Graphical abstract

Veratrum poisonings are known to the toxicology literature as multiple Veratrum species grow in different parts of the Northern Hemisphere and are occasionally ingested by mistake. Veratrum toxicity is attributed to the steroidal alkaloids contained in all parts of the plant. In Russia Veratrum poisonings are more common since there is an over-the-counter Veratrum Lobelianum-based tincture, Veratrum Aqua (VA), that is topically used for treatment of lice infestation. Despite its toxicity, VA is misused in traditional medicine as a remedy for alcohol use disorder. We describe four cases of VA poisoning that occurred in Moscow, Russia. Three main Veratrum Lobelianum alkaloids (jervine, protoveratrine A and protoveratrine B), were determined in patient plasma and urine samples using liquid chromatography tandem mass-spectrometry (LC-MS/MS). Here we describe a novel validated LC-MS/MS method for jervine and protoveratrine A quantification. Simple and rapid liquid-liquid extraction with methyl tert-butyl ether was utilized for analyte extraction. Chromatographic separation was achieved using Poroshell 120 EC-C18 column, and the total run time was 14 min. The lower limit of quantification was 0.1 ng/mL for jervine and proA in both plasma and urine. Biological samples were obtained upon hospital admission and during treatment, thus enabling to get a better understanding of the alkaloid elimination profile. Upon admission plasma concentrations of jervine (concentration range: 0.10–5.01 ng/mL) prevailed over protoveratrine A (concentration range: 0–0.67 ng/mL). At this time, protoveratrine A already reached maximum concentrations in urine (concentration range: 0.15–37.70 ng/mL). Maximum concentrations of jervine in urine were observed 24 hours after admission (concentration range: 0.10–9.55 ng/mL). In all cases plasma concentrations of Veratrum alkaloids correlated with condition severity. Since none of the patients confirmed VA intake, instrumental analysis was the basis for the definitive diagnosis of VA poisoning.

Cases of thallium poisonings are regularly reported in media. In the present work, the world experience in diagnostics and treatment of victims with thallium poisoning has been compiled and summarized, search for clinical guidelines for the diagnostics, treatment and rehabilitation of patients has been carried out. The toxicokinetics and toxicodynamics, as well as pathophysiological mechanisms of thallium influence on the body are described in detail. Toxic and lethal concentrations of poison in biological media, as well as its tropicity to various tissues and body systems were determined. The clinical picture depending on the timing of poisoning and the dose of poison is described in detail. Difficulties of the differential diagnosis are defined. The most interesting cases of criminal and household poisonings with various terms of establishment of the diagnosis, doses of poisoning and outcomes are presented.

The creation of the organizational foundations of clinical toxicology began after its separation in the first half of the 20th century from forensic medicine, pharmacology, and military and industrial toxicology. In this, the research started in the therapeutic clinic of the N.V. Sklifosovsky Research Institute for Emergency Medicine is important, which led to the opening of the country’s first toxicological department at the Institute and made it possible to resolve acute poisoning (AP) issues at a new level. The obvious successes achieved in this direction by the employees of the department served as a prerequisite for the creation of Republican and All-Union AP treatment centers on the basis of the N.V. Sklifosovsky Institute, where employees began actively work on the preparation of relevant regulatory documents and the organization of toxicological centers (departments) in the regions. As a result, by the end of the twentieth century, the foundation of the toxicological service was created in the Russian Federation — a network of 44 centers (departments) for AP treatment in 41 regions, which today provide specialized assistance to the population of 50% of the territory of the Russian Federation and serves as the basis for the implementation of advanced achievements in this area.An outstanding role in the formation of clinical toxicology as a new direction in clinical medicine and the creation of a scientific school of clinical toxicologists belongs to E.A. Luzhnikov, member of RAS.Creation of the organizational foundations of urgent clinical toxicology and its formation as an independent scientific and practical direction in medicine, in which a significant contribution belongs to the staff of N.V. Sklifosovsky Research Institute for Emergency Medicine, are closely related to scientific and practical achievements in this area, the prompt response of specialists to the toxicological situation in the country, as well as adoption of the experience gained in the course of organizational and information and advisory activities. At the same time, timely preparation and publication of legal and regulatory documents regulating practical work in this area are of particular importance.

Examinations of 406 patients aged from 60 to 93 years with acute poisoning with psychopharmacological medicines of varying severity were performed. The nomenclature of preparations that caused poisonings and combinations were analyzed. The concentrations of psychopharmacological preparations in blood and urine were monitored until they were absent in biological fluids. It was revealed that in patients of gerontological age more than half of poisonings occur as a result of combined intake of drugs of two or more pharmacological groups. It has been found that in patients older than 60 years with therapeutic concentrations of drugs in blood, symptoms of mild poisoning can be recorded in the case of use of one drug, and when combined intoxication is more severe. This category of persons is characterized by long-term excretion of psychopharmacological medicines from body during treatment, that influences the course of poisoning – can contribute to the fatal outcome as a result of prolonged intoxication and the development of life-threatening complications.