1
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Valli A, Ferretti VV, Klersy C, Lonati D, Giardini I, Papa P. Effectiveness of a Reliable Toxicological Analysis for a Correct Diagnosis of Acute Intoxication in Pediatrics: 2-Year Experience of an Analytical Toxicological Laboratory. Pediatr Emerg Care 2022; 38:e1601-e1605. [PMID: 36173433 DOI: 10.1097/pec.0000000000002641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study aimed to assess the role of the laboratory of toxicology as a support for a correct diagnosis of intoxication through the application of a reliable analytical approach, critically designed to meet pediatric needs. METHODS Data collected from 360 cases of suspected intoxications in pediatric patients (aged 1 day to 17 years) during the period 2018 to 2019 are presented. Toxicological analyses were performed through different techniques (immunoassay and chromatography) with parameters (limit of detection and cut-off) adjusted according to pediatric needs to produce reliable toxicological data for a wide number of prescription drugs, drugs of abuse, and poisons. RESULTS We present results about (1) agents involved in suspected poisonings and the methods adopted for a definite analytical diagnosis, (2) the assessment of the concordance of results for analyses proceeded by different techniques, and (3) the percentage of agreement between analytical result and clinical suspicion. CONCLUSIONS An analytical approach critically designed to minimize misinterpretation of laboratory data and able to provide reliable results for a wide number of substances in a time compatible with the urgency represents a useful support for a correct diagnosis of intoxication in pediatrics.
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Affiliation(s)
- Antonella Valli
- From the Clinical Chemistry Laboratory Unit-Specialized Section of Toxicology, IRCCS Policlinico San Matteo Foundation
| | | | - Cathrine Klersy
- Clinical Epidemiology and Biometrics Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Davide Lonati
- Poison Control Centre and National Toxicology Information Centre-Toxicology Unit, Istituti Clinici Scientifici Maugeri, IRCCS Maugeri Hospital, University of Pavia
| | - Ilaria Giardini
- From the Clinical Chemistry Laboratory Unit-Specialized Section of Toxicology, IRCCS Policlinico San Matteo Foundation
| | - Pietro Papa
- From the Clinical Chemistry Laboratory Unit-Specialized Section of Toxicology, IRCCS Policlinico San Matteo Foundation
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2
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Miró Ò, Waring WS, Dargan PI, Wood DM, Dines AM, Yates C, Giraudon I, Moughty A, O'Connor N, Heyerdahl F, Hovda KE, Vallersnes OM, Paasma R, Pold K, Jürgens G, Megarbane B, Anand JS, Liakoni E, Liechti M, Eyer F, Zacharov S, Caganova B, Bonnici J, Radenkova-Saeva J, Galicia M. Variation of drugs involved in acute drug toxicity presentations based on age and sex: an epidemiological approach based on European emergency departments. Clin Toxicol (Phila) 2021; 59:896-904. [PMID: 33724118 DOI: 10.1080/15563650.2021.1884693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To analyse the relative percentage of acute recreational drug toxicity emergency department (ED) presentations involving the main drug groups according to age and sex and investigate different patterns based on sex and age strata. METHODS We analysed all patients with acute recreational drug toxicity included by the Euro-DEN Plus dataset (22 EDs in 14 European countries) between October 2013 and December 2016 (39 months). Drugs were grouped as: opioids, cocaine, cannabis, amphetamines, gamma-hydroxybutyrate (GHB), hallucinogens, new psychoactive substances (NPS), benzodiazepines and ketamine. Descriptive data by age and sex are presented and compared among age/sex categories and among drug families. RESULTS Of 17,371 patients were included during the 39-month period, 17,198 (99.0%) had taken at least one of the investigated drugs (median age: 31 years; 23.9% female; ethanol co-ingestion recorded in 41.5%, unknown in 31.2%; multiple drug use in 37.9%). Opioids (in 31.4% of patients) and amphetamines (23.3%) were the most frequently involved and hallucinogens (1.9%) and ketamine (1.7%) the least. Overall, female patients were younger than males, both in the whole cohort (median age 29 vs. 32 years; p < 0.001) and in all drug groups except benzodiazepines (median age 36 vs. 36 years; p = 0.83). The relative proportion of each drug group was different at every age strata and some patterns could be clearly described: cannabis, NPS and hallucinogens were the most common in patients <20 years; amphetamines, ketamine and cocaine in the 20- to 39-year group; GHB/GBL in the 30- to 39-year group; and opioids and benzodiazepines in patients ≥40 years. Ethanol and other drug co-ingestion was more frequent at middle-ages, and multidrug co-ingestion was more common in females than males. CONCLUSION Differences in the drugs involved in acute drug toxicity presentations according to age and sex may be relevant for developing drug-prevention and education programs for some particular subgroups of the population based on the increased risk of adverse events in specific sex and/or age strata.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, Barcelona, Spain.,Medical School, Universitat de Barcelona, Barcelona, Spain
