Poisoning

This study aimed to determine the epidemiological differences between children and adult oral exposures in patients admitted to the busiest emergency department (ED) in the Eastern Anatolia region of Turkey.
METHODS:
The characteristics of 1950 patients were investigated retrospectively and in a cross-sectional manner in a two-year period.
RESULTS:
The ratio of poisoning exposures among all emergency admissions was 0.6%. Of these, 44.5% were children, and 54.4% were unintentional. The mortality rate was 0.1% and the rate of hospitalization was 14.9%. Among the children and adults, 50.3% and 29.5% were male, respectively. While the first two causes of exposures in both children and adults were licit drugs and foods, there were differences in other causes. Among causes, licit drugs and corrosive materials constituted the forefront in the 0-1 and 1-5-year age groups. In parasuicidal causes, the most common exposure was found to be licit drugs, followed by organophosphates. The most common cause of hospitalization was plants (60.5%). The hospitalization rate was found to be significantly high in males and unintentional exposures. The rate of admissions to the psychiatry polyclinic following exposure was 15%.
CONCLUSION:
This study hereby presents the original findings as to predict the problems in exposures. The distribution of etiological agents and suicidal intent rate may differ among pediatric and adult population (Tab. 4, Fig. 1, Ref. 50).

Techniques of molecular biology have improved diagnostic sensitivity, accuracy and validity in forensic medicine very much, especially in the field of identification (paternity testing, stain analysis). Since more than 10 years these techniques -meanwhile well established in clinical disciplines -are used also for other applications in forensic medicine: determination of cause and manner of death, tissue identification by mRNA and microRNA, examination of gene expression levels (survival time, time since death, cause of death), toxicogenetics.

Background: Platelet count is a readily available biomarker predicting disease severity and
risk of mortality in the intensive care units (ICU). This study aims to describe the frequency, to
assess the risk factors, and to evaluate the impact of thrombocytopenia on patient outcomes in
a Toxicological ICU (TICU).
Methods: In this prospective observational Cohort study, we enrolled 184 patients admitted
to our TICU from October 1st, 2019, to August 23rd, 2020. Mild/moderate and severe
thrombocytopenia were defined as at least one platelet counts less than 150×103/μL and
50×103/μL during the ICU stay, respectively.
Results: Of 184 enrolled patients, 45.7% had mild to moderate thrombocytopenia and 5.4%
had severe thrombocytopenia. Old age (OR: 1.042, 95%CI: 1.01-1.075, P=0.01), male
gender (OR: 4.348, 95%CI: 1.33-14.22, P=0.015), increased international normalized ratio
(INR) levels (OR: 3.72, 95%CI: 1.15-112, P=0.028), and administration of some medications
including heparin (OR: 3.553, 95%CI: 1.11-11.36, P=0.033), antihypertensive drugs (OR:
2.841, 95%CI: 1.081-7.471, P=0.034), linezolid (OR: 13.46, 95%CI: 4.75-38.13, P<0.001),
erythromycin (OR: 19.58, 95%CI: 3.23-118.86, P=0.001), and colistin (OR: 10.29, 95%
CI 1.44-73.69, P=0.02) were the risk factors of hospital-acquired thrombocytopenia. The
outcomes of patients with normal platelet count were significantly better than those who
developed thrombocytopenia (P<0.001).
Conclusion: We found that thrombocytopenia could develop in almost 50% of patients
admitted to TICU, which is associated with poor prognosis. Additionally, the platelet counts
should be closely monitored to administer some medications (heparin, antihypertensive drug,
and linezolid), especially in old patients.

Poisoning in children is a common accident and poison information services should be aware of the toxic agents responsible for poisoning in the community. A retrospective hospital based study was performed, before-the establishment of the National Poisons Information Centre in Sri Lanka. There were 4,556 admissions of poisoning to the selected hospitals in the Western Province in 1986 and of this, 540 (11.4%) were below 15 years. Males accounted for 66%. Kerosene oil was responsible for 47% of the poisoning cases in less than 5 years age group, while kerosene oil, pesticides and plants/mushrooms were the commonest toxic agents in the 5 to 14 years age group. The case fatality rate was 3.2%.

