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Background: This study was conducted to retrospectively assess the relationships between: rhabdomyolysis (quantified by creatine kinase (CK) activity) and kidney injury (quantified by serum creatinine concentration), sex, age, body temperature on admission, presence of seizures, and agitation or aggression in patients presenting to the Emergency Department with acute recreational drug toxicity. We also investigated the association with the substances ingested. Methods: All presentations to the 16 sentinel Euro-DEN centres in 10 European countries with acute recreational drug toxicity during the first year of the Euro-DEN study (October 2013 to September 2014) were considered. Cases that had abnormal CK activity recorded as part of routine clinical care were divided into 3 cohorts depending on peak CK activity. Cases with normal CK activity were included as a control group (4th cohort). Results: Only 1,015 (18.4%) of the 5,529 Euro-DEN presentations had CK activity concentration recorded. Of this group 353 (34.8%) had also creatinine concentration measured. There were 375 (36.9%) with minor rhabdomyolysis, 69 (6.8%) with moderate rhabdomyolysis, and 24 (2.4%) with severe rhabdomyolysis; 547 (53.9%) were included in the control group. There was a positive correlation between CK activity and creatinine concentration (correlation coefficient r = 0.71, p<0.0001). There was no correlation between CK activity and body temperature at the time of presentation to the ED (correlation coefficient r = 0.07, p = 0.03). There was a positive correlation between CK activity and length of stay in the hospital (r = 0.31, p<0.001). There was no association between CK activity and the presence of seizures (p = 0.33) or agitation/aggression (p = 0.45), patients age (p = 0.4) or sex (p = 0.25). The 5 most common agents amongst patients presenting with rhabdomyolysis were: cocaine (n = 107; 22.9% presentations), amphetamine (76; 16.2%), cannabis (74; 15.8%), GHB/GBL (72; 15.4%) and heroin (67; 14.3%). The distribution of rhabdomyolysis in 5 most common drugs was (drug; patients with rhabdomyolysis, patients without rhabdomyolysis): cocaine (107, 122), cannabis (74, 117), GHB/GBL (72, 81), amphetamine (76, 66), heroin (67, 70). Conclusions: Abnormal values of CK activity occurred in almost half (46.1%) of presentations to the Emergency Department with acute recreational drug toxicity in whom CK activity was measured; however, severe rhabdomyolysis is seen in only a small minority (2.4%). Those with rhabdomyolysis are at significantly higher risk of kidney injury and have a longer length of hospital stay. [ABSTRACT FROM AUTHOR]

Introduction: Cannabis is the most common recreational drug worldwide and synthetic cannabinoid receptor agonists are currently the largest group of new psychoactive substances. The aim of this study was to compare the clinical features and outcomes of lone acute cannabis toxicity with lone acute synthetic cannabinoid receptor agonist toxicity in a large series of presentations to European emergency departments between 2013-2020., Methods: Self-reported drug exposure, clinical, and outcome data were extracted from the European Drug Emergencies Network Plus which is a surveillance network that records data on drug-related emergency department presentations to 36 centres in 24 European countries. Cannabis exposure was considered the control in all analyses. To compare the lone cannabis and lone synthetic cannabinoid receptor agonist groups, univariate analysis using chi squared testing was used for categorical variables and non-parametric Mann-Whitney U- testing for continuous variables. Statistical significance was defined as a P value of <0.05., Results: Between 2013-2020 there were 54,314 drug related presentations of which 2,657 were lone cannabis exposures and 503 lone synthetic cannabinoid receptor agonist exposures. Synthetic cannabinoid receptor agonist presentations had statistically significantly higher rates of drowsiness, coma, agitation, seizures and bradycardia at the time of presentation. Cannabis presentations were significantly more likely to have palpitations, chest pain, hypertension, tachycardia, anxiety, vomiting and headache., Discussion: Emergency department presentations involving lone synthetic cannabinoid receptor agonist exposures were more likely to have neuropsychiatric features and be admitted to a psychiatric ward, and lone cannabis exposures were more likely to have cardiovascular features. Previous studies have shown variability in the acute toxicity of synthetic cannabinoid receptor agonists compared with cannabis but there is little comparative data available on lone exposures. There is limited direct comparison in the current literature between lone synthetic cannabinoid receptor agonist and lone cannabis exposure, with only two previous poison centre series and two clinical series. Whilst this study is limited by self-report being used to identify the drug(s) involved in the presentations, previous studies have demonstrated that self-report is reliable in emergency department presentations with acute drug toxicity., Conclusion: This study directly compares presentations with acute drug toxicity related to the lone use of cannabis or synthetic cannabinoid receptor agonists. It supports previous findings of increased neuropsychiatric toxicity from synthetic cannabinoid receptor agonists compared to cannabis and provides further data on cardiovascular toxicity in lone cannabis use.

