Poisoned Patients Research Articles

Acute methadone poisonings in patients in an emergency hospital

Methadone is a potent synthetic opioid used in several countries both for substitution therapy in people with opioid dependence and to prevent HIV infection spreading. In Russia methadone trafficking is prohibited. Despite the current ban, cases of hospitalization with methadone poisoning are regularly recorded in an intensive care units and toxicological departments of emergency hospitals (TD EH). Frequently polydrug consumption detected in a laboratory study. People who use psychoactive substances (PS) are vulnerable to HIV-infection as well as hard-to-reach group for HIV testing. Often HIV-infection and drug abuse pathology are revealed only when drug users hospitalized to an emergency hospital after overdose with one or several PS. During the period 2015–2018 to the toxicological department of Sklifosovsky Research Institute for Emergency Medicine hospitalized 732 patients with acute methadone poisoning. In 76,8–83,9% of cases, methadone was detected in combination with other PS, predominantly with opiates/opioids, psychostimulants, psychodysleptics, as well as pharmaceutical medicaments. In addition to methadone, we recorded the presence of ethanol in biological samples (blood and urine) in a concentration from 0,3 to 3,6‰ in 19,2–33,3% of cases. The prevalence of HIV infection in patients with acute methadone poisoning ranged from 15,7 to 31,8%, increasing by 1,5 times during the analyzed period. The reasons for the increase of prevalence HIV infection in hospitalized patients could be linked to a change in the structure of the taken PS and virus transmission pathways. Patients of TD EH are a high-risk group for the spread of HIV and can be considered as a focus group reflecting general trends in the consumption of drugs in Moscow.

Clinico-demoghraphic profile and outcome of critically ill poisoning patient admitted in the ICU of the largest tertiary care government hospital in Dhaka, Bangladesh

Background: Acute poisoning is a common chief complaint leading to emergency department visits andhospital admissions in developing countries such as Bangladesh. Aim: To study the demographic and clinical profiles of patients admitted to the ICU with acute poisoningand to study the factors that predict their mortality. Methodology: This observational study recruited all eligible 74 poisoning patients admitted in theintensive care unit from 1st July 2019 to 30th June 2020. This study is conducted in the Intensive CareUnit of Dhaka Medical College Hospital, Dhaka, Bangladesh. Result: Total 74 poisoning patients were admitted in the intensive care unit, of them female (55.54%)was more than male(44.59% ). Among the patients 67( 90.54 %) patient were Muslims and 43(58.10%)were married. The highest incidence of poisoning 28 (37.83%) were observed in the age group 11 to 20year and the mean age was 23.74 years. The majority of poisoning cases was suicidal intension(87.83%),accidental was 6.75% and homicidal or street poisoning was 5.40%.The most common type of poisoningwas organophosphorus compound (52.70%) followed by Drug overdose (16.21%), Paraquat poisoning(9.45%), rat killer( 5.4%),Insecticide poisoning (4.05%),Corrosive poisoning (2.74%).The most commonroute of poisoning was ingetion. Mechanical ventilation required 52.70% patients, majority of patientsrequired shorter period (1 to 5 days) of mechanical ventilation and mean duration of mechanical ventilationis 6.33 days . 83% patient were shifted /dischared from the ICU within 1 to 5 days. Mean duration was8.13 day in case of mechanical ventilated patients, but in non-ventilated patients, ICU stay was much lessthan ventilated patients. In this study, the mortality rate was 31% . Conclusion: Early ICU admission and appropriate management of patients after ingestion of poisonousagent results in reduced morbidity and mortality. JBSA 2020; 33(2): 85-91

Antidotal Sodium Bicarbonate Therapy: Delayed QTc Prolongation and Cardiovascular Events.

