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Hurtado D, Quintero JA, Rodríguez YA, Pérez DE, Paz RF, Diez-Sepúlveda J. Principal causes of acute poisoning in an emergency service: experience between 2014 and 2021 at a University Hospital in Southwestern Colombia. Sci Rep 2024; 14:3544. [PMID: 38347059 PMCID: PMC10861590 DOI: 10.1038/s41598-024-54159-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/09/2024] [Indexed: 02/15/2024] Open
Abstract
Acute poisonings are a global public health problem, which implies costs and disease burden for society. In Colombia, there is a significant underreporting of data on acute poisoning and data gaps on the toxicological profile of the population. This study aims to identify the epidemiology of acute poisoning in a high-complexity hospital in southwestern Colombia. A descriptive study with retrospective data collection was performed. The variables were expressed through the measure of central tendency and dispersion. Categorical variables were described in proportions. A total of 406 patients were included. The median age was 31 years (IQR 23-48), 56.2% were male, and only 19.2% had a history of mental illness. Suicidal intent represented 58.8% of the cases, and the most frequent route of exposure was the oral route (81.6%). The most prevalent groups of substances were pesticides (34.2%) and medicines (32%). The most common etiological agent was organophosphates (16.5%). Cholinergic toxidrome was the most common. The average stay in the ICU was 4.5 days (± 4.8), and the mortality was 4.2%. The principal causes of acute poisoning were drugs and pesticides, with a predominant etiology of organophosphates and depressants of the central nervous system. There was a significant predominance of young male patients with suicidal intent, low mental disorders, elevated unemployment rate, and similar mortality reported in other studies. This study improves the knowledge about acute poisoning in southwestern Colombian to carry out multicenter analytic studies.
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Affiliation(s)
- David Hurtado
- Departamento de Medicina de Emergencias, Fundación Valle del Lili, Carrera 98 No.18-49, 760032, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 # 122-135, Cali, Colombia
| | - Jaime A Quintero
- Departamento de Medicina de Emergencias, Fundación Valle del Lili, Carrera 98 No.18-49, 760032, Cali, Colombia.
- Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Carrera 98 No.18-49, 760032, Cali, Colombia.
- Facultad de Ciencias de la Salud, Semillero de Investigación en Medicina de Emergencias y Reanimación (SIMER), Calle 18 # 122-135, Cali, Colombia.
| | - Yeraldin Alejandra Rodríguez
- Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 # 122-135, Cali, Colombia
- Facultad de Ciencias de la Salud, Semillero de Investigación en Medicina de Emergencias y Reanimación (SIMER), Calle 18 # 122-135, Cali, Colombia
| | - Daniel Esteban Pérez
- Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 # 122-135, Cali, Colombia
- Facultad de Ciencias de la Salud, Semillero de Investigación en Medicina de Emergencias y Reanimación (SIMER), Calle 18 # 122-135, Cali, Colombia
| | - Roger Figueroa Paz
- Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 # 122-135, Cali, Colombia
- Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Carrera 98 No.18-49, 760032, Cali, Colombia
| | - Julio Diez-Sepúlveda
- Departamento de Medicina de Emergencias, Fundación Valle del Lili, Carrera 98 No.18-49, 760032, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 # 122-135, Cali, Colombia
- Facultad de Ciencias de la Salud, Semillero de Investigación en Medicina de Emergencias y Reanimación (SIMER), Calle 18 # 122-135, Cali, Colombia
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Aguilón-Leiva JJ, Tejada-Garrido CI, Echániz-Serrano E, Mir-Ramos E, Torres-Pérez AM, Lafuente-Jiménez A, Martínez-Soriano M, Santolalla-Arnedo I, Czapla M, Smereka J, Juárez-Vela R, Satústegui-Dordá PJ. Clinical and sociodemographic profile of acute intoxications in an emergency department: A retrospective cross-sectional study. Front Public Health 2022; 10:990262. [PMID: 36339228 PMCID: PMC9628748 DOI: 10.3389/fpubh.2022.990262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/20/2022] [Indexed: 01/26/2023] Open
Abstract
Background Epidemiological studies about acute poisoning are useful for developing clinical toxicology, especially those carried out in hospital emergency departments. We aimed to evaluate acute intoxication clinical and sociodemographic profile in South Aragon Hospital, Spain. Methods We carried out a retrospective cross-sectional study. We included 442 patients treated for acute poisoning in the emergency department during the 3 years 2015-2018. In the inferential analysis, the Chi-square test was used to compare proportions, and the Mann-Whitney U-test was used to compare ranges. A confidence level of 95 per cent was considered in all tests. Results The mean age was 44.1 years. 57.2% were men. Drugs of abuse were present in 243 patients (55%), drugs in 172 (38.9%), chemicals in 57 (12.9%) and three patients (0.7%) were poisoned by mushrooms. Nine different drugs of abuse, 73 drugs, 15 chemical compounds and 2 varieties of mushrooms were registered. Of the intoxicated patients, 92.3% had symptoms, 84.2% received treatment and 78.7% were discharged from the emergency department. Conclusions We obtain a clear clinical and sociodemographic profile of intoxicated patients who come to the emergency department; the five toxins that cause most acute poisoning are: alcohol, benzodiazepines, antiarrhythmics, cannabis and carbon monoxide.
