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Acute Respiratory Distress Syndrome Caused by Methadone Syrup

Abstract

Acute respiratory distress syndrome (ARDS) due to methadone (MTD) toxicity is a known but rather uncommon phenomenon. In most of the previously reported cases of MTD-related ARDS, MTD was ingested orally in the form of tablets in high or unknown amounts. Despite the findings from the available literature, this case report is aimed at demonstrating that even small amounts of MTD syrup can cause ARDS earlier than it is usually expected. We present a non-addicted MTD-overdosed patient who developed ARDS after ingesting a very small amount of MTD syrup. We suggest close monitoring of MTD-overdosed patients from at least 48 h to 72 h for possible respiratory complications such as pulmonary oedema.

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Snake Venom Poisoning in the Plovdiv Region from 2004 to 2012

ABSTRACT

INTRODUCTION: Envenomation by poisons of biological origin is very common globally in the tropical and subtropical areas mainly, where the biological diversity of the species clearly leads to evolution of highly toxic species. The weather warming trend in Bulgaria, whether cyclic or permanent, allows for a change in the biological response of reptiles and insects inhabiting the temperate zone by a possible migration of biological species from the subtropical zone towards the temperate zone because of the new environmental conditions. There are very few studies on snake bite envenoming in Bulgaria. The AIM of the study was to find the incidence of the acute accidental intoxication (AAI) caused by snake venom in adult individuals in a large region of Bulgaria between 2004 and 2012 and characterises it by number, type, main clinical features, course and socio-demographic parameters of the victims so that preventive measures can be taken, wherever necessary. MATERIALS AND METHODS: We studied retrospectively all 68 cases of AAI caused by snake venom in adult individuals (> 18 years old) hospitalized in the Clinic of Toxicology in St. George University Hospital, Plovdiv over the period from 2004 to 2012 by 23 quantitative and qualitative parameters. RESULTS: We found that the average annual incidence of snake venom AAI in adult population in the region of Plovdiv was relatively low for the specified period (9.5 per 100000 residents); the snake venom AAI increases or decreases every other year, with no clearly delineated trend for now. The prevalence of envenomation by poisons of biological origin increased from 2.3% in 1990-1998 to 9.5-10.33% between 2007 and 2012. The main sociodemographic characteristics of snake bite victims are similar to those in other Balkan and Central European countries. The clinical response to poisons of biological origin is generally identical with the response to the viper (Vipera ammodytes) - mild to medium intensity with predominantly local toxic syndrome. CONCLUSIONS: The algorithm of Clinical Pathway 293 (CP) is effective and conducive to the reduction of duration of the morbid condition. There are, however, still aspects of it that can be optimised

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Genetic diversity of three European Veratrum species revealed by Amplified Fragment Length Polymorphism

-473. http://dx.doi.org/10.3732/ajb.91.3.465 G robosch T., B inscheck T., M artens F. & L ampe D. 2008. Accidental intoxication with Veratrum album . J Anal Toxicol 32: 768-773. http://dx.doi.org/10.1093/jat/32.9.768 G uthridge K. M., D upal M. P., K ölliker R., J ones E. S., S mith K. F. & F orster J. W. 2001. AFLP analysis of genetic diversity within and between populations of perennial ryegrass ( Lolium perenne L.). Euphytica 122: 191-201. H ammer Ø., H arper D. A. T. & R yan P. D. 2001. PAST: Paleontological Statistics Software Package

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