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In recent years, an innovative approach has emerged in the field of toxicology for managing acute intoxications caused by lipophilic substances: intravenous lipid emulsions (ILEs). Through numerous experiments and case reports, the efficacy of lipid emulsions in counteracting toxicities induced by lipophilic agents, including a significant number of antiepileptic (AE) drugs, have become increasingly evident. Data spanning a 10-year period (2010–2020) were analyzed by searching through multiple scientific publication platforms like PubMed, Science Direct, Research Gate, and Springer Link. This study focused on reviewing relevant case reports detailing successful intravenous lipid emulsion (ILE) administration in patients with acute intoxications with antiepileptics, specifically examining the impact of fat emulsions on neurological status, Glasgow Coma Scale (GCS) scores, and corrected QT interval concerning hemodynamic instability. The typical symptoms of antiepileptic toxicity include central nervous system depression, ataxia, and nystagmus. Intravenous lipid emulsion application resulted in an increase in Glasgow Coma Scale scores and enhanced recovery from drug intoxication. This study provides a comprehensive overview of the potential utility of ILE as a component to antidote therapy in cases of acute AE poisoning involving neurotropic drugs. The process involves the engagement of various mechanisms of antitoxic activity. [ABSTRACT FROM AUTHOR]

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In recent years, an innovative approach has emerged in the field of toxicology for managing acute intoxications caused by lipophilic substances: intravenous lipid emulsions (ILEs). Through numerous experiments and case reports, the efficacy of lipid emulsions in counteracting toxicities induced by lipophilic agents, including a significant number of antiepileptic (AE) drugs, have become increasingly evident. Data spanning a 10-year period (2010–2020) were analyzed by searching through multiple scientific publication platforms like PubMed, Science Direct, Research Gate, and Springer Link. This study focused on reviewing relevant case reports detailing successful intravenous lipid emulsion (ILE) administration in patients with acute intoxications with antiepileptics, specifically examining the impact of fat emulsions on neurological status, Glasgow Coma Scale (GCS) scores, and corrected QT interval concerning hemodynamic instability. The typical symptoms of antiepileptic toxicity include central nervous system depression, ataxia, and nystagmus. Intravenous lipid emulsion application resulted in an increase in Glasgow Coma Scale scores and enhanced recovery from drug intoxication. This study provides a comprehensive overview of the potential utility of ILE as a component to antidote therapy in cases of acute AE poisoning involving neurotropic drugs. The process involves the engagement of various mechanisms of antitoxic activity.

It is generally believed that there is a great relationship between hangover and the age of Baijiu. However, what factors make Baijiu (stored for a long time) feel better after drinking has not been well explained. In this study, ethanol metabolism, oxidation stress, inflammation and release of inhibitory neurotransmitter were selected as the indicator of hangover. The results showed that the longer the age of Baijiu, the higher the antioxidant and anti-inflammatory levels, the less damage to the liver of mice. In addition, we also found that the longer the age of Baijiu, the faster the ethanol metabolism rate, the smaller the impact on the brain. A correlation analysis on Baijiu ingredients and hangover related indicators was conducted. These results showed that ethyl acetate, n-butanol, n-hexanol, butyl acetate, ethyl octanoate, isovaleric acid, 2-hydroxypropionic acid had a great correlation with all hangover related indicators.

This study investigated the circumstances of chemical occupational eye exposures reported to the Dutch Poisons Information Center. During a 1-year prospective study, data were collected through a telephone survey of 132 victims of acute occupational eye exposure. Victims were often exposed to industrial products (35%) or cleaning products (27%). Most patients developed no or mild symptoms. Organizational factors (such as lack of work instructions (52%)), and personal factors (such as time pressure and fatigue (50%), and not adequately using personal protective equipment (PPE, 14%), were the main causes of occupational eye exposures. Exposure often occurred during cleaning activities (34%) and personal factors were reported more often during cleaning (67%) than during other work activities (41%). Data from Poison Control Centers are a valuable source of information, enabling the identification of risk factors for chemical occupational eye exposure. This study shows that personal factors like time pressure and fatigue play a significant role, although personal factors may be related to organizational issues such as poor communication. Therefore, risk mitigation strategies should focus on technical, organizational, and personal factors. The need to follow work instructions and proper use of PPE should also have a prominent place in the education and training of workers. [ABSTRACT FROM AUTHOR]

Abstract Background Perchloroethylene is a colorless, strong-smelling substance commonly used for dry cleaning. Liver and kidney toxicities and carcinogenicity are well-known occupational hazards caused by chronic perchloroethylene exposure. Acute intoxication by ingestion of nondiluted perchloroethylene is rare in the adult population owing to its strong smell and taste. Very few data are available to physicians managing patients in this situation. Case presentation An 89-year-old Caucasian woman accidentally drank perchloroethylene while visiting her laundry, leading to a coma within a few minutes. The poison control center provided little information about perchloroethylene toxicity after ingestion, including an estimated long biological half-life (144 hour) and detrimental effects to liver and kidneys. A long intensive care unit stay was thus expected, potentially leading to several complications. After intubation, transitory hypoxemia appeared and rapidly resolved, while mild hemodynamic instability was managed with fluid resuscitation and anti-arrhythmic drugs. Twelve hours after perchloroethylene ingestion, the patient suddenly woke up and self-extubated. Less than 24 hours after ingestion, she was discharged from the intensive care unit, and 4 days later she was discharged home. Conclusion The patient drank perchloroethylene from a bottle, which prevented her from smelling it, and owing to its taste, only a small sip was likely drunk. However, a much larger intake was presumed, given her rapid and profound central nervous system depression. This case was challenging owing to the paucity of information available regarding acute perchloroethylene ingestion and the duration and magnitude of its effect. The present report will hopefully be of support for clinicians managing patients with this rare acute intoxication.

Carbamazepine is an anticonvulsant drug with multiple mechanisms of action, which condition the presence of a characteristic clinical picture after the overingestion of the drug. We expose a case report about a patient who, in the context of an attempted suicide, presented acute intoxication by benzodiazepines and carbamazepine, presenting the characteristic clinical picture of fluctuations in the level of consciousness, even presenting gaze deconjugation, almost unreactive coma and generalized hypotonia.

