Search

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.

Probably the most important threat currently affecting vultures worldwide is exposure to pesticides, both accidentally and through deliberate abuse. This is of special concern since around 70% of vulture species are threatened by human activities. However, information about this threat is sparse and geographically biased. We compiled existing knowledge about pesticide exposure in vulture species globally, providing unifying criteria to mitigate this problem with a joint global effort. Most information available about accidental exposure to pesticides in vultures is related to organochlorine pesticides. Non-lethal exposure to these compounds occurs on every continent that vultures inhabit. While concentrations of organochlorine pesticides reported in different samples appear to be too low to produce health impacts, some studies show vultures with levels compatible with health impacts. In addition, there are some reports of vultures contaminated accidentally by anticoagulant rodenticides and external antiparasitic drugs used in veterinary practices. Deliberate abuse of pesticides to poison wildlife also occurs on every continent where vultures live, affecting most (78%) vulture species. However, little information is available for some regions of America, Asia and Europe. The exact number of vultures killed due to deliberate poisoning with pesticides is not well known, but the available figures are alarming (e.g. up to 500 individuals in a single event). The most widely used pesticides affecting vulture populations, and associated with deliberate poisoning, are carbamates and organophosphorus compounds. Of particular concern is the fact that massive poisoning events with these compounds occur, in some cases, within protected areas. This suggests that if this situation is not reversed, some vulture populations could disappear. A combination of measures such as banning pesticides, controlling their distribution-acquisition and environmental education could produce better results that banning pesticides alone. If poisoning with pesticides is not stopped, this threatened avian group could inadvertently go extinct very soon. Fil: Plaza, Pablo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; Argentina. Universidad Nacional del Comahue. Centro Regional Universitario Bariloche. Laboratorio de Ecotono; Argentina Fil: Martínez López, Emma. Universidad de Murcia; España Fil: Lambertucci, Sergio Agustin. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; Argentina. Universidad Nacional del Comahue. Centro Regional Universitario Bariloche. Laboratorio de Ecotono; Argentina

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.

Submitted by Patricia Santos (psantos@ispa.pt) on 2021-02-10T15:35:19Z No. of bitstreams: 1 Science. 2020 Oct 16370.pdf: 1008882 bytes, checksum: 705b7a8f51d813fd305069a4599614d1 (MD5) Made available in DSpace on 2021-02-10T15:35:19Z (GMT). No. of bitstreams: 1 Science. 2020 Oct 16370.pdf: 1008882 bytes, checksum: 705b7a8f51d813fd305069a4599614d1 (MD5) Previous issue date: 2020 info:eu-repo/semantics/publishedVersion

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

Carbon monoxide (CO) has been recognized as a poison for centuries, and remains one of the most common causes of both accidental and deliberate poisoning worldwide. Despite this, there are widespread misconceptions with regards to the mechanisms, diagnosis and outcomes of CO induced poisoning such as the idea that CO poisoning is rare; that carboxyhaemoglobin levels above 20% and loss of consciousness are required before nervous system damage ensues; and that the binding of CO to haemoglobin is the only mechanism of toxicity. Prevention and diagnosis of CO poisoning is hampered by the lack of awareness of CO as a cause of illness, among both the general public and healthcare professionals. To complicate matters further there is no standardized definition of CO poisoning. Carboxyhaemoglobin levels are often used as a marker of CO poisoning, yet plasma levels rapidly reduce upon removal of the source and are therefore an unreliable biomarker of exposure and tissue damage. Adverse neuropsychiatric outcomes after CO poisoning are difficult to define, especially as they fluctuate, mimic other non-specific complaints, and are not present in all survivors. This paper challenges a number of misconceptions about CO poisoning which can result in misdiagnosis, and consequently in mismanagement. We illustrate how recent developments in the understanding of CO toxicology explain the particular susceptibility of the central nervous system to the effects of CO exposure.

Background/aim: Acute unintentional and deliberate poisoning by medications and chemicals is a frequent emergency, especially in Iran. This study aimed to evaluate the frequency and character of skin findings occurring in patients with acute intentional and aunintentional poisoning. Materials and methods: This prospective observational study was performed at the Loghman Hakim Hospital Poison Center over a period of 6 months from April 2016 to September 2016. Data including patient demographics, cause of poisoning, and level of consciousness were collected. Pediatric patients (under the age of 13) and patients who died in the first hours of admission were excluded from the study. Results: The most common cause of toxicity-related admission in our patients was methadone overdose. The most common skin finding in these patients was xerosis. According to our results, there was an association between tramadol poisoning and self-induced lesions. Shin hyperpigmentation was found to be significantly more frequent in patients with lead poisoning. Conclusion: Further study is recommended to shed light on the possible association of drug poisoning and skin lesions.

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.

