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Acute methoxetamine and amphetamine poisoning with fatal outcome: A case report

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Wiergowski M., Anand J., Krzyżanowski M., Jankowski Z.
International Journal of Occupational Medicine and Environmental Health
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2014
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vol. 27
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issue 4
683-690
EN
Methoxetamine (MXE) is a psychoactive substance distributed mostly via the Internet and is not liable to legal regulation in Poland. MXE has a toxicity profile similar to that of ketamine but longer-lasting effects. The paper describes a case of acute poisoning that resulted from recreational use of MXE and amphetamine and ended in death. In mid-July 2012, a 31-year old man was admitted to the clinical toxicology unit in Gdańsk because of poisoning with an unknown psychoactive substance. The patient was transported to the emergency department (ED) at 5:15 a.m. in a very poor general condition, in a deep coma, with acute respiratory failure, hyperthermia (> 39°C) and generalized seizures. Laboratory tests showed marked leukocytosis, signs of massive rhabdomyolysis, hepatic failure and beginning of acute renal failure. Despite intensive therapy, the patient died 4 weeks after the poisoning in the course of multi-organ dysfunction syndrome. Chemical and toxicological studies of serum and urine samples collected on the poisoning day at 1:40 p.m. confirmed that amphetamine and MXE had been taken earlier that day. Concentration of amphetamine in the serum (0.06 μg/ml) was within the non-toxic range, while MXE (0.32 μg/ml) was within the toxic range of concentrations. Amphetamine was also detected in the patient's hair, which suggested a possibility of its use within the last dozen weeks or so. The serious clinical course of intoxication and co-existence of amphetamine and MXE in the patient's blood and urine suggest the possibility of adverse interactions between them.
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The characteristics and outcomes of toxin-induced massive rhabdomyolysis

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Waldman W., Sein Anand J., Kabata P.
International Journal of Occupational Medicine and Environmental Health
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2020
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vol. 33
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issue 5
661-673
EN
ObjectivesThis study investigates common patterns in patients with exceptionally high creatine kinase (CK) levels to identify factors that could have contributed to the development of severe rhabdomyolysis in the studied cohort.Material and MethodsThe authors present a retrospective analysis of patients with massive rhabdomyolysis (measured CK activity >50 000 U/l) caused by xenobiotics. The patients were selected from a group of 7708 patients treated at the Regional Toxicological Center.ResultsThe most frequent causative agents were recreational drugs, sedatives and anti-epileptics. Six patients developed multi-organ failure, including 1 who died. Substance abuse disorder was diagnosed in 90% of the patients. Each patient had at least 1 contributory factor present (hypothermia, hyperthermia, injury, an episode of agitation, seizures, prolonged immobilization), and the median was 3 factors. Acute kidney injury was observed in 90% of the patients, and 70% needed renal replacement therapy due to acute renal failure, which meant a longer hospital stay. Creatinine concentration differences between days 2 and 1 of the presentation (Cdiff) correlated with the length of hospital stay (r = 0.73, p = 0.02). All patients with negative Cdiff values did not need dialysis. No patients experienced liver failure.ConclusionsMassive rhabdomyolysis seems to be the effect of coincidence of several factors rather than the myotoxic effect alone. A creatinine concentration difference between days 2 and 1 of hospitalization was a good prognostic factor for the need for further dialysis.
3
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Clinical pattern of poisoning among patients declared as taking novel recreational drugs

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Krakowiak A., Bąk M., Politański P., Piekarska-Wijatkowska A.
International Journal of Occupational Medicine and Environmental Health
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2020
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vol. 33
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issue 4
445-455
EN
ObjectivesIntoxication with novel psychoactive drugs poses a significant challenge for medicine due to diagnostic difficulties, complex clinical patterns resulting from the polyethiology of poisoning, and the risk of fatal complications.Material and MethodsThe authors of the present work have made a retrospective review of medical records of the patients hospitalized at the Toxicology Unit (TU), diagnosed with poisoning by novel recreational drugs.ResultsIn 2008–2013, 576 patients diagnosed with that type of poisoning were admitted to the TU. Of those, 192 (33.3%) patients were positive for ethanol in addition to the most popular toxins found in the material collected from the patients, such as tetrahydrocannabinol (50 [8.6%] patients) and amphetamine (35 [6.1%] patients). The most frequent clinical symptoms observed on admission were: anxiety (433 [75.1%] patients), agitation (275 [47.7%] patients), and complaints associated with the circulatory system (225 [39.1%] patients). In the subgroup of 104 (18.0%) psychiatrist-interviewed people, a relationship was found between the suicidal ideation reported during history-taking and the following factors: earlier psychiatric treatment (p = 0.000), financial problems (p = 0.015) and prolonged unemployment (p = 0.022).ConclusionsThe observed clinical pattern may be associated with sympathomimetic syndrome due to poisoning by novel psychoactive substances. Preliminary results of this research show that financial problems and a history of psychiatric treatment may enhance suicidal ideation in patients after acute poisoning by psychoactive substances.
4
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Późne następstwa zbiorowego ostrego zatrucia fosfanem – opis przypadku

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Waszkowska M., Walusiak-Skorupa J., Merecz-Kot D., Wiszniewska M.
Medycyna Pracy
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2018
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vol. 69
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issue 3
337-344
EN
This paper reports the case of collective acute phosphide (PH₃) intoxication among the crew aboard a merchant ship. All the intoxicated individuals were hospitalized 3 months after the accident. The aim of examinations was to identify late health effects of the accident. Laboratory tests and consultations were performed during their stay in the hospital. There were 5 cases of toxic liver damage. other 5 patients were diagnosed with posttraumatic stress disorder and adjustment disorders. The results of the study suggest that in cases of acute phosphide intoxication, the assessment of patients’ psychological functioning should be an indispensable part of diagnostic procedure. Med Pr 2018;69(3):337–344
PL
W artykule przedstawiono przypadek zbiorowego ostrego zatrucia fosfanem (PH₃) wśród załogi statku handlowego. Badaniu poddano wszystkie osoby w 3 miesiące po zdarzeniu w celu oceny późnych zdrowotnych następstw wypadku. W trakcie hospitalizacji wykonano konsultacje specjalistyczne i badania laboratoryjne, na których podstawie u 5 osób stwierdzono toksyczne uszkodzenie wątroby. Natomiast u 5 innych pacjentów rozpoznano zaburzenia stanu psychicznego w postaci zaburzeń adaptacyjnych i zespołu stresu pourazowego. Wyniki badań wskazują, że w podobnych przypadkach ocena funkcjonowania psychicznego pacjentów powinna być nieodzownym elementem procedury diagnostyczno-terapeutycznej. Med. Pr. 2018;69(3):337–344
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