Flubromazolam is a new designer drug. Recreational use may be a cause of prolonged, severe intoxication associated with coma, hypotension, and rhabdomyolysis.

No abstract

A serious case of barium intoxication from suicidal ingestion is reported. Oral barium chloride poisoning with hypokalemia, neuromuscular and cardiac toxicity, treated with intravenous potassium supplementation and hemodialysis, was confirmed by the determination of barium concentrations in gastric contents, blood, serum and urine using the inductively coupled plasma mass spectrometry method. Barium concentrations in the analyzed specimens were 20.45 µg/L in serum, 150 µg/L in blood, 10,500 µg/L in urine and 63,500 µg/L in gastric contents. Results were compared with barium levels obtained from a non-intoxicated person.

The post-injection olanzapine delirium/sedation syndrome (PDSS) was observed in a 60-year-old Caucasian, schizophrenic, non-smoker and underweight [body mass index (BMI), 18.2 kg/m 2 ] women after the fourth intramuscular injection of 405 mg olanzapine pamoate. Clinical symptoms of PDSS were similar to those of acute oral olanzapine intoxication. The patient received supportive treatment and recovered fully. High olanzapine concentrations in serum, with maximum level of 698 ng/mL, were confirmed by liquid chromatography with tandem mass spectrometry (LC-MS/MS). The authors wonder whether a low BMI and advanced age may predispose patients to PDSS occurrence.Long-acting injections of antipsychotic drugs are common in psychiatric practice, especially to treat patients with schizophrenia showing non-adherence to oral pharmacotherapy [1]. A depot intramuscular formulation of olanzapine is a crystalline salt composed of olanzapine and pamoic acid. Once injected, two components of the salt dissociate into separate molecular compounds. Slow rate of dissolution allows for a gradual drug release into the circulation over 2-4 weeks [2]. This ensures an olanzapine concentration at 5-73 ng/mL, which is within the range resulting from within-label oral olanzapine doses [3]. The analysis by Heres et al. [2] revealed that the average steady-state concentrations (10th-90th percentile) for 405 mg/4-week doses were 19-62 ng/mL. In contact with increased volume of blood, the olanzapine pamoate salt dissolves more rapidly. The rapid rate of drug release occurs to very high values of olanzapine concentrations, which also depends on the level of the administered dose. Significantly elevated olanzapine blood concentrations lead to potentially severe clinical symptoms of the post-injection olanzapine delirium/sedation syndrome (PDSS) [2,4]. Case ReportA 60-year-old, Caucasian, schizophrenic, underweight [body mass index (BMI), 18.2 kg/m 2 ] women lost consciousness 10 min. after the fourth intramuscular injection of 405 mg olanzapine pamoate administered every 4 weeks. She did not receive any other medication. The patient had been suffering from schizophrenia for about 26 years, but no other chronic diseases. On the day of injection, the patient felt well and did not experience any disturbing symptoms. She had not been addicted to any psychoactive substances nor smoked cigarettes. On admission, the patient was unconscious (Glasgow Coma Scale 1 + 2 + 3 points), with bilateral miosis, periodically agitated with slight rigidity and asymmetric abnormal flexion in all four extremities. Vital signs were the following: blood pressure 140/75 mmHg, sinus tachycardia 112-130/min., respiratory rate 16 breaths/min. Due to upper airway obstruction, intubation was performed, but mechanical ventilation was not necessary. During the first 5 hr, her body temperature increased from 36.6°C to 38.2°C, so external cooling was applied. The patient was carefully observed and given symptomatic treatment. Five milligrams of intravenous midazolam loadi...

The changes in biomarkers activity indicate a greater production of free radicals which exceeds the capability of antioxidant system, appearing with oxidative stress in the group of animals treated by 4-MP combined with EG and EA.