Sodium bicarbonate therapy (SBT) is currently indicated for the management of a variety of acute drug poisonings. However, SBT effects on serum potassium concentrations may lead to delayed QTc prolongation (DQTP), and subsequent risk of adverse cardiovascular events (ACVE), including death. Emergency department (ED)-based studies evaluating associations between SBT and ACVE are limited; thus, we aimed to investigate the association between antidotal SBT, ECG changes, and ACVE. This was a secondary data analysis of a consecutive cohort of ED patients with acute drug overdose over 3years. Demographic and clinical data as well as SBT bolus dosage and infusion duration were collected, and outcomes were compared with an unmatched consecutive cohort of patients with potential indications for SBT but who did not receive SBT. The primary outcome was the occurrence of ACVE, and secondary outcomes were delayed QTc (Bazett) prolongation (DQTP), and death. Propensity score and multivariable adjusted analyses were conducted to evaluate associations between adverse outcomes and SBT administration. Planned subgroup analysis was performed for salicylates, wide QRS (> 100ms), and acidosis (pH < 7.2). Out of 2365 patients screened, 369 patients had potential indications for SBT, of whom 31 (8.4%) actually received SBT. In adjusted analyses, SBT was found to be a significant predictor of ACVE (aOR 9.35, CI 3.6-24.1), DQTP (aOR 126.7, CI 9.8-1646.2), and death (aOR 11.9, CI 2.4-58.9). Using a propensity score model, SBT administration was associated with ACVE (OR 5.07, CI 1.8-14.0). Associations between SBT and ACVE were maintained in subgroup analyses of specific indications for sodium channel blockade (OR 21.03, CI 7.16-61.77) and metabolic acidosis (OR: 6.42, 95% CI: 1.20, 34.19). In ED patients with acute drug overdose and potential indications for SBT, administration of SBT as part of routine clinical care was an independent, dose-dependent, predictor of ACVE, DQTP, and death. This study was not designed to determine whether the SBT or acute overdose itself was causative of ACVE; however, these data suggest that poisoned patients receiving antidotal SBT require close cardiovascular monitoring.

The level of fecal carriage and the toxic potential of Clostridium perfringens in the feces of a Taiwan subpopulation

Clostridium perfringens ranks among the most common agents of food poisoning in industrialized nations. Little is known about the level of fecal carriage and the toxic potential of this microorganism in Taiwan. One of the criteria to confirm that C. perfringens was the causative agent of food poisoning is to isolate 105 organisms/g from stools of food poisoning patients. The aim of the present study was to determine the carriage of C. perfringens in the feces of a Taiwan subpopulation. The percentage of strains that have toxic potential was also determined by using polymerase chain reaction (PCR) assay and reverse passive latex agglutination (RPLA). As a result, 30 (60%) of the 50 fecal samples carried C. perfringens. The spore counts were between 50 and 2.5×108 CFU/g. The average spore count of all the test samples was 4.3×102 CFU/g. Eleven (22%) of the samples carried more than 105 spores per gram. Only three (1.8%) isolates from fecal samples were cpe gene positive. The RPLA results were in accordance with the genotypic results. Our findings emphasize that the culture of C. perfringens from fecal samples needs to be supplemented with presence of cpe gene or enterotoxin production in the outbreak situation.

Hematological parameters as early predictors of delayed neurological sequelae in acute carbon monoxide poisoning.

Introduction: Delayed neurological sequelae (DNS) are the most frequent morbidity after acute carbon monoxide (CO) poisoning. Therefore, their prevention and early prediction are the main goal of treatment. Aim of the work: This study aimed to investigate parameters based on peripheral complete blood cell count (CBC) as predictors of DNS in acute CO poisoning. Methodology: It included 67 acutely CO poisoned patients and 38 healthy volunteers. On admission, history, clinical examination and routine laboratory investigations were done. Ratios based on CBC counts were measured. Patients were followed up along 6 months for DNS signs. Results: The results revealed that total white blood cells (WBC) count, absolute neutrophil count & percentage and median values of neutrophil-lymphocyte ratio (NLR) & systemic immune inflammation index (SII) were significantly higher while lymphocytes percentage, absolute monocytic count and percentage were significantly lower in CO poisoned patients compared to control group. DNS-complicated patients had significantly lower total WBC count, absolute neutrophil count & percentage and significantly higher median values of NLR and SII than non-complicated. Based on receiver operating characteristic analysis (ROC), NLR and SII were significant predictors of DNS. Conclusion: It was concluded that, NLR and SII ratios may be helpful predictors of DNS after acute CO poisoning.

Meta-analysis of the efficacy of Xuebijing combined with hemoperfusion in treating paraquat poisoning.

