Hong Kong Poison Information Centre Research Articles

Hong Kong Poison Information Centre: Annual report 2019

Background:The Hong Kong Poison Information Centre (HKPIC) provides consultation service to health care professionals and collect epidemiological data on poisoning in Hong Kong since 2005.Objective:To report and analyse the data of Hong Kong Poison Information Centre on poisoning in 2019.Methods:This was a retrospective review of all poisoning cases recorded in the Poison Information and Clinical Management System of Hong Kong Poison Information Centre in 2019.Results:A total of 4016 poisoned cases were analysed, which involved 1698 men (42.3%), 2312 women (57.6%) and 6 sex‐unspecified patients (0.1%). Majority of cases (77.3%) were between 13 and 69 years of age, and 10.5% were teenagers 13–19 years of age. Self‐harm/suicidal attempt (42.1%), unintentional exposure (18.1%) and abusive substance use (11.1%) were common reasons of poisoning. Excluding ethanol, which was the common co‐ingestant, the five most common types of poison were benzodiazepines, paracetamol, household products, zopiclone and Chinese herbal medicine. While most patients were managed with supportive treatment, 16.5% and 16.8% of the consultation cases were treated with decontamination and antidotes, respectively. Majority of cases recovered uneventfully, but 1.0% died and 4.7% had a major outcome. A total of six interesting cases and two outbreaks were discussed in this report.Conclusion:This 14th annual report provided updated epidemiological information on the pattern of poisoning in Hong Kong and highlighted a number of important changes compared with our previous reports.

Evaluation of the utilization of extracorporeal toxin removal in lithium poisoning patients in Hong Kong

Background: Extracorporeal toxin removal is used for enhanced elimination in severe lithium poisoning. The Extracorporeal TReatments In Poisoning workgroup provides recommendations on the use of extracorporeal toxin removal in poisoning. Objectives: Our aim was to identify the pattern for using extracorporeal toxin removal in managing lithium poisoning in Hong Kong and compare the outcomes in extracorporeal toxin removal-treated patients and non-extracorporeal toxin removal-treated patients if indicated for treatment as defined by The Extracorporeal TReatments In Poisoning criteria. Methods: Lithium poisoning presented between year 2009 and 2019 in Hong Kong Poison Information Centre (HKPIC) database was categorized into extracorporeal toxin removal-treated group and non-extracorporeal toxin removal-treated group. Comparative analyses were performed. Results: Among 112 lithium-poisoned patients, 21% were treated with extracorporeal toxin removal. Larger proportion of patients had fulfilled at least one Extracorporeal TReatments In Poisoning criteria for extracorporeal toxin removal in the extracorporeal toxin removal-treated group (87% vs 18%, p < 0.005). The extracorporeal toxin removal-treat group patients were more commonly presented with impaired consciousness, seizure and dysrhythmia ( p < 0.05). They also got higher admission (3.62 mmol/L vs 2.18 mmol/L, p < 0.05) and peak (4.15 mmol/L vs 2.28 mmol/L, p < 0.05) serum lithium concentrations, as well as a significantly higher serum creatinine concentration upon presentation (263.74 µmol/L vs 98.66 µmol/L, p < 0.05). Extracorporeal toxin removal-treat group patients more frequently had a severe poisoning outcome (91.3% vs 9%, p < 0.05) and developed complications (69.6% vs 13.5%, p < 0.05). Logistic regression identified seizure, peak serum lithium concentration, and serum creatinine concentration upon presentation as risk factors for severe poisoning outcome. In subgroup analysis on patients with at least one indication for extracorporeal toxin removal as defined by Extracorporeal TReatments In Poisoning criteria, the proportion of severe poisoning remained higher in the extracorporeal toxin removal-treated group (90% vs 43.7%, p < 0.05). Complication rate was not significantly different between the two groups. Conclusion: Clinically severe lithium poisoning patients were treated with extracorporeal toxin removal in Hong Kong. Extracorporeal TReatments In Poisoning criteria can serve as a reference in considering extracorporeal toxin removal treatment for lithium poisoning patients. Nevertheless, Extracorporeal TReatments In Poisoning criteria recommend more extracorporeal toxin removal treatment than it was actually done. Lithium poisoning patients with positive Extracorporeal TReatments In Poisoning criteria have been managed without extracorporeal toxin removal. No statistically significant adverse outcome was observed in these cases.

