Severity Of Poisoning Research Articles

The occurrence of delayed neuropsychologic sequelae in acute carbon monoxide poisoning patients after treatment with hyperbaric or normobaric oxygen therapy.

This study aimed at assessing which one of the 2 therapies is better for treating carbon monoxide (CO) poisoning from the perspective of reducing delayed neuropsychologic sequelae (DNS).We used Taiwan's National Health Insurance Research Database (NHIRD) to conduct a nationwide population-based cohort study to assess which therapy is better for CO poisoning patients. To accurately identify patients with DNS, the definition of DNS is included neurological sequelae, and cognitive and psychological sequele. The independent variable was therapy and the dependent variable was DNS occurred within 1 year after discharge from a medical institution. The control variables were age, gender, the severity of CO poisoning, and comorbidities present before CO poisoning admission.The risk of developing DNS in patients treated with Hyperbaric Oxygen (HBO) was 1.87-fold (P < .001) than normobaric oxygen (NBO) therapy. The severity of CO poisoning and comorbidities were also found to have significant influences on the risk of developing DNS.HBO may be a risk therapy for treating CO poisoning.

Development of Quick Reference Manual for the Management of Drug Overdose and Poisoning

Aim: To develop a reference manual for the management of drug overdose and poisoning.Methods: A prospective developmental study was performed for a span of six months at a tertiary carehospital in Erode. Information on the management of cases of drug overdose and poisoning was providedbased on queries received at the Drug Information Center and the poisoning cases identified in the respectivehospital over the past three years. Further attention was paid to detecting local poisons. Such informationwas collected on the basis of literature reviews, magazines and newspapers. In addition to drug and poisonmonographs; android applications, toxicological databases and links, standard reference books and articleson drug overdose and poisoning were included. Locally reported cases have been given more focus.Results: A formulary was prepared which includes the management information for 100 drugs and 57 toxicsubstances that were identified after extensive research. The signs and symptoms of the various poisoningcases were graded as mild, moderate and severe based on poison severity scale (PSS) and respective antidoteswere mentioned.Conclusion: As per our knowledge, this is the first formulary that focus on local poisons. The implementationof the formulary may have a significant impact on healthcare professionals to improve the quality of lifeof patients.This provides important information of localized poisoning and drug overdose in a nutshell andtherefore offers as a quick data to the enquirer.

Clinical Spectrum and Severity of Poisoning in the Paediatric Intensive Care Unit of a Tertiary Care Centre in Uttarakhand: A Retrospective Cohort Study

Introduction: Acute poisoning causes significant mortality and morbidity among children worldwide. However, the pattern of poisoning and causative substances varies significantly in geo- demographic areas. Aim: To describe admissions due to acute poisoning in the Paediatric Intensive Care Unit (PICU) of a tertiary care centre in terms of demographics, clinical profile, specific agents involved and severity of poisoning. Materials and Methods: This was a retrospective cohort study conducted in PICU of a tertiary care level teaching institute of Uttarakhand, India, over a period of three years on subjects of age group from one month to 18 years. Data was collected and analysed for demography, clinical presentation, substance, management, complications, and outcome. Poison Severity Score (PSS) was used to assess the severity of poisoning. Data was analysed using Statistical Package for the Social sciences (SPSS) software version 21.0. Results: During the study period, out of total 751 PICU admissions, 45 were due to poisoning. Organophosphates 20 (44%) and aluminium phosphide 12 (26%) were the most common substances used. Accidental poisoning was common 6 (46%) among less than five years of age. However, suicidal attempts were noted more frequently 20 (64%) among &gt;15 years of age group. Vomiting 31 (69%), altered sensorium 23 (51%), and pain abdomen 16 (35%) were the most common presentations. Nine (20%) patients required ventilatory support as well. Three (6.6%) patients died; all associated with aluminium phosphide poisoning. Conclusion: The most common poison consumed is organophosphate. Aluminium phosphide is the most lethal poison, accounting for all the deaths in the study. Accidental poisoning is common in children less than five years of age. Suicidal poisoning is common among adolescents which must be prevented by early detection of stress. Primary health care facility hesitates to intervene even for basic poisoning care before referring.