Paraquat (PQ) is a herbicide that is highly toxic to humans and animals. Xuebijing can regulate immune and inflammatory mediators. Blood purification is a conventional treatment for paraquat poisoning. Therefore, this study aimed to investigate the clinical effect of Xuebijing combined with hemoperfusion on acute paraquat poisoning (APQ). The PubMed, Cochrane Library, EMbase, CNKI, CBM, and Wanfang databases were searched by computer for randomized controlled trials (RCT) of Xuebijing combined with hemoperfusion in the treatment of APQ. The search time was from the establishment of database to April 2020. The documents were screened and extracted according to the inclusion and exclusion criteria. Meta-analysis and Revman 5.3 were used to evaluate the quality. The metanalysis included 10 studies, totaling 636 patients. Results showed that the 7-day survival rate of Xuebijing combined with hemoperfusion group was higher than that of the control group [hazard ratio (HR) =1.17, 95% confidence interval (CI): (1.04, 1.32), P<0.008], while 14-day survival rate was higher [HR =1.52, 95% CI: (1.13, 2.06), P<0.006], alanine aminotransferase (ALT) was lower [mean difference (MD) =-32.5, 95% CI: (-52.24, -12.76), P=0.001], creatinine was lower [MD =-60.73, 95% CI: (-103.42, -18.04), P<0.005], oxygen partial pressure (PaO2) was higher [MD =6.21, 95% CI: (1.78, 10.64), P=0.006], and C-reactive protein (CRP) was lower [MD =-6.15, 95% CI: (-7.14, -5.16), P<0.00001]. However, there was no statistical difference in oxygen saturation (SpO2) and carbon dioxide PaO2 between the two groups. Xuebijing combined with hemoperfusion and conventional treatment can improve the 7-day and 14-day survival rate, oxygenation level, liver and kidney function, and inflammatory response of paraquat poisoning (PQ) patients.

Poisoning by agricultural pesticides in the state of Goiás, Brazil, 2005-2015: analysis of records in official information systems.

The effect of pesticide use on human health is a problem that has received attention from the scientific community worldwide, especially in central countries, where the highest number of deaths due to human exposure to these agents is observed. Production and productivity increased through the progress of agro-industrialization, but risks to the environment and health were not taken into account. Over time, several cases of environmental contamination and public health problems, poisoning of rural workers, and food residues were observed. These factors triggered the recognition of risks arising from pesticide abuse. This study aimed to characterize pesticide poisonings reported to a toxicological information center of the state of Goiás through a retrospective analysis from 2005 to 2015. Data were mapped and tabulated by the purpose of pesticides, the circumstance of poisoning, and case development. The poisoning profile pointed to a higher occurrence of work- and suicide-related poisonings, with a predominance of poisoned patients, although chronic effects were not recorded, suggesting a false diagnosis of cure.

An Analysis of Services Utilization and Medical Care Charge in Pesticide Poisoned Patients Using the National Health Security Office Database

Background: As the results of the high pesticides use, pesticide poisoning is an important health problem in Thailand. Most studies are about pesticide use behavior and health impact, but lack of studies that indicate the impact economically.&#x0D; Objective: To analyze the services and medical care charge of patient diagnosed with pesticide poisoning at the hospitals.&#x0D; Methods: This study was a cross-sectional descriptive study using data from the National Health Security Office both outpatients and inpatients. Data was during the year 2016 - 2018 and selected according to ICD-10 diagnosis code is T60.0-T60.9 (Toxic effect of pesticides), but excluding code X68 (Intentional self-poisoning by and exposure to pesticides). Data were analyzed using descriptive statistics.&#x0D; Results: During the year 2016 - 2018, mostly patient was inpatient care (97.0%), and diagnose with herbicide and fungicides (47.9%). The average cost per person per year of inpatient care was ฿7740, ฿11 048 and ฿9641, respectively. While the average cost per person per year of outpatient care was ฿1651, ฿1482, and ฿1668, respectively. The reasons for the treatment of inpatient and outpatient was herbicide and fungicides, followed by organophosphate and carbamate poisoning.&#x0D; Conclusions: The majority of patients affected by pesticides are inpatients who were poisoned by herbicide and fungicides with higher medical cost than outpatients. However, the causes of the highest average cost of treatment and the highest number of visits are organophosphate and carbamate insecticides.&#x0D;

The management of the poisoned patient using a novel emergency department-based resuscitation and critical care unit (ResCCU)

