reviewed from their stored records includes clinical presentation, demographic information, reference data, and treatment options. In this study, 79.5% were female respondents and 20.5% were male, and Faye and Kramer coefficients confirmed the existence of a strongly separate relationship between the gender variable and the first clinical signs of poisoning. The results showed that Diclofenac with 27% had the highest toxicity and nausea was the most common symptom in all drug toxicity with aspirin and NSAIDs. Nausea is a common symptom of poisoning with these drugs. There was a significant relationship between laboratory changes with the type of drug and the need for ICU admission, and this relationship was not strong due to the index values. According to the results, most of the patients were aged between 14-24 years old. Nausea was the most common symptom in all drug toxicity with aspirin and NSAIDs.

Eleusine coracana, a grain crop that may reach a height of 170 cm, is frequently referred to as a cereal food. It is a member of the Poaceae genus of plants. Due to its extreme toxicity at very low quantities, lead (Pb) is one of the most significant trace heavy metals to be examined. The main objective of this study was to determine the prevalence of lead in finger millet in the capital city of the Niger State. The lead metal was determined by flame atomic absorption spectrometry (FAAS) following a pressurized microwave-assisted wet digestion and the use of muffle furnace on the processed/certified finger millet samples with a combination of nitric acid, sulfuric acid, and perchloric acid (4:1:2). Based on calibration with a fortified analytical solution, the measurements were made (lead chloride). With the exception of Suleja millet, which recorded a range of 0.01-1.55 mg/L, the concentration of lead in finger millet samples evaluated in all Local Governments was found to be over the WHO recommended level of acceptable lead in cereals (0.01-0.05 mg/L). The LG (0.170.08 mg/L at range of 0.09-0.32 mg/L) and Kontagora Local Government (1.570.24 mg/L at range of 1.19-1.93 mg/L) had the highest and lowest amounts, respectively. Average lead values in different types of finger millet collected from diverse LGs were statistically different from one another (p<0.05). The primary source of Pb in finger millet grain in various depositional locations is atmospheric deposition. The majority of the lead in millet roots comes from the soil and lead contribution rates from the soil to the millet roots in high deposition locations would be much higher than those in low deposition areas.

Uncontrolled and unregulated mining of heavy metals causes easy release and littering of the products in the immediate environment, predisposing the inhabitants of the mining community to organ damage by the heavy metals. This cross-sectional study was done to examine whether such a practice causes liver damage to both miners and non-miners, living in the same environment or not. Liver function parameters – Aspartate transaminase, Alanine transaminase, Alkaline phosphatase, Total bilirubin, Total proteins, and Albumin were evaluated to determine the degree of toxicity (if any) and loss of detoxification and synthetic functions of the liver. The results showed that all the evaluated liver function parameters from the occupationally-exposed subjects were significantly higher (p<0.05) than those from environmentally-exposed and control subjects except albumin. Likewise, all the parameters from environmentally-exposed subjects were significantly higher (p<0.05) than those from control subjects except albumin. The results imply that both occupationally and environmentally-exposed subjects were susceptible to hepatotoxicity by the heavy metals, though at different rates of manifestation. This calls for concerted efforts by governments at all levels to enact and promulgate laws to control mining activities, not only to increase their revenue generation but most importantly to safeguard the lives of the inhabitants of the mining communities.

Nicotine has been reported to exert adverse effects on insulin sensitivity, predispose individuals to metabolic syndrome, and induce decreased functionality of the pancreas. The present study evaluated the influence of methanol extract of Basella Alba leaf on glucose utilization in nicotine treated male Wistar rats. Twenty male rats, weighing 200-240g were divided into four groups of five animals each as follows; Healthy Control (H-C) rats, which were given no treatment but placebo, Nicotine Control (N-C), which received 1.0 mg/kg of nicotine, Low Dose Nicotine + Basella Alba group (LDN-Ba), which received 0.5 mg/kg nicotine and 200mg/kg of MeBa, and High Dose Nicotine + Basella Alba group (HDN-Ba) that were given 1.0 mg/kg of nicotine and 200 mg/kg of MeBa. Following acute nicotine exposure, FBG levels were significantly higher (p ˂ 0.05) in NC, LDN-B and HDN-B rats when compared to H-C. Likewise, OGTT showed a significant (p ˂ 0.05) derangement in N-C and HDN-B when compared to HC and LDN-B groups. Body weight, weight and relative weight of pancreas were significantly decreased (p ˂ 0.05) in all nicotine treated groups when compared to the healthy control group. Histopathology also revealed general distortion of pancreatic histoarchitecture in the nicotine control rats. A significant decrease (p ˂ 0.05) in the blood glucose level and improved OGTT was observed in LDN-B rats after four weeks treatment with Basella Alba compared with N-C. The findings revealed that the dysfunction in glucose metabolism caused by nicotine toxicity is dose dependent and the administration of methanol extract of Basella Alba leaf ameliorate these effects to a greater extent in low dose than in high dose nicotine group.

