potassium-permanganate and Manganese-Poisoning

Encephalopathy caused by manganese compounds used for illicit production of ephedrone (methcathinone) is described. The onset of disease could be observed after some months of regular intravenous use of ephedrone contaminated with manganese. In clinical picture dominate neurological signs and symptoms, mainly extrapyramidal syndromes: parkinsonism, tremor, muscle distonia, pro- and retropulsion. Some other symptoms may be observed: hypophonia or dysarthria, gain disturbances, impairment of precise movement, and micrographia. In cranial NMR often appears bilaterally an increase of an intensity of T1 signal in globus pallidus and in some other brain structures. Elimination of manganese with the use of chelating therapy as well as symptomatic treatment, mainly with the antyparkinsonic drugs, seems to be ineffective.

Topics: Brain Chemistry; Brain Diseases; Chelation Therapy; Humans; Injections, Intravenous; Magnetic Resonance Spectroscopy; Manganese Poisoning; Potassium Permanganate; Propiophenones

To examine a syndrome of chronic manganism that occurs in drug addicts in eastern Europe who use intravenous methcathinone (ephedrone) contaminated with potassium permanganate. In many cases the basal ganglia, especially the globus pallidus and the putamen, are damaged irreversibly. Routine neuropsychological assessment has revealed no cognitive deficits, despite widespread abnormalities on brain imaging studies and severe extrapyramidal motor handicap on clinical examination.. Case-control study.. Ephedrone patients and patients with opioid dependence were recruited from Lviv, Ukraine.. We tested 15 patients with ephedrone-induced toxicity, 13 opiate-dependent patients who were receiving opioid replacement therapy and 18 matched healthy volunteers.. The 'beads task', an information-gathering task to assess reflection impulsivity, was used and feedback learning, working memory and risk-taking were also assessed.. Opiate-dependent patients differed from controls on three of four tasks, whereas ephedrone patients differed from controls on only one task. More specifically, both patient groups were more impulsive and made more irrational choices on the beads task than controls (P < 0.001). However, ephedrone patients had no deficits in working memory (P > 0.1) or risk-taking (P > 0.1) compared with controls. Opioid-dependent patients had significantly worse working memory (P < 0.001) and were significantly more risk-prone than controls (P = 0.002).. Ephedrone patients may have similar deficits in information-gathering and decision-making to opiate-dependent patients, with preservation of working memory and risk-taking. This may reflect specific damage to anterior cingulate- basal ganglia loops.

Topics: Adult; Amphetamine-Related Disorders; Case-Control Studies; Decision Making; Drug Contamination; Feedback, Psychological; Female; Humans; Impulsive Behavior; Information Seeking Behavior; Male; Manganese Poisoning; Memory, Short-Term; Neuropsychological Tests; Opiate Substitution Treatment; Opioid-Related Disorders; Parkinson Disease, Secondary; Potassium Permanganate; Propiophenones; Risk-Taking; Substance Abuse, Intravenous

Recently, neurological abnormalities in methcathinone users have been attributed to manganese. We report similar toxicity in three patients following the use of a mixture similar to methcathinone: potassium permanganate, ephedrine, and aspirin.. Three teenagers (15 to 19 years old) presented with extrapyramidal abnormalities and movement disorders following chronic intravenous use of a mixture known as "Russian Cocktail". All three patients had multiple movement disorders. One patient had normal blood manganese concentration (<19 microg/L) and MRI. The other two had elevated blood manganese (2100 microg/L and 3176 microg/L) and MRIs showing bilateral symmetric hyper-intensities on T1-weighted-images in the dentate nucleus, subcortical white substance of cerebellar hemisphere, globus pallidus, and putamen. Abstinence and treatment with EDTA, levodopa, and para-aminosalicylic acid was associated with decreasing blood manganese concentrations and subjective improvement, but no change in objective findings.. The "Russian Cocktail" likely contains manganese as a result of the oxidation of ephedrine by potassium permanganate in water acidified by acetylsalicylic acid. We believe that manganese with the possible contribution of methcathinone caused the neurological impairments.. Three toxic substances have been made into a mixture administered intravenously, similar to methcathinone. Our patients learned of this mixture, called "Russian Cocktail", from their friends. The toxicity from repeated use of this mixture is one of extrapyramidal abnormalities and movement disorders. Standard therapies were unsuccessful in reversing the clinical toxicity.

Topics: Adolescent; Aspirin; Basal Ganglia Diseases; Dyskinesia, Drug-Induced; Ephedrine; Humans; Illicit Drugs; Injections, Intravenous; Magnetic Resonance Imaging; Male; Manganese; Manganese Poisoning; Oxidation-Reduction; Potassium Permanganate; Substance Abuse, Intravenous; Treatment Failure; Young Adult

Chronic overexposure to manganese (Mn) may cause neuronal degeneration. Manganese intoxication is well known to induce parkinsonism. Manganese intoxication may be associated with abnormal magnetic resonance (MR) imaging (abnormal signal hyperintensity in the globus pallidus and substantia nigra on T1-weighted images).. We report an unusual presentation of manganese intoxication due to administration of a combination of acetylsalicylic acid and ephedrine HCl, potassium permanganate, and vinegar melted in tap water and administered parenterally as a psychostimulant substance in 2 cases who developed symptoms resembling parkinsonism. Neurologic examination of both cases revealed disturbances of the extrapyramidal system and a characteristic "cock walk." Tremor was present in the first case, whereas it was lacking in the second one. Cranial MRI showed bilateral symmetric T1-weighted hyperintense patterns in the globus pallidus, probably because of manganese accumulation. Different levels of response to levodopa were reported in the literature; in our cases, there was no response to levodopa.. Chronic overexposure to manganese may cause an atypical form of parkinsonism associated with increased T1 signal in the basal ganglia on magnetic resonance imaging.

