Cause Of Poisoning Research Articles

Childhood Poisoning - Associated Factors and Clinical Profile in a Tertiary Care Hospital

Background: Acute poisoning is a common medical emergency in the pediatric unit. It is a common preventable cause of morbidity and mortality in children. Most of the poisoning in children less than five years of age is accidental. This study aimed to determine the associated factors and clinical profile of childhood poisoning.
 Material & Methods: A cross-sectional descriptive study was carried out among 69 children aged six months to 12 years with a history of poisoning over six months. History, clinical examination, and details of the poisoning were obtained by using a structured questionnaire during admission. Analysis was done through standard statistical tests.
 Result: Among the 69 children of poisoning, 92.8% were accidental, and 7.2% were suicidal. Most cases (79.7%) were from the 6 - 59 months age group with male-female ratio 1.7:1. Most of the fathers (65.2%) and mothers (75.4%) had primary education, and 75.4% were poor. The most common cause of the poisoning was insecticide (60.9%), and the poison was stored at an available site (91.3%) in an unsealed container (47.8%). Accidental poisoning was more common in younger age group (<5 years) in male (70.31%) patients with normal family relationships (78.1%), whereas suicidal poisoning was more common in older age group (>10 years) in females (80%) patient with h/o familial disharmony (60%).
 Conclusion: Insecticides and kerosene were the common cause of poisoning. Most of the materials were stored in an unsafe place and stored in an attractive bottle. Poison should be stored in a safe home with a sealed container. Simple and active family preventive measures can reduce accidental poisoning.
 TAJ 2022; 35: No-2: 75-82

Bursa'daki Zehirlenme Vakalarına Genel Bakış

Aim: In this study, our aim is to examine the most common causes of poisoning in our city, to contribute to the epidemiological studies in our country and to ensure the efficient use of the country's resources. Material and methods: In our study, all patients who admitted to the emergency departments of public and private hospitals in Bursa between 01.02.2020 and 31.08.2022 due to poisoning and were reported to the statistical reporting unit of Bursa Provincial Health Directorate were retrospectively evaluated. Results: The gender differences in the causes of poisoning was seen that food-related poisoning was more common in men (n:322-78), and drug-induced poisoning was more common in women (n:363-556) and the difference was found to be statistically significant (x2=217.06, p<0.01). When we evaluated the differences in the causes of poisoning between age groups, it was seen that the lowest intoxication age group was <55 years of age (6.3%, n:111). Corrosive poisonings in the 0-13 age group constitute 72.7% (n:109) of all age groups. Methyl alcohol poisonings are most common in the 36-55 age group. In the chi-square analysis, a statistically significant difference was found between the age groups categorized in terms of the causes of poisoning (x2=641.80, p<0.01). When we look at the outcomes of the patients included in the study, the causes of poisoning in the patients who died were carbon monoxide poisoning (CO) (n:2), drugs (n:1), ethyl alcohol (n:1), were respectively. In addition, the most common cause of poisoning requiring ICU admission was drugs (n:82). When we look at the seasonal differences in the causes of poisoning, poisoning cases with drugs are seen more than other factors in every season, while CO is seen more in winter, food releated in summer and musrooms in autumn. The causes of poisoning show a statistically significant difference in terms of seasons (x2=565.35, p<0.01). Conclusions: Analysis of local causes in a region is very important in poisoning. In this way, measures specific to that region can be taken. In this way, antitoxin planning and manpower planning can be made more effective.

Çocuk Acile Karbonmonoksit Zehirlenmesi ile Başvuran Hastaların Değerlendirilmesi