| | - William S Waring
- Acute Medical Unit York Teaching Hospitals NHS Foundation Trust, York, UK
| | - Paul I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.,Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.,Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Alison M Dines
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - Christopher Yates
- Emergency Department, Hospital Son Espases, Palma de Mallorca, Spain
| | - Isabelle Giraudon
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Adrian Moughty
- Emergency Department Mater, Misericordiae University Hospital, Dublin, Republic of Ireland
| | - Niall O'Connor
- Department of Emergency Medicine, Our Lady of Lourdes Hospital, Drogheda, Republic of Ireland
| | - Fridtjof Heyerdahl
- Department of Prehospital Medicine, Oslo University Hospital, Oslo, Norway
| | - Knut E Hovda
- The National CBRNe Centre of Medicine, Department of Acute Medicine, Medical Division, Oslo University Hospital, Oslo, Norway
| | - Odd M Vallersnes
- Department of General Practice, University of Oslo, Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway
| | | | | | - Gesche Jürgens
- Clinical Pharmacology Unit, Zealand University Hospital Roskilde, Roskilde, Denmark.,Department and Clinical Pharmacology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Bruno Megarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris-Diderot University, Paris, France
| | - Jacek S Anand
- Department of Clinical Toxicology, Medical University of Gdansk, Gdansk, Poland.,Pomeranian Centre of Toxicology, Gdansk, Poland
| | - Evangelia Liakoni
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Liechti
- Division of Clinical Pharmacology and Toxicology, Basel University Hospital and University of Basel, Basel, Switzerland
| | - Florian Eyer
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sergej Zacharov
- Department of Occupational Medicine, Toxicological Information Centre, Charles Universtity and General Hospital University, Prague, Czech Republic
| | - Blazena Caganova
- National Toxicological Information Center, University Hospital, Bratislava, Slovakia
| | | | | | - Miguel Galicia
- Emergency Department, Hospital Clínic, IDIBAPS, Barcelona, Spain
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3
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Koskela LO, Raatiniemi LV, Liisanantti JH. How does socioeconomic status affect the incidence of hospital-treated poisonings? A retrospective study. Eur J Public Health 2020; 30:584-588. [PMID: 31628801 DOI: 10.1093/eurpub/ckz179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hospital-treated poisonings have a good outcome in general. The role of regional differences and socioeconomic status has been established in intensive care admissions and various causes of death, but not yet in hospital-treated poisonings. We set out to determine whether the incidence of hospital-treated poisonings is affected by the annual income of the residential area. METHODS All poisonings in Northern Ostrobothnia region of Finland treated in Oulu University Hospital during 2013-2016 were studied. Oulu University Hospital is the primary hospital in the area. Postal code areas of the county were categorized on the basis of their median annual net income as low-, middle- and high-income areas. RESULTS A total of 2142 poisoning cases were studied. The number of individual patients was 1525. In the low-income areas, the crude incidence of poisonings was more than 2-fold when compared with the middle- and high-income areas. In adolescents aged 13 to 17 years, the incidence in the low-income areas was almost 3-fold compared with the other two categories at 335/100 000/year (95% CI, 236-463). Four patients (0.2%) died during the hospital stay and 50 patients (2.3%) died within 6 months from the last admission. CONCLUSIONS The incidence of hospital-treated poisoning was at least 2-fold in low-income areas when compared with middle- or high-income areas. For adolescent population from 13 to 17 years, the incidence in low-income areas was almost 3-fold when compared with other areas.
