1/12. Late manifestation of Indian childhood cirrhosis in a 3-year-old German girl.We report on a 3.8-year-old German girl who presented with signs of subacute liver failure based on a 4-month history. Investigations done before admission excluded infectious, metabolic and immunological diseases. Laboratory findings were increased values of aminotransferases, hyperbilirubinaemia, hyperammonaemia and deteriorated plasmatic coagulation. Caeruloplasmin and serum copper concentrations were normal; however, urinary copper excretion was elevated (80 microg/l). Liver biopsy showed a micronodular liver cirrhosis and an extremely high liver copper concentration (1400 microg/g dry weight). Epidemiological investigations revealed an elevated copper concentration (8645 microg/l, normal: <2000) and a low pH value (6.3) of the drinking water supplied by copper pipes. The girl had been exposed to copper-contaminated drinking water since the age of 2 years. CONCLUSION: Laboratory, histopathological findings and a proven chronic copper intoxication lead to the diagnosis of Indian childhood cirrhosis in a German girl. Whereas this disease is mostly described in patients with increased copper intake in infancy, our patient developed toxic liver cirrhosis with relatively late copper exposure. Indian childhood cirrhosis should be considered in the differential diagnosis of early childhood liver cirrhosis.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
2/12. copper and the liver: late lessons from the Camperdown experience.In 1973 copper-associated liver disease was first described in an Australian boy of non-Indian origin who died at the age of 15 months with liver cirrhosis. At necropsy the hepatic copper concentration was excessively high (> 300 mg/g dry weight). It was shown that the boy s disease was caused by consumption of copper contaminated drinking water.- - - - - - - - - - ranking = 0.5keywords = water (Clic here for more details about this article) |
3/12. death following cupric sulfate emesis.Case history: A 25-year-old woman who had ingested about 20 tablets of diazepam 2.5 mg in a suicide attempt was given cupric sulfate 2.5 g in 1750 mL water as an emetic, but died 3 days later. On autopsy, death was attributed to acute hemolysis and acute renal failure due to copper poisoning. copper concentrations were 5.31 microg/mL in whole blood, 19.0 microg/g in the liver, 8.9 microg/g in the kidney, 1.1 microg/L in the brain, 1.1 microg/g in the gastric wall, 1.5 microg/g in the jejunal wall, 0.3 microg/g in the colon wall, 4.6 microg/g in the gastric contents, and 12.6 microg/g in the intestinal contents (fresh weight). This case and 10 others from the Chinese medical literature provide additional evidence that cupric sulfate is a corrosive poison and contraindicated as an emetic.- - - - - - - - - - ranking = 0.5keywords = water (Clic here for more details about this article) |
4/12. A case of acute strychnine poisoning.In most severe cases of strychnine poisoning, the patient dies before reaching the hospital. This report describes the treatment and successful outcome of a patient who had taken a dose of strychnine that would normally be fatal. A 28-y-old man was admitted 2 h after ingestion of 1 to 1.5 g of strychnine. He had a Glasgow coma Score of 14/15 and was severely agitated and in mild respiratory distress; blood pressure was 90/60 mmHg, pulse 110/min, and peripheral pulses weak. He had generalized hyperactive reflexes and had several generalized tonic-clonic convulsions in the emergency department. Treatment consisted of gastric lavage with water, oral administration of activated charcoal and sorbitol solution, continuous intravenous administration of midazolam and then sodium thiopental, furosemide, sodium bicarbonate and hemodialysis for acute renal failure. His clinical course included respiratory distress, agitation, generalized tonic-clonic convulsions, hyperactivity, oliguria and acute tubular necrosis prior to recovery in 23 days. This patient ingested what would normally be a fatal amount of strychnine, had signs and symptoms of severe toxicity and recovered, suggesting that with aggressive supportive care patients may have favorable outcomes.- - - - - - - - - - ranking = 0.5keywords = water (Clic here for more details about this article) |
5/12. hypernatremia due to repeated doses of charcoal-sorbitol.Hypernatremic dehydration due to unreplaced stool water losses often complicates the use of the osmotic cathartic lactulose in the treatment of hepatic encephalopathy. sorbitol, another osmotic cathartic commonly used in the treatment of drug intoxications, has been reported in the pediatric literature to induce severe hypernatremia, but there is only a rare case report in an adult. We report a dramatic case of severe hypernatremia secondary to repetitive administration of activated charcoal-sorbitol suspension for the treatment of phenobarbital intoxication in an adult. Based on our experience with this case, several recommendations are provided regarding management of drug intoxications with charcoal-sorbitol suspension, including meticulous attention to fluid-electrolyte balance, type of replacement fluid, and dosing of the suspension.- - - - - - - - - - ranking = 0.5keywords = water (Clic here for more details about this article) |
