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Bundesgesundheitsblatt,... Nov 2019Despite long-lasting international efforts to ban and disarm chemical warfare agents (CWAs), they pose an ongoing threat to the population. The reasons for this are... (Review)
Review
Despite long-lasting international efforts to ban and disarm chemical warfare agents (CWAs), they pose an ongoing threat to the population. The reasons for this are existing remainders, inappropriately disposed of chemical munitions and availability of instructions for synthesis in open literature. Dissemination of CWAs during war, warlike conflicts and terrorist incidents has recently resulted in thousands of deaths. In this manuscript CWAs and comparable substances are presented and the signs and symptoms of poisoning with these substances are described. Aside from clear recommendations for the treatment of poisoning by the single groups of CWAs, parallels to well-known related poisonings including pathophysiological similarities are demonstrated. Moreover, aspects of detection, diagnosis and general management, such as decontamination, verification and antidote stockpiling, are described.According to the respective pathophysiological target, CWAs are classified as lung, skin, nerve and incapacitating agents. They are generally liquids at ambient room temperature and are more or less able to vaporise. In recent years, pharmaceutical-based agents (PBAs) came on board although they are not listed in the chemical warfare convention and therefore not listed as CWAs. Due to their high toxicity, however, they are mentioned here. PBAs comprise, for example, synthetic opioids which can act after inhalative respiration.During the rescue of affected victims, early detection of CWAs, restriction of access to the contaminated area and use of protective clothes and masks by first responders are necessary. Exposure should be terminated as soon as possible by removal of the victim from the hot zone and decontamination. The latter is also important to avoid secondary contamination of other persons or facilities located outside of the contaminated zone. According to the type of poisoning, therapy should be started as soon as possible.
Topics: Chemical Warfare Agents; Decontamination; Germany; Humans; Poisoning
PubMed: 31602511
DOI: 10.1007/s00103-019-03035-4 -
Advances in Chronic Kidney Disease Jan 2020Management of the poisoned patient begins with supportive care, assessment of organ function and dysfunction, and consideration of known or suspected poisons. The... (Review)
Review
Management of the poisoned patient begins with supportive care, assessment of organ function and dysfunction, and consideration of known or suspected poisons. The possibility of multiple ingestions should be considered with intentional exposures or suicide attempts. Enteric decontamination involves treatment to prevent the absorption of toxins from the gastrointestinal system and includes the use of activated charcoal. Poisoned patients may benefit from the use if antidotes are available, or enhanced elimination as with salicylate ion trapping during urinary alkalinization. The use of intravenous lipid therapy is of clinical benefit in poisoning from bupivacaine, amitriptyline, and bupropion. Hemodialysis is the most inexpensive, widely available, and most commonly used method of extracorporeal drug removal in the treatment of poisoning. Chelators with different chemical properties can bind toxic metals, providing an essential mechanism for detoxification, and may be used in combination with extracorporeal therapies such as DFO with HD for aluminum or iron, and DMSA or DMPS with HD to treat arsenic or mercury intoxication. The use of displacers with hemodialysis can be considered to augment clearance of protein-bound toxins.
Topics: Antidotes; Charcoal; Chelating Agents; Combined Modality Therapy; Humans; Lipids; Poisoning; Renal Dialysis
PubMed: 32147001
DOI: 10.1053/j.ackd.2019.12.001 -
Bundesgesundheitsblatt,... Nov 2019Reports on adverse effects of chemical substances and mixtures (poisonings in the broader sense) are of great importance both for the improvement of medical care as well... (Review)
Review
Reports on adverse effects of chemical substances and mixtures (poisonings in the broader sense) are of great importance both for the improvement of medical care as well as for substance and product safety and for medical education and training. Case reports are the basis of toxicovigilance, i.e. the detection and assessment of poisoning risks in a community arising from clinical cases. Reports on poisonings are created mainly by medical doctors, but also by toxicologically trained nurses and non-medical scientists of poison centres and toxicology labs.In this article, basic terms of clinical toxicology are explained and the important roles of reporting on poisoning are described.Standards for poisoning reporting are partly developed. Reports differ in structure, information content and the degree of assignment of evaluation categories (administrative, clinical, product safety, e.g. agent group, degree of poisoning severity, causality). Methodologically, a distinction is made between detailed individual case reports and aggregated case series with little clinical information.As a result, case reports have recently been used to describe novel intoxications (e.g. new psychoactive substances [NPSs]). Case series facilitated the detection of poisoning outbreaks (sealant spray, ciguatera fish poisoning) and novel products with increased risk of poisoning (e.g. liquid laundry detergent capsules). Systematic toxicovigilance at the national level in Germany will be considerably improved by a national register of poisoning planned at German Federal Institute for Risk Assessment (BfR). For a European toxicovigilance scheme, the recently developed EuPCS product category system forms an important basis.
