Medication Overdoses at a Public Emergency Department in Santiago, Chile

Abstract

IntroductionWhile a nationwide poison control registry exists in Chile, reporting to the center is sporadic and happens at the discretion of the treating physician or by patients’ self-report. Moreover, individual hospitals do not monitor accidental or intentional poisoning in a systematic manner. The goal of this study was to identify all cases of intentional medication overdose (MO) that occurred over two years at a large public hospital in Santiago, Chile, and examine its epidemiologic profile.MethodsThis study is a retrospective, explicit chart review conducted at Hospital Sótero del Rio from July 2008 until June 2010. We included all cases of identified intentional MO. Alcohol and recreational drugs were included only when they were ingested with other medications.ResultsWe identified 1,557 cases of intentional MO and analyzed a total of 1,197 cases, corresponding to 0.51% of all emergency department (ED) presentations between July 2008 and June 2010. The median patient age was 25 years. The majority was female (67.6%). Two peaks were identified, corresponding to the spring of each year sampled. The rate of hospital admission was 22.2%. Benzodiazepines, selective serotonin reuptake inhibitors, and tricyclic antidepressants (TCA) were the causative agents most commonly found, comprising 1,044 (87.2%) of all analyzed cases. Acetaminophen was involved in 81 (6.8%) cases. More than one active substance was involved in 35% of cases. In 7.3% there was ethanol co-ingestion and in 1.0% co-ingestion of some other recreational drug (primarily cocaine). Of 1,557 cases, six (0.39%) patients died. TCA were involved in two of these deaths.ConclusionSimilar to other developed and developing nations, intentional MO accounts for a significant number of ED presentations in Chile. Chile is unique in the region, however, in that its spectrum of intentional overdoses includes an excess burden of tricyclic antidepressant and benzodiazepine overdoses, a relatively low rate of alcohol and recreational drug co-ingestion, and a relatively low rate of acetaminophen ingestion.

Quantification of cocaine in ternary mixtures using partial least squares regression applied to Raman and Fourier transform infrared spectroscopy

“…Costly laboratory analyses and analytical approaches may be unavailable in some countries, posing a further hindrance. Therefore, determinations of the type, quantity, and co‐ingestion of medication or drugs used are based on the history provided, without access to laboratory analyses . In forensic medicine, analyses of toxic substances in postmortem examinations may vary over time due to changes in the composition of body fluids, altering results that are important in criminal proceedings for determining the cause of death …”

Парацетамол Среди Средств Суицидальных Действий В России И Зарубежом

“…Paracetamol is the most common pharmaceutical agent involved in toxic effects in Singapore [24]. [30] 37,6 Ирландия / Iceland [31] 30 Канада / Canada [32] 30 Австралия / Australia [33] 28 США / USA [34] 10,9 Чили / Chile [35] 6,8 Россия / Russia ? (min) При этом, если рассматривать причины передозировки непосредственно парацетамола (табл.…”

“…Например, среди подростков Австралии употребление парацетамола в качестве одного агента отмечено в 53% случаев, а взрослых -34% [23]. В Чили одновременный приём более одного действующего вещества наблюдается в 35% [35].…”

“…For example, among teenagers in Australia, the use of paracetamol as a single agent was noted in 53% of cases, while for adults it decreases to 34% [23]. In Chile, simultaneous intake of more than one active substance is observed in 35% [35].…”

“…It can be noted that women are predom- [37] 85 Малайзия / Malaysia [53] 82 Австралия / Australia [23] 76 Исландия / Iceland [27] 75 Сингапур / Singapore [24] 71 Россия / Russia [43,44] 67-69* Чили / Chile [35,54] 67 Новая Зеландия / New Zealand [30] 54 *Данные указаны для всех преднамеренных самоотравлений медикаментами, в том числе и с участием парацетамола *Data is presented for all deliberate drug poisoning, including Paracetamo Не стоит игнорировать и мужчин. Исследования показывают, что, несмотря на количественное преобладание женщин среди лиц, совершивших преднамеренное отравление, дозы парацетамола, используемые при суицидальных попытках, значительно выше в мужской популяции, что может косвенно указывать на их более серьёзные суицидальные намерения и желание умереть [31].…”