Correlation of Serum Amylase, Lipase and Creatine Kinase with Severity of Organophosphate Poisoning- A Cohort Study

Introduction: Organophosphate Compounds (OP) are widely used pesticides in agriculture. It is easily available and OP poisoning is most common cause of poisoning and hospital admissions. Severe poisoning is associated with high mortality. Severity of poisoning can be assessed by Peradeniya Organophosphorus Poisoning (POP) scale, Acute Physiology and chronic Health Evaluation (APACHE) II, Glasgow Coma Scale (GCS) or serum Cholinesterase Level (ChE). Serum amylase, lipase, and creatine kinase are important biomarkers raised in OP poisoning. Aim: To correlate serum amylase, lipase, and creatine kinase with severity of OP poisoning. Materials and Methods: This was a hospital based observational cohort study conducted on 130 patients of organophosphate poisoning admitted in General Medicine wards of SCB Medical College, Cuttack, Odisha from June 2019 to December 2020. Serum Acetylcholine Esterase (AChE), amylase, lipase and creatinine kinase were estimated at admission, day 2, and at discharge. Other routine investigations were done. Acetylcholine Esterase (AChE) was used to confirm the diagnosis. The severity of poisoning was assessed using POP scale and graded as mild, moderate and severe. The severity of poisoning and the level of enzymes were correlated. The parameters were tabulated and mean values and Standard Deviation (SD) were analysed using Statistical Package For The Social Sciences (SPSS) software version 22.0. Results: Out of 130 patients 91 were males and 39 were females, mostly from rural areas, both farming and non-farming community. Age ranged from 14 years to 79 years, with majority in 19 to 39 years. AChE decreased in all cases depending on severity confirming OP poisoning. Severity as assessed by POP score were mild (52 patients), moderate (46 patients) and severe (32 patients). At admission, the Amylase (U/L), Lipase (U/L), and Creatine kinase (U/L) level (mean±SD) in mild poisoning were 83.7±41.9 U, 70.9±18.6, 72.5±34.9, in moderate poisoning 153.6±109.7, 91.9±47.4, 92.6±81.5, and in severe poisoning 243.9±113.8, 195.3±147.7, 298.8±207.4, respectively. Measurements on second day also remained elevated. Among the severe cases 24 patients developed Intermediate Syndrome (IMS), and 26 patients died. There was positive correlation between increase of enzyme levels and the severity of OP poisoning as per POP score. Conclusion: Serum amylase, lipase, and creatine kinase level correlated well with the severity of organophosphorus poisoning and scan be used additionally as an indicator to assess the severity. Serum amylase is a better indicator of severity than lipase and Creatine Kinase (CPK).

Unintentional Opioid Overdoses Treated at University Clinic of Toxicology-Skopje in a Nine-Year-Period.

The aim of this study was to assess the epidemiological profile of unintentional opioid overdoses, the prevalence and number of psychotropic substances involved in opioid overdoses. This was a descriptive study, in which 180 participants were enrolled, and covered a nine-years-period. For collecting data was used the National patient electronic system "My term". The variables as gender, age, duration of opioid dependence, number of overdoses, type of substance, number of antidote ampoules, duration of hospitalization were analyzed. Severity of poisoning was made by using the Poison severity score. Opioid overdose cases were significantly higher among males than females. Mean age with standard deviation (SD) was 32.23 ± 6.71 years. Mean years (±SD) of duration of opioid use disorder was 11.60 ± 5.89 years. The most commonly used primary substance was methadone in 68.89% and heroin in 31.11% cases. Twenty patients were treated with mechanical ventilation because of the severe respiratory depression. Poison severity score was moderate in 51.11%, severe in 45.56% and fatal in 3.33% of the cases. Most of the cases, predominantly males used one or two substances. The combination of methadone and benzodiazepine was most frequently used and the most common way was by injecting the abused substances. In most of the subjects PSS score was moderate and severe with no differences between genders.

