Treatment Of Acute Poisoning Research Articles

Current state of drug analysis in Japanese emergency departments: a nationwide survey.

In 1999, the Japanese Society for Clinical Toxicology proposed 15 toxicants that would be useful for analysis: methanol, barbiturates, benzodiazepines, bromovalerylurea, tricyclic acid, acetaminophen, salicylic acid, theophylline, organic phosphorus pesticides, carbamate pesticides, glufosinate, paraquat, arsenic, cyanide, and methamphetamine. We aimed to reveal the current state of drug analysis for acute poisoning in the emergency department of Japanese hospitals. From 1 April, 2017, we undertook a questionnaire survey in the emergency departments of 546 hospitals designated as educational institutions for emergency physicians. Responses were obtained from 246 hospitals (45.1%). Among drug abuse screening kits for qualitative testing, 80.9% used the Triage Drugs of Abuse Panel and 7.3% used Instant-View M-1. Analytical results have always been immediately obtained by 2.8% of facilities for methanol, 19.5% for barbiturates, 2.4% for benzodiazepines, 0.8% for bromovalerylurea, 1.2% for tricyclic acid, 12.2% for acetaminophen, 4.1% for salicylic acid, 44.3% for theophylline, 2.0% for organic phosphorus pesticides, 1.6% for carbamate pesticides, 1.2% for glufosinate, 2.4% for paraquat, 0.8% for arsenic, 1.2% for cyanide, and 1.2% for methamphetamine. In the treatment of acute poisoning, drug analysis is important for both clinical judgment and academic verification. However, many of the 15 toxicants proposed to be useful for analysis in 1999 are not yet immediately analyzed in the emergency department of Japanese hospitals. Furthermore, it is necessary to develop inexpensive testing systems and to provide insurance points for testing so that analysis can be carried out by emergency departments.

Clinical Toxicology and Overdose of Psychiatric Medications

This article reviews the poisoning epidemiology in Hong Kong, assessment and treatment of acute poisoning, and management of acute psychiatric medication overdose. In 2016, nearly 4000 poisoning cases involving approximately 6000 poisons were reported to Hong Kong Poison Information Centre. About 25% of the poisons involved were psychiatric-related medications. The initial medical assessment on poisoning includes history taking, vital signs monitoring, and focused physical examination. Approaches in managing acute poisoning include supportive measures, decontamination, antidote use, and enhanced elimination. Management on overdose of psychiatric medications (zopiclone, tricyclic antidepressants, selective serotonin reuptake inhibitor, antipsychotics, valproic acid, lithium, and methylphenidate) are discussed with practical tips highlighted.

Acute Poisoning with Ethyl Alcohol (Alcoholic Coma)

The article summarizes years of the authors experience in the diagnosis and treatment of acute poisonings with ethyl alcohol and presents data on the epidemiology of poisoning with ethyl alcohol, as well as modern terminology and systematization of poisoning with alcohols in accordance with the international classification of diseases ICD 10. We analyzed the pharmacokinetics and pharmacodynamics of ethyl alcohol in its toxic effects. The original clinical classification of alcoholic coma, confirmed by electrophysiological studies of the brain is given in the article. We also determined the involvement of deep structures of the brain in the pathogenesis of acute alcohol poisoning. The emergency therapeutic measures in acute alcohol intoxication and its complications, primarily related to accelerated detoxification of the body by forced diuresis are reported. The importance of effective correction of acid-base blood disorders and prevention of acute renal failure is emphasized. The article might provide a more accurate diagnosis of acute alcohol poisoning, accompanied by the development of alcoholic coma, and to improve the quality of treatment of this disease in the intensive care and toxicology departments.

