Poison Control Centers Research Articles

The epidemiology of poisoning and overdose in Saudi Arabia: exposures, risks, management and outcomes

Poisoning is a major public health concern. In Saudi Arabia, information related to poisoning is limited. Herein, we report a large number of poisoning cases from across The Kingdom of Saudi Arabia. We reviewed cases of poisoning received by the Poison Control Center (PCC) at the Saudi Medical Appointments and referral Center. This was a retrospective review of all documented calls to the PCC between September 2020 and September 2021. A total of 39,439 cases were reported to the PCC during the study period. The mean patient age was 7.1 ± 12.6 years, 52.8% were men, and 36.9% were women; 10.3% of the study population did not specify their gender. More than half of the cases (61.7%) were children ≤5 years-of-age. Public calls accounted for 76.1% of the cases, of which 76.4% were managed at home. Exposures to poisons were mostly acute (84.9%) and unintentional (69.1%). Medications were implicated in 34.7% of cases, the most common medications were analgesics (9.3%). Moderate or major effects were reported by 18.4% of the study population. The vast majority of toxicology consultations received by the PCC involved the accidental exposure of poisons to children less than five years-of-age. Therefore, there is an urgent need to develop educational campaigns targeting the safe use and storage of medications and chemicals in the household. Our findings also demonstrate that PCCs play a major role in reducing visits to the emergency department and will also reduce healthcare cost related to poisoning and overdose.

Multi–Organ Damage Due to Glufosinate Ammonium Poisoning

Glufosinate Ammonium herbicide poisoning is one of the diseases with a complicated course, a period of 4-60 hours without symptoms followed by sudden appearance of damage to multiple organs such as nerves, breathing, heart. A 67-year-old female patient admitted to our poison control center with symptoms of vomiting and impaired consciousness. Exploiting the patient's information, it was discovered that the patient bought Glufosinate ammonium and Metsulfuron methyl to take it with the intention of committing suicide. The patient was quickly treated with gastric lavage and activated charcoal. After 1 day, the patient lost consciousness, stopped breathing, and had a slow pulse of 45 beats per min, NH3 of blood 93.3 µmol/L, ECG: Sinus bradycardia, no ST elevation. The patient was then prescribed endotracheal tube placement and controlled ventilation. After 7 days of treatment, the patient's condition improved and the patient was extubated. This article aims to talk about multi-organ damage caused by Glufosinate Ammonium poisoning.

Role of Intravenous Lipid Emulsions in Improving Coma of Acute Antipsychotics Poisoning: A Randomized Controlled Trial in Poison Control Center of Ain Shams University Hospitals

Role of Intravenous Lipid Emulsions in Improving Coma of Acute Antipsychotics Poisoning: A Randomized Controlled Trial in Poison Control Center of Ain Shams University Hospitals

Evaluation of the effectiveness of fresh frozen plasma transfusion as adjuvant treatment in acute organophosphate-poisoned patients: A randomized clinical trial.

Organophosphorus (OP) poisoning is a significant cause of morbidity and mortality worldwide. Recent research has explored new approaches to improving treatment options, which present several challenges. This study aimed to evaluate the role of fresh frozen plasma (FFP) as an adjunctive therapy for acute OP intoxication. A prospective single-blinded randomized clinical trial was conducted on patients of both sexes admitted to the Intensive Care Unit (ICU) of the Poison Control Center at Ain Shams University Hospital (PCC-ASUH) with acute OP toxicity during the period from the beginning of August 2022 to the end of July 2023. According to the Peradeniya score, Group I consisted of 48 patients (52%) with moderate OP poisoning, and Group II consisted of 44 patients (48%) with severe OP poisoning. Patients in the moderate group were assigned to receive either standard treatment (Group Ia, n = 24) or standard treatment plus FFP (Group Ib, n = 24). In addition, patients in the severe group were assigned to receive either standard treatment (Group IIa, n = 22) or standard treatment plus FFP (Group IIb, n = 22). A total of 46 patients received FFP transfusion. The authors demonstrated that the early use of a total of nine packs of FFP (250mL each) over three consecutive days significantly reduced the total doses of atropine and oximes, the total hospitalization period, and the requirement for mechanical ventilation in patients with OP poisoning, both in the moderate and severe groups.