Aim: Carbon monoxide poisoning is one of the significant causes of intoxication and presentation to pediatric emergency departments, especially in winter. The primary aim of this study was to evaluate the demographic characteristics, and clinical and laboratory findings of pediatric patients who presented to the pediatric emergency department with carbon monoxide poisoning, and the secondary aim was to examine the laboratory values of the patients with impaired consciousness. Material and Methods: The demographic and clinical characteristics and laboratory values of 162 patients presented to the pediatric emergency department due to carbon monoxide poisoning between 2017 and 2020 were retrospectively analyzed. The laboratory parameters of the patients with and without symptoms of impaired consciousness were compared. Results: The mean age of the patients was 8.94±5.33 years, and the gender distribution was homogenous. The highest frequency of presentation was during winter. Nausea, vomiting, and headache were the most common symptoms. Fifteen of the patients had impaired consciousness. While the laboratory values of the patients were generally within normal ranges, patients with high carboxyhemoglobin, lactate, and troponin values, and low pH were encountered. The carboxyhemoglobin and lactate levels of patients with impaired consciousness were found to be significantly higher than the patients without impaired consciousness (p<0.001 and p=0.019, respectively). Conclusion: Elevated carboxyhemoglobin and lactate levels were associated with impaired consciousness. Although carboxyhemoglobin levels are important for diagnosis and clinical follow-up, they should not be used as the only marker. High lactate and troponin levels, and low pH should also be taken into account.

Exogenous poisoning in Tocantins - Brazil: a retrospective study from 2017 to 2021

Exogenous intoxication occurs due to the interaction with some chemical substances that lead to the appearance of varied signs and symptoms, from topical exanthema to severe systemic complications, hemorrhages, shock, coma and death. Therefore, it is important to report cases to epidemiological surveillance for the implementation of practices and actions that lead to their prevention. Thus, the objective was to analyze the compulsory notifications for exogenous intoxication in the Brazilian Northeast from 2014 to 2017. For that, a descriptive, retrospective and quantitative study was developed from cases reported in the National System of Diseases and Notifications (SINAN) in the Northeast region of Brazil. A total of 101,845 cases of exogenous intoxication were reported, with a greater predominance among: women (52.74%); brown race/color (61.42%) and age group from 20 to 39 years (37.88%). The drug was the main cause of intoxication with 35,646 cases (34.99%). The suicide attempt stood out in the circumstances studied (24.54%). The acute clinical criterion was the most relevant with 54,836 cases and the most observed clinical course was cure without sequelae (65.61%). There were no records for the following variables: Ethnicity (27.90%); Education (20.33%); Toxic agent (19.10%); Clinical evolution (30.10%) and Circumstance (23.84%). Thus, it was possible to verify that exogenous intoxication is an investigation event of extreme relevance to public health. This fact suggests the need for preventive actions and health education for the population of the region.

Epidemiological and faunistic characterization of scorpionism in the Beni Mellal-Khenifra region, Central Morocco

Scorpionism is a serious public health problem in several parts of the world including Morocco, where is considered as the first cause of intoxication. The Beni Mellal-Khenifra region is one of the most affected regions by this health problem. The aim of this study is to describe the epidemiological and faunistic characteristics of scorpionism in this area. A retrospective epidemiological study was conducted based on the data of 16,388 cases of scorpion stings recorded between 2016 and 2020. In the laboratory, the collected scorpions were determined morphologically based on the valid taxonomic keys. Statistical and descriptive analyses were performed using Excel 2016. Statistical significance was determined by P-value < 0.05. The study comprised 16,388 stung patients. The scorpion stings incidence was 123.58 cases/100,000 population/year and was significantly higher at Azilal province (217.69 cases/100,000 population/year). We found a positive correlation between the scorpion stings incidence and the percentage of the rural population (r = 0.72) and between the scorpion stings incidence and the number of harmful species found in each province (r = 0.69). The general lethality rate was on average of 0.30% with a higher rate in Fquih Ben Salah province (0.63%) followed by Azilal province (0.32%). Children have the highest lethality than adults (p < 0.05). In the study area, eight species were identified, belonging to the families Buthidae and Scorpionidae, including dangerous species. Scorpionism is a real health problem in the Beni Mellal-Khenifra region, which is a rich and diverse area of scorpion fauna. Our findings can be useful for better understanding the problem of scorpionism in this region in order to better control it.

