Patterns of poisoning exposure at different ages: the 2015 annual report of the Australian Poisons Information Centres

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Introduction Paracetamol is a common agent taken in deliberate self‐poisoning and in accidental overdose in adults and children. Paracetamol poisoning is the commonest cause of severe acute liver injury. Since the publication of the previous guidelines in 2015, several studies have changed practice. A working group of experts in the area, with representation from all Poisons Information Centres of Australia and New Zealand, were brought together to produce an updated evidence‐based guidance. Main recommendations (unchanged from previous guidelines) The optimal management of most patients with paracetamol overdose is usually straightforward. Patients who present early should be given activated charcoal. Patients at risk of hepatotoxicity should receive intravenous acetylcysteine. The paracetamol nomogram is used to assess the need for treatment in acute immediate release paracetamol ingestions with a known time of ingestion. Cases that require different management include modified release paracetamol overdoses, large or massive overdoses, accidental liquid ingestion in children, and repeated supratherapeutic ingestions. Major changes in management in the guidelines The new guidelines recommend a two‐bag acetylcysteine infusion regimen (200 mg/kg over 4 h, then 100 mg/kg over 16 h). This has similar efficacy but significantly reduced adverse reactions compared with the previous three‐bag regimen. Massive paracetamol overdoses that result in high paracetamol concentrations more than double the nomogram line should be managed with an increased dose of acetylcysteine. All potentially toxic modified release paracetamol ingestions (≥ 10 g or ≥ 200 mg/kg, whichever is less) should receive a full course of acetylcysteine. Patients ingesting ≥ 30 g or ≥ 500 mg/kg should receive increased doses of acetylcysteine.

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confidence: 99%

Updated guidelines for the management of paracetamol poisoning in Australia and New Zealand

Chiew

Reith

Pomerleau

et al. 2019

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“…In many countries, paracetamol is the drug most frequently involved in overdoses, and it is the most frequent cause of acute liver failure in the Western world . Australian poisons centres received 13 322 calls regarding paracetamol in 2015; United States poisons centres received more than 100 000 paracetamol‐related calls and recorded 313 deaths in 2016, while in the United Kingdom at least 80 000 people present to hospital with paracetamol overdoses each year, and there are 150–250 deaths …”

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confidence: 99%

Paracetamol poisoning‐related hospital admissions and deaths in Australia, 2004–2017

Cairns

Brown

Wylie

et al. 2019

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“…Children were regarded as lucky if they survived the festive season without some sort of injury; be it envenomation, burns, drowning or poisoning. It is just over 50 years since poisons centres came into existence, 2 along with a raft of public health injury prevention measures. It is therefore timely to ask what has replaced the annual festive season trip to the emergency department.…”

Section: Boxmentioning

confidence: 99%

Carols by glow sticks: a retrospective analysis of Poisons Information Centre data

Cairns

Brown

Dawson

et al. 2018

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Objective: To win a Christmas hamper. We also devised a study of our most festive seasonal poisoning, to demonstrate how hard we are working while everyone else is partying.Design: Retrospective analysis of the New South Wales Poisons Information Centre database, which we searched for exposures to the substance code “Cyalume light sticks/glow toys” from 1 July 2013 to 30 June 2017.Setting: A dimly lit basement with a constantly ringing phone. At the other end of the phone was a highly anxious parent and a luminescent child.Main outcome measures: Number of glow stick exposures, route of exposures, patient demographics and seasonal trends in exposures.Results: There were 2918 glow stick exposures over the 4‐year study period. The vast majority of exposures (94%) were in children aged 14 years and younger. Medical complications were very rare. Glow stick exposures were 4.38 times more likely in December (95% CI, 3.02–6.35; P < 0.001). Statistically significant increases were also observed in October, November, January, February and March. Glow stick exposures were 4.20 times more likely during the holiday period of 1 December to 7 January (95% CI, 3.42–5.15; P < 0.001), 2.52 times more likely over summer (95% CI, 2.12–3.00; P < 0.001), and 1.77 times more likely during school holidays (95% CI, 1.47–2.13; P < 0.001).Conclusions: This epidemic of poisoning is perhaps due to mass seasonal synaesthesia. The lack of any significant adverse consequences highlights the contribution that 50 years of injury prevention has made to everyone having a Merry Christmas and a Happy New Year.