Poisoned Patients Research Articles

Simultaneous analysis of paralytic shellfish toxins and tetrodotoxins in human serum by liquid chromatography coupled to Q-Exactive high-resolution mass spectrometry

Paralytic shellfish toxins (PSTs) and tetrodotoxins (TTXs) are powerful neurotoxins. Previous research reported that PSTs and TTXs are found together in seafoods and may pose a serious hazard to public health. In this study, a new analytical method combining modified QuEChERS (Quick, Easy, Cheap, Effective, Rugged, Safe) with high-performance liquid chromatography coupled to Q-Exactive Orbitrap high-resolution mass spectrometry was developed and validated for the quantification of 10 PSTs and 2 TTXs in human serum. Chromatographic separation was achieved using the HILIC TSK-Gel Amide-80 column. The mass spectrometer was operated in full scan/dd-MS2(data-dependent MS2) mode, and for quantification analysis. The dd–MS2 resolution was set to 17,500 fullwidthat halfmaximum （FWHM）. Results showed that methanol with 1 % (v/v) acetic acid extraction combined with 50 mg graphitized carbon black (GCB) and 50 mg octadecyl bonded silica gel (C18) was most suitable for purification. The mean recovery for all toxins ranged from 85.3 % to 118.2 % (RSD < 12 %). The limits of detection and quantification for human serum were in the ranges of 0.67–2.61 and 2.23–8.69 ng mL−1, respectively. The method was applied to analyze toxins in serum samples obtained from three poisoned patients in a case of poisoning caused by consumption of toxin-contaminated gastropoda (Bullacta exerata). The study has important application for rapid and accurate diagnosis of PSTs and TTXs toxin poisoning patients in clinic.

Assessment of Serum cholinesterase and Serum Creatinine Phosphokinase Levels in Organophosphorus Poisoning Patients at a Tertiary Care Centre of Northern India

Introduction: Poisoning with Organophosphorus compounds is an important global health problem, possibly the most common acute poisoning in developing countries. This study was done to correlate the severity of acute organophosphorus poisoning with serum cholinesterase and serum creatine phosphokinase level.Materials and Methods: A Prospective observational clinical study was done on 42 patients suspected of Organophosphorus poisoning of age &gt;15 years admitted to the emergency unit at a tertiary healthcare center in northern India. Serum cholinesterase levels and serum Creatinine phosphokinase levels were estimated at the time of admission in all patients and the severity of Organophosphorus poisoning was assessed according to Peradeniya Organophosphorous Poisoning (POP) Scale.Results: In this study, among 42 patients of acute organophosphorus poisoning 32(76.2%)were males and 10(23.8%) were females. Our study authors observed a significant correlation between the severity of poisoning categorized by the POP scale and the serum cholinesterase and Serum CPK level at the time of the patients’ initial presentation. Also found that there was a significant correlation between serum cholinesterase and serum CPK with the outcome of the patients.Conclusion: In our study severity as well as outcomes of OP poisoning was directly correlated with serum cholinesterase level and serum Creatinine phosphokinase.

Determination of six arsenic species in urine by high-performance liquid chromatography-inductively coupled plasma-mass spectrometr

Objective: Establishing an analysis method for the detection of six arsenic compounds trivalent arsenic, pentavalent arsenic, methyl arsenic, dimethyl arsenic, arsenical choline and arsenical betaine in urine by high-performance liquid chromatography-inductively coupled plasma-mass spectrometry (HPLC-ICP-MS) and providing a theoretical basis for health assessment of arsenic poisoning patients. Methods: HPLC-ICP-MS was used to detect six arsenic compounds with the hamilton PRP-X100 column and aqueous ammonium phosphate in a gradient elution as mobile phase. Results: There was a good linear relationship in the selected range of six arsenic compounds evidenced by a linear correlation coefficient greater than 0.999. The detection limit of 6 arsenic compounds was 0.46~0.57 μg/L, and the minimum quantitative concentration were 1.52~1.91 μg/L. The recovery rates of six arsenic compounds were 96.5%~106.4%, The within-run and between-run relative standard deviation was 2.9%~6.2% and 3.8%~8.7%. Conclusion: The established method with high accuracy and precision is suitable for detecting arsenic levels in urine of occupational arsenic exposure population.

