Methanol Poisoning Leading to Brain Death: A Case Report

Introduction The COVID-19 pandemic has put increased stress on medical systems, infrastructure, and the public in expected and unexpected ways. This case report summarises an unexpected case of methanol poisoning from hand sanitiser ingestion due to changes in industry regulations, increased demand for cleaning products and severe psychosocial stressors brought on by the pandemic. Severe methanol toxicity results in profound metabolic disturbances, damage to the retina and optic nerves, and potentially death. Case Presentation The patient was a 26-year-old male with alcohol use disorder who presented with one day of nausea, vomiting, and abdominal pain after consuming hand sanitiser. Within a few hours, the patient had suffered multiple seizures, cardiac arrests and required admission to the ICU for emergent management of methanol poisoning. EEG and brain perfusion imaging were performed to confirm brain death, given concerns about the cranial nerve exam after methanol poisoning. Conclusions While rare, methanol toxicity remains a potentially fatal poisoning in the United States and worldwide. When healthcare and public resources are strained, healthcare professionals must consider particularly abnormal presentations. In patients suspected of brain death from methanol toxicity, cranial nerve examination may be unreliable. Therefore, additional testing is necessary to confirm brain death.

Temporal trends of carbon monoxide poisoning mortality at the global, regional and national levels: a cross-sectional study from the Global Burden of Disease study, 1990 and 2017

ObjectivesCarbon monoxide (CO) poisoning is one of the most frequent causes of fatal poisoning worldwide. Few studies have explored the mortality trends of CO poisoning grouped by age and gender, at the regional, national and global levels. We therefore aimed to determine the pattern of CO poisoning mortality, as well as temporal trends at all levels.DesignA cross-sectional survey design was used in this study.SettingCO poisoning data collected from the Global Burden of Diseases (GBDs), from 1990 to 2017, was arranged by sex, age, region and country. In addition, we used human development index data at the national level from the World Bank.ParticipantsWe collected over 100 000 information on CO poisoning mortality between 1990 and 2017, derived from the GBD study in 2017.Main outcomes and measuresWe have calculated the estimated annual percentage changes in CO poisoning age-standardised mortality rate (ASR), by sex and age at different regions and countries to quantify the temporal trends in CO poisoning ASR.ResultsGlobally, death cases of CO poisoning decreased 7.2% from 38 210 in 1990 to 35 480 in 2017. The overall ASR decreased by an average of 1.83% (95% CI 2.10% to 1.56%) per year in this period. This decreasing pattern was heterogeneous across ages, regions and countries. The most pronounced decreases were generally observed in countries with a high sociodemographic index, including Estonia, South Korea and Puerto Rico.ConclusionsCurrent prevention strategies should be reoriented, and much more targeted and specific strategies should be established in some countries to forestall CO poisoning.

Fatal poisoning of a child with pyrafene and norsulfazole

Poisoning with pirafen is extremely rare, while poisoning with it in combination with norsulfazole, one must think, may occur sooner, which prompted us to report this case.

External study possibilities of a dead body solution about the death occurrence from psychotropic and narcotic drug poisoning

Background: Poisoning with psychotropic and narcotic substances is still leads to the general structure of fatal intoxications. A decreased traditional psychotropic and narcotic drug fatal poisoning and an increased new synthetic psychoactive substances and combined consumption are recorded in the country. Aims: This study aimed to study the dynamics of drug poisoning incidence according to the annual report data in 20172020 in the Krasnodar territory and establish their predominant etiology. Analyze the medical literature and identify the data mostly described during the external examination that suggests narcotic drug exposure possibility of the body. Comparison of the literature and external examination results of the corpse from the Expert Conclusions (Acts of forensic medical research) to further use the signs to create a profile of the suspected poisoned corpse with narcotic substances. Material and methods: The study material includes the annual reports of the State Budgetary Healthcare Institution Bureau SME of the Ministry of Health of the Krasnodar Territory in 20172020, archival medical documentation autopsy reports in cases of death from narcotic substances; domestic and foreign literary sources. Results: In the Krasnodar Territory, opiates account for a large proportion of drug deaths. Psychotropic and narcotic drug intake is often (up to 30%) combined with alcohol consumption. The study showed that forensic pathology rarely uses external signs that make up the profile of a corpse suspected of drug poisoning at the initial stage. The most common signs (in 50% of cases) were: injection traces, cyanotic and flushed face, conjunctival hemorrhages, and whitish-pink foam in the nose or mouth openings. Others were not given due attention. Conclusion: The research topic dictates the need for further study and problem development, accumulation, and systematization of the obtained material for subsequent use.