Energy production and storage has become a pressing issue in recent decades and its solutions bring new problems. This paper reviews the literature on the human and environmental risks associated with the production, use, and disposal of increasingly common lithium-ion batteries. Popular electronic databases were used for this purpose focused on the period since 2000. Assessment of the toxicological and environmental impact of batteries should then have a holistic scope to precede and guide the introduction of appropriate safety measures. In this short review the authors will try to touch upon this complex subject and point out some important issues related to an unprecedented development of lithium ion batteries-powered world. Given the multi-billion dollar business with the risks associated with the development of new technologies requires careful consideration of whether the balance of profits and losses is beneficial to humans and the planet. Int J Occup Med Environ Health. 2023;36(1):3-20., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Recently we observe an increase in the number of intoxications due to xenobiotics that may induce acute methemoglobinemia. Our study showed a case of acute methemoglobinemia (MetHb 55..2%) in 25 – year old man. Clinical symptoms were caused by ingestion of “poppers” which was used by patient as “aphrodisiac”. Summary: Conclusions: 1. Oral intake of alkyl nitrites, including isobutyl nitrite, is burdened with the risk of life-threatening methemoglobinemia . 2. In the case of poisonings running with normal pO2, reduced level of oxygen saturation, clinical signs of cyanosis does not react to oxygen therapy, and “chocolate” tinge of blood methemoglobinemia should be suspected. 3. In every case of MetHb the use of antidote, which is methylene blue, should be considered. 4. The severity of cyanosis correlates with the level of methemoglobin.

Introduction: During initial months of the year 2015 we observed the increase number of patients intoxicated with NPS in Poland. In our work we analysed the scale of this phenomenon in Pomeranian region., Materials and Methods: Study was carried out on period from 1 January 2015 to 31 July 2015. Analysis was based on records derived from Electronic Poison Information Database developed and used on a daily basis on Pomeranian Centre of Toxicology (PCT), data obtained from Centre for Monitoring of Adverse Effects of Medicaments and Chemical Substances based in PCT and on information gathered from patients treated in Pomeranian Centre of Toxicology for NPS intoxication., Results: Our study has shown slow, continuous rise in the number of intoxications with NPS in analysed period. The most frequent cause of intoxication were synthetic compounds. 99 cases needed treatment in Clinical Toxicology Unit due to their severe state. The youngest exposed person was 13 y.o., while the oldest was 53 y.o. Mean age was 22.5 y.o. with median 20 years. Majority of intoxications were among males (80.54%). 61.53% of all patients came from Tricity agglomeration. Ethanol was the prevalent coingestant. The most commonly used substance was generic NPS (70.59% of cases), followed by unknowns psychoactive substance (16.29% of cases), herbal mixture (16.29% of cases) and dextrometorphan (5.88% of cases). The study did not find one drug name that would be prevalent over others, with the most frequent commercial name being "Mocarz", found in 4 cases. Most dangerous substances found in NPS were PMA, PMMA, 25C-NBOMe and 251-NBOMe. There were no deaths of patients treated in PCT because of acute intoxication with NPS.

The paper presents a case of acute, accidental sertindole poisoning. Intoxication had a stormy clinical course with symptoms of cardiovascular, respiratory and nervous system. A relatively small dose of ingested preparation and severe overdose course may indicate a low therapeutic drug index.

Unlabelled: In the last decade we have observed a considerable increase in nonmedical usage of dextromethorphan (DXM) among young age groups, especially school children between 13 and 16 yrs. We analysed the "trip reports" after use of DXM, available on a website: www.hyperreal.info in the years 1999-2013. The data collected by authors were analysed according to: age, sex, symptoms, dose of DXM, a reason and a place of using the drug. A review of 124 "trip reports" showed that the majority of their writers are male (M 90.3%, F 9.7%). Young people, aged 16-20 (80.4%), dominated among the study population. The most common place of using DXM was a flat of a drug user (70.2%), and the reason of using a willingness to experiment with new psychoactive substances (41.9%) as well as the desire of "get high" (25.8%). The majority of users used DXM at least once again in their lives (56.5%). A single dose of the ingested drug ranged from 120 mg to 1575 mg (mean 539.25 mg). Most often received doses were 450 mg (30.4%), 300 mg (12%), 900 mg (11.2%). DXM was positively assessed by the internauts as a recreational psychoactive substance (84.7%). The most common clinical symptoms described by internauts were: difficulties with walking (74.2%), visual illusions (73.4%), altered sense of time (41.9%), feeling of exteriorisation (35.5%), euphoria (33.1%), nausea and vomiting (32.3%), auditory illusions (30.6%) and pruritus (29.8%)., Conclusions: 1. DXM is the popular psychoactive substance which has gained a positive opinion among the Internet users. 2. Easy accessibility of DXM may pose a serious threat to health of young people who experiment with psychoactive substances. 3. The improvement of DXM sales control should be considered.

