HELP for a suspected case of poisoning

Fabrizio Agostini faagosti at tin.it
Thu Jul 23 12:21:44 EST 1998


Dear Sirs,

I am currently working on a suspected case of poisoning which is quite
controversial. I would sincerely appreciate the possibility to share ideas and
point of views and/or any help or suggestion that You may give me.

Due to the very superficial diagnoses that the subject received by
many doctors I will sometimes be forced to describe the case in common words
eventually adding patient's declarations between "".

I will not add my personal point of view to this message in order to not
influence in any way Your replies.

1 - THE SUBJECT:
================
A 32 years white male of about 112 kg body weight, perfectly healthy (before),
no surgeries, no fractures, no previously known health/mental problems, mild
smoker (about 15 cigarettes/day), doing various sports at hobby level, no
hearth/liver/kidney problems, no drugs or narcotics habitual user/abuser, no
sexual problems/diseases.

2 - SURROUNDING ENVIRONMENT:
============================
I have controlled both the home and the workplace of the subject
in order to find any source of possible intoxication/contamination without
being able to find something interesting. Other persons of the family and
other workers are healthy and have never showed similar symptoms. Also the
food (and places of food storage) consumed both at home and at work were controlled
without results.

3 - SUSPECTED WAY OF POISONING:
===============================
It is an over the counter drug (a supplement) taken at the proper daily dosage
under medical control during a period of moderate dieting. Each oral tablet weights
approximately 1,5 grams. Subject ingested about 40 tablets, one each day, with
earliest symptoms showing almost immediately in a mild way. I have already
attempted to trace in which plant was manufactured and where was stored the
suspected bottle: unfortunately I have obtained only limited information from
FDA (under the Freedom of Information Act) pertaining similar cases related to
the same drug while the manufacturer refused to disclose any information. It
should be pointed out that the patient was previously (months before) using, under
medical control, a similar supplement without experiencing any intolerance or
bad effect.

4 - THE SYMPTOMS:
=================
I will describe many symptoms using the patient's words.


4.1 - FIRST PHASE: "very strange, very very short and repeated loss of equilibrium
sense... they were short like an electrical shock... but I never felt
down... they were not like common vertigo such those that you normally may
have turning on yourself rapidly"; "I was feeling generally nervous... in
tension..."; "I noticed that my heartbeat increased a lot when standing up
from my chair at work and returned to normal rate in about 15-20 minutes"; "during
exercise I have sometimes abdominal pains like those related to diarrhea but
if I rest they stops"; "I was very sensitive to light and to heat which I
normally accepted very well"; "sometimes I was waking up suddenly with a very
accelerated heartbeat and lack of breath but I thought it was related to a bad
posture during the sleep"; "I was progressively losing my appetite specially
in the morning after taking one tablet of the drug... I noticed a sensation to
the stomach like being empty... like having had a very bad diarrhea...";
"sometimes I have bad headaches"; "a passenger in my car told me that I have
strange eyes and I noticed I had very dilated pupils looking me in the rear
mirror"; "I had sometimes a persistent sense of burning in the mouth but I
thought about inflamed gums".

The above symptoms were reported to doctors and were left without further
evaluation even if specific questions pertaining the drug were made by the patient.


4.2 - SECOND PHASE: the patient suffered even more repeated and frequent
equilibrium loss. It is interesting to note that the duration of the loss is
reported to remain almost the same while the frequency of attacks increases.
Serious headaches and nausea. Horthostatic phenomena increases: when
patientraises from a sitting position tachicardia is near to unbearable while
it is reported a "sense of loss of consciousness" when raising from a laying
position to a sitting position. Sudden weak up increases. Loss of appetite
increases. Patient is almost working in the dark. Intolerance to noises arise.
Extra systoles phenomena are reported. Urination increase and mild diarrhea
are reported. Very prolonged MYDRIASIS (also after 7-8 hour after drug
ingestion) is reported specially in occasions were food intake was
moderate/reduced (travel etc.). Patient reports left testicle increased in
size and involuntary releases of drops of seminal liquid in circumstances not
related to sexual stimulation. Scotoma has been reported. Back pain and
rigidity has been reported.
EVENT: during the morning shower the patient suffered involuntary contractions
of the back musculature: "they were like deep waves starting from gluteus and
running on all my back to my neck where they exploded in an unbearable
sensation of heat to the back of the neck... I also had heartbeat
increase, diarrhea and increased urination". A general ipermobility sensation
is reported. The crisis of back fasciculations was about 5 minutes long while
the entire phenomena lasts for one hour. Patient loss 3 kg of body weight
during the day and started to be near to totally anorexic. 

Valeriana pills were advised by the doctor and
the patient reports that they were somewhat useful to "open the stomach and
try to eat something". Situation was treated as a panic attack syndrome. No
analyses were performed as the diagnosis was made by telephone and then
confirmed at glance. Valeriana pills were prescribed to be taken at necessity.
Patient interrupted the suspected drug for a day waiting to see the doctor: he
regained a better condition. Doctor prescribed to continue with the suspected
drug stating that there was not any
connection between the drug and the symptoms.


