Search

We present 50 years of scientific activity Depertment of Toxicology Jagiellonian University Medical Collage in Krakow on national and international arena. Scientific achievements are presented divided into thematic groups. The subject group covers a broad spectrum of research taking into account the epidemiology of poisoning, occupational and population exposure to chemical substances, specific toxicological problems like; diagnosis of poisoning, predicting the severity of poisoning, the implementation of appropriate treatment depending on the phase of intoxication and its severity, effectiveness evaluation diagnostic and treatment procedures, prevention and prophylaxis of poisoning.

Exposure to thyroid products is common, but acute poisonings in adults are rare. Most cases of severe toxicity are related to prolonged, repeated exposure (either inadvertent or deliberate abuse). There are a few reports of toxicity in children following large (greater than 10 mg) single ingestions. Expect significant toxicity in children and adults who have ingested more than 2 to 4 mg of levothyroxine. However, in comorbid elderly patients, the threshold may be lower. In this paper we present acute overdose of levothyroxine in nine adult patients (aged 21-44 years; mean--30.5 years); ingested doses were from 1.2 mg to 15 mg (mean--6.5 mg). Only in three cases (ingested doses were 5.6; 8.0 and 15 mg) minor and mild clinical symptoms were observed and pharmacological treatment was necessary. No severe symptoms were observed in our group. Asymptomatic clinical course in patients who ingested more than 3 mg of levothyroxine probably was related to coingestion of benzodiazepins, beta-blockers, ACE inhibitors and ethanol. Serum free triiodothyronine (T3) level of 20 pg/ml (normal, 4.1 pg/ml) was reported following an overdose of 15 mg levothyroxine in day five. Normalization was observed in day eleven.

Nowadays, anticoagulant therapy belongs to the most commonly used forms of pharmacotherapy in modern medicine. The most important representatives of anticoagulants are heparins (unfractionated heparin and low-molecular-weight heparin) and coumarin derivatives (vitamin K antagonists--VKA). Next to the many advantages of traditional oral anticoagulants may also have disadvantages. In Poland most often used two VKA: acenocoumarol and warfarin. The aim of the work is the analysis of the causes of the occurrence of bleeding disorders and symptoms of overdose VKA in patients to be hospitalized. In the years 2012 to 2014 were hospitalized 62 patients with overdose VKA (40 women and 22 men). The average age of patients was 75.3 years) and clotting disturbances and/or bleeding. At the time of the admission in all patients a significant increase in the value of the INR was stated, in 22 patients INR result was " no clot detected", on the remaining value of the INR were in the range of 7 to 13.1. On 51 patients observed different severe symptoms of bleeding (hematuria, bleeding from mucous membranes of the nose or gums ecchymoses on the extremities, bleeding from the gastrointestinal tract--as in 5 patients has led to significant anemia and transfusion of concentrated red blood cells. Up on 33 patients kidney function disorder were found--exacerbated chronic renal failure and urinary tract infection. 8 diagnosed inflammatory changes in the airways. On 13 patients, it was found a significant degree of neuropsychiatric disorders (dementia, cognitive impairment), which made impossible the understanding the sense of treatment and cooperation with the patient. In 6 patients the symptoms of overdose were probably dependent on the interaction with the congestants at the same time (change the preparation of anticoagulant, NSAIDs, antibiotics). In 2 cases, the overdose was a suicide attempt in nature. In addition to the above mentioned disorders, on two of those patients diagnosed with a malignant disease. Two patients died, the other has been improving and anticoagulant therapy with VKA was continued, in 4 VKA were changed to low-molecular-weight heparin, and on 4 commissioned new generation anticoagulant (rivaroxaban).

Unlabelled: The aim of the study was to evaluate the glucose metabolism in patients suffering from ethanol withdrawal syndrome. The study group comprised 88 alcohol dependent men aged 21- 50 y (mean 39.18 years, SD ±7.78), treated at the Clinical Toxicology Ward. Alcohol dependence was diagnosed accord- ing to the criteria of the International Statistical Classification of Diseases and Related Human Problems (ICD-10). The degree of alcohol withdrawal syndrome was assessed according to the scale CIWA-Ar. The blood ethanol concentration, and glucose serum concen- tration were measured on admission. On the next post-admission day blood glucose were determined after fasting and at the 0, 60th and 120th minute of an oral glucose tolerance test (OGTT) using 75 g glucose. Basing on the recommendations of Polish Diabetes Association (2013y) the patients were classified into one of groups according to their glucose tolerance test results., Results: Mean duration of alcohol dependence was 10.56 years ± 7.78. A mean CIWA-Ar scale score was 23.95 points ± 2.81. Mean BMI was 24.65 ±3.74, overweight and obesity were determined in 35.22% examined men. Normal glucose tolerance were found in 54.55%, abnormal fasting glucose and/or abnormal glucose tolerance were noted in 23.87%, diabetes in 10.23%, and hypoglycemia in 11.36% of examined patients. Intensity of withdrawal syndrome according to the CIWA- Ar (OR -1.59, p= 0.05) and duration of alcohol consumption (OR -1.01, p=0.03) were the risk factors of diabetes type 2 in examined group. Greater BMI was a protective factor against diabetes type 2 in the study group. There was no significant correlation between risk of hypoglycemia and age, BMI, duration of alcohol consumption, alcohol blood concentration on admission, intensity ofwithdrawal syndrome according to the CIWA- Ar scale. A higher frequency of hypoglycemia was found in patients who declared vodka drinking in interview (at the borderline of statistical significance OR - 7.43, p=0.06)., Conclusions: 1. In the study group of alcohol-dependent men, the risk of diabetes was inversely proportional to BMI value. 2. The risk factors of type 2 diabetes in the alcohol-dependent group included the duration of lasting alcohol drinking and the intensity of withdrawal symptoms according to the CIWA- Ar scale. 3. According to the preference of alcohol type, a higher frequency of hypoglycemia was confirmed only in persons preferring to drink vodka.

