Introduction: Organophosphorus POISONING (OP) represents a significant public health issue, particularly in developing countries, due to its extensive availability and high toxicity. Standard management includes atropine and oximes such as Toxogonin,however, emerging evidence suggests potential adverse effects associated with oximes. Case presentation: This case report examines the uncommon occurrence of acute KIDNEY injury (AKI) in a 64-year-old Egyptian farmer following accidental dermal and inhalational exposure to OP pesticides. The patient presented with symptoms of OP POISONING, including dizziness, sweating, and fasciculations. Initial treatment with atropine and Toxogonin (obidoxime) resulted in temporary symptomatic improvement. Nevertheless, renal function progressively deteriorated after initiating Toxogonin therapy, evidenced by elevated urea and creatinine levels. Renal impairment coincided temporally with Toxogonin administration and improved following its cessation. Discussion: Potential mechanisms of Toxogonin-induced AKI include direct nephrotoxicity, altered renal perfusion, or immune-mediated injury. Other causes, such as rhabdomyolysis, systemic hypotension, or intrinsic OP nephrotoxicity, were ruled out to reinforce the likelihood of oxime-related renal impairment. While oximes are essential in OP POISONING management, this case emphasizes the necessity for clinical vigilance concerning their potential nephrotoxic effects. Conclusion: The findings highlight the need to reassess the use of oximes, especially in patients with pre-existing renal conditions. Furthermore, additional research is required to elucidate the mechanisms and determine risk factors associated with oxime-induced nephrotoxicity.

Introduction: The compound 2, 4 Dichlorophenoxyacetic acid (2, 4-D) is present in most combinations of herbicides and is widely used by farmers in India, especially against weeds in cereal crops. Few self-POISONING cases have been reported worldwide, with guarded prognosis in most cases. Inadequate history regarding deliberate intoxication, indistinct clinical presentation, and unavailability of diagnostic facilities to detect and estimate the agent make it a significant concern in POISONING as it mimics one of the commonest POISONING which is organophosphorus POISONING. The therapy and management of this POISONING as well as prognosis of patients are not well described due to the paucity of cases in published literature. Case report: We present a case of 2, 4-D POISONING with a successful clinical outcome and highlight the challenges faced in management. Our patient (A 41-year-old farmer) had a stormy clinical course in the hospital with acute KIDNEY injury developing after a few days,he received supportive therapy along with renal replacement therapy in the form of hemodialysis. He however recovered completely and was well at follow-up. We also review the optimum management of this condition so that emergency medicine physicians and allied health personnel involved in caring for these patients can manage this effectively. Discussion: The toxicity of 2, 4 D POISONING mimics the common organophosphorus POISONING in terms of symptoms. Nephrotoxicity has been described mainly due to tubular toxicity though this may manifest later in the course of hospitalization. Early initiation of alkaline diuresis not only augments the elimination of toxins but also prevents nephrotoxicity. The worsening toxin-induced acute KIDNEY injury/acute renal failure should be promptly managed by hemodialysis, as it also helps in the elimination of 2, 4-D. Conclusion: 2, 4-D POISONING remains a significant clinical challenge due to its non-specific presentation. This article contributes to the limited available literature on this potentially fatal condition highlighting the successful management of a severe case through a multi-modal approach involving alkaline diuresis, hemodialysis, and potentially corticosteroids. Further research is needed to elucidate the pathophysiology of 2, 4-D toxicity and to develop specific antidotes.

Background: Cartap is a class 4 pesticide and categorized by the insecticide resistance action committee (irac) as safe and non-toxic to people. The main routes of exposure include ingestion, skin contact, and eye contact. Case presentation: A 35-year-old man, a bus driver from South Kerala, was bought to the emergency department with history of consumption of cartap hydrochloride after two hours of POISONING. Results: All the necessary measures were taken to prevent further exposure to the poison. Patient was intubated and mechanically ventilated. The patient's condition began to deteriorate gradually, culminating in multiorgan dysfunction and eventual death on the 7th day of hospitalization, with no restoration of consciousness. Conclusion: This report enables medical professionals to identify and manage an uncommon POISONING that causes lethal toxicity.

Background: Acute KIDNEY Injury (AKI) is an abrupt decrease in KIDNEY function, leading to the retention of urea and other nitrogenous waste products. Poisoned patients admitted to the Intensive Care Unit (ICU) may develop AKI due to some reasons. This study was done to evaluate the AKI in poisoned patients admitted to ICU. Methods: 146 patients, admitted to the ICU of Imam Reza Hospital from March 2017 to March 2018 were studied. AKI status was assessed using Acute KIDNEY Injury Network (AKIN) and Risk, Injury, Failure, Loss of KIDNEY function and End-stage KIDNEY disease (RIFLE) classification. Data analysis was done through SPSS V. 22 software. Results: Opioids, organophosphates, aluminum phosphide, multiple drugs, and other types of POISONING were the main five POISONING classes. Opioid toxicity was had the highest frequency with 51 patients; cases in this group experienced longer length of hospitalization stay and higher serum creatinine level than others did. Among 146 patients, 19 patients (12. 8%) died, and 97 patients (66%) were transferred to the ICU. Of all cases, 18 patients (12. 3%) had renal dysfunction (six patients were at risk, five patient at injury, and seven patients were at failure phase based on the RIFLE criteria). Renal replacement therapy was required in 24 cases (16. 4%). Conclusion: It is unlikely to detect a significant difference in the occurrence of AKI between the main POISONING classes. Being the largest group of intoxicated patients admitted to the ICU, the opioid POISONING had the highest rate of AKI.

This study aimed to investigate the protective effects of pomegranate peel (PoP) extract on the gill, liver, and KIDNEY tissues of common carp exposed to cadmium (Cd). For this purpose, 150 common carp weighing 65 ± 0.85 g were randomly divided into five groups with three triplicates for each group (30 fish per group). The control group received a standard diet without cadmium chloride (CdCl2), the Cd group was exposed to 0.5 mg/L CdCl2, and the extract groups received PoP extract with concentrations of 1%, 2%, and 4% (percentage of food weight) along with 0.5 mg/L CdCl2 in the water. After four weeks, tissue samples were collected from the gill, liver, and KIDNEY and stained with hematoxylin and eosin for histopathological examination. In the gills of the Cd group, lesions included congestion, hemorrhage, clubbing or fusion of the secondary lamellae, and telangiectasia of the lamellae. The liver tissue of the Cd group exhibited severe degeneration and necrosis of hepatocytes, while hemorrhage, congestion, cellular degeneration or necrosis, and hyaline cast were visible in the KIDNEY tissue of this group. The severity of the mentioned lesions was significantly reduced in the PoP extract groups, particularly at concentrations of 2% and 4% (p < 0.05). Based on the results, it can be concluded that PoP extract has significant protective effects on the gill, liver, and KIDNEY tissues of common carp exposed to CdCl2.