A case of suicidal poisoning with paraphenylenediamine (PPD) is reported. The patient presented with typical features of severe oropharyngeal oedema and rhabdomyolysis, He suffered sudden cardiac death within 4 hours of admission despite full supportive treatment. The diagnosis was only established after his death. Systemic poisoning with paraphenylenediamine (PPD) is rare in western countries, and therefore a high degree of awareness and circumstantial evidence is required to make an early diagnosis. The classical and other less commonly reported features of this poisoning are discussed. There is no specific antidote available but some guidelines for management of such a case are reviewed.
Ingestion of over 60 g of formic acid by an adult is potentially fatal. We report a case of a 36-year-old woman with a history of depression who ingested 110 g of formic acid. She survived a complicated intensive care hospitalization following usage of intravenous folinic acid, urinary alkalinization, intravenous furosemide and supportive care. We suggest a management protocol aimed at minimizing formate toxicity by enhancing hepatic formate degradation via the folinic acid 'one carbon pool' and by enhanced renal elimination of formate.
1 Two fatal cases of deliberate self-poisoning with lignocaine are reported, one by oral ingestion and one by intravenous injection. Post-mortem blood lignocaine concentrations were 40 and 53 mg/l, respectively. 2 Lignocaine self-poisoning is rare since no formulations for oral use other than gels are available. However, serious toxicity can follow the oral application or ingestion of such gels, especially in children and in the elderly. Fatalities due to accidental oral overdosage with 10-25 g of lignocaine in adults have also been reported. 3 The frequent incidental occurrence of lignocaine in specimens submitted for toxicological analysis should not exclude the possibility of poisoning with this compound.
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