Objective: Carbon monoxide (CO) exposure is still one of the leading causes of unintentional poisonings. Although its neurological sequels have been extensively studied, the knowledge about cytogenetic conse- quences still remains very limited. The aim of this study was to estimate the genotoxic potential of carbon monoxide in the course of acute poisoning., Methods: The examined group consisted of 73 patients treated because of accidental acute CO poisoning, and 22 healthy control individuals. Poisoning severity was estimated on the basis of neurological symptoms at admission, age, duration of exposure, carboxyhemoglobin (COHb) level and blood lactate concentration. The cytochalasine-B (cytokinesis blocker) micronucleus assay (CBMN) was used to analyze the cytogenetic alterations in lymphocytes from peripheral blood of the patients., Results: Intoxicated patients displayed higher numbers of micronuclei (MN) than controls. The frequency of MN depended on the age of patients, loss of consciousness, neurological symptoms at admission, and the level of carboxyhemoglobin, but did not correlate with lactate level. We also observed differences in cell responses depending on the gender., Conclusion: Our results confirm the presence of cytogenetic changes after carbon monoxide poisoning. Based on these data we conclude, that CO might have genotoxic potential.

Lipid emulsion intravenous infusion is recommended in reversing cardiac toxicity of local anaesthetics. Recent reports indicate, that it may be useful in the treatment of cardiotoxic drug overdose. While the mechanism of action is not fully understood, creation of a "lipid sink" is the predominant effect. The aim of the paper is to present the efficacy and indications for the use of lipid emulsion in acute poisoning, basing on the medical literature.

Unlabelled: Paracetamol is a widely known over-the-counter analgesic and antipyretic which, in acute poisoning usually causes liver damage, and less commonly damage to the kidney, heart, and pancreas. In the present paper we report a case of acute suicidal paracetamol intoxication complicated by acute hepatic and renal failure. The discussion covers the pathogenesis, clinical course, and treatment of acute renal failure in the course of paracetamol poisoning., Case Report: A thirty-four-year-old woman was admitted to hospital in the second day after ingestion of nearly 17 g of acetaminophen. During admission to the hospital, the maximum values of transaminases (AST 19 350 U/L, ALT 11 760 U/L) were found; they have gradually normalized over the next few weeks. Sequentially monitored serum creatinine showed an upward trend, reaching a value of 588 micromol/L in the fifth day after drug ingestion. The patient underwent 1 haemodiafiltration and 4 haemodialysis treatments resulting in an improvement in renal function., Conclusions: In acute acetaminophen poisoning, in addition to standard monitoring of liver function, the monitoring of kidney function is necessary because of the risk of acute renal failure due to acute tubular necrosis. Kidney damage is likely to be transient and generally will not need long-term renal replacement therapy.

The aim of this paper was the assessment of alcohol model in population of men living in big city. To achieve this target we used data concerning alcohol drinking model incorporated in questionnaire filled by men participants of the Multicentre Studies and Epidemiology of Diabetes conducted from 1998 to 2000, 35-75 years of age, living in the Podgórze district of the city of Kraków. Based on declared data involved drinking frequency and alcohol amount drunk in one sitting in population of 1074 men, 35-75 years of age, we determined that 46.7% participants used to drink more than 2 times weekly and 17.8% drinking alcohol every day or almost every day. Analysis of amount of drunk alcohol in one sitting shown that 81.4% participants use to drink more than 4 standard alcohol units in one sitting and 35% drunk more than 10 standard alcohol units per one sitting. Additionally, in subpopulation of men, 35-50 years of age, so it means at the peak of professional activity period, only 17.76% declared moderate model of alcohol drinking. This study helps to provide proper health services for alcohol addicted persons and induces to active seeking for persons with alcohol drinking problem. It is important not only from improvement of public health point of view but also for social and economic harm reductions followed by alcohol drinking.

Paper presents Polish Medical Society, Section of Clinical Toxicology position statement on the prehospital and hospital management in case of suspicion of intoxication with paracetamol.

In this paper we present the long-term follow-up of two patients, after injection of metallic mercury. Case 1. In 1997, 29-years-old man injected himself to left elbow about 20 ml of metallic mercury by mistake (he was heroin abuser for short time). Mercury concentration in the blood was 400 microg/L. X-ray of the chest, abdomen and affected elbow area showed radiopaque foreign material (depots of mercury). Depots of mercury were also visible on the tricuspid valve in echocardiography. Mercury from the soft tissue left elbow pit was partially surgically removed. During 15 years follow-up two times chelating therapy was performed with d-penicyllamine and DMPS. In 2012, he was admitted to hospital next time. The blood and urine mercury concentration was still elevated (55.2 microg/L and 197 microg/L), mercury depots in the lung and abdomen were present. The signs and symptoms of CNS damage, like peripheral polyneuropathy and ataxia, were diagnosed. CT of brain did not revealed any changes, despite head trauma before 6 years. However neurological findings are typical for chronic mercury poisoning, it is not possible to determine whether these changes are directly related to mercury, because head trauma history, Case 2. In 2003, 16-years-old woman injected herself one month before, in suicidal attempts to both elbows several millilitres of metallic mercury. Mercury concentration in the blood was 56.2 microg/L, in urine 906 microg/L and in the hair 1.12 microg/g. Chest Xray showed depots of mercury in the lung. Mercury from the soft tissue was two times surgically removed. During 9 years two times chelating therapy was performed with d-penicyllamine and DMPS. After 9 years there is no symptoms of mercury poisoning. Mercury depots in the lung are still present. The blood and urine mercury concentration is low (13.7 microg/L and 2.53 microg/L). In mean time she gave birth two healthy children. Further patients evaluation is necessary.