Temporal Trend and Spatial Distribution of Drug Poisoning in Semnan Province: A Retrospective Longitudinal Study

Background: Substance abuse and the risks of its consequences are the major public health problems in the world and Iran. Objectives: The objective of the present study is determination the epidemiological status and spatial distribution of high-risk and low-risk clusters along with estimating the relative risk of drug poisoning in Semnan in 8 years. Methods: A descriptive-analytical and retrospective longitudinal study was conducted that examined all 3360 poisoned patients who referred to the hospitals of Semnan province from 2011 - 2018. The total number of visits was received and analyzed by year with the relevant diagnostic code in ICD-10 from hospitals of the province, and data were analyzed using Joinpoint regression analysis, global Moran’s index and Kuldorff's spatial statistic scan at a significant level of 0.05. Results: The number of clients varied from 219 in 2011 to 570 in 2015. The patients' mean age was 26.7 years. The average annual number of cases per one hundred thousand individuals (annual cases/100000) was 598.4. The AAPC of the incidence of drug poisoning was 9.8 and significant in the whole province, demonstrating that the incidence of poisoning increased by an average of 9.8% per year in the whole province from 2011 to 2018. Semnan County with LLR = 533.07 was the most likely low-risk cluster, and Shahroud County was the most likely high-risk cluster with LLR = 219.94. Conclusions: Drug policies need to be adapted to the geographical differences in the place death. After clustering regions in poisoning incidents, the necessary interventions can be concentrated for these specific geographical locations.

Epidemiology of poisoning in Syria (1999 through 2020)

Introduction Acute poisoning is a significant international public health issue and one of the leading causes of death in the emergency department (ED). In the absence of any previous reports describing the poisoning profile in Syria, we present this study to assess the epidemiological and clinical characteristics of poisoning over 21 years. Methods We collected the data retrospectively from the Syrian Poisons Information Centre (SPIC) from January 1999 until December 2020. The data included patients who had accidental or non-accidental exposure to poisons, either by drugs, medicaments, and biological substances or substances chiefly nonmedicinal sources such as soaps and detergents, corrosive substances, pesticides, and other miscellaneous products. Results We collected the data of 120,972 poisoned patients, of whom 52.6% were females, and 47.4% were males. Aleppo governorate reported the highest number of poisoned cases (28.6%), followed by Damascus governorate (19.9%). The highest poisoning rates were recorded in 2020, 2014, and 2010. Pharmaceutical (37.0%) and animal (33.8%) sources were the most common causative agents. The oral route was the route of poisoning in 58.3% of patients, and 33.4% through the skin. The most common poison was scorpion stings 19.5% while the most common cause of death was organophosphates 15.7%. Discussion The differences in socioeconomic status, cultural habits, and agricultural and industrial activities between countries have led to a state of fluctuation regarding the most common poisoning agents. Conclusion Damascus and Aleppo, the two major governorates in Syria, had the highest poisoning cases. Oral administration of pharmaceutical agents was responsible for most of the poisoning cases. The most common individual poison was the scorpion poison, while the top killer was organophosphates.

Clinical application of BIS combined with LCR in assessing brain function and prognosis of patients with severe carbon monoxide poisoning