Topics: Animals; Ciguatera Poisoning; Disease Outbreaks; Documentation; Fishes; Germany; Humans; Poisoning; Risk Assessment
PubMed: 31562539
DOI: 10.1007/s00103-019-03021-w -
Annales Pharmaceutiques Francaises Sep 2019Organophosphorus compounds (OP) are toxic molecules developed as insecticides and chemical warfare nerve agents (CWNAs). Most OP are neurotoxic and act as nervous system... (Review)
Review
Organophosphorus compounds (OP) are toxic molecules developed as insecticides and chemical warfare nerve agents (CWNAs). Most OP are neurotoxic and act as nervous system disruptors by blocking cholinergic transmission. They are therefore responsible for many poisonings worldwide. OP toxicity may result either from acute or chronic exposure, and their poisoning effect were evaluated using several animal models. These latter were also used for evaluating the efficacy of antidotes. Strategies based on enzymes that can trap (stoichiometric bioscavengers) or degrade (catalytic bioscavengers) OP, were particularly studied since they allow effective decontamination, without toxicity or environmental impact. This review summarizes the results obtained in vivo with enzymes through three levels: prophylaxis, treatment and external decontamination. The efficiency of enzymatic treatments in different animal models is presented and the relevance of these models is also discussed for a better extrapolation to humans.
Topics: Animals; Antidotes; Chemical Warfare Agents; Cholinesterase Reactivators; Enzyme Replacement Therapy; Humans; Insecticides; Organophosphate Poisoning
PubMed: 31253354
DOI: 10.1016/j.pharma.2019.06.002 -
Arhiv Za Higijenu Rada I Toksikologiju Dec 2020Phosphylation of the pivotal enzyme acetylcholinesterase (AChE) by nerve agents (NAs) leads to irreversible inhibition of the enzyme and accumulation of neurotransmitter... (Review)
Review
Phosphylation of the pivotal enzyme acetylcholinesterase (AChE) by nerve agents (NAs) leads to irreversible inhibition of the enzyme and accumulation of neurotransmitter acetylcholine, which induces cholinergic crisis, that is, overstimulation of muscarinic and nicotinic membrane receptors in the central and peripheral nervous system. In severe cases, subsequent desensitisation of the receptors results in hypoxia, vasodepression, and respiratory arrest, followed by death. Prompt action is therefore critical to improve the chances of victim's survival and recovery. Standard therapy of NA poisoning generally involves administration of anticholinergic atropine and an oxime reactivator of phosphylated AChE. Anticholinesterase compounds or NA bioscavengers can also be applied to preserve native AChE from inhibition. With this review of 70 years of research we aim to present current and potential approaches to counteracting NA poisoning.
Topics: Acetylcholinesterase; Chemical Warfare; Chemical Warfare Agents; Cholinesterase Inhibitors; Cholinesterase Reactivators; Humans; Nerve Agents; Organophosphate Poisoning; Oximes
PubMed: 33410774
DOI: 10.2478/aiht-2020-71-3459 -
Bundesgesundheitsblatt,... Nov 2019Exposure to chemical substances results in a multitude of poisonings or suspected poisonings every year. Poison centres (PCs) advise the public and medical staff on... (Review)
Review
Exposure to chemical substances results in a multitude of poisonings or suspected poisonings every year. Poison centres (PCs) advise the public and medical staff on these issues and register cases in their databases. Additionally, the Federal Institute for Risk Assessment (BfR) maintains a case database with notifications reported by attending physicians within the framework of the Chemicals Act.This article describes important poisons from the field of chemicals and products and gives an example of poisoning risk management for a new product group. For this purpose, exemplary case information published in the annual reports of different PCs and the cases notified to the BfR were examined.An overview is provided on the product groups leading most frequently to poisonings and requests to the PCs. The spectrum of poisonings registered by the BfR and PCs differs clearly between reporting persons, route of exposure and severity. Substance groups with a relatively high risk compared to other chemical substances and products are highly concentrated detergents, acids and alkalis as well as carbon monoxide.PCs and the BfR databases contain valuable information to estimate the frequency and severity of various poisonings. By merging these data in a national poisoning register, new risks would be discovered more quickly in the future and a national overview of poisoning events would be gained.
Topics: Databases, Factual; Germany; Humans; Medical Staff; Poison Control Centers; Poisoning; Risk Assessment
PubMed: 31620819
DOI: 10.1007/s00103-019-03033-6 -
Theranostics 2021Poisons always have fascinated humankind. Initially considered as deleterious or hazardous substances, the modern era has witnessed the controlled utilization of... (Review)
Review
Poisons always have fascinated humankind. Initially considered as deleterious or hazardous substances, the modern era has witnessed the controlled utilization of dangerous poisons in medicine and cosmetics. Simultaneously, antidotes have become crucial as reversal agents to counteract the effects of a poison, and they are also used today to positively cancel the benefits of a poison after use. Currently, the majority of poisons are composed of small molecules. This review focuses on recent developments to reverse or prevent toxic effects of poisons by encapsulation in host molecules. Cyclodextrins, cucurbiturils, acyclic cucurbituril derivatives, calixarenes, and pillararenes, have been reported to largely impact the effects of toxic compounds, thus extending the current paradigm of small molecule antidotes by adding a new family of macrocyclic compounds to the current arsenal of antidotes. Along this line of research, endogenous "harmful" species are also sequestered by one or more of these supramolecular host molecules, expanding the potential of supramolecular antidotes to diverse therapeutic areas.