Introduction: Acute intoxication is an ongoing health issue worldwide and one of the most prevalent causes of hospital admission. Investigation of the features of acute intoxication occurrence allows for effectively planning preventive measures and required health resources. Objectives: The current study investigated acute intoxication’s demographic and clinical characteristics in an Iranian province. Patients and Methods: An observational case-series study was designed to investigate patients suffering from acute intoxication and admitted to two referral tertiary teaching hospitals over six months. Demographic data, vital parameters comprising neurologic, respiratory, and hemodynamic status, clinical symptoms, and blood analysis data were prospectively recorded. Data analysis was conducted using SPSS version 21 software. Results: In total, 447 patients were included in the study (3.5% of all emergency admission). The mean age of patients was 33±16 (4-88) years, and 190 (42.6%) patients were female. Seventy percent of patients were under 40 years. The male patients were significantly older than the female ones (P=0.001). Hospital mortality was 2.7%. Circulatory shock and respiratory apnea occurred separately in 13 (2.9%) patients, and alteration in consciousness affected 30%. Reduced arterial blood saturation and visual acuity were observed in 14% and 3.6% of the patients. A cumulative prevalence of electrocardiogram anomalies of 38% was also observed. The most prevalent electrolyte disorder was hypocalcemia (12%), followed by hypokalemia (10%); 17 % of patients were affected by severe blood acidosis. Conclusion: Acute intoxication is a medical emergency with a high risk of death. A multi-organ-based diagnosis and therapeutic approach should be implemented to manage the potentially lethal complications as soon as possible. Effective preventive planning for reducing acute intoxication should be performed concerning the socioeconomic status of the targeted population.

Background: Perchloroethylene is a colorless, strong-smelling substance commonly used for dry cleaning. Liver and kidney toxicities and carcinogenicity are well-known occupational hazards caused by chronic perchloroethylene exposure. Acute intoxication by ingestion of nondiluted perchloroethylene is rare in the adult population owing to its strong smell and taste. Very few data are available to physicians managing patients in this situation.Case Presentation: An 89-year-old Caucasian woman accidentally drank perchloroethylene while visiting her laundry, leading to a coma within a few minutes. The poison control center provided little information about perchloroethylene toxicity after ingestion, including an estimated long biological half-life (144 hour) and detrimental effects to liver and kidneys. A long intensive care unit stay was thus expected, potentially leading to several complications. After intubation, transitory hypoxemia appeared and rapidly resolved, while mild hemodynamic instability was managed with fluid resuscitation and anti-arrhythmic drugs. Twelve hours after perchloroethylene ingestion, the patient suddenly woke up and self-extubated. Less than 24 hours after ingestion, she was discharged from the intensive care unit, and 4 days later she was discharged home.Conclusion: The patient drank perchloroethylene from a bottle, which prevented her from smelling it, and owing to its taste, only a small sip was likely drunk. However, a much larger intake was presumed, given her rapid and profound central nervous system depression. This case was challenging owing to the paucity of information available regarding acute perchloroethylene ingestion and the duration and magnitude of its effect. The present report will hopefully be of support for clinicians managing patients with this rare acute intoxication. [ABSTRACT FROM AUTHOR]

Background: The I 3 Model posits that men are more likely to engage in sexual aggression (SA) when instigation (e.g., their masculinity is threatened) and impellance are high (e.g., high trait anger), and inhibition is low (e.g., alcohol intoxication). This study investigates the independent and interactive effects of trait anger and acute intoxication on men's SA propensity after exposure to a masculinity threat., Methods: Cisgender heterosexual men ( n = 120, aged 21-30) completed a self-report measure of trait anger, were randomly assigned to consume an alcoholic or nonalcoholic beverage and engaged in the Sexual Imposition Paradigm (SIP) which assessed laboratory-based SA propensity toward a female confederate. Prior to the SIP, all men's masculinity were threatened via feedback from a personality test which indicated that they were less masculine than other men., Results: The interaction between trait anger and beverage condition was significant. When intoxicated SA propensity increased among men with higher trait anger, whereas for sober men, their SA propensity decreased with higher trait anger., Discussion: Consistent with the I 3 Model, individual differences in trait anger may be a critical risk factor for men's SA under the influence of alcohol. These findings have implications for intervention programming. Anger often arises as a response to feeling vulnerable, such as when men's masculinity is threatened. Thus, the integration of established, evidenced-based approaches to regulate anger into SA interventions may be a promising approach to reduce SA, particularly among men who have consumed alcohol.

It is generally believed that there is a great relationship between hangover and the age of Baijiu. However, what factors make Baijiu (stored for a long time) feel better after drinking has not been well explained. In this study, ethanol metabolism, oxidation stress, inflammation and release of inhibitory neurotransmitter were selected as the indicator of hangover. The results showed that the longer the age of Baijiu, the higher the antioxidant and anti-inflammatory levels, the less damage to the liver of mice. In addition, we also found that the longer the age of Baijiu, the faster the ethanol metabolism rate, the smaller the impact on the brain. A correlation analysis on Baijiu ingredients and hangover related indicators was conducted. These results showed that ethyl acetate, n-butanol, n-hexanol, butyl acetate, ethyl octanoate, isovaleric acid, 2-hydroxypropionic acid had a great correlation with all hangover related indicators., Competing Interests: We declare that no conflict of interest exists in the submission of this manuscript and manuscript is approved by all authors for publication., (© 2024 The Authors. Published by Elsevier B.V.)

Carbamazepine is an anticonvulsant drug with multiple mechanisms of action, which condition the presence of a characteristic clinical picture after the overingestion of the drug. We expose a case report about a patient who, in the context of an attempted suicide, presented acute intoxication by benzodiazepines and carbamazepine, presenting the characteristic clinical picture of fluctuations in the level of consciousness, even presenting gaze deconjugation, almost unreactive coma and generalized hypotonia. [ABSTRACT FROM AUTHOR]