Generalized erythroderma or exfoliative dermatitis, is a disease characterized by the appearance of erythematous and scaling skin changes, which often cover greater than 90% of the body's surface. The resulting failure of the skin can coexist with other organ failure and is potentially life threatening. We present a case of a young woman admitted with symptoms of erythrodermia complicated lung and liver failure. The patient's medical history in the first row pointed to the possibility of the coexistence of flu-like infection and drug-induced reactions by antibiotic (makrolide) and nonsteroidal anti-inflammatory drugs (acetaminophen, ibuprofen) therapy two weeks before hospitalization. Rapid progress of the disease and the degree of liver damage found to meet the criteria for liver transplantation for acute liver failure. However, the coexistence of pneumonia and transfusion-related acute lung injury (TRALI) were the reason to postpone transplantation until healing inflammation process and improving lung function. Standard medical therapy was extended by liver albumin dialysis (MARS) with gradual improvement of general state and complete resolution of symptoms. Differential diagnosis was performed and coexistence of other systemic and neoplastic diseases was excluded.

Despite above 40 years the presence of sulpride on the pharmaceutical market, the acute poisonings are poorly reported in the medical literature. The discussed case of sulpiride intoxication concerns ingestion probably dose of 12 g, that exceeded 10-fold maximum therapeutic dose. 16-year-old girl, with no previous sulpiride treatment, was admitted to the Toxicology Department about 3 hours after ingestion. In clinical picture she presented quantitative consciousness disturbances with maximum 10 scores in GCS scale, with tendency to low BP (minimum 88/45 mmHg) and episode of orthostatic hypotension. The ECG demonstrated: normogram, sinus tachycardia with a heart rate of 125 beats/min, PQ = 120 ms, QRS = 80 ms, prolongation of QTc to 519,6 ms and unspecific changes of ST-T syndrome. The qualitative toxicological test confirmed the presence of chlorprothixene in urine, but the serum therapeutic concentration (0.126 microg/ml) excluded the overdose. The quantitative determination of sulpiride serum concentration confirmed acute sulpiride poisoning. The measured sulpiride toxic concentration on admission and in the consecutive hours were from 13.2 to 8.2 microg/ml. Sulpiride toxicokinetic parameters such as t max = about 3 h, t 1/2 = 24.02 h, k(el) = 0.029 h(-1) were also estimated. They point out that the absorption rate is similar and the elimination is prorogated in sulpiride acute poisoning compared to therapeutic doses.

The flow cytometry is acquiring more and more clinical importance. Despite its wide application in diagnostics, it is not used commonly in the clinical toxicology. The goal of the current investigation was to evaluate the mechanism for cell death (apoptosis or necrosis) and its manifestation in circulating human lymphocytes exposed to toxic concentration of carbon monoxide (CO). Since the large subpopulation of leukocytes have undergone apoptosis the next step of the studies was to assess the mobilization of progenitor cells (CD 34+) occurring in the peripheral blood after CO intoxication. Data were compared with those of 25 healthy controls comparable in terms of age, gender and physical activity. The application of the method in clinical reasoning was also evaluated. Significantly increased apoptosis of the lymphocytes in research group compared to control individuals correlates with the poisoning severity but does not depend on hypoxia. Decreased number of leukocytes caused by the cytotoxic effect of CO, stimulates the release of the CD 34+ to the peripheral blood. Increased cell death seems to be the relevant mechanism in the pathophysiology of acute carbon monoxide poisoning--the delayed apoptosis as the consequence of the reoxygenation can influence the delayed neurological and cardiological sequelae in patients after acute CO poisoning. In order to improve the treatment and help choose best fitting therapy, there should be need to introduce the new diagnostic methods like flow cytometry or innovative imaging techniques to the standard diagnostics in clinical toxicology.

Severe ethanol withdrawal syndrome, with psychosomatic symptoms, is life-threatening condition and if not treated can be fatal (in approximately 15% of cases). The purpose of this investigation was to assess cardiac muscle function using 99mTc-MIBI GSPECT in acute alcohol withdrawal. The group examined consisted of 10 males aged from 33 to 45 (45.7 +/- 8.82) because of alcohol withdrawal syndrome. The control group for quantitative analysis of the heart scintigraphy (GSPECT) consisted of 20 people referred for examination to the Laboratory of Nuclear Medicine, Jagiellonian University, which results of cardiac perfusion scintigraphy were assessed as normal. In acute withdrawal syndrome quantitative analysis of the heart scintigraphy (99mTc-MIBI GSPECT) revealed impaired regional wall motion and wall thickening related mainly to the lower wall segments. The abnormalities in myocardial perfusion (99mTc-MIBI GSPECT) was found in varying degrees of severity in all patients.

Twelve hospitals--five form Warsaw, three from Kraków, and four from Gdańsk and Gdynia were randomized for the study. The logistic preparedness of hospitals during massive chemical accidents has been investigated. There were 146 probands (9 managers, 31 ward heads, 75 assistants and 31 ward nurses) included in the study. In statistical analysis the generalized linear model extended by random factors, particularly the Poisson's regression has been used. No hospital in the three big cities in the country was prepared for any logistic action in case of massive chemical disaster. There were no stationary and mobile decontamination units in the investigated hospitals. There was no individual protective equipment in any of the analyzed hospitals. There were serious deficits in assortment and amount of antidotes which can be used in the treatment of contaminated patients. As much as 97.2% of respondents pointed the poison information centers as a main source of information in case of chemical accidents.

The aim of our study was the evaluation of strategic preparedness of twelve hospitals in Kraków, Warsaw and the Triple City to give aid during massive chemical accidents. The study was carried on 146 persons, including 9 managers, 31 ward heads, 75 assistants, and 31 ward nurses. In statistical analysis the generalized linear model extended by random factors, particularly the Poisson's regression has been used. In any of the investigated hospitals, there were no plans regarding of action in case of chemical accidents. The knowledge about sources of possible contamination as well as environment threats were insufficient. The majority of the medical staff did not know their role as well as the role of their hospitals in case of a chemical accident. There is an urgent need for courses about the procedures which should be used during chemical accidents. The lack of hospital preparedness to act during chemical disasters in the big cities suggests that a similar situation is common in other such medical units all over the country. Further investigations, especially in the hospitals which are placed near the potentially dangerous factories, should be carried on in the near future.