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Affiliation(s)
- Lauri O Koskela
- Medical Research Centre, Research Group of Surgery, Anaesthesiology and Intensive Care, Oulu University, Oulu, Finland
| | - Lasse V Raatiniemi
- Medical Research Centre, Research Group of Surgery, Anaesthesiology and Intensive Care, Oulu University, Oulu, Finland.,Centre for Pre-Hospital Emergency Care, Oulu University Hospital, Oulu, Finland
| | - Janne H Liisanantti
- Medical Research Centre, Research Group of Surgery, Anaesthesiology and Intensive Care, Oulu University, Oulu, Finland.,Division of Intensive Care Medicine, Department of Anaesthesiology, Oulu University Hospital, Oulu, Finland
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4
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Grimsrud MM, Brekke M, Syse VL, Vallersnes OM. Acute poisoning related to the recreational use of prescription drugs: an observational study from Oslo, Norway. BMC Emerg Med 2019; 19:55. [PMID: 31615421 PMCID: PMC6794774 DOI: 10.1186/s12873-019-0271-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/24/2019] [Indexed: 12/19/2022] Open
Abstract
Background Recreational use of prescription drugs is widespread. We describe acute poisonings related to the recreational use of prescription drugs. Methods Retrospective observational study. We retrospectively registered all patients presenting from October 2013 through March 2015 at a primary care emergency outpatient clinic in Oslo, Norway, with an acute poisoning related to recreational drug use. We registered demographic data, toxic agents taken, clinical course and treatment. From this data set we extracted the 819/2218 (36.9%) cases involving one or more prescription drugs. Results Among the 819 included cases, 190 (23.2%) were female. Median age was 37 years. The drugs most commonly involved were benzodiazepines in 696 (85.0%) cases, methadone in 60 (7.3%), buprenorphine in 53 (6.5%), other opioids in 56 (6.8%), zopiclone/zolpidem in 26 (3.2%), and methylphenidate in 11 (1.3%). Prescription drugs were combined with other toxic agents in 659 (80.5%) cases; heroin in 351 (42.9%), ethanol in 232 (28.3%), amphetamine in 141 (17.2%), cannabis in 70 (8.5%), gamma-hydroxybutyrate (GHB) in 34 (4.2%), cocaine in 29 (3.5%), and other illegal drugs in 46 (5.6%). The patient was given naloxone in 133 (16.2%) cases, sedation in 15 (1.8%), and flumazenil in 3 (0.4%). In 157 (19.2%) cases, the patient was sent on to hospital. Conclusions One in three acute poisonings related to recreational drug use involved prescription drugs. Benzodiazepines were by far the most common class of drugs. Prescription drugs had mostly been taken in combination with illegal drugs or ethanol.
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Affiliation(s)
- Marit Mæhle Grimsrud
- Faculty of Medicine, University of Oslo, Oslo, Norway.,The Norwegian PSC Research Center, Oslo University Hospital, Oslo, Norway
| | - Mette Brekke
- General Practice Research Unit, University of Oslo, Oslo, Norway
| | - Victoria Lykke Syse
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Oslo Accident and Emergency Outpatient Clinic, Department of Emergency General Practice, City of Oslo Health Agency, Oslo, Norway
| | - Odd Martin Vallersnes
- Oslo Accident and Emergency Outpatient Clinic, Department of Emergency General Practice, City of Oslo Health Agency, Oslo, Norway. .,Department of General Practice, University of Oslo, Oslo, Norway.
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5
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Lindqvist E, Edman G, Hollenberg J, Nordberg P, Ösby U, Forsberg S. Intensive care admissions due to poisoning. Acta Anaesthesiol Scand 2017; 61:1296-1304. [PMID: 28990178 DOI: 10.1111/aas.13005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 09/11/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Poisoning represents a significant part of admissions to intensive care units. The aim of this nationwide study was to describe recent national quality register data of demographics and mortality for these patients. METHOD A retrospective national observational study including all patients over 19 years admitted to an ICU in Sweden, between 1 January 2010 and 31 December 2011, with an ICD-10 code for poisoning. The data were collected from three national registers (The Swedish Intensive Care Register, The National Patient Register, and The Cause of Death Register). RESULTS The incidence of ICU-treated poisonings was 43/100,000. Twenty-one per cent (n = 8155) of all poisoned patients seeking medical care were admitted to the ICU. Their median age was 38 years (q1-q3: 26-51), as many men as women and 46.5% (n = 3790) had a previous registered poisoning. A mix of different substances was the most common type of suspected poisoning (29.7%, n = 2424). The in-hospital mortality was 1.9% and was correlated to invasive mechanical ventilation (OR 6.91 CI 95% 4.59-10.42), age > 40 (OR 4.54 CI 95% 2.86-7.21) and no previous hospitalisation for poisoning (OR 3.23 CI 95% 2.06-5.07). For 78.3% (n = 119) of the deceased patients, the fatal poisoning was their first diagnosed poisoning. The 30-day mortality was 2.7%, a majority died from poisoning (P < 0.01). CONCLUSION In Sweden, patients treated in the ICU due to poisoning represent a fifth of all poisoned patients seeking medical care. Older men with no previous poisoning were considered a high-risk group.
