A review of “Dippers’ Flu”. Sheep dip pesticides & farmers’ ill health in the UK
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S58 Abstracts / Toxicology Letters 211S (2012) S43–S216 Purpose: Methylphenidate is widely used, especially in the treat- ment of attention deficit hyperactivity disorder (ADHD). The aim of the study was to describe characteristics of methylphenidate expo- sures, such as distribution within different age groups, severity of intoxication and concomitant drug use. Method: Our database (2005–2010) was queried for all human methylphenidate expo- sures. Results and conclusion: The annual amount of information requests regarding methylphenidate exposures tripled from ∼200 requests in 2005 to >600 in 2010. Here we provide detailed information about exposure data in 2010. Roughly half of all requests concerned adults (≥18 yrs), whereas ∼20% concerned teens (13–17 yrs), indicating intentional misuse/abuse. In adults, ∼60% of exposures was estimated to result in a moderate to severe intoxication (moderate: 2–5 mg/kg, severe: ≥5 mg/kg). Common symptoms include agitation, tachycardia and hyperten- sion. In severe intoxications, hyperpyrexia, convulsions and cardiac arrhythmia might occur. In adults, male/female distribution was almost equal (47% vs. 38%, respectively; 14% unknown). In ∼70% of all cases, immediate-release methylphenidate was involved (slow-release in ∼25%). Route of exposure was nearly always inges- tion (∼98%), although in ∼2% of the cases methylphenidate was crushed and sniffed. In adults, concomitant drugs were used in ∼50% of all cases, of which benzodiazepines (20%), alcohol (16%), antidepressants (14%) and antipsychotics (13%) were most com- monly co-ingested. We are worried about the increase of toxic methylphenidate exposures and the relatively high percentage of concomitant drug use. Therefore, we will perform an additional study on exposure circumstances, actual clinical outcome and effects of concomitant drug and alcohol intake. doi:10.1016/j.toxlet.2012.03.228 P06-10 A review of “Dippers’ Flu”. Sheep dip pesticides & farmers’ ill health in the UK Huw Rees Cardiff University, United Kingdom Purpose: A review of farmers’ health and treatment of sheep with pesticides in the United Kingdom. Sheep farming is an impor- tant industry and treatment with organophosphates and other pesticides is commonly undertaken to prevent extensive animal suffering and economic loss. Since the 1990s ill health related to treatments has been the subject of considerable controversy. Methods: A literature review. Results and conclusions: Treatment methods vary and are difficult to study systematically. Studies demonstrate infrequent, low-dose pesticide exposure. There are a small number reports of human toxicity each year (more than from other occupational groups with higher pesticide exposures over far longer periods of time). Studies of acute ill health have found either symptoms attributed to psychological effects, symp- tom clusters unrelated to pesticide dose, or little evidence of toxicity. Studies of chronic health effects have attributed symptoms to psychological responses, but also found weak evidence of both neuropsychiatric impairment and peripheral neuropathy. Chronic symptoms have also been linked to PON1 genotype. The findings are not consistent with the classic toxicological syndromes associated with organophosphates. Many epidemiological studies have been flawed in terms of study design, low response rates, selection bias and weak quantitative measurements of pesticide exposures and symptoms. Pressure group activity and media speculation probably contribute to anecdotal reports of ill health and reporting bias. In conclusion, studies have failed to provide convincing evidence of a commonly occurring syndrome of disease with a truly distinctive pattern of symptoms, adverse physical effects, or dose-response relationships which might indicate causality. doi:10.1016/j.toxlet.2012.03.229 P06-11 Clinical toxicology evolution of body packers between 1997 and 2011 Graciela Sorrentino Eurnekian Hospital, Argentina Purpose: The intensive care unit of Dr. Eurnekian Hospital is the referral of Body Packers (BP) subjects dealing with foreign bodies (FB), intraabdominal containing illicit drugs for smuggling, usually taken orally and less