Yoğun bakım ihtiyacı olan pediatrik zehirlenme hastalarının değerlendirilmesi

Purpose: Our study was planned to reach out intoxication patient’s clinical characteristics, treatment modalities and outcomes of those patients followed up in pediatric intensive care unit. Materials and method: We examined patients admitted to our hospital or transferred from another medical center to our PICU, diagnosed with intoxication from 01 January 2019 to 31 December 2021, retrospectively. We collected patient’s demographic data. Glasgow Coma Scale score at admission, medical treatments applied to patients’ mechanical ventilation requirement, hemodialysis and plasmapheresis applied was recorded. Outcomes evaluated by survival, days in PICU and days in hospital. We divided study group as adolescent group (&amp;gt;120-month-old) and non-adolescent group (&amp;lt;120-month-old). All collected variables were compared between two groups. Results: During study period 114 patients included into the study. Most of the patients were in adolescent age group (52.6%). If we examined intoxication causes, in adolescent patient’s suicide was major cause of intoxication. In patients below &amp;lt;120-month-old unintentional intoxication was the main reason. Antipsychotics, antidepressants and analgesics were the most common medication causes of intoxication respectively. Mechanical ventilation applied to 4 patients. 5 patients were hemodialyzed. Plasmapheresis performed to 5 patients. All patients were survived. Median days in PICU was 1 day. Median days in hospital was 3 days. Conclusion: In our study, 2.8% of all PICU admissions were intoxications. Antipsychotics, antidepressants and analgesics were the most common medication causes of intoxications. Antidepressants intake were seen in higher rates in adolescent age group. Antidepressant prescription and drug control should be more carefully in adolescent age group.

Analysis of the Pattern of Poisoning in Patients Admitted to a Large Teaching Hospital in Iran

Introduction: Poisoning is one of the most common causes of hospital admission. This study aims at 1- to determine the characteristics of poisoning, 2-to discover the relationship of the patients’ characteristics, and 3- to suggest a pattern of characteristics of poisoning.&#x0D; Methods: The current cross-sectional study was conducted at Edalatian Emergency Center in 2016. Characteristics of patients with poisoning were extracted from the hospital information system (HIS) in a large teaching hospital. Gender, type of admission, the priority of admission, type of referral, cause of referral, insurance organization, age, and month of referral were the variables extracted. Data were analyzed using descriptive and analytical statistical methods in SPSS software version 21. &#x0D; Results: Of the 15204 patients included in this analysis, 55.2% of the patients were men. Also, 68.5% had nonurgent triage level, and the cause of the 60.7% of the poisoning was medication overdose. Most of the patients (86.2%) aged from 20 to 30 years with the most frequent referral in May, June, July, and August. According to logistic regression results, opium, toxin, alcohol and medication poisoning had the highest odds of being at urgent triage level (OR= 1.609, 1.559, 1.358, 1.218 respectively) and the food poisoning was the lowest cause of poisoning ( OR=0.018). Triage level was found to be significantly different in months of the year (P&lt;0.001). But, a routine trend was not observed.&#x0D; Conclusion: The use of preventive measures from the occurrence of poisoning is necessary for the country because this problem occurs due to the lack of awareness about its causative factors. Regarding the more prevalence of intentional poisoning, the necessary steps are needed to be taken to identify the Psychological causes and prevent suicide in at-risk groups.&#x0D;