Background: Between 1955 and 2011 there were marked fluctuations in suicide rates in Sri Lanka; incidence increased six-fold between 1955 and the 1980s, and halved in the early 21st century. Changes in access to highly toxic pesticides are thought to have influenced this pattern. This study investigates variation in suicide rates across Sri Lanka's 25 districts between 1955 and 2011. We hypothesised that changes in the incidence of suicide would be most marked in rural areas due to the variation in availability of highly toxic pesticides in these locations during this time period. Methods: We mapped district-level suicide rates in 1955, 1972, 1980 and 2011. These periods preceded, included and postdated the rapid rise in Sri Lanka's suicide rates. We investigated the associations between district-level variations in suicide rates and census-derived measures of rurality (population density), unemployment, migration and ethnicity using Spearman's rank correlation and negative binomial models. Results: The rise and fall in suicide rates was concentrated in more rural areas. In 1980, when suicide rates were at their highest, population density was inversely associated with area variation in suicide rates (r = −0.65; p < 0.001), i.e. incidence was highest in rural areas. In contrast the association was weakest in 1950, prior to the rise in pesticide suicides (r = −0.10; p = 0.697). There was no strong evidence that levels of migration or ethnicity were associated with area variations in suicide rates. The relative rates of suicide in the most rural compared to the most urban districts before (1955), during (1980) and after (2011) the rise in highly toxic pesticide availability were 1.1 (95% CI 0.5 to 2.4), 3.7 (2.0 to 6.9) and 2.1 (1.6 to 2.7) respectively. Conclusions: The findings provide some support for the hypothesis that changes in access to pesticides contributed to the marked fluctuations in Sri Lanka's suicide rate, but the impact of other factors cannot be ruled out.

Heavy metals can accumulate in organisms via various pathways, including respiration, adsorption and ingestion. They are known to generate free radicals and induce oxidative and/or nitrosative stress with depletion of anti-oxidants. Tuna by-product meal (TBM) is rich in proteins and can, therefore, offer an attractive protein source for animals. This study was undertaken to assess the effects of metals present in TBM, namely cadmium (Cd), lead (Pb), and mercury (Hg), separately or in combination with oxidative stress, on cell viability. Three cell models: rat liver FTO2B, human hepatoma HepG2, and human hepatic WRL-68, were used. Cell viability was determined following exposure to various concentrations of the metals. Two antioxidant genes, catalase (CAT) and superoxide dismutase (SOD), were measured to obtain a better understanding of oxidative stress-associated gene expression. Among the metals present in TBM, only Cd at a concentration of 30 M was noted to exhibit cytotoxic effects. This cytotoxicity was even more pronounced after co-stimulation with H 2 O 2 , used to mimic systemic oxidative stress. At non-toxic concentrations, Hg and Pb were noted to aggravate oxidative stress toxicity. The results further revealed that exposure to Cd, Pb, and a co-stimulation of H 2 O 2 with Hg resulted in the increased expression of antioxidant gene SOD. A risk assessment of toxic contaminants in TBM indicated that food safety objectives should consider the human health impacts of foods derived from animals fed on contaminated meal and that much care should be taken when TBM is used in animal diet.

Clinicians in the emergency department are often confronted with coma patients due to poisoning. A systematic general approach involving early consultation with a neurologist is of paramount importance. A high index of suspicion, a systematic first assessment already in the prehospital phase and early stabilisation of vital functions are the essential first steps. Specific antidotes like hypertonic glucose and thiamine are part of a "coma cocktail". The opiate antagonist naloxone should be used only

Four strains of Butyrivibrio fibrisolvens, transformed with a gene encoding fluoroacetate dehalogenase, maintained a combined population of 10 6 to 10 7 cells ml ؊1 in the rumens of test sheep. Five inoculated sheep showed markedly reduced toxicological symptoms after fluoroacetate poisoning when behavioral, physiological, and histological effects were compared with those of five uninoculated control sheep.