Pediatric poisoning pattern: A comparison of preadolescent and adolescent groups in Hong Kong over 3 years

Objective:To compare local poisoning patterns of preadolescents and adolescents.Methods:Retrospective cross-sectional study. Data collected through the Hong Kong Poison Information Centre (HKPIC) Poisoning Information and Clinical Management System (PICMS). Patients aged 10 to 17 years old from January 2016 to December 2018 were included and divided into preadolescent (10–12 years old) and adolescent (13–17 years old) groups. Statistical analysis for categorical variables was performed using chi-square test of independence, p < 0.05. Strength of association examined with Cramer’s V. Rate ratios with 95% confidence interval were used to determine nature of association, using preadolescents as comparison group.Results:A total of 703 cases were analyzed. There were 107 cases in the preadolescent group and 596 cases in the adolescent group. Three variables showed moderate association: intentional exposure (rate ratio: 2.91, 2.13–3.98), exposure in school (rate ratio: 0.30, 0.21–0.44), and the use of pharmaceuticals (rate ratio: 1.95, 1.57–2.44). The most common substance of exposure were analgesics (n = 213, 24.94%) and fumes, gases, and vapors (n = 19, 15.08%) in adolescents and preadolescents, respectively.Conclusion:Epidemiological difference still exists between preadolescents and adolescents. The association of adolescents with intentional poisoning, and the use of pharmaceuticals was highlighted. The study acts as a recent update of pediatric poisoning patterns and hopes to act as a reference for future studies.

Hong Kong Poison Information Centre: Annual Report 2015

Objective To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2015. Methods In 2015, all poisoning cases received by HKPIC were retrieved from its database [Poison Information and Clinical Management System (PICMS)] for analysis. Results A total of 3,960 poisoned cases were analysed. There were 1,770 male patients (44.7%), 2,176 female patients (55.0%) and 14 sex unspecified patients (0.4%). The majority of the cases (63.5%) were between 20 and 59 years old. Common causes for poisoning were suspected self-harm/suicidal attempt (38.4%), unintentional exposure (17.4%) and abusive substances use (11.6%). Excluding the common co-ingestant ethanol, the five commonest types of poison were paracetamol, benzodiazepine, household products, zopiclone and Chinese herbal medicine. Most patients were managed with supportive measures, while 16.4% and 16.2% of them were treated by decontamination and antidotes respectively. Majority of the cases had uneventful recovery; 1% resulted in death and 4.3% had major outcomes. Seven interesting cases and one outbreak were discussed. Conclusions This 10th annual report provided updated epidemiological information on poisoning pattern in Hong Kong and highlighted important changes in comparing with our previous reports.

Hong Kong Poison Information Centre: Annual Report 2014

Objective To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2014. Methods In 2014, all poisoning cases received by HKPIC were retrieved from its database [Poison Information and Clinical Management System (PICMS)] for analysis. Results A total of 3,609 poisoned cases were analyzed. There were 1,587 male patients (44.0%), 2,000 female patients (55.4%) and 22 sex unspecified patients (0.6%). Middle aged group (30-39 years) was the commonest and composed of about one-fifth (20.3%) of the poisoning cases while about two-third (66.2%) of them were between 20 and 59 years old. Common causes for poisoning were suspected self-harm/suicidal attempt (42.2%), unintentional exposure (16.5%) and abusive substances use (12.9%). Excluding the common co-ingestant ethanol, five commonest types of poison exposed were benzodiazepine, paracetamol, zopiclone, Chinese herbal medicine and household products. Majority of the patients were managed with supportive measures, and 14.7% and 15.0% of them were treated by decontamination and antidotes respectively. Most cases had uneventful recovery; 0.9% of the poisoning resulted in death and 5.0% had major outcomes. Conclusions This 9th annual report provided updated epidemiological information on poisoning pattern in Hong Kong and highlighted important changes in comparing with our previous reports. (Hong Kong j.emerg.med. 2015; 22:376-387)

Hong Kong Poison Information Centre: Annual Report 2013

Objective To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2013. Methods In 2013, all poisoning cases received by HKPIC were retrieved from its database [Poison Information and Clinical Management System (PICMS)] for analysis. Results A total of 3,783 poisoned cases were analysed. There were 1,595 male patients (42.2%), 2,185 female patients (57.8%) and 3 sex unspecified patients (0.1%). Middle aged group (30-39 years) composed about one-fifth (20.8%) of the poisoning cases while about two-third (66.8%) of them were between 20 and 59 years old. Common causes for poisoning were suspected self-harm/suicidal attempt (43%), unintentional exposure (15.3%) and abusive substances use (14.5%). Five commonest types of poison exposed were paracetamol, benzodiazepine, zopiclone, household products and Chinese herbal medicine. Majority of the patients were managed with supportive measures, and 13.2% and 10.8% of them were treated by decontamination and antidotes respectively. Most cases had uneventful recovery; 0.9% of the poisoning resulted in death and 4.3% had major outcomes. Conclusions This 8th annual report provided updated epidemiological information on poisoning pattern in Hong Kong and highlighted important changes in comparing with our previous reports. (Hong Kong j. emerg.med. 2014;21:249-259)