Impact of Social Media Challenges on Pediatric Single-Use Detergent Sacs and Diphenhydramine Ingestions Reported to United States Poison Control Centers

Impact of Social Media Challenges on Pediatric Single-Use Detergent Sacs and Diphenhydramine Ingestions Reported to United States Poison Control Centers

Opšti principi hitnog zbrinjavanja trovanja u ambulanti lekara opšte medicine - izazovi i prepreke

Introduction. Timely recognition of acute or chronic poisoning, as well as the pharmacodynamic mechanisms and pathophysiology of poisoning, is of the utmost importance in the general practice office. Objective. We aimed to find out the rate of awareness and education of primary healthcare physicians on necessary measures in the case of poisoning treatment. Method. Physicans working in general practice in the Republic of Serbia were sent an electronic questionnaire ''Urgent poisoning treatment in the general practice office''. The questionnaire had 13 questions referring to the physician's practical experience. Results. The rise of medication, product, and biological substance poisoning rate was registered at the primary healthcare level in the last five years and it went from 0,14 to 0,21. Poisoning with non-medical substances is on the steep decline, from 0,30 to 0,19 per 1000 inhabitants. We followed the experience of general physicians (GPs) from outpatient clinics, concerning the cases of acute and chronic poisoning, by examining the questionnaire which showed 71,43% of GPs met with this condition. Physicans were more likely to be met with accidental poisoning (41,07%), while (21,43%) were met with multiple intentional poisonings. A larger percentage of these cases (44,65%) were treated on-site. About the existence of the National Poisoning Control Center knew 53,57% of physicans and 58,93% were familiar with detoxication measures. Additional expertise in the area of poisoning is necessary in the opinion of 75% of physicians. Discussion. Poison intake, in different ways, into a body, may cause a patient's death if not recognized on time, at the initial encounter in the general physician's office. Conclusion. Awareness and education of the GPs in the outpatient clinics, as well as, readiness to learn additional skills proved to be an important factor in taking care of poisoned patients who call on their GPs first. Continuous education is a necessary measure for the improvement of healthcare quality in the treatment of acute and chronic poisoning.

Comparing the acute toxicities of co-exposure to cocaine and ethanol versus cocaine alone.

Cocaine is commonly consumed with ethanol, which leads to the formation of cocaethylene through transesterification. Cocaethylene is an active metabolite of cocaine with a longer duration of action. Literature on the combined toxicity of cocaine, ethanol, and cocaethylene is conflicting. We aimed to compare the acute toxicities of co-exposure to cocaine and ethanol versus cocaine alone in Hong Kong. This was a retrospective study on acute cocaine toxicities reported to the Hong Kong Poison Control Center from 1 January 2010 to 22 January 2023. Cocaine exposure was confirmed by urine immunoassays/laboratory tests and ethanol co-ingestion was confirmed by blood ethanol concentrations. A serious outcome was defined as a National Poison Data System outcome moderate or above. Univariate analyses and multivariable logistic regression were performed to compare the associations of clinical outcomes with and without ethanol, followed by subgroup analyses of cases with complete data. We analyzed 109 patients (median age 29 years, 71% men, 68% Chinese), of whom 20 had confirmed ethanol co-ingestion (mean blood ethanol concentration 1350mg/L). Multivariable analysis showed that co-exposure to cocaine and ethanol was associated with a lower risk of serious outcomes (adjusted odds ratio 0.09, 95% confidence interval 0.01-0.77; p = 0.03) after adjusting for age, sex, ethnicity, route of cocaine administration, and physical health status. Subgroup analyses showed similar findings. In contrast to previous studies, we did not identify a higher risk of serious outcomes after co-exposure to cocaine and ethanol compared to cocaine alone in a predominantly Chinese cohort.

Shock and modified shock indices in predicting poisoning severity and outcomes in acute aluminum phosphide poisoned patients.

