Adult ; Humans ; Male ; Nitrogen Oxides ; poisoning ; Occupational Exposure

Humans ; Nitrogen Oxides ; poisoning ; Pulmonary Edema ; chemically induced

A 27-yr-old postgraduate student was found lying at the floor of an unsealed underground dry area, where a valve-opened empty cylinder of liquid nitrogen (150 L) was connected to a cap-removed empty Dewar-flask (10 L) via a copper infusion tube. No injury was found externally or internally. There were petechiae in the bilateral conjunctivae and periorbital skin. The dry area, measuring 300X130X260 cm, had a communication to the basement of the research building by a window measuring 90X60 cm in size at 130 cm above the floor. The scene reconstruction and atmosphere gas analysis revealed that the O2 concentration at 60 cm above the base dropped to 12.0% in 3 min and 10 sec, 10.0% in 8 min and 53 sec, 6.0% in 18 min and 40 sec, and 4.2% in 20 min and 28 sec. The primary cause of death was asphyxia by evaporated liquid nitrogen..
*Accidents, Occupational ; Adult ; Asphyxia/*chemically induced ; Cause of Death ; Humans ; Male ; Nitrogen/*poisoning

Accidents, Occupational ; Adult ; Female ; Humans ; Male ; Nitrogen Mustard Compounds ; poisoning ; Occupational Exposure ; adverse effects

Although the most of mushroom poisoning have a clinical menifestation of mild to moderate gastroenteritis, some mushroom may cause a serious illness; acute renal failure, hepatic necrosis. We experienced two cases of acute renal failure complicated by the poisoning of amanita virosa. Amanita virosa have a amatoxin. Amatoxin deteriorate hepatocytes, renal tubular cells, intestinal mucosal cells, and pancreas. They were transferred from local hospital for renal failure management. On admission, blood urea nitrogen and serum creatinine were highly elevated. We diagnosed acute renal failure complicated by poisoning of amanita virosa. In one case, renal function was further deteriorated compared with initial laboratory findings after creatinine was normalized at fifth day. Thus, we did a kidney biopsy. Light microscopy and EM showed interstitial inflammation and moderate tubular atrophy. They were recovered with the supportive management. We report two cases of mushroom poisoning-induced acute renal failure with review of literature.
Acute Kidney Injury* ; Agaricales ; Amanita* ; Atrophy ; Biopsy ; Blood Urea Nitrogen ; Creatinine ; Gastroenteritis ; Hepatocytes ; Inflammation ; Kidney ; Microscopy ; Mushroom Poisoning ; Necrosis ; Pancreas ; Poisoning* ; Renal Insufficiency

OBJECTIVETo explore the clinical efficacy of early application of sequential gastrointestinal lavage in patients with acute paraquat poisoning by analyzing the clinical data of 97 patients.

METHODSA total of 97 eligible patients with acute paraquat poisoning were divided into conventional treatment group (n = 48) and sequential treatment group (n = 49). The conventional treatment group received routine gastric lavage with water. Then 30 g of montmorillonite powder, 30 g of activated charcoal, and mannitol were given to remove intestinal toxins once a day for five days. The sequential treatment group received 60 g of montmorillonite powder for oral administration, followed by small-volume low-pressure manual gastric lavage with 2.5%bicarbonate liquid. Then 30 g of activated charcoal, 30 g of montmorillonite powder, and polyethylene glycol electrolyte lavage solution were given one after another for gastrointestinal lavage once a day for five days. Both groups received large doses of corticosteroids, blood perfusion, and anti-oxidation treatment. The levels of serum potassium, serum amylase (AMY) alanine aminotransferase (ALT), total bilirubin (TBIL), blood urea nitrogen (BUN), creatinine (Cr), lactate (Lac), and PaO₂of patients were determined at 1, 3, 5, 7, and 10 days. Laxative time, mortality, and survival time of dead cases were evaluated in the two groups.

RESULTSThe incidence rates of hypokalemia (<3.5 mmol/L) and AMY (>110 U/L) were significantly lower in the sequential treatment group than in the conventional treatment group (P < 0.05). There were no significant differences in the incidence of ALT (>80 U/L), TBIL (>34.2 µmol/L), BUN (>7.2 mmol/L), and Cr (>177 µmol/L) between the two groups (P>0.05). However, the highest levels of ALT, TBIL, BUN, Cr, and Lac were significantly lower in the sequential treatment group than in the conventional treatment group (P < 0.05). Moreover, the sequential treatment group had significantly lower incidence of PaO₂(<60 mmHg), shorter average laxative time, lower mortality, and longer survival time of dead cases than the conventional treatment group (P < 0.05).

