Pere Munné

Urgencias por cocaína: un problema emergente

Fundamento y objetivo En los ultimos anos ha aumentado en Espana el consumo de cocaina, por lo que podrian estar produciendose cada vez mas episodios de sobredosis. El uso asociado de otras drogas de abuso puede potenciar su toxicidad y, por tanto, incrementar las consultas a los servicios de urgencias (SU). Pacientes y metodo Se han recogido los datos de los pacientes que consultaron al SU y que referian consumo de cocaina en las horas previas. Se ha analizado la relacion entre la droga y el motivo de consulta y se han revisado las historias clinicas de una muestra para conocer su perfil clinico. Resultados Durante un periodo de 3 anos (2002-2004) se identifico a 745 pacientes (edad media de 31 anos, un 68% varones). La distribucion anual fue de 223 casos en el ano 2002, 232 en 2003 y 290 en 2004. El 53% de los pacientes consultaron durante el fin de semana y el 53% acudio al SU entre las 0 y las 12 h. Otras drogas asociadas al consumo de cocaina fueron el alcohol etilico (38%), los opiaceos (14%), el cannabis (13%) y los derivados anfetaminicos (9%). La cocaina fue el toxico causante del cuadro clinico en el 70% de los casos. Los motives principales de consulta fueron ansiedad o agitacion (48%) y dolor toracico o palpitaciones (25%). El 11% requirio ingreso hospitalario (19 casos en la unidad de cuidados intensivos) y se registraron 3 casos mortales. Conclusiones El consumo de cocaina, asociado casi siempre a otras drogas de abuso, ha generado un incremento de las consultas a los SU. Si bien la mortalidad es baja, el consumo de cocaine comporta morbilidad y frecuente ingreso hospitalario.

Sensibilidad química múltiple: análisis de 52 casos

Fundamento y objetivo La sensibilidad quimica multiple (SQM) se caracteriza por la perdida de tolerancia a la presencia en el medio ambiente de agentes quimicos diversos. El objetivo de este trabajo es describir las caracteristicas clinicas de una serie de pacientes con SQM atendidos en nuestro hospital. Pacientes y metodo Se ha evaluado a los pacientes atendidos en las Unidades de Toxicologia y de Fatiga Cronica que presentaban sintomas de SQM. El diagnostico fue clinico. Todos ellos completaron el cuestionario QEESI (Quick Environmental Exposure and Sensitivity Inventory). Resultados Se ha incluido a 52 pacientes, con una edad media (desviacion estandar) de 47,2 (7,6) anos; 46 eran mujeres (88%). El origen del sindrome pudo relacionarse con una exposicion laboral a productos quimicos en 31 pacientes (59,6%) y en 14 de ellos fue una fumigacion con insecticidas en el lugar de trabajo. En 20 casos (38,5%) el sindrome no pudo relacionarse con ninguna exposicion toxica y constituia una manifestacion mas de un sindrome de fatiga cronica. En el cuestionario QEESI obtuvieron una media de 72,9 (18,6) puntos en la escala de exposicion inhalatoria; 45,5 (20,6) en la de exposicion no inhalatoria; 69,8 (20,6) en la de gravedad de los sintomas; 4,4 (1,8) en la de identificacion de la exposicion, y 66,6 (21,7) en la de repercusion sobre las actividades de la vida diaria. Todos los casos fueron controlados durante un minimo de 12 meses, periodo durante el cual permanecieron estables y no se registro ningun fallecimiento. Conclusiones La SQM incide habitualmente en mujeres de mediana edad. En general se desencadena por una exposicion a productos quimicos y muy en particular a insecticidas. La asociacion con el sindrome de fatiga cronica es frecuente. El pronostico vital es bueno, pero se reduce considerablemente la calidad de vida de los pacientes.

Acute Potassium Dichromate Poisoning

involving incubation without T4, the average sulphonamide concentrations for the five compounds after 1, 2 and 3 h were 108%, 97% and 105%, respectively, of the original levels. Thus the possibility that the observed loss of sulphonamide could be due to binding to albumin or to spontaneous degradation was eliminated. We are currently investigating the nature of the chemical interactions between sulphonamides and T4. However, the most likely reaction is iodination of the benzene ring of the sulphonamide at the relatively 8-positive 3 position. This would presumably involve the iodine atoms in positions 3’ and/or 5’ of the aromatic structure of T4 because these are more labile than those in

Análisis de las consultas generadas por el consumo de éxtasis en un servicio de urgencias

BACKGROUND AND OBJECTIVE: There has been in recent years an increase in the number of medical emergencies due to the consumption of designer drugs. We decided to study the characteristics of medical emergencies generated by the consumption of amphetamine derivates. PATIENTS AND METHOD: For the period 2000-2002, the medical records of patients attending the Emergency Department (ED) who claimed to have consumed ecstasy or other amphetamine derivates or whose toxicological tests were positive for amphetamines were reviewed. RESULTS: A total of 230 cases were identified, of whom 135 attended the ED due directly to ecstasy consumption. The average age was 23 years and 68% were men. Most patients were attended on weekend nights. The main reasons for attendance at the ED were anxiety, agitation or cognitive disturbances, reduced consciousness and fits or motor disturbances. Eighty per cent of patients admitted having consumed ecstasy and 65% of patients had consumed additional drugs. Three severe cases were recorded: two died in the ED and another was admitted to the ICU. CONCLUSIONS: Ecstasy consumption generates common attendance at the Emergency Department and can be potentially fatal.

