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Background Aconite is one of the most toxic known herbs, widely used for centuries as an essential Chinese medicine, but also for deliberate poisoning throughout history. Clinically indicated in herbal medicine for a range of ailments from headaches to muscle spasm, unfortunately the narrow therapeutic window may lead to a range of toxic presentations. The mechanism of action of the pharmacologically active compounds in Aconite relate to the activation of voltage gated sodium channels within a range of tissue including myocardial, neuronal and smooth muscle leading to persistent cellular activity. Case presentation We report on a rare case of a fifty year old male with intentional aconite overdose presenting with refractory cardiovascular instability from persistent life threatening arrhythmias, respiratory failure and seizure activity. Conclusion An overview of Aconite, its history, pharmacological effects, treatment of overdose and outcomes is presented.

Pharmaceuticals are considered emerging contaminants in terms of impacts on wildlife. One chemical group of concern is euthanasia agents used in veterinary medicine. Here we present data on the occurrence of barbiturate intoxication using samples collected from 2004 to 2020 of suspected wildlife and domestic animal poisoning cases in Spain (n = 3210). Barbiturate intoxication was seen in 3.4% (45/1334) of the total number of confirmed intoxicated animals. Barbiturates were detected in 0.2% (1/448) of baits containing detectable poisons. The most frequently detected barbiturate was pentobarbital (42/45, 93.3%), but we also detected phenobarbital, barbital, and thiopental (2.2% prevalence for each). Avian scavengers were most frequently affected by barbiturate intoxication (n = 36), especially Eurasian griffon vultures (Gyps fulvus) (n = 28). Median pentobarbital concentrations detected in intoxicated griffon vultures was 27.3 mg kg−1 in gastric content and 38.1 mg kg−1 in liver, which highlights the acute effect of the chemical soon after ingestion. At least two large intoxication events affecting griffon vultures were related to the consumption of carcasses from euthanized livestock. We also found phenobarbital in a prepared bait linked to the intoxication of one Eurasian buzzard (Buteo buteo). This study highlights the need for stronger regulation of barbiturates to avoid secondary intoxications due to improper disposal of euthanized livestock., This study was supported by the Spanish Ministry of Economy and Competitiveness [CGL 2013–40975-R] and contracts for the forensic analysis of wildlife poisoning events held with the regions of Aragon, Asturias, the Balearic Islands, the Basque Country, Cantabria, Castilla La Mancha, Catalonia, La Rioja, Madrid and Navarra. PRC benefited from a contract with reference PTA 2017-14583-I financed by the Spanish Ministry of Science and Innovation and CSIC.

Poisoning is a significant public health problem, globally as well as in India. 1 Poisoning among adults are mostly suicidal whereas among children are accidental in nature. 2 In India, childhood poisoning is usually under reported as there is no proper surveillance system is available India and only hospital based data are available. 2,3 We report our experience from a remote rural hospital from South India after getting institute ethical committee clearance for dissemination of data (Ref no. RC 18/55). We extracted the data of under-five children poisoning cases from poisoning register maintained in the hospital for the period of past eight years from 1 st January 2012 to 31 st December 2019. Total of 21 childhood poisoning were reported among them 12 (57%) were male and 9 (43%) were female. Most common poisoning was due to kerosene (8(38%)) followed by laundry bleaching detergent locally known as ‘Ala’ 5 (23%), pesticide poison 2 (10%), eucalyptus oil poisoning 2 (10%) and others like ant killer poisoning tablets overdose were 4 (19%). In children, poisoning are accidental nature and the amount consumed may also be less as the child has tendency for aversion due to smell and taste whereas in suicidal (deliberate poisoning) the dose will be higher to cause permanent damage and death. 2 But unlike other poisoning a peculiar finding on reported eucalyptus oil poisoning was, in both cases eucalyptus oil was given to the children to consume as a medicine to cure respiratory tract infection and both of them presented with seizure and unconsciousness. Eucalyptus oil is advice as a topical medicine in the indigenous system of medicine but not as a parenteral medicine. 4 In a place like India where there are prevailing false cultural beliefs, there is a need to educate and guide the people on misuse of medicines without proper advice, especially among children. A higher dose of eucalyptus oil poisoning may even result in death. 5,6 Another important observation was bleaching detergent poisoning which is not properly reported other major studies from India, but this poisoning is the second most commonest among under-five children. 2,3 This poison is an oxidizer and a corrosive in nature and on accidental ingestion may result in minor to transient adverse event with no sequelae in majority of cases. 7