Severe refractory hypotension and cardiogenic shock are the main contributors to death in acute aluminum phosphide (ALP) poisoning. Shock index (SI) and modified shock index (MSI) are easily obtained parameters that reflect shock at an early stage. This study aimed to evaluate the role of SI and MSI in the prediction of the severity and outcomes of acute ALP poisoned patients. This cross sectional study was conducted on patients admitted to Tanta University Poison Control Centre with acute ALP poisoning from April 2022 to March 2023. Socio-demographics and toxicological data were taken, findings of clinical examination and laboratory investigations were recoded, SI was calculated by dividing heart rate over systolic blood pressure, and MSI was obtained by dividing heart rate over mean arterial pressure. Poisoning severity was assessed using poisoning severity score (PSS). Patients were divided into groups according to intensive care unit (ICU) admission and mortality. The study enrolled 94 patients. The median values of SI and MSI were significantly higher in ICU-admitted patients and non-survivors rather than their comparable groups. Significant positive correlations were observed between each of SI and MSI and PSS. At cut-off >1.14, SI conveyed fair performance to predict ICU admission and mortality (AUC=0.710 and 0.739, respectively). Similarly, MSI had fair performance to predict ICU admission (AUC=0.731) and mortality (AUC=0.744) at cut-off >1.47 and >1.5, respectively. Both SI and MSI could be considered simple bedside adjuncts to predict ICU admission and mortality in acute ALP poisoning.

Hepatic Affection in Acute Poisoned Cases admitted at menoufia poison control center over one year

Hepatic Affection in Acute Poisoned Cases admitted at menoufia poison control center over one year

Evaluation of the new poisoning mortality score in comparison with PSS and SOFA scoring systems to predict mortality in poisoned patients admitted to the intensive care unit.

Mortality prediction in acute poisoning patients aids in prompt and effective treatment. This study aimed to evaluate the effectiveness of the new Poisoning Mortality Score (PMS) in comparison with the Poison Severity Score (PSS) and Sequential Organ Failure Assessment (SOFA) scoring systems in poisoned patients admitted to the intensive care unit (ICU). The medical records of 523 poisoned patients admitted to the ICU of the Poison Control Centre from September 2021 to June 2022 were examined retrospectively. The PMS, PSS, and SOFA scores were calculated based on the worst values of the first 24 h of admission. A total of 100 patients were enrolled in the study, and the in-hospital mortality rate was 28%. The best cut-off points for predicting mortality for PMS, PSS, and SOFA scores were > 53, > 2, and > 6, with sensitivities of 67.9%, 85.7%, and 82.4% and specificities of 73.6%, 84.7%, and 83.3% respectively. In a pairwise comparison of the AUCs for PMS, PSS, and SOFA scores, SOFA displayed significantly greater accuracy than PSS and PMS. The PMS, PSS, and SOFA scoring systems were significant predictors of mortality in ICU-admitted poisoned patients, however, the SOFA score showed the best performance (OR = 1.77, and 95% CI = 1.42-2.54) with significant P-value (0.002) as a predictor of mortality and highest AUC(0.904).

Pattern of Acute Poisoning Exposure Before, During and After the COVID-19 Pandemic: A Retrospective Study at Poison Control Centre- Zagazig University Hospitals

Pattern of Acute Poisoning Exposure Before, During and After the COVID-19 Pandemic: A Retrospective Study at Poison Control Centre- Zagazig University Hospitals

Pattern, Clinical Characteristics and Outcome in Cases of Castor and Croton Seeds Ingestion: Six Year's Retrospective Study at Tanta University Poison Control Centre

Pattern, Clinical Characteristics and Outcome in Cases of Castor and Croton Seeds Ingestion: Six Year's Retrospective Study at Tanta University Poison Control Centre

Hand hygiene compliance among health care workers and associated factors at the ICU – Poison Control Center, Bach Mai Hospital

Hand hygiene compliance among health care workers and associated factors at the ICU – Poison Control Center, Bach Mai Hospital

Hydrogen cyanamide exposure: a case series from Pavia Poison Control Centre.