CONCLUSIONThe early application of sequential gastrointestinal lavage can shorten laxative time, alleviate organ damage in the liver, kidney, lung, and pancreas, reduce mortality, and prolong the survival time of dead cases in patients with acute paraquat poisoning.

Acute Disease ; Bentonite ; administration & dosage ; Bilirubin ; Blood Urea Nitrogen ; Charcoal ; Combined Modality Therapy ; Creatinine ; Gastric Lavage ; methods ; Humans ; Liver ; Paraquat ; poisoning ; Poisoning ; therapy ; Treatment Outcome

This study was to investigate the effect of lead on the selected clinical renal function in female lead workers. The 123 female lead workers from 9 lead industry and 177 females who were not occupationally exposed were examined. Females who had history of renal disease or oral medication were excluded. Blood lead, zinc protoporhphyrin in blood, delta-aminolevulinic acid and haemoglobin were examined as of lead exposure indices and blood urea nitrogen, serum creatinine, serum uric acid and urine protein were examined as of renal function indices. Mean concentration of lead were 40.7(+/-13.02)ug/dl for lead workers and 10.7(+/-3.56)ug/dl for non-lead workers. Differences between lead workers and non-lead workers in blood lead, zinc protoporhphyrin in blood and delta-aminoleuvulinic acid were statistically significant. There were significant differences between lead workers and non-lead workers in blood urea nitrogen, serum creatinine, serum uric acid except urine protein but their mean concentrations were all within normal limits. Serum creatinine and urine protein were not increasing according to the increasing blood lead. When cut off points of 20mg/dl in blood urea nitrogen, 1.2mg/dl in serum creatine, 7.0mg/dl in serum uric acid, 8.0mg/dl in urine protein and 40ug/dl in blood lead, 100ug/dl in zinc-protoporhphyrin in blood, 7.0mg/l in delta-aminoleuvulinic acid were accepted, comparison between frequencies of blood urea nitrogen, serum creatine, serum uric acid, urin protein by the level of blood lead, zinc-protoporhphyrin in blood and delta-aminoleuvulinic acid respectively was not statistically different. There were no dose-repsonse relationships in risk ratios by the level of blood lead and zinc-protoporphyrin in blood respectively. In summary, there were no significant effect of lead on the selected clinical renal function among the female lead workers at level of blood lead 40ug/dl that is the permissible level of lead poisoning in Korea.
Aminolevulinic Acid ; Blood Urea Nitrogen ; Creatine ; Creatinine ; Female* ; Humans ; Korea ; Lead Poisoning ; Occupations* ; Odds Ratio ; Uric Acid ; Zinc

Nitrogen is an inert gas that is harmless to humans under normal conditions. While it is not inherently toxic, nitrogen gas becomes dangerous when it displaces oxygen, resulting in suffocation. Herein, we report a case of a 34-year-old man who attempted suicide by nitrogen asphyxiation who presenting with decreased mental function and agitation. Lactic acidosis and hyperammonemia were observed on presentation at the emergency department, but these improved after a few hours. After 2 days, the patient regained full consciousness, and was discharged without any complications. Survival after asphyxiation due to nitrogen gas is very rare, and these patients are more likely to have poorer outcomes. There is a potential for the increasing use of nitrogen gas as a method of committing suicide because of the ease of access to this gas.
Acidosis, Lactic ; Adult ; Asphyxia ; Consciousness ; Dihydroergotamine ; Emergency Service, Hospital ; Gas Poisoning ; Humans ; Hyperammonemia ; Methods ; Nitrogen* ; Oxygen ; Suicide ; Suicide, Attempted*

OBJECTIVETo investigate the clinical significance of dynamic changes of blood urea nitrogen (BUN), serum creatinine (Cr), serum cystatin (Cys C) and urinary protein on renal injury with paraquat poisoning.

METHODSAccording to the clinical manifestation and curative effect, the clinical information was analyzed retrospectively in 35 cases of acute paraquat poisoning, survival after eight weeks as the standard. Poisoning patients were taken a fasting blood 5 ml and the middle of urinary on the 1st day, 3rd day, 7th day, 14th day, 21st day and 8 weeks after the poisoning. Then the levels of serum BUN, Cr, Cys C and urinary protein were detected by automatic biochemistry analyzer. 30 cases healthy subjects were randomly selected as normal control group, and discharged kidney disease and other diseases of urinary system history. The same laboratory subjects have been done.