Copper contamination from domestic tap water with a descaler

Sir -- Drinking-water is potentially a major source of copper exposure because of the widespread use of copper pipes in household plumbing. We describe a patient who complained of abdominal pain and green hair. Examination revealed high levels of copper in the blood, urine and hair, which we were able to link to the installation of a household descaling device. A 32-year-old woman, with no history of substance abuse, who was not taking any regular medication and whose medical history was unexceptional except for sporadic self-limiting episodes of abdominal pain, requested medical advice for a patchy, non-homogenous green discoloration of the hair, especially of the temporal and occipital areas, that had begun two months earlier. Physical examination was normal; the natural hair colour was blonde. The analytical results included the following: copper in serum: 41 [micro]mol/l (normal range (NR): 11-23[micro]mol/l); copper in urine: 0.78 [micro]mol/24h (NR: [is less than] 0.6 [micro]mol/l); ceruloplasmin: 30 mg/dl (NR: 25-40 mg/dl); and copper in hair: 1392 [micro]g/g (NR: 41.7 [+ or -] 4-21.2 [micro]g/g). Microscopic examination of the hair showed some minor alterations of the cuticular layer of the shaft. The appearance of green hair coincided with a change of domicile. The patient had moved to a dwelling where all the water pipes were made of copper, and a descaler using a method of exchange resins had been incorporated into the household water system. Analysis of the water (pH, 7.2-7.4) from the kitchen and bathroom taps showed the following cation concentrations: copper, 1.2-1.95 mg/l; calcium, 5.8-8.6 mg/l; and magnesium, 3-4 mg/l. The copper concentrations were generally higher in water from the hot-water pipes than from the cold-water pipes. The mains water entering the house had the following cation concentrations: copper, 0.02 mg/l; calcium, 171 mg/l; and magnesium, 58 mg/l. The patient was treated only with shampoo containing D-penicillamine, the & scaler was disconnected, and the patients hair recovered its original colour within two weeks. Three months after disconnection of the descaler, significant changes were found in the cationic concentrations of the household tap water: copper, 0.5-0.9 mg/l; calcium, 140-160 mg/l; and magnesium, 47-50 mg/l. Over the same period, the concentrations of copper in the blood and urine of the patient fell to 29 [micro]mol/l and 0.27 [micro]mol/l, respectively. Effects observed in humans following the consumption of water contaminated with copper have been gastrointestinal (vomiting, diarrhoea, nausea, abdominal pain and a metallic taste in the mouth), hepatic (micronodular cirrhosis) and renal (necrosis of tubular cells) (1, 2), and an exogenous pigmentation (green hair) from increased copper in domestic tap water or swimming pool water (3). …

Acute Arsenical Myopathy: Morphological Description

We describe the histological findings of the muscle in a case of acute voluntary massive arsenic intoxication resulting in severe rhabdomyolysis. The main features on muscle biopsy were perifascicular hypercontracted fibers, myofibrillar disruption, mitochondrial abnormalities and abundant cytoplasmic vacuoles containing lipids.

Intoxicaciones medicamentosas (I): Psicofármacos y antiarrítmicos

In the evaluation of Acute Drug Poisoning (ADP) in patients seriously ill with a potentially non-toxic dose of the drug that is theoretically responsible, it is important to insist on anamnesis in the coingestion of other drugs or toxics. Initially attention is given to life support measures, oxygenation, protection of the airway and expanding the volemia. The ECG is a diagnostic tool of the first order in ADPs, above all for tricyclic antidepressants (TAD) and cardio-vascular drugs. In the majority of cases continuous monitoring is usually necessary during the first 12-24 hours. The benzodiazepines do not usually give rise to serious poisoning. The use of flumazenil will be reserved for cases of respiratory depression, deep coma or where the cause is undetermined. They can give rise to convulsions, above all in the case of mixed poisonings with anti-depressants and abstinence syndrome. The TADs have an enormous potential seriousness, as they can cause mortal arrhythmias. The therapeutic range of lithium is very narrow; it can produce signs of basically digestive and neurological toxicity. In the case of poisoning by digoxin, the use of anti-digital anti-bodies will be considered in cases of serious bradyarrhythmias, AV blocks or PCR. Glucagon is the antidote for serious poisoning by beta-blockers and for refractory hypotension in cases of calcioantagonists.