BackgroundThis study investigated the value of the bispectral index (BIS) and lactate clearance rate (LCR) in the assessment of cerebral neurological injury and prognosis in acute severe carbon monoxide poisoning (ASCOP) patients. MethodsA retrospective study was conducted on 86 ASCOP patients admitted to our hospital from November 2019 to March 2021. The patients' prognosis neurological function of the brain after 3 months of treatment was observed. The patients were divided into good (48) and poor (38) groups according to the different prognoses. The GCS-Pittsburgh score (G-P score) was performed on the patients after admission. BIS and LCR were recorded at admission, 6 h, 24 h, 48 h, and 72 h after admission. We conducted correlation and multivariate regression analysis for each factor. ROC curves were used to assess the diagnostic efficacy of each index on prognosis. ResultsThe two different prognosis groups showed that there were no significant differences for gender, age, treatment-free period, and APACHE II score at admission (P > 0.05); the G-P score, the BIS, and LCR at different times of admission was significantly higher in the good group than in the poor group (all P < 0.05). Both the 24 h of BIS and the LCR were diagnostically superior to the G-P score (P < 0.05); the diagnostic efficacy of the two combined was not superior to that of the individual factors (AUC=0.787), but had a high specificity (93.8 %). ConclusionBIS monitoring and LCR have clinical value in the assessment of neurological damage and prognostic in ASCOP patients.

Trends and Outcomes of Acute Poisoning in Felege Hiwot Comprehensive Specialized Hospital Medical Intensive Care Units: Retrospective Study.

Acute poisoning with agrochemicals, medicines and different environmental exposures continues to be a global health problems. However, with our search for reports about acute poisoning, there was no data regarding a change in trends and outcomes of acute poisoning in Ethiopia and its districts. This study was to determine the burden of poison-related health hazards, identify poisoning substances, and clinical outcomes of poisoning cases admitted to Felege Hiwot Comprehensive Specialized Hospital- Medical intensive care unit (FHCSH-MICU), Bahir Dar, Ethiopia. A retrospective hospital-based study was conducted using patient data archived from March 2019 to February 2020 at FHCSH-MICU. Collected data were analyzed using Statistical Package for Social Sciences (SPSS) software version 26 and descriptive statistics such as measures of central tendency and proportions were computed. The results were reported as text narrations, figures and tables. A total 121 poisoned patients were identified from the patient registration log books. Among the total FHCSH-MICU cases registered, acute poisoning accounted for 17.0%. Of 121 poison cases, 118 (98.3%) were due to suicide attempts with the female to male ratio being 1.5:1. The majority, 65 (54.0%), of cases were in the range of 21-30 years age. Nearly two-thirds, 75 (62.0%), of the poisoning cases died, accounting for 21.6% of all deaths in the FHCSH-MICU. The most common poisoning substance was aluminum phosphide, 92 (76%). Aluminum phosphide became the leading poisoning substance in the study area. Nearly two-thirds of the poisoning cases died. Hence, aluminum phosphide must be placed in secured and inaccessible places and it should be replaced by less poisonous rodenticides. Health education and awareness creation about this lethal toxin are strongly advisable.

Establishment and application of a screening method for 354 organic toxicants in blood and urine with high-performance liquid chromatography-high-resolution orbitrap mass spectrometry.

A rapid and sensitive high-performance liquid chromatography-high-resolution orbitrap mass spectrometry method was developed for the simultaneous screening of 354 organic poisons and metabolites in blood and urine, including drugs, medications, pesticides, rodenticides, veterinary drugs, alkaloids, and mycotoxins with a multi-toxicant chromatography-mass spectrometry information library. The method and library showed good prospects in clinical poisoning screening and forensic toxicological identification. Blood and urine samples were extracted successively with ethyl acetate in acidic and alkaline conditions; then, the extract was blown to nearly dry by nitrogen gas and redissolved with methanol-aqueous solution (v:v, 50:50), and the dissolved solution was analyzed by LC-MS/MS after filtering. Precursor ions' m/z was set for identification, retention time, fragment ions, and isotopic pattern which were used for confirmation. No interference peaks were found in the blank samples, showing good specificity. The LODs of toxicants in urine and blood were 1.00×10-3-50.0 ng/mL and 2.07×10-3-50.0 ng/mL, respectively, while the LOQs were 3.30×10-3-1.67×102 ng/mL and 6.91×10-3-1.67×102 ng/mL. The intra-day precision and inter-day precision of urine samples were 2.31-9.13% and 4.75-12.3%, respectively, which were 1.92-10.8% and 2.01-12.1% in blood samples. The established method was applied to analyze 9 cases of clinical poisoning patients, and bromadiolone, carbofuran, and amanitins were detected, respectively. A total of 382 biospecimens from drug abusers were analyzed with the proposed method, which indicated that some drugs were detected in 62 cases, mainly including methamphetamine, heroin, and MDMA. The results were consistent with the information from traditional liquid chromatography-triple quadrupole mass spectrometry.

