OBJECTIVE: To provide references for forensic expertise by investigating the kinds of toxicant, routes of exposure and manners of poisoning deaths, etc. METHODS: Six hundred and seven autopsy cases of poisoning deaths from 1957 to 2008 in Department of Forensic Medicine, Tongji Medical College (Tongji Forensic Science Identification Center of Hubei), were comparatively reviewed. RESULTS: In 218 cases from 1999 to 2008, more than 50% of decedents were male in the ages of 30-49. The toxicants are usually taken orally and the most common manner of death was accidental. The common substances involved in poisoning death were rodenticide, poisoning gas and insecticide. Compared to the data of 1983-1998 and 1957-1982, the common toxic agents had changed significantly. The number of cases involving insecticide and cyanide poisoning decreased in recent years, and the number of cases of rodenticide, poisoning gas, alcohols poisoning displayed an increase tendency, especially for drugs abuse. CONCLUSION Poisoning deaths of pesticides remain a major public health problem for a long time and the awareness of prevention need to be raised, especially for the prevention of deaths from multiple poisons.
Accidents/statistics & numerical data* ; Adolescent ; Adult ; Age Distribution ; Aged ; Alcoholic Intoxication/epidemiology* ; Anesthetics/poisoning* ; Autopsy ; Carbon Monoxide Poisoning/epidemiology* ; Cause of Death ; Child ; Child, Preschool ; China/epidemiology* ; Female ; Forensic Medicine ; Heroin/poisoning* ; Humans ; Hypnotics and Sedatives/poisoning* ; Infant ; Male ; Middle Aged ; Pesticides/poisoning* ; Poisoning/etiology* ; Retrospective Studies ; Rodenticides/poisoning* ; Sex Distribution ; Suicide/statistics & numerical data* ; Young Adult

OBJECTIVE: To establish a gas chromatography-mass spectrometry (GC-MS) method for determination of propofol in human blood. METHODS: Propofol and 2-(tert-Butyl)-4,6-dimethylphenol (internal standard) were isolated from human blood samples with liquid-liquid ether extraction. The organic layer was collected after centrifugation and dried using the water bath. The extracted residue was analyzed by GC-MS. RESULTS: Propofol and the internal standard showed a good separation with a good linear concentration ranged from 0.02 to 10 microg/mL in blood. The linear function was y = 0.313 6 x-0.006 8 with the correlation coefficient of 0.9997. The precision of intra-day and inter-day were less than 4.8% and the lower limit of detection of propofol was 0.005 microg/mL. Propofol concentration of blood was 0.14 microg/mL using this method in the practice work. CONCLUSION The GC-MS method is rapid, sensitive, reliable and suitable for qualitative and quantitative analysis propofol of blood in forensic toxicological analysis and clinical drug monitoring.
Anesthetics, Intravenous/poisoning* ; Drug Monitoring/methods* ; Forensic Toxicology/methods* ; Gas Chromatography-Mass Spectrometry/methods* ; Humans ; Male ; Molecular Structure ; Propofol/poisoning* ; Reproducibility of Results ; Sensitivity and Specificity

PURPOSE: The purpose of this study was to evaluate the usefulness of intravenous lipid emulsion as well as adverse events in acute poisoning patients. METHODS: Literature was accessed through PubMed, EMBASE, Cochrane library, Web of science, and KoreaMed. All forms of literatures relevant to human use of intravenous lipid emulsion for acute poisoning were included. Cases reports or letters without description of clinical outcomes for each case were excluded. The literature search was conducted by two investigators in March, 2015, with publication language restricted to English and Korean. The effect, onset time, and adverse event of lipid emulsion and final outcome of each case were analyzed. RESULTS: Eighty-one published articles were included, excluding articles whose title and abstract were not relevant to this study. No articles were classified as high level of evidence. Sixty-eight case reports were identified, consisting of 25 local anesthetics and 43 other drugs, such as tricyclic antidepressants and calcium channel blockers. Although most cases described significant clinical improvements, some of them showed no beneficial effect or worsening of clinical course. Several adverse events including hyperamylasemia and laboratory interference were reported. CONCLUSION: Although there were many case reports illustrating successful use of lipid for various drug poisonings, the effect cannot be estimated due to significant possibility of publication bias. Therefore, lipids might be considered in severe hemodynamic instability resulting from lipophilic drug poisoning, however further studies should follow to establish the use of lipid as the standard of care.
Anesthetics, Local ; Antidepressive Agents, Tricyclic ; Calcium Channel Blockers ; Drug Overdose ; Fat Emulsions, Intravenous ; Hemodynamics ; Humans ; Hyperamylasemia ; Lipid A ; Poisoning* ; Publication Bias ; Publications ; Research Personnel ; Standard of Care