Mortality and repeated poisoning after self-discharge during treatment for acute poisoning by substances of abuse: a prospective observational cohort study

BackgroundThough substance use is a known risk factor for self-discharge, patients self-discharging during treatment for acute poisoning have not previously been described. We charted characteristics of patients self-discharging during treatment for acute poisoning by substances of abuse looking for associations between self-discharge, repeated poisoning, and death.MethodsAll patients 12 years and older treated for acute poisoning by substances of abuse at an emergency outpatient clinic in Oslo, Norway, were included consecutively from October 2011 through September 2012. We collected data on gender, age, main toxic agent, suicidal intention, homelessness, history of severe mental illness, and self-discharge. Information on deaths was retrieved from the National Cause of Death Register. We did a multiple logistic regression analysis to look for associations between self-discharge and repeated poisoning and a Cox regression analysis for associations between self-discharge and death.ResultsDuring one year, 1731 patients were treated for 2343 episodes of acute poisoning by substances of abuse. Two-hundred-and-sixty-six (15%) patients self-discharged during at least one poisoning episode. Self-discharging patients were older, median age 39 years vs 32 years (p < 0.001), more frequently homeless, 20/266 (8%) vs 63/1465 (4%) (p = 0.035), and the main toxic agent more frequently was an opioid, 82/266 (31%) vs 282/1465 (19%) (p < 0.001). Self-discharge was an independent risk factor for repeated poisoning. The adjusted odds ratio for two or more poisoning episodes during one year among self-dischargers was 3.0 (95% CI 2.2–4.1). The association was even stronger for three or more poisoning episodes, adjusted odds ratio 5.0 (3.3–7.5). In total, there were 34 deaths, 9/266 (3.4%) among self-discharging patients and 25/1465 (1.7%) among patients not self-discharging (p = 0.12). The adjusted hazard ratio for death among self-discharging patients was 1.6 (0.75–3.6).ConclusionsSelf-discharge was associated with frequent poisonings by substances of abuse. Short-term mortality was doubled among self-discharging patients, though this increase was not statistically significant. Still, the increased risk of repeated poisoning marks self-discharging patients as a vulnerable group who might benefit from targeted post-discharge follow-up measures.

Letter to editor: The treatment of acute poisoning in Clinical Emergency Center of Kragujevac

Letter to editor: The treatment of acute poisoning in Clinical Emergency Center of Kragujevac

Emergency management of acute poisoning in children

The clinical manifestations of acute poisoning in children were nonspecific, most of all, the initial symptoms were disturbance of consciousness or even coma.The critical treatment of acute poisoning is quickly identify life-threatening situation, remove the unabsorbed toxins, promote the removal of poison which has been absorbed of blood, timely application the detoxification and organ functional support.The treatment of blood purification and extracorporeal membrane oxygenation technique are important progresses in children′s severe poisoning. Key words: Acute poisoning; Management; Emergency; Child

Some benefit from non-oximes MB408, MB442 and MB444 in combination with the oximes HI-6 or obidoxime and atropine in antidoting sarin or cyclosarin poisoned mice

The effect of three newly developed bispyridinium non-oxime compounds (MB408, MB442, and MB444) on the therapeutic efficacy of a standard antidotal treatment (atropine in combination with the oxime HI-6 or obidoxime) of acute poisoning by two nerve agents (sarin and cyclosarin) in mice was studied. The therapeutic efficacy of atropine in combination with an oxime with or without one of the bispyridinium non-oximes was evaluated by determination of the 24 h LD50 values of the nerve agents studied and by measurement of the survival time after supralethal poisoning. Addition of all tested non-oximes increased the therapeutic efficacy of atropine in combination with an oxime against sarin poisoning; however, the differences were not significant. The non-oximes also positively influenced the number of surviving mice 6 h after supralethal poisoning with sarin. In the case of cyclosarin, they were also slightly beneficial in the treatment of acute poisoning. The higher dose of MB444 was able to significantly increase the therapeutic efficacy of standard antidotal treatment of poisoning with cyclosarin. The benefit of each bispyridinium non-oxime compound itself was obviously dose-dependent. In summary, the addition of MB compounds to the standard antidotal treatment of acute nerve agent poisoning was beneficial for the antidotal treatment of sarin or cyclosarin poisoning, although their benefit at 24 h after poisoning was not significant, with the exception of the higher dose of MB444 against cyclosarin.