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Affiliation(s)
| | | | - Emmanuel Echániz-Serrano
- Research Group of the Transfercult, Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - Eduardo Mir-Ramos
- Health Emergencies 061 ARAGÓN, Aragon Health Service, Zaragoza, Spain
| | | | | | | | - Iván Santolalla-Arnedo
- Group in Research in Care (GRUPAC), Department of Nursing, University of La Rioja, Logrono, Spain
| | - Michal Czapla
- Group in Research in Care (GRUPAC), Department of Nursing, University of La Rioja, Logrono, Spain
- Department of Emergency Medical Service, Wroclaw Medical University, 51-618 Wroclaw, Poland
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, 51-618 Wroclaw, Poland
| | - Raúl Juárez-Vela
- Group in Research in Care (GRUPAC), Department of Nursing, University of La Rioja, Logrono, Spain
| | - Pedro José Satústegui-Dordá
- Research Group Water and Environmental Health (B43_20R), Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
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The Individualized Management Approach for Acute Poisoning. Adv Pharmacol Pharm Sci 2021; 2021:9926682. [PMID: 34056610 PMCID: PMC8133860 DOI: 10.1155/2021/9926682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/30/2021] [Indexed: 11/17/2022] Open
Abstract
Acute poisoning is a widespread emergency that mandates early management decisions for optimal outcomes. An individualized approach is an ideal way to provide those outcomes. Promoting awareness among healthcare professionals managing acute poisoning about the importance of incorporating the pharmacokinetics and following certain criteria to consider interventions such as activated charcoal, antidote, or specific investigations may improve their risk assessment strategies and management plans. To address the main aspects that should be considered to develop a customized poisoning management plan, we conducted this review based on relevant publications recovered by a careful search in PubMed. Our opinions as experts from the King Saud University (KSU) Drug and Poison Information Center (DPIC) were considered in the review.
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Martínez-Sánchez L, López-Ávila J, Barasoain-Millán A, Angelats-Romero CM, Azkunaga-Santibañez B, Molina-Cabañero JC, Alday A, Andrés A, Angelats C, Aquino E, Astete J, Baena I, Barasoain A, Bello P, Benito C, Benito H, Botifoll E, Burguera B, Campos C, Canduela V, Clerigué N, Comalrena C, Del Campo T, De Miguel B, Fernández R, Fernández B, García E, García M, García M, García M, García-Vao C, Herrero L, Huerta P, Humayor J, Hurtado P, Iturralde I, Jordá A, Khodayar P, Lalinde M, Lobato Z, López J, López V, Luaces C, Mangione L, Martín L, Martínez S. L, Martínez L, Martorell J, May M, Melguizo M, Mesa S, Molina J, Muñiz M, Muñoz J, Muñoz N, Oliva S, Palacios M, Pérez A, Pérez C, Pinyot M, Peñalba A, Pociello N, Rodríguez A, Rodríguez M, Señer R, Serrano I, Vázquez P, Vidal C. Actions that should not be taken with a paediatric patient who has been exposed to a potentially toxic substance. An Pediatr (Barc) 2021. [DOI: 10.1016/j.anpede.2020.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Martínez-Sánchez L, López-Ávila J, Barasoain-Millán A, Angelats-Romero CM, Azkunaga-Santibañez B, Molina-Cabañero JC. [Actions that should not be taken with a paediatric patient who has been exposed to a potentially toxic substance]. An Pediatr (Barc) 2020; 94:285-292. [PMID: 33131718 DOI: 10.1016/j.anpedi.