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Reisinger AC, Schneider N, Schreiber N, Janisch M, Rauch I, Kaufmann P, Wünsch G, Eller P, Hackl G. Critical care management of acute intoxications, dynamics and changes over time: a cohort study. Intern Emerg Med 2024:10.1007/s11739-024-03570-2. [PMID: 38502464 DOI: 10.1007/s11739-024-03570-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/22/2024] [Indexed: 03/21/2024]
Abstract
Acute intoxications and poisonings are a relevant cause for ICU admission of critically ill patients. This study aimed to determine the characteristics of intoxicated patients in a tertiary center medical ICU in Austria over time and to investigate parameters associated with ICU mortality. This study was a retrospective data analysis including adult ICU patients from the years 2007 to 2021. In addition to ICU documentation, pre-hospital, and emergency department documents as well as autopsy reports were utilized. In an exploratory subanalysis, we compared these findings to a historical dataset from our facility from 1992 to 1996. We identified 581 cases admitted to the medical ICU because of acute poisoning (2007-2021), of which 45% were female and 46.6% were mixed intoxications. Suicidal intent was the primary cause of intoxication (48.2%) and ICU length of stay was median 1.2 days. The majority of deceased patients received pre-hospital mechanical CPR. Primary and secondary poison/toxin removal modalities were used in 29.9% and 11.7% of cases, whereas antidotes were administered in 54.4%. Comparing the data with a historical cohort (n = 168), we found a shift in primary detoxification away from gastric lavage and an increase in alternative secondary poison/toxin removal techniques. The ICU mortality was 4.1% and 4.2% in the present and historic cohort, respectively. Pre-existing psychiatric illnesses increased from 49% in the historic to 69% in the present cohort. Psychiatric illness predisposes patients to severe intoxications necessitating ICU care, thus increasing prevention measures seems warranted. Females did present with a different spectrum of intoxications compared to males. ICU mortality remained low over time and most deceased patients had a grim prognosis already on ICU arrival.
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Affiliation(s)
- Alexander Christian Reisinger
- Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Nikolaus Schneider
- Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Nikolaus Schreiber
- Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Martina Janisch
- Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Ines Rauch
- Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
- Department of Anesthesiology, LKH Hochsteiermark, Bruck an der Mur, Austria
| | - Peter Kaufmann
- Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Gerrit Wünsch
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Philipp Eller
- Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Gerald Hackl
- Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
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Yang Y, Xu B, Li D, Zhang Q, Zhang J, Yang L, Ye Y. A comprehensive LC-MS/MS method for simultaneous analysis of 65 synthetic cannabinoids in human hair samples and application to forensic investigations. J Forensic Leg Med 2024; 101:102636. [PMID: 38134471 DOI: 10.1016/j.jflm.2023.102636] [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: 09/20/2023] [Revised: 12/09/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Abstract
Synthetic cannabinoids (SCs) represent a diverse class of new psychoactive substances characterized by extensive substance variety and severe abuse implications. The current situation of synthetic cannabinoid abuse in China is getting worse, with an increasing number of SC variants emerging. Therefore, it is imperative to improve synthetic cannabinoid detecting methods to align with the prevalent abuse situation in the region. In this study, a reliable and validated liquid chromatography-tandem mass spectrometry method was developed for the qualitative and quantitative analysis of 65 SC analogues in human hair samples. The validation results demonstrated satisfactory linearity (r ≥ 0.99) within the range of 25-2500 pg/mg for each SC analogue. The method exhibited limits of detection ranging from 10 to 15 pg/mg and limits of quantification ranging from 25 to 40 pg/mg. The relative standard deviations of intra-day precision and inter-day precision were below 15 %. Furthermore, negligible matrix effects were observed, with recovery rates ranging from 85.70 % to 119.43 %. Analysis of abuser demographics revealed that the primary group engaged in SC analogue abuse consisted of adolescents, predominantly males, accounting for 79.5 % of cases. Among the suspected individuals, ADB-BUTINACA and MDMB-4en-PINACA were the most frequently detected substances. The present study develops a highly sensitive analytical method and provides a comprehensive overview of the prevalence of SC abuse in the eastern region of China.