Unlabelled: Noni juice of an Indian mulberry fruit has recently become a very popular remedy for several diseases. The paper presents the case of hepatotoxic action of Noni juice in a previously healthy 55-years old female patient. After symptomatic therapy and cessation of exposure to the juice all symptoms dissapeared., Conclusions: 1. Indian mulberry formulations may, in some cases, lead to liver toxicity. 2. Treatment consists of cessation of exposure to preparations containing Indian mulberry fruits and a symptomatic therapy. 3 There is an urgent need to examine the therapeutic and toxic effects of commonly used herbal specifics.

We describe deployment of electronic toxicological information database in poison control center of Pomeranian Center of Toxicology. System was based on Google Apps technology, by Google Inc., using electronic, web-based forms and data tables. During first 6 months from system deployment, we used it to archive 1471 poisoning cases, prepare monthly poisoning reports and facilitate statistical analysis of data. Electronic database usage made Poison Center work much easier.

We present a case of acute nutmeg poisoning used for recreational purposes. Poisoning had a stormy clinical course with symptoms of gastrointestinal, cardiovascular and nervous system. The widespread availability of nutmeg suggests that real number of these poisonings may be underestimated in our country.

Metabolic acidosis (lactic and ketoacidosis) are frequent cause of sudden, unexplained deaths of alcohol abusers with negative results of pathomorphological and toxicological determinations. We described the pathomechanism leading to the acidosis.

There are numerous cases of acute intoxication with nicotine described in medical literature. The known routes of intoxication are transdermal, oral, inhalational, and intravenous. We presents a case of oral poisoning with nicotine from cartridges of e-cigaretes. According to the best of our knowledge this is first case of such poisoning in Poland. The intoxication had serious course, complicated with sudden cardiac arrest.

Paper presents proposal of guidelines concerning management of alcohol withdrawal syndromes. The paper is based on scientific medical societies standards, meta analyses and significant papers supporting some controversial questions. There are represented some practices used in intensive care units, that are not present in standards.

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.

Hydroxycarbamide (HCB), also known as hydroxyurea, is an urea derivative used mainly as antineoplastic and antisickling agent. We described a 31 yrs. female, with essential thrombocythemia, who was admitted to our clinic because of double suicidal ingestion of hydroxycarbamide. First time it was 7.5 g of HCB with coingestion of 50 mg of diazepam, and several glasses of wine, second time it was 10 g of HCB, with coingestion of 100 mg paroxetine and few glasses of vodka. Both suicidal attempts were triggered by multiple reactive factors. At the time of admissions the patient was conscious, restless, with decreased mood. Transient decrease of total leukocyte count was noted on fourth day of first overdose. The second overdose led to no significant changes in blood count. There were no other abnormalities in biochemical results. According to the best of our knowledge this is the first report of acute suicidal intoxication with hydroxy-carbamide in an adult.

Introduction: Despite the many side effects solutions of kitchen salt are still being used as efficient and safe homemade emetics., Case Reports: Saturated solutions of kitchen salt have been used by paramedics to provoke vomiting in two patients: a 50-years-old woman and a 44-years-old man. According to anamnesis patients received respectively around 330 and 500 g of dissolved kitchen salt. In both cases bloody emesis and bloody diarrhea, alteration of consciousness and low blood pressure were noted. Maximum blood sodium level was 177 and 173 mmol/l respectively. Due to signs of gastrointestinal bleeding gastric endoscopy was performed in both cases, which demonstrated widespread damage of gastric mucosa. Normalization of electrolyte disturbances and improvement of patients' status was achieved with intravenous infusion of 5% glucose. Both patients have been discharged to further outpatient treatment after 10-days hospitalization., Conclusions: 1. Use of salt kitchen solutions to induce emesis results in a high risk of life-threatening complications. 2. Particular emphasis must be put on training of paramedics in pre-hospital management of acute poisonings.

We present a case of psychosis caused by intake of clarithromycin in a young, healthy patient. Disturbance of consciousness occurred a few hours after the intake of the first dose and persisted for four days after drug discontinuation. Conducted numerous medical tests excluded other possible causes of psychotic disorders. The patient was observed in hospital, without using antipsychotic preparations up to the spontaneous resolution of the aforementioned disorders.