Carbon monoxide (CO) poisoning is a widespread cause of morbidity and mortality, with delayed neurological Sequelae  (DNS) among the most severe consequences of this silent killer. To study the relationship between neutrophil-lymphocyte ratio (NLR), ischemia-modified albumin (IMA), and severity of acute CO poisoning as well as their role in predicting delayed neurological manifestations.Patients and Sixty acutely CO-intoxicated patients were admitted to Alexandria Poison Center, Egypt. NLR and IMA were assessed. Six months after discharge, all patients were subjected to neuropsychometric testing using Mini-Mental Status Examination (MMSE). Brain magnetic resonance imaging (MRI) was conducted on cognitively impaired patients. NLR was abnormally high in most patients and the mean serum level of IMA was significantly elevated in acutely CO-intoxicated patients compared to the control group (P<0.001). NLR and IMA were significantly related to neurological manifestations and other laboratory parameters. Patients were subdivided into DNS group (n = 16) and non-DNS group (n = 44), according to MMSE and brain MRI done after six months, with significant elevation of NLR and IMA in DNS group (p<0.001). The accuracy of DNS prediction parameters was measured using the area under the receiver operating characteristics curve. Excellent accuracy was detected for IMA and NLR. The studied markers of NLR and IMA assessed on admission could be employed as useful biomarkers for correlating with acute CO poisoning severity and predicting the outcome including the possibility of development of DNS.

The cardiovascular effects of alcohol consumption are variable. In addition to its protective effects, it may also result in mortality. In this study, we presented a case, who developed cardiac arrest after excessive ethanol intake.

Case Report: 

A 68-year-old patient, who was brought to the emergency room due to out-of-hospital cardiac arrest, showed ST elevation in the electrocardiogram after returning to spontaneous circulation, and no vascular occlusion was detected in the coronary angiography. The patient’s blood ethanol level was found to be 605 mg/dl and he had cardiac arrest again in the follow-up. He did not respond to cardiopulmonary resuscitation (CPR) for 30 minutes and died.

 Acute alcohol intoxication causes various metabolic changes, cardiovascular side effects, gastrointestinal side effects, and respiratory depression. It has been stated that coronary vasospasm can occur even when ethanol levels reach a basal level after 9 hours of excessive alcohol intake. We believe that ST-segment elevation developed as a result of vasospasm and respiratory depression emerged after ethanol intake and that the patient had a cardiac arrest.

We contend that ST-segment elevation after spontaneous return to circulation in out-of-hospital cardiac arrest patients may be caused by excessive ethanol intake, besides acute coronary syndromes.

Siphoning diesel from fuel tanks is a common practice among auto mechanics and garage workers, particularly in rural areas, which has a high risk of aspiration. Hydrocarbon pneumonitis is a rare and under-reported emergency medical illness caused by accidental aspiration of volatile substances such as diesel. Although the actual prevalence of this type of accident injury is unknown, it is limitedly reported. There is a paucity of literature, with only a few case reports of such events and their consequences coming from India.

Case Report: 

A 24-year-old male was admitted with a provisional diagnosis of chemical pneumonitis and ARDS two hours after aspiration of diesel, while siphoning it from the fuel tank. On postmortem examination, Lungs were heavy, weighing 1265 grams and 1160 grams, congested and edematous with rupture of alveoli, consolidation was seen in middle and lower lobe of the lungs, and gastrointestinal mucosal was also congested. Histologically, sheets of foamy macrophages admixed with squamous epithelial cells were seen.

Diesel aspiration can induce a wide range of symptoms, from a simple cough and fever to severe ARDS and death. As a result, manual siphoning should be avoided, and if it must be done, it should be done with caution. Proper history taking, including occupation and examination, accurate diagnosis, and treatment may improve the prognosis of patients suffering from hydrocarbon pneumonitis as a result of fuel siphonage.