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Marano M, Goffredo BM, Faraci S, Torroni F, Gowda SH, Perdichizzi S, Di Nardo M. Pharmacokinetic effects of endoscopic gastric decontamination for multidrug gastric pharmacobezoars. Toxicol Rep 2024; 13:101683. [PMID: 39027424 PMCID: PMC11255119 DOI: 10.1016/j.toxrep.2024.101683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 06/17/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Intentional multiple drugs overdose is an often-encountered method of self-harm in adolescence. Treatments include supportive therapy, antidotes (when available) and decontamination techniques with the aim of reducing drugs absorption by the gastrointestinal system to minimize toxicity. Nevertheless, the decontamination techniques currently used, such as gastric lavage (GL), activated charcoal or whole-bowel irrigation, have a questionable effectiveness. Endoscopic gastric decontamination (EGD) treatment for massive ingestion of drugs or formation of pharmacobezoars is currently described only in anecdotal cases. Here we describe the management of an intentional drug overdose in an adolescent patient treated with EGD and the effects of this therapy on drugs pharmacokinetics. Case report A 15-year-old boy was admitted in an unconscious state (Glasgow Coma Scale: 7-8) to the pediatric intensive care unit after assuming an unspecified amount of quetiapine, aspirin, bisoprolol, fluoxetine, furosemide, alprazolam, and pregabalin pills. Rapid sequence intubation was immediately performed and then the patient was treated with symptomatic therapy and GL with minimal removal of gastric material. Accounting for the type of drugs, the time elapsed from oral assumption and the unknown quantity assumed, EGD was attempted with aim of removing potential aggregate of the drugs. Serial blood samples were taken before and after EGD to measure the plasma level of the drugs. A pharmacobezoar was found and was immediately removed with EGD. The results of the drug monitoring showed that quetiapine exceeded the toxic level reported in literature indicating that it may have been the drug assumed in higher quantity by our patient. PICU stay was uneventful, and the patient was transferred to the psychiatric ward after extubation. Discussion Our case shows how GL is not effective in mitigating multidrug absorption especially drugs potentially inducing pharmacobezoars. Furthermore, based on our plasma drug monitoring, we believe that early EGD should be considered in all cases of massive pill intake, prolonged release drugs that can form pharmacobezoars or in cases where a life-threatening dose cannot be excluded.
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Affiliation(s)
- M. Marano
- Pediatric Poison Control Center, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - BM Goffredo
- Division of Metabolic Biochemistry, Children’s Hospital Bambino Bambino Gesù, IRCCS, Rome, Italy
| | - S. Faraci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - F. Torroni
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Sharada H. Gowda
- Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, USA
| | - S. Perdichizzi
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - M. Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Schölin L, Eddleston M. Towards policy impact - an exploration of Clinical Toxicology research cited in policy documents and patents. Clin Toxicol (Phila) 2024; 62:636-642. [PMID: 39315987 DOI: 10.1080/15563650.2024.2398136] [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: 06/17/2024] [Revised: 08/22/2024] [Accepted: 08/23/2024] [Indexed: 09/25/2024]
Abstract
INTRODUCTION Individual researcher impact through scientific citations is carefully monitored, with little attention to the impact of individual journals through policy and patent mentions. We aimed to describe policy and patent mentions for articles published in Clinical Toxicology. METHODS Using Altmetric Explorer, we extracted mentions from 1 January 2013 to 31 December 2023, noting the citing source, Clinical Toxicology article title, and author-generated keywords. We used descriptive statistics to analyse the data. RESULTS We identified 165 individual policy documents (n = 139) and patents (n = 26), citing 146 articles with median of 6.4 years between publication and mention. The highest number of citing documents were by the World Health Organization (n = 45), European Monitoring Centre for Drugs and Drug Addiction (n = 22), and United States Centers for Disease Control and Prevention (n = 16). Most patents were registered in the United States (n = 17) and by the European Patent Office (n = 10), with the main classification of human necessities (n = 23). The commonest subjects of papers cited in policy and patents, from keywords, related to medical conditions and symptoms (26%) and recreational drugs (22%). The most cited article was "A systematic review of adverse events arising from the use of synthetic cannabinoids and their associated treatment." DISCUSSION Clinical Toxicology articles are cited in policy documents and patents, with a comparable number of mentions to the top-ranked journals in the field. This likely contributes to policy impact, but further work is needed to understand how cited articles are used and ripple effects through onwards citations of policy documents. CONCLUSIONS Clinical Toxicology is a toxicology journal for which published research gets recognised within influential policy sources. The Journal can play a key role in guiding public health policy through its selection and development of submitted publications.
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Affiliation(s)
- Lisa Schölin
- Centre for Pesticide Suicide Prevention, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Michael Eddleston
- Centre for Pesticide Suicide Prevention, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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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; 19:2015-2024. [PMID: 38502464 PMCID: PMC11466983 DOI: 10.1007/s11739-024-03570-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [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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Condon S, Cantu TG, Constantinou A, Degnan EC, Lungu M, Paglione MG, Parikh SJ, Szewczyk J. Overdosage Section in US and EU Labeling. Ther Innov Regul Sci 2024; 58:946-952. [PMID: 38886318 PMCID: PMC11335885 DOI: 10.1007/s43441-024-00673-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/07/2024] [Indexed: 06/20/2024]
Abstract
The Prescribing Information (PI) in the United States (US) and the Summary of Product Characteristics (SmPC) in the European Union (EU) are approved by the US Food & Drug Administration (FDA), and the European Medicines Agency (EMA), respectively. The inclusion of overdosage information in these documents is a regulatory requirement in both regions. This research evaluates the content of the overdosage section of US and EU labeling. The overdosage sections of labels for drugs approved in the US in three time periods were analyzed: 2000-2001, 2010-2011, and 2020-2021. EU labels for these same products were also reviewed if registered through the Centralized Procedure. Data collection and analyses were performed using a predefined questionnaire, focusing on adherence to regulatory requirements and identifying areas where additional regulatory guidance may be beneficial. The findings indicate that the content of the overdosage sections largely comply with the regulatory requirements of their respective regions. Fewer than half of the labels included information on supratherapeutic doses observed from clinical studies, risk factors for overdose or population specific data associated with overdose. Inconsistencies were noted concerning the incorporation of animal data when human data were available, in addition to the referencing of Poison Centers. The overall utility of non-specific treatment recommendations, in addition to gastric lavage is discussed. While the content of the overdosage section generally aligns with regulatory expectations, additional regulatory guidance could enhance consistency in how this section of labeling is presented and clarify expectations to improve its usefulness for health care professionals (HCPs).
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Rungta N, Ray B, Bhalla A, Samaddar DP, Paul G, Prasad S, Dongre A, Kumar P, Gautam PL, Mishra A, Tyagi RS. Indian Society of Critical Care Medicine Position Statement: Approach to a Patient with Poisoning in the Emergency Room and Intensive Care Unit. Indian J Crit Care Med 2024; 28:S217-S232. [PMID: 39234227 PMCID: PMC11369925 DOI: 10.5005/jp-journals-10071-24697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/15/2024] [Indexed: 09/06/2024] Open
Abstract
Poisoning and its aftermath are globally observed and acknowledged concerns. India has a large burden of "self-harm/suicides" with 12.4/per 100,000 population committing suicide. Consumption of poisonous substances is the second most common mode of self-harm in India. Patients present to both public and private institutions in a critically ill state. The Indian Society of Critical Care Medicine (ISCCM) and Indian College of Critical Care Medicine (ICCCM) decided to address common and contentious issues related to poisoning by developing a position statement that is expected to be appropriate in the Indian scenario by the constitution of an "expert group" to provide a "set of statements" aimed at addressing the common issues faced by intensivists in their practice in managing such patients. The structured approach, framework, and process adopted in developing the position statement on the approach to poisoning have been detailed in this statement. The formation of an expert advisory panel was followed by a literature search, and multiple sessions of consensus-building exercises to reach the current statement presented below. The statement consists of relevant questions with possible answers thereof. Each answer was further weighed against the data and evidence available in the literature. Recommendations were made using a simplified score to make the statement qualitatively meaningful. How to cite this article Rungta N, Ray B, Bhalla A, DP Samaddar, Paul G, Prasad S, et al. Indian Society of Critical Care Medicine Position Statement: Approach to a Patient with Poisoning in the Emergency Room and Intensive Care Unit. Indian J Crit Care Med 2024;28(S2):S217-S232.
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Affiliation(s)
| | - Banambar Ray
- Department of Critical Care Medicine, Sum Ultimate Medicare a Unit of SOA, Bhubaneswar, Odisha, India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - DP Samaddar
- Medical Affairs, Critical Care Unit, Academic and Quality Control, Ruby General Hospital, Kolkata, West Bengal, India
| | - Gunchan Paul
- Department of Critical Care Medicine, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Sayi Prasad
- Department of Critical Care Medicine, Diamond Super Specialty Hospital, Kolhapur, Maharashtra, India
| | - Anand Dongre
- Department of Intensive Care, Treat Me Multispecialty Hospital, Nagpur, Maharashtra, India
| | - Prashant Kumar
- Department of Anesthesia and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Parshottam L Gautam
- Department of Critical Care Medicine, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Anand Mishra
- Department of Critical Care Medicine, Sum Ultimate Medicare a Unit of SOA, Bhubaneswar, Odisha, India
| | - Ranvir S Tyagi
- Department of Anesthesia and Critical Care, Synergy Plus Hospital and Galaxy Hospital, Agra, Uttar Pradesh, India
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Asrie AB, Atnafie SA, Getahun KA, Birru EM, Mekonnen GB, Alemayehu GA, Endehabtu BF, Badi MB, Adinew GM. Poisoning cases and their management in Amhara National Regional State, Ethiopia: Hospital-based prospective study. PLoS One 2024; 19:e0303438. [PMID: 38820326 PMCID: PMC11142576 DOI: 10.1371/journal.pone.0303438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/23/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Poisoning is a significant public health problem globally. Ethiopia is a low-income country undergoing technological and social change that may increase access to drugs and chemicals, potentially increasing the incidence of poisoning. This study describes the epidemiology of hospital admissions due to poisoning in a region of Ethiopia. METHODS An institution based prospective observational study was employed, as a study design, in selected hospitals of the region from January to December 2018. RESULTS Of 442 poisoning cases, 78 (17.6%) died. Almost all poisoning cases were intentional self-poisonings. The most frequent poisonings were organophosphate compounds, 145 (32.8%), and metal phosphides (majorly aluminum phosphide), 115 (26.0%). The ingested poison was most frequently accessed from the patients' homes, 243 (55.0%), followed by purchases from local shops, 159 (36%). The median duration of admission was 24 hours. Of all the cases, 23 (5.2%) were admitted to intensive care units (ICU) requiring mechanical ventilation. Most of the cases admitted to the ICU were aluminum phosphide-poisoned patients. The majority of deaths (43 of 78) were due to metal phosphides. From the multivariate logistic regression analysis, altered level of consciousness on hospital arrival, metal phosphide poisoning, and no laboratory result as a part of the diagnosis process or investigation of the extent of toxicity were found to be significantly associated with the likelihood of poor treatment outcome. CONCLUSION The majority of the poisoning cases were females. The most common reasons for the intent of self-poisoning were dispute-related, mainly family disharmonies, followed by psychiatric conditions. The poisoning agents were mostly obtained from households. Organophosphate compounds and metal phosphides were the first and the second most frequently encountered poisoning agents, respectively, and it was noted that the later ones were responsible for most of the fatal cases. Of the pharmacologic interventions, atropine was the only agent regarded as an antidote. The most commonly employed agent for supportive treatment was cimetidine followed by maintenance fluids, while gastric lavage was the only GI decontamination method used among others. The fatality rate of poisoning in this study was found to be much higher than in other similar studies. Impaired consciousness upon hospital arrival, metal phosphide poisoning, and no involvement of laboratory investigation were found to significantly associate with the likelihood of death. Generally, the results dictate the need for the design and implementation of strategies to create awareness, prevent, and manage poisoning incidences in the community.
