Human toxicology
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Serial measurements of plasma mercury were made in a patient with severe and prolonged acute renal failure due to poisoning with mercuric chloride. An initial mercury concentration in whole blood of 1200 micrograms/l (6 mumol/l) was recorded, and recovery of renal function coincided with a fall in plasma mercury concentration to below 100 micrograms/l (0.5 mumol/l). The case demonstrates that survival and recovery of renal function is possible despite very high concentrations of mercury in the blood and oliguric renal failure of nearly six weeks' duration.
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In order to assess the significance of drug concentrations measured in clinical and toxicological investigations, it is essential that good collections of data are readily available. As a guide to interpreting findings, the present work provides a compilation of therapeutic, toxic and fatal blood concentration ranges of 298 drugs of interest to clinical pharmacologists, clinical toxicologists, and forensic toxicologists. Wherever possible, ranges are expressed concisely in terms of the maximum blood concentrations which account for 10, 50 and 90% of the data collected. ⋯ Where appropriate, the different toxic effects of a drug and/or the different degrees of severity of toxic symptoms associated with different drug levels are clearly defined. The original sources of all data used are provided to allow the analyst to obtain further analytical, pharmacokinetic and toxicological information should this be necessary. Those factors (e.g. age, capacity for drug metabolism, drug interactions, etc) which can modify the relationship between a drug concentration and the response it produces are briefly discussed.
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1 A total of 18 cases of Amanita phalloides intoxication was treated by combined chemotherapy during 1980 and 1981. After attempted primary elimination of the toxin all patients received silibinin as basic therapy mainly by infusion and in two instances orally. 2 In order to evaluate the effect of silibinin therapy a retrospective study of the followed-up case records was made. ⋯ With the exception of one fatality in a particularly high dosage suicidal intoxication, all patients survived. 4 Administration of silibrinin even up to 48 h after mushroom ingestion appears to be an effective measure to prevent severe liver damage in Amanita phalloides poisoning. Contrarily, the onset of general supportive treatment together with penicillin therapy which was throughout several hours before silibinin administration did not correlate with the severity of liver damage.
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1 During the 19th century inadequate control of the sale of poisons, widespread illiteracy, and the English addiction to self-medication contributed to the high incidence of accidental poisoning by oxalic acid mistaken for Epsom salt. 2 Chemical methods for identifying oxalic acid failed when the product was adulterated. 3 Many mechanical devices were proposed to prevent careless dispensing; designs for poison bottles of distinctive shape, colour and texture appeared regularly for 40 years.