The case of a patient w~th apparent cocaine toxicity and drug-mediated hypertension and tachycardia is presented. IV propranolol was used as the initial treatment for his hyperadrenergic state, resulting in a decrease in heart rate but a paroxsymaI increase in blood pressure. The patient required nitroprusside for control of elevated blood pressure. A mechanism of unopposed alpha stimulation as a result of beta-2 receptor blockade is proposed, and a cautious approach to the use of propranoloI in these patients is suggested.

Hay en la Unión Europea, según los datos oficiales (nada aireados), muchos miles de muertos y muchos centenares de miles de enfermos por efectos negativos de las vacunas "de nueva tecnología" contra el Covid-19. No esperen oír esto en la tele ni leerlo en el periódico.

The etiologic agent(s) that was responsible for the 1981 toxic oil syndrome [TOS] epidemic in Spain has not been identified. Liquid chromatography combined with atmospheric pressure ionization tandem mass spectrometry was used for the analysis of oils associated with TOS. Analyses focused on measuring 3-(N-phenylamino)-l,2-propanediol [PAP], the 3-oleyl ester of PAP [MEPAP], and the 1,2-di-oleyl ester of PAP [DEPAP]. DEPAP and MEPAP were found more frequently and at higher concentrations in TOS case-associated oils than in control oils with odds ratios of 13.7 (95% CI 5.0-38) and 21.9 (95% 6.1-78), respectively. Other fatty acid esters of PAP are also likely to be present in the TOS caseassociated oils. More significantly, DEPAP and MEPAP were found in aniline-denatured rapeseed oil refined at ITH, the oil refining company with the clearest link to TOS cases, yet these PAP esters were not detected in unrefined aniline-denatured samples of rapeseed oil delivered to ITH. These results show that the esters of PAP were products of the ITH refining process and were not formed spontaneously during storage. PAP esters were not detected in samples of other aniline-denatured rapeseed oils that were refined elsewhere, and which were not associated with illness. These findings provide strong support for the hypothesis that one or more of the fatty acid esters of PAP were the etiologic agents for TOS.

Sulfur mustard (SM) is a strong vesicant agent which has been used in several military conflicts. Large stockpiles still exist to the present day. SM is believed to be a major threat to civilian populations because of the persistent asymmetric threat by non-state actors, such as terrorist groups, its easy synthesis and handling and the risk of theft from stockpiles. Following an asymptomatic interval of several hours, acute SM exposure produces subepidermal skin blisters, respiratory tract damage, eye lesions and bone marrow depression.

The aim of this prospective study was to analyze the rate and characteristics of acute poisoning cases admitted to adult intensive care unit (ICU). All cases of acute poisoning admitted to ICU of the Harran University Hospital, Turkey, between July 2002 and May 2005, were included in this study. Clinical, laboratory, and demographic characteristics, type of poison and patient&#39;s outcomes were recorded. There were 86 poisoning cases among 844 patients admitted to the ICU. The mean age was 26 +/- 9 years and the majority of the patients (56.9%) were 15-24 years of ages. Eighty percent of acute poisonings were self-inflicted and 65.2% of these patients were singles. Medical drugs overdose were the major cause (51.2%) of intoxication followed by agricultural chemicals (37.2%). The most frequently involved medicinal drugs were benzodiazepines, antidepressants and analgesics. Eleven patients in pesticides-rodenticides and 9 patients in other medical drugs poisoning have required mechan...

Extracorporeal treatments (ECTRs) such as hemodialysis (HD), enhance the elimination of a small number of toxins. Changes in overdose trends, prescribing practices, antidotes, and dialysis techniques may alter the indications and rates of ECTR use over time. This study analyzed trends in ECTR for poisonings in four countries. A retrospective study of national poison center databases from the United States, Denmark, United Kingdom, and five regional databases within Canada was performed. All cases of patients receiving an ECTR were included. ECTR cases were totalled annually and reported as annual rates per 100,000 exposures with stratification per types of ECTR and toxins. The data collection varied by countries.