Topics: Acetic Acid; Adult; Aspirin; Brain; Central Nervous System Stimulants; Drug Interactions; Ephedrine; Gait Disorders, Neurologic; Globus Pallidus; Humans; Injections, Intravenous; Magnetic Resonance Imaging; Male; Manganese Poisoning; Parkinsonian Disorders; Potassium Permanganate; Self Administration

Parkinsonian syndrome related to intravenous use of a "designer" psychostimulant, derived from pseudoephedrine using potassium permanganate as the oxidant, has been observed in drug addicts in Estonia.. To describe the symptomatology of four young patients, history of drug administration and chemical analysis of a drug batch.. Mental and motor function and quality of life were scored and ephedrone was analyzed using electrospray mass spectrometry. Manganese content of the final synthetic mixture was analyzed using Inductively Coupled Plasma-Atomic Emission Spectrometry.. None of the four cases scored below the dementia threshold in MMSE, while other ratings (UPDRS, H&Y, PDQ-39) corresponded to disabilities seen in relatively advanced Parkinson's disease. The ephedrone yield of the reaction was approximately 44% and the mixture was found to contain 0.6 g/l of manganese.. The cases were exposed to extreme manganese load. Their symptomatology is probably identical to manganism. The role of ephedrone is presently unknown. Physicians must be aware of early signs of manganism in patients within social risk groups.

Topics: Adult; Brain; Central Nervous System Stimulants; Disability Evaluation; Disease Progression; Dyskinesia, Drug-Induced; Ephedrine; Humans; Male; Manganese Poisoning; Mass Spectrometry; Neuropsychological Tests; Parkinsonian Disorders; Potassium Permanganate; Propiophenones; Substance-Related Disorders; Sweden

Manganese intoxication is an unusual, severe form of intoxication. This report deals with a patient now 80 years old who accidentally ingested a solution of potassium permanganate for a period of at least 4 weeks 14 years ago. Since then, the patient suffers from a mild parkinsonian syndrome and distally accentuated polyneuropathies. Psychiatric disorders, especially demential or depressive symptoms, were not observed. Manganese analysis of his hair still shows a clear increase in manganese concentration. The MRI of his brain showed no pathological changes, in particular none of those often described with symmetric signal elevation in T1 in the area of the basal ganglia. In this study, we present clinical, laboratory, and neuroradiological findings. Unusual in this case with a short exposition is the long duration and clinical improvement without L-dopa treatment.

Topics: Aged; Aged, 80 and over; Brain; Humans; Levodopa; Magnetic Resonance Imaging; Male; Manganese Poisoning; Parkinson Disease, Secondary; Polyneuropathies; Potassium Permanganate; Psychiatric Status Rating Scales; Remission, Spontaneous

Cationic (MnSO4.H2O) and anionic (KMnO4) manganese salts in aqueous solutions enhanced the frequency of chromosomal aberrations including both chromosome- and chromatid-type breaks, gaps, translocations and spindle disturbances in different plant systems in vivo to a statistically significant level. The activity of the cationic salt was more drastic, particularly on the submerged plant studied (Vallisneria spiralis L.), on prolonged exposure, when compared with bulbs of Allium cepa L. and seeds of Pisum sativum L.

Topics: Chromosome Aberrations; Manganese Compounds; Manganese Poisoning; Mutagens; Plants; Potassium Permanganate; Sulfates

A comparison of the cytotoxic activity of cationic (MnSO4) and anionic (KMnO4) salts of inorganic manganese in the mouse in vivo indicated that the former was more strongly clastogenic than the latter. Mice were administered different doses of the salt orally over a period of 3 weeks. In general, both the frequencies of chromosomal aberrations in bone marrow cells and micronuclei were increased significantly by both salts. Sperm-head abnormalities showed a significant enhancement as well. The clastogenic effects were directly related to the concentrations used and were not markedly influenced by the duration of treatment. In view of the known affinity of Mn2+ for chromosomal components, it has been suggested that the effects were mediated by these ions produced directly from MnSO4 and indirectly from KMnO4 following conversion under acidic pH of the gastric juices.

Topics: Animals; Anions; Cations; Cell Line; Chromosomes; Male; Manganese Compounds; Manganese Poisoning; Mice; Micronucleus Tests; Mutagens; Potassium Permanganate; Sperm Head; Sulfates

Salts of metals which are carcinogenic, noncarcinogenic, or of unknown carcinogenicity were assayed for their abilities to modulate ultraviolet (UV)-induced mutagenesis in Escherichia coli WP2. In addition to the previously reported comutagenic effect of arsenite, salts of three other compounds were found to enhance UV mutagenesis. CuCl2, MnCl2 (and a small effect by KMnO4), and NaMoO4 acted as comutagens in E coli WP2, which has wild-type DNA repair capability, but were much less comutagenic in the repair deficient strain WP2s (uvrA). The survival of irradiated or unirradiated cells was not affected by these compounds. No effects on UV mutagenesis were seen for 16 other metal compounds. We suggest that the comutagenic effects might occur either via metal-induced decreases in the fidelity of repair replication or (in the case of CuCl2) via metal-induced depurination.

Topics: Chlorides; Copper; DNA Repair; Escherichia coli; Manganese Compounds; Manganese Poisoning; Metals; Molybdenum; Mutagenicity Tests; Mutation; Potassium Permanganate

Topics: Abortion, Induced; Abortion, Spontaneous; Death; Female; Humans; Ions; Manganese; Manganese Poisoning; Potassium Permanganate; Pregnancy