Introduction: Poisoning is regarded as a significant threat to public health all over the world. Determining the poisoning trend and its causative agents is essential for developing effective poisoning prevention and targeted intervention programs. Methods: A hospital-based retrospective observational study was conducted using electronic databases and medical records of acutely poisoned patients presented to the Poison Control Center of Ain Shams University Hospitals (PCC-ASUH) for the period from 2015 to 2019. Demographics and types of the poisoning exposures of all included patients were extracted, and descriptive analysis was performed to investigate the outcomes. Results: From 2015 to 2019, we collected data from 115402 patients. The current findings revealed that the majority of poisoned patients were between the ages of 15 and 25 across all studied years. The number of male and female patients was not significantly different. The oral route was the most common poisoning route. Suicidal and accidental modes of poisoning were the most common poisoning modes. Greater Cairo governorates had more patients than other Egyptian regions. Drug exposure was significantly more prevalent than non-drug poisoning. In all studied years, the mild degree of poisoning was the most pervasive. The majority of presented cases required hospitalization and poisoning management in less than 6 hours. Enhanced elimination was the most frequently used toxicological management measure used across all study years, followed by antidotes. Conclusion: The current study investigated the main intoxicated patients' demographics and characteristics of poisoning exposures in Egyptian people. We highlighted the impact of intentional, or accidental exposure, in addition to demonstrating the utility of specific poison centers in the management of various cases and the different strategies that can be implemented to decrease fatality and improve health care. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate hospital readmissions during 1 year after acute poisoning cases (APC), analyze the temporal behavior of early readmissions (ER) (in the month after the index episode) and predict possible ER. A descriptive analysis of the patients with APC assisted between 2011 and 2016 in the Emergency Department of Hospital La Paz is presented, and various methods of inferential statistics were applied and confirmed by Bayesian analysis in order to evaluate factors associated with total and early readmissions. Out of the 4693 cases of APC included, 968 (20.6%) presented, at least one readmission and 476 (10.1%) of them were ER. The mean age of APC with readmission was 41 years (12.7 SD), 78.9% had previous psychiatric pathology and 44.7% had a clinical history of alcohol addiction. Accidental poisoning has been a protective factor for readmission (OR 0.50; 0.26–0.96). Type of toxin ("drug of abuse" OR 8.88; 1.17–67.25), history of addiction (OR 1.93; 1.18–3.10) and psychiatric history (OR 3.30; 2.53–4.30) are risk factors for readmissions during the first year. Women showed three or more readmissions in a year. The results of the study allow for identification of the predictors for the different numbers of readmissions in the year after the index APC, as well as for ERs. [ABSTRACT FROM AUTHOR]

We are presenting a study on 136 cases performed in a 2‐year period (2018–2019) at the Bureau of Legal Medicine of the University of Milan for which toxicological analyses were requested and we are making a detailed interpretation of clinical records and discussing toxicological results from each case included in the study. Total number of autopsies was 1323 and in 10.3% of the cases, toxicological analyses were requested to obtain further information. Analyses were assessed with High‐Performance Liquid Chromatography‐Mass Spectrometry system and Gas Chromatography–Mass Spectrometry analyses. Additionally, Blood Alcohol Concentration and detection of volatile substances were obtained with Head Space‐Gas Chromatography–Mass Spectrometry system. From these analyses, 101 cases out of 136 provided positive results (74.3%). Main substances detected were cocaine, diazepam, morphine, and ethanol. The most representative profiles of individuals that emerged from this study were: a Caucasian male, age 41–50, that died for cocaine acute intoxication or was killed; a Caucasian male or female with a range‐of‐age of 31–50 deceased for simple suicide caused by acute intoxication or by complex suicide caused by acute intoxication and suffocation; and finally, a Caucasian male with a range‐of‐age 21–40 that died in a car accident without any toxicological evidence. From the results, acute intoxication at the time of death was confirmed in 54 cases and in 57 cases the toxicological analyses helped in the determination of the cause and manner of death. From this study, the importance of toxicological data among forensic sciences is confirmed. [ABSTRACT FROM AUTHOR]

Among adolescents, acute intoxications caused by drugs as well as intoxications caused by toxic substances make up an important chapter of emergency pediatric pathology. We conducted a retrospective study carried out for a period of 1 year, 2021–2022, which included a number of 37 patients, admitted in the Pediatric Clinic of the County Clinical Hospital "Sfântul Apostol Andrei" Constanța. Out of the total of admissions during a 12 months period, 0,5% consisted in acute intoxications in adolescents. There is a higher tendency for substance intoxication in females (65,5% of total cases). There is a higher tendency for adolescents with suicide ideation to use substances in order to end their life because of multiple risk factors, mental health disorders putting them at a higher risk to attempt suicide. Alcohol is widely used. [ABSTRACT FROM AUTHOR]

Background & Aims: Binge drinking is associated with an increased risk of liver disease. Morbidity and mortality of alcohol‐related liver disease (ALD) is associated with collagen deposition in the hepatic extracellular matrix (ECM). However, the acute effects of binge drinking on ECM turnover are unknown. We aimed to investigate the effects on hepatic ECM turnover following a binge drinking episode. Methods: We performed a pathophysiological intervention study with 15 non‐alcoholic fatty liver disease (NAFLD) patients, 15 ALD patients and 10 healthy controls. We used 40% ethanol in 9 mg/mL NaCl administered through a nasogastric tube to simulate binge drinking. Hepatic vein catheterisation allowed simultaneous hepatic‐ and systemic vein sampling. Markers of ECM formation and degradation were measured with competitive ELISA. Results: The interstitial matrix formation marker PRO‐C3 increased by 1.2 ng/mL (10%, P <.001) 24 hours after binge drinking. In participants with existing liver fibrosis determined by elevated baseline PRO‐C3, hepatic levels increased by 0.09 ng/mL (95% CI: 0.03‐0.15, P =.005) while systemic PRO‐C3 decreased 0.11 ng/mL (95% CI: −0.15 to −0.06, P <.001) in 3 hours. PRO‐C8 increased by 30% (+0.9 ng/mL, P =.014) in liver‐diseased patients with F0‐F1 but not in any other group. Twenty‐four‐hour changes in systemic C3M and PRO‐C3 were not associated (P =.911). Conclusions: Binge drinking induced an acute burst of PRO‐C3 in healthy individuals and patients with liver disease. Markers of ECM degradation were not correlated to markers of ECM formation, suggesting that even a single episode of binge drinking promotes excessive hepatic fibrogenesis. [ABSTRACT FROM AUTHOR]

Carbon monoxide (CO) intoxication is the inhalation of CO concentration above the tolerant threshold of the body. The quantity of CO concentration inhaled determines the level of damage which is proportional to either morbidity or mortality. The euphoria and rapidity of the mechanism of action of CO ranked it as a deleterious gas that could cause reparable to irreparable damage within a short interval. Disguised CO intoxication death is quite difficult to differentiate from that of accidental acute CO intoxication using autopsy findings. This gap is now utilized in committing heinous crimes. Postmortem use of blood is not practicable in most toxicological investigations due to fermentation and putrefaction. This has led to the use of vitreous humor in postmortem analytical toxicology. The dilemma in discriminating death truly resulting from CO intoxication from that of disguised (postmortem) CO intoxication is the quest of this study. This review elaborately takes a critical look at the literature relating to the subject of discourse with the view of drawing salient points that could be of critical importance in forensic science. A thorough review of the picture of vitreous chemistry resulting from acute CO intoxication was almost exhaustively analyzed based on the various perspectives found in the literature and other documents of importance.