The aim of the study was the evaluation of some aspects of doctors knowledge about the treatment in case of massive chemical accidents. The study was conducted in twelve hospitals in Kraków, Warsaw, and the Triple City. There were 106 doctors (31 ward heads and 75 assistants) included in the study. The questions contained some aspects of: external decontamination, the usage of 0.5% of sodium hypochlorite, the knowledge about the use of selected antidotes and the symptoms of chosen toxidromes. In statistical analysis the generalized linear model extended by random factors, particularly the Poisson's regression was used. The results confirm, that the medical staff is not well prepared to take an effective action in case of a chemical contamination. The essential knowledge of the medical staff in all investigated aspects of chemical safety has been found out to be not satisfactory. There is an urgent need for medical staff to undergo theoretical and practical courses about toxicity of major chemicals. The clinical toxicologists should be asked to prepare up-to-date, advanced methods and regulations for life support in case of heavy chemical accidents.

There were 10 acutely CO poisoned study patients without CNS history (head traumas, epilepsy, dementia, migraine or alcoholic diseases) in whom (99m)Tc-HmPAO SPET, HMRS and neuropsychological testing were performed. 99mTc-HmPAO SPET and neuropsychological testing were performed twice: in acute phase and at six months post CO exposure. HMRS was carried out at 8 months post CO exposure. A multidimensional analysis of variance (MANOVA) was used to statistical analysis. Regional CBF disturbances in acute phase of CO poisoning were observed in frontal cortex, basal ganglia and parietal cortex respectively. The most reversible, as seen in control (99m)Tc-HmPAO SPET examination, were the changes observed in parietal cortex. Diffuse generalized cortex hypoperfusion, both in acute phase and at 6 months post exposure, was seen only in one the patient. In all of the examined patients different elevation in mobile lipid or/and lactate concentration in frontal lobe or/and basal ganglia was revealed by HMRS evaluation at eight months post acute CO exposure. Results of neuropsychological testing at baseline and at 6 months partially correlated with neuro-imagine techniques applied.

The aim of the study was to present the increasingly alarming phenomenon of completed suicide in adolescents and young adults. The material analysed had been drawn from the records of post-mortem examinations conducted by the Institute of Forensic Medicine in Kraków. The analysis covered cases of completed suicide committed by 15-30 years old inhabitants of Kraków or its environs between the September 2002 and the September 2003. The group of subjects analysed comprised 47 individuals (9 females and 38 males); 57.4% of these had resided in a big city (Kraków), and the remaining 42.6%--in villages or little towns near Kraków. The data regarding cases of completed suicide were compared with the data regarding suicide attempts by self-intoxication in the period under consideration, extracted from the documentation of the Department of Clinical Toxicology in Kraków. The latter data encompassed 233 cases of suicide attempts by individuals ranging in age from 15 to 29 years, with females constituting 62.2% of these, and males--37.8%. 65% of the attempters had been residents of Kraków. The analysis of the data from the Institute of Forensic Medicine revealed that nearly half of the suicide victims concerned had been treated for mental disorders, mainly depression and addictive disorders. The occurrence of suicide attempts prior to the fatal act was established in the case of 17 subjects (18.5%). Over half of the subjects (48.9%) committed suicide by hanging themselves, 17%--by falling from a height, 8.6%--by drowning, and 19.1%--by self-intoxication with medicaments. 77.2% of the subjects committed suicide at home. In the case of 23 subjects (48.9%), the post-mortem examination revealed the presence of alcohol. The analysis of the cases of suicide attempts by self-intoxication revealed a significant percentage of depressive disorders (26%)--of high occurrence especially in the case of females, whereas alcohol addiction was the predominant diagnosis in the case of males. Furthermore, the majority of the attempters exhibited situational reactions or personality disorders. Suicide attempts constitute an essential part of the issue of suicide in adolescents and young adults and require further research. What attracts notice, is a high percentage of males among suicide victims, and a high percentage of suicide victims with earlier suicide attempts. The results of the study should be taken into consideration in suicide prevention in groups especially endangered by the risk of completed suicide, such as adolescents and young adults after suicide attempts.

Olanzapine is a new atypical antipsychotic drug acting on different receptors. A variety of pharmacologic effects are responsible for toxicity and the variety of clinical symptoms seen in overdose: tachycardia, agitation or aggression, dysarthria, extrapyramidal dystonic effects, sedation or coma, small pupils, blurred vision, respiratory depression, hypotension. A retrospective analysis of clinical course of eight acute olanzapine intoxication treated at the Department of Clinical Toxicology Jagiellonian University Medical College is presented. CNS symptoms manifested in fluctuations between somnolence/coma and agitation/aggression and miosis were observed in most of the patients. Increased CPK activity was stated in the most of patients. All of the patients recovered, poisoning severity according PSS was moderate and severe.

Chloroquine is a derivative of 4-aminoquinoline, which is used in the malaria prophylaxis and treatment and the therapy of some connective tissue diseases. Its narrow therapeutic index causes that the medicine is relatively toxic, especially in the case of an overdose or an acute intoxication. In the recent study two cases of the acute chloroquine poisoning, hospitalized in the Toxicology Department in Kraków, were described and one of them was fatal. The first case was 16-year-old girl who ingested 5 g of chloroquine phosphate in the suicidal attempt. After about 2 hours general seizures appeared followed by ventricular fibrillation and cardiac arrest. After near 2-hour-lasted reanimation procedures she was resuscitated, but 14 hours later another cardiac arrest appeared because of the bradyasystole. Despite the institution of advanced reanimation methods including external pacemaker and electrostimulation, spontaneous circulation did not return and the patient was declared dead. Postmortem toxicological examination of blood, vitreous humour, bile and liver revealed extremely high concentrations of chloroquine (252.15 mg/l in blood). The second case was the 15-year-old girl who ingested 7.5 g of chloroquine phosphate. She developed significant hypotension requiring intravenous infusions of fluids and catecholamines and respiratory distress positively treated with endotracheal intubation and mechanical ventilation. In both cases a considerable hypokalemia and prolonged QTc interval were observed. According to the literature, a clinical picture, diagnosis and recommended therapy of an acute chloroquine poisoning were reviewed.