6/12. Pesticide food poisoning from contaminated watermelons in california, 1985.aldicarb, a carbamate pesticide, is the most potent pesticide in the market and has a LD50 of 1 mg/kg. In the united states it is illegal to use aldicarb on certain crops, e.g., watermelons, because it is incorporated into the flesh of the fruit. Once an accidental or illegal use of such a potent pesticide occurs, there is no easy way for the agricultural or public health system to protect the populace. This paper describes the impact of one such event upon the health of individuals and the institutions of california. On July 4, 1985, california and other western states experienced the largest known outbreak of food-borne pesticide illness ever to occur in north america. This was attributed to watermelons contaminated through the illegal or accidental use of aldicarb by a few farmers in one part of the state. Within california, a total of 1,376 illnesses resulting from consumption of watermelons was reported to the california Department of health services (CDHS). Of the 1,376 illnesses, 77% were classified as being probable or possible carbamate illnesses. Many of the case reports involved multiple illnesses associated with the same melon among unrelated individuals. Seventeen individuals required hospitalization. There were 47 reports of illness involving pregnant women, two of whom reported having subsequent stillbirths. Thirty-five of the remaining pregnant women were followed-up 9 mo after the epidemic; no additional stillbirths were found.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 3.5keywords = water (Clic here for more details about this article) |
7/12. Acute arsenic intoxication.The diagnosis of acute arsenic poisoning should be considered in any patient presenting with severe gastrointestinal complaints. signs and symptoms include nausea, vomiting, colicky abdominal pain and profuse, watery diarrhea. hypotension, fluid and electrolyte disturbances, mental status changes, electrocardiographic abnormalities, respiratory failure and death can result. Quantitative measurement of 24-hour urinary arsenic excretion is the only reliable laboratory test to confirm arsenic poisoning. Treatment includes gastric emesis or lavage, chelation therapy, electrolyte and fluid replacement, and cardiorespiratory support.- - - - - - - - - - ranking = 0.5keywords = water (Clic here for more details about this article) |
8/12. water intoxication and hyponatremic encephalopathy from the use of an oxytocin nasal spray. A case report.Many nursing women returning to a full-time job and desiring to continue to breast feed are using oxytocin nasal sprays to facilitate breast emptying during the work day. Very few complications have been reported from its use, and the preparation has been assumed to be innocuous. However, we encountered a nursing mother whose life appears to have been jeopardized by the excessive and unmonitored application of such a spray. The patient was hospitalized for a viral illness and given a large quantity of intravenous fluid. In association with excessive self-administration of an oxytocin nasal spray, she developed severe water intoxication, with hyponatremic encephalopathy and convulsions. During the same hospitalization the patient subsequently developed a Guillain-Barre type of peripheral polyneuritis. The syndrome of inappropriate secretion of antidiuretic hormone has been reported to accompany the neurologic manifestations of the guillain-barre syndrome and may have been the cause of the convulsions. However, the temporal associations in this case strongly favor the unmonitored use of the oxytocin nasal spray as etiologic.- - - - - - - - - - ranking = 0.5keywords = water (Clic here for more details about this article) |
9/12. Intentional poisoning of children--an overlooked category of child abuse: report of seven cases and review of the literature.Seven instances of child abuse due to poisoning are reported; two of the children died. Forty-one cases of this form of poisoning are found in the literature. Of the total of 48 children, eight (17%) died as a result of the incident; and one was mentally retarded. The seven different agents described here are alcohol, glutethimide (Doriden), propoxyphene hydrochloride (Darvon), diazepam, insulin, lye, and pepper, constituting 27 different types of poison used by abusing guardians. The most common cause of abuse reported is excessive salt ingestion with water restriction. Excessive ingestion of water is the second most common cause. barbiturates and tranquilizers are also frequent agents. In 30% of the cases, poisoning persists even after hospitalization. child abuse by battering is associated in 20% of the cases. The need for a high index of suspicion of abuse in bizarre presentations of children for medical care when the etiology is obscure is emphasized.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
10/12. Extensive gastrointestinal damage following a saline emetic.A 27-year old female received about 1 kg of salt in about 600 ml of water as an emetic after a self-poisoning attempt. vomiting did not occur and massive necrosis of gastric, duodenal, and jejunal mucosa resulted in a severe and prolonged illness which required 31 weeks of continuous hospital care and 31 laparotomies over a period of 16 months. The dangers of salt emesis are emphasized.- - - - - - - - - - ranking = 0.5keywords = water (Clic here for more details about this article) |
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