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Affiliation(s)
- E. Lindqvist
- Department of Anaesthesiology and Intensive Care; Norrtälje Hospital; Norrtälje Sweden
- Department of Clinical Science and Education; Södersjukhuset; Karolinska Institutet; Stockholm Sweden
| | - G. Edman
- Department of Clinical Sciences; Danderyd Hospital; Karolinska Institutet; Stockholm Sweden
- Department of Psychiatry; Norrtälje Hospital; Norrtälje Sweden
| | - J. Hollenberg
- Karolinska Institutet; Department of Medicine; Centre for Resuscitation Science; Stockholm Sweden
| | - P. Nordberg
- Karolinska Institutet; Department of Medicine; Centre for Resuscitation Science; Stockholm Sweden
| | - U. Ösby
- Center for Molecular Medicine; Karolinska University Hospital Solna; Stockholm Sweden
- Department of Neurobiology; Care Sciences and Society; Center for Family Medicine; Karolinska Institutet; Stockholm Sweden
| | - S. Forsberg
- Department of Anaesthesiology and Intensive Care; Norrtälje Hospital; Norrtälje Sweden
- Department of Clinical Science and Education; Södersjukhuset; Karolinska Institutet; Stockholm Sweden
- Swedish Poisons Information Centre; Stockholm Sweden
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6
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Wikoff D, Welsh BT, Henderson R, Brorby GP, Britt J, Myers E, Goldberger J, Lieberman HR, O'Brien C, Peck J, Tenenbein M, Weaver C, Harvey S, Urban J, Doepker C. Systematic review of the potential adverse effects of caffeine consumption in healthy adults, pregnant women, adolescents, and children. Food Chem Toxicol 2017; 109:585-648. [DOI: 10.1016/j.fct.2017.04.002] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 03/21/2017] [Accepted: 04/03/2017] [Indexed: 12/21/2022]
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Koskela L, Raatiniemi L, Bakke HK, Ala-Kokko T, Liisanantti J. Do pre-hospital poisoning deaths differ from in-hospital deaths? A retrospective analysis. Scand J Trauma Resusc Emerg Med 2017; 25:48. [PMID: 28482932 PMCID: PMC5422974 DOI: 10.1186/s13049-017-0391-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/26/2017] [Indexed: 11/21/2022] Open
Abstract
Background Most fatal poisonings occur outside the hospital and the victims found dead. The purpose of this study was to determine the general pattern and patient demographics of fatal poisonings in Northern Finland. In particular, we wanted to analyze differences between pre-hospital and in-hospital deaths. Methods All fatal poisonings that occurred in Northern Finland in 2007–2011 were retrieved from the Cause of Death Registry provided by Statistics Finland. We noted the patient demographics, causal agents, and other characteristics of the poisoning events. Results A total of 689 fatal poisonings occurred during the study period, of which only 42 (6.1%) reached the hospital alive. Those who died pre-hospital were significantly younger (50 vs. 56 years, p = 0.04) and more likely to be male (77% vs. 57%, p = 0.003). Cardiopulmonary resuscitation was attempted less often in pre-hospital cases (9.9% vs. 47.6%, p < 0.001). Ethanol was more frequently the main toxic agent in pre-hospital deaths (58.4% vs. 26.2%, p < 0.001), and multiple ingestions were more common (52.2% vs. 35.7%, p < 0.001) in pre-hospital deaths. Discussion Most of the pre-hospital fatal poisoning victims are found dead and the majority of in-hospital victims are admitted to hospital in an already serious condition. According to results of this and former studies, prevention seems to be the most important factor in reducing deaths due to poisoning. Conclusions The majority of poisoning-related deaths occur pre-hospital and are related to alcohol intoxication and multiple ingestions.