frequently rectally or vaginally (O.M.S.). Clin- ical toxicology considers the body packers to be a relevant factor to the drug found. In this paper we propose to observe the evolu- tion of the clinic toxicology between 1997 and 2011. Materials and methods: Retrospective observational study. Source: Medical His- tory. Population: 1997–2011 BP entered. Results and conclusions: Sample: 420 BP. Diagnosis: Plain abdominal XR and CT of abdomen. A total of 30.482 capsules were obtained: 30.027 solid, 455 liq- uid. Removing FB: Rectal evacuation, surgery 3%. Capsules solid content: Cocaine hydrochloride. Liquid capsule contents: Cocaine hydrochloride from 2010 with diluents such as ethanol, and levami- zol. Complications: Total: 12 cases. BP with solid caps: convulsions followed by PCR. BP liquid capsules, seizures and metabolic acidosis refractory to treatment. In recent years there has been variation in the content, predominantly toxicological complications, not only due to illicit drugs but the diluent added as well, which leads to have difficulty detecting the capsules in the emergency. doi:10.1016/j.toxlet.2012.03.230 P06-12 Poisoning by penicillium toxins—Clinical and brain receptor effects Gunnar Sundstøl Eriksen 1 , Thomas Rundberget 1 , Mattis B. Wigestrand 2 , Frode Fonnum 2 , Aksel Bernhoft 1 , Angel Moldes-Anaya 1 1 Norwegian Veterinary Institute, Norway, 2 University of Oslo, Norway Purpose: The purpose of the study was to identify the cause of the intoxications of dogs arriving at several Norwegian veteri- nary clinics with seizures, convulsions and other classical signs of poisoning by nervous agents. Methods: All available samples of ingested feed, vomit and stomach content were examined for fungi and chemically analyzed for known tremorgenic penicillium mycotoxins. One dog was euthanized due to long-lasting clinical symptoms. Tissues from this dog were histopathologically exam- ined and chemically analyzed for tremorgenic penicillium toxins. Rats were given single oral doses of selected mycotoxins and the induction of tremors was registered in an experiment designed to evaluate the relative potency of several analogues. The effects of penitrem A on neurotransmitter receptors were tested in rat brain preparations. Results and conclusions: Several episodes of acute poisonings of dogs with tremorgenic penicillium mycotoxins, in particular penitrem A, were confirmed. Post-mortem examination of the euthanized dog showed that only penitrem A was present
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58 Abstracts / Toxicology L
Purpose: Methylphenidate is widely used, especially in the treat-ent of attention deficit hyperactivity disorder (ADHD). The aim of
he study was to describe characteristics of methylphenidate expo-ures, such as distribution within different age groups, severityf intoxication and concomitant drug use. Method: Our database2005–2010) was queried for all human methylphenidate expo-ures. Results and conclusion: The annual amount of informationequests regarding methylphenidate exposures tripled from ∼200equests in 2005 to >600 in 2010. Here we provide detailednformation about exposure data in 2010. Roughly half of allequests concerned adults (≥18 yrs), whereas ∼20% concernedeens (13–17 yrs), indicating intentional misuse/abuse. In adults,60% of exposures was estimated to result in a moderate to
evere intoxication (moderate: 2–5 mg/kg, severe: ≥5 mg/kg).ommon symptoms include agitation, tachycardia and hyperten-ion. In severe intoxications, hyperpyrexia, convulsions and cardiacrrhythmia might occur. In adults, male/female distribution waslmost equal (47% vs. 38%, respectively; 14% unknown). In ∼70%f all cases, immediate-release methylphenidate was involvedslow-release in ∼25%). Route of exposure was nearly always inges-ion (∼98%), although in ∼2% of the cases methylphenidate wasrushed and sniffed. In adults, concomitant drugs were used in50% of all cases, of which benzodiazepines (20%), alcohol (16%),ntidepressants (14%) and antipsychotics (13%) were most com-only co-ingested. We are worried about the increase of toxicethylphenidate exposures and the relatively high percentage of
oncomitant drug use. Therefore, we will perform an additionaltudy on exposure circumstances, actual clinical outcome andffects of concomitant drug and alcohol intake.