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/02/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To show the preparation process by the Poisoning Working Group of the Spanish Society of Paediatric Emergencies (GTI-SEUP), of the list of things «not to do» for a paediatric patient who has been exposed to a potentially toxic substance. METHOD The preparation process of the list was carried out in three phases. First: «Brainstorming» that was open to all members of the GTI-SEUP. Second: Recommendations were selected by following modified-Delphi methodology. All participants were asked to rate the proposals (from 1 = strongly disagree to 9 = strongly agree). Those with an average score greater than 8 were accepted (provided that at least two-thirds of the participants had given them a score ≥ 7), and a second consultation was made for the recommendations with an average score between 6 and 8. Third: Writing and creating a consensus of the final document was done. RESULT A total of 11 proposals were initially obtained. Thirty-two of the 57 GTI-SEUP participants completed the scoring questionnaire. In the first consultation, seven «not to do» recommendations were accepted, and four obtained a doubtful average score (between 6 and 8). After the second consultation, the list was made up of eight recommendations. Two refer to general management, four to gastrointestinal decontamination techniques, and two to the administration of antidotes. CONCLUSION The list of actions that should not be taken with a child that has been exposed to a possible poison is a consensus tool, within the GTI-SEUP, to promote improvement in the quality of care offered to these patients. This improvement is based on avoiding unnecessary measures, which can sometimes be harmful to the child.
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Affiliation(s)
| | - Javier López-Ávila
- Servicio de Urgencias de Pediatría. Hospital Universitario de Salamanca, Salamanca, España
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Walton KL, Otto CM. Retrospective evaluation of feline rodenticide exposure and gastrointestinal decontamination: 146 cases (2000-2010). J Vet Emerg Crit Care (San Antonio) 2018; 28:457-463. [PMID: 30129699 DOI: 10.1111/vec.12748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 08/17/2016] [Accepted: 10/09/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the prevalence of rodenticide exposure in cats, describe the use of gastrointestinal decontamination (GID) after rodenticide exposure, and examine the efficacy of GID following exposure to anticoagulant rodenticides (ACR). DESIGN Retrospective study from 2000-2010. SETTING Emergency service of an urban university teaching hospital. ANIMALS One hundred forty-six cats presented for rodenticide exposure. MAIN RESULTS Annually, the number of cats that were presented for rodenticide exposure averaged 13 of 3,336 (0.39%) and totaled 146 cases over 11 years. Cats that had been exposed to rodenticide were significantly more likely to be young (P < 0.001), sexually intact (P < 0.001), and presented in the fall season (P = 0.002). The majority of cats lived indoors (67.6%). The type of rodenticide involved in the exposure was unknown in 50% (71/142) of cases. Of the known types, ACRs were most common (59/142, 41.5%) followed by cholecalciferol (7/142, 4.9%) and bromethalin (5/142, 3.5%). Gastrointestinal decontamination was attempted in 21/36 (58%) cats with exposure to a known ACR. Emesis was attempted in 17/21 (81%) and charcoal administered in 14/21 (67%) cats that underwent GID. This study did not detect an effect of GID efforts on prothrombin time (PT) prolongation 48 hours after exposure to a known ACR. CONCLUSIONS Cats consume rodenticides. Due to the lack of evidence of altered outcome associated with GID in cats exposed to ACRs, a PT should be evaluated 48 hours after first exposure regardless of whether GID is performed. Treatment should be based on the results of the PT. Gastrointestinal decontamination should be performed at the clinician's discretion based on history, risks, calculated toxic dose, low prevalence of ACR toxicosis in cats, general resistance of cats to ACR toxicosis, and treatment options.
