Intentional Poisoning Research Articles

Pharmacokinetics and repeated dose 28-day oral toxicity studies of acetaminophen nanosuspension.

Wide availability and easy accessibility of acetaminophen oral dosage forms increase the risk of intentional poisoning or unintentional organ toxicity, leading to a wide range of liver failure, nephrotoxicity, and neurotoxicity. In this study, an attempt was made to improve oral bioavailability and reduce the toxicity of acetaminophen using nanosuspension technology. The acetaminophen nanosuspensions (APAP-NSs) were prepared by a nano-precipitation method using polyvinyl alcohol and hydroxypropylmethylcellulose as stabilizers. The mean diameter of APAP-NSs was 124 ± 3.8 nm. The dissolution profile of APAP-NSs was significantly point-to-point higher than the coarse drug in simulated gastrointestinal fluids. The in vivo study revealed 1.6- and 2.8-fold increases in the AUC0-inf and Cmax of the drug, respectively, in APAP-NSs-receiving animals compared to the control group. Moreover, no deaths and no abnormalities in clinical signs, body weights, and necropsy findings were detected in the dose groups up to 100 mg/kg of the 28-day repeated oral dose toxicity study in mice.

The use of analgesics for intentional self-poisoning: Trends in U.S. poison center data

In the U.S., intentional self-poisonings with analgesics that are available without a prescription increased from 2000 to 2018. Given concerns regarding mental health outcomes during the COVID-19 pandemic, we examined and compared trends in pediatric and adult intentional self-poisoning with acetaminophen, aspirin, ibuprofen, and naproxen from 2016 to 2021 using the National Poison Data System (NPDS) to see if these trends have continued. We extracted annual case counts of all suspected suicide attempts from intentional poisoning, and of suspected suicide attempts resulting in major effects or death, from the NPDS for non-prescription single ingredient adult formulation acetaminophen, non-prescription single ingredient adult formulation aspirin, single ingredient formulation ibuprofen, and single ingredient formulation naproxen. We enumerated the cases by year, age, and gender.Most cases of intentional self-poisoning within the review period involved acetaminophen and ibuprofen and the 13–19-year-olds constituted the highest proportion of intentional self-poisoning cases across age groups for all four analgesics. Cases involving females predominated cases involving males by 3:1 or greater. The 13–19-year-old age group also represented the largest proportion of cases that resulted in major clinical effects or deaths. An increasing trend in suicide poisoning cases with acetaminophen and ibuprofen was observed in the 6-19-years age group and this trend appeared to exacerbate from 2020 to 2021 corresponding with the start of the COVID-19 pandemic period.

Drug-Related Poisonings among Chilean Adult Population.

Poisonings is a preventable public health problem that globally affects the population. We aimed to characterize drug-related acute poisonings occurred in Chile between the years of 2016 and 2020. A retrospective study of poisonings among hospitalized patients was carried out. Data were obtained from the Medical Outcome Statistical Report database. Inclusion criteria were cases of patients admitted into either public or private healthcare settings with diagnosis of drug-related poisoning according to the WHO ICD-10 codes T30-T50. Statistical analyses were run to establish either significant associations or differences between variables selected in the study. Overall, 12,975 poisonings were identified during the 2016-2020 period. These events corresponded to 0.16% of all national hospital admissions in the study period. Women represented 71.1% of the cases. 76.7% of events were related to intentional poisonings while 7.3% and 16% were accidental and undetermined poisonings respectively. 44.6% of accidental and intentional poisonings occurred at the age of 18-29 yr old. Benzodiazepines (22.8%), antidepressants (11.2%), and acetaminophen (5.1) were the most common drugs associated with poisonings. Average length of hospitalization was between 3.3 and 8.2 days. 0.6% of poisonings resulted in deaths. Poisonings were characterized by patients' sex and age, circumstance of exposure, length of hospitalization, and outcome. Poisoning rates were stable along the years with a slight decrease in 2020. Intentional poisonings among young women and men were more common. Most of the cases had favorable outcome for patients.