ObjectivesThe Resuscitation & Critical Care Unit (ResCCU) is a novel ED-based ICU designed to provide early critical care services. This study sought to identify characteristics of poisoned patients treated in the ResCCU. MethodsWe conducted a retrospective, single-center case study of poisoned patients over the age of 18 years old over a 16-month period. Patient demographics, drug concentrations, and severity of illness scores were extracted from electronic medical records. Patients were divided into two groups, those who required short term ICU level care (< 24 h) and prolonged ICU care (> 24 h). ResultsA total of 58 ED visits with a tox-related illness were analyzed. There were 24 women (41%) and 34 men (59%). There were 42 patients (72%) who required short term ICU level care and 16 patients (28%) who required prolonged ICU care. In the short-term ICU group, 13 patients (31%) were discharged home directly from the ResCCU, 29 patients (69%) were sent to the inpatient floor, and 1 of the admitted floor patients expired. There were no patients admitted to the floor that required a step-up to the inpatient ICU. 56 patients (97%) were alive at post-admit day 7 and 28, and only 8 (14%) were re-admitted within 30 days. ConclusionsPatients who were treated in the ED-based ICU for toxicology-related illnesses were frequently able to be either discharged home or admitted to a regular floor after their initial stabilization and treatment, and none that were sent to the floor required an ICU step-up.

Comparing APACHE II, APACHE IV, SAPS II, and SOFA Predictive Power in Poisoned Patients Admitted to the Intensive Care Unit

Background: This study aimed to assess the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE IV, Simplified Acute Physiologic Score (SAPS) II, and Sequential Organ Failure Assessment (SOFA) scores in predicting mortality rate in poisoning patients admitted to an intensive care unit (ICU).Methods: This cross-sectional study was performed on all admitted patients in the poisoning ICU of Imam Reza Hospital, Mashhad City, Iran. All patients were evaluated for three consecutive days since admission time and then every two days until discharge from ICU or death. The scoring systems mentioned above were calculated and analyzed by MedCalc statistical software version 18.9.1 and SPSS version 16.Results: Overall, 150 patients were studied, out of whom 67% (101) were male. Their mean±SD age was 41.6±18.9 years. In their whole hospitalization period, APACHE II (79.5%), SAPS II (78.7%), APACHE IV (78.4%), and SOFA (72.9%) were the most precise measures. On the first day of admission APACHE II (77.4%), on the second day, APACHE II (83.1%), on the third day, APACHE II (90.7%), and on the fifth day, SOFA (81.6%) were the most precise measures.Conclusion: All four systems have acceptable discriminatory power for poisoned patients. However, it seems that APACHE II can be used for mortality prediction, especially in the early days of admission.

Enquiries to the New Zealand National Poisons Centre in 2018.

A retrospective analysis of enquiries made to the New Zealand National Poisons Centre (NZNPC) in 2018; which includes direct contacts through telephone of caller, patient and exposure substance characteristics, and indirect contacts through the internet of page hits by New Zealand (NZ) healthcare professionals on the TOXINZ poisons information database. All calls made to the NZNPC, and TOXINZ page hits by NZ based healthcare professionals, from 1 January to 31 December 2018 were analysed. For calls, caller location and relationship to the patient, reason and site for the exposure, patient demographics and the management advice given by NZNPC were described. Substance classes and most frequently encountered individual agents were described for both call data and web page hits to TOXINZ. There were 25 330 calls to the NZNPC and 39 028 TOXINZ web page hits in 2018. Most callers were members of the public (79.4%), calling from residential settings (77.2%), reporting an exposure which had occurred in a residential setting (88.2%) because of child exploratory behaviour (50.3%), and which involved a person aged 0-4 years (50.3%) who could be managed at home (74.3%). TOXINZ searches mostly involved therapeutics, especially paracetamol. In 2018, the NZNPC provided assessment and/or advice in 64 358 enquiries, comprising 25 330 direct contacts and 39 028 indirect contacts. The NZNPC provides specialised services regularly used by both members of the public and healthcare professionals that contributes to the clinical management of poisoned and potentially poisoned patients in NZ.

Use of the online poisons information database TOXBASE and admissions rates for poisoned patients from emergency departments in England and Wales during 2008 to 2015.

