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end of dialysis (p = 0.05, PS = 2.048). Mean for dialysis uid Sr concentrations was 38.17 7.74 g/L. The dialysis uid plays an important role in the acumulation of the element in the dialyzed patients. Hemoglobine range was 7.513.7 g/dl, PCR range was 0.112 UI and albumine range was 2.64.21 mg/L. Conclusions: We conclude that the present method is accurate and precise and may be useful for routine applications for strontium determination in whole blood of CRF patients. doi:10.1016/j.toxlet.2007.05.356 P22 Epidemiological prole of acute carbon monoxide poisoning admitted in ICU II Toxicology of Emergency Clinical Hospital Bucharest between 1997 and 2006 Radu Alexandru Macovei 1 , Ilenuta Luciana Danescu 1 , Genica Caragea 2 , Victor Voicu 2
1 ICU II Toxicology, Emergency Clinical Hospital, Bucharest, Romania; 2 Analytical Toxicology Laboratory of the Army Center of Medical Research, Bucharest, Romania

prevalence from year to year, affects relatively young population and is mainly accidental. The improper functioning of central heating is the most important cause of the poisoning. It is important to improve the legislation and the general public education. doi:10.1016/j.toxlet.2007.05.357 P23 A study of acute poisoning by p-phenylenediamine (hair dye) used orally in Upper Egypt Khaled Mohamed 1 , Maha Hilal 2 , Abd-Elmonem Abd-Elmoty 1
1 Assiut

Chemical Laboratory, Medico-Legal Department, Ministry of Justice, Assiut, Egypt; 2 Forensic Medicine and Toxicology, Faculty of Medicine, Sohag University, Sohag, Egypt Background: p-Phenylenediamine is primarily used as a dye intermediate and as a dye. In Upper Egypt black stone (commercial name) p-phenelenediamine (chemical name) is considered as one of the potent and cheap traditional material that utilized as hair dye. Aim: Evaluation of the problem of hair day toxicity in Upper Egypt as regards prevalence and management. Methods; along nearly 3 years (March 2004 to February 2007), we followed up the reported cases of acute toxicity by black stone which had been admitted to hospitals in Upper Egypt. Thirty-nine toxic cases by p-phenylenediamine were recorded. Their ages were ranging from 2 years to the 6th decade of life. Twelve of the recorded cases were males while the remainders 27 were females. Result: Thirty-ve cases were suicidal while two cases were homicidal and two cases were accidental. All the toxic female cases were suicidal except the child which was accidental, while the two homicidal and the accidental cases were males. The common manifestations of the recorded cases were severe edema of the face, eyes, mouth, pharynx and larynx, asthma, gastritis manifested by vomiting and abdominal pain, tremors, convulsions and coma. Discussion: Manifestations of acute renal failure were detected in the cases of longer survival. This came in agreement with death occurred within hours in most of cases while some cases lived for 1 day or more, the longest interval of life after toxicity was 3 days. Only one case of a male child 11 years old was saved by the use of hemodialysis, early after intoxication. While the other cases were managed by administration of antihistamines, corticosteroids, uids and other antishock measures. Tracheostomy was a common line of management. The post-mortem picture generally shows edema of the eyes,

Background: Carbon monoxide (CO) is the leading cause of the accidental poisoning worldwide. Acute carbon monoxide poisoning is the most common poisoning during the coldest months of the year in our country. Methods: We present the epidemiological prole of acute CO poisoning admitted between 1997 and 2006. Results: During 10 years, a total of 1070 cases of acute CO poisoning were diagnosed and admitted, with the frequency in total poisonings as follows: 19971% (34 cases), 19982.35% (73), 19992.64% (71), 20004.59% (113), 20015.22% (111), 20026.02% (127), 20039.39% (141), 20049.52% (126), 200512.89% (145), 200612.72% (129). Cases with COHb higher than 15% were admitted only. The mean age was 27.8 6.5 years (range 1590). There were 51.65% males and 48.35% females. The greater frequency was in November, December and January. CO poisoning was accidental in 98% of cases and in 84% of them related to house heating systems. Improper combustion of wood (32%) and natural gas (57%) were implicated. The main route of exposure was respiratory in all cases. The main symptoms were headache (92%), dizziness (52%), nausea (42%), and loss of consciousness (34%). Specic treatment with oxygen by mask was used in all cases. The mortality was 0.54%. Conclusion: Acute CO poisoning has a high

