A one-year observational study of all hospitalized acute poisonings in Oslo: complications, treatment and sequelae

Principal causes of acute poisoning in an emergency service: experience between 2014 and 2021 at a University Hospital in Southwestern Colombia

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.

Kardiyovasküler ilaç zehirlenmelerinin ileriye dönük analizi

Purpose: The aim of this study is to provide data about diagnosis, treatment, and results of the patients poisoned by drugs affecting the cardiovascular system. Materials and Methods: Patients aged 18 and over who applied to the emergency department with drug poisoning affecting cardiovasculer system were included in the study. The demographic data, drugs and doses, emergency treatment and the time of development of shock or bradycardia, treatment, antidotes and invasive procedures were recorded. Results: In our study twenty-five patients, 8 (32 %) male and 17 (68 %) female, were included. At the admission, 56 % (n=14) had hypotension, 8 % (n=2) had bradycardia, at the second hour 76 % (n=19) had hypotension, 16 % (n=4) had bradycardia. Within 6 hours after admission, 80 % (n=20) patients had hypotension, 28 % (n=7) patients had bradycardia at least once. Fifty-two percent (n=13) of the patients calcium, 36 % (n=9) glukagon, 32 % (n=8) lipid, 12 % (n=3) atropine, 20 % (n=5) positive inotropes were given. Conclusion: Lipid therapy produces positive results in patients who did not improve with calcium, glucagon and fluid therapy. Patients who received calcium channel blockers experienced more cardiogenic shock and bradycardia was more common in patients receiving beta-blockers.

Acute drug poisonings leading to hospitalization

Knowledge about current trends and epidemiology in poisonings is important to maintain quality in diagnostics, treatment and prevention. We performed a cross-sectional study of all cases (n = 261) admitted with drug poisoning to Aalborg University Hospital during 1 year in 2017-2018. Median age was 30 (22-49) years, and 58% were female. Fifty percent were suicide attempts. In most cases, involved drugs were identified by history taking; blood analysis barely revealed any additional paracetamol and salicylicate poisonings. Drugs prescribed to the patient or available over the counter were involved in nearly two thirds of cases. Weak analgesics dominated by paracetamol (n = 91, 35%) was the most frequently involved group of drugs followed by opioids and benzodiazepines. Gender differences were observed with respect to involvement of weak analgesics and central stimulants. A higher prevalence of unidentified involved drugs was observed in 26 cases (10%) in which the length of admission exceeded 2 days and/or intensive care was needed. No deaths, cardiac arrhythmias or physical complications occurred. Thus, current handling of the acute poisoning seems effective in most cases. However, a more tailored use of blood analyses including a toxicological screen in selected cases may represent an opportunity for improvement.

Substance abuse-related admissions in a mixed Norwegian intensive care population

BACKGROUND

Alcohol and drug abuse are potentially modifiable risk factors for critical illness. The aims of this study were to describe patients with substance abuse-related admissions (abbreviated SARA) in a mixed intensive care (ICU) population in Oslo, and to compare these patients with patients with non-SARA.

METHODS

Cross-sectional prospective study of a mixed medical and surgical ICU-population in Oslo, Norway. Data were collected consecutively using a questionnaire, medical records, and toxicology results. SARA included admissions due to acute or chronic complications of alcohol or drug abuse, as well as substance abuse-related injuries.

RESULTS

Of the 852 patients included, 168 (20%) had SARA; 102 (12%) alcohol-related and 66 (8%) drug-related. Male patients aged 18-39 had the highest proportion of SARA (47/97, 49%). Among the trauma patients, 69/182 (38%) were influenced by alcohol and drugs at the time of injury. Patients with SARA were significantly younger (median age 48 vs 66), had lower Charlson comorbidity index (mean 1.4 vs 2.5) and shorter length of stay (median days 2.4 vs 4.9), than non-SARA patients. Hospital mortality was similar when adjusting for age (OR 0.8, P = .27, non-SARA as reference).

CONCLUSION

Overall, one in five ICU admissions was associated with substance abuse. For male patients aged 18-39 this ratio was nearly half. More than one third of the trauma patients were influenced by alcohol or drugs at time of injury.

Characteristics and costs in adults with acute poisoning admitted to the emergency department of a university hospital in Belgium

Objective

The aims of this study were to assess the characteristics of all acute poisoning admissions among adult emergency department (ED) patients, to identify factors associated with admission and to calculate direct medical cost.

Methods

Data of 2017 (1^st January to 31^st December) were collected and analyzed retrospectively using patients’ medical records and hospital invoices. Factors associated with type of hospitalization were identified using appropriate statistics.