Introduction. The frequency of acute metformin intoxication is increasing with increasing availability and accessibility of children and adolescents to this oral antidiabetic. Acute metformin intoxication can be severe and evolve to multiple organ failure. Case report. A 16-year old teenager is transfered from another hospital to the Toxicology and Intensive Care unit of ”Grigore Alexandrescu” Emergency Hospital for Children, in Bucharest, for somnolence and vomiting after she has voluntarily taken 10 tablets of Siofor (Metformin). Laboratory findings on admission detected the presence of metabolic acidosis (pH =7.28, EB = -9.4mmol/l, HCO3 = 14.2 mmol/l, lactate = 4.06 mg/dl), and kidney function testes revelead an increased value of creatinine 1.57 mg/dl. Initial treatment included sodium bicarbonate and endovenous glucose and electrolytes without improvment in the clinical status of the patient who evolved with severe lactic acidosis (pH = 7.19, lactate = 5.5 mg/dl, HCO3 = 18 mmo/l), acute renal failure (urea = 59 mg/dl, creatinine = 4.06 mg/dl). She was transfered to the nephrology unit of another hospital to perform emergency hemodialysis. The patient subsequently underwenth two hemodialysis session, following dialysis normal renal function and full recovery was obtained. Conclusions. Acute metformin poisoning can be severe and lead to death if unrecognized, monitored and treated rapidly. Lactic acidosis imposes rapid and effective suportive treatment measures or renal replacement therapy

The objective of the study: to study certain parameters of the autonomic nervous system (ANS) and cognitive functions in patients with acute alcohol intoxication of different severity degrees. Subjects and methods. 312 patients with acute alcohol intoxication and chronic alcohol abuse were enrolled in the study. Manifestations, medical history, the duration of drinking bout, ethanol blood level were assessed. Blood panel included ALT, AST, LDH, and blood levels of free ammonia, lactate, and medium molecules. The subjects were divided into three groups: Group I - 78 patients with severe alcohol intoxication, Group II – 166 patients with moderate alcohol intoxication, and Group III – 68 patients with mild alcohol intoxication. The state of ANS was assessed according to the following indicators: heart rate, systolic and diastolic blood pressure, Kerdo vegetative index, and results of cardiointervalography by R.M. Baevsky (1986). The severity of intellectual impairment was assessed using the ММSE scale for 10 positions, the FAB scale for 6 positions, as well as the Reitan test in seconds on the 1st day. Results. In patients of Group I, the alcohol level was 1.5 and 1.35 times lower versus patients in Groups II and III. All patients with severe intoxication had symptoms of toxic hepatitis, which was manifested by a significant increase in ALT, AST, LDH and bilirubin, exceeding the normal limits by 5.4, 5.4, 1.8, and 1.7 times, respectively. Ammonia blood levels in patients with severe intoxication exceeded the norm by 5.6 times, in patients with moderate severity of intoxication – by 3 times, and even in patients with a mild degree – by 1.5 times. The lactic acid level in patients of Group I was 3.2 times above the norm, in patients of Groups II and III – 2.0 and 1.4 times, respectively. In patients with severe intoxication, there was an increase in blood levels of medium molecules over 0.6 units of optical density which reflected severe endogenous intoxication. Assessment of ANS parameters in patients of three groups revealed development of hypersympathicotonia due to the increased tone of the sympathetic department of ANS in proportion to intoxication severity. Cognitive functions at admission were inhibited in proportion to the severity of the patient's condition. Intelligence level as per MMSE scale: at admission, patients of Groups III and II demonstrated mild and moderate cognitive impairment (25.8 ± 2.1 and 23.31 ± 1.80 points); in Group I, indicators for all items were 1.5 times lower versus Groups II and III. Intelligence as per the FAB scale: in patients with severe intoxication, deviations in conceptualization and dynamic praxis were noted. The Reitan test results were best in patients from Group III. Subsequently, 63 (80.7%) patients with severe alcohol intoxication developed alcoholic delirium. Conclusion. Patients with alcohol intoxication demonstrated a decrease in cognitive functions and impaired intelligence proportional to the severity of intoxication and levels of lactate and free ammonia. Increased tone of the sympathetic division of the ANS is typical of acute alcohol intoxication during drinking bout. Cardiointervalography parameters can be used to assess the severity of alcohol intoxication.

Background: Children’s intoxication is a major problem in healthcare systems and given its high prevalence, it has received significant attention. Attention to children and adolescents’ healthcare is a fundamental factor in improving health in the community. There has been no comprehensive study of prevalence and causes of intoxication in children in Alborz Province so far. Goal of this study is to identify the prevalence and causes of intoxication in children visiting Bahonar Hospital in one-year period 2014-2015. Materials and Methods: In this cross sectional investigation, 309 children under age of 14 who were seen in Bahonar hospital with diagnosis of intoxication were studies. Data regarding their gender, age, cause of intoxication, and symptoms at presentation, length of stay, PICU admission, and parents’ level of education were gathered. In order to identify correlation between variables and “cause of intoxication” or “outcome”, we sued Chi Square or Fisher Exact test with minimum significance at P

Alcohol's link with sexuality is long-standing and prominent. While research continues to document robust associations between drinking and sexual behavior, scientific attention now centers primarily on evaluating mechanisms and attendant theoretical frameworks to advance our understanding of how alcohol exerts a causal impact. We describe four domains with reliable evidence of alcohol effects: sexualized social perceptions, sexual arousal, sexual risk taking, and sexual assault. We consider three contextual frames: distal factors associated with encountering opportunities for alcohol-involved sex, proximal factors associated with alcohol's acute effects, and distal-proximal interactions. We then examine the empirical support for mechanisms embedded within four theoretical frameworks: alcohol disinhibition, alcohol expectancy, alcohol myopia, and emotion regulation. Support for disinhibition mechanisms is evident with sexual arousal only. Expectancy and myopia mechanisms enjoy support across domains and make up bases for integrative expectancy-myopia causal explanations. Emotion regulation mechanisms evidence preliminary support in risk taking and sexual assault. Implications and future directions are considered.