The deliberate poisoning of A. Litvinenko in London in late 2006 with 210Po, attracted attention to the difficulties in identifying internal contamination with alpha emitting radionuclides and to the limited knowledge available on the cycling of many naturally occurring radioisotopes in the body and their baseline concentration values in humans. To cope with the emergency caused by the spread of high 210Po activity, which contaminated several people and places in London, we were called upon to analyze urine samples in potentially contaminated people. A reference group of adult humans was also selected for determination of baseline 210Po values to be used for comparative purposes. Concentrations of 210Po in urine samples from three Portuguese citizens that have been at contaminated places, in London, ranged from 2.3 to 4.1 mBq·L−1 while in the reference group 210Po concentrations ranged from 0.5 to 4.8 mBq·L−1. Analytical quality of results was ensured through participation in an international inter laboratory comparison exercise on 210Po determination in aqueous samples. Results indicated that people potentially exposed to 210Po in London were not internally contaminated with the radionuclide used as a poisoning agent, and the levels of this radionuclide measured in the urine were similar to the naturally occurring levels in the reference group. Polonium levels in urine and in man are discussed in the light of 210Po levels in the human diet.

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.

Man has used poisons for assassination purposes ever since the dawn of civilization, not only against individual enemies but also occasionally against armies. According to (Frischknecht, 2003)11 article on the History of Biological Warfare, during the past century, more than 500 million people died of infectious diseases. Several tens of thousands of these deaths were due to the deliberate release of pathogens or toxins. Two international treaties outlawed biological weapons in 1925 and 1972, but they have largely failed to stop countries from conducting offensive weapons research and large-scale production of biological weapons. Before the 20th century, biological warfare took on three main forms: (1) deliberate poisoning of food and water with infectious material, (2) use of microorganisms or toxins in some form of weapon system, and (3) use of biologically inoculated fabrics (Dire, 2013)8. This action plan is aimed at the recognition of the lack of current processes in place under an unidentified lead agency to detect, identify, track, and contain biological agents that can enter into the United States through a human host. This action plan program has been identified as the Consumer of Concern Early Entry Program or a simpler title is C-CEEP.

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.

An ingestion of an unknown quantity of Ivadal® (zolpidem) tablets in a case of drug abuse is described. The authors report a new and fast method of analysing and determining the zolpidem concentration in postmortem specimens. Quantitation of zolpidem was performed by ethyl acetate extraction from alkalinized body fluids before GC/MS analysis. The analyses were performed without any complex sample clean-up steps and with little sample material. Postmortem concentrations of zolpidem in body fluids are given. The proposed method is a rapid procedure of analysis in cases of deliberate poisoning with the sedative–hypnotic drug, zolpidem.

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.

1.Illegal human behaviour such as those affecting natural resource use or resulting from human-wildlife conflicts threaten the sustainable management of ecosystems and the conservation of biodiversity worldwide. However, the frequently scarce and incomplete data owing to the sensitive nature of illegal activities pose a challenge to developing tools to properly understand and prevent those activities. 2.We used species distribution models to identify factors related to a prominent illegal activity, wildlife poisoning, and to produce detailed, spatially explicit maps of the risk of occurrence in NW Spain. We alleviated the constraints of imperfect information and occurrence of absences by using presence-only methods, that is, maximum entropy modelling (MaxEnt). To our knowledge, this is the first time that this method has been used in the context of illegal activities affecting wildlife. 3.A total of 112 poisoning events involving 228 individuals of 25 different species were reported in the study area from 2000 to 2010. Most of the reported deaths (90·8%) were birds of prey (52·6%) and mammalian carnivores (38·2%), of which 95·2% were scavengers. Illegal poisoning affected eleven species classified as endangered at national and/or global level. 4.Our models highlighted the perceived risk of livestock predation by wolves Canis lupus, although not by bears Ursus arctos, as a major motivation for poisoning. The existence of protected areas was positively correlated to this illegal practice, while socioeconomic factors had less influence on predicting its occurrence. Over 56% of the study area was predicted to be under risk of illegal poisoning. 5.Synthesis and applications. We demonstrate a new use for presence-only models, illustrated using MaxEnt, to assist conservation managers dealing with illegal activities. This approach allows the main causes of an illegal practice to be identified and generates spatially explicit risk maps. Managers can take advantage of this modelling approach to allocate the scarce resources available in conservation to key sectors and locations. In our study system, actions against illegal poisoning should aim to resolve the potential conflict existing between cattle-farming and wolves, especially in protected areas., We thank C. Cano, L. Varona, R. Menéndez, Fundación para la Conservación del Quebrantahuesos, Junta de Castilla y León 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.