Objective: To present Erwin Ringel's theory of the presuicidal syndrome as an instrument for the assessment of suicidal risk., Method: The literature regarding the presuicidal syndrome was reviewed., Results: As it is evident from the research and works by Ringel, and also from the works by other classics of suicidological literature, such as Farberow, Poldinger, Schneidmann, Beck, and B6hme, the discovery of the presuicidal syndrome has opened up new vistas for the therapy of suicidal tendencies. The knowledge of the nature of the presuicidal syndrome indicates that a specific "anti-suicide" therapy has to be applied. The principal aims of such a therapy include the removal of the patient's feeling of alienation by the creation of a good doctor-patient relationship, the creation of the conditions enabling the patient to vent his/her aggression verbally, the removal of the presuicidal narrowing of the patient's consciousness by the reinforcement of the effective, positive behaviour, and the stimulation of the patient's imagination towards the formulation of new aims in life., Conclusion: The concept of the presuicidal syndrome, although somewhat forgotten, still can enhance the understanding of the psychopathology of suicide, contribute to the effective identification of individuals endangered by the occurrence of suicidal tendencies, and contribute to the increase in the effectiveness of the therapy required. Finally, the present authors suggest that the presuicidal syndrome, as a special multifactor psychopathological phenomenon, should be recognized as a diagnostic unit, thus filling in the present gap in the classifications of mental illnesses.

The aim of the work was to present the characteristics of suicide attempts, distinguished on the basis of the scores in the Suicidal Intent Scale questionnaire (SIS), created by Aaron Beck, professor of psychiatry from Philadelphia. The group examined comprised 238 patients (63 males and 175 females) hospitalised in the Department of Clinical Toxicology CMUJ in Kraków in the years 2000-2001, after a suicidal self-intoxication with xenobiotics. The examination was conducted by means of the Suicidal Intent Scale (SIS)--a psychological test created by Aaron Beck. In the case of about 65% of the patients examined, their suicide attempts most frequently were acts of impulsive behaviour, rarely planned for longer than three hours before the realization and usually made in another person's presence or in a situation in which another person's intervention was highly probable. Such attempts had the character of "a cry for help", and were aimed at effecting some change or at manipulating the environment. Nevertheless, the patients acted in a conviction that their act was a serious attempt at ending life, and, most frequently, they maintained such opinions during the examination. On the other hand, they rarely expressed further suicidal intents, and more frequently accepted the fact that their lives had been saved. By contrast, the remaining 35% of the patients examined had attempted suicide with the evident intention to kill themselves; they had taken full precautions against being discovered and had planned suicide carefully to eliminate the smallest possibility of intervention. In the majority of cases, they still maintained the wish to die after the attempt. As the results of the examination indicate, the Suicidal Intent Scale, and, especially, the Precautions subscale, point at the important aspect of suicidal intentions, which, being of vital importance for the diagnostic purposes and suicide prevention, requires further investigation.

The aim of the study was to estimate the risk factors for eventual suicide in the case of individuals hospitalised for a suicide attempts (or attempted suicide). The group examined comprised 238 patients, who, in the years 2000-2001, were hospitalised in the Department of Clinical Toxicology CM UJ in Kraków for suicidal self-intoxication with medical drugs. The group consisted of 63 males and 175 females ranging in age from 17 to 79 years (the mean age was 36 years). The instruments applied in the examination included a structured interview and a set of psychological tests; complementary information was obtained from the patients' case histories. In the year 2005, on the basis of the data from the Institute of Forensic Medicine in Kraków, it was established that 10 of the patients under consideration--6 females, and 4 males--had eventually committed suicide within the period concerned. The retrospective analysis of the case of each of these 10 individuals revealed that the majority of them had been treated psychiatrically for depression or alcoholic addiction, had experienced parental or marital bereavement, or had experienced serious financial difficulties. The subjects' case histories informed also about the cases of suicidal death in the families of several subjects. As should be pointed out, the results of psychological tests obtained earlier by the 10 subjects concerned did not unequivocally indicated high endangerment by the risk of eventually committing suicide. Finally, it is necessary to observe that alcoholism and depression were the most frequently diagnosed mental disorders in the case of the male suicides. In the case of the female suicides, the results of the analysis reveal a variety of psychological, psychiatric and socio-demographic factors that, eventually, could lead to suicide.

B-type natriuretic peptide (BNP) is synthesized in the cardiac ventricles upon ventricular myocyte stretch. BNP plasma concentration is useful in cardiology especially for identifying patients with congestive heart failure (CHF), as a prognostic marker of acute coronary syndromes and independent predictor of sudden cardiac death. Its value in clinical toxicology is unclear. As toxins frequently produce deleterious effects on the cardiovascular system we have decided to carry out the pilot study on BNP plasma levels in acutely poisoned patients. The 117 patients (65 males and 52 females) treated at the Department of Clinical Toxicology Jagiellonian University Medical College in Kraków in 2004 were included. 42 of them were intoxicated with ethanol, 35 with pharmaceuticals (mostly tricyclic antidepressants), 13 with CO. The mean age of examined group was 34.07 +/- 12.08 year. The control group consisted of 54 healthy volunteers and employees of the Department (mean age; 32.7 +/- 11.74). A significantly higher BNP concentration was found in poisoned patients than in the control group. The highest BNP plasma concentration was noted in pharmaceutical poisoned patients. Mean BNP concentration in poisonings of minor severity (grade 1) was significantly lower then in moderate (grade 2) or severe (grade 3) poisonings. BNP plasma measurement as an additional marker of cardiac disturbances in clinical toxicology practice may be suggested.