Chloroquine diphosphate is easily absorbed from the small intestine and peak serum levels are reached within hours. The initial half-life is 3-5 days, but chloroquine can be detected in the urine several months after cessation of therapy.' After 4 weeks of prophylaxis no further substantial increase of serum levels is achieved.2-4 Side-effects are dose-related, being more common when a serum level of 0.9 umol/1 is exceeded3 while concentrations below 0-05 ;mol/1 are not reliably protective.4 We found that serum levels after 8 months of 600 mg base a week exceeded, 0.9 9 V-mol/l 24 h after medication. Concentrations after six weeks and one year of 300 mg base a week are well above 0-05 mol/1, while a single dose of 300 mg base will not give full protection. In another study we found that twen-CHLOROQUINE CONCENTRATION IN SERUM AFTER DIFFERENT

Drawing from the general description that ethnopharmacology studies the human use of crude drugs and poisons in a traditional context, ethnopharmacological themes in native art can be defined as themes visualizing different features of traditional medicines and poisons, such as natural sources, methods of preparation, containers, usage and implements, target diseases and effects. This review documents that native African art objects and utensils are a goldmine of such ethnopharmacological themes by focusing on the following subjects: (a) objects related to the use of medicines (sources as well as tools for their collection, preparation and keeping); (b) objects related to the use of poisons (e.g. for ordeals, hunting and fishing); (c) objects related to the use of psychotropic agents (e.g. alcoholic beverages, kola nuts, smoking and snuffing materials); (d) pathological representations (e.g. treponematoses, leprosy, smallpox, swollen abdomen, scrotal enlargement, goiter and distorted faces); and (e) portrayals of certain types of treatment (e.g. topical instillations, perinatal care, and surgery). To avoid the impression that ethnopharmacology has little else to offer than armchair amusement, an epilogue outlines the medical relevance of this interdisciplinary science for Western and African societies.

Patients who are intoxicated with amphetamines frequently present to EDs. We have undertaken a review to determine the relative frequency of symptoms in these patients as well as the number and types of patients who required treatment or admission to the hospital.

Poison, Detection, and the Victorian Imagination-New England. In Poison, Detection and the Victorian Imagination, Ian Burney reconstructs the public, legal, and scientific cultures of poison, highlighting their distinctive. Poison, detection, and the Victorian imagination-Ian A. Burney 'Poison, Detection, and the Victorian Imagination' Asks.-PopMatters Poison, detection and the Victorian imagination Encounters MUP. Poison-it's hardly a new concept. Even in the Victorian era, it wasn't new. From Socrates to Shakespeare, by the time Queen Victoria took the throne, poison Poison, Detection and the Victorian Imagination-Goodreads Poison, detection and the Victorian imagination. Ian Burney. Published by Manchester University Press. Encounters MUP. Looks at the phenomenon of murder Review of Our Precarious Habitat-Yale School of Forestry. Aug 30, 2012. Poison-it's hardly a new concept. Even in the Victorian era, it wasn't new. From Socrates to Shakespeare, by the time Queen Victoria took the Poison, Detection and the Victorian Imagination review This fascinating book looks at the phenomenon of murder and poisoning in the nineteenth century. Focusing on the case of William Palmer, a medical doctor Poison, detection and the Victorian imagination Encounters MUP: 9780719073762: Medicine & Health Science Books @ Amazon.com. 'Poison, Detection, and the Victorian Imagination' Asks, Is Poison the. ABSTRACT This relatively brief book provides a carefully researched and well-written history of the development of the field of toxicology in Britain in the. Poison, Detection and the Victorian Imagination: Ian A. Burney Poison and the Victorian Imagination. an acquaintance, threw up deep-rooted anxieties about poison, detection, and professionalism in Victorian society.

