Laryngeal edema and metabolic acidosis after Omnicide ingestion

Suicidal attempt by disinfectant solution ingestion in case of opioid dependence

The current study presents a rare case of an opioid dependence (46‐year‐old man) ingesting a disinfectant solution (Wavicide‐01; 2.65% glutaraldehyde solution, pH:6). The doctor intubated the patient and ordered bicarbonate for systemic acidosis, anti‐proton‐pump inhibitors (PPIs), and mechanical ventilation because the patient's breathing was irregular and the endoscopy revealed grade 1 and grade 2 burns all the way through the gastrointestinal tract up to the duodenum. As a result, ingestion of glutaraldehyde compounds should be closely monitored for laryngeal edema and metabolic acidosis, which can result in upper airway obstruction requiring immediate airway stabilization. Furthermore, a better understanding of the clinical epidemiology of suicide attempts could aid in the early identification of people that use opioids and are at high risk of suicide, as well as the development of suicide prevention strategies for this vulnerable population.

The importance of paying attention to suicide risk in cases of opioid dependence with a history of psychiatric illness, even if hospitalized, maintaining patient safety issues in the hospital's ward and ICU, unavailability of dangerous equipment and careful monitoring by nurses, patient care in terms of self‐harm and/or to others, and psychiatric counseling for such patients is emphasized in the treatment of such patients.

Poisoning of glutaraldehyde-containing products: clinical characteristics and outcomes

OBJECTIVE

This study describes the clinical characteristics, outcomes, and factors at presentation associated with death of cases poisoned by glutaraldehyde (GA)-containing products.

METHODS

We performed a 5-year retrospective cohort study (July 2013-June 2018) using data from the Ramathibodi Poison Center.

RESULTS

There were 244 cases included in this study. Most were men with a median age of 37 years. The GA-containing products were mainly used as farm disinfectants (99.2%), with a median concentration of 15%. Most products (76.2%) contained co-formulants such as cationic detergents and formaldehyde.Most circumstances were accidental (56.9%). The others were suicide attempts by ingestion, except one patient who intentionally injected GA subcutaneously. The most common route of exposure was ingestion (95.0%). Local symptoms in areas of exposure were common. Ingestion resulted in more severe local effects than other routes, and corrosive effects occurred in 23 cases (9.4%). Systemic signs and symptoms occurred in 149 patients (61.1%). Systemic effects included abnormal vital signs, desaturation, altered mental status, hypo/hypernatremia, hypokalemia, low bicarbonate/metabolic acidosis, acute kidney injury (AKI), hepatitis, and rhabdomyolysis. Systemic effects mostly resulted from ingestion. Most patients had mild severity, received only supportive treatment, and fully recovered. The median length of hospital stay was 2 days. The one case of subcutaneous injection developed both local and systemic effects but survived. The mortality rate was 3.7%. Multivariate analysis indicated that either neurological symptoms or AKI at presentation were associated with death.

CONCLUSIONS

In our study, patients were exposed to GA-containing products that were mainly used as farm disinfectants and were generally co-formulated with other substances. Poisoning with these products commonly resulted in mild local irritative symptoms. However, some cases developed corrosive symptoms, systemic effects, or even died. As neurological symptoms or AKI could prognosticate deaths; physicians should look for these factors in patients with GA exposure at presentation for close monitoring and aggressive treatment.

Laryngeal Edema, Metabolic Acidosis, and Acute Kidney Injury Associated with Large-Volume Kohrsolin TH® Ingestion

BACKGROUND

Glutaraldehyde is a commonly used disinfectant in most hospitals. It is known to be an irritating agent to the airway. With the exception of one small-quantity (75 mL) ingestion, no large-volume ingestion has been previously reported.

CASE REPORT

A 59-year-old man presented with history of large-volume (500 mL) consumption of a solution containing 10% glutaraldehyde and developed respiratory distress, as well as gastrointestinal and kidney injury. His ingestion necessitated a feeding jejunostomy tube placement and tracheostomy. His condition improved with supportive care and he was discharged after 1 month with no long-term sequelae. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Ingestion of this easily accessible agent, which may initially seem clinically benign, warrants close observation. Emergent airway stabilization and supportive care is crucial to the survival of the patient.

