Jean-Michel Droy

Fomepizole (4-Methylpyrazole) in Fatal Methanol Poisoning with Early CT Scan Cerebral Lesions

BACKGROUND Methanol poisoning, potentially fatal, is generally treated with the combination of ethanol as antidote, and hemodialysis. Fomepizole, a competitive inhibitor of alcohol dehydrogenase, has more recently been used, and is capable of blocking the toxic metabolism of methanol. To our knowledge, its use has never been reported as an antidote in severe methanol poisoning requiring hemodialysis. CASE REPORT We report a case of fatal methanol poisoning (1.9 g/L on admission) suspected due to the combined presence of coma and severe metabolic acidosis with normokalaemia. CONCLUSION The fomepizole treatment protocol (10 mg/kg by i.v. infusion over 1 hour before dialysis, repeated 12 hours later in combination with 1.5 mg/kg/h during dialysis) was simple to use and appeared effective in eliminating methanol in combination with hemodialysis. The case is also unusual in terms of severity and the early onset of cerebral lesions demonstrated by computed tomography (CT) scan.

Syndrome of inappropriate secretion of antidiuretic hormone in two elderly women with elevated serum fluoxetine.

OBJECTIVE Fluoxetine is widely prescribed for depressed patients. Hyponatremia secondary to inappropriate secretion of antidiuretic hormone has been reported in a few cases associated with routine use of fluoxetine, especially in elderly patients. The mechanism has been postulated to be linked to the inappropriate secretion of antidiuretic hormone. Serum concentrations of antidiuretic hormone and fluoxetine have not been reported in previously published reports. CASE REPORT We report two new cases of severe and reversible hyponatremia associated with routine use of fluoxetine therapy in two elderly women. Fluoxetine-induced inappropriate secretion of antidiuretic hormone was confirmed by elevated serum concentrations of antidiuretic hormone and fluoxetine.

Toxicological analysis in agitated patients

Objective: To assess the toxicological etiologies in agitated patients and to evaluate their initial clinical diagnosis in the light of toxicological results analysis. Design: Prospective clinical study. Setting: Emergency Department (ED) in a 2,650-bed University Hospital. Patients: Fifty-eight consecutively enrolled patients admitted to the ED in agitated states over a 6-month period. Measurements and results: All patients underwent laboratory tests including blood glucose, ethanol and serum drug screening. Toxicology tests were conducted by fluorescence polarization immunoassay and confirmed by high performance liquid chromatography/diode array detector and gas chromatography-mass spectrometry. The physicians initial diagnosis was evaluated in the light of toxicological analysis results. Serum toxicological analysis revealed that 50/58 patients were under the influence of alcohol and/or a drug. Benzodiazepines (22/58), selective serotonin reuptake inhibitors (5/58) and opiates (4/58) were the most frequently observed. The initial clinical diagnosis was alcohol intoxication in 39 patients, although 1 patient was not under the influence of alcohol and 16 also had benzodiazepine in their sera. Moreover, the diagnosis of serotonin syndrome was overlooked in two patients. Conclusion: Most agitated patients were under the influence of alcohol and/or a drug. Benzodiazepine alone or in association with alcohol was surprisingly frequent. A serotonin syndrome may explain the agitation state.

SETH: an expert system for the management on acute drug poisoning in adults.

The aim of SETH is to give end-users specific advice concerning treatment and monitoring of adult drug poisoning. SETH is developed with an off the shelf expert system shell (KBMS) and runs on a microcomputer. Technical choices were done according to this analysis, financial considerations and portability. Currently, the database contains 1000 French drugs from 75 different toxicological classes. The SETH expert system simulates the expert reasoning, taking into account for each toxicological class delay, signs and dose. Two phases of evaluation were performed. The experimental implementation of Seth began in April 1992 in our Poison Control Centre. Since then, 1100 cases inputted by residents were analysed by SETH. The extension of the knowledge base to child poisoning began in March 1993.

Functional Evaluation of SETH: An Expert System In Clinical Toxicology

The aim of SETH is to give end-users specific advice concerning treatment and monitoring of drug poisoning. It is developed with an off the shelf expert system shell and runs on a microcomputer. The SETH expert system simulates the expert reasoning, taking into account for each toxicological class delay, signs and dose. The implementation of Seth began in April 1992 in our Poison Control Centre (PCC). SETH is then daily used by residents as telephone response support on drug poisoning. Between April 1992 and October 1994, 2099 cases inputted by residents were analysed by SETH. In October 1994, a functional evaluation of SETH showed that its effect in the daily practise of our PCC is positive: the performance of the residents increased and they would agree to use it outside our University Hospital. An expert system in clinical toxicology is a valuable tool in the daily practise of a Poison Control Centre.

Severe self-poisoning with oxetorone: report of one case

The authors report a case of severe self-poisoning with oxetorone. Plasma concentration of the drug assessed by HPLC was a thousand times higher than therapeutic levels. Coma, convulsions, and cardiac conduction defects were observed, similar to those noted with tricyclic and tetracyclic antidepressant poisoning. Similar cardiac disorders consisting of conduction defects had not been previously described during oxetorone intoxication.

SETH: A toxicological expert system in adult drugs poisoning

The aim of SETH is to give end-users specific advice concerning treatment and monitoring of adult drug poisoning. SETH is developed with an off the shelf expert system shell (KBMS) and runs on a microcomputer. No errors were detected in final conclusions in the internal evaluation.