Summary The aim of the study was to carry out a toxicological chemical analysis of methanol in detectable quantities in the blood of patients with acute alcohol intoxication. Blood samples from 85 patients with acute alcohol intoxication were analysed for the presence of methanol. All patients with acute methanol intoxication were excluded from the study. The methods of gas chromatography with vapor-phase analysis (head-space) and flame ionization detection (FID) were used. The limit of detection (LOD=0.015 g/L) and the limit of quantification (LOQ=0.025 g/L) of methanol in whole blood were evaluated. In 30% of the cases, methanol was found in the blood in detectable quantities. The levels of methanol were on the average 5 to 6 times lower than the toxic methanol level (0200 g/L) and they were not due to natural metabolic processes (ingestion of fruit, fruit juices or vegetables). No reliable statistically linear correlation between the concentration of ethanol and methanol was found. Methanol subintoxications are major factors in alcohol intoxications, in which the quantity of the alcohol ingested is not as important as its quality. Chronic methanol subintoxication of people who often consume alcohol of poor quality is discussed.

Purpose: To develop a simple yet sensitive, reliable and robust method for qualitative determination of cocaine and a series of its tropane metabolites in biological samples (blood, urine, etc.). The method should be optimized for routine forensic expertise in analytical toxicology.\ud Material/Methods: Gas chromatography coupled with mass spectrometry (GC-MS) has been used as the method for analytical identification. Certified analytical standards were used as a reference material for validation.\ud Results: Sample preparation procedure has been simplified and organized in such a way, that only common reagents are required. Initial matrix purification is done by means of solid phase extraction (SPE), during which a carefully chosen set of simple solvents is applied. Additional derivatization (BSTFA/MTBSTFA) has been shown to be of a major importance for benzoylecgonine determination. Limit of detection (LOD) has been determined to be as low as 50 ng/mL for cocaine and 25 ng/mL for benzoylecgonine. Results are given within 90 minutes

Purpose: To develop and implement a UHPLC method for quantitative determination of sertraline in biological samples – mostly human blood and urine.\ud Material&Methods: Blood and urine samples available from Laboratory of analytical toxicology and Clinic for intensive treatment of acute intoxications and toxicoallergies were used during method validation and case monitoring. Analytical identification of sertraline and/or metabolites was done by GC-MS. Gas chromatography coupled with flame ionization detection was used for alcohols/volatiles screening of clinical samples. Ultra high-performance liquid chromatography system in tandem with diode-array detector has been used as the main quantitative instrument.\ud Results: After critical consideration of available reference data a carefully set of experimental conditions for sertraline extraction and UHPLC determination were adopted and optimized. Preliminary liquid-phase sample purification was applied. Zorbax Extend-C18 column (150 x 4.6 mm, 5 µm) was used under isocratic conditions with phosphate buffer (pH 2.7; 10 mM) containing 1.5 ml L–1 triethylamine – acetonitrile (65:35, v/v) at 20oC, at the flow-rate of 1.0 mL/min and UV detection at 220 nm. This method was validated for the determination of sertraline in human plasma/serum samples (70% recovery).\ud Conclusions: A simple yet sensitive and reliable method for sertraline determination was introduced. Linearity over 20-1000 ng mL–1 range was shown; LOQ was 20 ng mL–1. The method was clinically applied for monitoring the blood sertraline levels during a course of detoxication of a female patient

Purpose: Poisoning with drugs occupies a leading position among the causes of acute intoxications. Etiological distribution of medicated poisoning in different countries, even if they are adjacent, is different. In the most studies it was reported that the highest incidence of poisoning is with benzodiazepines or other psychoactive drugs. A retrospective analysis of acute poisoning with benzodiazepines and other hypnotic drugs in the Varna region for 25 years period – from 1991 to 2015 was carried out.\ud Material and Methods: The number of patients who received hospital treatment after poisoning with benzodiazepines is 1741, and those with other hypnotics is 293, representing respectively 26.37% and 4.44% of all drug intoxications.\ud Results: The share of poisoning with benzodiazepines and hypnotics compared to all acute intoxications is 11.66%. They are more common in women – 1566 (77%). Men are 468 (23%), the ratio of men to women was 3.34:1. The largest number of intoxications is in the age group up to 24 years - 1123 (55.2%), and only 4.1% of patients over 60 years. Intentional suicide attempts are 1896 (93.2%). Death is registered in 8 (0.4%) patients

Caffeine is widely consumed and generally considered safe at customary doses. How-ever, high-dose preparations available online pose a risk of severe and potentially fatal intoxication. Although uncommon, lethal caffeine poisoning is associated with profound cardiovascular and neurological toxicity. A rare case of intentional acute caffeine intoxication with fatal outcome is presented. A 25-year-old woman ingested an estimated 60 tablets containing 200 mg of caffeine each, purchased online. She was admitted to hospital shortly after ingestion of the caffeine tablets with palpitations, agitation, dizziness, and repeated vomiting. On examination, she presented with arterial hypotension (90/60 mmHg) and marked sinus tachycardia (150 beats/min), accompanied by psychomotor agitation. Her blood caffeine concentration measured by means of high-performance liquid chromatography (HPLC) was 177 µg/mL. The patient’s condition rapidly deteriorated, with the development of convulsive syndrome progressing to coma, extreme ventricular tachycardia, exotoxic shock, and toxic cardiomyopathy. Despite intensive care management, including mechanical ventilation and advanced cardiopulmonary resuscitation, the patient died several hours after admission. In conclusion, this case underscores the life-threatening potential of acute high-dose caffeine ingestion and highlights the risk associated with unrestricted access to concentrated caffeine products. Early recognition and aggressive management are crucial, yet may be insufficient in cases of massive overdose.