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Affiliation(s)
- Yiqi Yang
- Department of Forensic Toxicological Analysis, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Buyi Xu
- National Anti-Drug Laboratory Sichuan Regional Center, Chengdu, 610299, Sichuan, China
| | - Daoxia Li
- Sichuan Institute for Food and Drug Control, Chengdu, 611731, Sichuan, China
| | - Qifu Zhang
- Sichuan Dingcheng Forensic Center, Chengdu, 610017, Sichuan, China
| | - Jing Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610016, Sichuan, China
| | - Lin Yang
- Department of Forensic Toxicological Analysis, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yi Ye
- Department of Forensic Toxicological Analysis, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, Sichuan, China.
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Tao Z. 106 Cases of homicide poisoning in China-A retrospective study. Leg Med (Tokyo) 2023; 65:102317. [PMID: 37651821 DOI: 10.1016/j.legalmed.2023.102317] [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: 04/30/2023] [Revised: 07/14/2023] [Accepted: 08/14/2023] [Indexed: 09/02/2023]
Abstract
Homicidal poisoning has received limited scholarly attention, despite having recently increased in frequency in China, especially in rural areas, where it causes numerous deaths and disabilities. In this study, the author collected data on 106 cases of homicidal poisoning from 1995 to 2000. Of these cases 105 were found through website established by the Supreme Court of China, and one case was as an exception identified from the internet. There were 46 male perpetrators and 59 female perpetrators. The most common reason male perpetrators poisoned someone was conflict among neighbours (include residents in the same village) (ten cases), and the most common reason female perpetrators did so was an affair (13 cases). Compared with the perpetrators of general homicide, those who poisoned people included a high proportion of female, elderly, and well-educated individuals. This is related to the nonviolent nature of the poisoning, which requires no physical strength. Residents living in rural and urban areas chose poisoning based on convenience. People living in rural areas used pesticides most often, and people in urban areas have greater access to drugs or medications obtained at work or online. In this study, a total of 9.4% of the perpetrators were diagnosed with psychiatric disorders or psychosis. In all, the 106 cases resulted in 58 human deaths. Tetramine and paraquat caused many of the deaths, and this suggests a need for the government to manage and monitor these highly toxic pesticides. These cases are representative of issues in contemporary Chinese society, for example, population mobility, fierce competition.
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Affiliation(s)
- Zhuoli Tao
- The Psychology Research Center, Department of Medical Humanities, the School of Humanities, National Southeast University China.
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Wang X, Xiang P, Zhang S, Wang J, Zhang J, Wu H, Wang X. Retrospective analysis of forensic toxicology data from 2021 to identify patterns of various forensic cases. Forensic Sci Int 2023; 347:111683. [PMID: 37068373 DOI: 10.1016/j.forsciint.2023.111683] [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: 12/04/2022] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE Knowing and analyzing the characteristics and trends of forensic toxicology cases in a certain area is particularly important for a local government to establish an effective prevention and control system. The purpose of this work was to summarize data from forensic toxicology cases received by the Academy of Forensic Sciences (AFS) in 2021. METHODS As requested by the police or according to the details of cases, samples were systematically screened or analyzed by various methods. Liquid chromatography-tandem mass spectrometry and gas chromatography-mass spectrometry were used to identify medicinal drugs, drugs of abuse, pesticides, poison gases, etc. RESULTS: AFS received a total of 17,758 cases in 2021, of which 314 cases underwent autopsy. The main cause of death was sudden death, and the manner of death was mainly accident. Among 13,744 drug abuse cases, the number of positive cases was 1721, with a positive rate of 12.5%, and synthetic cannabinoids were the most frequently detected substances. In 3640 traffic cases, 85.3% of drivers were suspected of drunk driving. In 103 poisoning cases, hydrogen sulfide poisoning and pesticide suicide account for a large proportion. In drug-facilitated crimes, zolpidem was the most frequently tested component. In 55 case of dog poisonings, the main poisons were cyanides and succinylcholine, and the main poisoning tools were poisonous baits and poisonous syringe darts. CONCLUSIONS This study profiles the toxicological characteristics of forensic toxicological cases conducted at the AFS in 2021 and provides a scientific basis for poisoning cases and drug abuse prevention.
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Affiliation(s)
- Xinying Wang
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Academy of Forensic Science, Shanghai, China; School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | - Ping Xiang
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Academy of Forensic Science, Shanghai, China
| | - Sujing Zhang
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Academy of Forensic Science, Shanghai, China
| | - Jinming Wang
- Department of Forensic Pathology, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Academy of Forensic Science, Shanghai, China
| | - Jianhua Zhang
- Department of Forensic Pathology, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Academy of Forensic Science, Shanghai, China
| | - Hejian Wu
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Academy of Forensic Science, Shanghai, China.
| | - Xin Wang
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Academy of Forensic Science, Shanghai, China.