Genome-wide DNA methylation pattern in whole blood of patients with coal-burning arsenic poisoning

Exposure to coal-burning arsenic leads to an increased risk of cancer, multi-systems damage and chronic diseases, with DNA methylation one potential mechanism of arsenic toxicity. There are few studies on genome-wide methylation in the coal-burning arsenic poisoning population. Illumina 850 K methylation beadchip is the most suitable technology for DNA methylation of epigenome-wide association analysis. This study used 850 K to detect changes in Genome-wide DNA methylation in whole blood samples of 12 patients with coal-burning arsenic poisoning ( Arsenic poisoning group) and four healthy control participants (Healthy control group). There is clearly abnormal genome-wide DNA methylation in coal-burning arsenic poisoning, with 647 significantly different methylation positions, 524 different methylation regions and 335 significantly different methylation genes in arsenic poisoning patients compared with healthy controls. Further functional analysis of Gene ontology (GO) and Kyoto encyclopedia of genes (KEGG) found 592 GO items and 131 KEGG pathways between patients of coal-burning arsenic poisoning and healthy control. Then, analysis of gene degree and combined-score identified NAPRT1, NT5C3B, NEDD4L, SLC22A3 and RAB11B as target genes. Further validation by qRT-PCR indicates that mRNA expression of five genes changes significantly in the arsenic poisoning group (n = 72) compared to the healthy control group (n = 72). These results showed the genome-wide methylation pattern and highlighted five critical genes within the coal-burning arsenic poisoning population that involve Nicotinate and nicotinamide metabolism, Choline metabolism in cancer, and Ubiquitin mediated proteolysis. Next, the methylation profile of coal burning arsenic poisoning will be further excavation and the mechanism of coal burning arsenic poisoning will be further explored from five genes related pathways and functions.

Characteristics of suicidal poisoned patients admitted to tertiary care center during COVID-19 pandemic

BackgroundSuicidal poisoning is a major concern during the COVID-19 pandemic that has several physical and mental hazards. This study aimed to evaluate the characteristics of suicidal poisoned patients admitted to a tertiary poison control center during the pandemic lockdown and assess COVID-related knowledge and attitude among those patients to identify the high-risk group for suicide. This cross-sectional study was conducted on acutely poisoned patients admitted to Tanta University Poison Control Center from June to December 2020. Upon admission, socio-demographic data, causative poisoning agents, COVID-related knowledge and attitude, Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D) were collected from all participants.ResultsA total of 254 poisoned patients were categorized into suicidal (85.04%) and accidental (14.96%) poisoning groups. The former was caused mainly by phosphides and was significantly associated with a history of using psychotropic medications and high HAM-A and HAM-D results. Logistic regression analysis showed that a history of psychiatric illness, low attitude scores, and high HAM-D scores were significant risk factors for suicidal poisoning.ConclusionsConsiderable number of suicidal poisoned patients had moderate-to-severe depressive symptoms, highlighting the importance of providing specialized psychiatric services in poisoning centers, particularly among vulnerable populations, to prevent the overwhelming repeated suicidal attempts.

