Acute Adult Poisoning Research Articles

Exploring the Landscape of Adult Acute Poisoning in Saudi Arabia: A Comprehensive Narrative Review.

This narrative review meticulously examines the intricate landscape of poisoning incidents within Saudi Arabia, delineating the prevalence and characteristics across three main categories: pharmaceutical, illicit, and chemical substances. Pharmaceutical agents, particularly analgesics and antipsychotics, are identified as leading causes of acute adult poisoning, highlighting the paramount role of their widespread accessibility and the potential risks associated with over-the-counter availability. The review underscores the alarming prevalence of over-the-counter analgesics, such as paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs), as the most frequent culprits in poisoning cases, with a significant correlation observed between analgesic poisoning and gender, notably affecting the female population. Additionally, the study delves into the burgeoning issue of illicit drug use, with opioids and amphetamines emerging as substantial contributors to the poisoning landscape, reflecting a broader global trend of increasing substance misuse and its associated health risks. Chemical poisoning, encompassing a range of substances from household cleaners to industrial chemicals, presents another critical area of concern, with specific emphasis on the dangers posed by antiseptics, detergents, and organophosphates. The review identifies a pressing need for targeted public health interventions and policy reforms aimed at mitigating the risks associated with these diverse types of poisoning. By offering a comprehensive overview of the poisoning epidemiology in Saudi Arabia, the study contributes valuable insights into the multifaceted nature of this public health challenge, advocating for enhanced regulatory measures, public awareness campaigns, and improved access to mental health services to address the underlying factors contributing to poisoning incidents.

Public health risks associated with methadone in Iran: A systematic review and meta-analysis.

There has been a marked growth in methadone maintenance treatment (MMT) in Iran in the past two decades with positive health outcomes. We conducted a systematic review of studies on the prevalence of non-prescribed methadone use, methadone use disorder, and methadone-related poisoning and mortality in Iran. We searched International and Iranian databases up to May 2020 and contacted relevant experts. The pooled proportions were estimated through random-effects model. Methadone-related adverse outcomes were evaluated over time. Sixty-five studies were included. The pooled estimates of non-prescribed methadone use in the last 12-month were 2.7% (95%CI: 0.9-5.4) and 0.1% (95%CI: 0.03-0.2) in the male and female general population, respectively. Among people who use drugs, 8.4% reported daily non-prescribed use in 2018. Four heterogeneous studies in drug treatment centers reported the existence of treatment-seeking for methadone use disorder. Methadone was responsible for 10.4% (95%CI: 4.5-18.3) of cases of acute poisoning in adults and 16.0% (95%CI: 9.3-24.1) in children. Methadone was reported as a cause of death in 53.5% of substance-related deaths referred to the Legal Medicine Organization while being the only cause in 35.8% of all cases. Non-prescribed use of methadone in the general population is much less than opiates and some other available prescription opioids, like tramadol. However, notwithstanding the large and successful MMT program in Iran, increasing trends in methadone-related poisoning and deaths pose serious public health concerns. There is an urgent need to explore these fatal and non-fatal poisoning cases and implement policies to curb the harms associated with methadone use.

An epidemiological study of poisoning trend in sonipat Haryana region-A one year study

Poison is a substance that causes damage or injury to the body and endangers one’s life due to its exposure by means of ingestion, inhalation, or contact and it is an important public health problem causing significant morbidity and mortality throughout the world. Hence, this study was done at tertiary care Hospital in north India (Haryana region) from year 2012 to 2013. 59 cases of acute poisoning in adults due to chemicals were included. Data on age, sex, marital status, occupation, locality, type of poison, were recorded and analyzed by descriptive method. Among 120 postmortem cases, 59 cases were of poisoning. Males (40 cases) outnumbered females (19 cases) and 46 cases were married. Peak occurrence was in the age group of 31-40 years (18 cases). Occupation wise poisoning was commonly found among male laborers (25.4%) and farmers (20.3%) followed by house wives (28.1%) and students (6.8%). Organophosphorus was the commonest agent (42.4%). The incidence of poisoning and its morbidity and mortality can be reduced by developing and implementation of effective prevention strategies.