Hydrogen cyanamide is a plant growth regulator introduced in Italy as Dormex in 2000, but recalled from the market in 2008. It's currently not authorized in Europe. Inhalation/dermal contact may cause irritation/caustic burns, ingestion of severe organ damage and concomitant alcohol consumption disulfiram-like reaction due to aldehyde-dehydrogenase inhibition by hydrogen cyanamide. To study all exposure cases referred to our centre, evaluating temporal and geographic distribution and analysing clinical manifestations, including the ones after alcohol consumption. We retrospectively evaluated all hydrogen cyanamide exposures referred to our Poison Control Centre (January 2007-December 2021). For each case, age, sex, exposure route/year, geographical location, intent of exposure, alcohol co-ingestion, emergency department-admission Poison Severity Score, signs/symptoms and treatment were analysed. Thirty subjects were included. Median case/year was 1 [1; 2]: 79% occurred after market withdrawal, 92% in Sicily. All exposures were unintentional and work related; 41% of patients also co-ingested alcohol. Mean poison severity score at emergency department admission was 1.54, more severe when ingestion occurred. The most common signs/symptoms were flushing, secondary to peripheral vasodilation (41%), hyperaemia/erythema (29%), dyspnoea (25%), nausea (20%), vomiting (12%), oedema (12%), II-III degrees burns (12%) and pharyngodynia (12%). All patients were treated symptomatically and fully recovered. Hydrogen cyanamide exposure can lead to severe clinical manifestations. Despite its withdrawal from the Italian market, hydrogen cyanamide is still used: through PCC's crucial role in monitoring exposure to agricultural products efforts should be made to contrast illegal trade and increase awareness of its potential toxicity in those countries in which it's still legal.

Evaluation of the rate and pattern of suicide attempts and deaths by self-poisoning among Egyptians before and during the COVID-19 pandemic.

Concerns about increased suicidal attempts, especially by self-poisoning as a consequence of Coronavirus disease 2019 (COVID-19) pandemic have been raised worldwide. This study aimed to evaluate the rate and pattern of suicide attempts and deaths by self-poisoning among patients admitted to Tanta University Poisoning Control Center one year before and following COVID-19 pandemic declaration in Egypt. It was conducted on the medical records of 3,200 poisoned patients, from March 2019 to February 2021. Demographic, toxicological data and patients' outcomes were collected. During the pandemic year, 63.8% of total admitted patients alleged suicidal self-poisoning. Adults significantly decreased from 59% to 52.3%, while adolescents significantly increased from 34.6% to 41.7%. Monthly numbers of admitted suicidal self-poisoned patients significantly decreased during the lockdown but significantly increased from 7% to 26.5%, during the peak of the second wave of the pandemic as well as suicidal deaths (increased from 1.9% to 21.2%). Suicidal self-poisoning in females increased late in the pandemic year and suicidal self-poisoning deaths were significantly reported from rural areas (P=0.025). The delay time was significantly longer, length of hospital stay was significantly shorter, intensive care unit admission rates and suicidal deaths were significantly increased during the pandemic year (P<0.001, 0.026, <0.001, <0.001, respectively). Phosphides were the most commonly used poison for committing suicide and suicidal deaths during this year. Psychological support should be directed to females and adolescents, especially from rural areas in Egypt to help reduce suicidal attempts and deaths by self-poisoning during any future pandemics and lockdowns.

Caustic Ingestions: Feel the burn

A 56-year-old male with a past medical history of depression presented with intentional caustic ingestion. This resulted in lactic acidosis, intubation for impending airway compromise, and ultimately to gastrectomy due to the extent of the gastric injury. Caustic ingestions cause either coagulative (acidic substance) or liquefactive (alkaline substance) necrosis. Management and treatment include observation, labs, imaging, endoscopy, and may require more urgent interventions such as intubation and vasopressors. Consider consulting the local poison control center early and GI, ENT or surgery depending on severity and types of injuries. Endoscopy is useful for prognosis, but early CT imaging may also be useful and more readily available.

Methylene Blue-Induced Serotonin Toxicity: Case Files of the Medical Toxicology Fellowship at the New York City Poison Control Center.

Methylene Blue-Induced Serotonin Toxicity: Case Files of the Medical Toxicology Fellowship at the New York City Poison Control Center.