Study of emergency laboratory parameters in acute oraganophosphorus poisoning in a rural population- retrospective study

Introduction: Organophosphorus poisoning (OPP) is one of the common medical emergencies among rural population in India due to suicide attempts. The purpose of this study was to investigate the relationship between the initial emergency laboratory parameters (electrolytes, liver function test, random blood glucose (RBS), renal function test, Hb, RBC and WBC) and severity of organophosphate poisoning based on Bardin’s Classification and type of OP compound consumed in patients admitted to emergency department with OPP. Materials and Methods: A retrospective observational study was done in OPP patients admitted to emergency medicine department. Based on Bardin’s classification all OPP cases were classified into 3 Grades of severity of poisoning.1-3 Hematological and biochemical parameters were compared based on this severity of poisoning. Results: With random sampling of 45 patients, 19 male and 26 female patients aged between 25-35 years, admitted with OPP were included in the study. The severity of poisoning was worst in females. The pseudocholinesterase, potassium and creatinine levels were significantly low in patients of grade 3 than grade 1 and grade 2 (p Conclusion: Emergency laboratory parameters in acute oraganophosphorus poisoning reflect the need for basic diagnostic facility in rural area. Laboratory parameters can also serve as possible predictive markers for severe outcomes and prognosis in OP poisoning. The knowledge of type of OP compound consumed can predict the severity of OP intoxication and need for emergency intervention. Keywords: Oragano phosphorous poisoning, Biochemical parameters.

A Study of Correlation of Peradeniya Organophosphorus Scale (POP) and Serum Amylase Level in Assessing the Clinical Severity and Outcome of Organophosphorus Compound Poisoning

A Study of Correlation of Peradeniya Organophosphorus Scale (POP) and Serum Amylase Level in Assessing the Clinical Severity and Outcome of Organophosphorus Compound Poisoning

Unintentional exposure to pregabalin in ≤6-year-old children: a nationwide French Poison Control Center study

Introduction In France, pregabalin is widely prescribed in adults but still not approved for children. We aimed to investigate the incidence of pregabalin exposure in ≤6-year-old children, to describe the characteristics and outcome of ingestions involving pregabalin alone, and to estimate a clinically relevant toxic dose in this population. Methods Retrospective analysis of pregabalin exposures in ≤6-year-old children, collected by the French Poison Control Centers in 2004–2019. The incidence was estimated using pregabalin prescription data from the Health Improvement Network database (the French version of THIN). The poison severity score (PSS) was used to grade severity. Results We found 313 unintentional immediate-release pregabalin ingestions in ≤6-year-old children. The number of cases per 100,000 pregabalin-treated adults increased over time (p < 0.001). One hundred twenty-six cases involving pregabalin alone (age, 2 years [1.6–3.0] (median [25th–75th percentiles]); median ingested dose 6.4 mg/kg [3.6–10.9]) were analyzed. No child presented an underlying neurological/cardiac disease and/or took concomitant medications. Most of the children (77%) remained asymptomatic (PSS0) while 21% and 2% developed minor (PSS1) or moderate (PSS2) neurological symptoms, respectively. No severe complications/fatalities were reported. All symptomatic children recovered within 24 h. The ingested pregabalin dose was positively correlated with PSS (p < 0.0001). Using a ROC curve approach (area under the curve, 0.85; p < 0.001), ingestion of ≥19.4 mg/kg pregabalin was appropriate to recommend hospital referral (sensitivity, 39% [95% confidence interval (95% CI), 24–56], specificity, 100% [95% CI, 96–100], predictive positive value, 100% [95% CI, 64–100], and negative predictive value, 85% [95% CI, 82–89]). Symptomatic children who ingested <19.4 mg/kg pregabalin developed minor symptoms. Conclusion Despite increasing prescriptions in adults in France, unintentional pregabalin ingestions in ≤6-year-old children remain rare and cause minimal toxicity. Children with no underlying neurological/cardiac disease and concomitant medication ingesting <19.4 mg/kg immediate-release pregabalin alone can be safely observed at home.