BackgroundThe impact of poison information services on patient care in hospital, particularly decisions on whether to admit patients after initial attendance at an emergency department (ED), is unclear. In the United Kingdom, the vast majority of poisons information is provided by use of the online poisons information database, TOXBASE. We investigated the relationship between rates of hospital access to TOXBASE and rates of poisoning admissions from EDs in England and Wales to begin to address the interactions between use of poisons information and patient management as reflected by hospital activity.MethodsData were obtained on attendances and admissions due to poisoning for individual National Health Service (NHS) Trusts in both England and Wales, together with data on the overall number of accesses to TOXBASE for drugs (pharmaceuticals and drugs of abuse), from 2008 to 2015. Rates of TOXBASE access and admissions per poisoning attendance in London were clearly different to the rest of England and Wales; London was therefore analyzed separately. Negative binomial generalized additive models were fit, incorporating an interaction effect, for accesses, attendances and admissions to check for variability according to hospital size. Additional models were then fit to assess whether there was any variation in association of overall TOXBASE use with rates of admission for 6 key drug subgroups: antidepressants, paracetamol, antipsychotics, opioids (including all medicines, but excluding heroin), heroin and non‐opioid drugs of abuse.ResultsRates of TOXBASE use per Trust increased across the study period by 39.3% (95% confidence interval [CI] = 34.1%, 44.8%) in England and 76.9% (24.7%, 151.0%) in Wales, showing an increase in TOXBASE use which was substantially greater than the increase in poisoning attendances. Admission rates exhibited seasonality, with lower rates in January and February, increasing by 2.0% (1.0%, 3.1%) in England and 5.8% (5.5%, 5.9%) in Wales toward the middle of the year. The initial model fit indicated that the average proportion of poisoning patients admitted increased with both increasing attendances and increasing TOXBASE use (England and Wales overall, P < 0.0001; England and Wales excluding London, P < 0.0001; London, P < 0.0001). In England and Wales overall, and in London alone, increased TOXBASE access to non‐opioid drugs of abuse advice was associated with a significant decrease in admissions (England and Wales, −0.15% [−0.29%, −0.01%] [P = 0.032]; London, −1.02% [−1.53%, −0.50%] [P < 0.0001]). In contrast, increased access to heroin advice was associated with a significant increase in admissions in London (+2.03% [+0.11%, +3.99%] [P = 0.034]). Increasing access to TOXBASE for paracetamol advice was associated with lower admissions in England and Wales (England and Wales, −0.11% [−0.23%, −0.01%] [P = 0.036]; England and Wales excluding London, −0.18% [−0.30%, −0.06%] [P = 0.001]) but higher admissions in London (+0.52% [+0.03%, +1.01%] [P = 0.035]).ConclusionsWe have shown that greater overall use of TOXBASE by hospitals is associated with a higher proportion of poisoning attendances being admitted. Interestingly, looking at particular drug groups, we found significant associations in both directions between overall TOXBASE use and rates of admission for some drug groups. The current methodology is unable to determine whether such decisions might be appropriate or not. Mixed‐methods research is now required to gain a better understanding of how provision of poisons information affects decisions within the ED.

Predictive Role of Cardiac Troponin I, Creatine Kinase-Mb and Electrocardiogram in Early Assessment of Acute Cardiotoxicity in Patients Poisoned by Cardiotoxic Drugs and Toxins

Background: In spite speedy development of clinical toxicology researches and protocols cardiovascular failure in severe acute intoxication remains a leading cause of death. Early cardiovascular risk assessment in acutely intoxicated patients is a must nowadays.&#x0D; This study aims to evaluate the role of ECG, serum cardiac troponin I (cTnI) and creatine kinase myocardial band (CK-MB) for early detection of cardio-toxicity in acutely poisoned patients.&#x0D; Methods: Prospective study was carried on100 patients with acute cardiotoxicity by drugs and toxins known to cause cardiac injury admitted to Sohag University hospitals, informed written consent has been obtained from each patient; ECG and biochemical analysis of serum cTnI and CK-MB were estimated in all studied patients.&#x0D; Results: (90%) of studied patients had complete free recovery, (4%) discharged with complications and (6%) of patients died. ECG test can be used as a predictor of mortality and had sensitivity 100%, specificity 46.8% and negative predictive value (NPV) 100%. Serum cTnI was highly significantly increased with death hence could be used as predictors of outcome. While serum CK-MB couldn't be used as an outcome predictor. ROC curve analysis to assess serum cTnI as a predictor of mortality of acute cardiovascular toxicity with cut off &gt; 1.0 ng/ml had sensitivity 100%, specificity 89.4% and NPV 100% with excellent diagnostic characteristic (accuracy rate 96.4%). There is no significant difference of serum CK-MB and serum cTnI among cardiac drugs toxicity patients and non-cardiac toxins patients.&#x0D; Conclusion: the study concluded that ECG and serum cTnI can be used as a predictor of mortality. Also, the protocol of management will be same in acute cardiotoxicity by cardiac drugs and non-cardiac drugs and toxins.&#x0D; Recommendation: the study recommends combining of ECG changes and serum cTnI as they can early detect acute cardiovascular effects in acutely poisoned patients.