Prediction rule of supratherapeutic peak serum salicylate level in poisoning patients attending emergency departments

Background:Analgesic poisoning is common in Hong Kong. Analgesics containing salicylate are easily available. Salicylate poisoning may be encountered in the daily practice of the accident and emergency department. The issue of routine salicylate screening was discussed in a number of articles, and the viewpoints of most authors were that routine salicylate screening was unnecessary.Objectives:The primary outcome is to explore the predictive factors of supratherapeutic peak serum salicylate level (&gt;2.17 mmol/L) and delineate the role of routine screening serum salicylate level in poisoned patients attending the accident and emergency department.Methods:This is a retrospective cohort study. Poisoning cases presented to Hong Kong Poison Information Centre between 1 July 2008 and 31 October 2020 with serum salicylate level checked were included. The demographics, laboratory parameters and clinical outcomes were reviewed.Results:There were 8673 cases included with serum salicylate level checked, accounting for 17% of all poisoning cases. Sixty-six (0.76%) cases had supratherapeutic peak serum salicylate level and 11 (0.13%) of them were undeclared salicylate ingestion. Worse clinical outcomes were observed in cases with supratherapeutic peak serum salicylate level. Univariate analysis showed that tinnitus, hyperthermia, alkalaemia, metabolic acidosis, respiratory alkalosis and therapeutic use of aspirin were significantly associated with supratherapeutic peak serum salicylate level. Variables with p &lt; 0.3 were entered into the backward stepwise logistic regression by likelihood ratio. A clinical prediction rule with three attributes (tinnitus, therapeutic use of aspirin and partial pressure of CO2&lt;5 kPa) was derived. It showed 100% sensitivity in internal validation.Conclusion:Serum salicylate level should be checked in poisoned patients with (1) tinnitus, (2) the therapeutic use of aspirin or (3) partial pressure of CO2&lt;5 kPa in arterial or venous blood gas. Routine salicylate screening remained a tool for clinicians not experienced in toxicology.

Ambulance referrals to an Australian Poisons Information Centre: a retrospective series

Introduction For poisoned patients, ambulance services may be the first point of contact for medical attention. With limited training in toxicology, ambulance services are encouraged to contact the Poisons Information Centre (PIC) for advice. This study aims to characterise referrals to a PIC from a state ambulance service with the purpose of improving information delivery and efficient use of these services. Methods This was a retrospective observational series of referrals to an Australian state PIC from ambulance staff from 1 January 2020 to 31 December 2020. Referrals were identified through the PIC Pharmhos database where the call originated from either a paramedic or emergency dispatch officer. Call reports were reviewed to extract data on patient demographics, exposure details and advice provided by the PIC. Results There were 1537 calls regarding 1420 poisoning exposures over the 12-month period, with 117 (7.6%) follow-up calls, representing 4.1% (1537/37835) of total calls to the PIC. Initial calls originated from paramedics in 999/1420 (70.4%) referrals, with dispatch officers referring 421/1420 (29.6%). Paediatric patients aged <15 years were involved in 492/1420 (34.6%) exposures with the commonest age range being 1–4 years. Most referrals involved pharmaceuticals exposures (756/1420 [53.2%]) followed by chemicals (557/1420 [39.2%]) and drugs of abuse (69/1420 [4.9%]). The commonest agents involved were paracetamol followed by quetiapine and sertraline. The PIC advised no treatment following benign exposures in 617/1420 (43.5%) calls, first aid measures in 333/1420 (23.5%) calls, supportive measures in 339/1420 (23.9%) calls and specific treatment in 32/1420 (2.3%) calls. Referral to the hospital was advised in 761/1420 (53.6%) calls, the majority of these were following deliberate self-poisonings (428/1420 [30.1%]). Conclusions Ambulance staff commonly contact the PIC following benign exposures where no treatment is required. Ambulance referral to a PIC following suspected poisonings may have a role in preventing unnecessary transfer to hospital in poisoned patients.