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Affiliation(s)
- Lauri Koskela
- Department of Anesthesiology, Division of Intensive Care Medicine, Oulu University Hospital, P.O. BOX 21, 90029 OYS, Oulu, Finland. .,Medical Research Center, Study Group of Surgery, Anesthesiology and Intensive Care, Oulu University, Oulu, Finland.
| | - Lasse Raatiniemi
- Medical Research Center, Study Group of Surgery, Anesthesiology and Intensive Care, Oulu University, Oulu, Finland.,Centre for Pre-Hospital Emergency Care, Oulu University Hospital, Oulu, Finland
| | - Håkon Kvåle Bakke
- Anesthesia and Critical Care Research Group, University of Tromsø, Tromsø, Norway.,Mo i Rana Hospital, Helgeland Hospital Trust, Mo i Rana, Norway
| | - Tero Ala-Kokko
- Department of Anesthesiology, Division of Intensive Care Medicine, Oulu University Hospital, P.O. BOX 21, 90029 OYS, Oulu, Finland.,Medical Research Center, Study Group of Surgery, Anesthesiology and Intensive Care, Oulu University, Oulu, Finland
| | - Janne Liisanantti
- Department of Anesthesiology, Division of Intensive Care Medicine, Oulu University Hospital, P.O. BOX 21, 90029 OYS, Oulu, Finland.,Medical Research Center, Study Group of Surgery, Anesthesiology and Intensive Care, Oulu University, Oulu, Finland
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8
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Vallersnes OM, Persett PS, Øiestad EL, Karinen R, Heyerdahl F, Hovda KE. Underestimated impact of novel psychoactive substances: laboratory confirmation of recreational drug toxicity in Oslo, Norway. Clin Toxicol (Phila) 2017; 55:636-644. [DOI: 10.1080/15563650.2017.1312002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Odd Martin Vallersnes
- Department of General Practice, University of Oslo, Oslo, Norway
- Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway
| | | | - Elisabeth Leere Øiestad
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
- School of Pharmacy, University of Oslo, Oslo, Norway
| | - Ritva Karinen
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | - Fridtjof Heyerdahl
- The Norwegian CBRNe Centre of Medicine, Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Knut Erik Hovda
- The Norwegian CBRNe Centre of Medicine, Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
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9
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Camilleri R. A Meta-Analysis of the Reliability of the History in Suspected Poisoning. J Emerg Med 2015; 48:679-84. [DOI: 10.1016/j.jemermed.2014.12.067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 11/22/2014] [Accepted: 12/22/2014] [Indexed: 11/30/2022]
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XXXV International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) 26–29 May 2015, St Julian's, Malta. Clin Toxicol (Phila) 2015. [DOI: 10.3109/15563650.2015.1024953] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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11
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In-Hospital Mortality and Long-Term Survival of Patients With Acute Intoxication Admitted to the ICU*. Crit Care Med 2014; 42:1471-9. [DOI: 10.1097/ccm.0000000000000245] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Lund C, Bjornaas MA, Sandvik L, Ekeberg O, Jacobsen D, Hovda KE. Five-year mortality after acute poisoning treated in ambulances, an emergency outpatient clinic and hospitals in Oslo. Scand J Trauma Resusc Emerg Med 2013; 21:65. [PMID: 23965589 PMCID: PMC3846782 DOI: 10.1186/1757-7241-21-65] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 08/16/2013] [Indexed: 11/26/2022] Open
Abstract
Background The long-term mortality after prehospital treatment for acute poisoning has not been studied previously. Thus, we aimed to estimate the five-year mortality and examine the causes of death and predictors of death for all acutely poisoned patients treated in ambulances, the emergency outpatient clinic, and hospitals in Oslo during 2003–2004. Methods A prospective cohort study included all adults (≥16 years; n=2045, median age=35 years, male=58%) who were discharged after treatment for acute poisoning in ambulances, the emergency outpatient clinic, and the four hospitals in Oslo during one year. The patients were observed until the end of 2008. Standardized mortality rates (SMRs) were calculated and multivariate Cox regression analysis was applied. Results The study comprised 2045 patients; 686 treated in ambulances, 646 treated in the outpatient clinic, and 713 treated in hospitals. After five years, 285 (14%) patients had died (four within one week). The SMRs after ambulance, outpatient, and hospital treatment were 12 (CI 9–14), 10 (CI 8–12), and 6 (CI 5–7), respectively. The overall SMR was 9 (CI 8–10), while the SMR after opioid poisoning was 27 (CI 21–32). The most frequent cause of death was accidents (38%). In the regression analysis, opioids as the main toxic agents (HR 2.3, CI 1.6–3.0), older age (HR 1.6, CI 1.5–1.7), and male sex (HR 1.4, CI 1.1–1.9) predicted death, whereas the treatment level did not predict death. Conclusions The patients had high mortality compared with the general population. Those treated in hospital had the lowest mortality. Opioids were the major predictor of death.