Introduction:There are various means of suicide out ofwhich intentional or deliberate poisoning is one ofthe leading.

Deliberate poisoning of children is rare in the UK but carries a high morbidity and mortality. Two-thirds of cases in the major UK epidemiological survey in the early 1990's were associated with FII abuse. Diagnosis is often delayed with severe consequences for the child concerned. This paper reviews how poisoning may present in the context of FII abuse and describes the types of poisoning agents that may be identified, along with a brief guide to diagnosis and management of cases. Detailed guidance on managing cases is available through RCPCH and government documents.

We thank C. Cano, L. Varona, R. Menendez, Fundacion para la Conservacion del Quebrantahuesos, Junta de Castilla y Leon and SEPRONA for informationon poisoning events. Toxicologic analyses performed at IREC were funded by Principado de Asturias. P.M.T. was supported by a postdoctoral grant funded by Junta de Comunidades de Castilla-La Mancha and Fondo Social Europeo.

IntroductionParacetamol is the most commonly used drug in deliberate poisoning. N-acetylcysteine is the standard antidote for significant acute paracetamol overdose, but the route of administration varies between countries. This review aimed to find and appraise those comparative studies which would help answer the following question: in patients who have taken an overdose of paracetamol requiring antidote, is there any difference between intravenous and oral N-acetylcysteine in mortality, hepatotoxicity, adverse drug reactions or cost?MethodsA literature search was conducted using Medline and other databases. Relevant papers were identified and appraised.ResultsOne animal study and seven comparative clinical studies were identified and appraised. The quality of the evidence was generally poor, and there was no clear difference in outcomes between the two routes of administration.ConclusionsWithout evidence of advantage for one route over the other, routine practice should not be changed. However, after 30 years experience, both routes appear to be effective and safe, and in countries where intravenous administration is the standard, it would be reasonable to consider the oral route as an alternative when intravenous access is problematic. There is a need for prospective, randomised trials to determine the relative effectiveness, safety and cost of intravenous and oral formulations of N-acetylcysteine.

Acute carbon monoxide poisoning remains a major cause of morbidity and mortality, both due to accidental and deliberate poisoning. This article reviews the current concepts of the pathophysiology of carbon monoxide poisoning and the historical evolution of these concepts. The clinical presentation is discussed as it relates to the various organ systems. Finally, the history and role of hyperbaric oxygen is also discussed. Hyperbaric oxygen remains an established, although inconclusively proven, treatment option.

A suicidal ingestion of an unknown quantity of Resochin (chloroquine) tablets is described. Although chloroquine is known since 1934, intoxications due to chloroquine overdose are rather rare in European countries. The authors report on a new and fast method of analysing and determining the chloroquine concentration in body fluids and postmortem specimens. The analytes were extracted from alkalinized samples into ethyl acetate before GC/MS analysis. The analyses of chloroquine were performed without any complex sample clean-up steps and, in addition, with little sample material. The proposed method resulted in a rapid procedure most useful in cases of deliberate poisoning with the anti-inflammatory and antimalarial drug chloroquine.

