Latest Articles and News - Jul 17, 2025

A case of serotonin syndrome following the reintroduction of aripiprazole after dextromethorphan overdose.

Serotonin syndrome is a potentially life-threatening condition that arises from excessive serotonergic activity. Dextromethorphan (DXM), commonly used as a non-prescription antitussive, can induce serotonin syndrome when taken in high doses or in combination with other serotonergic agents. At supratherapeutic levels, DXM acts as a serotonin reuptake inhibitor and N-methyl-D-aspartate (NMDA) receptor antagonist, thereby significantly increasing the risk of serotonin toxicity. We present the case of an 18-year-old female diagnosed with attention-deficit/hyperactivity disorder (ADHD) and comorbid depressive symptoms who developed serotonin syndrome after the reinitiation of aripiprazole in the context of recent DXM overdose. Following ingestion of an estimated 600 mg of DXM, the patient exhibited signs of toxicity. The subsequent administration of aripiprazole was temporally associated with the emergence of serotonin syndrome, evidenced by hyperreflexia, hypertonia, and fever, in accordance with the Hunter Serotonin Toxicity Criteria. This case illustrates the necessity of cautious reintroduction of serotonergic or dopaminergic medications following DXM overdose. Given the potential for prolonged metabolism and interaction-especially in individuals with reduced CYP2D6 activity-clinicians should allow for adequate washout periods before restarting psychotropic agents, such as aripiprazole.

https://pubmed.ncbi.nlm.nih.gov/40673125/

The Evolving Industrial Landscape in Occupational Chronic Benzene Poisoning - 6 PLADs, China, 2020-2023.

As a major producer and consumer of benzene, China has long confronted the challenge of occupational chronic benzene poisoning (OCBP). Between 2005 and 2019, OCBP in China primarily occurred in private enterprises, small- and medium-sized enterprises, and the general/special-purpose equipment manufacturing industry. However, with the continuous strengthening of national supervision and restrictions on the use of benzene-containing materials, the industrial distribution of OCBP may have changed from 2020 to 2023. A total of 6 provincial-level administrative divisions (PLADs) with concentrated benzene-related industries - Jiangsu, Zhejiang, Shandong, Sichuan, Fujian, and Tianjin - were selected for analysis. We collected data on 162 newly reported OCBP cases from 2020 to 2023. Based on the National Economic Industry Classification standards, we analyzed these cases according to enterprise size, economic type, and industry classification. The number of OCBP cases in China decreased significantly, reaching a historical low of 56 cases in 2023 [accounting for 15.3% of chronic occupational poisoning (COP)], compared to an average of 256 cases annually from 2005 to 2019 (26.7% of COP). From 2020 to 2023, OCBP continued to occur predominantly in manufacturing, private, and small- and medium-sized enterprises. However, the primary industry associated with OCBP shifted to chemical raw materials and chemical products manufacturing, followed by petroleum, coal, and other fuel processing industries. OCBP remains a major component of COP in China. While continuing to regulate the manufacturing industry, especially small- and medium-sized enterprises, supervision should be strengthened in the evolving industries where benzene poisoning now predominantly occurs.

https://pubmed.ncbi.nlm.nih.gov/40672987/

Incidence and independent risk factors of lower extremity deep vein thrombosis in patients with acute carbon monoxide poisoning: a retrospective study.

To investigate the incidence and independent risk factors of lower extremity deep vein thrombosis (DVT) in patients with acute carbon monoxide poisoning and to evaluate the predictive performance of a risk factor model to support early identification and individualized intervention for high-risk patients. This retrospective cohort study included 180 patients diagnosed with acute carbon monoxide poisoning from January 2021 to December 2023. Lower extremity venous ultrasound was performed within 48 hours of admission to detect DVT, and patients were categorized into DVT and non-DVT groups. Clinical data - including demographic characteristics, poisoning-related variables, and biochemical markers - were collected and analyzed. Variables with statistical significance were subjected to logistic regression analysis to identify independent risk factors for DVT. Spearman correlation analysis and receiver operating characteristic (ROC) curve analysis were further conducted to assess variable relationships and the predictive performance of the risk model. Among the 180 patients, 23 (12.78%) developed DVT. Spearman correlation analysis showed that coma duration, carboxyhemoglobin concentration, C-reactive protein, procalcitonin, D-dimer, creatinine, blood urea nitrogen, lactate dehydrogenase, myoglobin, and creatine kinase were positively correlated with DVT (all P < 0.001), whereas earlier initiation of hyperbaric oxygen therapy and higher albumin levels were negatively correlated (r = -0.397, P < 0.001). Logistic regression identified coma duration, D-dimer level, and carboxyhemoglobin concentration as independent risk factors for DVT. The ROC curve demonstrated good predictive performance, with an area under the curve of 0.888 (95% CI: 0.827-0.948, P < 0.05). Lower extremity DVT is relatively common in ptients with acute carbon monoxide poisoning. Coma duration, D-dimer levels, and delayed initiation of hyperbaric oxygen therapy are significantly associated with increased risk. The proposed risk factor model demonstrates strong predictive value and may assist in early clinical detection and targeted prevention strategies.