Results

A total of 1,214 hospital admissions were included, accounting for 3.6% of all ED admissions. Men (62.2%) and the age group 21–40 years (43.0%) accounted for the largest proportion. Substances most commonly involved were ethanol (52.9%), benzodiazepines (9.7%), cocaine (4.9%), cannabis (4.6%), antidepressants (4.6%) and psychostimulants (4.6%). A total of 4,561 treatment acts were recorded, most commonly monitoring of vital signs (63.6%) and medication and/or intravenous drip administration (62.9%). Patients were discharged home after having received care in the emergency department (ED-amb) in 54.5% of admissions, were admitted to the emergency-department-24-hours-observation unit (ED-24h) or were hospitalized (Hosp) in 24.6% and 20.9% of admissions, respectively. Factors found to be associated with hospitalization type were age, hour of admission, victim location, degree of severity, use of antidotes, involvement of antidepressants, antipsychotics, psychostimulants, benzodiazepines and ethanol. Total cost was €1,512,346 with an average of €1,287 per admission.

Conclusion

Poisonings entail a considerable percentage of patients admitted to an ED and financial burden. In particular, ethanol poisonings account for the largest proportion of all ED admissions. Comparison of our figures with other data is hampered by the heterogeneity in inclusion criteria. Availability of a uniform template would facilitate comparison and allow better monitoring policies for prevention and cost reduction.

Clinical Effects of Activated Charcoal Unavailability on Treatment Outcomes for Oral Drug Poisoned Patients

Background

Activated charcoal is the most frequently and widely used oral decontaminating agent in emergency departments (EDs). However, there is some debate about its clinical benefits and risks. In Korea, activated charcoal with sorbitol was unavailable as of the mid-2015, and our hospital had been unable to use it from September 2015. This study examined the differences of clinical features and outcomes of patients during the periods charcoal was and was not available.

Methods

We retrospectively reviewed the electronic medical records of patients who had visited an urban tertiary academic ED for oral drug poisoning between January 2013 and January 2017.

Results

For the charcoal-available period, 413 patients were identified and for the charcoal-unavailable period, 221. Activated charcoal was used in the treatment of 141 patients (34%) during the available period. The mortality rates during the available and unavailable periods were 1.9 and 0.9%, respectively (p = 0.507). There was also no interperiod difference in the development of aspiration pneumonia (9.9 versus 9.5%, p = 0.864), the endotracheal intubation rate (8.4 versus 7.2%, p = 0.586), and vasopressor use (5.3 versus 5.0%, p = 0.85). Intensive care unit (ICU) admission was higher in the unavailable period (5.8 versus 13.6%, p = 0.001). ICU days were lower in the unavailable period (10 [4.5-19] versus 4 [3-9], p = 0.01). Hospital admission (43.3 versus 29.9%, p = 0.001) was lower in the unavailable period.

Conclusions

In this single center study, there appeared to be no difference in mortality, intubation rates, or vasopressor use between the charcoal-available and charcoal-unavailable periods.

Patients admitted to hospital after suicide attempt with violent methods compared to patients with deliberate self-poisoning -a study of background variables, somatic and psychiatric health and suicidal behavior

BACKGROUND

In Norway, there are about 550 suicides recorded each year. The number of suicide attempts is 10-15 times higher. Suicide attempt is a major risk factor for suicide, in particular when violent methods are used. Suicide attempts with violent methods have hardly been studied in Norway. This study describes demographic, psychiatric and somatic health in patients admitted to somatic hospitals in Norway after suicide attempt by violent methods compared with suicide attempters using deliberate self-poisoning (DSP).

METHODS

Patients admitted to somatic hospital after suicide attempt aged > 18 years were included in a prospective cohort study, enrolled from December 2010 to April 2015. Demographics (gender, age, marital and living condition, educational and employment status), previous somatic and psychological health were registered. Patients who had used violent methods were compared with patients admitted after suicide attempt by DSP.

RESULTS

The study included 80 patients with violent methods and 81 patients with DSP (mean age both groups 42 yrs.). Violent methods used were cutting (34%), jumping from heights (32%), hanging (14%), others (10%), shooting (7%) and drowning (4%). Patients with violent methods had more often psychosis than patients admitted with DSP (14% vs 4%, p <  0.05), less anxiety disorders (4% vs 19%, p <  0.01) and less affective disorders (21% vs. 36%, p <  0.05). There were no significant differences between the numbers of patients who received psychiatric treatment at the time of the suicide attempt (violent 55% versus DSP 48%) or reported previous suicide attempt, 58% in patients with violent methods and 47% in DSP. Patients with violent methods stayed longer in hospital (14.3 (mean 8.3-20.3) vs. 2.3 (mean 1.6-3.1) days, p <  0.001), stayed longer in intensive care unit (5 days vs. 0.5 days, p <  0.001) and were in need of longer mechanical ventilation (1.4 vs 0.1 days, p <  0.001).

