Mercury is a chemical element that has been known since prehistoric times and has been used over time as a component of paints, in the treatment of various diseases, and later in various industrial compounds. Mercury enters the body transcutaneously, by inhaling or by ingesting food contaminated with mercury. The most common cause of mercury poisoning is eating seafood, but people can get mercury poisoning from industrial processing, thermometers, dental work, and old paints. The most vulnerable are people at occupational risk due to chronic exposure, as well as fetuses in the intrauterine period. Mercury poisoning produces extremely serious effects on the nervous, renal, and gastrointestinal systems. The nature and extent of mercury poisoning depend on factors such as the route of exposure, the rate of exposure, the distribution and biotransformation of mercury in the body, the chemical form of mercury or the mercury compound. Both mercury in the blood and the urine should not exceed 10 μg/L. The critical values of mercury in the blood are >150 μg/L and the lethal ones exceed 800 μg/L. New diagnostic methods allow the rapid and accurate identification of the concentration of mercury in biological products. Treatment is based on the use of chelating agents. However, the prognosis of mercury poisoning is extremely variable, due to the potentially irreversible nature of the lesions.
Copper is essential to all living beings, as a food mineral, being an essential component of the cytochromoxidase enzymes complex. It is also an essential component of several systems involved in the production of hemoglobin, of sugar metabolism, of catecholamines’ synthesis and in the formation of cross-links between collagen, elastin and keratin fibers within the hair. The dysregulation of copper through impaired absorption or excretion, either genetically based or in acute or chronic poisoning, results in deficiency or toxicity. For this reason, the measurement of copper levels in various biological samples: urine, blood, or hair, provides the physician with information regarding contamination, poisoning, or a metabolic disease. Due to low concentrations in most heavy metals’ and metalloids’ cases, finding traces in biological samples is a difficult problem. Classical methods (staining, flame photometry, reagent kits, electrochemical methods) can only be used for a limited number of elements, such as sodium, potassium, calcium, magnesium, copper, iron and zinc. The analysis of biological samples is the most important use of graphite furnace atomization. The advantages of using this technique are its great sensitivity and the very low quantity of sample necessary for performing the measurement. In modern medicine, determining microelements is very important in diagnosing diseases and/or in treating them. The GF- AAS method is quick, reproductible and has very good sensitivity.
Acute drug-related acute intoxications or suicidal ideation following overdose with anticonvulsants may cause major morbidity, in many cases requiring intensive care and prolonged periods of hospitalization. The case of a 35-year-old patient known for a history of epilepsy with phenobarbital and carbamazepine treatment is brought to the Emergency Unit by transfer from another hospital in a comatose state with insufficient respiratory performance, bilateral active mydriasis. From the family members' claims, the patient discontinued treatment with phenobarbital two weeks ago. Following interdisciplinary examination, hospitalization in the Neurology Department with the diagnosis of epileptic status is decided. Due to the progressive aggravation of acute respiratory insufficiency, the ventilator support is constituted. Since the biological samples related to probability diagnosis and cerebral imaging were not conclusive, toxicological samples were collected. The GC/MS analytical toxicology screening in urine reveals the presence of carbamazepine and phenobarbital and their plasma levels (5.92 and 92.3 mg/l) as determined by the FPIA method indicate an overdose of phenobarbital therapy. The patient is taken over by the Department of Clinical Toxicology where specific intensive care measures are applied. Clinical evolution is favorable. The psychiatric examination highlights the depressive idea, suicidal ideas, and uselessness. The suicide attempt is confirmed. It also presents a review of the main information about acute poisoning with anticonvulsants, but also about the analytical laboratory methods that bring precious information in establishing the diagnosis of certainty.
One of the great dreams of humanity has been the improvement of its behavioural, affective and emotional status. Depression represents the suffering of beings over their existential course, as a point of passage between the human condition and its destiny. The attempts of psychiatry to introduce efficient and increasingly performing antidepressants represent one of medicine’s great achievements. At the same time, antidepressant overdosing may lead to cardiotoxic manifestations presenting lethal risks as consequences [1]. We hereby present the case of a patient that was poisoned with tianeptine, ingested for suicidal purposes, who survived repetitive episodes of ventricular fibrillation, electrically converted to sinusal rhythm. The GC/MS analytical diagnosis played an essential part in detecting tianeptine in the biological samples. The rapid and very competent therapeutic intervention allowed for the patient’s survival, despite further complications. A review of main tianeptine information is also presented, as this type of intoxication may have deadly consequences.
Mass spectrometry is a chemical analytical method of determining organic substances by comparing their mass spectrum with mass spectra found in system libraries. In the case of biological products, substances of interest, like organophosphorus compounds, must be separated and identified for rapid and good medical measures (antidotism procedures) in acute intoxication case. A gas chromatograph coupled with a Varian mass spectrometer (GC-MS), was used to develop the application. The proposed objective is presenting the medical applicability in acute organophosphorus compounds intoxication management of the GC/MS method (gas chromatography coupled with mass spectrometry) as a separation and identification method for these compounds and their metabolites in urine samples.
