An 89-year-old woman checked herself into our emergency room presenting with diplopia after a snake bite one day before on the third finger of her left hand by Gloydius blomhoffii (mamushi). We treated her with snake antivenom 30 hours after the snake bite. The treatment improved her double vision, and she was discharged after 4 hospital days. Mamushi venom contains a hemorrhagic toxin and a small amount of neurotoxin that induces extraocular muscle impairment. Her double vision indicated the large dose and reflected the severity of the venom intoxication and considering this she was treated with antivenom therapy for the diplopia. We should treat patients with severe symptoms of snake venom with antivenin therapy as soon as possible. However, it is sometimes difficult to identify the snake bite as that of a mamushi. That is why the victims of venomous snakes delay in seeking medical attention. Antivenom can be administered safely by preparing for an anaphylaxis reaction or serum disease.

A 15-year-old female patient was transported to our hospital due to altered consciousness after valproic acid (VPA) overdose. She attempted suicide by taking 18 g of sustainedrelease VPA 19 hours before arrival. On admission, she was in a comatose state, her serum NH₃ level was high (723 μg/dL), and her serum free carnitine level was low (12.1 mmol/L). Oral intubation, administration of activated charcoal and levocarnitine, and continuous hemodiafiltration were performed. The serum levels of VPA and NH₃ decreased immediately. She regained consciousness on day 3 and was discharged on day 9 with no sequelae. Patients with overdose of sustained-release VPA need to be observed for a longer time and carnitine administration should be considered for hyperammonemia.

Colchicine, which is used as a remedy for gout, is found in some plants, including Gloriosa superba. Gloriosa superba is a member of the family Colchicaceae and is sold commercially as an ornamental plant. In this study, we describe a case of colchicine poisoning caused by accidental ingestion of Gloriosa superba. The patient, an 84-year-old man, developed symptoms of vomiting and diarrhea. The next day, he was admitted to our hospital owing to suspicion of acute enteritis. On the second day of hospitalization, he experienced disturbed consciousness and lactic acidosis. On the third day of hospitalization, he died, despite intensive care. Additional interviews with the family revealed that he accidentally ate a bulb of Gloriosa superba before the appearance of gastrointestinal symptoms. Subsequent investigation revealed the presence of colchicine in his urine and blood and he was diagnosed with colchicine poisoning caused by ingestion of Gloriosa superba. Colchicine poisoning can cause rapid multi-organ damage depending on the amount ingested, and can be fatal. Symptoms of poisoning are nonspecific, and measurement of colchicine levels is time-consuming. Therefore, a detailed interview is extremely important for diagnosis.

Acetaminophen overdose results in acute liver damage. Measurement of the plasma concentration and a nomogram identify patients who require hepatoprotective treatments. The patient was a 28-year-old woman who ingested 100-200 pills of 200-mg acetaminophen and was found unconscious at home. She was brought to the emergency room and subsequently referred to our hospital 4 days later. The plasma concentration of acetaminophen could not be measured. However, she showed signs of acute liver failure and hepatic encephalopathy, and was treated with N-acetylcysteine (NAC) to treat liver failure. She also required plasma exchange with continuous hemodiafiltration. Treatments were successful in improving her consciousness impairment, and she was discharged on day 9. Although the plasma concentration of acetaminophen could not be measured, it was not necessary for determining the diagnosis and treatment plans.