Paraphenylenediamine (Kala Pathar) Poisoning at the National Poison Control Center in Karachi: A Prospective Study.

IntroductionSuicide by self-poisoning is a common cause of death, especially in the younger population. More specifically, hair-dye poisoning is being increasingly used for suicide. Paraphenylenediamine (PPD), also known as “Kala pathar”, is a highly toxic ingredient present in hair-dye that can cause death. Therefore, this study is designed to assess the demographics, clinical features, laboratory findings, and outcomes of PPD poisoning in patients admitted to the National Poison Control Center in Karachi, Pakistan.Materials and methodsWe conducted a prospective study for a period of six months at the National Poison Control Center, Karachi, Pakistan. A total of eight patients with PPD poisoning with no cardiac, liver, or renal co-morbidities were included in this study. The demographic characteristics, clinical features, laboratory findings, mode of intoxication, and route of intoxication were noted in a proforma. Furthermore, hospitalization time, tracheostomy status, mechanical ventilation status, and mortality rates were also recorded. For continuous variables, the means and SDs were calculated. Whereas for categorical data, percentages were calculated.ResultsIn our study, the mean age of the patients was estimated at 25.38 ± 3.77 years. It was deemed that the majority of poisoning cases were intentional in nature (75%). These suicide cases were more commonly observed in young females (75%) who belonged to a low socioeconomic class (87.5%). The preferred route of administration was oral (87.5%). In 87.5% of the patients, the characteristic clinical features such as cervicofacial edema, dysphagia, dysphonia, and stridor were noted. During the later clinical stages of poisoning, clinical features such as rhabdomyolysis (62.5%), chocolate-colored urine (87.5%), hepatitis (75%), and acute renal failure (12.5%) were noteworthy. The mean ± SD of total leukocyte count (TLC), creatine phosphokinase (CPK), aspartate aminotransferase (AST), alanine aminotransferase (ALT), serum creatinine and serum potassium were, respectively, noted at 10,500 ± 3,854.4 cells/mm3, 32.87 ± 11.36 IU/L, 1,239.1 ± 1,106.2 IU/L, 776.8 ± 1,149.8 IU/L, 2.125 ± 2.275 mg/dL, and 4.9 ± 1.094 mmol/L. In our patients, the mean intensive care unit stay was 8.25 ± 3.99 days. Emergency tracheostomy was performed in 25% of patients. Mechanical ventilation was required for 50% of our patients. Overall, the mortality rate observed in our study stands at 25%.ConclusionPPD poisoning is associated with a high rate of morbidity and mortality. Therefore, it is imperative for physicians to be mindful of the clinical characteristics and treatment options in order to optimally manage such cases of poisoning. In addition, the use of hair-dyes composed of highly lethal PPD should also be banned.

Abdominal pain related to adulterated opium: An emerging issue in drug addicts.

Lead may contaminate opium, heroin and illicit opiates and is particularly observed in Iran. Lead, a natural heavy metal is able to interfere with several organ functions after ingestion or inhalation. Lead poisoning manifestations are non-specific and thus lead poisoning remains difficult to diagnose. Among the manifestations, abdominal pain is almost the most frequent symptom causing patients to seek medical care. In patients with a history of opium addiction presenting with moderate-to-severe abdominal pain, lack of diagnosis of lead toxicity may thus result in time-consuming and unnecessary medical work-ups that can end up in invasive surgery. This paper aims to briefly review abdominal pain as an emergency issue and the leading symptom of lead poisoning that brings most of the patients to healthcare facilities. All published adult cases and case series of opium addicts admitted with abdominal pain due to lead-adulterated opium consumption have been reviewed. A trend of increasing numbers of lead poisoning cases has recently emerged among opium addicts in Iran. Due to the non-specific manifestations and hazardous effects, psychiatrists and emergency physicians should consider lead poisoning in patients with a past or present history of opium addiction referred for acute abdominal pain, particularly in case of colicky abdominal pain.

