A combined HPLC-immunoenzymatic comprehensive screening for suspected drug poisoning in the emergency department

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 4h. 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.

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Change in profile of acute self drug-poisonings over a 10–year period

Human & Experimental Toxicology ◽

10.1191/0960327104ht487oa ◽

2004 ◽

Vol 23 (11) ◽

pp. 507-511 ◽

Cited By ~ 21

Author(s):

Frédérik Staikowsky ◽

Florence Theil ◽

Paule Mercadier ◽

Séebastien Candella ◽

Jean Pierre Benais

Keyword(s):

Public Health ◽

Emergency Department ◽

Serotonin Reuptake ◽

Selective Serotonin Reuptake Inhibitors ◽

Emergency Department Visits ◽

Serotonin Reuptake Inhibitors ◽

Selective Serotonin ◽

Drug Poisoning ◽

One Year

All acute, deliberate, drug-poisoning-related emergency department visits over two periods of one year, 1992-1993 (P1) and 2001-2002 (P2), were reviewed to investigate trends in substances used for acute self drug-poisonings over a 10-year period. For P1 and P2 respectively, 804 and 830 episodes of acute self drug-poisonings were compared. For the two studied periods, psycholeptic drugs predominated (78 and 77%); however, benzodiazepines declined (67 to 55%; P <0.01) and antidepressants in-creased (9.5 to 15%; P <0.01). Moreover, the type of antidepressant changed markedly with a decrease of the imipraminic antidepressants (48.4 to 10.7%) and an increase of selective serotonin reuptake inhibitors (31.2 to 74%). The proportion of benzodiazepine-related drugs increased with time (7.9 to 14.1%). The proportion of analgesics was 5.4% for P1 and 7.3% for P2; paracetamol, alone or associated to other compounds, remained the most incriminated. Nevertheless, opioids were more often mentioned during the later period (11.6 to 24.5%). The trend of the different pharmacological families used in acute self drug-poisonings is not fundamentally different over a 10-year period. However, there are some qualitative modifications, which are important for readjusting the emergency physician's toxicological knowledge and public health actions.

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Access in New Zealand to antidotes for accidental and intentional drug poisonings

Journal of Primary Health Care ◽

10.1071/hc12100 ◽

2012 ◽

Vol 4 (2) ◽

pp. 100 ◽

Cited By ~ 9

Author(s):

Victoria Abbott ◽

Michaela Creighton ◽

Janelle Hannam ◽

Timothy Vincent ◽

Carolyn Coulter

Keyword(s):

Primary Care ◽

Emergency Department ◽

New Zealand ◽

Health Professionals ◽

Rare Event ◽

Morbidity And Mortality ◽

Common Reason ◽

Drug Poisoning ◽

Prior Use ◽

Hospital Pharmacies

INTRODUCTION: Access to antidotes for the treatment of drug poisonings can impact on morbidity and mortality. Treatment for drug poisonings usually occurs at the nearest emergency department; however, health professionals working in primary care are often the first point of contact for patients. As New Zealand has a small, diffuse population, and poisonings are a rare event, it can be difficult to anticipate what antidotes are required. AIM: The aim of the study was to determine what antidotes are frequently used and stocked in hospital pharmacies. METHODS: A survey was sent out to all 25 hospital pharmacies, excluding private and satellite hospitals. The survey contained questions about the stocking, and prior use, of over 30 antidotes. Also included were open-ended questions asking about reasons for not stocking antidotes and procedures for procuring antidotes in an emergency. RESULTS: Twenty out of 25 hospital pharmacies completed the survey. Most hospital pharmacies were found to stock large quantities of commonly used antidotes and low quantities of uncommonly used antidotesbut in sufficient quantity to treat one to two patients. A low number of poisonings was the most common reason cited for not stocking antidotes, followed by high cost. Most hospitals had clear guidelines for procuring and lending antidotes in an emergency. DISCUSSION: New Zealand hospital pharmacies stock adequate quantities of most antidotes, including antidotes that are expensive and rarely required, but which may be needed urgently. Hospital pharmacies also have clear procurement procedures for obtaining other antidotes in an emergency. KEYWORDS: Antidote stocking; access to antidotes; drug poisoning

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