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Affiliation(s)
- Cathrine Lund
- Department of Acute Medicine, Oslo University Hospital Ullevaal, Kirkeveien 166, Oslo 0450, Norway.
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14
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Battal D, Hilal A, Daglioglu K, Unal I, Gulmen MK. Evaluation of paracetamol distribution and stability in case of acute intoxication in rats. Hum Exp Toxicol 2013; 32:82-9. [DOI: 10.1177/0960327112456314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Effects of different storing conditions on paracetamol concentration in biological samples of acute intoxicated rats were investigated. The stability and distribution of paracetamol was observed in postmortem serum, liver, kidney and brain tissues. The serum samples were stored for 30 days and daily changes were evaluated for paracetamol. A significant difference ( p = 0.05) was noticed on the 30th experimental day. Paracetamol serum levels changed as much as 66.30% and 33.78% for 4°C and −20°C, respectively. The stability of paracetamol in liver stored at −20°C was also evaluated for 30 days. The paracetamol concentration levels taken from liver samples dramatically decreased from 30.36% on the 1st day to 94.97% on the 30th day. The paracetamol distribution in organs was as 2.68 , 1.11 and 0.68 mg/g in liver, kidney and brain samples, respectively. Meaningful difference in paracetamol in serum and liver samples was in observed in 30th day values ( p = 0.05).
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Affiliation(s)
- D Battal
- Department of Toxicology, Faculty of Pharmacy, Mersin University, Mersin, Turkey
| | - A Hilal
- Department of Forensic Medicine, School of Medicine, Cukurova University, Adana, Turkey
| | - K Daglioglu
- Vocational High School of Health, Cukurova University, Adana, Turkey
| | - I Unal
- Department of Biostatistics, School of Medicine, Cukurova University, Adana, Turkey
| | - MK Gulmen
- Department of Forensic Medicine, School of Medicine, Cukurova University, Adana, Turkey
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15
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Lund C, Teige B, Drottning P, Stiksrud B, Rui TO, Lyngra M, Ekeberg O, Jacobsen D, Hovda KE. A one-year observational study of all hospitalized and fatal acute poisonings in Oslo: epidemiology, intention and follow-up. BMC Public Health 2012; 12:858. [PMID: 23046743 PMCID: PMC3542203 DOI: 10.1186/1471-2458-12-858] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 10/02/2012] [Indexed: 11/16/2022] Open
Abstract
Background Up to date information on poisoning trends is important. This study reports the epidemiology of all hospitalized acute poisonings in Oslo, including mortality, follow-up referrals, and whether the introduction of over-the-counter sales of paracetamol outside pharmacies had an impact on the frequency of poisonings. Methods All acute poisonings of adults (≥16 years) treated at the five hospitals in Oslo from April 2008 to April 2009 were included consecutively in an observational cross-sectional multicentre study. A standardized form was completed by the treating physician, which covered the study aims. All deaths by poisoning in and outside hospitals were registered at the Institute of Forensic Medicine. Results There were 1065 hospital admissions of 912 individuals; 460 (50%) were male, and the median age was 36 years. The annual incidence was 2.0 per 1000. The most frequent toxic agents were ethanol (18%), benzodiazepines (15%), paracetamol (11%), and opioids (11%). Physicians classified 46% as possible or definite suicide attempts, 37% as accidental overdoses with substances of abuse (AOSA), and 16% as other accidents. Twenty-four per cent were discharged without any follow-up and the no follow-up odds were highest for AOSA. There were 117 deaths (eight in hospital), of which 75% were males, and the median age was 41 years. Thus, the annual mortality rate was 25 per 100 000 and the in-hospital mortality was 0.8%. Opioids were the most frequent cause of death. Conclusions The incidence of hospitalized acute poisonings in Oslo was similar to that in 2003 and there was an equal sex distribution. Compared with a study performed in Oslo in 2003, there has been an increase in poisonings with a suicidal intention. The in-hospital mortality was low and nine out of ten deaths occurred outside hospitals. Opioids were the leading cause of death, so preventive measures should be encouraged among substance abusers. The number of poisonings caused by paracetamol remained unchanged after the introduction of over-the-counter sales outside pharmacies and there were no deaths, so over-the-counter sales may be considered safe.