The Scenario of Acute Poisoning in Jashore, Bangladesh.

Background Acute poisoning is a common scenario in the emergency department of any general hospital globally, but its pattern may vary in different parts of the world and even may be a different regional variation in the same country. Objective Our recent study aims to assess the demographic characteristics, psychological aspect, pattern, and treatment outcome in different acute poisoning. Method The present cross-sectional study was conducted in the medicine department of Jashore Medical College and Hospital from 1st January to 30th June 2018, which recruited 487 eligible cases of admitted acute poisoning patients. Results The study reveals that the total incidence of acute poisoning in Jashore, Bangladesh, is 17.1 per 100,000 populations over a 6-month period. The mean age of our study population was 27 ± 11 (SD) years with having significant female preponderance in acute poisoning (female: 253/52% and male: 234/48%; p = 0.002). Female subjects were significantly younger than male (p <0.001). Moreover, the total suicidal intension of acute poisoning in our study was 97.3%, whereas the female subjects were more committed to suicidal attempts (p = 0.027). Organophosphorus compounds (OPCs) were the significant leading agents (66.1%, p = 0.029) of acute poisoning, and even, it had been significantly used as suicidal intention of poisoning substance (65.1%, p <0.001) in our observation. Muslim (97.5%, p = 0.005), 10–29 year age group (68.0%, p = 0.002), rural (99.2%), unmarried (51.3%), middle class (50.1%), students (48.9%), and secondary educational background population (76.4%) were more victimized of acute poisoning. Among different factors, familial disharmony constituted of 56.1% cases of suicidal attempt in acute poisoning. Finally, we had observed that the death incidence by acute poisoning in Jashore, Bangladesh, was 1.9 per 100,000 population over a 6-month period. Conclusion The recent study reveals that there is high incidence of acute poisoning in Jashore, Bangladesh, with a significant amount of death toll. Organophosphorus compound is the most common agent of deliberating self-poisoning in our study due to its easy availability in our agriculture-based community.

Extracorporeal Membrane Oxygenation for Poisonings Reported to U.S. Poison Centers from 2000 to 2018: An Analysis of the National Poison Data System.

To assess trends in the use of extracorporeal membrane oxygenation for poisoning in the United States. Retrospective cohort study. The National Poison Data System, the databased owned and managed by the American Association of Poison Control Centers, the organization that supports and accredits all 55 U.S. Poison Centers, 2000-2018. All patients reported to National Poison Data System treated with extracorporeal membrane oxygenation. None. In total, 407 patients met final inclusion criteria (332 adults, 75 children). Median age was 27 years (interquartile range, 15-39 yr); 52.5% were male. Median number of ingested substances was three (interquartile range, 2-4); 51.5% were single-substance exposures. Extracorporeal membrane oxygenation use in poisoned patients in the United States has significantly increased over time (z = 3.18; p = 0.001) in both adults (age > 12 yr) and children (age ≤ 12 yr), increasing by 9-100% per year since 2008. Increase in use occurred more commonly in adults. We found substantial geographical variation in extracorporeal membrane oxygenation use by geospatially mapping the ZIP code associated with the initial call, with large, primarily rural areas of the United States reporting no cases. Overall survival was 70% and did not vary significantly over the study period for children or adults. Patients with metabolic and hematologic poisonings were less likely to survive following extracorporeal membrane oxygenation than those with other poisonings (49% vs 72%; p = 0.004). The use of extracorporeal membrane oxygenation to support critically ill, poisoned patients in the United States is increasing, driven primarily by increased use in patients greater than 12 years old. We observed no trends in survival over time. Mortality was higher when extracorporeal membrane oxygenation was used for metabolic or hematologic poisonings. Large, predominantly rural regions of the United States reported no cases of extracorporeal membrane oxygenation for poisoning. Further research should focus on refining criteria for the use of extracorporeal membrane oxygenation in poisoning.