Objectives: In this study, we aimed to retrospectively evaluate poisoning cases followed in tertiary care between 2019 and 2020. Materials and Methods: 2726 cases followed between January 2019 and December 2020 were reviewed retrospectively. 154 (5.65%) of these cases were identified as poisoning cases. Cases under the age of 18 and chronic poisoning cases were not included in the study. Results: A total of 154 cases, 87 women and 67 men, were retrospectively analyzed. The mean age of the patients was found to be 37.11 ± 15.7 years. 106 cases were recorded as suicide, 42 cases as accidental and 6 cases as poisoning due to overdose. Conclusion: The highest poisoning agent was found to be drug. The fact that the cause of poisoning is the highest rate of drugs suggests that issues such as educating the public about drug use, reducing the sale of over-the-counter drugs and not keeping drugs within the reach of everyone should be taken into consideration. [ABSTRACT FROM AUTHOR]

ABSTRACT: This study describes an outbreak of acute necrotic hepatopathy associated with spontaneous poisoning by Lantana camara L. in dairy cattle. A herd of 15 cows and heifers was introduced into a native pasture with limited food supply, and, sixteen days later, eight animals had spontaneous nasal hemorrhage, fever, lethargy, jaundice, and dry, dark stools with mucus and blood. The clinical course varied from two to five days. In the pasture where the cattle were kept, abundant adult specimens of L. camara L. with evident signs of consumption were observed. In total, seven cattle died and necropsy was performed in three of them. All animals had moderate jaundice, hemorrhage in the subcutaneous tissue and on the surface of different organs. The liver was slightly enlarged, with orange discoloration and enhanced lobular pattern. Histologically, multifocal areas of coagulative necrosis of hepatocytes in the centrilobular area, occasionally extending to the midzonal area, were observed, as well as marked hepatocellular degeneration and prominent cholestasis. The current study suggests that L. camara L. poisoning should be considered a differential diagnosis of acute and necrotic hepatotoxicity in cattle, despite the absence of photosensitization.

Organophosphorus pesticides (OPS) are widely used in the world, and many poisoning cases were caused by them. Phorate intoxication is especially common in China. However, there are currently few methods for discriminating phorate poisoning death from phorate exposure after death and interpretation of false-positive results due to the lack of effective biomarkers. In this study, we investigated the metabonomics of rat plasma at different dose levels of acute phorate intoxication using ultra-performance liquid chromatography quadrupole-time of flight mass spectrometry (UPLC-Q-TOF–MS) analysis. A total of 11 endogenous metabolites were significantly changed in the groups exposed to phorate at LD50 level and three times of LD50 (3LD50) level compared with the control group, which could be potential biomarkers of acute phorate intoxication. Plasma metabonomics analysis showed that diethylthiophosphate (DETP) could be a useful biomarker of acute phorate intoxication. The levels of uric acid, acylcarnitine, succinate, gluconic acid, and phosphatidylcholine (PC) (36:2) were increased, while pyruvate level was decreased in all groups exposed to phorate. The levels of ceramides (Cer) (d 18:0/16:0), palmitic acid, and lysophosphatidylcholine (lysoPC) (18:1) were only changed after 3LD50 dosage. The results of this study indicate that the dose-dependent relationship exists between metabolomic profile change and toxicities associated with apoptosis, fatty acid metabolism disorder, energy metabolism disorder especially tricarboxylic acid (TCA) cycle, as well as liver, kidney, and nervous system functions after acute exposure of phorate. This study shows that metabonomics is a useful tool in identifying biomarkers for the forensic toxicology study of phorate poisoning. [ABSTRACT FROM AUTHOR]

MDPHP is a synthetic cathinone (SC) belonging to α-pyrrolidinophenone derivatives. It is a central nervous system stimulant and may induce hallucinations, paranoia, tachycardia, hypertension, chest pain, and rhabdomyolysis. In literature, a few cases of intoxication have been reported. In the present study, 17 cases of MDPHP intake were described including the analytical findings and clinical manifestations. MDPHP was quantified by liquid chromatography–tandem mass spectrometry in blood (range 1.26–73.30 ng/mL) and urine (range 19.31–8769.64 ng/mL) samples. In three cases the presence of α-PHP was observed. In one case, MDPHP was the only detected substance. Concomitant use of MDPHP with other substances, particularly psychostimulants, was common and it was difficult to describe the peculiar clinical characteristics of this SC. Most of the symptoms overlapped those expected, some of them were unusual and all of them particularly severe thus inducing the research of NPS in laboratory tests. We demonstrated the presence of psychiatric, neurological, and respiratory symptoms, as well as the possible presence of rhabdomyolysis and cardiotoxicity associated with the use of MDPHP. ED admissions were also more frequent in patients with addiction problems. In some cases, MDPHP intake required intensive supportive care. A multidisciplinary approach, including specialist consultation, is recommended for patients showing challenging features. Moreover, we demonstrated that the adoption of advanced analytical techniques, i.e., liquid chromatography–tandem mass spectrometry, is necessary to detect these molecules. Further studies are needed to understand MDPHP intake patterns and associated symptoms. It is essential to raise awareness in addiction treatment centers and among potential users, especially young people, and chemsex addicted. • 17 MDPHP intoxication cases were described in this paper. • Clinical symptoms and concentrations were reported. • MDPHP causes dystonia, psychomotor agitation, delirium, and sensory-perception alterations. [ABSTRACT FROM AUTHOR]

Cannabis use is a modifiable risk factor for the development and exacerbation of mental illness. The strongest evidence of risk is for the development of a psychotic disorder, associated with early and consistent use in youth and young adults. Cannabis-related mental health adverse events precipitating Emergency Department (ED) or Emergency Medical Services presentations can include anxiety, suicidal thoughts, psychotic or attenuated psychotic symptoms, and can account for 25–30% of cannabis-related ED visits. Up to 50% of patients with cannabis-related psychotic symptoms presenting to the ED requiring hospitalization will go on to develop schizophrenia. With the legalization of cannabis in various jurisdiction and the subsequent emerging focus of research in this area, our understanding of who (e.g., age groups and risk factors) are presenting with cannabis-related adverse mental health events in an emergency situation is starting to become clearer. However, for years we have heard in popular culture that cannabis use is less harmful or no more harmful than alcohol use; however, this does not appear to be the case for everyone. It is evident that these ED presentations should be considered another aspect of potentially harmful outcomes that need to be included in knowledge mobilization. In the absence of a clear understanding of the risk factors for mental health adverse events with cannabis use it can be instructive to examine what characteristics are seen with new presentations of mental illness both in emergency departments (ED) and early intervention services for mental illness. In this narrative review, we will discuss what is currently known about cannabis-related mental illness presentations to the ED, discussing risk variables and outcomes both prior to and after legalization, including our experiences following cannabis legalization in Canada. We will also discuss what is known about cannabis-related ED adverse events based on gender or biological sex. We also touch on the differences in magnitude between the impact of alcohol and cannabis on emergency mental health services to fairly present the differences in service demand with the understanding that these two recreational substances may impact different populations of individuals at risk for adverse events.