Topics: Animals; Antidotes; Humans; Macrocyclic Compounds; Poisons; Small Molecule Libraries
PubMed: 33391548
DOI: 10.7150/thno.53459 -
The Veterinary Clinics of North... Nov 2020The liver is one of the most commonly affected organs by ingested toxicants. This article familiarizes veterinarians with clinical signs, serum biochemistry changes,... (Review)
Review
The liver is one of the most commonly affected organs by ingested toxicants. This article familiarizes veterinarians with clinical signs, serum biochemistry changes, necropsy findings, and field information found in livestock poisonings with hepatotoxic plants. The focus is on the most common plant-derived hepatotoxins important to livestock in North America. Pyrrolizidine alkaloids are covered in greater detail than the other toxins, because they are likely the most important plant-derived toxins worldwide in livestock, wildlife, and even human exposure. Additionally, many of the principles discussed regarding clinical diagnosis of pyrrolizidine alkaloid intoxication can be applied to the other poisonous plants listed.
Topics: Animals; Cattle; Cattle Diseases; Liver Diseases; Livestock; North America; Plant Poisoning; Plants, Toxic; Pyrrolizidine Alkaloids
PubMed: 33032701
DOI: 10.1016/j.cvfa.2020.08.003 -
BMC Public Health Jan 2022Self-harm and suicide are important causes of morbidity and mortality in Sri Lanka, but our understanding of these behaviours is limited. Qualitative studies have...
BACKGROUND
Self-harm and suicide are important causes of morbidity and mortality in Sri Lanka, but our understanding of these behaviours is limited. Qualitative studies have implicated familial and societal expectations around sex and relationships. We conducted an explorative analysis using case-control data to investigate the association between sex education and self-poisoning in Sri Lanka.
METHODS
Cases (N=298) were self-poisoning inpatients on a toxicology ward, Teaching Hospital Peradeniya. Controls (N=500) were sex and age frequency matched to cases and were outpatients/visitors to the same hospital. Participants were asked whether they had received sex education, and to rate the quality and usefulness of any sex education received. Logistic regression models adjusted for age, sex, and religion quantified the association between receipt, quality and usefulness of sex education and self-poisoning. We tested whether the associations differed by sex.
RESULTS
Roughly 1-in-3 cases and 1-in-5 controls reported having not received sex education. Individuals who did not receive sex education were nearly twice as likely to have self-poisoned than those who did (OR 1.68 (95% CI 1.11-2.55)). Those who reported the sex education they received as not useful were more likely to have self-poisoned compared to those who reported it useful (OR 1.95 (95% CI 1.04-3.65)). We found no evidence of an association between self-poisoning and the self-rated quality of sex education, or that associations differed by participant sex.
CONCLUSION
As sex education is potentially modifiable at the population-level, further research should aim to explore this association in more depth, using qualitative methods and validated measurement tools.
Topics: Humans; Poisoning; Poisons; Self-Injurious Behavior; Sex Education; Sri Lanka; Suicide
PubMed: 34991547
DOI: 10.1186/s12889-021-12374-4 -
Annals of the New York Academy of... Nov 2020Although 193 states have committed to the Chemical Weapons Convention and 98% of the declared chemical weapons stockpiles have been destroyed so far, nerve agent... (Review)
Review
Although 193 states have committed to the Chemical Weapons Convention and 98% of the declared chemical weapons stockpiles have been destroyed so far, nerve agent poisoning remains a lingering threat. The recent dissemination of sarin in Syria, the assassination of Kim Jong-Nam in Malaysia, and the assault on Sergei Skripal in the United Kingdom underline the need for effective treatment. The current therapeutic options of a muscarinic receptor antagonist, an oxime, and an anticonvulsant have been unchanged for decades. Therefore, new therapeutic strategies, for example, bioscavengers and receptor-active substances, are promising concepts that have to be examined for their benefits and limitations. In order to facilitate rapid diagnosis in challenging clinical situations, point-of-care diagnostics and detection are of importance. Therapeutic guidance concerning the duration and success of the current oxime therapy via determination of the cholinesterase status can contribute to an optimal use of resources. In summary, the challenges of current and future therapies for nerve agent poisoning and key diagnostic devices will be discussed.
Topics: Antidotes; Cholinesterase Reactivators; Humans; Nerve Agents; Organophosphate Poisoning; Oximes; Sarin; United Kingdom
PubMed: 32198755
DOI: 10.1111/nyas.14336