Trends in intentional and unintentional poisonings among older adults - A national register-based study in Sweden

BackgroundAmong older people intentional poisoning outnumber unintentional ones. While there are indications that time trends differ by poisoning intent, studies are scarce. We assessed how the annual prevalence of intentional and unintentional poisoning changed over time, overall and by demographic groups.MethodsWe conducted a national open cohort study of individuals aged 50–100 years, resident in Sweden during 2005–2016. Individuals were followed up in population-based registers for their demographic and health attributes from 2006–2016. Annual prevalence of hospitalization and death by poisoning intent (unintentional vs. intentional or undetermined; ICD-10 definitions) were compiled for the categories of four demographic attributes (age, sex, marital status, and birth cohort “baby boomers”). The time trends were assessed by multinomial logistic regression with year as an independent variable.ResultsThe annual overall prevalence of hospitalization and death by intentional poisonings consistently exceeded that of unintentional poisonings. There was a significant downward trend in intentional poisonings but not in unintentional ones. This difference in trends also applied when considering men and women separately, married and unmarried people, the young-old individuals (but not the older- or oldest-old ones), and the baby boomers and non-baby boomers. The largest demographic differences within intent were found between married and unmarried people, and the smallest one between men and women.ConclusionAs expected, the annual prevalence of intentional poisonings considerably exceed that of unintentional ones among Swedish older people. The recent trends reveal a significant reduction of intentional poisonings, consistent across a range of demographic attributes. The scope for action regarding this preventable cause of mortality and morbidity remains considerable.

Injuries, Poisonings, and Other External Causes of Morbidity among Drug Crime Offenders: A Follow-Up Study of Former Adolescent Psychiatric Inpatients

Introduction: Criminal offenders have high incidences of injury- and substance-related emergency department visits. Very few studies focus on drug crime offenders or the medical specialties involved in treating these offenders. We aimed to study how drug crime offenders’ treatment events in specialized health care due to injuries, poisonings, or other external causes of morbidity differed from treatment of non-criminal controls and which of the medical specialties were involved in their care. Methods: The study population included 508 former adolescent psychiatric inpatients (age 13–17 years), who were followed up through Finnish national registers. A total of 60 had committed a drug crime during the 10–15 years’ follow-up. They were matched with 120 non-criminal controls from the study population. Hazard ratios (HRs) with 95% confidence intervals (Cl) for drug crime offending were assessed using a Cox regression model. Results: Almost 90% of drug crime offenders had treatment events in specialized health care due to injuries, poisonings, and other external causes of morbidity, compared to 50% of non-criminals. The majority of the drug crime offenders had been treated for accidental injuries (65% vs. 29%; p < 0.001) in comparison to non-criminal controls. More drug crime offenders had been treated for intentional poisonings (42% vs. 11%; p < 0.001) than non-criminal controls. For drug crime offenders, the lifetime probability of a treatment event due to poisoning was almost doubled (HR: 1.89, 95% CI: 1.26–2.84; p = 0.002), and for treatments due to injury, there was a 2.5-fold increase (HR: 2.54, 95% CI: 1.69–3.82; p < 0.001) in comparison to non-criminal controls. Conclusion: In emergency care, substance use screening and referral for appropriate psychiatric and substance abuse treatment services should be considered for all adolescents and young adults attending hospitals due to injuries or poisonings.

Repeated Intentional Swallowing of Foreign Objects by an Adolescent Girl (Case Report)

Introduction: Intentional swallowing of foreign objects is a relatively rare psychopathological behavior. Adolescents and young adults may carry out this act to hurt themselves or even suicide. Often, most reports related to deliberate swallowing are typically either surgical or gastrointestinal and rarely are found in psychiatric articles; more often, the swallowed foreign objects (80 - 90%) are disposed of spontaneously, and 10 - 20% of them require endoscopy for more study and less than 1% of them need surgery to be removed or its complications. Case Presentation: The presented patient is a 17-year-old girl admitted to the psychosomatic ward of Afzalipour Hospital due to intentional poisoning. During the year before her admission, on three separate occasions, she detached the knife blade from its haft and swallowed it. She underwent laparotomy twice, one time for sigmoid tearing and damage to the left Ovary, to remove the knife and regeneration of the left ovary and sigmoid, and another time to remove the knife in order not to cause damage to her intestines. To our knowledge, this is the first reported case in the world in which an ovary has been damaged. Further investigation into her background shows some extent of privation due to her family's long-term economic problems and instability; moreover, sexual and physical abuse was also confirmed. The patient was prescribed clozapine, which decreased her suicidal behavior and attempts noticeably. Conclusions: Swallowing foreign bodies in this patient is interpreted as both self-punishment and punishing others (those who thought they were hurt or may be blamed for their despair or rejection). Intentional swallowing of foreign objects behavior is more resistant than other self-harming activities and may have a worse prognosis. Swallowing foreign objects requires a sophisticated process that, if not correctly managed, may result in serious complications; therefore, appropriate psychiatric counseling and supportive treatment are necessary for these patients. Specific to this patient eliminating the effects of suicide and reaching medical stability with a short admission was necessary. Her suicidal behavior and attempts decreased significantly after starting clozapine treatment. Therefore, clozapine treatment is recommended for patients with suicidal behavior and self-harm.