oi:10.1016/j.toxlet.2012.03.228
06-10review of “Dippers’ Flu”. Sheep dip pesticides & farmers’ ill
ealth in the UK
uw Rees
Cardiff University, United Kingdom
Purpose: A review of farmers’ health and treatment of sheepith pesticides in the United Kingdom. Sheep farming is an impor-
ant industry and treatment with organophosphates and otheresticides is commonly undertaken to prevent extensive animaluffering and economic loss. Since the 1990s ill health relatedo treatments has been the subject of considerable controversy.ethods: A literature review. Results and conclusions: Treatmentethods vary and are difficult to study systematically. Studies
emonstrate infrequent, low-dose pesticide exposure. There aresmall number reports of human toxicity each year (more than
rom other occupational groups with higher pesticide exposuresver far longer periods of time). Studies of acute ill health haveound either symptoms attributed to psychological effects, symp-om clusters unrelated to pesticide dose, or little evidence ofoxicity. Studies of chronic health effects have attributed symptomso psychological responses, but also found weak evidence of botheuropsychiatric impairment and peripheral neuropathy. Chronicymptoms have also been linked to PON1 genotype. The findings areot consistent with the classic toxicological syndromes associatedith organophosphates. Many epidemiological studies have beenawed in terms of study design, low response rates, selection bias
nd weak quantitative measurements of pesticide exposures andymptoms. Pressure group activity and media speculation probablyontribute to anecdotal reports of ill health and reporting bias. Inonclusion, studies have failed to provide convincing evidence of a211S (2012) S43–S216
commonly occurring syndrome of disease with a truly distinctivepattern of symptoms, adverse physical effects, or dose-responserelationships which might indicate causality.
doi:10.1016/j.toxlet.2012.03.229
P06-11Clinical toxicology evolution of body packers between 1997and 2011
Graciela Sorrentino
Eurnekian Hospital, Argentina
Purpose: The intensive care unit of Dr. Eurnekian Hospital is thereferral of Body Packers (BP) subjects dealing with foreign bodies(FB), intraabdominal containing illicit drugs for smuggling, usuallytaken orally and less frequently rectally or vaginally (O.M.S.). Clin-ical toxicology considers the body packers to be a relevant factorto the drug found. In this paper we propose to observe the evolu-tion of the clinic toxicology between 1997 and 2011. Materials andmethods: Retrospective observational study. Source: Medical His-tory. Population: 1997–2011 BP entered. Results and conclusions:Sample: 420 BP. Diagnosis: Plain abdominal XR and CT of abdomen.A total of 30.482 capsules were obtained: 30.027 solid, 455 liq-uid. Removing FB: Rectal evacuation, surgery 3%. Capsules solidcontent: Cocaine hydrochloride. Liquid capsule contents: Cocainehydrochloride from 2010 with diluents such as ethanol, and levami-zol. Complications: Total: 12 cases. BP with solid caps: convulsionsfollowed by PCR. BP liquid capsules, seizures and metabolic acidosisrefractory to treatment. In recent years there has been variation inthe content, predominantly toxicological complications, not onlydue to illicit drugs but the diluent added as well, which leads tohave difficulty detecting the capsules in the emergency.
doi:10.1016/j.toxlet.2012.03.230
P06-12Poisoning by penicillium toxins—Clinical and brain receptoreffects
Gunnar Sundstøl Eriksen 1, Thomas Rundberget 1, Mattis B.Wigestrand 2, Frode Fonnum 2, Aksel Bernhoft 1, AngelMoldes-Anaya 1
1 Norwegian Veterinary Institute, Norway, 2 University of Oslo,Norway
Purpose: The purpose of the study was to identify the causeof the intoxications of dogs arriving at several Norwegian veteri-nary clinics with seizures, convulsions and other classical signsof poisoning by nervous agents. Methods: All available samplesof ingested feed, vomit and stomach content were examined forfungi and chemically analyzed for known tremorgenic penicilliummycotoxins. One dog was euthanized due to long-lasting clinicalsymptoms. Tissues from this dog were histopathologically exam-ined and chemically analyzed for tremorgenic penicillium toxins.Rats were given single oral doses of selected mycotoxins and theinduction of tremors was registered in an experiment designed toevaluate the relative potency of several analogues. The effects ofpenitrem A on neurotransmitter receptors were tested in rat brain
preparations. Results and conclusions: Several episodes of acutepoisonings of dogs with tremorgenic penicillium mycotoxins, inparticular penitrem A, were confirmed. Post-mortem examinationof the euthanized dog showed that only penitrem A was present