Status of clinical toxicology education and ethics in medical care of poisoned patients in the Islamic Republic of Iran and a comparison with other countries.

Clinical toxicology is not recognized as a clinical speciality in Iran. After the chemical war gas attack by the Iraqi army against the Iranian troops in the 1980s, health professionals and Iranian authorities noticed the importance of this field in clinical medicine. Collaboration between the clinical toxicologists and toxicologists of pharmacy schools resulted in the establishment of the Iranian Society of Toxicology and Poisonings in 1991 and the National Board of Toxicology in 1993. Clinical toxicology fellowship was also formed as a joint collaboration between the toxicology and internal medicine boards in 2010. Medical doctors who specialized in clinical medicine are eligible to take the entrance examination of the fellowship. In spite of the advancement of clinical toxicology and increased number of acute poisonings and drug abuse, undergraduate teaching in this field is still lacking and being taught as part of the forensic medicine curriculum since 1952. There is a lack of an efficient national poison information and control centre (s) in Iran, and no action plan and practical efforts have been done for poisoning prevention. Therefore, the number of drug abuse and acute poisonings has increased over the past four decades and induced cultural, social and health problems. According to Iranian legal medicine organization reports, poisoning is the second-most occurring cause of unnatural death. The suicidal attempt is the most common method of acute poisoning in adults. Suicidal attempt including self-poisoning is not accepted in the Islamic point of view, and thus self-poisoning is mostly neglected and may not be treated appropriately in time in some regions of Iran. Accidental poisoning in children is also common in Iran and estimated to be between 20000 and 25000 cases annually over the recent years. In addition, social, cultural and economic problems have induced more health problems such as drug abuse and addiction even in children. Adulterated opium to lead for economic gaining has produced thousands of cases of lead poisoning over the past few years in nearly all opium addicts, which is still a major health problem in Iran. Ban on alcoholic beverages leads some people to make their own home-made spirits, which is unfortunately contaminated with methanol. Thousands of cases of methanol poisoning and even some epidemics have occurred over the past four decades in some parts of the country. Lack of availability of essential antidotes such as succimer and fomepizole has been a major problem for the effective treatment of poisoned patients. Despite the well-known fact that cases of poisoning and drug overdose constitute a significant proportion of hospital admissions in some developing countries, clinical toxicology education and medical care of the poisoned patients are lacking. Therefore, policymakers and health authorities should realize the importance of toxicology in clinical medicine. The Iranian Ministry of Health, medical care and Medical Education should implement clinical toxicology courses for medical students; establish effective national poisons information and control centres and advance clinical toxicology services for appropriate management of poisoned patients to improve public health and the overall health policy goals.

A Clinical and Demographic Profile of Acute Poisoning in Adults: A Two Year Experience from a Tertiary Care Centre in Bangalore, India

A Clinical and Demographic Profile of Acute Poisoning in Adults: A Two Year Experience from a Tertiary Care Centre in Bangalore, India

Pattern of Acute Adult Poisoning in Gorgan, North of Iran

Pattern of Acute Adult Poisoning in Gorgan, North of Iran

English

Article history: Received on: 12/12/2012 Revised on: 29/12/2012 Accepted on: 09/01/2013 Available online: 28/01/2013 Poisoning is an important public health problem causing significant morbidity and mortality throughout the world. Information available with regard to acute poisoning in adults is limited at Salem, Tamil Nadu. Hence this study was done with the above objective. It is a retrospective study conducted during Jan 2009-Jan 2012 in a tertiary care hospital. 150 cases of acute poisoning in adults due to drugs and chemicals were included. Data on age, sex, marital status, occupation, religion, locality, type of poison, time and month of intake, route of exposure, associated co-morbid conditions and outcome of poisoning were recorded and analyzed by descriptive method. Among 150 cases, 148 cases were of intentional poisoning and two cases were of accidental poisoning. In all the cases the route of exposure was oral. Males (92 cases) outnumbered females (58 cases) and 101 cases were married. Peak occurrence was in the age group of 21-30 years (47 cases). Occupation wise poisoning was commonly found among male laborers (18.66%) and farmers (13.33%) followed by house wives (28%) and students (16.66%). 147 cases (98%) were Hindus. More cases were reported during summer season (36%) and day time (80%). Organophosphorus was the commonest agent (58.66%). Associated co-morbid conditions were found in 16 cases. The incidence of poisoning and its morbidity and mortality can be reduced by developing and implementation of effective prevention strategies.