Vasodilation in patients with calcium channel blocker poisoning treated with high-dose insulin: a comparison of amlodipine versus non-dihydropyridines

Background: High dose insulin (HDI), an inotrope and vasodilator, is a standard therapy for calcium channel blocker (CCB) poisoning. HDI causes vasodilation by stimulating endothelial nitric oxide synthase (eNOS). Most literature supporting HDI for CCB poisoning involves verapamil toxicity; however, amlodipine now causes more CCB poisonings. Unlike other CCBs, amlodipine stimulates eNOS and may cause synergistic vasodilation with HDI. The purpose of this study was to determine if amlodipine-poisoned patients treated with HDI had more evidence of vasodilation than similarly treated patients with non-dihydropyridine (non-DHP) poisoning. Methods: This was a retrospective study from a single poison center. Cases were identified via the generic code “Calcium Antagonists” in which the therapy “High Dose Insulin/Glucose” was “performed, whether or not recommended” from 2019–2021. Evidence of vasodilation was assessed via maximum number of vasopressor infusions per case, vasopressor doses, and use of rescue methylene blue to treat refractory vasoplegia. Results: Thirty-three patients were enrolled: 18 poisoned with amlodipine, 15 with non-DHPs (verapamil n = 10, diltiazem n = 5). The median number of maximum concomitant vasopressors in the amlodipine group was 3 (IQR: 2–5; range 0–6) and 2 in the non-DHP group (IQR: 1–3; range 0–5; p = 0.04); median difference in maximum concomitant vasopressors between groups was 1 (95% confidence interval: 0–2). Median maximum epinephrine dosing was higher in the amlodipine group (0.31 mcg/kg/min) compared to non-DHPs (0.09 mcg/kg/min; p = 0.03). Use of rescue methylene blue was more common in the amlodipine group (7/18 [39%]) than in the non-DHP group (0; p = 0.009). Conclusions: Amlodipine poisoned patients treated with HDI required more vasopressors, higher doses of epinephrine, and more often received rescue methylene blue than similarly treated patients with verapamil or diltiazem poisoning. These differences suggest amlodipine-poisoned patients had more evidence of vasodilation. Further study is warranted to determine if synergistic vasodilation occurs when HDI is used to treat amlodipine poisoning.

Frequency of Patterns and Risk Factors of Acute Accidental Poisoning Among Children of Age 5-10 Years

Background &amp; Objective: Poisoning in children is a leading cause of fatalities across the globe; around 2% of injury related deaths are incriminated due to accidental poisoning in the developing countries.1The objective of this study was to determine the frequency of patterns and contributing factors of acute accidental poisoning among children of age 5-10 years. Methods: A cross-sectional type of study was done at the Jinnah Hospital, Lahore from November 20, 2018 to May 20, 2019. All accidental poisoning patients were enrolled. General and specific management steps were carried out in all the cases. After discharge they were kept on follow up in Pediatrics Outdoor Patient Department. Information regarding their demographic data was noted in the proforma. The patterns and contributing factors of acute accidental poisoning among children were identified. SPSS v23.0 was used to assess the obtained data. Results: Age range in this study was from 5 to 10 years. Mean age of child was 7.3±1.6 years. Among 145 children, 89(61.4%) were males and 56(38.6%) were females. The result of the study were unsafe storage of household poison 94(64.8%), inadequate supervision 91(62.8%), working mother 49(33.8%), low SES 19(13.1%) and illiterate mother 13 (9.0%). Conclusion: Unsafe storage of household poison 94(64.8%) was the most common factor followed by inadequate supervision 91(62.8%), working mother 49(33.8%), low SES 19(13.1%) and illiterate mother 13 (9.0%).There is a need to arrange health promotion and protection programs at various levels through projects, brochures and electronic media campaigns so that the awareness of parents can be raised regarding accidental poisoning and they can observe preventive measures in the future to reduce its incidence .

