Page 1048 - Basic _ Clinical Pharmacology ( PDFDrive )

1034 SECTION IX Toxicology

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C ASE STUD Y ANSWER

Bacterial food poisoning is the most common cause of gas- the likelihood that inorganic mercury was responsible. An
trointestinal signs and symptom appearing in a group of indi- epidemiologic investigation subsequently revealed that all
viduals within several hours of a common meal. Consumption affected individuals had consumed the deliberately adulter-
of food contaminated with preformed bacterial toxins such as ated coffee, which contained 6300 ppm of inorganic arsenic.
Staphylococcus or Bacillus cereus toxins can result in vomiting Analysis of urine for arsenic and mercury and stool and
after an incubation interval as short as 1–2 hours. However, emesis for bacterial pathogens would be reasonable initial
the onset of vomiting in some individuals within 15 minutes diagnostic tests. Pending test results, prompt empiric treat-
and the progression to hypotension and metabolic acidosis in ment of this constellation of findings with the chelating agents
several individuals are not typical for bacterial food poisoning unithiol, succimer, or dimercaprol would be appropriate.
and are more suggestive of intoxication by certain toxic chemi- [Based on an actual incident, see: Gensheimer KF et al: Arse-
cals or drugs, including inorganic arsenic and mercury salts nic poisoning caused by intentional contamination of coffee at
(eg, sodium arsenite or mercuric chloride). The absence of a church gathering: An epidemiological approach to a forensic
hematemesis, bloody diarrhea, or renal insufficiency lowered investigation. J Forensic Sci 2010;55:1116].