Serotonin syndrome onset following 25H-NBOH and MDPHP consumption: A case report

The continual emergence of new psychoactive substances remains a global health issue. We reported a case of serotoninergic syndrome following the consumption of 3,4-methylenedioxy-α-pyrrolidinohexanophenone (MDPHP) and 25H-NBOH documented by liquid chromatography coupled to high-resolution mass spectrometry (LC-HRMS). A 23-year-old man, with a history of cathinone regular use, presented a seizure and a loss of consciousness 30 min after the consumption of a powder identified as 25I-NBOH. The way of exposure was not documented. On arrival at the mobile emergency unit, the patient exhibited a serotonin syndrome with hyperthermia at 41 °C, hypertonia of the upper limbs, bilateral mydriasis, Glasgow coma 3, hypertension at 16/8, tachycardia at 180 bpm, and SaO 2 = 50%. During the hospitalization, he developped acute renal failure, acute liver failure, rhabdomyolysis and disseminated intravascular coagulation. He was discharged after 20 days of hospitalization but kept neurological sequelae. Following his hospital admission, blood and urine samples were drawn and sent to the toxicology laboratory to determine the cause of poisoning. In total, 200 μL of plasma and urine samples were extracted with QuEChERS salts and acetonitrile. The extracts were analyzed by liquid chromatography hyphenated to high-resolution mass spectrometry (Orbitrap, Exploris 120) allowing both a non-targeted screening and the simultaneous quantification of 132 compounds frequently found in poisonings. Analysis was realized in full scan experiment with a nominal resolving power of 60,000 FWHM within the 125–650 m/z mass range, followed by four cycles of DDA with a mass resolution of 16,000 FWHM. Pharmaceuticals administered to the patient during his medical care were found in plasma and urine: midazolam, hydroxyzine and its metabolite cetirizine, ketamine, etomidate, laudanosine (atracurium metabolite), lidocaine. Additionally, two NPS were identified and then confirmed with certified reference materials (CRM): MDPHP in plasma and urine, and 25H-NBOH in urine. 25H-NBOH was not detected in plasma despite a limit of detection being 0.01 ng/mL. Unfortunately, there were not enough remaining samples after the screening analyzes, therefore the quantification could not be carried out. In order to estimate the concentration, a calibration curve was carried out with the two compounds under the same conditions as the screening analysis (same pretreatment, same internal standards at the same concentrations, as well as the same analytical conditions), and the data corresponding to the initial acquisition was then reprocessed. MDPHP concentration was 1 ng/mL in plasma and 48 ng/mL in urine, 25H-NBOH concentration was 0.4 ng/mL in urine. 25I-NBOH was specifically searched in both samples and was not detected. MDPHP is a synthetic cathinone of the pyrovalerone type (e.g. MDPV), it acts as a stimulant on the release of dopamine and norephedrine and simultaneously as reuptake inhibitor, causing a pronounced stimulatory effect on the central nervous system (Grapp M, et al., Drug Test Anal 2020;12:1320–35). 25H-NBOH is a psychedelic belonging to the NBOMe family, they are potent agonists of 5-HT2A receptor (Pottie et al., Biochem Pharmacol 2020;182:114251). The clinical manifestations observed here are similar to those described in cases of NBOMe poisoning, and are probably attributable to 25H-NBOH, they may have been potentiated by the presence of MDPHP (Kyriakou C, et al., Eur Rev Med Pharmacol Sci 2015;19:3270–81). To our knowledge, very few study have been dedicated to MDPHP poisoning, and this is the first describing 25H-NBOH poisoning.

Acute poisoning among children and adolescents: a narrative review

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.

Методы профилактики и терапии судорожного синдрома при отравлении конвульсантами холинергического ряда

Organophosphates (OPs) and carbamates are a common cause of intoxication associated with convulsive disorders. These cholinergic substances form a bond with acetylcholinesterase (AChE), thus contributing to accumulation of acetylcholine in synapses and causing typical manifestations of toxicity, including seizures. Standard antidote therapy provides sufficient symptom control, reduces seizures and decreases mortality only in case of prescription at the early stage of poisoning or preventive administration. Traditionally, atropine is used, that blocks the activity of the muscarinic cholinergic receptors in the parasympathetic nervous system and reduce the smooth muscle contraction activity, along with oximes that reactivate the reversibly inhibited AChE in the nicotinic acetylcholine receptors found in skeletal muscle. If these are not sufficient, benzodiazepines that interact with γ-aminobutyric acid receptors are used to jugulate seizures, prevent organic brain desease and post-traumatic epilepsy. There are no unified guidelines for the cases of antidotes having no effect or insufficient efficacy of antidotes. Unwanted side effects of the existing drugs and progressive decrease of efficiency within 30 min after exposure to OPs necessitate the search for new agents. Combination therapy, new dosage forms, developing original molecules or modifying the existing ones are among the developed approaches discussed in our review.