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Affiliation(s)
- Karie L Walton
- Department of Clinical Sciences and Advanced Medicine, College of Veterinary Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, 19104
| | - Cynthia M Otto
- Department of Clinical Sciences and Advanced Medicine, College of Veterinary Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, 19104
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Tuuri RE, Wright JL, He J, McCarter RJ, Ryan LM. Does prearrival communication from a poison center to an emergency department decrease time to activated charcoal for pediatric poisoning? Pediatr Emerg Care 2011; 27:1045-51. [PMID: 22068066 DOI: 10.1097/pec.0b013e318235ea02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE A poison center plays an important role in directing appropriate care, which is critical in reducing morbidity due to poisoning. Activated charcoal (AC) is one intervention for some poisonings. This study examined whether children with a poisoning who were preannounced by a poison center received AC earlier than patients without a referral. METHODS A retrospective review of AC administration in children aged 0 to 18 years in a pediatric emergency department (ED) from 2000 to 2006 was performed. Abstracted covariates were poison center referral status, age, sex, acuity, disposition, transportation mode, triage time, and time of AC administration. Analysis of variance controlling for covariates tested the equality of mean time intervals between the groups with and without a poison center referral. RESULTS Three hundred fifty-one cases met the inclusion criteria. One hundred thirty-five (39%) were male. Eighty cases (23%) had a poison center referral. Time from triage to charcoal administration for patients with a poison center referral was a mean of 59 (SD, 34) minutes. Time for the group without a referral was a mean of 71 (SD, 43) minutes (P = 0.0036). CONCLUSIONS Advanced communication from a poison center was associated with earlier administration of AC in the ED for this population. Nevertheless, the duration to charcoal administration was frequently suboptimal. Triage and prehospital practices should be reexamined to improve timeliness of AC when indicated and consider exclusion of administration if beyond an appropriate time frame. Advanced notification should be the paradigm for all poison centers, and early response protocols for poison center referrals should be used by EDs.
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Affiliation(s)
- Rachel E Tuuri
- Division of Pediatric Emergency Medicine, Medical University of South Carolina, Charleston, SC, USA.
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Albertson TE, Owen KP, Sutter ME, Chan AL. Gastrointestinal decontamination in the acutely poisoned patient. Int J Emerg Med 2011; 4:65. [PMID: 21992527 PMCID: PMC3207879 DOI: 10.1186/1865-1380-4-65] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 10/12/2011] [Indexed: 12/15/2022] Open
Abstract
Objective To define the role of gastrointestinal (GI) decontamination of the poisoned patient. Data Sources A computer-based PubMed/MEDLINE search of the literature on GI decontamination in the poisoned patient with cross referencing of sources. Study Selection and Data Extraction Clinical, animal and in vitro studies were reviewed for clinical relevance to GI decontamination of the poisoned patient. Data Synthesis The literature suggests that previously, widely used, aggressive approaches including the use of ipecac syrup, gastric lavage, and cathartics are now rarely recommended. Whole bowel irrigation is still often recommended for slow-release drugs, metals, and patients who "pack" or "stuff" foreign bodies filled with drugs of abuse, but with little quality data to support it. Activated charcoal (AC), single or multiple doses, was also a previous mainstay of GI decontamination, but the utility of AC is now recognized to be limited and more time dependent than previously practiced. These recommendations have resulted in several treatment guidelines that are mostly based on retrospective analysis, animal studies or small case series, and rarely based on randomized clinical trials. Conclusions The current literature supports limited use of GI decontamination of the poisoned patient.
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Affiliation(s)
- Timothy E Albertson
- Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, California, USA.
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Affiliation(s)
- Kent R Olson
- California Poison Control System, San Francisco Division, University of California, San Francisco, San Francisco, CA 94143-1369, USA.
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Tuuri RE, Ryan LM, He J, McCarter RJ, Wright JL. Does Emergency Medical Services Transport for Pediatric Ingestion Decrease Time to Activated Charcoal? PREHOSP EMERG CARE 2009; 13:295-303. [DOI: 10.1080/10903120902935272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sterling J. Recent Publications on Medications and Pharmacy. Hosp Pharm 2008. [DOI: 10.1310/hpj4305-429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hospital Pharmacy presents this feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest will be abstracted monthly regarding a broad scope of topics. Suggestions or comments may be addressed to: Jacyntha Sterling, Drug Information Specialist at Saint Francis Hospital, 6161 S Yale Ave., Tulsa, OK 74136 or e-mail: jasterling@saintfrancis.com .
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