RESULTSThe level of serum Bun, Cr, Cys C of survival group increased significantly compared with control group within 21 days (P < 0.05). The level of serum BUN, Cr Cys C decreased on the 14th day. The decreased level of serum Cys C was lower than that of serum BUN and Cr. The renal function of 29 cases among 35 cases survival patients recovered on 21st day. The renal function of 31 cases among 35 cases survival patients recovered 8 weeks late. The positive rate of urinary protein of survival patients was high in the early intoxication (76.9%).

CONCLUSIONSerum Cys C is sensitive indicator to reveal the kidney injury on paraquat poisoning patients and have higher value of clinical applications in the diagnosis of the kidney injury of paraquat poisoning, which sensitivity is higher than serum BUN and Cr. The kidney injury caused by paraquat poisoning is reversible.

Acute Kidney Injury ; blood ; chemically induced ; Adolescent ; Adult ; Blood Urea Nitrogen ; Case-Control Studies ; Creatinine ; blood ; Cystatin C ; blood ; Female ; Humans ; Male ; Middle Aged ; Paraquat ; poisoning ; Young Adult

OBJECTIVEIn China, with the development of public health and medical treatment, accident became the first cause of death of children aged form 1 to 14 years, and poisoning became one of the main causes. The present study was conducted to investigate the efficacy of hemoperfusion (HP) on poisoning, and the pharmacokinetics of the poison during and after HP. The study was also to observe the effect of HP on blood cell and blood biochemistry, blood flow and dosage of heparin during HP in children.

METHODSThirty-five children with acute poisoning (including 26 boys and 9 girls aged from 10 months to 13 years, mean 3.35 +/- 2.50 years) were treated with HP for one to three times. Among them 12 children were treated with HP for two times and 4 children for three times. Two ml blood samples of 6 children with Fluoroacetamide (FAM) poisoning and 10 children with Tetramine (TET) poisoning were collected. The concentration of poison was measured by gas chromatography (GC).

RESULTSThe poisoning symptoms of all cases were relieved or alleviated obviously. In the end, 27 (77%) cases recovered and 6 (17%) cases improved, while 2 (6%) cases died of multi-organ failure (MOF). Clinical symptom happened again 6 - 24 hours after HP in 1 case with FAM poisoning and 3 cases with TET whose clinical symptoms were relieved during HP. The PLT, RBC counts and Hb decreased significantly after HP compared with pre-HP (P < 0.05), while WBC, alanine aminotransferase (ALT), aspartate aminotransferase (AST), reatine kinase (CK), blood urea nitrogen (BUN), creatinine (CRE), Creatine kinase isoenzymes (CK-MB), total protein (TP), albumin (ALB) and globulim (GLO) after HP did not significantly change (P > 0.05). The FAM concentration was significantly reduced (P < 0.030). The concentration of TET in the poisoned children also significantly decreased with the treatment (P = 0.001). The cleaning efficacy of HP was higher during the first hour than that during the second hour of HP. The concentration of poison rose again 2 - 6 hours after HP in 1 case with FAM poisoning and 3 cases with TET poisoning, but the level was lower compared with pre-HP level. The t(1/2) of FAM and TET with and without HP was (2.40 +/- 0.66) h, (15.60 +/- 8.22) h, (4.10 +/- 1.66) h and (67.01 +/- 48.42) h, respectively. The first dose of heparin was (0.54 +/- 0.15) mg/kg; then (0.20 +/- 0.06) mg/kg was added for every 30 minutes. The velocity of blood flow was (4.39 +/- 0.99) ml/min.

CONCLUSIONSThe t(1/2) of the poison was shortened, and the poison clearing was accelerated by HP. The HP is a safe and effective therapy in children. The concentration of poison in some patient may rise again 2 to 6 hours after HP temporarily. The charcoal HP cannot remove the poison that conjugated with plasma albumin and globulin. The charcoal HP can cause temporary reduction of platelet and erythrocyte. The dosage of heparin used in children was lower than that in adult.

Blood Urea Nitrogen ; Charcoal ; therapeutic use ; Child, Preschool ; China ; Creatinine ; blood ; Female ; Hemoperfusion ; methods ; Humans ; Infant ; Male ; Multiple Organ Failure ; blood ; therapy ; Neonatology ; Poisoning ; blood ; therapy