Comparison of different scores as predictors of mechanical ventilation and intensive care unit admission in acute theophylline poisoning.

Theophylline is commonly used to control respiratory diseases, especially in developing countries. Theophylline has a narrowed therapeutic index, and its toxicity is associated with morbidity and mortality. Physicians should be aware of the early prediction of the need for intensive care unit admission (ICU) and mechanical ventilation (MV). This study aimed to assess the power of the Rapid Emergency Medicine Score (REMS), Modified Early Warning Score (MEWS) and Simple Clinical Score (SCS) in predicting the need for ICU admission and/or MV in acute theophylline-poisoned patients. This cross-sectional study included 58 patients with acute theophylline poisoning who were admitted to our Poison Control Center from the 1st of July 2022 to the 31st of January 2023. The REMS, MEWS and SCS were calculated for all patients on arrival at the hospital. The area under the curve (AUC) and receiver operating characteristics were tested to compare scores. The median values of all studied scores were significantly high among patients who needed MV and/or ICU admission. The AUC of SCS was >0.9, with a sensitivity of 92.9% and specificity of 90.9% for the prediction of ICU admission. Meanwhile, MEWS was an excellent predictor of the need for MV (AUC=0.996, 95% CI=0.983-1.000). We recommend using SCS as an early predictor for ICU admission in acute theophylline-poisoned patients. However, MEWS could effectively predict MV requirements in acute theophylline-poisoned patients.

Evaluation of the role of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and mean platelet volume (MPV) time series as predictors of diagnosis and prognosis of hemotoxic snakebite

BackgroundThis study aimed to assess the predictive value of NLR, PLR, and MPV time series for diagnosis and prognosis of hemotoxic snakebite envenomation.MethodsThis is a prospective study among snakebite patients admitted to the Poison Control Center of Ain Shams University Hospitals and Assiut University Hospitals from the beginning of July 2019 to the end of October 2021. Patients were classified according to their clinical severity into three groups: mild, moderate, and severe.ResultsThe maximum incidence of snakebite was found in males (95%) from rural areas (80%); at lower limbs (70%); at night (51%); and during the autumn season (43.3%). The admission NLR and PLR can predict hemotoxic snakebite envenomation with an AUC of 0.940 and 0.569. The combination of NLR with PLR can develop a more predominant prediction of snakebite envenomation with an area under the curve (AUC) of 0.979. Furthermore, higher admission NLR and PLR levels are associated with prolonged hospital stays.ConclusionWhile NLR and PLR levels may be helpful in the diagnosis of snakebite, MPV plays no part in the prognosis of snakebite patients. Serial NLR, PLR initially, at 24 hours, and predischarge can be used to evaluate the early treatment response.

An Examination of the Complex Pharmacological Properties of the Non-Selective Opioid Modulator Buprenorphine.

The goal of this review is to provide a recent examination of the pharmacodynamics as well as pharmacokinetics, misuse potential, toxicology, and prenatal consequences of buprenorphine. Buprenorphine is currently a Schedule III opioid in the US used for opioid-use disorder (OUD) and as an analgesic. Buprenorphine has high affinity for the mu-opioid receptor (MOR), delta (DOR), and kappa (KOR) and intermediate affinity for the nociceptin (NOR). Buprenorphine's active metabolite, norbuprenorphine, crosses the blood-brain barrier, is a potent metabolite that attenuates the analgesic effects of buprenorphine due to binding to NOR, and is responsible for the respiratory depressant effects. The area under the concentration curves are very similar for buprenorphine and norbuprenorphine, which indicates that it is important to consider this metabolite. Crowding sourcing has identified a buprenorphine street value (USD 3.95/mg), indicating some non-medical use. There have also been eleven-thousand reports involving buprenorphine and minors (age < 19) at US poison control centers. Prenatal exposure to clinically relevant dosages in rats produces reductions in myelin and increases in depression-like behavior. In conclusion, the pharmacology of this OUD pharmacotherapy including the consequences of prenatal buprenorphine exposure in humans and experimental animals should continue to be carefully evaluated.