Cannabis use is a modifiable risk factor for the development and exacerbation of mental illness. The strongest evidence of risk is for the development of a psychotic disorder, associated with early and consistent use in youth and young adults. Cannabis-related mental health adverse events precipitating Emergency Department (ED) or Emergency Medical Services presentations can include anxiety, suicidal thoughts, psychotic or attenuated psychotic symptoms, and can account for 25–30% of cannabis-related ED visits. Up to 50% of patients with cannabis-related psychotic symptoms presenting to the ED requiring hospitalization will go on to develop schizophrenia. With the legalization of cannabis in various jurisdiction and the subsequent emerging focus of research in this area, our understanding of who (e.g., age groups and risk factors) are presenting with cannabis-related adverse mental health events in an emergency situation is starting to become clearer. However, for years we have heard in popular culture that cannabis use is less harmful or no more harmful than alcohol use; however, this does not appear to be the case for everyone. It is evident that these ED presentations should be considered another aspect of potentially harmful outcomes that need to be included in knowledge mobilization. In the absence of a clear understanding of the risk factors for mental health adverse events with cannabis use it can be instructive to examine what characteristics are seen with new presentations of mental illness both in emergency departments (ED) and early intervention services for mental illness. In this narrative review, we will discuss what is currently known about cannabis-related mental illness presentations to the ED, discussing risk variables and outcomes both prior to and after legalization, including our experiences following cannabis legalization in Canada. We will also discuss what is known about cannabis-related ED adverse events based on gender or biological sex. We also touch on the differences in magnitude between the impact of alcohol and cannabis on emergency mental health services to fairly present the differences in service demand with the understanding that these two recreational substances may impact different populations of individuals at risk for adverse events. [ABSTRACT FROM AUTHOR]

Introduction: Since ancient times, man has used plants in cases of poisoning and suicide. The indigenous people for hunting applied their toxins to arrows with the aim of catching prey and as a therapeutic resource. Other uses have been related to recreation and the development of new drugs. At present, there is a considerable number of records of acute poisonings by plants that involve animals in the scientific literature, however, poisoning of man is less well documented. Likewise, it is recommended that phytotherapy and the consumption of plant-based foods should be restricted to those identified, to avoid the occurrence of acute events. A poisoning by plants is the set of clinical manifestations, consequent to the exposure of a plant to toxic doses or by contact through different routes with the organism. These can be conveyed by both solid and liquid foods. Objective: To describe acute intoxication due to consumption of Datura Stramonium for the purpose of abuse in young people. Method: To carry out this research, a bibliographic review related to acute poisoning due to the consumption of Datura Stramonium for the purpose of abuse in young people was carried out. Books and articles available in the academic databases of Google Scielo, PubMed, Science Direct and Lilacs were used. Conclusions: There is an increase in acute poisonings due to consumption of Datura Stramonium for abuse purposes in young people. [ABSTRACT FROM AUTHOR]

Caffeine, a naturally occurring purine-based alkaloid, is the most consumed psychostimulant worldwide. Since caffeine pharmacokinetics shows extreme interindividual variability, it is not easy to establish its toxic dose. Only a few cases of death due to acute caffeine intoxication have been described so far, the majority of which attributable to massive assumption of caffeine-based medications. We present a case of acute caffeine overdose due to ingestion of pure caffeine. The extremely high blood concentration of caffeine determined a strong cardiovascular response, leading to fatal arrhythmia, as supported by histological evidence of myocardial injury. Quantitation of catecholamines and their metabolites in urine samples was performed and showed level near the highest limit of normal ranges for norepinephrine and high level of epinephrine. Contraction band is a pathological modification of the myocell caused by the catecholaminergic action and can occur in conditions of alteration due to the interaction between calcium and catecholamines. We demonstrated the β1-adrenoceptor involvement in our fatal case by immunohistochemical analysis. [ABSTRACT FROM AUTHOR]

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ABSTRACT The properties of oil-resin of copaiba, Copaifera multijuga are commonly mentioned in the literature, but there are few studies on extracts from its stem bark. We evaluated the antioxidant effects of ethanolic (EE) and ethyl acetate (EA) crude stem bark extracts from copaiba and compared them to rutin in a paracetamol (PCM)-induced oxidative stress model in mice. All test comparisons differed significantly. Hepatic catalase (CAT) and glutathione-S-transferase (GST) activity decreased in the PCM group, and there was an increase of protein carbonyls in the liver, kidney and brain. However, the protein carbonyls decreased in the liver for the PCM + EE group, in the kidneys for the PCM + EA and PCM + Rutin groups, and in the brain for all treatments. Hepatic GSH decreased in the PCM group and increased in the PCM + EE group. The extracts showed a positive effect on ascorbic acid (ASA), since they were able to restore the levels of parameters that had been changed by PCM. There was an increase of ALT and AST activity in the plasma within the PCM group. Even though ALT decreased in the PCM + Rutin, PCM + EE and PCM + EA groups, EE and EA did not have an effect on AST. The strongest antioxidant effect was observed for EE, due to the presence of the phenolic compounds epicatechin and epiafzelechin, as well as the highest concentration of total phenols and an excellent antioxidant potential observed in the DPPH· test.