Unlabelled: Acetaminophen is found to be potentially hepatotoxic drug. Both, acute acetaminophen intoxication (dose >10 g) and therapeutic dose administration in the case of glutathion depletion (chronic alcohol abuse) hepatotoxic effect may occur. Late N-acetylcysteine (NAC) administration does not prevent liver injury. Molecular Adsorbents Recirculating System (MARS) is useful liver support device based on albumin dialysis for saving time for spontaneous liver regeneration or bridging technique to liver transplantation., Case Series: Two cases admitted to the Department in 19 and 20 hour post-ingestion of hepatotoxic paracetamol doses as confirmed by toxiocological examination (serum paracetamol concentration). Despite of NAC administration the signs of the liver injury (progressive encephalopathy and jaundice, decreased prothrombin activity) developed. On day four post exposure according to King's College of Medicine London criteria both cases were qualified to MARS therapy. Albumin dialysis of 8 hour duration was performed in both cases and a full recovery with normalization of the liver function was noted. Patient three: patient with the liver and the kidney insufficiency due to alcohol-paracetamol syndrome admitted to the Department of Clinical Toxicology for MARS therapy. Five performed dialysis resulted in the liver function improvement. The patient was disqualified from the liver transplant because of heart failure, pneumonia, hyperthyroidism and alcoholism. Patient died because of heart failure.

The aim of the study was to present the phenomenon of suicide attempts by self-poisoning in a group of females and males ranging in age from 15 to 29 years, and treated in the Department of Clinical Toxicology Jagiellonian University College of Medicine in Kraków in the years 2000-2002. The group analyzed comprised of 1117 patients, 629 (69.1%) women and 425 (38.1%) men. In the female group, teenagers under 19 constituted 48.9%, whereas young females ranging in age from 20 to 29 years--51.1%. In the male patients group teenagers under 19 constituted 29.4%, the young men (20-29 years of age)--70.6%. The group was analyzed from the point of view of demographic, clinical and social factors such as gender, age, level of education, marital status and occupation (if applicable), the course of self-poisoning and kind of toxic substance involved. In the majority of cases, self-poisoning had been caused by taking one type of medicines, and less frequently by taking mixed-type medicines or by simultaneously taking medicines and ethanol. The most typical drugs used in the attempts included benzodiazepines, phenothiazines, nonsteroidal antiinflammatory and antiepileptic drugs. The assessment of the poisoning severity based on the PSS classification, indicates the predominance of the minor and moderate poisoning. Up to 50% of subjects suffered from mental disorders--most frequently from affective disorders, neurotic disorders, and personality disorders. As an essential part of the problem of suicidal behaviors in teenagers and young adults, suicide attempts among young population require an in-depth analysis. The scale of the problem indicates the necessity of initiating appropriate preventive actions and organizing appropriate psychological and psychiatric care.

Sex and the age structure have been for decades the crucial factors determining the dimensions of suicide. In the literature of the subject, it is possible to find different interpretations concerning the widely known facts of larger effectiveness of suicide among males. Females, on the other hand, exhibit suicidal behaviour and suicide attempts several times bigger than the number of completed suicides. In comparison with wide literature dealing with the problematic of completed suicide, the number of publications concerning suicide attempts is, both in foreign and in Polish literature rather scarce. That is why the present authors have undertaken the analysis of suicide attempts by subjects hospitalized in the Department of Clinical Toxicology Jagiellonian University College of Medicine in Krakow in the years 2000-2002. On the basis of the medical documentation, 2757 cases of attempted suicide through self-intoxication by subjects undergoing treatment in the toxicological department. In the period concerned, the number of hospitalizations after suicide attempts increased from 856 cases in the year 2000 to 971 cases in 2001, and subsequently slightly decreased to 930 cases in 2002. The highest indicator of suicide attempts through self-intoxication has been observed among adolescents and young adults. In the absolute values, within the span of the years in question, there is a substantial predominance of suicide attempts undertaken by adults ranging in age from 20 and 50. On the contrary, in the oldest age group (over 60), the number of suicide attempts through self-intoxication was in the years concerned the lowest. In contrast with completed suicide, where the proportion of males to females is 4:1, in the group examined, females constituted 50% of subjects after suicide attempts. The number of females after suicide attempts in the consecutive years analysed was higher among adolescents and young women under 30. Despite drawbacks in data gathering, there is convincing testimony indicating that suicide is the result of number of complex risk factors. Sex and the age structure belong to non-modifiable factors, and thus emphasis should be put on the importance of the gathering of relevant data and on further research into the factor of sex and age structure in suicide attempts and completed suicide.

The subject of the research was the analysis of frequency and type of psychoactive substances used, basing on the determinations the blood and/or urine samples, performed in the toxicological laboratory of the Department of Clinical and Industrial Toxicology Jagiellonian University in Kraków in the period from December 2001 to November 2003. From 17,649 performed determinations--45.5% were positive. 50% of the positive determinations were psychoactive substances. The most often psychoactive substance determined was ethyl alcohol (52.86%), next benzodiazepines (17.41%), amphetamines (10.54%), opiates (8.05%), THC (6.87%), barbiturates (3.74%), and occasionally atropine and cocaine. There was observed a variety of mixed, simultaneously taking psychoactive substances, especially ethyl alcohol, opiates, amphetamine derivatives and cannabinoids. The analysis of the occurrence of psychoactive substances in biological samples from patients treated in different hospital departments, others hospitals and ordered by private persons also was performed. In the last two years 369 private patients ordered psychoactive substances determinations and 78 of them were positive.

The aim of the study was to analyze seasonality and temporal fluctuations in suicide attempts by persons living in Krakow and hospitalized in the Department of Clinical Toxicology CMUJ in the years 2000-2002. The research focussed on the frequency of suicide attempts in relation to the time of the day, day of the week, and month of the year. Temporal fluctuations in the frequency of suicide attempts have been assessed on the basis of the data from medical documentation concerning 2757 suicide attempts by individuals ranging in age from 14 to 90 years. The group consisted of 1607 females and 1150 males. According to the results of the research, seasonality and temporal fluctuations in the frequency of suicide attempts is different for males and females. In the case of the males examined, no dependence between the frequency of suicide attempts and a particular month or season has been observed. In the case of females, on the contrary, the data indicate the existence of a seasonal pattern with the peak in the spring (or early part of the summer), and in the autumn--in October and November. In males, the peak day for attempted suicide was Monday, whereas in females--Sunday and Monday. As regards the time of the day, both the results of the present research and data collected by WHO/EURO indicate that suicide attempts occurred most frequently in the evening, late in the evening or in the early part the night. In conclusion, it has been emphasized that the majority of suicide attempts, especially by females, occurs late in the evening or early in the night. This finding seems to be of particular importance for suicide prevention--it can contribute to the increase in the effectiveness of the organization of work in the Crisis Intervention Centres and make therapists and patients' families aware of the existence of periods of an increased suicide risk. The research has been conducted owing to the cooperation between the department of Clinical Toxicology, CMUJ and the Department of Adult Clinical Psychiatry, CMUJ in Kraków. The results obtained, together with the results of the research conducted by the centres participating in WHO/EURO are vital for suicide prevention and treatment.