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Kouli M, Al Houri HN, Jomaa S, Issa A, Arrouk DMN, Alhouri A, Almhanni G, Alhouri AN, Wardeh R, Kouli M. Epidemiology of poisoning in Syria (1999 through 2020). Clin Toxicol (Phila) 2023; 61:116-122. [PMID: 36524826 DOI: 10.1080/15563650.2022.2156882] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Acute poisoning is a significant international public health issue and one of the leading causes of death in the emergency department (ED). In the absence of any previous reports describing the poisoning profile in Syria, we present this study to assess the epidemiological and clinical characteristics of poisoning over 21 years. METHODS We collected the data retrospectively from the Syrian Poisons Information Centre (SPIC) from January 1999 until December 2020. The data included patients who had accidental or non-accidental exposure to poisons, either by drugs, medicaments, and biological substances or substances chiefly nonmedicinal sources such as soaps and detergents, corrosive substances, pesticides, and other miscellaneous products. RESULTS We collected the data of 120,972 poisoned patients, of whom 52.6% were females, and 47.4% were males. Aleppo governorate reported the highest number of poisoned cases (28.6%), followed by Damascus governorate (19.9%). The highest poisoning rates were recorded in 2020, 2014, and 2010. Pharmaceutical (37.0%) and animal (33.8%) sources were the most common causative agents. The oral route was the route of poisoning in 58.3% of patients, and 33.4% through the skin. The most common poison was scorpion stings 19.5% while the most common cause of death was organophosphates 15.7%. DISCUSSION The differences in socioeconomic status, cultural habits, and agricultural and industrial activities between countries have led to a state of fluctuation regarding the most common poisoning agents. CONCLUSION Damascus and Aleppo, the two major governorates in Syria, had the highest poisoning cases. Oral administration of pharmaceutical agents was responsible for most of the poisoning cases. The most common individual poison was the scorpion poison, while the top killer was organophosphates.
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Affiliation(s)
- Moudar Kouli
- Doctor of Medicine M.D, Syrian Arab Republic Ministry of Health, Damascus, Syria
| | - Hasan Nabil Al Houri
- Internal Medicine Department, Damascus University, Al Assad University Hospital and Al Mouwasat University Hospital, Damascus, Syria
- Internal Medicine Department, Al-Sham Private University, Damascus, Syria
| | - Sami Jomaa
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Abdulmoez Issa
- Department of Radiology, Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Abdullah Alhouri
- Division of Gastroenterology, Department of Medicine, Royal Berkshire Hospital, Reading, United Kingdom
| | - Ghaith Almhanni
- Department of Radiology, Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Rahaf Wardeh
- Department of pediatrics, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Maher Kouli
- Head of Syrian Poison Information Center, Ministry of Health, Damascus, Syria
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Chidiac AS, Buckley NA, Noghrehchi F, Cairns R. Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease. Expert Opin Drug Metab Toxicol 2023; 19:297-317. [PMID: 37436926 DOI: 10.1080/17425255.2023.2223959] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/05/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Paracetamol is one of the most used medicines worldwide and is the most common important poisoning in high-income countries. In overdose, paracetamol causes dose-dependent hepatotoxicity. Acetylcysteine is an effective antidote, however despite its use hepatotoxicity and many deaths still occur. AREAS COVERED This review summarizes paracetamol overdose and toxicity (including mechanisms, risk factors, risk assessment, and treatment). In addition, we summarize the epidemiology of paracetamol overdose worldwide. A literature search on PubMed for poisoning epidemiology and mortality from 1 January 2017 to 26 October 2022 was performed to estimate rates of paracetamol overdose, liver injury, and deaths worldwide. EXPERT OPINION Paracetamol is widely available and yet is substantially more toxic than other analgesics available without prescription. Where data were available, we estimate that paracetamol is involved in 6% of poisonings, 56% of severe acute liver injury and acute liver failure, and 7% of drug-induced liver injury. These estimates are limited by lack of available data from many countries, particularly in Asia, South America, and Africa. Harm reduction from paracetamol is possible through better identification of high-risk overdoses, and better treatment regimens. Large overdoses and those involving modified-release paracetamol are high-risk and can be targeted through legislative change.