The incidence of self-harm ingestions in adolescents and young adults at a tertiary care center

BackgroundThere has been an increasing incidence of self-harm attempts in recent years in the United States. Particularly concerning, there has been a growing trend of self-harm in the adolescent and young adult population. In order to inform initiatives to address this trend, risk factors and substances used for self-harm need to be clarified. MethodsThis is a descriptive retrospective observational study on all cases of self-harm poisoning in patients between the ages of 12 and 25 years reported at the state's only tertiary care center from January 2019 through March 2022. ResultsThere was an increased incidence of 69% for self-harm poisonings for all ages and a 90% increase in ages 12–17 years between the years 2019 and 2021. Fifty percent of all cases occurred in patients aged 14–17 years, 69% were female, and 22% required an intensive care unit. The top three most common substances used are available without a prescription. DiscussionThere was a persistent increase in self-harm attempts via poisoning throughout the study period with a particularly vulnerable period in the adolescent age group.

Compliance to whole bowel irrigation recommendations: a single poison center study

Introduction: Whole Bowel Irrigation (WBI) is used as a method of gastrointestinal decontamination for poisoned patients and may have low compliance when recommended by poison centers (PC). We set out to determine WBI compliance and analyze trends and possible associations between WBI compliance and clinical outcomes. Methods: We conducted a single-center retrospective chart review of PC data from 1/1/2011 to 12/31/2019 and included cases in which WBI was recommended. We collected demographic data, exposure history, therapies recommended and performed, and clinical outcomes. Compliance rate was calculated. Chi-squared and Mann-Whitney U tests were performed to look for differences in compliance based on case characteristics such as compliance rate by year, compliance based medication ingested and presence of intubation. We also looked for a possible association between WBI compliance and clinical outcome. Results: Four hundred and eighty-three cases met inclusion criteria. Fifty-five percent of patients were male and the median age was 32.5 years. Compliance to WBI recommendations was 58.2%. There was no significant difference in compliance when comparing by age, gender, medication ingested, or year. There was no association between compliance to WBI and clinical outcomes. Conclusions: We calculated a compliance rate of 58% when WBI was recommended. Compliance to WBI does not appear to be associated with changes in clinical outcome.

Accuracy of dispatch and prehospital triage performance in poisonings - A retrospective study from northern Finland.

Increasing numbers of dispatches place a burden on EMS; this study sought to assess the prehospital evaluation of poisoned patients transported to hospital. The primary aim of this study was to measure dispatch centre and EMS provider performance as well as factors contributing to the recognition of poisoning among prehospital patients. The secondary aim was to compare triage performance between dispatch centres and EMS providers. A retrospective single-centre study in Northern Finland was conducted. Patients suspected as poisonings by dispatch centres as well as other EMS-transported patients who received a diagnosis of poisoning in hospital between June 1, 2015 and June 1, 2017, were included. There were a total of 1668 poisoning-related EMS missions. Dispatch centres suspected poisonings with sensitivity of 79.9% (95% CI 76.7-82.9) and specificity of 98.9% (95% CI 98.9-99.0) when all EMS missions were taken into account. In a logistic regression model, decreased state of consciousness as dispatch code (OR 7.18, 95% CI 1.90-27.05) and intravenous fluid resuscitation (OR 6.58, 95% CI 1.34-32.37) were associated with EMS transport providers not recognizing poisoning. Overtriage rate appeared significantly higher (33.6%, 95% CI 28.6-39.2) for dispatch when compared with transport (17.8%, 95% CI 13.9-22.6). Dispatch centres seem to suspect poisonings fairly accurately. Poisonings unrecognized by EMS providers may be linked with intravenous fluid resuscitation and decreased patient consciousness. Overtriage appears to resolve somewhat from dispatch to transport. There were no fatal poisonings in this study population.