Patterns, Associated Factors, and Clinical Outcomes of Poisoning among Poisoning Cases Presented to Selected Hospitals in Western Ethiopia: Hospital-Based Study

Results The broad types of poisoning were identified in about 193 (91.47%) cases of poisoning in this study. Pesticides exposure and food poisoning have, respectively, contributed for 32.70% and 20.91% of the poisoning incidence. On the other hand, chemical from industry has contributed the least percentage (2.81%). Out of a total of 24 agents identified, 26.80% of the agents were organophosphates followed by raw meat (18.40%). Difference in the incidence of poisoning was also observed as seasons in a year change. Among the victims who have taken household materials as a poisoning agent, about 47.87% of them have taken the agents during daytime. The remaining cases of poisoning developed by household chemicals occurred at night. More than half (54.98%) of the poisoned patients have encountered the incidents inside their home. Regarding the final poisoning outcome, about 7.10% poisoning cases in this study died of the poisonings. Factors such as place, time, intention, and source of poisoning were observed to determine poisoning outcomes. Although poisoning attempt was lesser among urban residents as compared to rural community, rural dwellers were four times more likely to die of poisoning they had attempted (AOR: 4.072 (1.197–13.85)). Conclusion This study has clearly showed that the incidence of poisoning was varied with seasonal variations. The encountered poisonings ended up with mixed clinical outcomes, which were also affected by patients' demographic and clinical characteristics. Fertilizers, unclean food items, household materials, and drugs have caused majority of the poisonings. Creating community awareness and designing sound prevention strategies are recommended to reduce morbidity and mortality related to poisoning.

PNS38 PREDICTION OF TOTAL HOSPITALIZATION COSTS ASSOCIATED WITH COMPLICATIONS IN ORGANOPHOSPHATE POISONING

Organophosphate poisoning is a major public health problem in rural and low socio-economic populations in India. The economic burden of this poisoning is high due to the manifestation of associated complications and its high treatment costs. This study attempts to predict the total hospitalization costs associated with the various significant complications in organophosphate poisoning. A retrospective cross-sectional study was conducted in a Tertiary care hospital in India after procuring the ethical approval. Data of patients diagnosed with organophosphate poisoning (ICD–T60) during January 2012- July 2018 were collected from the Medical and Finance Record Department and analyzed using R package and SPSS. A Regression tree was generated to identify the predominant complications that affected the cost. Generalized Linear Model was further used in predicting the mean total cost in the presence of those complications and their association with the cost. The original data was split into 70:30 ratio where 70% of the data was used for model building and 30% for its validation. A total of 638 organophosphate poisoned patients were included in the study. Majority of the patients were farmers [n=152 (23.8%)] with maximum suicidal rate [n=147 (24.1%)]. The total cost for treating 638 patients was 43501732.07 INR (median=45422.5 INR). According to the Regression tree, patients undergoing tracheostomy paid the highest amount (170000 INR) followed by seizures (150000 INR). Generalized Linear Model predicted that the majority of the patients were within 20000-50000 INR of actual cost reported (52.5% of the population falling under 20000 INR and 81.8% under 50000 INR). All significant complications except cardiac arrest (B= -0.252), had a positive association with the cost. The complications associated with organophosphate poisoning significantly increased treatment costs. This model will help the clinicians in estimating the total costs associated with complications in organophosphate poisoning.

Potential prognostic roles of serum lactate and Creatine kinase levels in poisoned patients

BackgroundExamination of serum lactate level and its changes, as an indicator of tissue oxygenation, as well as level of creatine kinase (CK) inhibitors, as a factor of mortality which partially expresses heart, brain, and muscle damage, may be considered as tools to determine prognosis in critically ill patients. We aimed to evaluate these two factors as potential prognostic factors in critically poisoned patients admitted to our toxicology ICU.MethodThis is a cross-sectional descriptive-analytic study that was performed on poisoned patients referred to emergency department of Loghman Hakim Hospital. One-hundred critically poisoned patients who had been admitted to ICU were conveniently chosen using a random number table and included into the study after obtaining consent forms from their next of kin. Their serum lactate and CK levels were checked on admission. These levels were compared subsequently between survivors and non-survivors to seek for their potential prognostic role.ResultsIn a total of 100 patients enrolled, 61 were male. Serum level of lactate (with a cut off of 26 mg/dL) and serum CK with a cutoff point of 169 U/L could have prognosticated death with sensitivity and specificity of 78 and 77% (for lactate) and 74 and 62% (for serum CK), respectively.ConclusionsIn poisoned patients, serum lactate and CK can be used as possible prognostic factors because they rapidly increase in the serum and are easily detectable.