Kind and estimated stocking amount of antidotes for initial treatment for acute poisoning at emergency medical centers in Korea.

Antidotes for toxicological emergencies can be life-saving. However, there is no nationwide estimation of the antidotes stocking amount in Korea. This study tried to estimate the quantities of stocking antidotes at emergency department (ED). An expert panel of clinical toxicologists made a list of 18 emergency antidotes. The quantity was estimated by comparing the antidote utilization frequency in a multicenter epidemiological study and the nation-wide EDs' data of National Emergency Department Information System (NEDIS). In an epidemiological study of 11 nationwide EDs from January 2009 to December 2010, only 92 (1.9%) patients had been administered emergency antidotes except activated charcoal among 4,870 cases of acute adult poisoning patients. Comparing with NEDIS data, about 1,400,000 patients visited the 124 EDs nationwide due to acute poisoning and about 103,348 adult doses of the 18 emergency antidotes may be required considering poisoning severity score. Of these, 13,224 (1.9%) adult doses of emergency antidotes (575 of atropine, 144 of calcium gluconate or other calcium salts, 2,587 of flumazenil, 3,450 of N-acetylcysteine, 5,893 of pralidoxime, 287 of hydroxocobalamin, 144 of sodium nitrite, and 144 of sodium thiosulfate) would be needed for maintaining the present level of initial treatment with emergency antidotes at EDs in Korea.

Homicidal Acute Formalin Poisoning in an Infant From a Rural Sericulture Family Presenting With Multisystem Failure

Acute poisoning of formalin is rare because of its strong irritating effect and alarming odor. Although few cases of acute poisoning in adults have been reported in literature, to our knowledge, this is the first case report of formalin poisoning in an infant presenting with multisystem failure. Despite proper supportive treatment in the absence of antidote, the infant died within 13 hours after deliberate poisoning.

Characteristics and determinants of adult patients with acute poisoning attending the accident and emergency department of a teaching hospital in Qatar

Data about etiologic and demographic characteristics of acute poisoning in adults in Qatar are lacking. This prospective observational study was undertaken to analyze characteristics and possible determinants of acute poisoning in adults in Qatar. During 2010, 18,073 patients attended the emergency department of Hamad General Hospital, a teaching hospital in Qatar. Out of them, 599 (3.3%) patients were diagnosed as "poisoning case" with either chemical or pharmaceutical substances. The prevalence rate of poisoning incidence was 35.3/100,000 population. Seven patients died, corresponding with a case-fatality rate of 0.39/1000. The majority were male (65%) and the mean age was 34 years. The poisons involved were mainly chemicals (61.6%) and pharmaceuticals (38.4%). Female, mainly single, suffered more intentional poisoning compared to male. Of the patients aged 60 years and above (7.2%), the majority (95.3%) suffered unintentional poisoning with pharmaceuticals; 56% with warfarin, 12% with digoxin and 7% with insulin. Multivariate analysis shows that female gender, single status, younger than 35 years of age, being poisoned by pharmaceutical products, and the need for hospitalization are significant determinants for acute intentional poisoning after adjusting all other possible covariates. The findings of this study can be used to establish awareness and prophylactic campaigns in Qatar.