Current situation and influencing factors for suicidal intent in patients with intentional acute pesticide poisoning.

Since pesticides have been widely used in agricultural production, acute pesticide poisoning (APP) has gradually become a worldwide public health problem. Recently, the number of APP cases has been high in China, and the intentional self-administration of pesticides is the main cause of APP. However, there is a lack of relevant studies on the factors influencing suicidal intent in patients with intentional APP. This study aimed to explore the current situation and influencing factors for suicidal intent among patients with intentional APP. In this cross-sectional study, we enrolled a total of 225 patients with intentional APP admitted to the emergency department of our Grade A comprehensive hospital in Shandong Province between June 2019 and January 2021. Patients were investigated using a health status interview questionnaire, Beck Suicidal Intent Scale, Duke Social Support Index, psychological stress scale, Dickman Impulsivity Inventory, Trait Anxiety Inventory, Center for Epidemiologic Studies Depression Scale, and Beck Hopelessness Scale. Descriptive statistics, single-factor analysis, and multiple linear regression were used for data analysis. Suicidal intent scores were collected and averaged (14.23 ± 6.22). Multiple linear regression analysis revealed that marital status, residential area, impulsivity, hopelessness, depression, psychological strain, and social support impact suicidal intent. Patients with intentional APP have high suicidal intent. Therefore, different interventions should be tailored to different patients.

Patterns of Accidental and Intentional Alcohol Intoxication Initiation among French Young Adults: A Survival Analysis

Background: The aim of the study was to explore patterns of accidental and intentional intoxication among French young adults who use alcohol. Methodology: The study draws on data from the 2017 French Health Barometer. Cox proportional hazards models were used to explore the factors associated with accidental and intentional alcohol intoxication initiation. Covariates studied were gender, age, employment status, consultation for mental health problems, depression lasting at least two weeks in the past 12 months, and previous tobacco or cannabis use as time-dependent variables. Results: Women accounted for 50.4% of our sample, and the mean age of respondents was 29.2 (standard deviation = 6.3). The prevalence of lifetime accidental intoxication among alcohol users was 77.0% and 17.3% for intentional intoxication. Kaplan-Meier analyses showed that the first intentional intoxication experience occurred later than the first accidental intoxication. Factors associated with accidental intoxication initiation in multivariate analyses were: male gender, age under 30, previous use of tobacco and cannabis, experiencing depression that lasted at least two weeks in the past 12 months, and having consulted for mental health problems in the past 12 months. Economically inactive people and students had a lower risk of experiencing accidental intoxication than those who were employed. Similar correlates were found for intentional intoxication, but being economically inactive was more strongly associated with intentional intoxication initiation. Conclusions: These results suggest the strong potential for alcohol consumption to become hazardous, particularly if tobacco or cannabis are also used. Prevention programs on alcohol must target consumers at the earliest stage and integrate other substances often used in a festive context.