Antimicrobial drug usage and poultry production: case study in Ghana

Antimicrobial use in food animal production could lead to the occurrence of antimicrobial residues in the animal products. In Ghana, there is no monitoring program for antimicrobial residue in foods of animal origin. We determined the types of antimicrobial drugs used in poultry production in Dormaa municipality and the levels of residue found in poultry products. Performing a cross-sectional study, a structured questionnaire and direct observation methods were used to assess antimicrobial usage, knowledge of and adherence to withdrawal periods in randomly selected poultry farms. Eggs and ready-for-sale broilers were purchased from selected respondents’ farms for detection and quantification of residues using the microbial inhibition plate assay. A total of 132 farmers were interviewed from 115 farms. Farms (86%) administered drugs to birds for prophylactic purposes. A total of 28 (24.3%) farms had tetracycline residue in eggs, 25 (21.7%) in kidney and 14 (12.2%) in liver. Mean (±s.d.) tetracycline concentration (μg/g) found were: eggs 0.02 ± 0.003; kidneys 0.02 ± 0.01; and liver 0.01 ± 0.008. Twenty-six farms (92.9%; ρ > 0.05) that had residues in eggs had sold eggs during treatment of the laying birds. A disinfectant and two antibiotics in human formulations were administered to birds in 44.3%, 17.4% and 2.6% farms respectively on an extra-label basis. Tetracyclines were the main antimicrobial drugs used in poultry farming in the study area with little or no regard to withdrawal periods. Tetracycline residue was found in poultry but below the Maximum Residue Level set by Codex Alimentarius. Extra-label use of disinfectant to water-medicate birds poses a health hazard to farmers and consumers alike.

Respiratory complications from acute corrosive poisonings in adults

INTRODUCTION

Acute corrosive poisonings are caused by ingestion of corrosive chemicals which are most commonly used as household agents. Intoxications with these kind of agents produce numerous and severe post-corrosive complications of the upper gastrointestinal tract. On the other hand, our experience showed that corrosive agents may also cause injuries of the respiratory system, which makes the treatment very hard and additionally complicates the severe clinical condition of the patient.

OBJECTIVE

The aim of the study is to show the incidence of respiratory complications in acute corrosive poisonings, the need of various clinical investigations and also the treatment and final outcome of these kind of poisoning.

METHODS

We retrospectively analyzed clinical records of 415 patients hospitalized and treated at the University clinic for toxicology and urgent internal medicine, in Skopje, Republic of Macedonia, in the period between 2007 and 2011. The protocol consisted of methods for analyzing the systemic complications, with an accent on the post-corrosive respiratory complications.

RESULTS

From the total number of patients even 98 (23.61%) exhibited systemic complications, from which 51 (52.04%) are respiratory complications. The majority of patients are female (n=40, 78.43%) and the most common complication is pneumonia (n=47). The youngest patient in this study was 14 and the oldest was 87 years old.

CONCLUSION

Besides the gastrointestinal complications in the acute corrosive poisonings respiratory complications are also very often. They complicate the clinical state of patient and very often lead to fatal endings.

Pharmacologically-induced metabolic acidosis: a review

Metabolic acidosis may occasionally develop in the course of treatment with drugs used in everyday clinical practice, as well as with the exposure to certain chemicals. Drug-induced metabolic acidosis, although usually mild, may well be life-threatening, as in cases of lactic acidosis complicating antiretroviral therapy or treatment with biguanides. Therefore, a detailed medical history, with special attention to the recent use of culprit medications, is essential in patients with acid-base derangements. Effective clinical management can be handled through awareness of the adverse effect of certain pharmaceutical compounds on the acid-base status. In this review, we evaluate relevant literature with regard to metabolic acidosis associated with specific drug treatment, and discuss the clinical setting and underlying pathophysiological mechanisms. These mechanisms involve renal inability to excrete the dietary H+ load (including types I and IV renal tubular acidoses), metabolic acidosis owing to increased H+ load (including lactic acidosis, ketoacidosis, ingestion of various substances, administration of hyperalimentation solutions and massive rhabdomyolysis) and metabolic acidosis due to HCO3- loss (including gastrointestinal loss and type II renal tubular acidosis). Determinations of arterial blood gases, the serum anion gap and, in some circumstances, the serum osmolar gap are helpful in delineating the pathogenesis of the acid-base disorder. In all cases of drug-related metabolic acidosis, discontinuation of the culprit medications and avoidance of readministration is advised.