We present a case of fatal intoxication by the application of a transdermal fentanyl patch upon a superficial bleeding abrasion of a 2-year-old girl. The grandmother discovered the body of the child in bed at approximately 7 a.m. External examination revealed a properly developed, nourished and hydrated child, with some vomit in the nostrils and inside the mouth. There was no evidence of trauma besides small contusions and abrasions on knees, with a patch placed over the largest abrasion. Closer inspection revealed that this was transdermal fentanyl patch.Internal examination and microscopic analysis revealed regurgitation of stomach content, cerebral and pulmonary edema and liver congestion. Toxicology analysis revealed trace levels of fentanyl in the blood just above the limit of detection (2 ng/mL), while concentrations in the urine, liver and kidney were approximately 102, 28 and 10 ng/mL, respectively. Investigation discovered that the child injured her knee while playing the evening before. The grandmother applied the patch to cover the injury, unaware that she had used a fentanyl transdermal patch instead of simple band-aid.Although fatal intoxications are uncommon among young children in high-income countries, it is of major interest to raise awareness of such events especially since a great majority of these are preventable. The presented case points at the need for more thorough education of users and more strict rules in prescribing and handling of this potent medicine. As well, we find this case to be a useful contribution to the evaluation of postmortem fentanyl concentrations in fatal intoxication in a small child.
We present a case in which postmortem blood ethanol concentration was 0.02 g/kg and acetone concentration was 0.51 g/kg, while urine ethanol concentration was 6.0 g/kg and acetone concentration was 0.63 g/kg. In the urine sample, sodium fluoride was not added. The urinary ethanol concentration continued to increase without any remarkable increase of isopropanol concentration and external contamination was excluded. Species of bacteria and yeasts, including Candida glabrata, were isolated from urine and blood samples. A few days after the collection of samples, we received the information that the patient was diabetic and did not receive insulin therapy regularly. To prevent postmortem microbial ethanol production and incorrect diagnosis of the cause of death, it is necessary to add sodium fluoride to blood and urine samples collected from diabetic patients.
This study presents two cases of lethal bentazone poisonings, their clinical presentation, the course of the disease and the autopsy findings. The first is a 50-year-old male who had sprayed corn with a solution of bentazone and was admitted to the hospital with sweating, fever, nausea, vomiting of aqueous and hemorrhagic content, and bloody, watery stools. He was treated according to the symptoms including extracorporeal hemodialysis, but eventually suffered from multiorgan failure (acute respiratory failure, acute liver failure, coagulopathy, acute renal failure, metabolic acidosis, and gastrointestinal bleeding) and died 11.35 h after admittance. The cause of death was probable bentazone intoxication. The second case, also a male, aged 49 who committed suicide by ingesting a bentazone solution. He was transferred to the hospital prostrated and cyanotic and died 14.15 h after admittance despite all efforts by the hospital staff. The cause of death was acute bentazone intoxication.
Introduction: The lives of most people around the world have changed since the onset of SARS-CoV-2 pandemic (SARS-CoV - severe acute respiratory syndrome corona virus). According to the WHO data, the first cases in Croatia were registered on February 26, in Bosnia and Herzegovina on March 5, and in Serbia on March 10, 2020. The assumption was that due to stress caused by imposed isolation, the alcohol consumption began to increase. Methods: In order to obtain information on alcohol consumption in the period before and during Covid-19 lockdown, an online anonymous survey was conducted, in which a total of 930 persons participated: 542 from Croatia, 219 from Bosnia and Herzegovina, and 169 from Serbia. Results: Among those who completed the survey were 659 women and 271 men, mostly between 20-45 years old, with higher or secondary education. Most were employed, living in urban areas with a larger population. The obtained results did not show the influence of lockdown on alcohol consumption. On the contrary, 20.21% of participants, who had previously consumed alcohol, answered that they stopped consuming during the lockdown. Only 0.43% of participants started consuming alcohol precisely because of isolation.
Conclusions: This research sheds new light on the daily practice of people during Covid-19 pandemic in the Western Balkans, known as a region where alcohol consumption is quite widespread
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