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Affiliation(s)
- Assefa Belay Asrie
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Seyfe Asrade Atnafie
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kefyalew Ayalew Getahun
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eshetie Melese Birru
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gashaw Binega Mekonnen
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Geta Asrade Alemayehu
- Department of Health Service Management and Health Economics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhanu Fikadie Endehabtu
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Marta Berta Badi
- Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getinet Mequanint Adinew
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Ichibayashi R, Togawa M. Coloration Phenomenon of Flunitrazepam on the Tongue of an Elderly Patient: A Case Report. Cureus 2024; 16:e60627. [PMID: 38903315 PMCID: PMC11187469 DOI: 10.7759/cureus.60627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/22/2024] Open
Abstract
Patients with dementia may forget to take their oral medications or may accidentally take too much. Furthermore, there are cases where people lick the medicine without recognizing it as a medicine or accidentally ingest it. An 88-year-old woman with a history of insomnia presented to the hospital, complaining of her weakness and mild loss of consciousness. Although her blood tests, imaging studies, and neurological findings were unremarkable, we noticed that her tongue was blue and determined that she had mistakenly taken flunitrazepam. This accidental ingestion was diagnosed as the cause of the symptoms. Patients with dementia report that they may take medicine by licking it, and some oral medicines have a coloring effect.
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Affiliation(s)
- Ryo Ichibayashi
- Division of Emergency Medicine Department of Internal Medicine, Toho University Medical Center Sakura Hospital, Chiba, JPN
| | - Miwako Togawa
- Division of Emergency Medicine, Department of Internal Medicine, Toho University Medical Center Sakura Hospital, Chiba, JPN
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De Santi O, Orellana MJ, Di Niro CA, Lashin HI, Greco V. The adjuvant effect of oil-based gastric lavage on the outcome of acute Aluminum phosphide poisoning: a systematic review and meta-analysis. Toxicol Res (Camb) 2024; 13:tfae029. [PMID: 38496382 PMCID: PMC10939350 DOI: 10.1093/toxres/tfae029] [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: 10/30/2023] [Revised: 01/04/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction Aluminum Phosphide (AlP) poisoning constituted the most common cause of poisoning death in some low- and middle-income countries (LMICs). This study aimed to evaluate the safety and efficacy of oil-based gastric lavage (GL) compared with standard therapy for the treatment of AlP poisoning. Materials and methods. This systematic review complied with "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) Protocols. A comprehensive search was carried out, identifying randomized controlled trials (RCTs), including anyone presenting within 6 h of exposure to AlP, and the administration of GL with oils, including liquid paraffin or coconut oil. Results We identified 7 RCTs. The evidence from 4 RCTs indicates that GL with paraffin oil is an effective treatment for acute AlP poisoning, decreasing the mortality rate (RR = 0.62; 95% CI = 0.48 to 0.81; participants = 226; I 2 = 10%; low-quality evidence). We estimate the Number Needed to Treat of 4. Likewise, this intervention reduces the need for intubation and mechanical ventilation (RR = 0.62; 95% CI = 0.40 to 0.79; I2 = 0%; low-quality evidence). Regarding GL with coconut oil, the evidence from 4 RCTs, indicates a slight reduction in mortality (RR = 0.82; 95% CI = 0.69 to 0.98; participants = 112; I2 = 0%; very low-quality evidence). Conclusions Limited evidence suggests that GL with paraffin oil is effective in reducing the mortality rate. Likewise, limited evidence showed in favor of paraffin oil concerning the need for intubation and mechanical ventilation. Very limited evidence suggests that GL with coconut oil could reduce mortality. Both interventions would have a benign safety profile.
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Affiliation(s)
- Omar De Santi
- Toxicology, Hospital Nacional Professor Alejandro Posadas, Centro Nacional de Intoxicaciones (CNI), Buenos Aires, Arturo U. Illia Av. (w/o number) and Marconi Morón 386, B1684, El Palomar, Buenos Aires, Argentina
| | - Marcelo J Orellana
- Toxicology, Hospital Nacional Professor Alejandro Posadas, Centro Nacional de Intoxicaciones (CNI), Buenos Aires, Arturo U. Illia Av. (w/o number) and Marconi Morón 386, B1684, El Palomar, Buenos Aires, Argentina
| | - Cecilia A Di Niro
- Cardiology, Hospital Municipal Central de San Isidro “Melchor A. Posse”, Buenos Aires, Argentina. Av. Sta Fe 431, B1641 Acassuso, Provincia de Buenos Aires, Argentina
| | - Heba I Lashin
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University Toxicologist. Tanta University, Poison Control Center (TUPCC), Tanta, Gharbia 31111, 31527, Egypt
| | - Vanina Greco
- Toxicology, Hospital Nacional Professor Alejandro Posadas, Centro Nacional de Intoxicaciones (CNI), Buenos Aires, Arturo U. Illia Av. (w/o number) and Marconi Morón 386, B1684, El Palomar, Buenos Aires, Argentina
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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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Farah R, Carpenter JE, Morgan BW. Oral potassium poisoning: a retrospective review of the National Poison Data System 2010-2021. Clin Toxicol (Phila) 2024; 62:46-52. [PMID: 38421360 DOI: 10.1080/15563650.2024.2308730] [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: 05/31/2023] [Accepted: 01/17/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Oral potassium poisoning can be life-threatening. The study aimed to describe patterns of oral potassium poisoning in adult and pediatric populations and characterize its clinical presentation and management as reported by United States poison centers. METHODS This is a retrospective review of the National Poison Data System from 1 January 2010 through 30 June 2021. We descriptively analyzed cases involving single substance, oral potassium salts. In a second step, we requested a subset of case-specific narratives for cases that resulted in major outcome or death, as well as cases where patients received any of the following therapies: whole bowel irrigation, sodium bicarbonate, calcium, insulin or hemodialysis. We classified hyperkalemia by expected toxicity: mild (peak potassium concentration <6.5 mEq/L), moderate (peak potassium concentration 6.5 to <8 mEq/L) or severe (peak potassium concentration ≥ 8mEq/L). RESULTS The National Poison Data System included 1,820 cases, 52.3 percent being adults. Among adult cases, 20% (n = 189) resulted in a moderate effect, major effect or death. Among pediatric cases aged <10 years, all exposures were unintentional. Analysis of 49 case narratives showed a median peak potassium concentration of 7.1 mEq/L (interquartile range 5.4-8.6) and a moderate correlation with the dose ingested (r = 0.66). Severe hyperkalemia was associated with QRS complex widening (P < 0.001), peaked T-waves (P = 0.001), and neurological symptoms (P = 0.04). Whole bowel irrigation was associated with mild hyperkalemia (P = 0.011), and hemodialysis was associated with severe hyperkalemia (P < 0.001). DISCUSSION Analysis of data showed that therapy to promote intracellular shift of potassium is the mainstay of management of oral potassium poisoning, followed by hemodialysis. LIMITATIONS Poison center data are susceptible to reporting bias. National Poison Data System data are affected by completeness and accuracy of reporting from health care providers and the lay public. CONCLUSIONS Single substance, oral potassium poisoning, reported to United States poison centers, is mostly unintentional and rarely results in hyperkalemia.
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Affiliation(s)
- Rita Farah
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
- Health's Blue Ridge Poison Center, University of Virginia, Charlottesville, VA, USA
| | - Joseph E Carpenter
- Department of Emergency Medicine, Emory University, Atlanta, GA, USA
- GA Poison Center, Atlanta, GA, USA
| | - Brent W Morgan
- Department of Emergency Medicine, Emory University, Atlanta, GA, USA
- GA Poison Center, Atlanta, GA, USA
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Liu KH, Chang SS, Tu CY, Chen HY, Lee WC, Tsai KF, Kuo PY, Yen JC, Wang IK, Yen TH. Human poisoning with glyphosate-surfactant herbicides: Retrospective analysis of mortality outcomes of patients treated in a poison center. Hum Exp Toxicol 2024; 43:9603271241297004. [PMID: 39439199 DOI: 10.1177/09603271241297004] [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] [Indexed: 10/25/2024]
Abstract
INTRODUCTION The toxicity and carcinogenicity of glyphosate have long been debated. Nevertheless, the mortality rate in patients with acute glyphosate-surfactant poisoning varies across different groups. METHODS Between 2002 and 2020, 109 patients with glyphosate-surfactant poisoning received treatment at Chang Gung Memorial Hospital. Patients were stratified into two subgroups according to their prognosis: good (n = 74) or poor (n = 35). Baseline demographics, psychiatric comorbidities, medical complications, and laboratory data were collected, and mortality data were analyzed. RESULTS The patients were 54.1 ± 17.5 years of age and were mostly male (68.8%). Most patients (91.7%) ingested pesticides intentionally, and patients arrived at the hospital within 7.1 ± 12.7 h. Psychiatric comorbidities were prevalent, and the top three comorbidities were mental (71.6%), depressive (48.6%), and adjustment (14.7%) disorder. Patients with poor prognoses were older than those with good prognoses (p = .007). Moreover, patients with poor prognoses had lower Glasgow Coma Scale scores (p < .001) and diastolic blood pressure (p = .008), but higher incidences of upper gastrointestinal bleeding (p < .001), aspiration pneumonia (p < .001), hypotension (p < .001), hyperglycemia (p = .002), acute kidney injury (p < .001), and metabolic acidosis (p < .001) than patients with good prognoses. The mortality rate was 5.5%. A multivariate-logistic-regression model revealed that the Glasgow Coma Scale score was a significant risk factor for poor prognosis (odds ratio 0.653, confidence interval 0.427-0.998; p = .049). However, no risk factors for mortality were identified. CONCLUSIONS A total of 32.1% of patients with glyphosate-surfactant poisoning had poor prognoses, and 5.5% of patients died despite treatment. The mortality outcome is comparable to that of published reports from other international poison centers.
