Page 107 - Hospital Authority Convention 2017

Masterclasses

M8.1 Cosmetic Drug/Toxicology 16:15 Room 221

Illicit Slimming Agents: From the Notorious to the Unbelievable
Mak T
Department of Pathology, Princess Margaret Hospital, Hong Kong HOSPITAL AUTHORITY CONVENTION 2017
The slimming and beauty service market is huge in Hong Kong and China that is worth billions of dollars. Slimming, being
described classically as the balance of energy intake and output, has been commonly tackled by approaches beyond the
orthodox diet-and-exercise. Who would have imagined, to achieve a desired body image, drugs that may cause cancer,
psychosis, heart attack or suicidal, would be used? The ever-growing demand and supply for slimming agents have created
many bio-psycho-social complications, and also a unique field in clinical toxicology. Myriads of pharmaceutical agents
intended for slimming purposes, together with the variety of clinical and biochemical presentations, brought a diagnostic
challenge for clinicians and laboratories.

As the only tertiary referral toxicology laboratory in Hong Kong, the Hospital Authority Toxicology Reference Laboratory
received over 400 requests for suspected slimming agent-related poisoning from all around Hong Kong in the past decade.
By analysis, we have confirmed that there is often uninformed use of raw materials for explosives, animal gland tissues, or
even soft drugs. We are witnessing the dynamic evolution of the trend in the types and sources of such agents. Our clinical
examples demonstrate the important public health implications associated with misuse of slimming agents, as well as the
essential role of the Laboratory in the diagnosis of slimming agent-related toxicities. Tuesday, 16 May

M8.2 Cosmetic Drug/Toxicology 16:15 Room 221

Botulinum Toxin – Beauty or Beast
Tse ML
Hong Kong Poison Information Centre, United Christian Hospital, Hong Kong

Botulinum toxin is a group of proteins synthetised by the clostridium botulinum bacterium. It is extremely potent and
specifically lysed the SNARE proteins in the axon endings that are essential for acetylcholine release. This effect of botulinum
toxin was first utilised for the treatment of squinted eyes and then for other illnesses with spastic muscles. However the most
popular indication now is for uplifting in the face and in other body parts.
While the effect of botulinum toxin on appearance has been so popular, many have forgotten that it is actually a powerful
beast. The toxin is the most fatal poison known to the man-kind that as little as one gram of it, if dispersed effectively, can
paralyse and kill millions of people.
An outbreak of iatrogenic botulism after illicit botulinum toxin injection for cosmetic purpose was recorded in Hong Kong in
2016. The victims developed muscle weakness that progressed from a few days to weeks after the injections. The majority
of the patients were managed conservatively. Three patients with moderate weakness that affected their breathing or
swallowing were treated with botulinum antitoxin. None of them required mechanical ventilation and no death was recorded.
Illicit products containing supra-therapeutic concentration of botulinum toxin was the likely cause of the outbreak.

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