Clinical characteristics of hospitalized patients with paracetamol poisoning before and after restrictions of over-the-counter sale of paracetamol

Introduction Paracetamol poisoning is a frequent cause of hospitalization in Denmark. On 30 September 2013, the Danish authorities restricted packages available without a prescription in pharmacy outlets to contain a maximum of 10 g of paracetamol. We aimed to investigate the effects of this regulation. Methods This was a cross-sectional study of two groups of patients admitted consecutively to a Danish University Hospital due to poisoning with paracetamol in 365 days in 2012–13 before 30 September 2013, and a corresponding 365-day period in 2017–18. Data were extracted from patient records. Results In 2012–2013 and 2017–18, 156 and 92 admissions in 127 and 78 unique patients, respectively, were identified. Ingestion of more than 20 g paracetamol occurred in a significantly higher proportion of cases in 2012–13 compared to 2017–18 (29% vs 13%, P < 0.01). In accordance, there were no cases of international normalized ratio >1.5 or alanine aminotransferase activity >1000 U/L in the post-legislation period, and seven and five cases in the pre-legislation period, respectively. Females accounted for 80% and 78% of patients in the two periods, respectively, and were considerably younger than males (median [interquartile range]: 22 [17–40] vs. 47 [30–56], P < 0.01 in 2012–13, and 23 [18–46] vs. 43 [27–49] years, P = 0.02 in 2017–18). Furthermore, in 2012-13, intentional poisonings occurred in a higher proportion of females than males 2012–13 (97% vs 85%, P < 0.01). Conclusions The present study demonstrated a lower number of paracetamol poisonings, a decreased proportion of poisonings involving ingestion of more than 20 g of paracetamol, and a lower occurrence of hepatotoxicity after the regulation. However, circumstances other than pack size restrictions, such as increased public awareness of the danger of paracetamol poisonings, may affect these associations. Furthermore, the study showed that females and males constitute two distinct groups in terms of age and intentional poisoning.

Intentional paediatric poisoning presentations to emergency departments during the COVID-19 pandemic.

To characterise paediatric poisoning presentations to EDs and determine if the advent of the COVID-19 pandemic was associated with increased intentional paediatric poisoning presentations. We performed a retrospective analysis of paediatric poisoning presentations to three EDs (two regional and one metropolitan). Simple and multiple logistic regression analysis were performed to determine the association between COVID-19 and intentional poisoning events. In addition, we calculated the frequency with which patients reported various psychosocial risk factors as being an implicating factor in engaging in an intentional poisoning event. A total of 860 poisoning events met inclusion criteria during the study period (January 2018-October 2021), with 501 being intentional, and 359 unintentional. There was an increased proportion of intentional poisoning presentations during the COVID-19 pandemic (261 intentional and 218 unintentional in the pre-COVID-19 period vs 241 intentional and 140 unintentional during the COVID-19 period). In addition, we found a statistically significant association between intentional poisoning presentations and an initial COVID-19 lockdown (adjusted odds ratio 26.32, P < 0.05). 'The COVID-19 lockdown' or 'COVID-19' was reported to be implicating factor for psychological stress in patients who presented with intentional poisonings during the COVID-19 pandemic. Intentional paediatric poisoning presentations increased during the COVID-19 pandemic in our study population. These results may support an emerging body of evidence that the psychological strain of COVID-19 disproportionately impacts adolescent females.