Pediatric cannabis poisonings in France: more and more frequent and severe

Context Accidental pediatric cannabis poisonings are an incidental effect of cannabis use. The average THC content of cannabis resin and the number of consumers are rising sharply in the USA and in most European countries. The objective is to study the evolution of prevalence and severity of pediatric exposures to cannabis in France. Method This is a retrospective observational study of cases detected by French poison centers between January 1st 2010 and December 31st 2017 of cannabis exposure by ingestion in children aged ten or younger. The clinical severity was assessed using the Poisoning Severity Score (PSS). The criteria used for assessing the overall severity were as follows: PSS ≥ 2, admission to pediatric intensive care, coma and respiratory depression (univariate and multivariate logistic regression). Results A total of 965 cases of poisoning were covered. The annual average number of cases was 93 between 2010 and 2014 and 167 between 2015 and 2017. The median age was 15 months (range, 6 months–10 years) and the sex ratio was 1:1. The form of cannabis ingested was mainly resin (75%). During the period covered by the study, 26.1% of children (n = 252) presented with a PSS ≥ 2, 4.5% (n = 43) coma, 4.6% (n = 44) with respiratory depression and 11.7% (n = 113) were admitted into pediatric intensive care (out of 819 hospitalizations). No fatal cases were reported. In comparison to the 2010–2014 period, the length of hospital stays was significantly higher (p < 0.0001) and the comas were significantly deeper (lower score on the Glasgow coma scale, p < 0.005) in 2015–2017. Following adjustments made for the sex, age and weight of the children, the data show that the severity of the poisonings was significantly greater in 2015–2017 in terms of PSS score, the number of comas and monitoring in intensive care (p < 0.001). Conclusion The data indicates a significant increase in the number of cases of pediatric exposure to cannabis and a rise in the seriousness of poisonings between 2010 and 2017.

Serum Netrin-1 and Asymmetric Dimethylarginine as Biomarkers of Acute and Chronic Carbon Monoxide Poisoning

Diagnosis of carbon monoxide (CO) poisoning is done traditionally by detecting carboxyhemoglobin (COHb) level. However, the severity of clinical manifestations is unrelated to the absolute levels of COHb. Netrin-1 (Net-1) is a protein with anti-inflammatory and anti-apoptotic properties while asymmetric dimethylarginine (ADMA) is an oxidative stress indicator. This study aimed at assessing and comparing between Net-1, ADMA and COHb as biomarkers in CO poisoning. This cross-sectional clinical study was carried out on 30 acutely CO poisoned adults admitted to Benha Poisoning Control Unit, Benha University Hospitals; 30 chronic CO exposed workers at four different car service centres, plus 30 healthy controls. Results showed a positive correlation between serum levels of Net-1 and ADMA and the severity of acute CO poisoning both on admission, and after oxygen therapy. There was a positive correlation between COHb level and both serum levels of Net-1 and ADMA in chronic cases. In conclusion: COHb level can only support the initial diagnosis of acute CO poisoning. Both ADMA and Net-1 are better biomarkers in assessing the severity of acute CO poisoning, where ADMA is better than Net-1. In diagnosis of chronic CO poisoning, both ADMA and Net-1 are as dependable as COHb.

Childhood accidental poisoning among hospitalised children in a tertiary health care in North Central Nigeria - A two year prospective report

Background: The young child can be at risk of accidental poisoning because of its being very inquisitive to mouth objects. The prevalence and typesof poisoning vary within Nigeria and different parts of the world.&#x0D; Aim: To describe the sociodemographics, clinical features and outcome in childhood poisoning seen at the National hospital Abuja (NHA) Nigeria.&#x0D; Subjects and Methods: A descriptive prospective study on children admitted for acute poisoning from September 2014 -August 2016. Consecutive children with a history of poisoning were recruited during the study period. The children were examined, and poison severity scores were recorded into a proforma, and followed up till discharge or demise.&#x0D; Results: Twenty-two children were admitted for acute poisoning, out of the 2336 children seen during the study period, with a prevalence rate of 0.94%. Fourteen (63.6%) were of upper social class, with 12 (54. 5%) mothers having tertiary level education. The mean time (±SD) of presentation was 11.9 ± 23.9 hours, while the mean (SD) duration of hospital stay was 4.8 ± 6.2 days; hospital stay was significant with types of poisoning (Fisher exact test 22.062, p&lt;0.0001). The common poisoning agents were kerosene and organophosphate, 8(36.4%) each, while main clinical features were cough in 8 (36.4%), tachypnoea in 7(31.8%), fever in 6 (27.3%) and 8(36.4%) had home intervention. Two (9.1%) and 4(18.2%) had poison severity scores (PSS) of 3 and 4 respectively, which was significant for time interval of presentation and use of harmful home intervention (Fisher exact test3.697, p=0.024) and (Fisher exact test10.04, p=0.018) respectively. Fatality was 18.2%.&#x0D; Conclusion: kerosene and organophosphate were most common poison agents, while PSS was related to time of presentation, home intervention and types of poisoning agents.&#x0D; Key words: childhood, poisoning, hospitalized, outcome.