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Affiliation(s)
- Cathrine Lund
- Department of Acute Medicine, Oslo University Hospital Ullevaal, Kirkeveien 166, Oslo 0407, Norway
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Bartoli M, Berny C, Capolaghi B, Danel V, Delahaye A, Desch G, Guitton J, Lacarelle B, Lapostolle F, Mathieu D, Mégarbane B, Nisse P, Szymanowicz A. Recommandations pour la prescription, la réalisation et l’interprétation des examens de biologie dans le cadre des intoxications graves. ANNALES FRANCAISES DE MEDECINE D URGENCE 2012. [DOI: 10.1007/s13341-012-0238-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lund C, Drottning P, Stiksrud B, Vahabi J, Lyngra M, Ekeberg I, Jacobsen D, Hovda KE. A one-year observational study of all hospitalized acute poisonings in Oslo: complications, treatment and sequelae. Scand J Trauma Resusc Emerg Med 2012; 20:49. [PMID: 22828054 PMCID: PMC3413541 DOI: 10.1186/1757-7241-20-49] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 07/24/2012] [Indexed: 11/17/2022] Open
Abstract
Objectives Changes in poisoning trends may affect both complications and outcomes in patients with acute poisoning. This study reports the treatments given and the frequency of complications, also related to treatment, mortality and sequelae related to various toxic agents. Methods All acute poisonings in adults (≥16 years) admitted to the five hospitals in Oslo were included consecutively during one year (2008 to 2009) in an observational cross-sectional multicenter study. A standardized form was completed by the treating physician, which covered the study aims. Results There were 1065 admissions in 912 patients. The median length of hospital stay was one day, and 49% were observed in an intensive care unit (ICU). Active treatment was given to 83%, and consisted of supportive therapy (70%), antidote(s) (38%), activated charcoal (16%) and gastric lavage (9%). The most commonly used antidotes were flumazenil (19%), naloxone (17%) and N-acetylcysteine (11%). The rate of treatment-related complications was 2.4% (21/884). Neither flumazenil, naloxone, nor the combination, was associated with convulsions or other complications. Among those receiving N-acetylcysteine, 5% (6/120) developed allergic reactions, one of which mandated discontinuation of treatment. Nineteen percent presented in a coma. Complications developed in 30%, compared with 18% in a 2003 study, mainly respiratory depression (12%), prolonged QTc interval (6%) and hypotension (5%). Eight patients died (0.8%) and five (0.5%) survived with permanent sequelae, mainly anoxic brain damage. Discussion Few patients stayed more than two days. The use of the ICU was liberal, considering that only one out of five presented in a coma. Antidotes were frequently given diagnostically. Although N-acetylcysteine induced allergic reactions, most were mild and treatment discontinuation was only necessary once. The frequency of complications had almost doubled in five years, although the poisoning pattern was largely unchanged. However, few patients developed permanent sequelae.
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Affiliation(s)
- Cathrine Lund
- Department of Acute Medicine, Oslo University Hospital Ullevaal, Kirkeveien 166, Oslo (0407), Norway
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Long-term mortality in patients hospitalized due to acute drug poisoning: 14-years follow-up study with controls. J Public Health (Oxf) 2012. [DOI: 10.1007/s10389-012-0524-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Duineveld C, Vroegop M, Schouren L, Hoedemaekers A, Schouten J, Moret-Hartman M, Kramers C. Acute intoxications: Differences in management between six Dutch hospitals. Clin Toxicol (Phila) 2012; 50:120-8. [DOI: 10.3109/15563650.2011.649092] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lund C, Vallersnes OM, Jacobsen D, Ekeberg O, Hovda KE. Outpatient treatment of acute poisonings in Oslo: poisoning pattern, factors associated with hospitalization, and mortality. Scand J Trauma Resusc Emerg Med 2012; 20:1. [PMID: 22217253 PMCID: PMC3285081 DOI: 10.1186/1757-7241-20-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 01/04/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most patients with acute poisoning are treated as outpatients worldwide. In Oslo, these patients are treated in a physician-led outpatient clinic with limited diagnostic and treatment resources, which reduces both the costs and emergency department overcrowding. We describe the poisoning patterns, treatment, mortality, factors associated with hospitalization and follow-up at this Emergency Medical Agency (EMA, "Oslo Legevakt"), and we evaluate the safety of this current practice. METHODS All acute poisonings in adults (> or = 16 years) treated at the EMA during one year (April 2008 to April 2009) were included consecutively in an observational study design. The treating physicians completed a standardized form comprising information needed to address the study's aims. Multivariate logistic regression analysis was used to identify the factors associated with hospitalization. RESULTS There were 2348 contacts for 1856 individuals; 1157 (62%) were male, and the median age was 34 years. The most frequent main toxic agents were ethanol (43%), opioids (22%) and CO or fire smoke (10%). The physicians classified 73% as accidental overdoses with substances of abuse taken for recreational purposes, 15% as other accidents (self-inflicted or other) and 11% as suicide attempts. Most (91%) patients were treated with observation only. The median observation time until discharge was 3.8 hours. No patient developed sequelae or died at the EMA. Seventeen per cent were hospitalized. Gamma-hydroxybutyric acid, respiratory depression, paracetamol, reduced consciousness and suicidal intention were factors associated with hospitalization. Forty-eight per cent were discharged without referral to follow-up. The one-month mortality was 0.6%. Of the nine deaths, five were by new accidental overdose with substances of abuse. CONCLUSIONS More than twice as many patients were treated at the EMA compared with all hospitals in Oslo. Despite more than a doubling of the annual number of poisoned patients treated at the EMA since 2003, there was no mortality or sequelae, indicating that the current practice is safe. Thus, most low- to intermediate-acuity poisonings can be treated safely without the need to access hospital resources. Although the short-term mortality was low, more follow-up of patients with substance abuse should be encouraged.