PROFILE OF CHILDHOOD POISONING: A RETROSPECTIVE STUDY FROM A TERTIARY CARE HOSPITAL IN ASSAM

Acute poisoning forms a substantial part of emergency visits to a hospital for the pediatric population. It is mostly noted amongst the families in the lower socio-economic strata of the society with limited access to the basic amenities of life. Majority of childhood poisonings are unintentional, occur at home, and home surroundings and hence preventable. It is a retrospective study conducted in the Department of Pediatrics of Fakhruddin AliMETHODOLOGY: Ahmed Medical College &amp; Hospital, Barpeta,Assam. To determine the types of acute childhood poisoning andOBJECTIVE: demographic prole in children admitted Fakhruddin Ali Ahmed Medical College &amp; Hospital. A total of 69 cases ofRESULT: poisoning was reported during the study period. 46 (66.6%) were males while 23 (33.33%) were females. Mineral oil was the most common cause of poisoning (40.5%), followed by organophosphorus compounds (28.9%), drugs (11.5%) and unknown causes (18.8%).Of the 69 cases, 61 (89.8%)were discharged while 8(11.1%) cases went home against medical advice. CONCLUSION: Acute poisoning in children is mostly accidental in nature, with preventable morbidity and mortality.In our study, mineral oil and organophosphorus compounds were the most common causes as the study population comprised of cases of lower socioeconomic strata and mostly related to the agrarian sector. Careful storage of household products and keeping medicines in child-proof containers may reduce poisoning to a great extent.

The trend of top five types of poisonings in hospitalized patients based on ICD-10 in the northeast of Iran during 2012-2018: A cross-sectional study.

Background and AimsPoisoning remains a major health issue in developing countries with high morbidity and mortality rates; also it is one of the most common causes of admission to hospitals. This study aimed to investigate the trend of the top five types of poisonings in hospitalized patients according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD‐10) in Imam Reza hospital, Mashhad, Iran.MethodsThis was a cross‐sectional study performed from March 20, 2012, until September 22, 2018. We collected data from all patients hospitalized for poisoning admitted to the poisoning center at Imam Reza hospital in northeast Iran. ICD‐10 was adopted to categorize all types of poisonings (T36‐T65). The results obtained were analyzed by SPSS 16.ResultsThirty‐four thousand eight hundred and ten cases were included. The mean age of the patients was 29.64 ± 14.69 years, of them, 50.7% were males. Benzodiazepine poisoning (T42.4) has the highest frequency among other subcategories and it was more common among females (60.5%). Opium poisoning (T40.0) has the highest mortality rate (5.4%) among other subcategories that is more common in males (72.0%). The mortality associated with narcotics was the highest frequency (2.7%). Suicide (83.6%) was the most common cause of poisoning. Most poisonings occurred in summer (27.4%).ConclusionThese findings could help health care managers and policymakers develop prevention and educational programs to reduce these poisonings and limit people's easy access to drugs and substances.

Medication errors in inquiries to the Poison Information Center Erfurt — a systematic analysis

Introduction Poison Information Centers (PICs) fulfil the legal mandate to provide advice and answer inquiries from healthcare professionals and medical nonprofessionals on measures to be taken in the event of an intoxication. Medication errors might be a frequent cause of intoxication. However, hardly any data on medication errors are available from PICs. Aim We aimed to investigate the incoming inquiries of a PIC with regard to medication errors. Methods In the PIC database, we identified and analyzed medication errors in a retrospective analysis of inquiries from 2013 to 2020. We distinguished between medication errors committed by (i) laypersons or by healthcare professionals in (iia) medical care facilities or (iib) home care facilities. We evaluated the estimated potential risk of toxicity to assess the potential harm to the patient. Results From 152,149 inquiries in total, 43.5% (n = 66,229) dealt with drug exposures. We identified medication error in 19.1% (n = 12,619) of those inquiries. Of those medication errors, 80.1% (n = 10,113) were committed by (i) laypersons and 19.9% (n = 2506) were committed by healthcare professionals, with nearly equal proportions occurring in medical care and in home care [(iia) 49.6% and (iib) 50.4%, respectively]. A total of 18,718 drugs were involved, with most medication errors found for ibuprofen, acetaminophen, and levothyroxine. The medication errors led to a minor estimated risk of toxicity in 46.6% (5,877/12,619); moderate and severe risk occurred in 7.0% (886/12,619) and 2.6% (329/12,619), respectively. Medication errors caused by laypersons or healthcare professionals in home care were associated with a lower risk compared to those caused by healthcare professionals in medical care (p < 0.001). Conclusion This study identified medication errors that were committed mainly by laypersons in almost 80% of the medication inquiries to a PIC. Medication errors caused by healthcare professionals in medical care led to a higher risk of harm to the patients.

