Identification of Drugs Ingested in Acute Poisoning: Correlation of Patient History With Drug Analyses

Abstract

The aim of this study was to assess the reliability of patient history in the identification of the drugs taken by patients who have an acute drug overdose. To this end, a prospective study involving 51 cases of acute, deliberate drug poisoning was carried out (patients with ethanol as the only apparent cause of intoxication were excluded). Information based on interviews with the patients and their companions or on circumstantial evidence (e.g., drug containers found) was compared with the results from drug analyses of various body fluids. The information obtained on admission was completely in accordance with the laboratory findings in only 27% of the cases. Minor discrepancies between the history and the results from drug analyses concerning the identity of the drugs taken were found in 55% of the cases. In 18% of the cases, the discrepancies were considered clinically important. Serious symptoms occurred in approximately 20% of the patients, but none of them were the result of incorrect information obtained on admission. All the patients survived. These results support the prevailing view that rapid identification of the drugs taken in overdose by means of comprehensive drug screens would have little effect on the treatment of most cases of acute poisoning. However, such assays would enable optimal treatment of many cases of acute poisoning by reducing the need for supervision and costly treatments and facilitating the identification of cases that would require prompt drug-specific treatment.

A retrospective analysis of the impact of toxicological diagnostics on clinical decision making in cases of acute drug poisoning

“…Also in the previous Finnish series by PohjolaSintonen et al the discrepancies that were considered clinically significant did not lead to specific therapies and were not related to recorded complications. 9 In the present results it is notable that only 3 of the 6 unexpected findings among patients who required specific therapies were detected by the routine screening (paracetamol) and in only 2 of these cases the patient had a lowered level of consciousness. The detection of the other 3 cases required specific laboratory testing (lithium and salicylate concentration).…”

“…This result is interesting when compared to the results of Pohjola-Sintonen at al and Heyerdahl et al, which showed that there were high discrepancies between clinical and laboratory assessments most often with products affecting central nervous system. 9,10 These discrepancies were considered clinically important in 11% to 18% of the cases. In our series 16% of the screening results were considered unexpected.…”

“…7,8 The diagnostics in acute poisoning is challenging as shown in one Finnish and one Norwegian study where the suspected causes of poisoning and the results of the toxicological screenings did not correlate well with patient history. 9,10 However, the evidence supporting the use of toxicological screenings is lacking. There are studies questioning the use of screenings, but they are with limited number of patients or including also not poisoned patients [11][12][13] or conducted with pediatric population.…”

Moclobemide poisoning: toxicokinetics and occurrence of serotonin toxicity

“…However, all overdose patients admitted to HATS have the drug ingested confirmed by history from the patient, and this is confirmed with collateral history from family, friends and ambulance officers, as well as evidence of empty drug containers. Previous studies of overdose have demonstrated that this corresponds to definite ingestion in the majority of cases [31,32].…”

A multicentre programme of clinical and public health research in support of the National Suicide Prevention Strategy for England

“…42,54,92 It is not known whether or not there was any change in the sizes of overdoses in Ireland following the introduction of the 2001 legislation on pack sizes there. 77 However, the size of overdose for which calls were made to the National Poisons Centre decreased in the first 2 years after the legislation was introduced.…”