Psychotic depression and the risk of death due to suicide

IntroductionDepression markedly increases the risk of suicide, and depression is the most common psychiatric disorder diagnosed in persons with a completed suicide, but the interplay between depression and psychotic symptoms in suicides has remained unsettled.ObjectivesThe purpose of this study was to establish the risk of suicide associated with incident psychotic depression (PD) compared to incident non-psychotic severe depression (NPD) in a large nationwide cohort.MethodsThis cohort study used routine data from nationwide health registers in Finland. Eligible participants were aged 18 ̶ 59 years at the index diagnosis. Causes of death were defined by the International Classification of Diseases, 10th revision codes. The follow-up time was up to five years. Adjusted Cox regression models were used to analyse risk of death by method of suicide.ResultsWe included 17331 individuals with incident PD and 85989 individuals with incident NPD. Most of the deaths due to suicides occurred within the first two years after the index diagnosis. Compared to NPD, PD was associated with an overall two-fold increased risk of suicide (adjusted hazard ratio, (aHR) 2.19, 95% confidence interval (CI) 1.95, 2.46), after adjusting for psychiatric comorbidities. In PD, the highest relative risks were for impact-related suicides (aHR 3.03, 95%CI 2.23, 4.13) and for suffocation-related suicides (aHR 2.72, 95%CI 2.23, 3.30), whereas the lowest relative risk was for intentional poisonings (aHR 1.66, 95%CI 1.37, 2.02).ConclusionsPsychotic symptoms increased the risk of suicide 2-fold of the risk that was associated with severe depression, after controlling for comorbid psychiatric disorders. The severity of suicidal ideation may be higher in PD than in NPD, which then leads to more lethal methods of self-harm.Disclosure of InterestT. Paljarvi: None Declared, J. Tiihonen Grant / Research support from: Janssen-Cilag, Eli Lilly, Consultant of: HLS Therapeutics, Orion, and WebMed Global, Speakers bureau of: Eli Lilly, Evidera, Janssen-Cilag, Lundbeck, Mediuutiset, Otsuka, Sidera, and Sunovion, M. Lähteenvuo Shareolder of: Genomi Solutions ltd, Nursie Health ltd, Springflux ltd, Grant / Research support from: Finnish Medical Foundation, Emil Aaltonen Foundation, Speakers bureau of: Sunovion, Lundbeck, Otsuka Pharma, Orion Pharma, Recordati, Janssen, Janssen-Cilag, A. Tanskanen Grant / Research support from: Janssen-Cilag, Eli Lilly, S. Fazel Grant / Research support from: Wellcome Trust, H. Taipale Grant / Research support from: Janssen-Cilag, Eli Lilly, Academy of Finland, Speakers bureau of: Janssen-Cilag, Otsuka

Concerns about intentional paracetamol poisoning, maximum pack sizes to be reduced in Australia

Concerns about intentional paracetamol poisoning, maximum pack sizes to be reduced in Australia

Spatial and temporal trends and risk factors for intentional carbon monoxide poisoning hospitalizations in England between 2002 and 2016

IntroductionSuicide and mental health disorders are a recognized increasing public concern. Most suicide prevention rely on evidence from mortality data, although suicide attempts are a better predictor for completed suicides. Understanding spatio-temporal patterns and demographic profiles of people at risk can improve suicide prevention schemes, including for carbon monoxide (CO) poisoning, a common method for gas-related suicides. ObjectiveDescribe spatio-temporal patterns of intentional CO poisoning hospitalization rates in England between 2002 and 2016, and identify population sub-groups at risk. MethodsWe used NHS Digital's Hospital Episode Statistics (HES) routinely collected data on hospital admissions for intentional CO poisoning. We estimated age-standardised rates (ASR) by year, gender and residential small-area characteristics, including rural/urban, deprivation and ethnic composition. Temporal trends were assessed through linear regression and joinpoint regression analysis. Regional differences were explored. ResultsOn average, we identified 178 hospital admissions for intentional CO poisoning per year. The ASR decreased substantially over the study period, particularly among males (average annual percent change of −7.8 % (95 % CI: −11.0; −4.6)), in comparison to 3.9 % (95%CI, −6.4; −1.4) among females. Most admissions (81 %) occurred in males. White men aged 35–44 years were particularly at risk. The ASR in London (0.08/100,000) was almost six times lower than in the South-West (0.47/100,000). ConclusionsThis study provides novel insights into attempted suicides by intentional CO poisoning. Further prevention interventions, targeting sub-groups at risk (i.e. white men in their 30s/40s), need to be developed and implemented to reduce the burden of suicides and of CO poisoning.

TOXICOLOGICAL PATTERN OF POISONING IN TERTIARY CARE CENTER OF SOUTHERN INDIA

Background and Objectives: Poisoning is a signicant global public health problem which leads to nearly a million deaths each year. Incidence of poisoning in India is among the highest in the world. Despite the vast number, evidence on prevalence pattern in India is yet limited. Objective: The present study aimed to characterize acute poisoning cases with respect to the demographics, effect due to time lag and treatment outcomes. Methods: The cross sectional retrospective study was conducted from March 2021 to August 2022 (18 months) in private teaching hospitals. Results: Of all reviewed cases male over female predominance was observed.Maximum poisoning was observed in the age group 21-40 years with an increased incidence of male cases in age category 21-30 years. Household and agricultural agents were associated with most poisoning in which organophosphates were more common (31%).All cases were of Intentional poisoning and predominant in age category 21-30 years. Maximal exposure was observed between 12 am – 6 am. Maximum patients (76%) responded to the therapy given while 7% absconded, took discharge against medical advice or were referred to another hospital. The mortality rate was 17% with male predominance. Conclusion: The study concludes that the burden of poisoning demands strategies for prevention, identication and rational management providing optimal treatment outcomes.There was a statistically signicant relationship between outcome in patient and delay in admission. It is important to educate people through drug awareness

