[Human Single Drug Exposures to Non-opioid Analgesics Reported to the Poisons Information Centre Erfurt from 2003 to 2012]

AIM OF THE STUDY

Because of their frequency, non-opioid analgesics (NOA) single drug exposures registered by Poisons Information Centre (PIC) Erfurt have been studied over a decade.

METHODS

A retrospective analysis of frequencies, circumstances of exposure, symptom severity, and age groups in NOA single drug exposures received by the PIC Erfurt from the beginning of 2003 to the end of 2012 was undertaken.

RESULTS

Of all 4749 NOA single drug exposures, the 10 most frequent were caused by paracetamol (n=1 686), ibuprofen (n=1 439), acetylsalicylic acid (n=456), dipyrone (n=274), diclofenac (n=267), flupirtine (n=138), naproxen (n=41), etoricoxib (n=36), indomethacin (n=24), and dexketoprofen (n=19). Paracetamol single drug exposures increased from 158 in 2003 to 216 in 2007 and fell afterwards to 133 in 2012. Ibuprofen single drug exposures continously rose from 57 in 2003 to 258 in 2012. Adults were more often involved in NOA (53.8%) and all single drug exposures (54.1%) than children (45.9% and 45.6%, respectively). Suicidal attempts were more frequent in NOA (43.1%) than in all single drug exposures (34.2%), whereas accidental exposures or exposures in abuse were less often (33.4 and 0.2%, 46.0 and 0.9% respectively). NOA single drug exposures resulted mostly in none to minor symptoms (77.0%) and rarely in moderate (2.1%) or severe symptoms (1.0%). One adult was found dead after probable ingestion of 32 g of acetylsalicylic acid in suicidal intention.

CONCLUSIONS

Because many NOA are over-the-counter drugs, it is difficult to obtain data on their use. PIC data could provide information on the NOA use in the population.

Calcium channel antagonist exposures reported to the Poisons Information Center Erfurt

BACKGROUND

We investigated the toxicity profile of the three main groups of calcium channel antagonists (CCA) and compared mixed CCA exposures (CCA plus another drug) with mono CCA exposures.

METHODS

All CCA exposures reported to the PIC Erfurt from 2000 to 2009 were analyzed retrospectively.

RESULTS

In total, 727 (230 mono and 497 mixed) CCA exposures were registered. Although CCA exposures increased almost twofold from 56 in 2000 to 108 in 2009 their relative frequency to all exposures remained constant. The five CCAs most frequently involved in exposures were the five most frequently prescribed ones in Germany over the same period. In mono and mixed CCA exposures, none or minor symptoms were most often seen with dihydropyridines (mono: 84.7%; mixed: 68.0%) followed by diltiazem (mono: 71.4%; mixed: 62.5%) and verapamil (mono: 57.1%; mixed: 50.0%). Highest rates of moderate (mono: 8.6%: mixed: 20.2%) and severe symptoms (mono: 18.6%; mixed: 23.7%) were observed after verapamil ingestions. Death most frequently occurred with diltiazem (mono: 28.6%; mixed: 12.5%). Rates of moderate symptoms were higher in mixed (13.3%) than in mono CCA exposures (4.8%). No distinct differences were seen regarding the relative frequency of none or minor symptoms, severe symptoms, and death between mono and mixed CCA exposures.

CONCLUSION

Exposures to verapamil more often resulted in moderate and severe symptoms than with dihydropyridines. Death mainly occurred with diltiazem. Moderate symptoms were more frequent in mixed than in mono CCA exposures. The frequency of CCAs involved in exposure was related to their prescription.

Stratified multiphase model for blood flow in a venular bifurcation

Available in vitro and in vivo experimental observations suggest that red cell aggregation and blood vessel geometry are important determinants of the flow characteristics of blood in venules. However, no consistent relationship has been observed between red blood cell aggregation and vascular resistance. The present work attempts to understand this relationship by evaluating computationally the effect of red cell aggregation on the flow characteristics of blood in a converging vessel bifurcation. The proposed mathematical model considers blood as a two-phase continuum, with a central core region of concentrated red cell suspension that is surrounded by a layer of plasma adjacent to the vessel wall. In the central core region, blood is described by Quemada's non-Newtonian rheological model, in which local viscosity is a function of both the local hematocrit and a structural parameter that is related to the size of red blood cell aggregates. Fluids from the two feeding branches are immiscible, which results in a stratified multiphase flow in the collecting venule. Calculations predict a complex, three-dimensional pattern of blood flow and generally nonaxisymmetric distribution of velocity, hematocrit, and shear stress in the collecting venule. The calculations are a first step toward a realistic model of blood flow in the venous microcirculation.

A numerical study of plasma skimming in small vascular bifurcations

Owing in part to a plasma-skimming mechanism, the distribution of red blood cells (RBCs) into branches of microvascular bifurcations typically differs from the distribution of the bulk blood flow. This paper analyzes the plasma-skimming mechanism that causes phase separation due to uneven distribution of red blood cells at the inlet cross section of the parent vessel. In a previous study, the shape of the surface that divides the flow into the branches was found by numerical simulation of three-dimensional flow of a homogeneous Newtonian fluid in T-type bifurcations. Those findings are used in this study to determine, as a first approximation, the side-to-parent vessel RBC flux ratio and discharge hematocrit ratio as a function of corresponding flow ratios. Calculations are based on the assumption that RBCs move along streamlines of a homogeneous Newtonian fluid and are uniformly distributed within a concentric core at the inlet cross section of the parent vessel. The results of our calculations agree well for a wide range of flow parameters with experimental data from in vivo and in vitro studies.

An analytical solution for steady flow of a Quemada fluid in a circular tube

An analytical solution is obtained for steady flow of Quemada-type fluids in a circular tube driven by a constant pressure gradient. Expressions are derived for velocity distribution and for volumetric flow rate as a function of pressure gradient or wall shear stress.

A numerical study of the shape of the surface separating flow into branches in microvascular bifurcations

The shape of the separating surface formed by the streamlines entering the branches of microvascular bifurcations plays a major role in determining the distribution of red blood cells and other blood constituents downstream from the bifurcation. Using the finite element method, we determined the shape of the surface through numerical solution of three dimensional Navier-Stokes equations for fluid flow at low Reynolds numbers in a T-type bifurcation of circular tubes. Calculations were done for a wide range of daughter branch to parent vessel diameter ratios and flow ratios. The effect of Reynolds number was also studied. Our numerical results are in good agreement with previously reported experimental data of Rong and Carr (Microvascular Research, Vol. 39, pp. 186-202, 1990). The numerical results of this study will be used to predict the concentration of blood constituents downstream from microvascular bifurcations providing that the inlet concentration profile is known.

A numerical simulation of the flow in a T-type bifurcation and its application to an "end to side" fistula

Some recent surgical procedures such as arteriovenous fistula, or coronary and cerebral by-passes were observed to yield counterdirectional branching blood flows. There is a lack of knowledge about the role of the counterdirectional flow ratio, the angle of anastomosis and the shear stresses in the process of thrombogenesis that leads to shunt occlusion. The program developed to simulate these hemodynamic conditions uses an efficient numerical scheme for the solution of the 2-D Navier-Stokes equations and can be easily adapted to flows in other geometrical configurations.