The estimation of oxime efficiency is affected by the experimental design of phosphylated acetylcholinesterase reactivation

Reactivation of acetylcholinesterase (AChE), an essential enzyme in neurotransmission, is a key point in the treatment of acute poisoning by nerve agents and pesticides, which structurally belong to organophosphorus compounds (OP). Due to the high diversity of substituents on the phosphorous atom, there is a variety of OP-AChE conjugates deriving from AChE inhibition, and therefore not only is there no universal reactivator efficient enough for the most toxic OPs, but for some nerve agents there is still a lack of any reactivator at all. The endeavor of many chemists to find more efficient reactivators resulted in thousands of newly-designed and synthesized oximes−potential reactivators of AChE. For an evaluation of the oximés reactivation efficiency, many research groups employ a simple spectrophotometric Ellman method. Since parameters that describe reactivator efficiency are often incomparable among laboratories, we tried to emphasize the critical steps in the determination of reactivation parameters as well as in the experimental design of a reactivation assay. We highlighted the important points in evaluation of reactivation kinetic parameters with an aim to achieve better agreement and comparability between the results obtained by different laboratories and overall, a more efficient evaluation of in vitro reactivation potency.

Intox, detox, antidotes – Evidence based diagnosis and treatment of acute intoxications

Background and aimAim of this review is to describe the role of clinical toxicology in the context of acute medicine. A special focus is put on antidotes and important aspects of diagnosis and therapy of acute intoxications. The data of the annual report of GIZ-Nord Poisons Centre is analyzed concerning the following aspects: what intoxications are relevant in acute medicine, are there special aspects in therapy, e.g. antidotes, and what antidotes are relevant? More over intoxication-related fatalities are analyzed. Results and conclusionIn 2015 the poisons centre was consulted in 33,000 cases of acute intoxications. The most important groups are drugs (e.g. antidepressants, beta blockers and calcium channel blockers), chemical products (e.g. products containing surfactant, corrosive substances and toxic alcohols like methanol), plants and recreational drugs. Intoxications are relevant in acute medicine. Some substances can cause fatal intoxications. Important antidotes are naloxone for opiods, acetylcystein for paracetamol, fomepizole and ethanol for toxic alcohols and diazepam for intoxications caused by chloroquine.

A structural analysis of acute exotoxicoses in people of elderly and senile age

Based on the analysis of reports of the Department for treatment of acute poisonings at the N.V. Sklifosovskiy Research Institute of Emergency Medicine from 2009 to 2014 and medical records of in-patients hospitalized during that period, the structure of acute poisoning in elderly and senile patients was investigated. The share of patients of the senior age groups averages 12.5% of all patients. The most frequent reason for poisoning is a suicide attempt-71.9%. Psychopharmacological (46.5%) and cardiotropic (13.6%,) medications take the key place in poisonings as well as combined poisonings. The lethality analysis revealed its growth with increase in age of victims. One of the main causes of lethal outcomes is pneumonia.

A 6-year review of new psychoactive substances at the Centre antipoison Grand-Ouest d’Angers: Clinical and biological data