4.3 - THIRD PHASE: patient becomes almost totally anorexic (he took about one
hour to ingest 100 grams of carbohydrates). Horthostatic problems are at peak.
Digestive problems. Acute weakness and nausea. Repeated and serious extra systoles.
Tachicardia and bradicardia. Patient sleeps only few minutes, only in a
semi sitting position and only on the left side: all other postures cause a
sense of lack of consciousness. Sudden weak up increases. Parestesia. Tingling.
Patient stops smoking because just one cigarette makes him "feeling very bad".
Patient is unable to drink any form of alcohol (even very mild) and to consume
coffee or caffeine containing products (unable to drink a simple Coca Cola) as
he report symptoms similar to those suffered if smoking. Sensation of thoracic
constriction ..."like being underwater"... and some pains in the sternal
region have been reported. Some diagnoses of digestive blocking have been made
during some acute events. Patient is feeling continuously ill and it is almost
unable to work or to attend to his normal activities.

Another doctor changes the prescription from Valeriana to Xanax 1,5 mg. No
analyses were performed. Patient insists that all his problems have started
with the use of the suspected drug. Doctor advises to continue with the drug
while patient stops the assumption by himself. Patient showed to be very
sensitive to Xanax as 1,5 mg helped him to eat a little but precipitated him
in an half an hour, sitting position sleep, 30 minutes after assumption.
Patient sees a neurologist which advises to continue with Xanax and add
Prozac without making any analyses: once more a diagnosis of panic attacks has
been made at glance. 

5 - ANALYSES:
=============
It MUST be observed that the blood testing of the subject in a period before
but close to the assumption of the suspected drug were all normal. 

Patient stops Xanax and do not even start to take Prozac and experience
immediately a general amelioration of his conditions while sees a cardiologist
to discuss his problems. After one year finally some analyses are prescribed
(after insistent request of the subject).

Urine normal. 

All blood levels including hormonal levels and protidograph are found in a
normal range excluding:

PROTEINS TOTAL (met. biureto): g/dl 8.1 (against a max. of 8.0)
ALT/GPT (met. IFCC 37C): 80 u/l (against a max. of 45)
GAMMA-GT (met opt. DGKC 37C): 47 (against a max. of 45)
CHOLESTEROL LDL: 182 mg/dl (against a max. of 170)
CHOLESTEROL HDL: 42 mg/dl (against a min. of 40 - in the norm but close to the border).

Further investigation for hepatitis results all negative.

Hecography of the upper abdomen shows a liver with slightly augmented
dimensions and tissue finely non homogenous as for diffuse hepatopaty. No
focal images.

Neck carotid are pervious as for doppler test.

ECG Holter 24 hours shows sporadic paroxistic atrioventricular hearth blocks
of 1° grade and many atrioventricular hearth blocks of 2° grade Mobitz 1. 
ECG Holter 48 hours gives an image of ipocinetic arrhythmia with atriov.
hearth blocks 1° grade, many atriov. hearth blocks 2° grade, short interval of
atriov. hearth blocks 2:1 and a period of AV incomplete dissociation. Some
upper ventricular not repetitive extra systoles are observed.

Cardiac ecocolordoppler normal.

Testing for cathecolamines in urine results normal.

X rays of torso region is normal.


6 - BACK PAINS, EARS, MOUTH, YELLOW SWEAT:
==========================================
Cardiologist conclusion is that a probably toxic phenomena has occurred.
Suspected product is not taken in consideration. No therapy is administered.
Lexotan drops are given in substitution of Xanax tablets to be taken at
necessity to control what is suspected to be extra systoles. Patient is advised
to reprise sport activity...!

From this moment the patient, being still ill and seriously incapacitated,
sees a lot of other doctors and specialist receiving the most disparate
suggestions from placing a pacemaker to don't do anything.

Patient starts to have broken teethes and many perforating cavities (for two years).

Repeated auricular occlusions to the same ear occur requiring specialist
intervention. Hearing is normal as all other pertaining organs. This doctor
suspects a central poisoning. 

After 3,5 years (without any kind of therapy):

ALT/GPT (met. IFCC 37C): 55 u/l (against a max. of 45)
GAMMA-GT (met opt. DGKC 37C): 48 (against a max. of 45)
CHOLESTEROL LDL: 141 mg/dl (against a max. of 170)
CHOLESTEROL HDL: 54 mg/dl (against a min. of 40).

Back pains are so intense (the specialist is talking of fibromialgia to the
dorsal region) that patient is almost unable to sleep or is been waken up by
pains. Subject receives a one year treatment of intensive chirotherapy and,
after one year, a 3 weeks administration of interferential electrotherapy with
modest results. 

NOTE: the only thing that seems to give some relief and a general amelioration
of the condition is administration of a B vitamin complex for short periods
before going to bed.

Patient develops also near incapacitating pains to feet but x-rays do not show
fractures. Pains have ameliorated with time.

NOTE: after about two years patient started to leave bright YELLOW indelible
traces on the towels and on his shirts during summer. Apparently this yellow
color has
been transported out of the body by sweat. Checking of home, workplace, food,
shoes, clothes etc. for other reasonable sources of the color proved negative.


7 - LAB TESTING ON THE PRODUCT:
===============================
GC/MS and "head space" were not able to "see" almost anything.

ICP/MS showed unexpected abundance os sulfur inside the product (about 10
times more) and unexpected presence of aluminum, strontium, sodium, titanium.

HPLC/MS showed unexpected presence of a molecule containing chlorine at 242 M.W.
which has a quite long alkyl chain inside it. We are trying to refine
this test.




Any help, suggestion or comment will be highly appreciated.

Thank You in advance and best regards to all the members from Florence, Italy.

----------------------------
Fulcrum Institute
Fabrizio Agostini
Director
e-mail: faagosti at tin.it
----------------------------



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