White-Tailed Eagles' (Haliaeetus albicilla) Exposure to Anticoagulant Rodenticides and Causes of Poisoning in Poland (2018-2020).

The white-tailed eagle (Haliaeetus albicilla) is strictly protected in Poland due to its threat of extinction. This study’s main goal was to assess their exposure to indirect poisoning by anticoagulant rodenticides (AR). This study presents the investigation results of 40 white-tailed eagles’ suspected poisoning cases in the years 2018–2020 in Poland. In all tested liver samples, using a liquid chromatography–mass spectrometry method, at least one of the AR (bromadiolone, brodifacoum, difenacoum, flocoumafen) was detected and confirmed. The other tested AR compounds (chlorophacinone, coumachlor, coumatetralyl, difethialone, diphacinone, warfarin) were not detected. The mean concentration of the sum of rodenticides was 174.4 µg/kg (from 2.5 to 1225.0 µg/kg). In 20 cases, the sum concentration was above 100 µg/kg and in 10 cases it was above 200 µg/kg. Interpretation of cases of AR poisonings should take into account their concentration in the liver, anatomopathological lesions, circumstances of death/finding of the animal, and elimination of other possible causes of poisoning. Based on this study, AR was the direct cause of death in 10% of incidents. Extensive use of rodenticides generates a high risk of poisonings of white-tailed eagles in Poland.

Delayed liver toxicity and delayed gastroenteritis: A 5 year retrospective analysis of the cause of death in Mushroom poisoning.

ABSTRACTIntroduction:Mushroom poisoning occurs from consumption of the wild variants of mushroom containing varied forms of toxins. Among those toxins, amatoxin containing mushrooms are known for the significant morbidity and mortality from hepatic toxicity and delayed gastroenteritis. Although not a very common cause of poisoning, it is prevalent in the north-eastern region of India, especially during the rainy summer seasons when the wild variants are found abundantly and often confused with the edible variants.Aims and Objectives:To study the clinical and biochemical profiles and short term outcomes of patients with mushroom poisoning admitted to a tertiary care hospital.Materials and Methods:We analyzed the data of patients with mushroom poisoning admitted to a tertiary care institute in north-eastern India between January 2015 to December 2020 to study their clinical and biochemical profiles, and short-term outcomes. Their clinical features, biochemical parameters, management, and in-hospital outcomes were noted. All data was recorded in Microsoft MS Excel and analyses done using SPSS version 22.Results:Of the 44 patients with mushroom poisoning, 23 (52%) were male and 21 (47%) were female, with a mean age of 20.13 years. Seventeen patients (38%) had delayed liver failure and delayed gastroenteritis, 19 patients (43%) had acute gastroenteritis syndrome, 5 patients (11%) had cholinergic symptoms, one patient (2%) each had acute kidney injury and a disulfiram-type reaction with headache. The mean hospital stay of the patients was 5 days. In-hospital mortality occurred in 10 (58%) patients with delayed liver failure and none of the patients with the other complications died.Conclusion:This study revealed a high prevalence of mushroom poisoning that caused delayed liver toxicity and delayed gastroenteritis, probably amatoxin-induced, which is fatal, thus accounting for high mortality and poor outcomes in these patients.

Acute poisoning in children admitted to pediatric emergency department: a five-years retrospective analysis.

Background and aim:to identify most frequent risk factors and to propose prevention strategies for the children admitted to Pediatric Emergency Department (PED) with acute poisoning.Methods:We performed a retrospective study in a tertiary care hospital, describing the frequency and nature of pediatric poisoning, clinical management and outcome.Results:We collected data of 436 children admitted for acute poisoning. The mean age was 30 months and 51.1% were male. Most poisoning incidents (90.1%) were unintentional and drug ingestion (39.4%) was the leading cause of poisoning. Acute poisoning happened at home in 83,7% of cases and the mother was the most frequent caregiver during the event in 61.5%. No died were reported.Conclusion:Our study showed that the two categories of patients at greatest risk for acute poisoning are children under 3 years and adolescents over 12 years. Adequate information campaigns about toxic substances are essential for children, adolescents and their parents. (www.actabiomedica.it)

HIGH-DOSE INSULIN EUGLYCEMIC THERAPY.