Envenenamento fatal por mordedura de Naja Nigricollis em Angola e uso da terapia tradicional: um caso clínico em Benguela

Introdução: O envenenamento por mordedura de serpentes constitui um importante problema de Saúde Pública e uma emergência médico-cirúrgica frequente, que afecta as comunidades rurais de África. É responsável por elevado número de vítimas que podem evoluir para morte, principalmente nas áreas rurais, onde estas comunidades são as que mais sofrem por viverem longe dos serviços de saúde, acabando por submeterem-se a tratamentos tradicionais impedindo o manuseio precoce e adequado dos casos em ambiente hospitalar. O presente artigo tem como objectivo descrever o primeiro caso clínico fatal ocorrido numa criança na Província de Benguela - Angola com envenenamento por naja nigricollis, a espécie que é considerada a segunda mais perigosa de África a seguir à Dendroaspis polylepsis. Trata-se de uma criança que foi mordida de noite no pescoço e pé direito. Durante cinco dias os pais submeteram-na a tratamento tradicional fitoterapêutico com um curandeiro, tendo a mesma acorrido ao Hospital Geral de Benguela com um quadro séptico de fasceíte necrotizante grave, anemia severa tendo-se realizado a necrectomia das regiões afectadas e tratamento adequado da anemia. Resultados: A morte da criança após 4 dias nos cuidados intensivos do mesmo Hospital. Conclusões: A fatalidade deste caso clínico demonstra que apesar do manuseio clinico cirúrgico tardio adequado o espectro da gravidade do envenenamento por naja nigricollis ainda constitui uma realidade que poderia ser evitada se educássemos as nossas comunidades rurais em relação à crença do uso de terapias tradicionais nos acidentes ofídicos em Angola.

Study of serum creatinine phosphokinase and serum lactate dehydrgenase as prognostic markers in organophosphorus poisoning

Background: Organophosphorus (OP) compounds are insecticides which are widely used in agriculture. Acute organophosphorus poisoning is an important cause of morbidity and mortality in developing countries like India. In a limited resourced country like India, we need cheap and easily measurable biomarkers for predicting prognosis.Objective was to estimate creatinine phosphokinase and serum lactate dehydrgenase as prognostic markers in acute organophosphorus poisoning.Methods: Total 94 cases of OP poisoning admitted to KIMS Hospital, Hubbali between January 1st 2017 to December 31th 2017 were studied. Detailed history, clinical examination and lab investigations like pseudo cholinesterase, serum LDH and serum CPK were carried out. Peradeniya OP poisoning scale was applied to all study subjects and the severity of OP poisoning was graded as mild, moderate, severe. Data obtained was analysed by different statistical methods.Results: OP poisoning is more common in adults of age group between 20 - 30 years, Incidence is was more in male patients, Mortality rate is 12.8%. Mean values of serum LDH, serum CPK were negatively correlated with pseudcholinesterase levels and it was statistically significant. Correlation between the severity of OP poisoning (based on Peradenyia score) and biochemical parameters like serum CPK, serum LDH, was statistically significant.Conclusions: The correlation between the severity of OP poisoning and biochemical parameters was statistically significant and they are usefull in predicting development of respiratory failure.

MRI-based brain volumetry and retinal optical coherence tomography as the biomarkers of outcome in acute methanol poisoning