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Affiliation(s)
- Kuan-Hung Liu
- Division of Cardiology, Department of Internal Medicine, Jen Ai Hospital, Dali Branch, Dali, Taiwan
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chao-Ying Tu
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsien-Yi Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wen-Chin Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kai-Fan Tsai
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Yen Kuo
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ju-Ching Yen
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - I-Kuan Wang
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nephrology, China Medical University Hospital, Taichung, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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12
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Wang L, Wang Y, Zhang RY, Wang Y, Liang W, Li TG. Management of acute carbamazepine poisoning: A narrative review. World J Psychiatry 2023; 13:816-830. [DOI: 10.5498/wjp.v13.i11.816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/23/2023] [Accepted: 10/11/2023] [Indexed: 11/17/2023] Open
Abstract
Standard management protocols are lacking and specific antidotes are unavailable for acute carbamazepine (CBZ) poisoning. The objective of this review is to provide currently available information on acute CBZ poisoning, including its management, by describing and summarizing various therapeutic methods for its treatment according to previously published studies. Several treatment methods for CBZ poisoning will be briefly introduced, their advantages and disadvantages will be analyzed and compared, and suggestions for the clinical treatment of CBZ poisoning will be provided. A literature search was performed in various English and Chinese databases. In addition, the reference lists of identified articles were screened for additional relevant studies, including non-indexed reports. Non-peer-reviewed sources were also included. In the present review, 154 articles met the inclusion criteria including case reports, case series, descriptive cohorts, pharmacokinetic studies, and in vitro studies. Data on 67 patients, including 4 fatalities, were reviewed. Based on the summary of cases reported in the included articles, the cure rate of CBZ poisoning after symptomatic treatment was 82% and the efficiency of hemoperfusion was 58.2%. Based on the literature review, CBZ is moderately dialyzable and the recommendation for CBZ poisoning is supportive management and gastric lavage. In severe cases, extracorporeal treatment is recommended, with hemodialysis as the first choice.
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Affiliation(s)
- Luan Wang
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yang Wang
- Department of General Surgery, The 4th Affiliated Hospital of China Medical University, Shenyang 110032, Liaoning Province, China
| | - Ruo-Ying Zhang
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yao Wang
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Wei Liang
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Tie-Gang Li
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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Zhou Y, Tong JL, Peng AH, Xu SY. Comparison of drug concentrations in blood and gastric lavage fluid before and after gastric lavage: A case report. World J Clin Cases 2023; 11:7680-7683. [DOI: 10.12998/wjcc.v11.i31.7680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/02/2023] [Accepted: 10/17/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Gastric lavage (GL) is one of the most important early therapies to remove unabsorbed toxins from the gastrointestinal tract. However, the details of performing gastric lavage remain to be established. There is controversy in clinical practice regarding individual choice of the timing of GL and its efficiency.
CASE SUMMARY We report the case of a young woman who presented to the Emergency Department with drug intoxication for four hours. We used the latest toxicological screening techniques to compare drug concentrations in the patient's blood and gastric lavage fluid before and after gastric lavage. The results confirmed that gastric lavage was effective in reducing drug concentrations in the stomach; a small amount of drug remained in the stomach at the end of gastric lavage.
CONCLUSION Gastric lavage is effective in reducing drug concentrations in the stomach, with a small amount of drug remaining in the stomach at the end of gastric lavage.
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Affiliation(s)
- Yue Zhou
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Disaster Medical Center, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jia-Le Tong
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Disaster Medical Center, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ai-Hua Peng
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Disaster Medical Center, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Shu-Yun Xu
- Department of Emergency Medicine and West China School of Nursing, Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Disaster Medical Center, Sichuan University, Chengdu 610041, Sichuan Province, China
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14
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Mathansingh AJ, Jose A, Fleming JJ, Abhilash KPP, Chandiraseharan VK, Lenin A, Hansdak SG, Iyyadurai R, Mani T, Peter JV, Eddleston M, Zachariah A. Quantification of Organophosphorus Insecticide Removed by Gastric Lavage in Acutely Poisoned Patients: An Observational Study. Indian J Crit Care Med 2023; 27:397-402. [PMID: 37378371 PMCID: PMC10291665 DOI: 10.5005/jp-journals-10071-24475] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/08/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction The effectiveness of gastric lavage in organophosphorus (OP) poisoning has not been established. We assessed the ability of gastric lavage to remove OP insecticides as a preliminary stage in assessing effectiveness. Patients and methods Organophosphorus poisoning patients presenting within 6 hours were included, irrespective of prior gastric lavage. A nasogastric tube was placed and gastric contents aspirated, followed by at least three cycles of gastric lavage with 200 mL of water. Samples from the initial aspirate and the first three lavage cycles were sent for identification and quantification of the OP compounds. Patients were monitored for complications of gastric lavage. Results Around 42 patients underwent gastric lavage. Eight (19.0%) patients were excluded from the study because of a lack of analytical standards for ingested compounds. Insecticides were detectable in the lavage samples of 24 of 34 (70.6%) patients. Lipophilic OP compounds were detected in 23 of 24 patients, while no hydrophilic OP compounds could be detected in six patients with reported ingestion of hydrophilic compounds. For chlorpyrifos poisoning (n = 10), only 0.65 mg (SD 1.2) of the estimated ingested amount (n = 5) of 8,600 mg (SD 3,200) was recovered by gastric lavage. The mean proportion of the compound removed by initial gastric aspirate was 79.4% and subsequent three cycles removed 11.5, 6.6, and 2.7%. Conclusion Lipophilic OP insecticides could be quantified in the stomach contents of OP poisoning patients with the first aspiration or lavage being most effective. The amount removed was very low; hence, routine use of gastric lavage for OP poisoning patients arriving within 6 hours is unlikely to be beneficial. How to cite this article Mathansingh AJ, Jose A, Fleming JJ, Abhilash KPP, Chandiraseharan VK, Lenin A, et al. Quantification of Organophosphorus Insecticide Removed by Gastric Lavage in Acutely Poisoned Patients: An Observational Study. Indian J Crit Care Med 2023;27(6):397-402.
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Affiliation(s)
| | - Arun Jose
- Department of Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jude Joseph Fleming
- Department of Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | | | | | - Audrin Lenin
- Department of Internal Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Samuel George Hansdak
- Department of Internal Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ramya Iyyadurai
- Department of Internal Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Thenmozhi Mani
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - John Victor Peter
- Medical Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Michael Eddleston
- Pharmacology, Toxicology, and Therapeutics, University of Edinburgh, Edinburgh, United Kingdom
| | - Anand Zachariah
- Department of Internal Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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15
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Jaffal K, Chevillard L, Mégarbane B. Lipid Emulsion to Treat Acute Poisonings: Mechanisms of Action, Indications, and Controversies. Pharmaceutics 2023; 15:pharmaceutics15051396. [PMID: 37242638 DOI: 10.3390/pharmaceutics15051396] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Biodetoxification using intravenous lipid emulsion (ILE) in acute poisoning is of growing interest. As well as for local anesthetics, ILE is currently used to reverse toxicity caused by a broad-spectrum of lipophilic drugs. Both pharmacokinetic and pharmacodynamic mechanisms have been postulated to explain its possible benefits, mainly combining a scavenging effect called "lipid sink" and cardiotonic activity. Additional mechanisms based on ILE-attributed vasoactive and cytoprotective properties are still under investigation. Here, we present a narrative review on lipid resuscitation, focusing on the recent literature with advances in understanding ILE-attributed mechanisms of action and evaluating the evidence supporting ILE administration that enabled the international recommendations. Many practical aspects are still controversial, including the optimal dose, the optimal administration timing, and the optimal duration of infusion for clinical efficacy, as well as the threshold dose for adverse effects. Present evidence supports the use of ILE as first-line therapy to reverse local anesthetic-related systemic toxicity and as adjunct therapy in lipophilic non-local anesthetic drug overdoses refractory to well-established antidotes and supportive care. However, the level of evidence is low to very low, as for most other commonly used antidotes. Our review presents the internationally accepted recommendations according to the clinical poisoning scenario and provides the precautions of use to optimize the expected efficacy of ILE and limit the inconveniences of its futile administration. Based on their absorptive properties, the next generation of scavenging agents is additionally presented. Although emerging research shows great potential, several challenges need to be overcome before parenteral detoxifying agents could be considered as an established treatment for severe poisonings.
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Affiliation(s)
- Karim Jaffal
- Department of Medical and Toxicological Critical Care, Federation of Toxicology, Lariboisière Hospital, 75010 Paris, France
- INSERM UMRS-1144, Paris-Cité University, 75006 Paris, France
| | - Lucie Chevillard
- Department of Medical and Toxicological Critical Care, Federation of Toxicology, Lariboisière Hospital, 75010 Paris, France
- INSERM UMRS-1144, Paris-Cité University, 75006 Paris, France
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Federation of Toxicology, Lariboisière Hospital, 75010 Paris, France
- INSERM UMRS-1144, Paris-Cité University, 75006 Paris, France
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16
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Dos Santos JCP, Valli JB, Sesse NS, Mackenzie Ross S, Zandonade E, Ayres LR, Sampaio KN. Pesticide exposure and poisoning in Brazil: Outcome severity, clinical manifestations and management of cases reported to a poison control center. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2022; 78:177-186. [PMID: 36573257 DOI: 10.1080/19338244.2022.2161456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This work aimed to identify variables associated with increased risk of outcome severity as well as to describe clinical manifestations/symptoms and management of pesticide-related cases reported to a poison center in Brazil. An increased risk of more severe outcomes was observed when exposures occurred in rural areas, involved suicide attempts and moderately to extremely hazardous pesticides. Clinical manifestations with higher frequencies included vomiting, nausea, sialorrhea, headache, miosis and sweating. From the treatment initially applied to the patient, 51.91% encompassed gastric lavage, but this procedure was only recommended in 20.01% of cases by the CIATox. Identifying risk factors associated with poor outcome, describing clinical manifestations, and contrasting initial treatment measures adopted against those recommended by the Poison Center can help determine diagnosis, prognosis and ensure appropriate clinical interventions are used in cases of pesticide poisoning.
