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Acute severe poisoning with disinfectant in senior aged patient-case report and overview of literature considering age influence on treatment decision in alcohol-based intoxications
(2021)
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Berat-Huseini, Afrodita
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We present our experiences in the first case of severe suicidal poisoning with 70% ethanol-disinfectant in North Macedonia, in an elderly patient with immunocompromising comorbidities. A 66-year-old unconscious woman was admitted at our clinic, with a history of seropositive rheumatoid arthritis treated with methotrexate. She was in a coma, without signs of serotonin syndrome, recurrent episodes of cardio-respiratory insufficiency under supportive treatment without invasive ventilation, metabolic acidosis, increased D-dimer 3254 ng/mL. The toxicology screening confirmed low benzodiazepines levels and alcoholaemia of 526 mg/dL (5.26 g/L), due to ingestion of 70% ethanol. Considering the decreased biotransformation in the elderly, immunocompromising comorbidities, reports of fatal outcome in poisoned elderly patients with disinfectants under standard fluids supportive protocol, haemodialysis was initiated, with registered associated hypercoagulability which resulted in complete stabilization after 48 h of admission. Treatment protocols of poisoning with ethanol-based disinfectant in the elderly should consider timely performing haemodialysis at lower alcoholaemia levels than recommended.
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Neurotoxicity and Renal Impairment in a Patient with Acute Poisoning with Antipsychotic Drugs-Literature Review
(2021-05)
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Kostadinovski, Kristin
Neuroleptic malignant syndrome is a rare, severe and potentially fatal condition characterized by hyperthermia, muscle rigidity, changes in mental status (delirium, altered consciousness). There are many risk factors responsible for development of this syndrome such as the use of high-dose, high-potency and long-acting antipsychotic drugs, rapid increase in the dosage, using multiple antipsychotic drugs or other medications like antidepressants and mood stabilizers, especially lithium. A correlation between chronic kidney diesease and sudden lithium intoxication has been postulated, but the relationship between both remains unclear. We present here a case with neurotoxicity, rhabdomyolysis, renal impairment and hyperparathyroidism caused by acute poisoning with lithium, haloperidol, diazepam. The purpose of this case report is to increase awareness and vigilance of the fact that concurrent use of multiple antipsychotic and other drugs may cause multiple organ failures.
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Cardiovascular toxicity in acute tricyclic antidepressant (Amitriptyline) overdose
(Elsevier BV, 2006-09)
Pavlovski, Branimir
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Becarovski, Niko
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Melovska, Letka
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Popovski, Nestor
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Influence of Duration of Heroin Dependence on Humoral Immunologic Indicators
(American Society of Addiction Medicine, 2016-11)
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Zafirova-ivanovska, Beti
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Babulovska, Aleksandra
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Zanina Pereska
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Irena Jurukov
Objective: The incidence of autoantibodies may be associated with the duration of drug use. In this study, we assessed the association between the duration of heroin dependence and various humoral immunologic indicators, including IgA, IgG, IgM, complement component 3, complement component 4, rheumatoid factor, antib2-glycoprotein 1 (IgA, IgG, IgM), antinuclear antibody, circulating immune complexes, and cryoglobulins. Methods: A total of 363 patients with heroin dependence were enrolled in this cross-sectional and prospective study over a 3.5- year period. Depending on the duration of heroin use, participants were divided into 3 groups: up to 3 years, 4 to 7 years, and more than 7 years of heroin dependence. All patients were analyzed for the indicators. Results: There was a significant difference between the duration of heroin dependence and increased concentration of IgA (P ¼ 0.0000), IgG (P ¼ 0.0000), IgM (P ¼ 0.0001), complement component 3 (P ¼ 0.042), rheumatoid factor (P ¼ 0.0001), anti-b2-glycoprotein 1 (IgA, P ¼ 0.0098; IgG, P ¼ 0.0000; IgM, P ¼ 0.0000), the presence of antinuclear antibody (P ¼ 0.01) and cryoglobulins (P ¼ 0.0000), and decreased concentration of complement component 4 (P ¼ 0.002). There was no significant difference in circulating immune complex concentration (P ¼ 0.097). Conclusions: A longer duration of heroin dependence was associated with increased concentrations of IgA, IgG, IgM, complement component 3, rheumatoid factor, anti-b2-glycoprotein 1 (IgA, IgG, IgM), presence of antinuclear antibodies and cryoglobulins, and decreased concentrations of complement component 4, but there was no influence on circulating immune complex values

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