Chronic manganese toxicity due to substance abuse in Turkish patients

Abstract

Manganese toxicity, which may cause a distinctive irreversible neurodegenerative disorder, can be seen frequently with "Russian Cocktail" abuse, a substance which can be accessed very easily and at a low cost.

Manganese Exposure and Cognition Across the Lifespan: Contemporary Review and Argument for Biphasic Dose–Response Health Effects

“…It is ubiquitous in the environment, naturally occurring in air, water, soil, and food [3]. Excess environmental exposure may arise from contaminated drinking water [4–6], air pollution [7–10], gasoline enhanced with methylcyclopentadienyl manganese tricarbonyl (MMT) [11], agricultural fungicides [12, 13], infant formulas [14], parenteral nutrition [15, 16], and illicit intravenous drug use [17]. Abundant in the diet, nutritional intake is the most common source for those who are not occupationally exposed [18].…”

Focus on Over-the-Counter Drugs' Misuse: A Systematic Review on Antihistamines, Cough Medicines, and Decongestants

“…Seven articles, including six case reports (106)(107)(108)(109)(110)(111) and one case series (112), described the misuse of pseudoephedrine (Supplementary Table 1). Cases mostly involved male adults (age range, 18-45 years) (F/M, 3/7) suffering from mood disorders (107,(109)(110)(111).…”

“…One paper recorded an SUD [e.g., alcohol, cannabis, and heroin; (112)]. Massive dosages [e.g., 3,000-4,500 mg of pseudoephedrine/day; (107)] and IV administrations (108,111,112) have been associated with the misuse of pseudoephedrine. Physical symptoms associated with pseudoephedrine high dosage ingestion included stimulating effects such as decreased appetite, dry mouth, palpitations (106,107,112), and motor symptoms [e.g., gait and balance disorder, postural instability, generalized dystonia, hypokinesia, bradykinesia, psychomotor retardation; (106)(107)(108)112)].…”

“…Massive dosages [e.g., 3,000-4,500 mg of pseudoephedrine/day; (107)] and IV administrations (108,111,112) have been associated with the misuse of pseudoephedrine. Physical symptoms associated with pseudoephedrine high dosage ingestion included stimulating effects such as decreased appetite, dry mouth, palpitations (106,107,112), and motor symptoms [e.g., gait and balance disorder, postural instability, generalized dystonia, hypokinesia, bradykinesia, psychomotor retardation; (106)(107)(108)112)]. Pseudoephedrine effects were dose dependent and ranged from euphoria, insomnia, diminished sense of fatigue, and accelerated thinking, to psychotic symptoms with auditory and visual hallucinations, persecutory delusions, fear, and disorganized behavior (106,(109)(110)(111).…”

“…Withdrawal symptoms have been recorded after the abrupt interruption of the longterm use (106,107). Some cases required hospitalization and treatment with antipsychotics, e.g., haloperidol (106,(109)(110)(111); benzodiazepines (108); and antidepressants, e.g., amitriptyline (106,108). No fatalities have been recorded.…”