Profile of poisoning cases in a Tertiary care Hospital, Tamil Nadu, India

Article history: Received on: 12/12/2012 Revised on: 29/12/2012 Accepted on: 09/01/2013 Available online: 28/01/2013 Poisoning is an important public health problem causing significant morbidity and mortality throughout the world. Information available with regard to acute poisoning in adults is limited at Salem, Tamil Nadu. Hence this study was done with the above objective. It is a retrospective study conducted during Jan 2009-Jan 2012 in a tertiary care hospital. 150 cases of acute poisoning in adults due to drugs and chemicals were included. Data on age, sex, marital status, occupation, religion, locality, type of poison, time and month of intake, route of exposure, associated co-morbid conditions and outcome of poisoning were recorded and analyzed by descriptive method. Among 150 cases, 148 cases were of intentional poisoning and two cases were of accidental poisoning. In all the cases the route of exposure was oral. Males (92 cases) outnumbered females (58 cases) and 101 cases were married. Peak occurrence was in the age group of 21-30 years (47 cases). Occupation wise poisoning was commonly found among male laborers (18.66%) and farmers (13.33%) followed by house wives (28%) and students (16.66%). 147 cases (98%) were Hindus. More cases were reported during summer season (36%) and day time (80%). Organophosphorus was the commonest agent (58.66%). Associated co-morbid conditions were found in 16 cases. The incidence of poisoning and its morbidity and mortality can be reduced by developing and implementation of effective prevention strategies.

Causes of acute poisoning in adults: a retrospective study, in a hospital in Istanbul, Turkey

Aim Acute poisoning is one of the major topics in emergency medicine practices. Despite the recent developments in toxicology, technological advances and changing lifestyles reveal new factors, and poisoning cases remain to be a problem. All poisonings should be considered serious and independent from their clinical presentation at the time of admission. Identifying the cause and prompt initiation of treatment is life-saving. Causes of poisoning vary between countries and different regions of the same country. In the present study, cases admitted to the Emergency Department of Internal Medicine at Haseki Training and Research Hospital were evaluated and causes of acute poisoning were investigated.

Acute adult poisoning cases admitted to a university hospital in Tabriz, Iran

The aim of our study was to investigate the etiological and demographical characteristics of acute adult poisoning cases admitted to a university hospital in Tabriz, Iran. This retrospective study was performed on 1342 poisoning admissions to a university hospital from 2003 to 2005, by data collection from the medical records of patients. Poisonings were 5.40% of the total admissions. There was a predominance of female patients (55.7%) compared to male patients (44.3%) with a female-to-male ratio of 1.2:1. Most poisonings occurred in the age range of 11-20 years (38.9%). Drugs were the most common cause of poisonings (60.8%). Among the drug poisonings, benzodiazepines (40.31%) were the most frequent agents, followed by antidepressants (31.98%). The seasonal distribution in poisoning patients suggested a peak in spring (28%) and summer (27.5%). In 9.8% of cases accidental and in 90.2% intentional poisonings were evident. Most suicide attempts were made by women (58.51%) and unmarried people (51.4%).The mean duration of hospitalization was 3.02 +/- 2.8 days. There were 28 (2.3%) deaths; the majority (13 cases) was due to pesticides. This was a university hospital-based study, so these results may not be representative of the general population. Despite this drawback, these data still provide important information on the characteristics of the poisoning in this part of Iran. To prevent such poisonings, the community education about the danger of central nervous system-acting drugs and reducing the exposure period of people to pesticides are recommended.

Etiological and demographical characteristics of acute adult poisoning in Adana, Turkey

The objective of this study is to define the etiological and demographical characteristics of the patients applying to the emergency department in Faculty of Medicine, Cukurova University because of poisoning. This retrospective study was carried out by examining the records of 491 people who applied to the main emergency department in Faculty of Medicine, Cukurova University, with the complaint of poisoning between January 1, 2004 and December 31, 2004. It was determined that the reason why 491 of 20 817 persons (2.4%) applied during this term was because of poisoning: 159 (32.4%) of such patients were male and 332 of them (67.6%) were female. It was found that the average age of men was 27.1 +/- 10.5 years and that of women was 24.4 +/- 9.5 years (P = 0.005); 427 of poisoning cases (87.0%) happened intentionally as suicide attempts and 64 of them (13.0%) were accidental. The rate of suicide-purposed poisoning was higher in women and the rate of unintentional poisoning was higher in men (P +/- 0.001). The drugs were accountable for 71.1% of all poisoning cases and the pesticides were accountable for 18.9% of such cases. Poisonings increase during summers. The mortality rate in poisonings was found as 0.8%. The drugs and pesticides in Ckurova region constitute 90.0% of all poisoning cases. The mortality rate in poisoning will be decreased by training the physicians employed in the emergency department about poisoning by drugs and pesticides.

