Veterinary and human toxicology
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Alkane arsenate herbicides are available commercially, and their acute toxicity has been well documented in previous studies. Animal studies have indicated that dimercaptosuccinic acid (DMSA) can be used as an oral chelating agent. A 20-y-old white male cocaine addict attempted suicide by drinking approximately 500 ml of a 16% monosodium methanearsenate solution. ⋯ However liver functions were abnormal, with elevation of serum transaminases, which later proved secondary to chronic hepatitis. No side effects of DMSA was encountered during the therapy. DMSA was successfully used to detoxify acute organoarsenate poisoning in a clinical setting, supporting experimental reports in the literature.
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In this retrospective study, we evaluated the clinical value of screening for salicylates in 347 patients with acute poisoning presenting to the Prince of Wales Hospital, Hong Kong, between January 1992 and June 1993. In 83 patients (24%), ingestion of salicylates was suspected; the incidence of elevated plasma salicylate concentrations (> 0.1 mmol/L) in those who had taken identifiable drugs, unidentifiable drugs but known type, or topical medicaments was 71%, 16% and 61%, respectively. ⋯ Restricting plasma measurements to only those suspected of having ingested salicylates would have saved up to 76% of requests. All physicians should be aware of the high salicylate content of some Chinese proprietary topical medicaments.
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The harmful effects of some Chinese herbal medicines (CHM) have become a cause for concern among the medical profession and the general public in Hong Kong. From 1989 to 1993, at least 33 patients were treated in the Prince of Wales Hospital because of severe poisoning by CHM. Of these, 20 presented with clinical features typical of aconitine poisoning following the ingestion of "chuanwu", the main root of Aconitum carmichaeli, or "caowu", the root of Aconitum kusnezoffii. Strict legislation controlling the use of chuanwu and caowu alone would have prevented many of the severe poisonings by CHM in Hong Kong.
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Twenty horses died 30 d after being fed a diet containing 40% of tritured Crotalaria juncea seeds. Before death, they had staggering, dyspnea and fever. At necropsy the most evident lesions were areas of lung parenchyma consolidation and enlarged and congested livers. ⋯ After 4 mo of feeding the animals died with dyspnea. Their lungs had diffuse fibrosing alveolitis with discrete formation of hyaline membranes and the livers were congested. Reproduction of the lesions implicated the plant and supported the diagnosis of C juncea intoxication in the horses.
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Both "chuanwu", the main root of Aconitum carmichaeli, and "caowu", the root of A kusnezoffii, are believed to possess anti-inflammatory, analgesic and cardiotonic effects and have been used in Chinese materia medica mainly for the treatment of musculoskeletal disorders. They contain the highly toxic C19 diterpenoid alkaloids of aconitine, mesaconitine and hypaconitine. After ingestion, patients may present with signs and symptoms that are typical of aconitine poisoning. ⋯ Management of aconitine poisoning is essentially supportive. There are no adequate studies in humans to indicate the most effective treatment of the ventricular arrhythmias. All clinicians should be alerted to the potential toxicity of "chuanwu" and "caowu".