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Affiliation(s)
| | - Joanina Bicalho Valli
- Toxicological Information and Assistance Center of Espírito Santo (CIATox-ES), Vitória, ES, Brasil
| | - Nixon Souza Sesse
- Toxicological Information and Assistance Center of Espírito Santo (CIATox-ES), Vitória, ES, Brasil
| | - Sarah Mackenzie Ross
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Eliana Zandonade
- Public Health Postgraduate Program, Federal University of Espírito Santo, Vitória, ES, Brazil
- Statistical Department, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Lorena Rocha Ayres
- Department of Pharmaceutical Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Karla Nívea Sampaio
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil
- Department of Pharmaceutical Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil
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17
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Stanton MT. Part
II
: Interactive case: Toxicology and poison control. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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18
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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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Süzen-Orhan E, Botan E, Gün E, Özen H, Gurbanov A, Balaban B, Kahveci F, Vatansever G, Tekin D, Kendirli T. Colchicine Poisoning Cases in a Pediatric Intensive Care Unit: A Twenty-Year Study. Pediatr Emerg Care 2022; 38:489-493. [PMID: 36018729 DOI: 10.1097/pec.0000000000002835] [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: 11/26/2022]
Abstract
OBJECTIVES Colchicine intoxication is rare but potentially fatal. The toxic dose of colchicine is not well established; it has been reported that major toxicity starts after doses of 0.5 mg/kg. We aimed to evaluate the demographic, clinical aspects, treatments, and outcome of colchicine toxicity cases in the pediatric intensive care unit (PICU). METHODS We collected the data of patients aged between 0 and 18 years, admitted to Ankara University Faculty of Medicine PICU for colchicine poisoning (n = 22), from October 1999 to January 2020, retrospectively. Data extracted from the cases included age, sex, chronic condition, time between intake of drug and admission to PICU, source of drug, amount of drug ingested, other drug intake, symptoms, clinical findings, cardiac involvement, laboratory results, time of stay in PICU, treatment, and outcome. RESULTS Patients' age ranged from 7 months to 17 years. Median age was 86 months. The most common symptom at time of admission was vomiting, occurring in 13 (59%) of the patients. Two of the patients presented with change in mental status. Time between taking medication and applying to the hospital ranged from half an hour to 4 days. Medication intake of 3 of 22 patients was more than 0.5 mg/kg. One patient whose parents' best estimate of dose ingested was 0.48 mg/kg died because of the development of multiorgan failure. One patient who ingested 0.4 mg/kg of colchicine underwent plasma exchange and recovered without any complications. CONCLUSIONS Colchicine poisoning has a high risk of mortality, and death can be seen in doses less than a single acute dose of 0.5 mg/kg. These patients need close monitoring because there is always a risk of them to require aggressive support. Prognosis is poor in patients who have rapidly developing hemodynamic failure.
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Affiliation(s)
| | - Edin Botan
- Department of Pediatric Critical Care Medicine
| | - Emrah Gün
- Department of Pediatric Critical Care Medicine
| | - Hasan Özen
- Department of Pediatric Critical Care Medicine
| | | | | | | | - Göksel Vatansever
- Department of Pediatric Emergency Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Deniz Tekin
- Department of Pediatric Emergency Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
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20
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Takia L, Kc S, Randhawa M, Angurana SK, Nallasamy K, Bansal A, Jayashree M. Clinical Features, Intensive Care Needs, and Outcome of Carbamazepine Poisoning in Children. Indian J Pediatr 2022; 89:1022-1024. [PMID: 35277811 DOI: 10.1007/s12098-022-04155-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 12/24/2021] [Indexed: 11/26/2022]
Abstract
Carbamazepine is commonly used antiseizure medication with a narrow therapeutic range. The data on carbamazepine poisoning in children from India is limited. In this retrospective study, the authors reported 10 children with carbamazepine poisoning admitted to pediatric intensive care unit (PICU) of a tertiary care teaching hospital in North India over a period of 8 y (2013 to 2020). The median age was 5.5 (4.3-6) y and 60% cases were males. All had accidental ingestion and the dose ingested was 96 (80-103) mg/kg. The common clinical features were drowsiness (100%), tachycardia (80%), vomiting (60%), seizures (60%), respiratory failure (60%), and dystonia (50%). At admission, 60% children had coma. The treatment included gastric lavage (70%), single-dose-activated charcoal (60%), multidose-activated charcoal (30%), mechanical ventilation (60%), and dialysis (20%). The duration of PICU and hospital stay was 36 (22-45) h and 48 (48-60) h, respectively. There was no mortality.
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Affiliation(s)
- Lalit Takia
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatric Center (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Sudeep Kc
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatric Center (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Manjinder Randhawa
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatric Center (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Suresh Kumar Angurana
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatric Center (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Karthi Nallasamy
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatric Center (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Arun Bansal
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatric Center (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Muralidharan Jayashree
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatric Center (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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21
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Grabska K, Pilarska I. Acute poisoning among children and adolescents: a narrative review. MEDICAL SCIENCE PULSE 2022. [DOI: 10.5604/01.3001.0015.9656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Acute poisoning is a frequent emergency and a significant health concern in the pediatric population. The pattern of acute intoxication differs between countries and within each country. Poisoning depends on many factors. It can be divided into two categories (accidental and intentional), and each one has its own characteristics.
Aim of the study: This study aimed to analyze and discuss the overall patterns of accidental and intentional poisoning among children and adolescents.
Material and methods: A systematic literature search was conducted using Google Scholar, Elsevier, and the PubMed database. The following keywords were used: “acute poisoning”, “pediatric poisoning”, “intentional poisonings”, “unintentional poisonings”, and “suicide attempts”.
Results: A total of 38 articles were included in the review. Half had been published in the last five years. The analysis focused on the characteristics of the materials and methods, results, and conclusions sections of each study.
Conclusions: Unintentional poisonings dominate among younger children, with a slight male predominance. They usually occur at home and occasionally lead to severe harm or even death. The most common causes of intoxication in this population are medications and household products. The majority of poisonings among adolescents are intentional suicide attempts. Among older children, over-the-counter analgesics are the most common cause of acute poisoning. Accidental poisoning can be avoided by providing preventive educational programs to guardians and replacing potentially toxic household products with safer ones. The prevention of intentional poisoning should be based on a community support system and behavioral programs. Healthcare professionals should be familiar with poisoning and be aware of the different patterns of intoxication according to age and gender.
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Affiliation(s)
- Kinga Grabska
- St. Anna’s Hospital of Trauma Surgery in Warsaw, Poland; Student Research Association of Pediatric Emergency Medicine, Medical University of Warsaw, Poland
| | - Izabela Pilarska
- Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland; Student Research Association of Pediatric Emergency Medicine, Medical University of Warsaw, Poland
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22
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Villegas-Belman S, Esparza-Gallegos TC, Lizalde-Moreno JA, Marquez-Romero JM. Fatal arrhythmia following ingestion of hawthorn root (Crataegus pubescens) extract: a case report. Clin Exp Emerg Med 2022; 9:373-376. [PMID: 35863376 PMCID: PMC9834822 DOI: 10.15441/ceem.21.086] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/09/2021] [Indexed: 01/21/2023] Open
Abstract
The use of extracts from the hawthorn plant as cardiovascular agents dates back to the 1st century; recently, they have also been made available online as weight loss aids. Herein, we present a case of intentional intoxication with hawthorn root extract (HRE) in an adult patient that resulted in death. A 20-year-old female patient, who was clinically diagnosed with depression, developed hypotension, bradycardia, and depressed consciousness after ingestion of this extract. An electrocardiogram recorded a sinus arrest with a slow nodal rhythm, which rapidly deteriorated, leading to cardiac arrest. This case report illustrates the potentially fatal consequences of HRE for which the constituents have not yet been characterized. All physicians, especially those in the emergency department, should be aware of the dangerous, even potentially fatal interactions of HRE with prescription medications.
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Affiliation(s)
| | | | | | - Juan Manuel Marquez-Romero
- Department of Internal Medicine, Instituto Mexicano del Seguro Social, Aguascalientes, Mexico,Correspondence to: Juan Manuel Marquez-Romero Instituto Mexicano del Seguro Social, Av. de los Conos 102, Fraccionamiento Ojo Caliente, Aguascalientes 20190, Mexico E-mail:
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23
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Nordmeyer SD, Kaiser G, Schaper A. Das Dreisäulenmodell der klinischen Toxikologie. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01520-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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TUGCAN MO, SEBE A, AÇIKALIN A, DİŞEL R, TUGCAN Y, TAŞKIN Ö, KARAHAN T, AVCİ BŞ, SÜMBÜL HE, AVCİ A. Kardiyovasküler ilaç zehirlenmelerinin ileriye dönük analizi. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1088964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
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.
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Affiliation(s)
| | - Ahmet SEBE
- Cukurova University, Faculty of Medicine, Department of Emergency Medicine, Adana, Turkey
| | - Ayça AÇIKALIN
- Cukurova University, Faculty of Medicine, Department of Emergency Medicine, Adana, Turkey
| | - Rana DİŞEL
- Cukurova University, Faculty of Medicine, Department of Emergency Medicine, Adana, Turkey
| | - Yagmur TUGCAN
- Cukurova University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Adana, Turkey
| | - Ömer TAŞKIN
- Yüreğir State Hospital, Emergency Clinic, Adana, Turkey
| | - Talha KARAHAN
- Kars Harakani State Hospital, Emergency Clinic, Kars, Turkey
| | - Begüm Şeyda AVCİ
- Health Science University, Adana City Research and Training Hospital, Department of Internal Medicine, Adana, Turkey
| | - Hilmi Erdem SÜMBÜL
- Health Science University, Adana City Research and Training Hospital, Department of Internal Medicine, Adana, Turkey
| | - Akkan AVCİ
- Health Science University, Adana City Research and Training Hospital, Department of Emergency Medicine, Adana, Turkey
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25
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Zhang Y, Xu Y, Liu H, Sun B. Ultrahigh sensitivity nitrogen-doping carbon nanotubes-based metamaterial-free flexible terahertz sensing platform for insecticides detection. Food Chem 2022; 394:133467. [PMID: 35717347 DOI: 10.1016/j.foodchem.2022.133467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 05/20/2022] [Accepted: 06/09/2022] [Indexed: 11/24/2022]
Abstract
With the rapid advances in terahertz (THz) spectroscopy, metamaterial-free THz sensors have been of importance due to efficient cost, high sensitivity and overcoming the limited tunability of the optical constants of metals. Here, a metamaterial-free and flexible THz sensor based on nitrogen-doping carbon nanotubes (N-CNTs) coupled with signal-enhancing Au NPs was proposed for detecting nereistoxin-related insecticides (NRIs). Sensitivity and selectivity for NRIs detection have been realized over the range of 3.3-100 μg/L with good linear fitting (R2 ≥ 0.9003) and LOD was 1.33 μg/L. Accuracy was validated by the recovery rates of 105.87-109.75% of NRI in spiked food-matrix sample. These results indicated the developed signal-enhancing THz method, validated by LC-MS/MS, exhibited high sensitivity and simplicity detection, which has noteworthy potential for applications in food safety and environment monitoring.