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Affiliation(s)
- Annabelle S Chidiac
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, Australia
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
| | - Nicholas A Buckley
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
- Faculty of Medicine and Health, School of Medical Sciences, Discipline of Biomedical Informatics and Digital Health, The University of Sydney, Sydney, Australia
| | - Firouzeh Noghrehchi
- Faculty of Medicine and Health, School of Medical Sciences, Discipline of Biomedical Informatics and Digital Health, The University of Sydney, Sydney, Australia
| | - Rose Cairns
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, Australia
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
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Albano GD, Malta G, La Spina C, Rifiorito A, Provenzano V, Triolo V, Vaiano F, Bertol E, Zerbo S, Argo A. Toxicological Findings of Self-Poisoning Suicidal Deaths: A Systematic Review by Countries. TOXICS 2022; 10:toxics10110654. [PMID: 36355945 PMCID: PMC9698482 DOI: 10.3390/toxics10110654] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/06/2022] [Accepted: 10/26/2022] [Indexed: 05/15/2023]
Abstract
The use of illicit and non-illicit substances is widespread in suicides. The toxicological data may help in understanding the mechanism of death. This systematic review aimed to analyze autopsies related to suicides by consuming poison, focusing on the correlation between substance use and the country of origin to create an alarm bell to indicate that suicide maybe attempted and prevent it. The systematic review was conducted according to the PRISMA guidelines, with the primary objective of identifying autopsies conducted in cases of suicide by consuming poison in specific geographic areas. Significant differences in substances were observed between low-income and Western countries that confirm previous literature data. In rural areas and Asian countries, most suicides by consuming poison involve the use of pesticides, such as organophosphates and carbamates. In Western countries, illicit drugs and medically prescribed drugs are the leading cause of suicide by self-poisoning. Future research should shed light on the correlation between social, medical, and demographic characteristics and the autopsy findings in suicides by self-poisoning to highlight the risk factors and implement tailored prevention programs worldwide. Performing a complete autopsy on a suspected suicide by self-poisoning could be essential in supporting worldwide public health measures and policy makers. Therefore, complete autopsies in such cases must be vigorously promoted.
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Affiliation(s)
- Giuseppe Davide Albano
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
- Correspondence: ; Tel.: +39-3312264328
| | - Ginevra Malta
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Corinne La Spina
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Arianna Rifiorito
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Valeria Provenzano
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Valentina Triolo
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Fabio Vaiano
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Elisabetta Bertol
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Stefania Zerbo
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
| | - Antonina Argo
- PROMISE Department, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy
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Li S, Wang X, Bi G, Xin G, Qin S, Xu P, Wang Y. A retrospective analysis of data from illicit drug abuse cases in Beijing between 2018 and 2020. Leg Med (Tokyo) 2022; 58:102086. [DOI: 10.1016/j.legalmed.2022.102086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/05/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
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Chaudhari V, Das S, Sahu S, Devnath G, Chandra A. Epidemio-toxicological profile and reasons for fatal suicidal poisoning: A record-based study in South India. J Family Med Prim Care 2022; 11:547-552. [PMID: 35360760 PMCID: PMC8963612 DOI: 10.4103/jfmpc.jfmpc_1171_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/11/2021] [Accepted: 10/16/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Poisoning is the second frequent cause of suicide in India. To plan an effective intervention and awareness program, it is essential to know the sociodemographic profile, pattern, and reasons for suicide. Objective: We conducted this study to find the sociodemographic profile, pattern, and reasons for fatal suicidal poisoning. Methods: We conducted a record-based study in a tertiary hospital in Puducherry. We reviewed autopsies conducted between January 2010 and December 2014 for fatal suicidal poisoning. We extracted data using a data collection sheet for age, gender, marital status, occupation, residence, the reason for suicide, time of injury, time of death. We entered data in Microsoft Excel, and we did a descriptive analysis by using R software version. Results: We reviewed 3996 medicolegal autopsies, out of which 595 cases were of fatal suicidal poisoning. The mean age of the cases was 35.8 years (SD-14.6). The majority of the cases were married (74.8%) for 20–30 years (31.8%). Most of the victims were agriculture workers (22.2%), lived in a rural setting (84.4%), died during the daytime (61.2%), and in the summer season (54.5%). The most common poison used was organophosphates (48.7%), and the most common reason was family problems (30.2%). The median survival time (h) for the cases (n = 564) was 45.8 h (IQR: 16.4 to 110.6). Conclusion: We found fatal suicidal poisoning was common among males, young adults, married, agriculture workers/laborers, and in a rural setting. The findings help plan an effective intervention for suicide prevention in India.
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