The goal of the study was to examine the influence of methadone maintenance treatment programme on instances of DNA damage manifested in the micronuclei. The material of the study (cultures of lymphocytes from peripheral blood) obtained from 12 opiate dependent patients was taken two times: at the start of and during the course of a methadone programme conducted at the Department of Clinical Toxicology of the Jagiellonian University's Medical College. The observed decrease in the number of micronuclei indicates that this type of treatment in conjunction with appropriate life style changes on the part of the subjects reduces the risk of genomic lesions.

In the clinical practice there are three types of lithium intoxication: acute poisoning in patients not previously treated with lithium, acute on chronic poisoning, i.e., an acute overdose in patients who are under lithium treatment and chronic poisoning that occurs in patients who are under lithium treatment. Threats and the clinical management in these types are different. The paper describes a case of a young woman acutely intoxicated with lithium carbonate, never treated lithium before. Plasma concentration of lithium, 15 hours after ingestion of 9.75 g lithium carbonate, was 2.56 mmol/L. Only minor clinical symptoms were observed. Calculated elimination half-life was 15-26.8 hours.

The aim of the study was to assess the phenomenon of suicide attempt in the elderly inhabitants of Kraków. Special attention has been paid to the group of "seniors"--aged 75 years or over. The authors have analyzed all the 136 cases of suicide attempts by individuals aged over 60 years, selected from the cases of suicide attempts by self-intoxications by patients hospitalized in the Department of Clinical Toxicology, CMUJ in Kraków in the years 2000-2002. The group concerned included 45 males and 91 females. A large number of subjects (over a half of the total) ranged in age from 60 to 65 years. The group of seniors comprised 35 individuals (aged 75 years or over), including 7 males and 28 females. On the basis of the data from medical documentation, the subjects were analysed from the point of view of their health condition and in the psycho-social context. In the majority of cases the subjects are pensioners residing in Kraków, often living alone. In the case of 98% of the subjects, it was their first suicide attempt. Pharmaceuticals used for self-poisoning were most frequently psychotropic, or mixed-type drugs. The assessment of the severity of poisoning indicates that in about 20% patients poisoning was severe. 70% of the subjects suffered from depressive, reactive, or situational disorders, affective depression or organic brain disorders, often with dementive signs. A significant number of subjects suffered from hypertension, coronary artery disease, arteriosclerosis, or alimentary tract diseases. In the group of the seniors, the most conspicuous problems included serious somatic diseases (malignant diseases and chronic respiratory system diseases), depression, organic dementia, loneliness, and bad family situation. Taking into consideration the scantiness of research into attempted and completed suicide in the elderly and in the old elderly, the present authors stress the importance of the continuation of the research to prevent suicide in the aforesaid age group.

We report the case of 52-year-old woman, who ingested 3.6 g of diltiazem, 16 g of potassium chloride and 6.5 g of magnesium, in a suicide attempt 4 hours before admission. She developed cardiorespiratory failure, with severe hypotonia and acute renal failure, in ECG third degree atrioventricular block was stated. The highest potassium concentration was 8.0 mmol/l, magnesium 2.15 mmol/l. As a result of multiple pharmacologic intervention, including intravenous fluids, calcium, glucagon, dopamine, dobutamine, norepinephrine, transvenous pacing and peritoneal dialysis (haemodynamic instability makes haemodialysis noneffective) the haemodynamic stabilization of cardiovascular system and normalization of potassium and magnesium concentration were achieved. The diltiazem concentration was measured using liquid chromatography, the result was 0.89 microgram/ml. She was discharged in a good clinical condition on day 26th.

In this paper the case of intoxication in two women (19-year-old and 23-year-old), who in suicide attempts ingested at the same time different doses of nifedipine and acebutol. In 23-year-old woman 4 hours post ingestion cardiorespiratory arrest was stated. Resuscitation procedures were ineffective, she died. Acebutol concentration in postmortem blood was 24.1 mg/l and nifedipine-1.8 mg/l. The second one (19-year-old) was treated successfully, only mild cardiac disturbances were observed. Acebutol concentration in blood was 1.8 mg/l, nifedipine was not stated.

We report the case of an adolescent, 15-year-old woman, who ingested 4.0 g of amantadine in a suicide attempt 2 hours before admission. She developed central nervous system symptoms including confusion and psychomotor agitation. The main cardiovascular symptoms were due to disturbances in atrioventricular conduction and propagation of stimuli in sinus node. All cardiovascular symptoms disappearanced after 12 hours of admission, CNS symptoms were observed 48 hours. No other systems were involved. She was discharged in a good state on day 5th.

Psychological examination done in the Toxicological Department covers almost all patients treated after suicidal attempts. Elder people constitute a small percentage of this population. Our observation shows, that this percentage is growing in recent years. This analysis covers 188 patients over 60 years of age. Involvement of a psychologist was not only diagnostic but also therapeutic. Important part of the treatment included a session with patient's family and effort targeted to help patients for whom coming back to their previous environment could present life threatening danger.

