A prospective study of acute poisonings in Finnish hospital patients

Abstract

1. We have carried out a prospective study of all adult patients presenting with acute poisoning during one month to the Helsinki University Central Hospital (Meilahti Hospital). 2. Two hundred and twenty-six cases of acute poisoning (113 males and 113 females) presented to the emergency department. Most cases in both men (66%) and women (67%) involved alcohol. As to drugs, psychotropic agents predominated in both men and women. The frequency of patient presentation peaked between 7 p.m. and 9 p.m. and was lowest between 8 a.m. and 10 a.m. In most cases, the delay from ingestion of the poison to presentation was longer than 4 h. 3. The clinical status of the patients on arrival was generally good; more than half (55%) of them were fully awake. Serious symptoms (e.g. unconsciousness, insufficient respiration necessitating intubation, aspiration, convulsions or hypotension) occurred in 15% of the presentations. There were no fatalities. 4. One hundred and thirty-five patients (60%) received at least one 50-g dose of activated charcoal. However, charcoal was given in 86% of the cases of drug poisoning. Gastric lavage was performed in 112 cases (50%), and 106 cases (47%) involved both gastric lavage and administration of charcoal. Twenty-one patients received antidotes (flumazenil, calcium gluconate or naloxone) and three patients were hemodialysed. 5. Of the 226 cases, 142 (63%) were managed solely in the emergency department. Of the 84 cases admitted to the hospital, eight had to be managed in the intensive care unit. Almost all patients (94%) were discharged within 24 h. 6. In this survey on 226 consecutive cases of acute poisoning, about two-thirds of the cases involved alcohol, while the most common drugs taken were psychotropic agents. The poisoning was mild in the great majority of the cases. Activated charcoal was generally administered in all but trivial cases of drug poisoning.

Etiology and outcome of patients presenting for poisoning to the emergency department in Taiwan: a prospective study

“…The predominance of young female cases, compared to the general population in the study area, was also different from the report of PCCs in Taiwan,9,10 which should be seriously taken into consideration by the local public health authorities in designing strategies to prevent suicides and poisoning. We found drugs (49.9%) were the predominant agents, which is similar to the recent studies in southern Taiwan, 10 other Asian countries, 12,14,17 some Western countries, 2,5,18,19 and Turkey (an Eastern Mediterranean country). 1 Among the drugs, analgesics are the predominant agents in the USA, 5 Turkey, 1,13 Malaysia, 12 and Oman, 14 whereas hypnotics/anxiolytics, benzodiazepines in particular, are predominant in Finland, 2 Spain, 18 Greece, 20 southern Taiwan, 10 and our study area.…”

Akute Vergiftungen in der internistischen Intensivmedizin

“…Neben einer kontinuierlichen visuellen Beobachtung und neurologischen Verlaufsbeurteilung sind Kontrollen des Säure-Basen-sowie des Flüssigkeits-und Elektrolythaushaltes und eine Überwachung der kardio-respiratorischen Situation notwendig. Da diese aufwendige Überwachung vielerorts nur auf einer Intensivstation möglich ist, kann die Zahl der Kurzzeitlieger (≤ 1 Tag) auf der ICU sowie die große Schwankungsbreite in der Inzidenz von Intensivbehandlungen und der Letalität in anderen Ländern (4,6,8,9,20) erklärt werden. Auch national unterschiedliche Selektionskriterien für eine Aufnahme auf Intensivstation sind diesbezüglich wahrscheinlich von Relevanz (26).…”

Effect of activated charcoal alone or given after gastric lavage in reducing the absorption of diazepam, ibuprofen and citalopram

“…The timing of the gastric decontamination procedures (at 30 min after drug ingestion) was designed to simulate conditions in patients presenting soon after an overdose. Although poisoned patients often present several hours after ingestion of the toxic agent, there are also cases of overdose in which the patient presents without delay [8, 9]. The dose of charcoal used, 25 g, is half the normal single dose used in the treatment of acute poisonings, and it is unlikely that a larger dose would have had a greater effect in the present study in which therapeutic doses of the drugs were ingested.…”