For the last 10 years, recreational use of new psychoactive substances (NPS) with hallucinogenic properties was more and more described either in a context of consumption during a rave-party or at home alone or in small group. A review of 62 cases (56 M, 6 F, 16–46 y) registered from 2011 to 2016 at the French Grand Ouest centre antipoison of Angers is presented. Some of them ( n = 15) presented a severe clinical state (poison severity score, PSS = 3) and only one was a fatal intoxication (PSS = 4). Treatment of acute intoxication was mainly based on supportive care with a quick recovery in less than 48 h. A high number of these cases were documented by plasma (pl) and/or urine analyses using LC-UV, GC-MS and LC-MS 2 . Several powders or other forms bought on the web market by the patients were also analysed. Six amphetamines derivates were detected such as methiopropamine (pl: 50 – 430 μg/L, n = 6) or 5 others (6-APB, 6-APDB, 5-EAPB, 5-MAPB, 2-FA each once). Four 2,5-dimethoxy-derivates of phenylethylamines (2Cs) or of amphetamines (DOs) were detected as 2C-P (pl: < 10–20 μg/L, n = 5), 2C-T-4 (88 μg/L) or 2C-E (only in one urine) and DOC ( n = 5, pl: < 10–18 μg/L). In 24 cases, 12 different cathinones were observed in plasma samples ( n = 8) as MDPV (pl: 10–40 μg/L, n = 4), 3-MMC (pl: 7–300 μg/L, n = 6), 4-MEC (pl: 240 – 890 μg/L, n = 3), mexedrone (pl: 100 and 180 μg/L) and methylone (3130 μg/L in a peripheral post-mortem blood). Others cathinones (4-MMC, α-PVP, 4-chloro-α-PVP, bk-2C-B, MDPP, MPHP, pentedrone) were essentially observed in urine or in powders. Two tryptamine analogs were found as AMT (pl: 440 μg/L in one plasma sample) and 5-MeO-DALT ( n = 5). The 3 ketamine-like compounds ( n = 17) detected in plasma were methoxetamine (pl: 8.6–360 μg/L, n = 12), methoxphenidine (pl: 254–590 μg/L, n = 3) and diphenidine (pl: 20 μg/L, n = 1). Five other miscelleanous drugs were found in 11 cases and 9 different synthetic cannabinoids (AB-CHMINACA, AB-FUBINACA, AKB48, 5F-AKB48, 5FUB-AKB48, 5F-PB22, AM1220, MDMB-CHMICA, UR-144) were found in 7 different patients. For the same period, illicit amphetamines constituted 52 cases with amphetamine or ecstasy intake sometimes combined with NPS. These data were presented to show the increasing use of wide-range NPS in a French region and to provide quantitative data in clinical situations besides the large information on the post-mortem cases available in the literature.

Successful usage of intravenous lipid emulsion in treatment of acute verapamil poisoning: A case report

Introduction. During the last few years, intravenous lipid emulsions have been effectively used in treatment of acute poisonings with lipophilic substances, including verapamil. Case report. A 37-year-old women presented 1 hour after ingestion of 2.8 g verapamil with hypotension and complete heart block. Because of the applied standard therapy failure and further patients impairment, Intralipid? 20% was used. Sinus rhythm was restored, arterial blood pressure increased and verapamile concentrations, both total and free decreased. Conclusion. Intravenous lipid emulsion can be important in treatment of severe acute intoxication and cardiotoxicity caused by verapamil.

Protection studies of new bis quaternary 2-(hydroxyimino)-N-(pyridin-3yl) acetamide derivatives (HNK-series) oximes against acute poisoning by dichlorvos (DDVP) in Swiss albino mice.

The available antidotal therapy against acute poisoning by organophosphates involves the use of atropine alone or in combination with one of the oximes, e.g. 2-PAM, Obidoxime, TMB-4 or HI-6. Each of these oximes has some limitation, raising the question of the universal antidotal efficacy against poisoning by all OPs/nerve agents. In the present study, newly synthesized bis quaternary 2-(hydroxyimino)-N-(pyridin-3yl) acetamide derivatives (HNK-series) oximes were evaluated for their antidotal efficacy against DDVP intoxicated Swiss mice, in terms of the Protection Index (PI) and AChE reactivation in brain and serum. The inhibition concentration (IC50) was determined in brain and serum after optimizing the time point for maximum inhibition (60 min post DDVP exposure). AChE reactivation efficacy of the HNK series was evaluated at IC50 and compared with 2-PAM. HNK-102 showed a ~2 times better Protection Index (PI) as compared to 2-PAM against DDVP toxicity. IC50 at 60 min DDVP post exposure was found to be approximately one fifth and one half of the LD50 dose for brain and serum AChE, respectively. Out of three HNK oximes, HNK-102 & 106 at 0.20 LD50 dose significantly reactivated DDVP intoxicated brain AChE (p<0.05) as compared to 2-PAM at double IC50 dose of DDVP. In light of double PI and higher AChE reactivation, HNK 102 was found to be a better oxime than 2-PAM in the treatment of acute poisoning by DDVP.