Vultures are nature's most successful scavengers, and they provide an array of ecological, economic, and cultural services. As the only known obligate scavengers, vultures are uniquely adapted to a scavenging lifestyle. Vultures' unique adaptations include soaring flight, keen eyesight, and extremely low pH levels in their stomachs. Presently, 14 of 23 (61%) vulture species worldwide are threatened with extinction, and the most rapid declines have occurred in the vulture-rich regions of Asia and Africa. The reasons for the population declines are varied, but poisoning or human persecution, or both, feature in the list of nearly every declining species. Deliberate poisoning of carnivores is likely the most widespread cause of vulture poisoning. In Asia, Gyps vultures have declined by >95% due to poisoning by the veterinary drug diclofenac, which was banned by regional governments in 2006. Human persecution of vultures has occurred for centuries, and shooting and deliberate poisoning are the most widely practiced activities. Ecological consequences of vulture declines include changes in community composition of scavengers at carcasses and an increased potential for disease transmission between mammalian scavengers at carcasses. There have been cultural and economic costs of vulture declines as well, particularly in Asia. In the wake of catastrophic vulture declines in Asia, regional governments, the international scientific and donor communities, and the media have given the crisis substantial attention. Even though the Asian vulture crisis focused attention on the plight of vultures worldwide, the situation for African vultures has received relatively little attention especially given the similar levels of population decline. While the Asian crisis has been largely linked to poisoning by diclofenac, vulture population declines in Africa have numerous causes, which have made conserving existing populations more difficult. And in Africa there has been little government support to conserve vultures despite mounting evidence of the major threats. In other regions with successful vulture conservation programs, a common theme is a huge investment of financial resources and highly skilled personnel, as well as political will and community support.

A 25-year-old female died from a suicidal overdose of Imlpramlne, acetaminophen, codeine, dlphenhydramine, and ethanol. Blood samples from ten segregated arterial and venous sites, twenty-four tissue samples, cerebrospinal fluid, vitreous humor, and bile were analyzed. Imipramine and desipramine, which were highly concentrated in the liver and lungs, each showed marked site dependent differences in blood concentrations. The highest concentrations were in pulmonary venous blood and the lowest in peripheral venous blood. Imipramine concentrations in the ten blood samples differed by as much as 760% (range 2.1 to 16.0 mg/L). Blood desipramlne concentrations ranged from 1.4 to 10.6 mg/L. In contrast, blood concentrations of acetaminophen differed by less than 20% (55 to 65 mg/L) and blood ethanol concentrations ranged from 151 to 175 mg/100 mL. Blood concentrations of diphenhydramine ranged from 0.34 to 2.07 mg/L and codeine from 0.33 to 0.89 mg/L. The data illustrates that a marked site dependent variability in postmortem blood concentrations exists for some drugs but not others.

The lack of a reference Veterinary Poison Control Centre for the European Union (EU) means that clinicians find it difficult to obtain information on poisoning episodes. This three-part review collates published and unpublished data obtained from Belgium, France, Greece, Italy and Spain over the last decade in order to provide a broader toxicoepidemiological perspective. The first article critically evaluates the national situation in the five European countries and concludes that information for livestock and poultry is limited and fragmentary compared to other animal groups. The analysis has revealed that clinical cases of poisoning are only occasionally studied in depth and that cattle are the species most frequently reported. Several plants and mycotoxins, a few pesticides and metals, together with contaminants of industrial origin, such as dioxins, are responsible for most of the recorded cases.

Para-methoxyamphetamine (PMA) is a substituted synthetic amphetamine used in the recreational drug scene. It is unusual because of the high incidence of significant morbidity and mortality in overdose. We report a case of PMA overdose in South Australia, and review our experience with the drug. We review the literature on PMA overdose and offer suggestions on the management of overdose with this dangerous drug.