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Affiliation(s)
- Cathrine Lund
- Department of Acute Medicine, Oslo University Hospital Ullevaal, Norway.
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Bjornaas MA, Teige B, Hovda KE, Ekeberg O, Heyerdahl F, Jacobsen D. Fatal poisonings in Oslo: a one-year observational study. BMC Emerg Med 2010; 10:13. [PMID: 20525396 PMCID: PMC2889934 DOI: 10.1186/1471-227x-10-13] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 06/06/2010] [Indexed: 11/30/2022] Open
Abstract
Background Acute poisonings are common and are treated at different levels of the health care system. Since most fatal poisonings occur outside hospital, these must be included when studying characteristics of such deaths. The pattern of toxic agents differs between fatal and non-fatal poisonings. By including all poisoning episodes, cause-fatality rates can be calculated. Methods Fatal and non-fatal acute poisonings in subjects aged ≥16 years in Oslo (428 198 inhabitants) were included consecutively in an observational multi-centre study including the ambulance services, the Oslo Emergency Ward (outpatient clinic), and hospitals, as well as medico-legal autopsies from 1st April 2003 to 31st March 2004. Characteristics of fatal poisonings were examined, and a comparison of toxic agents was made between fatal and non-fatal acute poisoning. Results In Oslo, during the one-year period studied, 103 subjects aged ≥16 years died of acute poisoning. The annual mortality rate was 24 per 100 000. The male-female ratio was 2:1, and the mean age was 44 years (range 19-86 years). In 92 cases (89%), death occurred outside hospital. The main toxic agents were opiates or opioids (65% of cases), followed by ethanol (9%), tricyclic anti-depressants (TCAs) (4%), benzodiazepines (4%), and zopiclone (4%). Seventy-one (69%) were evaluated as accidental deaths and 32 (31%) as suicides. In 70% of all cases, and in 34% of suicides, the deceased was classified as drug or alcohol dependent. When compared with the 2981 non-fatal acute poisonings registered during the study period, the case fatality rate was 3% (95% C.I., 0.03-0.04). Methanol, TCAs, and antihistamines had the highest case fatality rates; 33% (95% C.I., 0.008-0.91), 14% (95% C.I., 0.04-0.33), and 10% (95% C.I., 0.02-0.27), respectively. Conclusions Three per cent of all acute poisonings were fatal, and nine out of ten deaths by acute poisonings occurred outside hospital. Two-thirds were evaluated as accidental deaths. Although case fatality rates were highest for methanol, TCAs, and antihistamines, most deaths were caused by opiates or opioids.
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Affiliation(s)
- Mari A Bjornaas
- Department of Acute Medicine, Oslo University Hospital Ulleval, Kirkeveien 166, N-0407 Oslo, Norway.
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Muan B, Heyerdahl F, Lindås R, Prestmo A, Skjønsberg H, Berg K. Kodepraksis ved forgiftningsdødsfall. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010; 130:1601-5. [DOI: 10.4045/tidsskr.09.0571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Björnstad K, Hultén P, Beck O, Helander A. Bioanalytical and clinical evaluation of 103 suspected cases of intoxications with psychoactive plant materials. Clin Toxicol (Phila) 2009; 47:566-72. [DOI: 10.1080/15563650903037181] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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