SUMMARYCalcium channel blockers and beta-blockers toxicity/poisoning are one of the most common causes of poisoning. More importantly, they are among the deadliest types of poisoning caused by cardiac drugs that emergency physicians can encounter. Common toxidrome caused by these medications includes the following symptoms: hypotension, bradycardia, hypoglycemia/hyperglycemia, hypothermia, arrhythmia, and seizures. Treatment is usually complex, It consists of administration of various medications, such as crystalloids, intravenous calcium, glucagon, vasopressors/inotropes, and especially high-dose insulin euglycemic therapy. In this paper, we will review the mechanism for this type of treatment, propose a potential protocol for its application and address possible adverse effects. High-dose insulin euglycemic therapy should be an integral part of the treatment protocol for calcium channel blockers and beta-blockers toxicity.

Polypharmacy, automedication, and the use of potentially inappropriate medications: cause of intoxications in the elderly

Polypharmacy, automedication, and the use of potentially inappropriate medications: cause of intoxications in the elderly

Quantification of panel of most potent antipsychotic medicines by high throughput UPLC method

The delegated work entails the simultaneous quantification and validation of a panel of common antipsychotic compounds in dosage form using the UPLC method. The antipsychotic medications used in the study were; Amisulpride, Risperidone, Paliperidone, Ziprasidone, Aripiprazole and Lurasidone. Acquity UPLC@BEH shield RP C18 (100 mm X 2.1 mm id, 1.7 m particle size) column was used to separate the samples with gradient elution consisting of 0.1% TFA and ACN with a PDA detector. The entire analysis took only 7 min with a 0.3 ml/min flow rate, 1 µl injection volume and a 45 °C column oven temperature. The current approach provides good resolution and low solvent consumption in a short amount of time. In most Quality Control laboratories, time-consuming methods and distinct mobile phases are used for different dosage forms of pharmaceuticals, however, the proposed method saves time and money by removing the need to change mobile phases. As a result, the method can be used in QC laboratories where time-consuming methods are used with different mobile-stationary phases. Antipsychotic drug analysis is mainly utilised in QC laboratory and forensic toxicology to monitor medication therapy or to explain the cause of intoxication in human performance and post-mortem situations.

Causative Substance and Time of Mortality Presented to Emergency Department Following Acute Poisoning: 2014-2018 National Emergency Department Information System (NEDIS)

Purpose: The purpose of this study was to investigate the cause of acute fatal poisoning and the time of death by analyzing the National Emergency Department Information System (NEDIS) of South Korea. Methods: The NEDIS data from 2014 to 2018 excluding non-medical visits were used for this study. The patients with acute poisoning were extracted using diagnostic codes. The toxic substances were classified into pharmaceuticals, pesticides, gases, artificial poisonous substances, and natural toxic substances. Patients were classified according to the time of death, place of death, and region. In each case, the most causative substances of poisoning were identified. Results: There were 380,531 patients including poisoning-related diagnoses, of which 4,148 (1.1%) died, and the WHO age-standardized mortality rate was 4.8 per 100,000. Analysis of 2,702 death patients whose primary diagnosis was acute poisoning, the most common cause of poisoning death was pesticides (62%), followed by therapeutic drugs, gas, and artificial toxic substances. Herbicides were the most common pesticides at 64.5%. The proportion of mortality by time, hyperacute (&lt;6 h) 27.9%, acute (6-24 h) 32.6%, subacute (1-7 d) 29.7%, and delayed period (&gt;7 d) were 9.8%. Conclusion: This study suggests that the most common cause of poisoning death was pesticides, and 60% of deaths occurred within 24 hours. The 71% of mortality from pesticides occurred within 6-24 hours, but mortality from gas was mostly within 6 hours. According to the geographic region, the primary cause of poisoning death was varied to pesticides or pharmaceuticals.