Summary Background: The recommendations of consensus conferences (CC) contribute to the improvement of care if they result in changes in clinical practice. We have studied how consensus guidelines on gastrointestinal decontamination and elimination of ingested substances in acute poisoning affected clinical practice in an emergency medical admissions unit. Method: On the initiative of the unit's director, the consensus guidelines were posted in the treatment rooms and explained to physicians through regularly updated courses. Clinical files were reviewed and critically discussed with the physicians. Results: Two years after the CC, the number of gastric lavages had decreased by 83.5%, and the prescription of activated charcoal had risen by 92.3%. Gastric lavages practice had almost disappeared for deliberate poisoning with benzodiazepines alone. Conclusions: The committed involvement of an opinion leader, or of a head physician, who shares with colleagues his/her conviction that the recommendations are valuable in daily practice, provides an excellent guarantee that dissemination will lead to implementation. The involvement of all medical staff also seems important.

Acute poisoning of formalin is rare because of its strong irritating effect and alarming odor. Although few cases of acute poisoning in adults have been reported in literature, to our knowledge, this is the first case report of formalin poisoning in an infant presenting with multisystem failure. Despite proper supportive treatment in the absence of antidote, the infant died within 13 hours after deliberate poisoning. Language: en

The poisoning of animals is one of the top issues that owners of animals are faced with.The method the poisoning of animals can be intentional or unintentional. In most cases the poisoning of animals is unintentional. The main culprit is the owner of the animal that is careless in the use of chemical, toxic substances or plants that are later ingested by the animals. Deliberate poisoning on the other hand, is caused by people who intentionally poison the food of the animals.In R. Macedonia in January 2008 came into force the Law on Veterinary Health and the Law on Protection and Welfare of Animals (Official Gazette, No.113 / 2007) in which, among other things, minimum requirements are laid down for veterinary health, protection and animal welfare in various aspects among which is the poisoning of animals.The purpose of this research is to make a comparative analysis of the views of citizens who own animals and those who do not regarding poisoning. The research was conducted in 2014.According to the received data we can conclude that there is a difference in the views between citizens who own animals (80% are against the poisoning of animals) and those who are not owners (40% are against the poisoning of animals). From the conducted research we can conclude that there is a need for greater education of the population, especially those who are not owners of domestic animals, against the poisoning of animals and an introduction to the existence and functioning of the Law on the protection and welfare of animals in R. Macedonia.

An ingestion of an unknown quantity of Leponex® (clozapine) tablets in a suicide is described. Although clozapine is known for over 30 years now, relatively few cases of intoxications due to clozapine overdose have been reported. The authors report a new and quick method to analyze and determine the clozapine and N-desmethylclozapine concentration in body fluids. The analytes and an internal standard (zolpidem) were extracted from alkalinized samples into ethyl acetate before GC/NPD analysis. The proposed method resulted in a rapid procedure most useful in cases of deliberate poisoning with the neuroleptic drug Leponex®.

1 Although accidental poisoning of children with drugs and chemicals is a common precipitant for admission to hospital, the possibility of deliberate poisoning as an extension of 'the battered baby syndrome' is rarely considered. 2 Most children admitted following accidental ingestions require little active management other than induction of emesis. Reports of relatively large overdoses in infancy are rare, and protocols for management of such cases largely untried. This case report demonstrates the successful application of a current treatment regimen to an infant who had ingested a substantial quantity of paracetamol.

Munchausen Syndrome by Proxy is a mental condition in which a patient, usually a mother, persistently fabricates symptoms for another. A child will usually be the victim, and may undergo numerous distressing, unnecessary and sometimes painful medical investigations, treatment and even operations. Sometimes death may result, for example from deliberate poisoning. Immediate and effective protection for the child is essential and possible legal remedies including Wardship, Care, Place of Safety Orders, and prosecution of offenders are described and evaluated. An account is given of a case of suspected Munchausen Syndrome by Proxy in a child of eleven years, and arising therefrom, a discussion of the problems of management of a child who is or has been the victim of the syndrome over a period of years.

International audience; Deliberate poisoning with Cortinarius orellanus. Identification of orellanine in renal biopsy ten days and 6 months after the toxic mushroom ingestion