BackgroundBasal ganglia lesions are typical findings on magnetic resonance imaging (MRI) of the brain in survivors of acute methanol poisoning. However, no data are available on the association between the magnitude of damaged brain regions, serum concentrations of markers of acute methanol toxicity, oxidative stress, neuroinflammation, and the rate of retinal nerve ganglion cell loss. ObjectivesTo investigate the association between MRI-based volumetry of the basal ganglia, retinal nerve fibre layer (RNFL) thickness and prognostic laboratory markers of outcomes in acute methanol poisoning. MethodsMRI-based volumetry of putamen, nucleus caudatus and globus pallidus was performed and compared with laboratory parameters of severity of poisoning and acute serum markers of oxidative damage of lipids (8-isoprostan, MDA, HHE, HNE), nucleic acids (8−OHdG, 8−OHG, 5−OHMU), proteins (o-Thyr, NO-Thyr, Cl-Thyr) and leukotrienes (LTC4, LTD4, LTE4, LTB4), as well as with the results of RNFL measurements by optic coherence tomography (OCT) in 16 patients with acute methanol poisoning (Group I) and in 28 survivors of poisoning two years after discharge with the same markers measured within the follow-up examination (Group II). The control group consisted of 28 healthy subjects without methanol poisoning. ResultsThe survivors of acute methanol poisoning had significantly lower volumes of basal ganglia than the controls. The patients with MRI signs of methanol-induced toxic brain damage had significantly lower volumes of basal ganglia than those without these signs. A positive correlation was found between the volume of putamen and arterial blood pH on admission (r = 0.45; p = 0.02 and r = 0.44; p = 0.02 for left and right putamen, correspondingly). A negative correlation was present between the volumes of putamen and acute serum lactate (r = -0.63; p < 0.001 and r = -0.59; p = 0.01), creatinine (r = -0.53; p = 0.01 and r = -0.47; p = 0.01) and glucose (r = -0.55; p < 0.001 and r = -0.50; p = 0.01) concentrations.The volume of basal ganglia positively correlated with acute concentrations of markers of lipoperoxidation (8-isoprostan: r = 0.61; p < 0.05 and r = 0.59; p < 0.05 for left and right putamen, correspondingly) and inflammation (leukotriene LTB4: r = 0.61; p < 0.05 and r = 0.61; p < 0.05 for left and right putamen, correspondingly). The higher the volume of the basal ganglia, the higher the thickness of the RNFL, with the strongest positive association between global RNFL and the volume of putamen bilaterally (all p < 0.01). In the follow-up markers of oxidative stress and inflammation, only o-Thyr concentration negatively correlated with the volume of putamen bilaterally (r = –0.39; p < 0.05 and r = –0.37; p < 0.05 for left and right putamen, correspondingly). ConclusionIn survivors of acute methanol poisoning with signs of toxic brain damage, the magnitude of affected areas correlated with acute parameters of severity of poisoning, markers of oxidative stress and neuroinflammation. There was a positive association between the basal ganglia volume and the thickness of RNFL, making OCT an important screening test and MRI-based volumetry the confirmative diagnostic method for the detection of CNS sequelae of methanol poisoning.

Peripheral polyneuropathy after acute methanol poisoning: Six-year prospective cohort study

BackgroundMethanol is a widely used industrial short-chain aliphatic alcohol with known neurotoxic properties. Mass poisoning outbreaks due to the consumption of methanol-adulterated alcoholic drinks present a challenge to healthcare providers due to the high mortality and serious central nervous system (CNS) damage in survivors. However, the impact of methanol exposure on the peripheral nervous system is unknown. ObjectivesTo investigate the role of acute methanol exposure in the development of peripheral polyneuropathy (PNP) during the years following discharge from the hospital. MethodsA total of 55 patients with confirmed methanol poisoning (mean age of 47.9 ± 3.6 years; 9 females) were examined 4 times within a 6-year prospective longitudinal cohort study. The program included neurological and electromyographic examinations, visual evoked potentials, ocular examinations with retinal nerve fibre layer thickness measurements, brain magnetic resonance imaging, and a series of biochemical and toxicological tests. ResultsPNP was observed in 20/55 (36 %) patients, which, in most of the cases, was mild axonal sensorimotor neuropathy. In 8/55 (15 %) patients, worsening of electromyographic findings was registered during the follow-up period, including 5 cases with newly diagnosed PNP and 3 cases of PNP progression. In one subject, complete reversal of PNP was registered after cessation of alcohol intake. The patients with PNP were significantly older (57.3 ± 5.3 versus 42.5 ± 3.9 years; p < 0.001), with higher blood glucose (5.93 ± 0.97 versus 4.81 ± 0.32 mmol/L; p = 0.035) and lower vitamin B1 (45.5 ± 7.4 versus 57.5 ± 5.2 ug/L; p = 0.015) concentrations. The number of chronic alcohol abusers was significantly higher in the PNP group (17/20 versus 20/35; p = 0.034). No associations between PNP prevalence/ dynamics and acute parameters of poisoning severity, arterial blood pH (7.26 ± 0.07 with PNP versus 7.18 ± 0.09 without PNP; p = 0.150), or serum methanol (1320.0 ± 700.0 with PNP versus 1430.0 ± 510.0 mg/L without PNP; p = 0.813) and ethanol (460.0 ± 560.0 with PNP versus 340.0 ± 230.0 mg/L without PNP; p = 0.675) concentrations at admission were found. No difference in the number of patients with visual (9/20 with PNP versus 12/35 patients without PNP; p = 0.431) and CNS sequelae (9/20 with PNP versus 15/35 patients without PNP; p = 0.877) of poisoning was present. DiscussionDespite the relatively high number of PNP cases, no association was found between the severity of acute methanol poisoning and the prevalence of PNP and its dynamics during six years of observation. We did not find an association between methanol-induced visual/ brain damage and the prevalence of PNP in survivors of poisoning. A high prevalence of PNP and its progression might be attributed to other causes, mainly a history of chronic alcohol abuse and insufficiently treated diabetes mellitus. Our results highlight the importance of complete cessation of alcohol consumption and better control of glycaemia in diabetic patients in the prevention and treatment of peripheral PNP.