Cathartics, calcined magnesium sulfate vs mannitol plus activated carbon for the treatment of acute poisonings

Cathartics, calcined magnesium sulfate vs mannitol plus activated carbon for the treatment of acute poisonings

An analysis of the clinical and epidemiological characteristics of acute poisoning patients in a general hospital

Objective: To analyze the clinical and epidemiological characteristics of acute poisoning patients in a general hospital, then to provide a reference for the prevention and treatment of acute poisoning in the future. Methods: A retrospective analysis was made on the clinical data of 660 patients with acute poisoning admitted in emergency medical center of the First Affiliated Hospital of Wenzhou Medical University from July 2009 to May 2015. Results: More men than women in 660 cases with acute poisoning(the ratio of male to female was 1.36∶1) ; ≥30 years old was the high incidence age (78.79%) ; The top occupation was farmers (39.70%) ; Most were life poisoning (88.18%) , suicide was the main reason (62.42%) especially happened in women, and the main cause of suicide was family conflicts; Toxic species dominated by pesticide (67.58%) , most were severe poisoning (81.82%) ; The top two pesticide poisoning were organic phosphorus and paraquat, and the proportion of blood purification in paraquat was significantly higher (χ2=105.21, P=0.00) ; There were 212 cases with organ dysfunction, main were pesticide poisoning patients, and the proportionof organ dysfunction in paraquat was significantly higher than the rest allpesticide poisoning (χ2=45.09, P=0.00) ; The general fatal rate of acute poisoning was 2.27%, and the proportion in paraquat poisoning was .higher than the rest pesticide poisoning who were death and give up when discharged (χ2=56.83, P=0.00) . Conclusion: The focus of acute poisoning in the general hospital is still pesticide (especially organic phosphorus and paraquat) , and most were severe poisoning.

Evaluation of the benefit of the bispyridinium compound MB327 for the antidotal treatment of nerve agent-poisoned mice

The potency of the bispyridinium non-oxime compound MB327 [1,1′-(propane-1,3-diyl)bis(4-tert-butylpyridinium) diiodide] to increase the therapeutic efficacy of the standard antidotal treatment (atropine in combination with an oxime) of acute poisoning with organophosphorus nerve agents was studied in vivo. The therapeutic efficacy of atropine alone – or atropine in combination with an oxime, MB327, or both an oxime and MB237 – was evaluated by the determination of LD50 values of several nerve agents (tabun, sarin and soman) in mice with and without treatment. The addition of MB327 increased the therapeutic efficacy of atropine alone, and atropine in combination with an oxime, against all three nerve agents, although differences in the LD50 values only reached statistical significance for sarin. In conclusion, the addition of the compound MB327 to the standard antidotal treatment of acute poisonings with nerve agents was beneficial regardless of the chemical structure of the nerve agent, although at the dose employed, MB327 in combination with atropine, or atropine and an oxime, provided only a modest increase in protection ratio. These results from mice, and previous ones from guinea-pigs, provide consistent evidence for additional, albeit modest, efficacy resulting from the inclusion of the antinicotinic compound MB327 in standard antidotal therapy. Given the typically steep probit slope for the dose–lethality relationship for nerve agents, such modest increases in protection ratio could provide significant survival benefit.

Significance of Blood Perfusion in Treatment of Acute Intoxication Induced by Drug and Poison

Significance of Blood Perfusion in Treatment of Acute Intoxication Induced by Drug and Poison

A comparison of the reactivating efficacy of a novel bispyridinium oxime K203 with currently available oximes in VX agent-poisoned rats

The ability of a novel bispyridinium oxime K203 to reactivate VX agent-inhibited acetylcholinesterase was compared with the reactivating efficacy of four commonly used oximes (obidoxime, trimedoxime, methoxime, HI-6) using in vivo model. Our results showed that the reactivating efficacy of the oxime HI-6 is higher than the reactivating efficacy of the other oximes studied including the oxime K203 although the differrences between the oxime HI-6 and some other oximes are not significant, especially in the blood. Based on the obtained data, we can conclude that the antidotal treatment involving the oxime HI-6 brings the higher benefit for the antidotal treatment of acute poisonings with VX agent than other oximes.