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Affiliation(s)
- Ying Zhang
- Beijing Technology and Business University (BTBU), No. 11 Fucheng Road, Beijing 100048, People's Republic of China
| | - Yuqing Xu
- Beijing Technology and Business University (BTBU), No. 11 Fucheng Road, Beijing 100048, People's Republic of China
| | - Huilin Liu
- Beijing Technology and Business University (BTBU), No. 11 Fucheng Road, Beijing 100048, People's Republic of China.
| | - Baoguo Sun
- Beijing Technology and Business University (BTBU), No. 11 Fucheng Road, Beijing 100048, People's Republic of China
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Wendt S, Lübbert C, Begemann K, Prasa D, Franke H. Poisoning by Plants. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:arztebl.m2022.0124. [PMID: 35140011 PMCID: PMC9453220 DOI: 10.3238/arztebl.m2022.0124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/26/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Questions on poisoning by plants are a common reason for inquiries to poison information centers (PIC). Over the years 2011-2020, plant poisoning was the subject of 15% of all inquiries to the joint poison information center in Erfurt, Germany (Gemeinsames Giftinformationszentrum Erfurt, GGIZ) that concerned poisoning in children (2.3% in adults). In this patient collective, plant poisoning occupied third place after medical drugs (32%) and chemical substances (24%), and was a more common subject of inquiry than mushroom poisoning (1.5%). METHODS This review is based on pertinent publications retrieved by a selective literature search in PubMed/TOXLINE on plant poisoning and on 12 epidemiologically and toxicologically relevant domestic species of poisonous plants in risk categories 2 and 3 (up to 2021). RESULTS Medical personnel should have basic toxicological knowledge of the following highly poisonous plants: wolfsbane (aconitum), belladonna, angel's trumpet, cowbane (cicuta virosa), autumn crocus, hemlock, jimson weed, henbane, castor bean (ricinus), false hellebore, foxglove (digitalis), and European yew. The intoxication is evaluated on the basis of a structured history (the "w" questions) and the clinical manifestations (e.g., toxidromes). Special analysis is generally not readily available and often expensive and time-consuming. In case of poisoning, a poison information center should be contacted for plant identification, risk assessment, and treatment recommendations. Specimens of plant components and vomit should be obtained, if possible, for further testing. Measures for the elimination of the poisonous substance may be indicated after a risk-benefit analysis. Specific antidotes are available for only a few types of plant poisoning, e.g., physostigmine for tropane alkaloid poisoning or digitalis antibodies for foxglove poisoning. The treatment is usually symptomatic and only rarely evidence-based. Individualized medical surveillance is recommended after the ingestion of large or unknown quantities of poisonous plant components. CONCLUSION The clinician should be able to recognize dangerous domestic species of poisonous plants, take appropriate initial measures, and avoid overdiagnosis and overtreatment. To improve patient care, systematic epidemiological and clinical studies are needed.
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Affiliation(s)
- Sebastian Wendt
- Division of Infectious Diseases and Tropical Medicine, Department of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, University Hospital, Leipzig
- University Hospital Leipzig, Interdisciplinary Centre for Infectious Diseases (ZINF)
- Postgraduate Study of Toxicology and Environmental Protection, Leipzig
| | - Christoph Lübbert
- Division of Infectious Diseases and Tropical Medicine, Department of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, University Hospital, Leipzig
- University Hospital Leipzig, Interdisciplinary Centre for Infectious Diseases (ZINF)
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig
| | - Kathrin Begemann
- German Federal Institute for Risk Assessment, Department Exposure,Berlin
| | - Dagmar Prasa
- *These authors share last authorship
- Joint Poison Information Center of Mecklenburg-Vorpommern, Sachsen, Sachsen-Anhalt und Thüringen c/o HELIOS Klinikum Erfurt
| | - Heike Franke
- *These authors share last authorship
- Postgraduate Study of Toxicology and Environmental Protection, Leipzig
- Rudolf-Boehm-Institute of Pharmacology and Toxicology, University of Leipzig
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27
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Pejčić AV. Acute Hydroxychloroquine Overdose: A Review of Published Pediatric Cases With Confirmed Hydroxychloroquine Exposure. Pediatr Emerg Care 2022; 38:174-182. [PMID: 34570079 DOI: 10.1097/pec.0000000000002547] [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: 10/20/2022]
Abstract
OBJECTIVES This review aimed to explore and summarize information from available cases of pediatric acute hydroxychloroquine overdose with confirmed hydroxychloroquine exposure to give the clinicians a helpful perspective for its better recognition and management. METHODS Electronic searches were conducted in PubMed/MEDLINE, Web of Science, Scopus, EBSCO and Serbian Citation Index. The abstracts from 2 toxicology conferences were manually checked for additional relevant publications, as well as reference lists of the retrieved publications. Descriptive statistics, narrative summation, and tabulation of the extracted data were made. RESULTS Nine publications and a total of 9 patients were included in the review. Reported age of the patients varied from 2.5 to 16 years (median, 16 years). There were more female patients (77.8%). Estimated total ingested hydroxychloroquine dose was reported in 7 cases (77.8%), and it ranged from 4.0 to 20.0 g (median: 12.0 g). Four patients (44.4%) ingested hydroxychloroquine with a coingestant. Altered mental status (100.0%), cardiotoxicity (88.9%), hypotension (77.8%), and hypokalemia (55.6%) were the most commonly reported clinical manifestations. The majority of the patients were hospitalized (88.9%). More than half of the patients (55.6%) were reported to be treated in the intensive care unit. Most frequently reported therapeutic measures were the following: administration of intravenous fluids/infusions (77.8%), vasopressors (77.8%), bicarbonate therapy-sodium bicarbonate (66.7%), potassium replacement (55.6%), and intubation/ventilation (55.6%). Three patients (33.3%) died. CONCLUSIONS Management of acute hydroxychloroquine overdose in children should be symptomatic and tailored to observed clinical manifestations. There is a need for additional investigations to better understand the impact and effectiveness of various treatment options.
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Affiliation(s)
- Ana V Pejčić
- From the Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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28
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Ross JA, Eldridge DL. Pediatric Toxicology. Emerg Med Clin North Am 2022; 40:237-250. [DOI: 10.1016/j.emc.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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Murphy L, Rasmussen J, Murphy NG. Venlafaxine overdose treated with extracorporeal life support. CMAJ 2021; 193:E167-E170. [PMID: 33526543 PMCID: PMC7954576 DOI: 10.1503/cmaj.201318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Laurel Murphy
- Departments of Emergency Medicine and Critical Care (L. Murphy), and Surgery; Division of Plastic Surgery, Department of Critical Care (Rasmussen); Department of Emergency Medicine and IWK Regional Poison Centre (N. Murphy), Dalhousie University, Halifax, NS
| | - Jack Rasmussen
- Departments of Emergency Medicine and Critical Care (L. Murphy), and Surgery; Division of Plastic Surgery, Department of Critical Care (Rasmussen); Department of Emergency Medicine and IWK Regional Poison Centre (N. Murphy), Dalhousie University, Halifax, NS
| | - Nancy G Murphy
- Departments of Emergency Medicine and Critical Care (L. Murphy), and Surgery; Division of Plastic Surgery, Department of Critical Care (Rasmussen); Department of Emergency Medicine and IWK Regional Poison Centre (N. Murphy), Dalhousie University, Halifax, NS
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30
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Doyno CR, White CM. Sedative-Hypnotic Agents That Impact Gamma-Aminobutyric Acid Receptors: Focus on Flunitrazepam, Gamma-Hydroxybutyric Acid, Phenibut, and Selank. J Clin Pharmacol 2021; 61 Suppl 2:S114-S128. [PMID: 34396551 DOI: 10.1002/jcph.1922] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/03/2021] [Indexed: 12/29/2022]
Abstract
There are many nonopioid central nervous system depressant substances that share a gamma-aminobutyric acid (GABA) receptor-related mechanism of action. These sedatives-hypnotics can be indicated to treat anxiety, seizures, depression, and insomnia but are also used as substances of abuse and used to facilitate sexual assault. Barbiturates, methaqualone, and glutethimide were among the first type A GABA receptor-mediated sedative-hypnotics. Their clinical use was limited for most indications by serious adverse events and strong abuse potential but continue to be used illicitly around the world. The benzodiazepines supplanted barbiturates for most indications because they were less likely to cause severe adverse events in monotherapy. Flunitrazepam is a newer benzodiazepine that is preferentially used recreationally and to facilitate sexual assault. Flunitrazepam has greater potency and higher affinity for the type A GABA receptor than most benzodiazepines. Gamma-hydroxybutyric acid is sought illicitly for its hypnotic, euphoric and anabolic effects as well as to facilitate sexual assault. When any of these GABAergic drugs are used in high doses or with other sedative hypnotic agents, respiratory depression, coma, and death have occurred. Chronic use of these GABAergic drugs can lead to significant withdrawal syndromes. Phenibut and selank are poorly studied Russian drugs with GABAergic mechanisms that are inexplicably sold to US consumers as dietary supplements. Poison control center calls regarding phenibut have increased substantially over the past 5 years. Desired euphoriant effects account for the recreational and illicit use of many GABA-modulating agents. However, illicit use can lead to significant toxicities related to abuse, dependence, and subsequent withdrawal syndromes. Significant evaluation of developing agents with GABA properties should be conducted to determine abuse potential before public access ensues.
