Background: Drug overdose continues to be the most common cause of acute poisoning worldwide. There has been a substantial increase in drug overdose incidence and prevalence over the past decade, probably as a result of the emergence of new synthetic designer drugs. The purpose of this study is to describe the clinical and epidemiological characteristics of patients with acute drug intoxication admitted to the Intensive Care Unit (ICU). Methods: A single center, prospective, observational study was conducted among all adult patients with clinical signs suggestive of acute drug intoxication admitted from the Emergency Department (ED) to ICU during a 6-month period (September to March). Results: Sixty-five patients were admitted. Their median age was 49 years (mean 48.2, range 20–72), and the majority were male (48, 74%). Median Sequential Organ Failure Assessment (SOFA) score on admission to ICU was 6 (mean 6, range 0–13). Fifty-five patients (85%) had a positive urine and/or serum toxicology screen. Most commonly detected substances were: opiates (18, 33%), cocaine (13, 24%), methadone (12, 22%), benzodiazepines (10, 18%), and marijuana (9, 16%). In 16 patients (29%), >1 substance was isolated. Twenty-three patients (35%) had negative urine toxicology screen. Ethyl alcohol was detected in the serum of 23 patients (35%). Five patients (8%) expired in ICU. Conclusion: Classic recreational drugs remain the most common substances involved in acute drug poisoning. More sensitive detection methods are warranted to identify new designer drugs of abuse such as synthetic cannabinoids.

RESULTS: 1. Early pre-cancerous lesions in the macroscopically normal kidney from VHL patients mainly express HIF1 and this correlates with the presence of the pro-apototic protein BNip3. 2. More advanced lesions express both HIF1 and HIF2 and this correlates with the presence of the key cell cycle regulatory protein Cyclin D1. 3. In sporadic CCRCs areas of tumour are seen with strong expression of HIF2 and apparent 'loss' of HIF1 expression. Serial adjacent sections show that those areas with sole expression of HIF2 have markedly increased expression of VEGF, Cyclin D1 and increased cell proliferation. 4. Cell culture experiments indicate that BNip3 is a target for HIF1 and Cyclin D1 for HIF2. 5. Metastatic deposits from CCRC primaries display strong expression of HIF2.CONCLUSIONS: HIF1 and HIF2 appear to have different roles in CCRC tumorigenesis. We hypothesize that lesions demonstrating activation of HIF1 will not progress unless there is also activation of HIF2. The transition from expression of HIF1 alone, to dual expression, and then un-opposed HIF2 expression may explain the switch from slow growth to aggressive metastastic behaviour in renal cancer.