Accidental or deliberate poisoning of food is of great national and international concern. Detecting and identifying potentially toxic agents in food is challenging due to their large chemical diversity and the complexity range of food matrices. A methodology is presented whereby toxic agents are identified and further characterized using a two-step approach. First, generic screening is performed by LC/MS/MS to detect toxins based on a list of selected potential chemical threat agents (CTAs). After identifying the CTAs, a second LC/MS analysis is performed applying accurate mass determination and the generation of an attribution profile. To demonstrate the potential of the methodology, toxins from the mushrooms Amanita phalloides and Amanita virosa were analyzed. These mushrooms are known to produce cyclic peptide toxins, which can be grouped into amatoxins, phallotoxins and virotoxins, where α-amanitin and β-amanitin are regarded as the most potent. To represent a typical complex food sample, mushroom stews containing either A. phalloides or A. virosa were prepared. By combining the screening method with accurate mass analysis, the attribution profile for the identified toxins and related components in each stew was established and used to identify the mushroom species in question. In addition, the analytical data was consistent with the fact that the A. virosa specimens used in this study were of European origin. This adds an important piece of information that enables geographic attribution and strengthens the attribution profile.

Short-chain alcohols are embedded into several aspects of modern life. The societal costs emanating from the long history of use and abuse of the prototypical example of these molecules, ethanol, have stimulated considerable interest in its general toxicology. A much more modest picture exists for other short-chain alcohols, notably as regards their immunotoxicity. A large segment of the general population is potentially exposed to two of these alcohols, methanol and isopropanol. Their ubiquitous nature and their eventual use as ethanol surrogates are predictably associated to accidental or deliberate poisoning. This review addresses the immunological consequences of acute exposure to methanol and isopropanol. It first examines the general mechanisms of short-chain alcohol-induced biological dysregulation and then provides a tentative model to explain the molecular events that underlie the immunological dysfunction produced by methanol and isopropanol. The time-related context of serum alcohol concentrations in acute poisoning, as well as the clinical implications of their short-term immunotoxicity, is also discussed.

Deliberate poisoning of domestic animals and wildlife with commercial formulations of pesticides has been documented worldwide. We have compiled the analytical results obtained by four Spanish Laboratories of Veterinary Toxicology since 1990. The frequency of poisonings and the intentional use of pesticides were compared between formulations with restricted and unrestricted use, including the toxicity of the commercial formulations as a covariant in the model. The frequency of poisoning was inversely related with the lethal dose of specific formulations, but not with the amounts consumed in agriculture in Spain. The intentional illegal use of some pesticides as poisons was not affected by the commercial restriction of their formulations, but was inversely correlated with their LD50. The examination of the data permits us to detect three highly toxic compounds (aldicarb, carbofuran, and strychnine), more widely implicated in animal poisonings than other compounds of similar toxicity., M. Martínez-Haro was supported by a postgraduate grant (I3P) from Consejo Superior de Investigaciones Científicas. Work done at the Instituto de Investigación en Recursos Cinegéticos was supported with a grant of the Ministerio de Educación y Ciencia (CGL2004-02568/BOS).

This paper examines both the historical and clinical aspects of deliberate poisoning and the psychopathology of the poisoner. The paper describes three contemporary phenomena of criminal poisoning: the intentional poisoning of children by parents; threats and acts of random mass poisoning; the poisoning of sick patients by hospital staff. Clinical vignettes of four alleged poisoners with an account of their individual psychopathology are presented. A tentative profile of some specific characteristics of the poisoner and his or her motive is drawn from these sources, together with a theoretical discussion of the available literature.

Endosülfan tarım alanlarında yaygın olarak kullanılan organik klorlu bir insektisittir. İnsektisidler arasında en toksik olanlarındandır. Endosülfana toksik düzeyde akut olarak maruz kalındığı zaman meydana gelen başlıca etkiler; gastrointestinal irritasyon, santral sinir sistemi instabilitesi, respiratuar depresyon ve kardiyovasküler sistem kollapsıdır. Yapılan çalışmalarda endosülfanın primer etkilerinin santral sinir sistemi üzerine olduğu, özellikle konvülzyona bütün akut zehirlenme vakalarında rastlandığı görülmüştür. Çalışmamızda endosülfanın içilen kutu sütlerin içinde tespit edilmesi orijini kaza ya da intihar olasılığından uzaklaştırmaktadır. Ölümün gerçekleştiği olgularda zehirlenmenin kaza veya intihar olasılıklarının yanı sıra olgularımızda görüldüğü gibi cinai orijinli olabileceği de akıldan çıkartılmaması gereken bir noktadır. Çalışmamızda iki olgu orijin açısından literatürdeki benzer olgulardan farklı bulunması nedeniyle sunulmuştur.Anahtar kelimeler: İnsektisid, endosülfan, kasıtlı zehirleme.

An ingestion of an unknown quantity of Harmomed (dothiepin and diazepam) capsules in a suicide is described. The authors report a new and fast method of analysing and determining the dothiepin concentration in postmortem specimens. Quantitation of dothiepin, and its metabolite desmethyldothiepin was performed by ethyl acetate extraction from alkalinized body fluids before GC-MS analysis. The analyses were performed without any complex sample clean-up steps and with little sample material. Postmortem concentrations of dothiepin, desmethyldothiepin, diazepam and desmethyldiazepam in body fluids are given. The proposed method is a rapid procedure for analysis in cases of deliberate poisoning with the antidepressant drug dothiepin.

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