E‐cigarettes and heat‐not‐burn cigarettes (HNBC) present new health risks due to their rising popularity, high content of nicotine and serious adverse effects. The objective of the study was to analyse the cases of acute exposure to e‐cigarettes, e‐liquids and HNBC products containing nicotine that led to toxicological consultations at our poisons control centre during a 7‐year period (2012‐2018) and identify the categories of special concern that require further investigation and intervention. The demographic, toxicological and clinical data were analysed by descriptive statistics. Poisoning severity score (PSS) was estimated. From 119 229 consultations, 148 cases concerned acute exposure to e‐cigarettes. Children and adolescents were exposed in 91 (61%) cases, including exposure of neonates and infants in 54 (36%) cases. The main route of exposure was ingestion in 129 (87%), inhalation in nine (6%), ocular in six (4%) and intravenous administration in three (2%) cases. The source of exposure was the cartridge with e‐liquid (107; 72%), refillable tank in 29 (20%) and HNBC refill in nine (6%) cases. The reason for exposure was accidental in 110 (74%), incorrect application of the device in 10 (7%), abuse in six (4%), suicide attempt in six (4%) and other/unknown in 16 (11%) cases. The dose estimation was severe/lethal in 6 (4%), toxic in 53 (36%), low‐to‐moderate in 35 (24%) and unknown in 54 (36%) cases. Vomiting was observed in 38 (26%) patients; 72% of patients were hospitalised. In symptomatic cases, 41 patient had PSS 1, 12 patients had PSS 2, and one patient had PSS 3. Activated charcoal was applied in 57 (39%) patients, and symptomatic treatment was recommended in 75 (51%) patients. Cases of unintentional exposure of children demonstrate the need for preventive risk reduction measures. [ABSTRACT FROM AUTHOR]

Introduction. The frequency of acute metformin intoxication is increasing with increasing availability and accessibility of children and adolescents to this oral antidiabetic. Acute metformin intoxication can be severe and evolve to multiple organ failure. Case report. A 16-year old teenager is transfered from another hospital to the Toxicology and Intensive Care unit of ”Grigore Alexandrescu” Emergency Hospital for Children, in Bucharest, for somnolence and vomiting after she has voluntarily taken 10 tablets of Siofor (Metformin). Laboratory findings on admission detected the presence of metabolic acidosis (pH =7.28, EB = -9.4mmol/l, HCO3 = 14.2 mmol/l, lactate = 4.06 mg/dl), and kidney function testes revelead an increased value of creatinine 1.57 mg/dl. Initial treatment included sodium bicarbonate and endovenous glucose and electrolytes without improvment in the clinical status of the patient who evolved with severe lactic acidosis (pH = 7.19, lactate = 5.5 mg/dl, HCO3 = 18 mmo/l), acute renal failure (urea = 59 mg/dl, creatinine = 4.06 mg/dl). She was transfered to the nephrology unit of another hospital to perform emergency hemodialysis. The patient subsequently underwenth two hemodialysis session, following dialysis normal renal function and full recovery was obtained. Conclusions. Acute metformin poisoning can be severe and lead to death if unrecognized, monitored and treated rapidly. Lactic acidosis imposes rapid and effective suportive treatment measures or renal replacement therapy. [ABSTRACT FROM AUTHOR]

Diseases related to drug addiction are among the acute and chronic diseases that the doctor often encounters, but at the same time they are among the most difficult to recognize, due to the patient's purposefully modified history. Most medical faculties deal with the issue of addiction only marginally in the teaching of psychiatry. Addictive substance (AS) abuse causes tolerance and mental or physical dependence and causes adaptive changes in the body. In recreational use, signs of damage to health may not appear, in chronic use they appear, but they are often not associated with the abuse of AS by a doctor, or they manifest only when AS is withdrawn, when withdrawal symptoms occur to varying degrees. For the correct diagnosis and treatment of pathological conditions that are associated with the abuse of AS, it is necessary to have good information about the effects of individual AS. This text brings basic knowledge about the effects of the most frequently abused AS in the Czech Republic. [ABSTRACT FROM AUTHOR]

Background: Olanzapine is a frequently prescribed atypical antipsychotic drug and a common cause of voluntary intoxications. Acute muscle toxicity, also known as rhabdomyolysis, is a severe muscle injury resulting in muscle pain and necrosis, myoglobinuria and elevated serum creatin kinase levels. Objective: The aim of this study is to raise awareness on rare medical findings, such as acute muscle toxicity associated with olanzapine overdose. Material and methods: We present the case of a 31 year old female with prior history of depression who was admitted to the Emergency Department after being found lethargic, on her knees by her family, allegedly after ingesting 30 Olanzapine pills. Upon arrival, she was evaluated to GCS 8, her labs showed: CK=16.905(U/L), GFR=82,42(ml/min), GOT=215U/L) and after being evaluated, she was transferred to the ICU, where additional pathological discoveries were found: she had hyperchrome, highly concentrated urine and pressure injuries on both her knees and calves. Her labs displayed: CK=79.115(U/L), GFR=103,72(ml/min), GOT=1.156(U/L), for which she was given fluid therapy and a loop diuretic. The next day her labs elevated even further: CK=85.340(U/L), GOT= 2.066(U/L), and her left leg was edematous, thus a compartment syndrome suspicion was raised. Results: Immediately, continuous renal replacement therapy was initiated and eventually fasciotomy was successfully avoided. The postprocedural evolution was favorable and 10 days later her labs were within normal limits. Conclusions: Olanzapine overdose is in itself a rather difficult to manage intoxication and if associated with acute muscle toxicity, the treatment becomes even more challenging. In our case, continuous renal replacement therapy, although invasive and complex, was required for a proper outcome. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Acute intoxication is a important public health problem that occur suicidal or unintentionally drug overdose.We aimed to retrospectively review the demographic and clinical data of the patients who were followed up in intensive care unit due to acute intoxication. METHODS: We retrospectively reviewed the files of all 152 patients who admitted to intensive care unit between January 2014- January 2016 due to acute intoxication. RESULTS: The 118 of 152 patients were female, 34 were male. The mean length of stay in the intensive care unit was 1,85+-1,05 days. The 118 of 152 /%77.6) patients were under 30 years old. The rate of intoxications were statistically lower in male than females under 30 years old. (p

Objectives: To present the Brazilian Psychiatric Association's Consensus on the Management of Acute Intoxication., Methods: A group of experts selected by the Brazilian Psychiatric Association searched for articles on the MEDLINE (by PubMed) and Cochrane databases, limited to human studies and acute intoxication. Working groups reviewed these materials for appropriateness to the topic and the quality of the work. A survey was conducted using the Delphi method to produce a table of agreed recommendations presented at the end of the systematic review. Three survey rounds were held to reach consensus., Results: Support for intoxication should start with Initial Management: Resuscitation/Life Support/Differential Diagnosis. For this, the group proposed the following sequence of assessments: A (airway), B (breathing), C (circulation), D.1 (disability), D.2 (differential diagnosis), D.3 (decontamination), D.4 (drug antidotes), E (enhanced elimination). The group of experts then presented specific interventions for the main drugs of abuse., Conclusions: Management of intoxication with drugs of abuse is complex and requires systematic protocols. The group suggests adoption of the A-B-C-D-E technique first, with constant investigation. Then, specific conduct and support until remission of intoxication. The literature is still scarce in evidence on the subject. Therefore, this consensus was necessary. We believe that at present this document can help psychiatric, general, and emergency physicians deal with emergency psychiatric episodes due to acute intoxication. This work could stimulate future studies on the topic., Competing Interests: No conflicts of interest declared concerning the publication of this article.