Organophosphorus pesticide self-poisoning is an important clinical problem in rural regions of the developing world, and kills an estimated 200 000 people every year. Unintentional poisoning kills far fewer people but is a problem in places where highly toxic organophosphorus pesticides are available. Medical management is difficult, with case fatality generally more than 15%. We describe the limited evidence that can guide therapy and the factors that should be considered when designing further clinical studies. 50 years after first use, we still do not know how the core treatmentsatropine, oximes, and diazepam-should best be given. Important constraints in the collection of useful data have included the late recognition of great variability in activity and action of the individual pesticides, and the care needed cholinesterase assays for results to be comparable between studies. However, consensus suggests that early resuscitation with atropine, oxygen, respiratory support, and fluids is needed to improve oxygen delivery to tissues. The role of oximes is not completely clear; they might benefit only patients poisoned by specific pesticides or patients with moderate poisoning. Small studies suggest benefit from new treatments such as magnesium sulphate, but much larger trials are needed. Gastric lavage could have a role but should only be undertaken once the patient is stable. Randomised controlled trials are underway in rural Asia to assess the effectiveness of these therapies. However, some organophosphorus pesticides might prove very difficult to treat with current therapies, such that bans on particular pesticides could be the only method to substantially reduce the case fatality after poisoning. Improved medical management of organophosphorus poisoning should result in a reduction in worldwide deaths from suicide.

Although the three most commonly used large mammal species in the safety assessment of drugs remain the dog, the macaque and the marmoset, swine, especially minipigs, have also been widely used over the years in many toxicological studies. Swine present a number of interesting biological and physiological characteristics. Similarities in skin properties with humans have led to extensive in vitro and in vivo studies. There is a specific interest in cardiovascular research, as well as in anaesthesiology and critical care medicine due to common features of swine and human physiology. Although knowledge of swine brain structure and functions remains incomplete, data does exist. The multiple blood sampling that is necessary in pharmacokinetic and toxicokinetic studies are possible, as well as multiparametric monitoring and interventions with equipment used in human clinical settings. Practicality (handling), scientific (stress reduction) and ethical (invasive monitoring) reasons have led research teams to incorporate anaesthesia into their paradigms which makes the analysis of data increasingly difficult. Although not substantiated by scientific data, the swine appears to have an intermediate position in the scale of public perception between non-human primates and animals commonly referred to as pets (i.e. dogs and cats) and rodents. The benefits of the swine model justify the use of these animals in the design of more effective medical countermeasures against known chemical warfare agents (nerve agents, vesicants and lung damaging agents). Exposure to organophosphorus (OP) pesticides represents a severe health issue in developing countries, while OP intoxication with the more lethal military nerve agents is not only of military concern but also a terrorist threat. Tailoring therapeutic regimens to the reality of OP poisoning is of the utmost importance when little experimental data and sparse human clinical data are available in the decision making process. We will present some of the advantages and disadvantages of the swine model in OP countermeasures elaborating on two examples. First, we will present the issues related to the use of anaesthesia during experimental OP poisoning and second we will show how results from experiments with swine can be integrated into a kinetic-based dynamic model to evaluate oxime efficacy. A better knowledge of OP poisoning in swine (comparative toxicokinetics, pharmacokinetics and biochemistry) is definitely necessary before accepting it as a first choice non-rodent model. However, there exists a large amount of data in the ଝ The studies on the development of a swine seizure model had been presented as posters in two occasions-Dorandeu, F., Foquin, A., Delacour, F. Dorandeu et al. / Toxicology 233 (2007) 128-144 129 model on anaesthesia and different types of shock favouring their use for evaluation of complex situations such as the anaesthesia of OP poisoned patients and combined injuries.

