Case studies on poisoning

Habibul was a healthy 10 years-old boy who suffered from time-to-time with mild eczema
which usually resolved itself without the need for treatment. On one occasion, however,
Habibul’s eczema was much worse than normal and he complained to his mother about the
itchy, painful red skin behind his knees. His mother who believed in traditional remedies
consulted a local herbalist who supplied her with a paste containing ground up Nicotiana
leaves, coffee beans and lime. On returning home she applied the paste to Habibul’s legs.
About 30 minutes later, Habibul began to feel dizzy and nauseous and he was unsteady on his
feet. Soon afterwards he vomited and started to drool and perspire. He complained of pains
in his stomach and became very agitated.
On admission to hospital it was noted that Habibul was sweaty and drooling but his body
temperature was normal, his pupils were dilated and his pulse rate and blood pressure were
both elevated. His level of consciousness varied and during one period of agitation he had a
generalized seizure. With supportive care and appropriate treatment, Habibul recovered but
some symptoms such as increased perspiration lasted for three days.
Questions
 What toxidrome best fits Habibul’s symptoms?
 What is the likely toxicant and its source?
 How does it produce its effects?
 Why in some patients do the tachycardia, hypertension and mydriasis progress to
badycardia, hypotension and miosis?
 Why does muscle weakness occur in some patients?
 Is the presence of lime in the herbal preparation significant?
 What are Green Tobacco Sickness and Cow’s Urine Concoction?
 How might poisoning of young children with this toxicant occur in the domestic
environment?
Case study 2
Outline of case
Mike and Dean worked as car mechanics. They were good friends but Dean liked to gamble
and frequently borrowed small sums of money from Mike which he normally paid back as

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soon as he could. However, the relationship between the two men deteriorated when, after a
losing streak, Dean confessed that he could not pay back what he owed. Mike decided to
teach Dean a lesson so he put about 60 mL of antifreeze fluid into Dean’s mug of sweet tea.
About 20 minutes after the tea break Dean began to feel merry and started to behave as
though he was thoroughly drunk. The workshop manager thought Dean had been drinking
during work so he sent him home with a warning that he would be dismissed if it happened
again. On the way home, Dean felt sick and started to vomit. He lost consciousness and was
admitted to a local hospital. Clinical tests revealed severe acidosis with raised ketones,
hypocalcaemia and the presence of microscopic crystals in urine. Dean eventually recovered
but he was left blind and his hearing was impaired.
Questions
 What was the likely toxicant?
 How is it metabolised?
 Explain the outcomes of the clinical tests
 Why might Dean have felt weak and why might some of his muscles have gone into
tetany?
 What treatments do you think Dean received and why were these treatments used?
 Why are dogs and cats at risk from poisoning with this agent?
 Is there any connection between this case study and cases of poisoning following
ingestion of rhubarb leaves?