A Case of High Dose Metoprolol Poisoning; Case Report and Literature Review

β-Blockers are prescribed by physicians for many medical reasons (hypertension, long-term prophylaxis of angina pectoris, myocardial infarction, stable heart failure treatment, cardiac arrhythmias, etc.). Although cases of β-blocker poisoning have a low rate of 0.9% among all poisoning cases, they have a high mortality rate. In β-blocker poisoning with high lipid solubility; seizures, respiratory depression, coma, resistant bradycardia-hypotension and shock may occur. Metoprolol, a type of β-blocker, is a selective β1-adrenoceptor antagonist with sympathomimetic effect. It is also reported that metoprolol is the 2nd most commonly prescribed β-blocker after bisoprolol all over the world. This article aims to present a case who took high-dose metoprolol for suicidal purposes and to examine metoprolol poisoning and its treatment in the light of current literature.

POISONING CASES OF NOXIOUS SUBSTANCES EATEN AS FOOD: A RETROSPECTIVE STUDY AT A TEACHING HOSPITAL IN MALAYSIA

There is limited information regarding the epidemiology of food poisoning in Malaysia as the issue of food poisoning is often perceived as not as huge as compared to other poisoning cases like intoxication by drugs and chemicals. Patients who experience severe food poisoning require hospitalisation, aggressive hydration, and some even require antibiotic treatment. In this study, we aimed to determine an overview of food poisoning cases reported in UMMC. A 10-year retrospective study on the poisoning of other noxious substances eaten as food (ICD10: T62.0-T62.9) in the University of Malaya Medical Centre (UMMC) was performed. A total of 23 medical records of patients, admitted from January 2009 to December 2019 were reviewed. The greatest proportion of food poisoning occurred between the ages of 0 and 9 years, with a predominance of the male gender. Malay patients accounted for most food poisoning cases. All cases of poisoning, including a mushroom poisoning case (T62.0), were accidental. The mushroom poisoning case was then carefully reviewed. To conclude, this study revealed that the most common cause involved in the poisoning was unspecified food poisoning, followed by ingestion of poisonous mushroom. Most patients were given symptomatic and supportive treatments. All patients had favourable outcomes and were discharged with full recovery.

A CLINICAL THERAPEUTIC CORRELATION IN POISONING CASES - A RETROSPECTIVE ANALYSIS IN A TERTIARY CARE HOSPITAL

Background: Acute poisoning is a major public health problem. This retrospective study was done to analyse the characteristics of acute poisoning cases admitted in a tertiary care hospital in Chennai so as to ensure effective poisoning prevention and targeted interventions to reduce the mortality and morbidity due to poisoning, as the incidence of poisoning is rising worldwide. Methodology: This retrospective analysis was done by analysing the poisoning case sheets in the medical records department in a tertiary care hospital for a duration of 3 months. Data pertaining to patient's demographic details, pattern, manner of poisoning, the mode of ingestion, clinical prole, severity of poisoning using Poisoning Severity Score, treatment prole and outcome were collected using a pre-structured proforma. Results: In this study 488 poisoning case sheets were analysed. Most of poisoning cases (40%) occurred in the age group of 21-30 years. 59% were males. Chemical poisoning 79% was most common among males and tablet poisoning 63% among females. Manner was suicidal in 82% cases, accidental in 13% and 0.2% was homicidal. The incidence of Rat killer poisoning (33%) was highest followed by tablet poisoning (20%), Insecticide poisoning (13.5%), Animal poison (13%), Corrosive poisoning (5.7%), Chemical poisoning (4.9%), and Plant poison (2.7%). 5.7% patients had associated Psychiatric illness and 16% were alcoholic. 74% patients were admitted within 3 hours of poison intake. Gastric lavage, Activated charcoal, N-Acetylcysteine, Inj. Vitamin K, Ursodeoxycholic acid, Rifaximin, Atropine, Anti-snake Venom, and Pralidoxime were the treatments given. Of the total 488 patients 94% were discharged, 4% death and 2% left against medical advice. The mean duration of hospital stay was 4 days. Conclusion: This study shows that Rodenticide poisoning was most common followed by tablet poisoning which mainly includes benzodiazepines, thyroid supplements, antiepileptics and antihypertensive agents. The next common was organophosphate poisoning of which chlorpyrifos and cypermethrin were common. Overall mortality rate was 4% of which Rat killer paste was the most common cause of mortality ( 35%) associated with coagulopathy, acute encephalopathy and toxic hepatitis. With proper Counselling, stress management, restricted access to OTC drugs and insecticides, by ensuring protective measures to avoid exposure and by prompt diagnosis and timely initiation of treatment at the primary level we can reduce the mortality