Acid–Base Balance in the Poisoned Patient

Borron, Stephen W.

doi:10.1007/978-3-319-20790-2_67-2

Cited by 3 publications

(3 citation statements)

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“…The common clinical presentation of combined drugs was CNS (coma, hallucination and agitation) Zaki et al;2019 Heroin toxicity manifested by cyanosis, constricted pupil and disturbed conscious level which was the classical manifestations of opioid toxidrome. These results were similar to results published by Cobaugh et al, 2014. According to the effect of acute toxicity of abused drugs on arterial blood gases, metabolic acidosis common in alcoholic toxicity especially methanol, 100 % of patients admitted to Minia University Poison Control Center with acute methanol toxicity had sever metabolic acidosis due to formation of formic acid during its metabolism and inhibition of cellular respiration which lead to accumulation of lactic acid similar to results reported by Paasma et al, 2009. On the other hand tramadol and synthetic cannabinoid (strox and voodoo) toxicity lead to respiratory acidosis (57.1 %, 63.1 % and 55.6 respectively) due to inhibition of respiratory center and decrease ventilation in agreement with Borron (2016) and Alon & Saint-Fleur (2017).…”

Section: Discussionsupporting

confidence: 86%

Acute Toxicity of Abused Drugs in Minia Poison Control Center

Mahmoud

sarhan

2022

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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Background: Drug abuse is one of the most serious threats in several countries; acute toxicity of these drugs was more common in all poison control centers. Objectives: This study aimed to recognize the incidence of acute toxicity of abused drugs Methods: This retrospective study was conducted on 375 patients presented to Poison Control Center (PCC) of Minia university hospital from 1 st of January 2017 to 31 st of December 2019, data collected regarding socio demographic information, types of toxins, mode of toxicity, clinical manifestations, investigations, and outcome. Results: Patients of this study aged 6 months-58 years old, hospital stay duration ranged between 1 to 8 days. Combined drugs were the most common type 19.2 %, most patients were males 99.2 %, lived in urban areas 70.1 %, unemployed 91.5 %, single marital status 54.7 %. 41.9 % of patients had intermediate qualification; accidental overdose toxicity is the most common mode of poisoning 69.9 %. Regarding clinical manifestation, most patients had stable vital signs and normal arterial blood gases (ABG), and coma was the commonest manifestation. 91.7 % of patients survived while 8.3 % died. Conclusion: combined drugs addiction is most common between addicts nowadays; also synthetic cannabinoid addiction had increased.

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Section: Discussionsupporting

confidence: 86%

Acute Toxicity of Abused Drugs in Minia Poison Control Center

Mahmoud

sarhan

2022

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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“…Metabolic acidosis in alcohol toxicity could be attributed to formic acid accumulation and lactic acidosis as a result of impairment of cellular respiration by formate or increased generation of NADH during the metabolism of methanol (Paasma et al, 2009). Borron (2016) reported that respiratory alkalosis and acidosis are related to increased and decreased ventilation. Opiates and BZs decrease the respiratory rate by depressing the central respiratory and brainstem regulatory centers.…”

Section: Discussionmentioning

confidence: 99%

Retrospective study of addictive drug-induced acute toxicity of cases admitted to the Poison Control Centre of Ain Shams University Hospital (2015–2016)

Zaki

Ghaleb

Abdelmenem

et al. 2019

Egypt J Forensic Sci

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Background: The acute toxicity with addictive drugs is one of the most common problems in the emergency department. This is a global problem affecting societies as it deals with young people at the age of work and productivity. This study aims to recognize the prevalence of addictive drug-induced acute toxicity regarding socio-demographic factors, common clinical presentation, and outcome of management. Methods: This is a descriptive retrospective study conducted on patients admitted to the Poison Control Centre of Ain Shams University Hospital during the period between the start of January 2015 and the end of December 2016. The total number of cases was 803 cases collected and analyzed regarding the socio-demographic data, condition of poisoning, prevalence of addictive drugs, route of intake, common clinical presentation, management plan, and final outcome of management. Data was analyzed using the computer software package SPSS 22. Results: A total of 803 cases were reviewed, their age ranged from 1 month to 83 years with mean ± SD 21.6 ± 16.8 years, and most cases were male (72.9%), living in urban areas (67.4%), and of single marital status (66.6%). Accidental overdose characterized most (86.8%) cases. Tramadol was the most commonly abused drug (36.5%), and most of the drugs were ingested orally. Disturbed conscious level was the most common clinical presentation in all drugs, and most of the cases were vitally stable and had normal sodium, potassium, ABG, and blood glucose level. Most of the cases received medical treatment in ICU (60%) and 93.5% improved while 6.5% died. Conclusions: Drug abuse is a serious problem in many countries especially among young males. Tramadol abuse and toxicity is increasing every day in the Egyptian community. Like other cases of poisoning, treatment of acute toxicity with addictive drugs is mainly supportive and symptomatic.

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“…Various studies were conducted to predict mortality in acute poisoning. Borron [30] showed that high anion gap is the most significant risk factor for death, regardless of the accompanying acid-base balance status in patients with acute intoxication. Additionally, Han et al [31] found in their Korean study on 42568 cases that SBP, heart rate, respiratory rate, body temperature and mental status were significant parameters in predicting mortality in acute poisoning.…”

Section: Discussionmentioning

confidence: 99%

A Proposal for a Novel Scoring System for Triage of Acutely Poisoned Patients at Tanta University Poisoning Treating Center, Egypt

Elfatah

Ghonem²,

Wahdan³

et al. 2022

JAMMR

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Background: Poisoning is defined as exposure of an individual to a potentiality harmful substance either by inhalation, skin contact, ingestion, or injection. Aim of the Work: This study aimed to develop and validate a novel scoring system using vital signs, arterial blood gases (ABG) and consciousness level as a tool of triage for evaluation and outcome prediction of acutely poisoned patients. Methods: The current prospective cohort study was conducted on patients with acute poisoning who were admitted at Tanta University Poisoning Treating Center (TUPTC) throughout a period of start of April 2020 to the end of June 2021. For each patient, age, sex, and toxicological characteristics were obtained. Clinical examination and routine laboratory investigations were also done. Results: Significant differences were observed between survivors and non-survivors in the derivation group (444 patients) regarding systolic blood pressure, diastolic blood pressure, respiratory rate, temperature, blood pH, PaCO2, serum HCO3, and O2 saturation. Using univariate and multivariate regression analysis SBP, serum HCO3, and O2 saturation were valid to construct the prediction score at cut off ≤100 mmHg, ≤16.6 mEq/L, and ≤93% respectively. Variables were given points and the score has range from 0 (the best score) to 3 (the worst score). The discrimination power in the derivation group at cut-off point >1 was excellent (AUC: 0.925) with 91.3% sensitivity and 94.9% specificity. Additionally, the discrimination power in the validation group (140 patients) at cut-off point >1 was excellent (AUC: 0.965) with 87.5% sensitivity and 93.8% specificity. Conclusion: This proposed score could be considered a simple and excellent tool for triage to identify acutely poisoned patients who are at risk of mortality. In addition, it is validated and so it could be used in other populations.

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Acid–Base Balance in the Poisoned Patient

Cited by 3 publications

References 204 publications

Acute Toxicity of Abused Drugs in Minia Poison Control Center

Acute Toxicity of Abused Drugs in Minia Poison Control Center

Retrospective study of addictive drug-induced acute toxicity of cases admitted to the Poison Control Centre of Ain Shams University Hospital (2015–2016)

A Proposal for a Novel Scoring System for Triage of Acutely Poisoned Patients at Tanta University Poisoning Treating Center, Egypt

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