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Affiliation(s)
- Cassandra R Doyno
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut, USA.,John Dempsey Hospital, University of Connecticut, Farmington, Connecticut, USA
| | - C Michael White
- Department of Research Administration, Hartford Hospital, Hartford, Connecticut, USA
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31
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[Acute intoxications in the intensive care unit: A 10-year analysis]. Med Klin Intensivmed Notfmed 2021; 117:129-136. [PMID: 34302193 DOI: 10.1007/s00063-021-00839-8] [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: 09/26/2020] [Revised: 04/15/2021] [Accepted: 06/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Acute intoxications play a special role in preclinical emergency medicine, in the emergency department, and in intensive care. This study characterizes cases of acute intoxications from an intensive care perspective. OBJECTIVES All cases of acute intoxications admitted to the intensive care units at the University Hospital Hamburg-Eppendorf between 01 January 2007 and 30 June 2017 were retrospectively analyzed. RESULTS During the study period, 587 patients with acute intoxications were admitted to the university hospital's intensive care units. Median age was 45 years (interquartile range [IQR] 31 years); 83.1% of patients were younger than 70 years. The most common cause of intoxication in the younger patients was a suicide attempt (55.1%), while in older patients it was an iatrogenic event (47.5%). Cases involving intoxications with psychotropic medication (48.7%), alcohol (32.9%), analgesics (23.3%), and drugs (17.0%) were most frequent. In 50.6% of cases, intoxication was due to more than one substance. Intoxication-specific therapy was performed in 40.0% of cases and intensive care therapy in 42.4% of cases. The median length of intensive care unit stay was 2 days (IQR 3). Hospital mortality was 5.5%. In older patients (≥ 70 years) compared with younger patients, the need for intensive care treatment (56.6% vs. 39.5% of cases, p = 0.002), the length of intensive care unit stay (3 days [IQR 5] vs. 2 days [IQR 3], p = 0.0004) and in-hospital mortality (17.2% vs. 3.1%, p < 0.001) were significantly higher. CONCLUSIONS Acute intoxications are part of the spectrum of disorders treated in the intensive care unit. In older patients, iatrogenic causes are frequently found, which is associated with an increased risk of death.
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Menichetti F, Bartolucci P, Matteucci ML, Gori L, Ieri A, Gambassi F, Baronti R, Vanni S, Mannaioni G, Del Rosso A. A perfect refractory electrical storm by acute toxicity of accidental aconitine intake. EMERGENCY CARE JOURNAL 2021. [DOI: 10.4081/ecj.2021.9736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 51-years-old male presented with drooling, hematemesis and diarrhea in emergency department after accidental ingestion of homemade aconitine tincture. Examination revealed shock and initial ECG showed atrial fibrillation. The patient suddenly developed a pulseless wide QRS complex tachycardia requiring resuscitation maneuvers. The rhythm varied from monomorphic ventricular tachycardia to torsade de point to ventricular fibrillation. Repeated direct-current cardioversions were unsuccessful. After intravenous electrolyte correction and anti-arrhythmic drugs administration, a last direct-current shock was finally successful. Bradycardia and ventricular excitability persisted over 12 hours with gradual normalization. Patient was discharged in normal sinus rhythm without any medication and on follow-up he was totally asymptomatic.
With the increasing popularity of traditional medicine, clinicians should be alerted to the risk of herbal substances with low margins of safety like Aconitum in order to allow correct diagnosis and treatment. The general public should be educated that herbal medicine is not always safe.
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Lott C, Truhlář A, Alfonzo A, Barelli A, González-Salvado V, Hinkelbein J, Nolan JP, Paal P, Perkins GD, Thies KC, Yeung J, Zideman DA, Soar J. [Cardiac arrest under special circumstances]. Notf Rett Med 2021; 24:447-523. [PMID: 34127910 PMCID: PMC8190767 DOI: 10.1007/s10049-021-00891-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 01/10/2023]
Abstract
These guidelines of the European Resuscitation Council (ERC) Cardiac Arrest under Special Circumstances are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the modifications required for basic and advanced life support for the prevention and treatment of cardiac arrest under special circumstances; in particular, specific causes (hypoxia, trauma, anaphylaxis, sepsis, hypo-/hyperkalaemia and other electrolyte disorders, hypothermia, avalanche, hyperthermia and malignant hyperthermia, pulmonary embolism, coronary thrombosis, cardiac tamponade, tension pneumothorax, toxic agents), specific settings (operating room, cardiac surgery, cardiac catheterization laboratory, dialysis unit, dental clinics, transportation [in-flight, cruise ships], sport, drowning, mass casualty incidents), and specific patient groups (asthma and chronic obstructive pulmonary disease, neurological disease, morbid obesity, pregnancy).
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Affiliation(s)
- Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Deutschland
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Tschechien
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Charles University in Prague, Hradec Králové, Tschechien
| | - Anette Alfonzo
- Departments of Renal and Internal Medicine, Victoria Hospital, Kirkcaldy, Fife Großbritannien
| | - Alessandro Barelli
- Anaesthesiology and Intensive Care, Teaching and research Unit, Emergency Territorial Agency ARES 118, Catholic University School of Medicine, Rom, Italien
| | - Violeta González-Salvado
- Cardiology Department, University Clinical Hospital of Santiago de Compostela, Institute of Health Research of Santiago de Compostela (IDIS), Biomedical Research Networking Centres on Cardiovascular Disease (CIBER-CV), A Coruña, Spanien
| | - Jochen Hinkelbein
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Köln, Deutschland
| | - Jerry P. Nolan
- Resuscitation Medicine, Warwick Medical School, University of Warwick, CV4 7AL Coventry, Großbritannien
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, BA1 3NG Bath, Großbritannien
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Österreich
| | - Gavin D. Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, Großbritannien
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, Großbritannien
| | - Karl-Christian Thies
- Dep. of Anesthesiology and Critical Care, Bethel Evangelical Hospital, University Medical Center OLW, Bielefeld University, Bielefeld, Deutschland
| | - Joyce Yeung
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, Großbritannien
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, Großbritannien
| | | | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, Großbritannien
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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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35
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Murphy L, Rasmussen J, Murphy NG. Surdose de venlafaxine traitée par assistance cardiorespiratoire extracorporelle. CMAJ 2021; 193:E531-E535. [PMID: 33846207 PMCID: PMC8087331 DOI: 10.1503/cmaj.201318-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Laurel Murphy
- Départements de médecine d'urgence et de soins intensifs (L. Murphy) et de chirurgie; Division de chirurgie plastique, Département de soins intensifs (Rasmussen); Département de médecine d'urgence et IWK Regional Poison Centre (N. Murphy), Université Dalhousie, Halifax, N-É.
| | - Jack Rasmussen
- Départements de médecine d'urgence et de soins intensifs (L. Murphy) et de chirurgie; Division de chirurgie plastique, Département de soins intensifs (Rasmussen); Département de médecine d'urgence et IWK Regional Poison Centre (N. Murphy), Université Dalhousie, Halifax, N-É
| | - Nancy G Murphy
- Départements de médecine d'urgence et de soins intensifs (L. Murphy) et de chirurgie; Division de chirurgie plastique, Département de soins intensifs (Rasmussen); Département de médecine d'urgence et IWK Regional Poison Centre (N. Murphy), Université Dalhousie, Halifax, N-É
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Lott C, Truhlář A, Alfonzo A, Barelli A, González-Salvado V, Hinkelbein J, Nolan JP, Paal P, Perkins GD, Thies KC, Yeung J, Zideman DA, Soar J. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation 2021; 161:152-219. [PMID: 33773826 DOI: 10.1016/j.resuscitation.2021.02.011] [Citation(s) in RCA: 331] [Impact Index Per Article: 110.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
These European Resuscitation Council (ERC) Cardiac Arrest in Special Circumstances guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the modifications required to basic and advanced life support for the prevention and treatment of cardiac arrest in special circumstances; specifically special causes (hypoxia, trauma, anaphylaxis, sepsis, hypo/hyperkalaemia and other electrolyte disorders, hypothermia, avalanche, hyperthermia and malignant hyperthermia, pulmonary embolism, coronary thrombosis, cardiac tamponade, tension pneumothorax, toxic agents), special settings (operating room, cardiac surgery, catheter laboratory, dialysis unit, dental clinics, transportation (in-flight, cruise ships), sport, drowning, mass casualty incidents), and special patient groups (asthma and COPD, neurological disease, obesity, pregnancy).
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Affiliation(s)
- Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany.
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, Charles University in Prague, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Annette Alfonzo
- Departments of Renal and Internal Medicine, Victoria Hospital, Kirkcaldy, Fife, UK
| | - Alessandro Barelli
- Anaesthesiology and Intensive Care, Catholic University School of Medicine, Teaching and Research Unit, Emergency Territorial Agency ARES 118, Rome, Italy
| | - Violeta González-Salvado
- Cardiology Department, University Clinical Hospital of Santiago de Compostela, Institute of Health Research of Santiago de Compostela (IDIS), Biomedical Research Networking Centres on Cardiovascular Disease (CIBER-CV), A Coruña, Spain
| | - Jochen Hinkelbein
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Jerry P Nolan
- Resuscitation Medicine, University of Warwick, Warwick Medical School, Coventry, CV4 7AL, UK; Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, BA1 3NG, UK
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Karl-Christian Thies
- Department of Anesthesiology, Critical Care and Emergency Medicine, Bethel Medical Centre, OWL University Hospitals, Bielefeld University, Germany
| | - Joyce Yeung
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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Daaboul A, Sedding D, Nuding S, Schott A. Successful Treatment of an Acute High-Dose Clozapine Poisoning without Detoxication. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e929147. [PMID: 33591960 PMCID: PMC7897594 DOI: 10.12659/ajcr.929147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patient: Male, 28-year-old Final Diagnosis: Clozapine poisoning Symptoms: Drowsiness • hyperventilation • impaired consciousness • respiratory insufficiency • tachycadia Medication: — Clinical Procedure: — Specialty: Critical Care Medicine • Psychiatry
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Affiliation(s)
- Amjad Daaboul
- Mid-German Heart Center, Department of Cardiology, Angiology and Critical Care Medicine, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Daniel Sedding
- Mid-German Heart Center, Department of Cardiology, Angiology and Critical Care Medicine, University Hospital Halle (Saale), Halle (Salle), Germany
| | - Sebastian Nuding
- Mid-German Heart Center, Department of Cardiology, Angiology and Critical Care Medicine, University Hospital Halle (Saale), Halle (Salle), Germany
| | - Artjom Schott
- Mid-German Heart Center, Department of Cardiology, Angiology and Critical Care Medicine, University Hospital Halle (Saale), Halle (Salle), Germany
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El Zahran T, Mostafa H, Hamade H, Hitti E, Morgan BW, Kazzi Z. Toxicological exposures among the pediatric patients at a tertiary care center in Lebanon: the case for establishing a national poison center. Clin Toxicol (Phila) 2021; 59:780-785. [PMID: 33555968 DOI: 10.1080/15563650.2021.1874404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite its preventable nature, poisoning remains one of the leading causes of morbidity and mortality in the pediatric population. In Lebanon, this population is poorly studied and there is no poison center to which healthcare providers and the public can refer in case of toxicological exposure, leading to unnecessary Emergency Department (ED) visits. This study describes the pediatric toxicological exposures seen at the largest tertiary care center in Lebanon. It also evaluates the appropriateness of ED visits among confirmed or suspected toxicological exposures in children, in order to assess the role of a national poison center in reducing unnecessary ED visits. METHODS This is a secondary analysis of a database for a telephonic medical toxicology service at the American University of Beirut Medical Center, the largest tertiary care center in Lebanon. Data relating to all pediatric patients aged 0-19 years of age were entered into the database by the medical toxicology team. The cases were independently reviewed by 2 medical toxicologists for the adequacy of referral to the ED and performance of invasive procedures. RESULTS Two hundred and nine exposures were recorded between 15 April 2015 and 31 December 2019, of which 53.1% were females. Children aged less than 5 years were involved in 67.0% of cases while adolescents aged 13-19 years were involved in 21.1%. The most commonly involved substances were analgesics (14.8%) and cardiovascular drugs (10.0%). The majority had no (59.3%) or minor (26.3%) effects and were treated and discharged home (67.5%). More than a third of ED visits were deemed unnecessary by the toxicologists (Kappa = 0.705), and when including only unintentional cases, around 45% of the ED visits were deemed unnecessary (Kappa = 0.677). CONCLUSION Our data show that 37% of all pediatric poisoning ED visits and 45% of ED visits due to unintentional pediatric poisonings were unnecessary. Additionally, more often than not lavage suctions were done unnecessarily. Future research investigating the possibility of preventing unnecessary visits by establishing a national poison center is needed.