Rising prescription stimulant poisoning in Australia: a retrospective case series

With rising therapeutic use worldwide, prescription stimulants are increasingly implicated in poisonings. Most of the limited research on stimulant poisoning focuses on illicit amphetamines. We aimed to investigate the clinical effects of intentional prescription stimulant poisoning. This is a retrospective review of hospitalised patients referred to a Poisons Information Centre and a toxicology unit following intentional exposures to prescription stimulants (dexamfetamine, lisdexamfetamine and methylphenidate) from 1 January 2018 through 31 December 2021. Patients were identified from both units’ databases and data extracted from medical records. To facilitate comparison a dexamfetamine-equivalent dose was calculated. There were 186 intentional exposures in 178 patients (median age 17 years, males 54%) over the study period, consisting of 44 (24%) dexamfetamine, 50 (27%) lisdexamfetamine and 92 (49%) methylphenidate exposures. Stimulant exposures rose annually from 34 presentations in 2018 to 61 in 2021. Deliberate self-poisoning accounted for 139 (75%) presentations and the remaining 47 (25%) were recreational. Co-ingestions were taken in 101 (54%) presentations, leaving 85 (46%) single-agent exposures with a median dexamfetamine-equivalent dose ingested of 135 mg (range 15-4500 mg). Of the single-agent exposures tachycardia (69%), hypertension (47%) and agitation (58%) were the commonest clinical features. Most patients (58%) had mild-moderate symptoms, managed solely with supportive cares or oral sedation. Twenty-three (27%) patients had severe agitation receiving parenteral sedation. Rhabdomyolysis occurred in 3 single-agent exposures (4%) and 8 (9%) had an acute kidney injury. Severe cardiovascular toxicity was rare, with one patient developing hypertensive crisis and another having a supraventricular tachycardia. The median length of stay for single-agent exposures was 11 h (IQR 5-19 h). Prescription stimulant poisoning appears to be rising and commonly results in tachycardia, hypertension, and agitation. Severe cardiovascular toxicity was rare.

Diagnosis and treatment of sodium hypochlorite poisoning with ingestion of household bleaching agents

Background: Sodium hypochlorite is commonly used as a household bleaching agent (for example, the Clorox brand). Sodium hypochlorite poisoning with ingestion of a bleaching agent is often observed in clinical practice.Current Concepts: Ingestion (intentional or accidental) is the most common route of exposure to household bleaching agents. Accidental ingestion of household bleaching agents is rarely clinically important. However, ingestion of a large amount of a dilute formulation or a high-concentration preparation of bleaching agents can result in severe and rarely fatal corrosive injury. Therefore, prompt supportive care is essential because a specific antidote is currently unavailable. Severe poisoning requires hospital admission. Emergency endoscopy and thoracic and abdominal computed tomography are warranted to aid with diagnosis and management of hypochlorite-induced corrosive injury in patients with severe poisoning, who develop clinical features suggestive of corrosive injury.Discussion and Conclusion: Intentional poisoning, which accounts for most cases of household bleaching agent poisonings in Korea, is likely to cause severe corrosive injuries. Therefore, it is necessary to gain deeper and accurate understanding of the clinical aspects and treatment of poisoning by household bleaching agents.