Eucalyptus oil (EO) intoxications are rare. We present a case of 58 yrs old chemist, who due to intense delusions consumed 4-5 drops of concentrated EO in order to self-medication of ascariasis. Despite the low dose of ingested xenobiotic the course of poisoning was severe. The intoxication was complicated with acute lung and heart injury, tachycardia and hypertension. Most of the clinical symptoms and biochemical abnormalities disappeared after the treatment.

Reactive oxygen species, which plays a role in pathogenesis of many neurodegenerative diseases, seems to be important also in pathogenesis of the Parkinson's disease. Experiments performed recently, revealed in the cerebrum of patients suffering from this disease (induced by the oxidative stress) elevated levels of 3,4-dihydroxyphenylacetaldehyde (DOPAL)--a strong endogenous neurotoxin to dopamine neurons.

We presented a case of sudden and painless vision impairment connected with the recreational usage of cocaine. According to many authors illicit use of cocaine has been associated with the most common adverse effect among all psychoactive drugs. In the last years there were a few articles about vision problems after the usage of cocaine. In most cases the main mechanism was central retinal artery occlusion (CRAO). The vision impairment developed from 3 to 10 hrs after the cocaine use and the outcome, despite the intensive treatment, was usually poor. All doctors should keep in mind the possibility of cocaine usage, in young and healthy people, who developed a sudden and painless vision loss.

Unlabelled: The aim of our study was to find out the relationship between the serum CBZ level and the clinical symptoms of acute intoxication. The research was conducted on 130 patients including 64 females and 66 males, aged from 14 to 59 years. We noted 65 cases of acute CBZ intoxication and 65 cases of mixed intoxications. In 115 patients the CBZ plasma level was higher than therapeutic range. Acute pulmonary failure was observed in 3 persons., Conclusions: 1. Positive correlation has been found at the serum CBZ concentrations and systolic blood pressure and pulse. 2. We failed to find any significant correlation between CBZ plasma level and the remaining parameters. 3. The heavier course of poisoning was not affirmed in the case of mixed intoxication in comparison to poisonings with only CBZ. 4. In persons treated with CBZ earlier, the course of poisoning was less severe.

The strong positive relationship between cholesterolaemia and ischaemic heart disease is unquestioned and comes from several lines of evidence. In this paper results of questionnaire studies concerning cholesterolemia performed among patients of the Cardiology Ward of a Regional Hospital in Wejherowo are presented.

Unlabelled: Problem of adulteration of herbal medicines with synthetic drugs is getting a common and dangerous phenomenon in Poland. The purpose of this study was the qualitative estimation of content of the Chinese herbal medicine for slimming "Meizitanc" as well as the estimation of hazard for human health and life. Twenty herbal packages which were secured by police in the 2006 year were investigated. The main ingredient of herbal medicine "Meizitanc" was sibutramine. The average mass of sibutramine hydrochloride in the "Meizitanc" capsule was about 10 mg. Additionally the trace amount of xylene and a starch were detected in the capsules. The presence of mentioned above substances were confirmed by different analytical methods like: gas chromatography with mass spectrometry GC/MS, thin layer chromatography TLC, high-pressure liquid chromatography HPLC/UV-DAD and infrared spectrometry IR. There were not determined any herbal-originated substances, which were mentioned on the packages. It was not found any pharmacologically active substance in one of the twenty examined packages., Conclusions: The medicine containing sibutramine should be used under the strict medical control. For safety of the patients all herbal products should be buy from authorized her

Fourteen patients were included to the albumin dialysis--MARS in the Clinic of Internal Medicine Geriatry and Clinical Toxicology in the years 2004-2006 because of acute intoxication with Amanita phalloides. The 26 procedures were done. Ten patients recovered, one was transplanted and three patients at the age from 68 to 79 (average 72.6) years died because of acute liver failure (21.4% cases). All deceased patients had significant higher plasma bilirubin level and INR in compare to other probants. The procedures of albumin dialysis caused significant lowering of blood glucose level, red blood cells and platelets, but without the need for intervention.

Unlabelled: The aim of our study was the evaluation of tobacco smoking among students of VI year of Medical University of Gdańsk. Anonymous questionnaire was done among one hundred and ten students including 70 women and 40 men in the age from 23 to 29 (24.82 +/- 1.03) years., Conclusions: 1. There were 12.7% of daily smoking students including 8.6% women and 15% men. 2. Almost 79% volunteers ineffectively attempted to give up smoking within last year. 3. The smoking students abused alcohol (with high likelihood) and used recreational drugs twice more than nonsmoking colleagues. 4. Almost all volunteers (96.4%) want to use smoking cessation intervention in their patients. 5. Above 75% students declared to broaden their knowledge about diagnostic and smoking cessation therapy.