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Affiliation(s)
- Tharwat El Zahran
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hala Mostafa
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Hamade
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Eveline Hitti
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Brent W Morgan
- Department of Emergency Medicine, Emory University, Atlanta, GA, USA
| | - Ziad Kazzi
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Emergency Medicine, Emory University, Atlanta, GA, USA
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Angurana S, Randhawa M, Sharma P, Bansal A. Acute carbamazepine toxicity in a child: A case report. JOURNAL OF PEDIATRIC CRITICAL CARE 2021. [DOI: 10.4103/jpcc.jpcc_65_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Burket GA, Horowitz BZ, Hendrickson RG, Beauchamp GA. Endotracheal Intubation in the Pharmaceutical-Poisoned Patient: a Narrative Review of the Literature. J Med Toxicol 2021; 17:61-69. [PMID: 32394224 PMCID: PMC7785763 DOI: 10.1007/s13181-020-00779-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/08/2020] [Accepted: 04/16/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Endotracheal intubation (ETI) is an essential component of the supportive care provided to the critically ill patient with pharmaceutical poisoning; however, specific nuances surrounding intubation including techniques and complications in the context of pharmaceutical poisoning have not been well elucidated. DISCUSSION A search of the available literature on ETI in pharmaceutical-poisoned patients was undertaken using Medline, ERIC, Cochrane database, and PsycINFO using the following MeSH and keyword terms: ("toxicology" OR "poisons" OR "drug overdose" OR "poisoning") AND ("intubation, intratracheal" OR "intubation, endotracheal" OR "airway management" OR "respiration, artificial"). A hand-search was also performed when the literature in the above search required additional conceptual clarification, including using the "Similar Articles" feature of PubMed, along with reviewing articles' reference lists that discussed intubation in the context of a poisoning scenario. Articles with any discussion around the ETI process in the context of a pharmaceutical poisoning were then included. Intubation may be performed in patients poisoned with pharmaceuticals in the context of both single and multiple organ dysfunction including central and peripheral nervous system, pulmonary, or cardiovascular toxicity with hemodynamic instability, or localized effects resulting in mechanical airway obstruction. Certain classes of poisonings may require modifications to the standard rapid sequence induction airway management algorithm. CONCLUSIONS ETI is a key component of the supportive care provided to the patient poisoned by a pharmaceutical agent. Clinicians should be aware of the spectrum of toxicities that can necessitate intubation, as well as airway management nuances that are specific to various poisoning presentations.
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Affiliation(s)
- Glenn A Burket
- SCL Health St Mary's Medical Center, 2635 North 7th Street, Grand Junction, CO, 81501, USA
- Mesa County EMS, 215 Rice St, Grand Junction, CO, 81501, USA
| | - B Zane Horowitz
- Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd, Portland, OR, 97239, USA
- Oregon Poison Center, 3181 S.W. Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Robert G Hendrickson
- Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd, Portland, OR, 97239, USA
- Oregon Poison Center, 3181 S.W. Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Gillian A Beauchamp
- Lehigh Valley Health Network Department of Emergency and Hospital Medicine, Division of Medical Toxicology, USF Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown, PA, 18101, USA.
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Yumoto T, Hamaguchi H, Mae S, Nakao A. Potentially fatal ingestion of heat-not-burn cigarettes successfully treated by gastric lavage. J Am Coll Emerg Physicians Open 2020; 1:1709-1711. [PMID: 33392579 PMCID: PMC7771750 DOI: 10.1002/emp2.12283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/10/2020] [Accepted: 09/24/2020] [Indexed: 11/14/2022] Open
Abstract
Newly introduced heat-not-burn or electronic cigarettes can cause lethal nicotine intoxication if ingested at higher doses. Although routine gastric lavage is not recommended, it should be considered if the amount of intoxicant is lethal. A 59-year-old man with a history of depression was brought to our emergency department after intentional ingestion of 8 heat-not-burn cigarettes, which were estimated to contain a total of 100 mg of nicotine. Abdominal computed tomography confirmed the gastric contents, detecting multiple stick-like and rod-shaped high-density structures. Gastric lavage was performed to minimize absorption of the potentially lethal nicotine dose. The patient exhibited only mild gastrointestinal symptoms. Emergency physicians should be aware of this novel heat-not-burn cigarette and its toxicity.
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Affiliation(s)
- Tetsuya Yumoto
- Department of Emergency MedicineKasaoka Daiichi HospitalKasaokaOkayamaJapan
- Department of Emergency, Critical Care, and Disaster MedicineOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesKitaOkayamaJapan
| | - Hisashi Hamaguchi
- Department of Emergency MedicineKasaoka Daiichi HospitalKasaokaOkayamaJapan
- Department of Medical EducationKurashiki Central HospitalKurashikiOkayamaJapan
| | - Souichiro Mae
- Department of Emergency MedicineKasaoka Daiichi HospitalKasaokaOkayamaJapan
- Emergency and Critical Care CenterKurashiki Central HospitalKurashikiOkayamaJapan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster MedicineOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesKitaOkayamaJapan
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Mégarbane B, Oberlin M, Alvarez JC, Balen F, Beaune S, Bédry R, Chauvin A, Claudet I, Danel V, Debaty G, Delahaye A, Deye N, Gaulier JM, Grossenbacher F, Hantson P, Jacobs F, Jaffal K, Labadie M, Labat L, Langrand J, Lapostolle F, Le Conte P, Maignan M, Nisse P, Sauder P, Tournoud C, Vodovar D, Voicu S, Claret PG, Cerf C. Management of pharmaceutical and recreational drug poisoning. Ann Intensive Care 2020; 10:157. [PMID: 33226502 PMCID: PMC7683636 DOI: 10.1186/s13613-020-00762-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/09/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Poisoning is one of the leading causes of admission to the emergency department and intensive care unit. A large number of epidemiological changes have occurred over the last years such as the exponential growth of new synthetic psychoactive substances. Major progress has also been made in analytical screening and assays, enabling the clinicians to rapidly obtain a definite diagnosis. METHODS A committee composed of 30 experts from five scientific societies, the Société de Réanimation de Langue Française (SRLF), the Société Française de Médecine d'Urgence (SFMU), the Société de Toxicologie Clinique (STC), the Société Française de Toxicologie Analytique (SFTA) and the Groupe Francophone de Réanimation et d'Urgences Pédiatriques (GFRUP) evaluated eight fields: (1) severity assessment and initial triage; (2) diagnostic approach and role of toxicological analyses; (3) supportive care; (4) decontamination; (5) elimination enhancement; (6) place of antidotes; (7) specificities related to recreational drug poisoning; and (8) characteristics of cardiotoxicant poisoning. Population, Intervention, Comparison, and Outcome (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Analysis of the literature and formulation of recommendations were then conducted according to the GRADE® methodology. RESULTS The SRLF-SFMU guideline panel provided 41 statements concerning the management of pharmaceutical and recreational drug poisoning. Ethanol and chemical poisoning were excluded from the scope of these recommendations. After two rounds of discussion and various amendments, a strong consensus was reached for all recommendations. Six of these recommendations had a high level of evidence (GRADE 1±) and six had a low level of evidence (GRADE 2±). Twenty-nine recommendations were in the form of expert opinion recommendations due to the low evidences in the literature. CONCLUSIONS The experts reached a substantial consensus for several strong recommendations for optimal management of pharmaceutical and recreational drug poisoning, mainly regarding the conditions and effectiveness of naloxone and N-acetylcystein as antidotes to treat opioid and acetaminophen poisoning, respectively.