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mouth, larynx and neck. Congestion and ulceration of the stomach. The kidneys appeared swollen and deeply black in colour. Urine was scanty and black in colour. Detection of p-phenylenediamine was done by TLC and HPLC. Conclusion: p-Phenylenediamine is considered as a tool for suicidal and homicidal crimes. It is recommended to do further researches for the value of the use of hemodialysis in the management or nd effective antidotes against that aggressive rapidly killing poison. doi:10.1016/j.toxlet.2007.05.358 P24 A prospective comparative cohort study on the dosing pattern of atropine in organophosphate poisoning in rural Sri Lanka Mark Perera, Sayed Shahmy, Andrew Dawson University Of Peradeniya, Peradeniya, Sri Lanka Objective: There is wide variation in the recommendation for atropine dosing schedules and subsequent variation in clinical practice. The purpose of this paper is to examine the safety and efcacy of atropine in a cohort of patients with acute cholinesterase inhibitor pesticide poisoning. Design: A prospective cohort study was conducted in three provincial secondary referral hospitals in Sri Lanka using a structured data collection form that collected details of clinical symptoms and atropine dosing. We compared two hospitals using a titrated dosing protocol and structured monitoring sheet for atropine with another hospital using a xed dose regimen. Findings: Symptomatic patients (226) were recruited in three secondary referral hospitals. Chlorpyrifos was the most common organophosphate in each hospital. The majority of patients were males (148). There was no signicant difference in mortality between the three hospitals. Signicantly higher doses of atropine were given at the hospital using xed doses. At this hospital the average rate of atropine infusion was 2.1 mg/h and this was associated with 1.5 times longer hospital stay than the other hospitals. This hospital also had higher rates of delirium (23% versus 0.8%), hallucinations (30% versus 0.8%) and need for patient restraint (48% versus 2%). Conclusions: Fixed high dose atropine regimens are associated with more frequent atropine toxicity without any improvement in patient outcome compared with doses titrated for clinical effect. The need for patient restraint would appear to be a strong indication of excessive atropine use. Atropine doses should be titrated against response and toxicity. Further education and the use of a structured monitoring sheet may

assist in more appropriate atropine use. It is likely that xed dosing schedules are used in other rural hospitals in Asia and causing signicant morbidity and unnecessary expense. doi:10.1016/j.toxlet.2007.05.359 P25 Oxidative stress in heroin abuse and detoxication Zanina Pereska, Cvetanka Bozinovska, Lidija Petkovska, Danail Petrovski, Aleksandra Babulovska Clinic of Toxicology and Urgent Internal Medicine, Clinical Center-Skopje, Skopje, Macedonia Objectives: The aims of this study are to estimate the level of the systemic oxidative stress (OS) in heroin addicts with regular abuse of heroin and detoxication (chlorpromazine and benzodiazepine) and to evaluate the correlation between the observed parameters of OS. Materials and methods: The study is designed as crosssectional one including 20 pts on regular heroin abuse, 26 pts on detoxication programs and 22 pts representing control group. The average age of the pts was 23.6 4.2 years, more males (58 males/10 females) (2 = 33.882, d.f. = 1, r < 0.01), referent BMI (22.69 5.8 kg/m2) and predominantly intravenous use of heroin compared to inhalation (2 = 28.174; d.f. = 1, r < 0.01). Statistical testing showed homologue intergroup distribution of age sex, BMI, route of drug administration and period of heroin misuse (7.20 3.13 years). They were anti HIV antibody negative, negative urine analysis on psihostimulative drugs and blood alcohol levels, normal plasma C-reactive protein and serum aminotransferases levels. OS was evaluated by measuring free radical production using estimating reactive oxygen substances (d-ROMs, colorimetrical, DIACRON) and lipid per oxidation by measuring the intermediary-product of this reactionmalondialdehid (MDAcolorimetrical, using TBARS method). Results: Statistically signicant difference was noted for d-ROMs (d.f. = 3, F = 6.651, p = 0.001) and MDA (d.f. = 3, F = 5.295, p = 0.003) in heroin group (d-ROMs 349.35 102.2 UCarr, MDA 4.0176 0.38768 mol/L) compared to the detoxication (d-ROMs 230.18 96.396 UCarr, MDA 3.5937 0.30653 mol/L) and control group (d-ROMs 349.35 102.2 UCarr; MDA 3.7136 0.2455 mol/L). The values of both parameters showed signicant positive correlation (r = 0.647, p < 0.001) completely dening OS in studied heroin addicts. Conclusion: Heroin abuse induces increased systemic OS and lipid peroxidation. Introduction of detoxication improves the