Acute poisonings among children and adolescents- results of the analysis of 401 cases

IntroductionAcute poisoning is a significant concern in modern pediatrics and emergency medicine, as it is the fifth leading cause of life-threatening injuries in children under 5 years of age. The aim of this study was to analyze and evaluate the overall patterns of acute poisoning among pediatric patients admitted to the Emergency Department of the Pediatric Hospital of the Medical University of Warsaw.Material and methodsThe study is a retrospective analysis of the medical records of children aged 0–18 years admitted to the emergency department due to acute poisoning from January 2020 to June 2021 (18 months).ResultsA total of 401 children aged from 1 month to 18 years old were included in the study. It was the patient’s first poisoning in the vast majority of cases. Most cases were accidental. Acute poisoning was more common among females than males. The most common route of exposure to the poisonous substance was the oral route. The overwhelming majority of patients did not require any antidote treatment. Most children reached the hospital within 1–5 hours after taking the substance and were in generally good condition. Detergents were the most common cause of accidental poisoning, while combined pharmaceuticals and narcotics were the most common causes of intentional intoxication. No deaths were recorded.ConclusionsPediatricians and emergency department staff should be familiar with the management of acute poisoning and be aware of the changing patterns of intoxication depending on age and gender.

Profile and outcomes of acute poisoning in the toxicology treatment and control center at Tanta University Hospital, Egypt

BackgroundPoisoning is a major health problem especially in developing countries and leads to high morbidity and mortality.AimTo identify the profile of acute poisoning in the Toxicology Unit at Tanta University Hospital, Egypt (2017-2021).MethodsA cross-sectional study using data extracted from medical records from beginning of January 2017 to end of December 2021. Data including demographic data, Glasgow coma scale, type of poisons, manner of poisoning, time of admission and discharge and state at discharge.ResultsThis study included 9713 cases. Rodenticides represented the most frequent cause of poisoning among both males (30%) and females (27%). Pharmaceutical drugs, CNS abused pharmaceutical drugs, and chemicals represent the most common categories (24%, 22%, and 21%, respectively) among children (up to 12 years). Rodenticides and pharmaceutical drugs represent the highest categories among other age groups. Evening admissions represented 52% of cases. Glasgow coma scale was 15 among 86.3% of cases. Intentional poisoning was more common than accidental poisoning (58.6% and 34.7%, respectively). One half (52.2%) of the admitted cases were discharged within 24 hours of admission and 44.4% of them were discharged after 48-72 hours. Family request was the main reason of discharge of cases (70.3%), 15.7% were improved, 4% died. Mortality by rodenticide was 12.5%.ConclusionRodenticides, pharmaceutical and CNS abused pharmaceutical drugs were the most common categories of poisoning. Intentional poisoning was more common than accidental poisoning. Rodenticides were responsible for most deaths.

Barbecue charcoal burning: an alternative means of carbon monoxide suicide

Intentional carbon monoxide poisoning is most commonly achieved by inhaling exhaust fumes from a vehicle in a confined space. However, there are a small proportion of cases which utilise barbeque (BBQ) charcoal to produce fatal carbon monoxide levels. This method is most prominently observed throughout East/Southeast Asia and such cases demonstrate consistent demographic and socioeconomic trends,1 particularly those in Korea (young males in cars).2 However, suicides utilising this method in other countries occur in lower numbers and exhibit markedly different profiles. The current study was undertaken to analyse rates of charcoal-burning suicides in South Australia (SA) as a point of comparison against existing Asian and European studies. A total of 502 carbon monoxide-related deaths occurred in SA between 2000–2019. Of those, 20 cases (4%) involved burning BBQ charcoal resulting in fatal carbon monoxide poisoning, 18 (90%) of which were suicides. While no significant demographic trends were identified due to limited reporting of nationality, 78% of decedents were male and were found either in the bathroom (n=4), bedroom (n=3) or loungeroom (n=2) of their home address or seated in a vehicle (n=9). While demographic trends were not significant, BBQ charcoal burning appears to be associated with intentional self-harm rather than inadvertent exposure.

Adverse effect of lockdowns during the COVID-19 pandemic: increased incidence of pediatric crisis admissions due to eating disorders and adolescent intoxications.

During the COVID-19 pandemic, admission rates for eating disorders and intentional intoxications showed a substantial increase, indicating a high burden of pediatric psychiatric diseases. •The COVID-19 pandemic has had an impact on psychosocial wellbeing in children and adolescents. •There was an increase in admissions due to psychosocial problems in the Netherlands in the period after the pandemic. • This was mainly caused by an increase in crisis admissions due to eating disorders and intoxications in adolescents.