Retrospective evaluation of emergency service patients with poisoning: A 3-year study

The purpose of this retrospective study was to evaluate the characteristics of cases of acute poisoning in adults who were admitted to emergency service over a 3-year period. Clinical charts were analyzed retrospectively for etiologic and demographic patient characteristics. A total of 810 adults were admitted to the emergency center with acute poisoning. The female-to-male ratio was 2:1. Mean ages of female and male patients were 28.8+/-12.9 years and 35.1+/-15.4 years, respectively, and many patients (46.9%) were between the ages of 16 and 25 years. Medicinal drugs were found to be the primary cause (60.5%) of poisoning, and tricyclic antidepressants were the most frequent causative agents (36.3%). Seasonal distribution of poisoning cases suggested a peak in the summer months (35.4%). Overall, 68.6% of acute poisonings were suicide attempts, and of these patients, 84.9%, 14%, and 1.1% were attempting suicide for the first, second, and third times, respectively. Among 810 cases of acute poisoning, 15 were fatal. The following conclusions were reached by investigators: (1) in the test region, younger females, especially single females, were at greater risk for poisoning than other patient groups, (2) self-poisoning cases constituted the majority of all poisonings, and (3) the main agents of self-poisoning were medicinal drugs, with antidepressants used most frequently. It was also found that unintentional poisoning commonly resulted from intake of foods, especially mushrooms.

Analysis of acute adult poisoning in a 6-year period and factors affecting the hospital stay

Case management of adult patients with acute poisoning in a university-based emergency department to determine the factors that affect duration of hospital stay was assessed. In this survey, data were obtained for the period between January 1, 1997 and December 31, 2002 at the emergency department (ED). Case analyses of 2229 patients older than 14 years of age were reviewed. Of all patients, 725 (32.5%) were male, 801 (35.9%) were younger than 20, and 540 (24.2%) were older than 30 years. Mean ages of patients were 29.3+/-13.2 for the males and 23.8+/-9.6 for the females (P<.001). During the study, the greatest number of patients were admitted in May (11.0%). Suicidal poisoning was the observed etiology in the majority of cases (76.4%). Moreover, the mortality rate due to poisoning was 3.9%. Drug ingestion was the most frequent means of poisoning (59.0%), followed by pesticides (19.0%). The rate of poisoning with multiple drugs has declined over time, whereas the rate owing to psychoactive drugs has increased markedly. The mean length of hospital stay was 2.9+/-1.8 days and the proportion of patients who stayed for longer than 2 days was 44.3%. The mean length of hospital stay was longer for males, those older than 30 years, those who had been poisoned unintentionally, and for confused and unconscious patients and those who had arrived to ED more than 2 hours after the event. This study suggests that morbidity for adult patients with poisoning varied by sex, age, and season. Length of hospital stay was affected by sex, age, arrival time to ED, mode of transport, severity of poisoning, and type of agent.