Assessment of the Sociodemographic Profile, Pattern, and Outcomes of Intentional Poisoning Cases in an Emergency Department of a Tertiary Care Teaching Hospital.

Background: Intentional self-poisoning has become a major health problem in low- and middle-income countries. Aims: We aimed to assess the sociodemographic profile, pattern, and outcomes of intentional poisoning cases in the emergency department of a tertiary care teaching hospital. Method: A prospective observational study was conducted at the department of emergency medicine of a South Indian tertiary care hospital for 1 year to study the sociodemographic profile, pattern, and outcomes of intentional poisoning cases. Results: The majority of poisonings were observed in the male population (64.5%) and among the age group of 19-40 years (65.2%). Poisoning was prevalent in rural/semi-urban populations (77.5%) and in people engaged in agriculture (28.4%) for their livelihood. Pesticides were the most common agents implicated (65.9%) in poisonings. Based on the Glasgow Coma Scale (GCS) and Poison Severity Scale (PSS), the majority of people with poisoning presented with mild (53.9%) and minor symptoms (36.3%). In 78.5% of the cases, patients recovered while mortality was observed in 5.4% of cases. Conclusion: There was a strong association between outcomes of poisoning and age. Organophosphate pesticides were the most commonly implicated substances in poisonings. Regulation policies should be made by the government to regulate the transport, distribution, and use of insecticides and pesticides.

Non-Opioid Substances Acute Poisonings with Suicidal Intent in Patients with Opioid Use Disorder.

Several epidemiological studies have evaluated the role of illicit drug use in suicide behaviour. To assess patients with opioid use disorder and suicidal intent related to behavior, severity of acute poisoning and the most commonly used non-opioid substances. This cross sectional study included 67 patients diagnosed with opioid use disorder. The study was conducted at the University Clinic of Toxicology in Skopje over a 5-year period (2013-2017). The following variables were examined: gender, age, duration and route of opioid administration, duration of hospitalization, and types of substances used in acute poisoning. Assessment of patients’ behavior and severity of poisoning was made by using the Suicide Behaviours Questionnaire-Revised and the Poison severity score. The majority of patients were male (88.1%). The mean age of patients was 30±6.1 years. The average duration of opioid use disorder was 8.5±3.9. A single poisoning was found in 62.7%, double poisoning in 25.4%, and triple poisoning in 11.9% of participants. Benzodiazepines were most commonly used by the patients (55.2%). The largest number of patients (32.8%) had minor Poison severity score (PSS), and only 17.9% had severe PSS. None of the patients had a fatal suicide attempt. 86.6% of patients had a score of ≥7 indicating a high risk of repeat suicide attempts. Benzodiazepines were most commonly used as a single or combined substance in patients with opioid use disorder. PSS indicated that most of the participants were with minor PSS and with high risk of a repeat suicide attempt.