The study presents the results of the interdisciplinary research conducted on the basis of cooperation between the Institute of Forensic Medicine, the Department of Clinical Toxicology, and the Clinic of Psychiatry in Kraków. The aim of the research was to determine similarities and differences between attempted and completed suicide from the point of view of socio-demographic and clinical traits. The authors analysed 220 cases of completed suicide committed in Kraków and its environs in the year 2000. The material presented in the study was based on the archive data from post mortem examinations conducted in the Institute of Forensic Medicine in Kraków. The sample consisted of 177 males and 43 females ranging in age from 13 to 89 years. The mean age was 43.6 years for the entire group, 42 years for males and 50 years for females. The majority of subjects were males, either unemployed, or pensioners. A similar tendency was observed in the group of female subjects. Mental disorders and alcoholic addiction in anamnesis were discovered in a significant number of cases, both in the group of males and in the group of females. Subjects, in whom serious somatic diseases had been detected, constituted a separate group of cases. According to the archive data, in the last century, suicide was most frequently committed by hanging. Similarly, in the sample examined, in 133 cases, suicide was committed by hanging. In 37% of cases, the level of alcohol in the suicides' blood was between 0.5 and 3 or more g/L. In 2000/2001, within the analogical period of 12 months, the group of 200 patients after a suicide attempt by drug intoxication was examined in the Department of Clinical of Toxicology Jagiellonian University College of Medicine. This group included 49 males and 150 females, ranging in age from 18 to 79 years (mean age 35). The examination was conducted by means of structured investigation and medical documentation. Contrary to completed suicide, in the group of suicide attempters, females outnumbered males. Young people under thirty, living in a large city, possessing elementary or secondary education, and either unemployed, or pensioners, constituted the majority of the examined group. A significant percentage of females was divorced and lived with their children only. The majority of the examined population of suicide attempters had used alcohol during the attempt, had suffered from depression, personality or behavioural disorders, had undergone psychiatric treatment, or had had cases of suicide among their friends or relatives.

The pattern of poisonings in patients hospitalised in the Department of Clinical Toxicology Jagiellonian University Medical College in 1997-2001 was presented in the study. The analysis includes 17,931 patients: 6,016 (33.5%) women and 11,915 (66.4%) men. The rate of patients between 20-39 years old was highest in all the analysed year, however downward trend was noticed. The upward tendency was noted in older group of poisoned patients. A suicidal poisonings were mostly common in 1998 and 1999 in the youngest and oldest groups: 37.1%, 37% in 1998, and 25.5%, 22.2% in 1999 respectively. The medication drugs were the most common cause of acute poisoning only in the group of adolescent patients. Ethyl alcohol was the common cause of poisoning in adult groups. The highest rate of ethanol intoxication was noted in patients between 40 to 59 years old. A 89 lethal intoxication were noted in analysed period. The average mortality rate was low (0.5). A medication drugs (30.4%) followed by ethanol (17.4%), carbon monoxide (13%) and solvents (13%) were involved in lethal poisonings in the oldest group of patients.

The exposition to tobacco smoke is overall: in home, work and public places. For the examination of the presence and concentration of environmental tobacco smoke (ETS) in indoor environments the nicotine and respirable suspended particulates (RSP) are determined. A variety of biomarkers (nicotine, cotinine, thiocyanate, carboxyhemoglobin, protein and DNA adducts) are propose for measurement of exposure to tobacco smoke. The most popular is measurement of cotinine concentration in body fluids (blood, urine, saliva). Plasma cotinine concentration correlated to numbers of cigarettes smoked and to various biological effects of cigarette smoking and exposure to ETS. Other biomarkers as carboxyhemoglobin, thiocyanate, and amines and polycyclic aromatic hydrocarbons adduct can be also use.

The different course of acute carbon monoxide poisoning in two young people exposed to the same Carbon monoxide source are reported in the study. The pulmonary edema was diagnosed in the man, but not in the woman. The brain morphological changes revealed by MRI were significantly marked in the women compared to the intoxicated man. MRI detected the brain changes invisible in CT scans and seems be more useful for evaluation CNS abnormalities. The neuropsychological examination, of the brain functional changes is also necessary for proper evaluation of the CNS damage.

The authors present the most common in clinical toxicology cardiovascular disturbances and mechanism of action the selected drugs (tricyclic antidepressants, cardiac glycosides, beta-blocking agents and calcium channel blockers). General management in acute poisoning with these drugs is also presented, concerning their toxicodynamics.

The aim of the study is to establish the composition and nutritional value of daily food in the group of opiate addicted patients qualified to methadone therapy. The presented data show the results of the survey carried out at the start of the treatment in the group of 42 patients (13 women aged from 21-33 years and 29 men aged from 21-46 years). For the dietary survey the method of 24 hour recall was used: nutrients of daily individual diets and mean values with standard deviations for examined groups were calculated with use of own computer programme and polish food composition data. The proportion of energy covered by groups of food products was also calculated. The results show wide distribution of food consumption: the mean level of the daily energy intake was 2438 kcal (SD +/- 976, range 492 kcal to 4193 kcal.) in the group of men, and 2039 kcal (SD +/- 925, range 561-3860 kcal) in the group of women. The mean protein intake was 82 g (13.4 E%) for men and 63 g (12.4 E%) for women. In the diet of 5 men and 6 women carbohydrate energy exceeded 70% of the total energy intake, indicating high consumption of food items containing considerable amounts of sugar (bonbons, confectionery, cakes, sweets, chocolate, sweet drinks and similar).

During last 5 years only single cases of poisoning with plants containing psychoactive substances, especially Datura stramonium, were treated in the Department of Clinical Toxicology in Kraków. In autumn 1999, during 1 month, 7 patients, aged from 14 to 27 years (mean 18 years) poisoned with Datura stramonium were treated. On admission in all patients central and peripheral anticholinergic symptoms were stated. Four of them ingested seeds, three of them chewed seeds and leaves. Only one ingested Datura seeds in suicidal attempts. In the group, only one--20-years-old--previously abused amphetamine and smoked marihuana. For the remaining 5 boys (14-18 years-old), it was the first experience with psychoactive substances. All were successfully treated, in 5 patients physostigmine was used, in dose ranged from 2 to 6 mg, with no adverse effects. Seasonal accessibility of natural psychoactive products may be the first, easy, free step of addiction.