BCPT Nordic Prize in Basic &amp; Clinical Pharmacology &amp; Toxicology for 2011 to Pertti J. Neuvonen

The BCPT Nordic Prize of 10,000 € in Basic & Clinical Pharmacology & Toxicology for 2011 will be awarded to Professor Pertti J. Neuvonen from the Department of Clinical Pharmacology at the University of Helsinki, Finland. Professor Pertti J. Neuvonen has dedicated his working life for the benefit of basic and clinical pharmacology and toxicology. His main positions have been Lecturer or Acting Professor of Clinical Pharmacology at the University of Helsinki (1972–1988), Professor and Chairman of Pharmacology at the University of Turku (1988–1992) and Professor and Chairman of Clinical Pharmacology at the University of Helsinki (1992–present). Pertti J. Neuvonen is widely recognized for his outstanding contributions in the field of drug interactions. During his early career, he was interested especially in drug absorption and gained an international reputation already in the 1970s for characterizing the clinically important interactions of tetracyclines with iron and other bivalent cations. His studies on oral activated charcoal in the 1970s and 1980s consolidated his reputation and played a central role in the expansion of the use of activated charcoal in the treatment of acute poisonings during the 1990s. For his studies on drug absorption and activated charcoal, he was selected as Drug Absorption Foundation Lecturer in 1993 (Edinburgh, UK). In the early 1990s, Pertti J. Neuvonen focused his research efforts on the roles of inhibition and induction of cytochrome P450 enzymes in drug interactions. He was the first to demonstrate that plasma concentrations of drugs undergoing extensive first-pass metabolism may increase even more than 10-fold, as a result of inhibition of P450-mediated biotransformation. In recent years, he has also been heavily engaged in pharmacogenetics and genomics research. His findings have significantly improved the safety and efficacy of drug therapy and benefited the principles and guidelines applied in drug development. Pertti J. Neuvonen has published about 460 original articles and more than 150 review articles and chapters in textbooks. The high number of citations to his articles reflects the outstanding scientific quality of his work. His Hirsch-index is 57, the total number of citations to his publications is more than 13,000 (17 July 2011) and he is one of the most highly cited pharmacologists in the world (ISIHighlyCited.com). Pertti J. Neuvonen is distinguished for his groundbreaking work to create better possibilities for clinical drug research, to promote training in pharmacology and to develop the speciality of clinical pharmacology in Finland. He is the founder and director of the Clinical Drug Research Graduate School, which forms an important national resource for education in pharmacology and organizes several postgraduate courses annually. He has supervised 39 PhD doctoral theses and has currently six doctoral students. For his exceptional merits in research education in Finland, Pertti J. Neuvonen has received the Lauri Saxén prize in 1997 and the Maud Kuistila prize in 2003. He was the first chairman of the Finnish Society of Clinical Pharmacology (founded in 1994). Moreover, he is the chief editor of the Finnish textbook in clinical pharmacology and therapeutics (published in 1994, 2002 and 2011) and an editorial board member of four international journals. Since 1998, Pertti J. Neuvonen has been a member of the Finnish Academy of Science and Letters.

The influence factors and the treatment of acute poisoning in children

Acute poisoning occurs in age of children and threatens children's life.In developed country,monitoring network about children's poisoning showed related risk factors,which helped preventing and managing poisoning quickly.The fatality rate of children's poisoning is high in China.There is no monitoring network in our country.We summarized the influencing factors and treatment of acute poisoning in children. Key words: Acute poisoning; Epidemiology; Treatment; Children