A prospective study to assess glycemic status as a possible prognostic marker in non diabetic acute organophosphate poisoning patients

Background: Organophosphates (OP) are a diverse group of insecticides used for pest control. Due to easy availability of these compounds over the counter, organophosphate poisoning continues to be a major cause of deliberate self-harm. Although choline esterase inhibition plays a key role in OP poisoning, other metabolic factors like dysglycemia contribute to the severity of poisoning. The present study attempts to assess glycaemic variability as a probable prognostic factor in acute OP poisoning. Aim of the study was to correlate the blood glucose levels with the severity and treatment outcome of acute organophosphate poisoning.Methods: 100 patients of acute organophosphate poisoning admitted in the hospitals affiliated to Bangalore Medical College and Research Institute during the study period from August 2018 to July 2019, were enrolled into the study as per the inclusion criteria and graded into mild, moderate &amp; severe, based on Peradeniya organophosphorus poisoning (POP) scale. Random blood sugar (RBS) was estimated at the time of admission and patients were followed up till recovery/death.Results: The patients in this study were categorized into hypoglycemics (10%), euglycemics (75%) and hyperglycemic (15%). 16% of euglycemics, 30% of hypoglycemics and 60% of hyperglycemics had severe grade of poisoning. The ventilator requirements in hypoglycaemics, euglycemics and hyperglycemics were 40%,48% and 80% respectively. The outcome in terms of mortality was 8% in euglycemics group and 20% in hyperglycemics group. Hence hyperglycemia was found to be a poor prognostic marker in acute organophosphate poisoning.Conclusions: RBS at admission in acute organophosphate poisoning patients is a simple, inexpensive tool that may help to predict the clinical outcome. Early identification of the poor prognostic indicators may help in timely intervention, to reduce morbidity and mortality, especially in a resource limited country like India.

Effect of age on the severity of chronic lithium poisoning

Objectives: Severe lithium toxicity is commonly observed in older people. We aimed to determine the extent to which age is associated with increased severity of chronic lithium poisoning and of which a range of possible factors might explain the associations.Method: We did a retrospective review of patients aged ≥15 years old with serum lithium concentrations ≥1.3 mmol/L from three hospitals. Clinical details, treatment and outcomes were recorded. eGFR, creatinine and lithium clearance were calculated. The severity of lithium toxicity was graded into five categories (Amdisen score). ANOVA was used to quantify the association between age and severity. Spearman correlation coefficient was used to explore relationships between age and different factors expected to alter severity. Ordinal regression analysis was used to determine the interdependence of age and these factors and age on severity of lithium toxicity.Results: From 2008–2018, there were 242 patients with a median age of 56.5 years (IQR: 41–69). There were 156 females (64%). There was a statistically significant association between Amdisen severity scores and age (p = .0004). The median calculated eGFR was 65 mL/min/1.73 m2 (IQR: 41–91) with a corresponding estimated lithium clearance of 18 mL/min (IQR: 13.8–22.8). There was no correlation of age with initial serum lithium concentration (p = .76). There was a strong correlation between age and estimated lithium clearance (r = –0.72, 95% CI: –0.78 to –0.66, p < .001), lithium daily dose (r = –0.65, 95% CI: –0.72 to –0.57, p < .0001) and lithium concentration/dose (r = 0.62, 95% CI: 0.53–0.69, p < .0001). There was a weak correlation between age and infection (r = 0.18, 95% CI: 0.04–0.31, p = .009) and drug interactions (r = 0.25, 95% CI: 0.11–0.37, p = .0003). Ordinal regression indicated the independent predictors for severity of lithium toxicity were lithium concentration (p < .0001) and lithium clearance (p = .03) adjusted for age and dose.Conclusions: Despite lower lithium doses, older patients had more severe toxicity. Increased severity of lithium toxicity in the elderly is largely explainable by decreased lithium clearance from multiple factors such as age-related decline in renal function, drug interactions and infection.

A Study to Assess the Utility of Peradeniya Organophosphorous Poisoning (POP) Scale, Poisoning Severity Score (PSS) and Glasgow Coma Scale (GCS) in Predicting Severity and Treatment Outcome in Acute Organophosphorous Poisoning

A Study to Assess the Utility of Peradeniya Organophosphorous Poisoning (POP) Scale, Poisoning Severity Score (PSS) and Glasgow Coma Scale (GCS) in Predicting Severity and Treatment Outcome in Acute Organophosphorous Poisoning