Hepatotoxicity Among Poisoned Patients: A Cross-sectional Study

Background: Drug-induced liver injury is a major cause of hepatitis worldwide. In patients diagnosed with acute poisoning, drug-induced liver injury is a critical challenge. This study aims to evaluate the pattern of hepatotoxicity in poisoned patients admitted to Loghman Hakim Hospital. Methods: In this cross-sectional study that was conducted at Loghman Hakim hospital, the clinical records of poisoned patients were evaluated and patients with hepatotoxicity were selected for final analysis. The clinical and para-clinical information of these patients was recorded. The SPSS software, version 23. was used for statistical analysis. Results: A total of 260 cases were included in this study. The Mean±SD age of patients was 38.24±16.29 years and most of them were male (79.2%). Patients with narcotics poisoning had the highest prevalence (38.5%), especially when they were taken together with acetaminophen or benzodiazepine. In addition, among the patients studied, those with underlying cardiovascular disease are more likely to develop hepatotoxicity. Conclusion: In conclusion, among people with various types of poisoning, it seems that narcotics (opium, heroin, methadone, etc.), particularly when taken together with acetaminophen or benzodiazepines, cause hepatotoxicity and increase serum levels of liver aminotransferases. Also, in the study population, patients with underlying cardiovascular disease had a higher chance of liver injury. Therefore, clinicians are recommended to accurately monitor the sign and symptoms of hepatotoxicity in these populations.

106 Lipid Emulsion Therapy During Resuscitation of the Critically-Ill Poisoned Patient: A Prospective Cohort Study

Intravenous lipid emulsion (ILE) has emerged as a potential antidote for treatment of intoxication by lipophilic drugs. Despite conflicting pre-clinical (animal) data, its use continues to expand. The “lipid sink” theory, which is the prevailing theory on ILE mechanism of action, suggests that ILE generates a flux of drugs from the periphery into the vascular compartment, thereby reducing the target organ exposure and toxicity of lipophilic drugs. The primary aim of this pragmatic, real-life prospective cohort study was to compare efficacy (measured by patient survival to hospital discharge) of ILE during resuscitation of critically-ill poisoned patients intoxicated by xenobiotics with wide spectrum of lipophilicities (determined by the octanol water partition coefficient (Log P).

Diagnosis and Treatment of 100 Cases of Liver Poisoning

Objective — To analyze the diagnosis and treatment of hallucinic mushroom poisoning and provide evidence for the early diagnosis and treatment of mushroom poisoning. Methods — 100 patients included from May 2017 to April 2021 were analyzed, monitored the relevant laboratory indicators, counted the impaired organ function, and analyzed the efficacy of relevant treatment programs. Results — Among 100 patients with liver poisoning, in 11 cases of gastrointestinal poisoning, for 11.00%, disease course (5.32 ± 3.12) h; in 89 cases, neuropsychiatric poisoning occurred, for 89.00%, disease course (2.05 ± 0.61) h, among them, the neuropsychiatric poisoning patients accounted for the highest proportion, patients with gastrointestinal type have a long disease duration. Of the 100 patients with BHF poisoning, in 7 cases of nausea and vomiting, for 7.00%; in two cases of abdominal pain, for 2.00%; one case of severe diarrhea, for 1.00%; one case of gastrointestinal bleeding, for 3.00%; in 12 cases, for 12.00%; tears in 5 cases, for 5.00%; in 32 cases, for 32.00%; slow pulse in 13 cases, for 13.00%. Vision — 74 cases, Accounting for 74.00%.There were no abnormal changes in liver and kidney function indicators (ALT, AST, A S T, BUN, SCr, CK, CK-MB, LDH, WBC, Tbil, PTA, and Dbil) in 100 patients with vine liver bacteria intoxication, and no significant difference was found before and after treatment (P&gt; 0.05). All the 100 patients with bovine liver bacteria poisoning recovered and were discharged after relevant treatment measures, with a cure rate of 100%, among which the neuropsychiatric hospital stay time was shorter than the gastrointestinal type (P &lt;0.05). Will 100 poisoning patients according to the severity of mild group (mild, moderate) 78 cases, severe group 22 cases, the influence of both groups, mild group age, hypertension, diabetes, hyperlipidemia, high homocysteinemia are significantly lower than the severe group (P &lt;0.05). Conclusion — most patients with neuropsychiatric damage, after taking timely treatment measures, the cure rate is quite large, including the toxic prognosis is affected by the factors such as age, basic disease history, with basic diseases of elderly poisoning groups need to pay special attention, when necessary, such as blood perfusion to ensure the cure rate.