Acute Poisoning in Adults in the Years 1996-2001 Treated in the Uludag University Hospital, Marmara Region, Turkey

Acute Poisoning in Adults in the Years 1996-2001 Treated in the Uludag University Hospital, Marmara Region, Turkey

Acute Poisoning in Adults in the Years 1996–2001 Treated in the Uludag University Hospital, Marmara Region, Turkey

Background: Acute poisonings are frequent causes of admission to emergency departments and these cases may have hazardous outcomes. Methods: In the present study, medical records of 1818 poisoned patients admitted to Uludag University Medical School's Emergency Department between January 1996 and December 2001 were investigated. The age, sex, outcomes of the patients, and type of poisoning are described. Results: The mean age for females (63% of the patients) was 27 years, whilst the mean age of male patients was 31 years. The major types of poisonings were ingestions of medications (59.6%), mushrooms (3.3%), corrosives (2.5%), organophosphates (3.2%), and methyl alcohol (0.4%). Carbon monoxide accounted for 6.9% of intoxications. Approximately 65% of the patients survived, while the methyl alcohol and corrosive ingestions led to the highest fatality averages (100% and 14.8%, respectively). Conclusions: The demographic and diagnostic features of acute poisoning cases treated in our hospital are similar to those reported in the literature. Adults and women are in a high-risk group for acute poisonings and medicine poisoning, which is the most common type of poisoning.

Characteristics of acute adult poisoning cases admitted to a university hospital in Istanbul.

The aim of this retrospective study was to analyse the characteristics of acute adult poisoning cases admitted to a university hospital in Istanbul, Turkey. All cases admitted to the Emergency Unit of the Istanbul University Cerrahpaşa Medical Faculty Hospital, between January 2001 and December 2001, were included in this study. We analysed the clinical charts for aetiological and demographical characteristics of the acutely poisoned patients. There were 284 poisoning cases (207 females and 77 males) among 11834 patients admitted to the Emergency Unit. This was 2.4% of all emergency admissions. The female-to-male ratio was 3:1. The mean age was 27+/-12 years (age range 15-87) and the majority of the patients (73.94%) were below the age of 30 years. The median age was 24 years. Medicinal drugs were the major cause (69.37%) of the cases, followed by inhalation of gases (14.44%), alcohol (5.99%), alcohol together with illicit drugs (4.23%), food (3.17%), corrosives (1.76%) and pesticides (1.06%). The route of administration was as follows: 84.51% orally, 14.44% by inhalation and 1.06% by intravenous injection. Seventy-one per cent of acute poisonings were self-inflicted and 88% occurred at home. The most frequently involved medicinal drugs were antidepressants and analgesics. In 32.04% of cases, there was more than one medicinal drug responsible for the poisoning. The seasonal distribution in poisoning patients suggested a peak in summer (31.7% of presentations) and winter (30.9%) and lower numbers in spring (22.9%) and autumn (14.5%). The follow-up period of the patients were 1-12 hours for 42 cases (15%), 13-24 hours for 134 cases (47%) and more than 24 hours for 108 cases (38%). Two of the 284 cases with acute poisonings were fatal. This was a university hospital-based study, so these results may not be representative of the general population. Despite this drawback, these data still provide important information about the characteristics of poisoning in the largest city of the country. cn

Characteristics of acute adult poisoning in Gaziantep, Turkey.

The objective of this prospective hospital-based study was to evaluate the rate and characteristics of acute human poisoning in our province (Gaziantep City, Turkey). All cases of acute human poisonings admitted to the emergency department of the Gaziantep University Hospital, Gaziantep, Turkey, between January 2000 and December 2001, were included in the study. The rate and causes of mortality from poisoning as well as demographic data of the patients were investigated. There were 179 (0.7%) poisoning cases among 25,605 patients who admitted to the emergency department. Of the poisoning cases, 64.3% were female and 35.6% were male patients. The poisoning made a peak between the ages of 16 and 25. The majority of poisonings resulted from oral ingestion with deliberate intake accounting for 78.7% of the cases. Most of the suicide attempt cases were also females. Analgesics were the most common agents (42.4%) among the drugs incriminated in poisoning. Twenty-four patients (13.7%) were admitted to intensive care unit, of whom 42% were female and 58% were male patients. Drugs for suicide attempts were the main cause of poisoning in the patients who admitted to intensive care unit. Five patients (2.8% of all cases) died in the intensive care unit. These data provide important preliminary information on the pattern of symptomatic poisonings in this south-east part of our country.