https://pubmed.ncbi.nlm.nih.gov/40672587/

Ethylene glycol poisoning: A case report and review of the literature.

Ethylene glycol (EG) poisoning is often caused by the accidental ingestion of antifreeze. EG is metabolized into glycolate and oxalate and may cause metabolic acidaemia, neurotoxicity, acute kidney injury, and death. A variety of EG poisoning case reports have been published, and we wrote this case report and literature review to summarize the clinical experience of patients who survived EG poisoning. In this case report, a 55-year-old man developed EG poisoning after ingesting antifreeze by accident and experienced acute kidney injury, nervous system dysfunction and inhalation pneumonia. The timely use of ethanol for detoxification, initiation of haemodialysis, and protection of organ function are effective treatment methods for patients with antifreeze poisoning. The patient was discharged in the 3rd week after admission. When discharged, the patient did not report any discomfort, had stable vital signs, did not have fever or diarrhoea, and had improved liver and kidney functions. A timely diagnosis, haemodialysis, and organ protection are the keys to the successful treatment of poisoned patients.

https://pubmed.ncbi.nlm.nih.gov/40671749/

Association between Full Moon Day overdose-related intensive care unit admissions and hospital mortality: a medical enigma or mere myth?

There is limited evidence on whether Full Moon Day is linked to drug overdoses severe enough to need intensive care unit (ICU) admissions. To investigate the association between Full Moon Day overdose-related ICU admissions and hospital mortality. This retrospective multicentre observational study that included data from 172 ICUs across Australia and New Zealand reported to the Australia New Zealand Intensive Care Society Adult Patient Database. We included all adult (≥16 years) patients admitted to an ICU following an overdose between 1 January 2018 and 31 December 2023. The primary outcome was the prevalence of overdose presentations. The secondary outcome was hospital mortality. We used logistic regression models to investigate the association between Full Moon Day overdose and hospital mortality, after adjusting for key confounders. We also analysed this association in a subgroup based on sex. We included 25 577 patients; 4426 (17.3%) were admitted on Full Moon Day. The prevalence of overdose-related ICU admissions for Full Moon Day was similar to those on other lunar days (mean prevalence: 1.4% (standard deviation (SD) 0.6%) vs. 1.4% (SD 0.2%)). The hospital mortality was comparable in both groups of patients (1.3% vs. 1.3%; P = 0.99). There was no association between Full Moon Day overdose-related ICU admission and hospital mortality (adjusted odds ratio = 1.10; 95% confidence interval: 0.77-1.57; P = 0.60). This relationship was consistent in both male and female patients. This large registry-based study found no difference in overdose-related ICU admissions between full moon days and other lunar days, with no association with hospital mortality. This reinforces that the full moon's influence on overdose admissions to the ICU is a myth.

https://pubmed.ncbi.nlm.nih.gov/40671637/

[Case report of a lethal voluntary drug intoxication with mirtazapine and venlafaxine complicated with a massive pharmacobezoar].

https://pubmed.ncbi.nlm.nih.gov/40670198/

Wischnewski spots and ethylene glycol fatal poisoning: a case report.

We present the case of a woman who was found dead in a countryside 11 days after disappearing from home. At the examination of the scene of death a black plastic can of antifreeze fluid was found near the body. The autopsy and complementary analysis allowed us to establish that the cause of death was an irreversible cardio-circulatory arrest caused by acute poisoning by the ingestion of ethylene glycol. Moreover, the gastric mucosa showed numerous black hemorrhagic spots, histologically diagnosed to be "Wischnewski spots". Therefore, because most of the toxicity of ethylene glycol comes from its acid metabolites, we suggest that the presence of WSs in this case is strictly related to metabolic acidosis, supporting the thesis that acidosis plays a crucial role in the pathogenesis of WSs. This is the first paper, to the best of our knowledge, that shows a correlation between ethylene glycol poisoning and Wischnewski spots.

https://pubmed.ncbi.nlm.nih.gov/40669443/