Hong Kong Poison Information Centre: Annual Report 2012

Objective To report and analyze the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2012. Methods In 2012, all poisoning cases received by HKPIC were retrieved from its database: Poison Information and Clinical Management System (PICMS) for analysis. Results A total of 4,814 poisoned cases were analyzed. There were 1,771 male patients (42.3%), 2,399 female patients (57.3%) and 14 sex unspecified patients (0.3%). Middle aged group (30-39 years) contributed about one-fifth (20.1%) of the poisoning cases while more than two-third (67.7%) of them were between 20 and 59 years old. Common causes for poisoning were suspected self-harm/suicidal attempt (45%), abusive substances use (13.9%) and unintentional exposure (13.0%). Five commonest types of poison exposed were paracetamol, benzodiazepine, zopiclone, bites and envenomation and household products. Majority of the patients were managed with supportive measures, and 15.7% and 11.9% of them were treated by decontamination and antidotes respectively. Most cases had uneventful recovery; 0.6% of the poison exposure resulted in death and 4.7% of the exposure had major outcomes. Conclusions This seventh annual report provides updated epidemiological information on poisoning pattern in Hong Kong and highlights important changes in comparing with our previous reports. (Hong Kong j.emerg.med. 2013;20:371-381)

Hong Kong Poison Information Centre: Annual Report 2011

Objective To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2011. Methods In 2011, all poisoning cases received by HKPIC were retrieved from its database: Poison Information and Clinical Management System (PICMS) for analysis. Results A total of 4,331 poisoned cases were analysed. There were 1,915 male patients (44.2%), 2,411 female patients (55.7%) and 5 patients with sex unknown. More than two-third (68%) of them were between 20 and 59 years old. Common causes of exposure were suspected self-harm/suicidal attempt, unintentional exposure and abusive use. Paracetamol, benzodiazepine, household product, zopiclone, and Chinese herbal medicine were the top five commonest poisons encountered. Majority of the patients were managed supportively, with 12.1% and 8.5% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; 1.0% of the poison exposure resulted in death and 4.8% of the exposure had major outcomes. Conclusions This 6th annual report provided updated epidemiological information on poisoning pattern in Hong Kong and emphasized some changes in comparing with our previous reports.

Acute and Chronic Toxicity Pattern in Ketamine Abusers in Hong Kong

Ketamine has been the commonest abusive substance used by Hong Kong teenager since 2005. It is also the fourth commonest poison encountered in Hong Kong Poison Information Centre (HKPIC) poisoning data in 2010. From June 2008 to July 2011, HKPIC managed 188 and 96 cases of acute and chronic ketamine poisoning, respectively, which reflect its acute and chronic toxicity pattern. Demographically, there is a male predominance, and the majority is between the ages of 10-39. For the acute cases, 48 % presented with neurological features such as confusion, drowsiness, or transient loss of consciousness which usually subside with supportive care in a few hours. For the chronic cases, 92 % of them presented with features of ketamine cystitis while about 66 % presented with chronic abdominal pain. The current understanding of ketamine cystitis and chronic abdominal pain will be reviewed. Management is primarily symptomatic measures and most importantly abstinence from ketamine use.

Hong Kong Poison Information Centre: Annual Report 2010

Objective To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2010. Methods In 2010, all poisoning cases received by HKPIC were retrieved from its database (PICMS) for analysis. Results A total of 4,418 poisoned cases were analysed. There were 1,863 male patients (42.2%) and 2,540 female patients (57.5%). More than two-third of cases (68.3%) were between 20 and 59 years old. Common causes of exposure were suspected self harm/suicidal attempt, unintentional exposure and abusive use. Benzodiazepine, paracetamol, ketamine, zopiclone, and Chinese herbal medicine were the common agents involved. Majority of the patients were managed supportively, with 10.2% and 9.7% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; 1.0% of the poison exposure resulted in death and 5.3% of the exposure had major outcomes. Conclusions This fifth annual report provides updated epidemiological information on poisoning pattern in Hong Kong and emphasized some changes in comparing with our previous reports.