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Affiliation(s)
- Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Federation of Toxicology, Lariboisière Hospital, AP-HP, INSERM MURS-1144, University of Paris, 2 Rue Ambroise Paré, Paris, 75010 France
| | - Mathieu Oberlin
- Emergency Department, HuManiS Laboratory (EA7308), University Hospital, Strasbourg, France
| | - Jean-Claude Alvarez
- Department of Pharmacology and Toxicology, Inserm U-1173, FHU Sepsis, Raymond Poincaré Hospital, AP-HP, Paris-Saclay University, Garches, France
| | - Frederic Balen
- Emergency Department, Toulouse University Hospital, Toulouse, France
| | - Sébastien Beaune
- Department of Emergency Medicine, Ambroise Paré Hospital, AP-HP, INSERM UMRS-1144, Paris-Saclay University, Boulogne-Billancourt, France
| | - Régis Bédry
- Hospital Secure Unit, Pellegrin University Hospital, Bordeaux, France
| | - Anthony Chauvin
- Emergency Department, Hôpital Lariboisière, AP-HP, Paris, France
| | - Isabelle Claudet
- Pediatric Emergency Department Children’s Hospital CHU Toulouse, Toulouse, France
| | - Vincent Danel
- Department of Emergency Medicine, University Hospital of Grenoble, Grenoble, France
| | - Guillaume Debaty
- 5525, University Grenoble Alps/CNRS/CHU de Grenoble Alpes/TIMC-IMAG UMR, Grenoble, France
| | | | - Nicolas Deye
- Department of Medical and Toxicological Critical Care, Federation of Toxicology, Lariboisière Hospital, AP-HP, INSERM U942, University of Paris, Paris, France
| | - Jean-Michel Gaulier
- Laboratory of Toxicology, EA 4483 - IMPECS - IMPact de L’Environnement Chimique Sur La Santé Humaine, University of Lille, Lille, France
| | | | - Philippe Hantson
- Intensive Care Department, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Frédéric Jacobs
- Polyvalent Intensive Care Unit, Antoine Béclère Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, Clamart, France
| | - Karim Jaffal
- Department of Medical and Toxicological Critical Care, Federation of Toxicology, Lariboisière Hospital, AP-HP, INSERM MURS-1144, University of Paris, 2 Rue Ambroise Paré, Paris, 75010 France
| | - Magali Labadie
- Poison Control Centre of Bordeaux, University Hospital of Bordeaux, Bordeaux, France
| | - Laurence Labat
- Laboratory of Toxicology, Federation of Toxicology APHP, Lariboisière Hospital, INSERM UMRS-1144, University of Paris, Paris, France
| | - Jérôme Langrand
- Poison Control Center of Paris, Federation of Toxicology, Fernand-Widal-Lariboisière Hospital, AP-HP, INSERM UMRS-1144, University of Paris, Paris, France
| | - Frédéric Lapostolle
- SAMU 93-UF Recherche-Enseignement-Qualité, Inserm, U942, Avicenne Hospital, AP-HP, Paris-13 University, Bobigny, France
| | - Philippe Le Conte
- Department of Emergency Medicine, University Hospital of Nantes, Nantes, France
| | - Maxime Maignan
- Emergency Department, Grenoble University Hospital, INSERM U1042, Grenoble Alpes University, Grenoble, France
| | - Patrick Nisse
- Poison Control Centre, University Hospital of Lille, Lille, France
| | - Philippe Sauder
- Intensive Care Unit, University Hospital of Strasbourg, Strasbourg, France
| | | | - Dominique Vodovar
- Poison Control Center of Paris, Federation of Toxicology, Fernand-Widal-Lariboisière Hospital, AP-HP, INSERM UMRS-1144, University of Paris, Paris, France
| | - Sebastian Voicu
- Department of Medical and Toxicological Critical Care, Federation of Toxicology, Lariboisière Hospital, AP-HP, INSERM MURS-1144, University of Paris, 2 Rue Ambroise Paré, Paris, 75010 France
| | - Pierre-Géraud Claret
- Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, Nîmes, France
| | - Charles Cerf
- Intensive Care Unit, Foch Hospital, Suresnes, France
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Tirolla RM, Girotto E, Guidoni CM. CLINICAL AND EPIDEMIOLOGICAL ANALYSIS OF SUICIDE ATTEMPTS IN CHILDREN ASSISTED BY A POISON CONTROL CENTER. REVISTA PAULISTA DE PEDIATRIA 2020; 39:e2019345. [PMID: 33146292 PMCID: PMC7594506 DOI: 10.1590/1984-0462/2021/39/2019345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/11/2020] [Indexed: 11/25/2022]
Abstract
Objective: To assess suicide attempts in children seeking care at a Poison Control
Center. Methods: Cross-sectional study with children (<12 years old) that attempted
suicide and were cared at the Poison Control Center in Londrina, Paraná,
Southern Brazil, from April 1985 to December 2018. Results: We identified 59 children, most of them females (74.6%), who used only one
product (77.9%). Among the products involved, medications were the most
important ones (88.1%). Neurological/psychiatric/muscular manifestations
(61.0%) were the main symptoms presented. The main reason identified for the
suicide attempt was conflicts with family and/or friends (27.1%). Suicide
attempts were more frequent in 2001-2003 and 2016-2018. Conclusions: Suicide attempts occurred mainly in female children with a single agent
(mainly medications), and the main reason was family conflicts..
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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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Zellner T, Prasa D, Färber E, Hoffmann-Walbeck P, Genser D, Eyer F. The Use of Activated Charcoal to Treat Intoxications. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:311-317. [PMID: 31219028 DOI: 10.3238/arztebl.2019.0311] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 12/18/2018] [Accepted: 03/26/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND In 2016, according to the German Federal Statistical Office, 178 425 cases of intoxication (poisoning) were treated in German hospitals. The poison control centers in the German-speaking countries gave advice in a total of 268 787 instances of poisoning in that year, and use of activated charcoal was recommended in 4.37% of cases. The application of activated charcoal plays a major role in both primary and secondary detoxification. This article serves as an overview of the mechanism of action, indications, contraindications, modes of application, and dosing of activated charcoal. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed. The opinions of experts from the poison control centers in the German-speaking countries were considered in the interpretation of the data. RESULTS The administration of activated charcoal is indicated to treat moderately severe to life-threatening intoxication. It should be carried out as soon as possible, within the first hour of the ingestion; timed-release preparations can be given up to 6 hours after the ingestion. An important contraindication is impaired consciousness with the danger of aspiration in a patient whose air- way has not yet been secured. Activated charcoal is ineffective or inadequately effective in cases of poisoning with acids or bases, alcohols, organic solvents, inorganic salts, or metals. The proper dosage consists of an amount that is 10 to 40 times as much as that of the intoxicating substance, or else 0.5-1 g/kg body weight in children or 50 g in adults. Repeated application is indicated for intoxications with agents that persist for a longer time in the stomach and for intoxications with timed-release drugs or drugs with a marked enterohepatic or entero-enteric circulation. The routine combination of activated charcoal with a laxative is not recommended. CONCLUSION Even though intoxications are common, there is still no internationally valid guideline concerning the administration of activated charcoal. A precise analysis of the risks and benefits is needed for each administration, and a poison control center should be consulted for this purpose.
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Affiliation(s)
- Tobias Zellner
- Department of Internal Medicine II, SDepartment of Clinical Toxicology and Poison Control Center Munich, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich; Joint Poisons Information Center for Mecklenburg-West Pomerania, Saxony, Saxony-Anhalt and Thuringia, Erfurt; Poisons Information Center North for Bremen, Hamburg, Lower Saxony and Schleswig-Holstein, Faculty of Medicine, University of Göttingen; Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health Poison Information Center; Poisons Information Center Vienna, Gesundheit Österreich GmbH, Vienna, Austria
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Puiguriguer J. Intoxicaciones en España: mirando hacia otro lado. Rev Clin Esp 2020; 220:248-249. [DOI: 10.1016/j.rce.2019.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 11/28/2022]
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Poisonings in Spain: looking the other way. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Das P, Bellapukonda S, Nayak B, Mallick M. Can intubate but cannot ventilate! An unexpected event in a child with stridor after accidental aspiration of the potassium permanganate solution. Saudi J Anaesth 2020; 14:272-273. [PMID: 32317898 PMCID: PMC7164467 DOI: 10.4103/sja.sja_786_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/04/2022] Open
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Ornillo C, Harbord N. Fundaments of Toxicology-Approach to the Poisoned Patient. Adv Chronic Kidney Dis 2020; 27:5-10. [PMID: 32147001 DOI: 10.1053/j.ackd.2019.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/05/2019] [Indexed: 12/17/2022]
Abstract
Management of the poisoned patient begins with supportive care, assessment of organ function and dysfunction, and consideration of known or suspected poisons. The possibility of multiple ingestions should be considered with intentional exposures or suicide attempts. Enteric decontamination involves treatment to prevent the absorption of toxins from the gastrointestinal system and includes the use of activated charcoal. Poisoned patients may benefit from the use if antidotes are available, or enhanced elimination as with salicylate ion trapping during urinary alkalinization. The use of intravenous lipid therapy is of clinical benefit in poisoning from bupivacaine, amitriptyline, and bupropion. Hemodialysis is the most inexpensive, widely available, and most commonly used method of extracorporeal drug removal in the treatment of poisoning. Chelators with different chemical properties can bind toxic metals, providing an essential mechanism for detoxification, and may be used in combination with extracorporeal therapies such as DFO with HD for aluminum or iron, and DMSA or DMPS with HD to treat arsenic or mercury intoxication. The use of displacers with hemodialysis can be considered to augment clearance of protein-bound toxins.
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Jiang YF, Kang J, Huang PP, Yao JX, Wang ZH, Jiang L, Wang J, Qiao L, Zhu BL, Sun H, Zhang JS. Evaluation of gastric lavage efficiency and utility using a rapid quantitative method in a swine paraquat poisoning model. World J Emerg Med 2020; 11:174-181. [PMID: 32351651 DOI: 10.5847/wjem.j.1920-8642.2020.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Gastric lavage (GL) is one of the most critical early therapies for acute paraquat (PQ) poisoning; however, details of the treatment protocol remain to be established. METHODS A rapid quantitative method involving sodium dithionite testing was developed. It was validated for the determination of the PQ concentrations in gastric juice and eluate samples from a swine acute PQ poisoning model with early or delay GL, or without. The vital signs, laboratory testing, and PQ plasma concentrations were collected for therapeutic effect evaluation. RESULTS The reaction conditions of the test were optimized for two types of samples. Early GL at one hour (H1) could improve the signs and symptoms after acute PQ poisoning at 24 hours (H24). In contrast, GL at 6 hours (H6) could only partially relieve the vital signs. The H1 GL group effectively reduced the peak of the plasma PQ concentration. In addition, the PQ concentrations in the plasma and the gastric juice were significantly decreased in both the GL groups as compared to the untreated group at H24. Moreover, there was no significant difference in the washing efficiencies calculated from the total eluates between the two GL groups. However, the washing efficiency of the first 10 L eluate is superior to that of the additional 10 L eluate. CONCLUSION GL only at early stage may it benefit PQ poisoning in an animal model. The currently used 20 L GL volume may need to be reduced in view of the low washing efficiency in the later 10 L eluate. The rapid quantitative method can be used for gastric juice sample and has a certain value for clinical GL practices.
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Affiliation(s)
- Yun-Fei Jiang
- Department of Emergency, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Department of Emergency, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jian Kang
- Department of Emergency, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pei-Pei Huang
- Department of Emergency, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jia-Xi Yao
- Key Lab of Modern Toxicology, Ministry of Education and Department of Hygienic Analysis and Detection, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Zhong-He Wang
- Key Lab of Modern Toxicology, Ministry of Education and Department of Hygienic Analysis and Detection, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Lei Jiang
- Department of Emergency, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Wang
- Key Lab of Modern Toxicology, Ministry of Education and Department of Toxicology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Li Qiao
- Department of Emergency, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bao-Li Zhu
- Department of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Hao Sun
- Department of Emergency, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jin-Song Zhang
- Department of Emergency, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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