Indoor fungal contamination has been associated with a wide range of adverse health effects, including infectious diseases, toxic effects and allergies. The diversity of fungi contributes to the complex role that they play in indoor environments and human diseases. Molds have a major impact on public health, and can cause different consequences in hospitals, homes and workplaces. This review presents the methods used to assess fungal contamination in these various environments, and discusses advantages and disadvantages for each method in consideration with different health risks. Air, dust and surface sampling strategies are compared, as well as the limits of various methods are used to detect and quantify fungal particles and fungal compounds. In addition to conventional microscopic and culture approaches, more recent chemical, immunoassay and polymerase chain reaction (PCR)-based methods are described. This article also identifies common needs for future multidisciplinary research and development projects in this field, with specific interests on viable fungi and fungal fragment detections. The determination of fungal load and the detection of species in environmental samples greatly depend on the strategy of sampling and analysis. Quantitative PCR was found useful to identify associations between specific fungi and common diseases. The next-generation sequencing methods may afford new perspectives in this area.

2014 will mark the thirtieth anniversary of the massive toxic gas leak from the Union Carbide Corporation’s pesticide plant in Bhopal, Madhya Pradesh, India. Even after three decades, the effects of the tragedy are still visible throughout the slums surrounding the abandoned site. The aim of this research was to examine the aftermath and a few instances of disastrous consequences of the catastrophe. Various consequences, let it be long-term or short, will be presented in this paper.

In some situations, and particularly when intoxications are suspected, it would be advantageous if medicines and drugs of abuse could be swiftly detected in serum or urine. The Department of Clinical Pharmacology at St. Olav University Hospital has since 2004 been developing a comprehensive toxicology service (at all hours 7-days/week) for immediate quantitative analysis of between 80 and 90 substances. We here present the service in further detail and evaluate its usefulness during its first full year, 2005. Two case reports are presented to further illustrate the possible benefits of this service. Urgent testing was requested for a total of 390 samples; 351 serum and 39 urine samples. The most common indications for requesting such analyses were suspected acute intoxication (46%) and suspected therapeutic failure/adverse drug reaction (31%). 88% of the serum samples obtained for acute intoxications were positive, and 48 different substances were detected. The substances most often...

After his spectacular conquests from Persia to India in 334!24 BC, Alexander the Great died of mysterious causes after a heavy drinking party in Babylon (Iraq) in 323 BC, just before his 33rd birthday. Alexander’s untimely death aroused suspicions of poisoning among his closest companions; conspirators were accused of killing him with a mysterious toxin collected from the River Styx in southern Greece. Ancient historians were divided about the cause of death; some favored a plot while others believed in natural causes. Modern histor- ians and toxicologists are also divided on whether Alexander died of disease or poison. Modern attempts to retrodiagnose Alexander’s fatal illness, by analyzing the detailed symptoms the king reportedly suffered in the 2 weeks before death, have resulted in many theories. Proposed natural causes include alcohol poisoning, malaria, typhoid fever, septi- cemia, and accidental physician error; deliberate murder theories focus on aconite, arsenic, fermented hellebore, and strychnine.

Marijuana (Cannabis sativa) is a commonly used recreational drug among humans; animals may be exposed following ingestion or accidental inhalation of smoke. From January 1998 to January 2002, 213 incidences were recorded of dogs that developed clinical signs following oral exposure to marijuana, with 99% having neurologic signs, and 30% exhibiting gastrointestional signs. The marijuana ingested ranged from 1/2 to 90 g. The lowest dose at which signs occurred was 84.7 mg/kg and the highest reported dose was 26.8 g/kg. Onset of signs ranged from 5 min to 96 h, with most signs occurring within 1 to 3 h after ingestion. The signs lasted from 30 min to 96 h. Management consisted of decontamination, sedation (with diazepam as drug of choice), fluid therapy, thermoregulation and general supportive care. All followed animals made full recoveries.

Colourless and odourless, each year carbon monoxide is responsible for several thousand cases of poisoning. Often collective, their symptoms are non specific and can result in serious neurological sequelae or even death, if they are not detected in time. The (pre-) hospital emergency nurse plays an important role in the management of these patients, in terms of assessment, treatment and monitoring as well as the organisation of the admittance of victims, categorisation and medical triage. As part of a team, the nurse ensures that the patient enters an adapted, regulated pathway, with the most serious cases being directed towards a hospital equipped with a hyperbaric medicine facility.