Hong Kong Poison Information Centre: Annual Report 2009

ObjectiveTo report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2009.MethodsIn 2009, all poisoning cases received by HKPIC were retrieved from its database (PICMS) for analysis.ResultsTotally 4338 poisoned cases were analysed. There were 1955 male patients (45.1%), 2,367 female patients (54.6%) and 16 patients with no gender specified. More than two‐third of cases (68.6%) were between 20 and 59 years old. Common causes of exposure were suspected self harm/suicidal attempt, abusive use and unintentional exposure. Paracetamol, ketamine, zopiclone, benzodiazepine and household products were the common poisons exposed. Majority of the patients were managed supportively, with 13.6% and 13.1% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; about 1% of the poison exposure resulted in death and about 5% of the exposure had major outcomes.ConclusionsThe 2009 annual report provides updated epidemiological information on poisoning pattern in Hong Kong and emphasized some changes in comparing with our previous reports.

Hong Kong Poison Information Centre: Annual Report 2008

Objective To report the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2008. Methods From 1st January 2008 to 31st December 2008, all poisoning cases received by HKPIC were retrieved from its database (DATOX & PIC-MS) for analysis. Results 4,029 poisoned cases were analyzed. There were 1,755 male patients (43.6%) and 2,262 female patients (56.1%). Nearly two-thirds of them were between 20 and 59 years old. Common causes of exposure were suspected self harm/suicidal attempt, unintentional exposure and abusive use. Sedatives, household products, paracetamol, and ketamine were common poisons exposed and non-benzodiazepine sedative-hypnotics were involved in about one-seventh of the poisoning cases. The majority of the patients were managed conservatively, with 6.0% and 5.9% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; about 1% of the poison exposure resulted in death and about 5% of the exposure had major outcomes. Conclusions This annual report provides updated epidemiological information on poisoning in Hong Kong in 2008 and highlights some changes in comparison with our previous reports. The increase in abusive substance poisoning, in particular ketamine, requires further attention.

Hong Kong Poison Information Centre: Annual Report 2007

ObjectiveTo report the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2007.MethodsFrom 1st January 2007 to 31st December 2007, all poisoning cases received by HKPIC were retrieved from its database (DATOX) for analysis.Results2842 poisoned cases were analyzed. There were 1199 male and 1610 female patients and more than two‐thirds of the cases were between 20 and 59 years old. Common causes of exposure were suicidal attempt, accident and abusive use. Non‐benzodiazepine sedative‐hypnotic, household products and paracetamol were common poisons exposed. The majority of the patients were managed conservatively, with 8.4% and 6.4% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; less than 1% of the poison exposure resulted in death and about 5% of the exposure had major outcomes.ConclusionsThis 2007 annual report provided updated epidemiological information on the poisoning pattern in Hong Kong and highlighted some changes in comparison to the situation in 2006.

Venomous Fish Sting Cases Reported to Hong Kong Poison Information Centre: A Three‐Year Retrospective Study on Epidemiology and Management

ObjectiveTo study the epidemiology of venomous fish sting injuries, management and clinical outcomes of injured patients reported to the Hong Kong Poison Information Centre (HKPIC).MethodsAll venomous fish sting cases reported to HKPIC from July 2005 to June 2008 were retrieved from its database (DATOX) and the Hong Kong Hospital Authority (HA) Electronic Patient Record (ePR) computer system for analysis.ResultsThere were a total of 33 fish sting cases in this study. The average age of the patients was 43 years (range 20 to 84) and 24 patients were males. Most cases were injured by catfish (n=12), followed by stonefish (n=7) and lionfish (n=4). Ten cases sustained fish sting injury whilst at work. Five patients developed fish sting complications including cellulitis, subacute tenosynovitis, abscess formation and foreign body retention. No mortality was recorded. Within 7 cases of stonefish injury, 3 cases were classified as moderate effect outcome. Two patients received stonefish antivenom and none developed anaphylaxis.ConclusionThe majority of marine envenomations did not result in significant morbidity and required only supportive management. However, stonefish injuries might be associated with an increased risk of severe local symptoms which therefore required aggressive treatment including antivenom.

Hong Kong Poison Information Centre: Annual Report 2006

Objective To report the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2006. Methods From 1st January 2006 to 31st December 2006, all poisoning cases received by HKPIC were retrieved from its database (DATOX) for analysis. Results A total of 2555 poisoned cases were analysed. There were 1051 male and 1466 female patients and nearly 60% of the cases were between 20 and 49 years old. Common causes of exposure were suicidal attempts and accidents. Paracetamol, sedative-hypnotic and household products were common sources of poison exposure. The majority of the patients were managed conservatively, with 18.8% and 10.5% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; less than 1% of the poison exposure resulted in death and about 5% of the exposure had major outcomes. Nearly half of the cases were managed in the accident & emergency department without hospitalisation. Conclusions This annual report provides updated epidemiological information on poisoning in Hong Kong. Subsequent annual reports would provide important information on the trend of poisoning pattern and may guide further strategies in poison control and prevention in Hong Kong.