Dilated Cardiomyopathy Associated with Paraquat Herbicide Poisoning

Dilated cardiomyopathy is a subset of cardiomyopathies defined by reduced ejection fraction of less than 45% and a dilated left ventricle. While dilated cardiomyopathy is common, its etiology is not always readily evident. Paraquat is used as an herbicide worldwide and is one of the main causes of fatal poisoning in underdeveloped countries in Asia, Central America, and the Pacific Islands. The most commonly affected organs are the lungs and kidneys. However, experimental research has shown that Paraquat can affect the heart indirectly through increased vascular permeability. In vivo animal studies have shown that paraquat poisoning causes myocardial contractile dysfunction by decreased fractional shortening and cardiac remodeling. We report the first case in published literature of a 52-year-old Hispanic man with dilated cardiomyopathy strongly associated with Paraquat exposure. It is important to obtain detailed medical history and proper diagnostic work-up including work, social, and family history, and echocardiography, baseline EKG, lab work, and ischemia cardiac testing as it can lead to improved diagnostic evaluation of possible etiologies of the commonly seen dilated cardiomyopathies and help identify less well-known etiologies as seen in our patient.

Acute lethal poisonings in children: a 10-year retrospective study of the Moscow Region, Russia

Background: Poisoning is a critical public health problem. Toxic substances differ across time, region and age. Little is known about poisoning in Russia, and even less is known about lethal poisoning in children in Russia. We aimed to describe the characteristics of cases of lethal poisoning in children and adolescents.Design and methods: Our retrospective study was based on autopsy reports from archives of the Moscow Region Bureau of Forensic Medical Examination for the period of 2009 to 2018.Results: A total of 438 lethal poisoning cases were recorded. The average age of the poisoned children was 11.3 years. Deaths predominantly occurred in boys, mostly due to the higher frequency of poisoning with household and technical chemicals (p<0.01). Accidental deaths were also higher in males (p < 0.01). Therapeutic drug poisoning (p<0.01) and suicide (p < 0.01) were more frequent in females. The leading cause of lethal poisoning in children was exposure to carbon monoxide, especially in children aged 5 to 9 years (p<0.01) and 1 to 4 years (p<0.01). Carbon monoxide poisoning occurred more often in winter (p<0.01). Regarding the structure of poisoning with household and technical chemicals, the most frequent was poisoning by a mixture of utility gases.Conclusion: Our study shows that carbon monoxide poisoning is a serious problem in the region. This may be associated with the ongoing use of individual heating systems. A significant increase in the frequency of fatal poisoning by chemicals, especially by propane-butane gas mixtures while sniffing, has become a disturbing trend.

Pathomorphological changes in internal organs in acute poisoning with 4-hydroxybutanoic acid (according to the data of the Bureau of forensic medical expertise)

The aim of the study was to establish objective reliable morphological signs of fatal poisoning with 4-hydroxybutanoic acid (4-HBA).Material and methods. The 49 acts of forensic medical examination of corpses with «Acute poisoning with 4-hydroxybutanoic acid» as the main cause of death were analyzed. The work was done in the Saint Petersburg Bureau of Forensic Medical Expertise.The results of morphological (macro - and microscopic) as well as forensic chemical studies of biological tissues were evaluated.The results were statistically processed using Statistic for Windows software (version 10). The numerical characteristics of the variables (M ± SD, Me [Q25; Q75]), χ2 — Pearson's criterion, and Spearman's correlation coefficient were applied for statistical processing.Results. The average lethal dose of 4-HBA in arterial blood was found to be equal to 273,6 ± 125,1 mg/l. In a forensic chemical study the combined use of 4-HBA and other narcotic substances (NS) and psychoactive substances (PAS) was diagnosed in 48.9% of cases. Of the causes leading to death, non-violent and «non-criminal» death due to 4-HBA poisoning was established more often - in 67.3% (33) of cases, a fall of the victim from a height with a fatal outcome - in 22.4% (11), less often violent death as a result of blunt and acute trauma - in 4.09% (2) cases.Among the macroscopic signs of acute lethal poisoning with 4-HBA were an increased mass of internal organs (heart, lungs, spleen, liver) in direct connection with the concentration of the toxicant in the blood. Microscopic signs of acute lethal poisoning by a toxicant included blood circulation features characteristic of sudden death.Concomitant pathology was diagnosed in 32.6% of cases in the form of degenerative changes in internal organs. In turn, hepatitis C and human immunodeficiency virus (HIV) were detected in 26.5% (13) of the dead.Conclusions. Thus, the signs characteristic for acute fatal poisoning with 4-HBA include the features of hemocirculation characteristic of sudden death. The brain is most severely affected, which is manifested by destructive edema. Poisoning is also characterized by the presence of serous pulmonary edema. Macroscopic signs of poisoning were revealed, including an increase in the weight of the heart, lungs, spleen and liver in direct connection with the concentration of the toxicant in the blood.It should be noted that the concomitant pathology in the form of dystrophic changes in the internal organs indicates the long-term nature of the use of the toxicant leading to pronounced metabolic disorders.