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Objective: Acute intoxication is a life-threatining clinical issue. Therefore, patients need follow-up in the intensive care unit (ICU). In this study, we aimed to evaluate the incidence, demographic characteristics, intoxication agents and mortality rate in patients diagnosed with acute intoxication in our ICU. Materials and Methods: The records of the patients who were diagnosed with acute intoxication between April 1, 2014 and March 31, 2018 were retrospectively analyzed and were included in this study. Result: Of the 300 patients included in the study, 68.7% n=206 were female, 31.3% n=94 were male and the mean age was 28.36±12.3 years. According to age groups, most patients in 21-30 years group with 37.3% n=112 rate and the least in ≥61 years group with 3.7% n=11 rate. It was detected that 94.3% n=283 of cases took drugs and/or chemical matter for suicide attempt, 5.7% n=17 of cases influenced by exposure or accidentally. Patients accepted to ICU owing to medicine intoxication (88%), chemical matter intoxication (%6.3), mushroom intoxication (4%), drug abuse (1.4%) and snakebite (0.3%). According to medicine groups; patients took most common antidepressants (n=55), subsequent to nonsteroid antiinflamatory drugs (n=38) , analgesics (n=37), influenza medicine (n=34) and intoxication occured most frequently in summer (29.7%). Tricyclic antidepressants were the most common intoxication-affecting agent in the antidepressant group, paracetamol in the analgesic group, carbamazepine in the antiepileptic group, ibuprofen+chlorpheniramine combination in the anti-depressant drugs, quetiapine in the antipsychotics, metformin in the oral antidiabetic group, pantoprozol in the proton pump inhibitor group. Duration of hospitalization in ICU of cases was 1.39±1.57 days and mortality rate was 0.67%. Conclusion: Acute intoxication cases may be severe and should therefore be followed in ICU. In this group of patients, drug and/or chemical causing intoxication should be detected as soon as possible, and physicians should be careful about possible side effects and treatment should be started immediately. [ABSTRACT FROM AUTHOR]

The aim of this study was to collect all available data from 2009 to 2016 focusing on the epidemiological, clinical and pharmacological issues only related to acute intoxication fatalities in the Unit of Legal Medicine of the Department of Medicine and Surgery at the University of Parma. All death certificates and autopsy reports were retrieved from the archives and evaluated to identify cases in which only acute intoxication from xenobiotics could be defined as the cause of death, however statistical and descriptive analyses were applied to all the data. A more comprehensive analysis on all causes of death showed that out of 1005 total cases the most common is haemorrhagic shock/traumatic shock (36.5%), followed by cardiogenic shock with 27.4%; asphyxia ranks as the third cause of death (11.8%); concerning encephalic injuries, our data show 10.9% of cases, while acute intoxication by xenobiotics accounts for 5.7%. Data show that the majority of subjects are poly-abuser (75.4%); people not enrolled within a preventive treatment (59.4%) were more likely to commit suicide (28.1%), whereas only 6.2% in the sub-population in treatment (40.6%) committed suicide: therefore, data strongly suggest the evidence that joining a preventive programme can decrease the probability of extreme action. Access to a full case history may indeed save considerable time and expense in carrying out tests, but also valuable targeted samplings. The investigating officer should, therefore, submit as much information as possible about the case, as this may influence the type and extent of analysis undertaken, as well as the interpretation of analytical results. [ABSTRACT FROM AUTHOR]

The consequences for exposure to pesticide exposure and/or agrochemicals is a concern of the World Health Organization. The Government of each nation has the responsibility to preserve the health of the population in the presence of a toxic substance and especially in the handling, storage, use and application of pesticides. This Is a mission of the Angola Drug and Toxicology Research and Information Center. Objectives: To Characterize the acute poisonings by agrochemicals consulted to the Center of Investigation, Information of Medicaments and Toxicology of Angola in the period 2014 - 2018. To Identify the behavior of the cases according to year, pesticide according to chemical group, sex, age group, occupation of the patient, circumstance, pathway of exposión and the clinical manifestations. Methodology: A descriptive cross-sectional study Was conducted of the cases consulted at the Emergency Toxicological Information Service, with the diagnosis of acute intoxication and whose causative agent were pesticides, in the period from January 2014 - December 2018. Results: The study reflected that there are frequent poisonings by agrochemicals in Angola. The year of most cases consulted was 2016, insecticide-type pesticides the most used. The male sex The most affected, the age group of 20-40 years. The patients most affected were the unemployed, the greater number of intoxicated were of accidental cause. It predominated as a gateway to the organism topical and clinical manifestations at the level of skin and mucous membranes. [ABSTRACT FROM AUTHOR]

Intoxications related to γ-Hydroxybutyric acid (GHB), arising from its success as recreational drug due to its psychotropic properties, are significantly and alarmingly jeopardizing public health, posing major challenges to medical staff. In recent years, GHB's prodrug -butyrolactone (GBL) has often supplanted GHB in recreational settings, owing to its lower cost and the ease with which it can be obtained, mainly due to its various legal industrial applications. The Authors intend to stress that symptoms should be assessed and confirmed by timely toxicological analyses by highly-trained, expert professionals. Such tests aimed at analytical confirmation are instrumental in providing physicians valuable indications in terms of the proper pharmacological treatments in order to revert the adverse, or even fatal, side effects, particularly when the overall intoxication picture looks ambiguous. At the time being, little is known about the pharmacological therapies effective in GHB intoxication cases; further comprehensive research is therefore essential, if we are to tackle such a burgeoning public health emergency before it is too late. [ABSTRACT FROM AUTHOR]