Fatal Intoxications Due to Administration of Isosorbide Tablets Contaminated with Pyrimethamine
Identifieur interne : 000E14 ( Main/Exploration ); précédent : 000E13; suivant : 000E15Fatal Intoxications Due to Administration of Isosorbide Tablets Contaminated with Pyrimethamine
Auteurs : Muhammad Imran [Pakistan] ; Humera Shafi [Pakistan] ; Zahid Mahmood [Pakistan] ; Mohammad Sarwar [Pakistan] ; Hafiz Faisal Usman [Pakistan] ; Mohammad Ashraf Tahir [Pakistan] ; Muhammad Zar Ashiq [Pakistan]Source :
- Journal of Forensic Sciences [ 0022-1198 ] ; 2016-09.
Abstract
In January 2012, 664 cases of pyrimethamine toxicity and 151 deaths were reported among cardiac patients that had recently received free medicines from pharmacy of Punjab Institute of Cardiology, Lahore, Pakistan. These patients, ages ranged from 58 to 75 years, were prescribed simvastatin, clopidogrel, aspirin soluble, isosorbide mononitrate, and amlodipine. On examination of medications being given to them, it was found that a particular batch of isosorbide mononitrate tablets was contaminated with 50 mg pyrimethamine. Cardiac patients were taking isosorbide contaminated with pyrimethamine twice daily (100 mg pyrimethamine/day), whereas therapeutic dose of pyrimethamine for malaria is 25 mg/week. Postmortem urine, cardiac blood, and femoral blood specimens of three deceased males were submitted to author's laboratory for analysis. Postmortem toxicological analysis revealed that pyrimethamine concentration fell within the range of 1–10 μg/mL by liquid chromatography. Clinical, autopsy, histopathological, and toxicological findings strongly suggested toxicity due to pyrimethamine accumulation that resulted in deaths of these cardiac patients.
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DOI: 10.1111/1556-4029.13125
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These patients, ages ranged from 58 to 75 years, were prescribed simvastatin, clopidogrel, aspirin soluble, isosorbide mononitrate, and amlodipine. On examination of medications being given to them, it was found that a particular batch of isosorbide mononitrate tablets was contaminated with 50 mg pyrimethamine. Cardiac patients were taking isosorbide contaminated with pyrimethamine twice daily (100 mg pyrimethamine/day), whereas therapeutic dose of pyrimethamine for malaria is 25 mg/week. Postmortem urine, cardiac blood, and femoral blood specimens of three deceased males were submitted to author's laboratory for analysis. Postmortem toxicological analysis revealed that pyrimethamine concentration fell within the range of 1–10 μg/mL by liquid chromatography. Clinical, autopsy, histopathological, and toxicological findings strongly suggested toxicity due to pyrimethamine accumulation that resulted in deaths of these cardiac patients.</div></front></TEI><affiliations><list><country><li>Pakistan</li></country></list><tree><country name="Pakistan"><noRegion><name sortKey="Imran, Muhammad" sort="Imran, Muhammad" uniqKey="Imran M" first="Muhammad" last="Imran">Muhammad Imran</name></noRegion><name sortKey="Ashiq, Muhammad Zar" sort="Ashiq, Muhammad Zar" uniqKey="Ashiq M" first="Muhammad Zar" last="Ashiq">Muhammad Zar Ashiq</name><name sortKey="Mahmood, Zahid" sort="Mahmood, Zahid" uniqKey="Mahmood Z" first="Zahid" last="Mahmood">Zahid Mahmood</name><name sortKey="Sarwar, Mohammad" sort="Sarwar, Mohammad" uniqKey="Sarwar M" first="Mohammad" last="Sarwar">Mohammad Sarwar</name><name sortKey="Shafi, Humera" sort="Shafi, Humera" uniqKey="Shafi H" first="Humera" last="Shafi">Humera Shafi</name><name sortKey="Tahir, Mohammad Ashraf" sort="Tahir, Mohammad Ashraf" uniqKey="Tahir M" first="Mohammad Ashraf" last="Tahir">Mohammad Ashraf Tahir</name><name sortKey="Usman, Hafiz Faisal" sort="Usman, Hafiz Faisal" uniqKey="Usman H" first="Hafiz Faisal" last="Usman">Hafiz Faisal Usman</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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