CONCLUSIONS

Patients with violent methods had more often psychosis, less anxiety disorders and affective disorders than patients with DSP. Psychiatric treatment before the attempt and previous suicide attempt was not significantly different between the groups and about half of the patients in both groups were in psychiatric treatment at the time of the suicide attempt.

Intensive care admissions due to poisoning

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.

Outpatient treatment of acute poisoning by substances of abuse: a prospective observational cohort study

Background

Procedures for the clinical assessment of acute poisoning by substances of abuse should identify patients in need of hospital admission and avoid hazardous discharges, while keeping the observation time short. We assess the safety of a systematic procedure developed at the Oslo Accident and Emergency Outpatient Clinic (OAEOC).

Methods

All patients 12 years and older treated for acute poisoning by substances of abuse at the OAEOC were included consecutively from October 2011 to September 2012. Data were collected on pre-set registration forms. Information on re-presentations to health services nation-wide during the first week following discharge was retrieved from the Norwegian Patient Register and from local electronic medical records. Information on fatalities was obtained from the Norwegian Cause of Death Registry.

Results

There were 2343 cases of acute poisoning by substances of abuse. The main toxic agent was ethanol in 1291 (55 %) cases, opioids in 539 (23 %), benzodiazepines in 194 (8 %), central stimulants in 132 (6 %), and gamma-hydroxybutyrate (GHB) in 105 (4 %). Median observation time was four hours. The patient was hospitalised in 391 (17 %) cases. Two patients died during the first week following discharge, both from a new opioid poisoning. Among 1952 discharges, 375 (19 %) patients re-presented at the OAEOC or a hospital within a week; 13 (0.7 %) with a diagnosis missed at the index episode, 169 (9 %) with a new poisoning, 31 (2 %) for follow-up of concomitant conditions diagnosed at index, and 162 (8 %) for unrelated events. Among the patients with missed diagnoses, five needed further treatment for the same poisoning episode, two were admitted with psychosis, one had hemorrhagic gastritis, another had fractures in need of surgery and four had minor injuries.

Conclusion

The procedure in use at the OAEOC can be considered safe and could be implemented elsewhere. The high re-presentation rate calls for better follow-up.

Endogenous opiates and behavior: 2012

This paper is the thirty-fifth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2012 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (Section 2), and the roles of these opioid peptides and receptors in pain and analgesia (Section 3); stress and social status (Section 4); tolerance and dependence (Section 5); learning and memory (Section 6); eating and drinking (Section 7); alcohol and drugs of abuse (Section 8); sexual activity and hormones, pregnancy, development and endocrinology (Section 9); mental illness and mood (Section 10); seizures and neurologic disorders (Section 11); electrical-related activity and neurophysiology (Section 12); general activity and locomotion (Section 13); gastrointestinal, renal and hepatic functions (Section 14); cardiovascular responses (Section 15); respiration and thermoregulation (Section 16); and immunological responses (Section 17).

Antídotos e medicamentos utilizados para tratar intoxicações no Brasil: necessidades, disponibilidade e oportunidades

Antídotos e determinados medicamentos são essenciais ao tratamento de algumas intoxicações e não podem sofrer falhas no abastecimento, sob o risco de prejudicar a saúde e a segurança da população. O objetivo deste trabalho foi avaliar a disponibilidade de antídotos e medicamentos recomendados para o tratamento de intoxicações no Brasil. A partir de consensos internacionais, foram selecionados 41 antídotos para análise, todos sem patente em vigência. Desses, 27 são registrados, porém 11 estão disponíveis em formas inadequadas ao tratamento de intoxicações, restando 16 medicamentos comercialmente disponíveis. Somente um terço dos medicamentos necessários para o tratamento de intoxicações está incluído na relação de medicamentos essenciais do país. Em adição, é apresentada proposta de suprimento das demandas a um dos antídotos, anticorpo antidigoxina, considerando a capacidade de produção nacional de imunobiológicos. Os resultados demonstram limitação da assistência adequada aos pacientes intoxicados no país e reforçam a necessidade urgente de políticas públicas na área.

A one-year observational study of all hospitalized and fatal acute poisonings in Oslo: epidemiology, intention and follow-up

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.