Increasing emergency department attendances in central London with methamphetamine toxicity and associated harms

BackgroundMethamphetamine is a stimulant drug of abuse with increasing prevalence of use worldwide leading to public health concern. While previous research by our group a decade ago found no evidence of increasing harms associated with methamphetamine use in the UK, there are conflicting data on whether or not this is still the case. This paper aims to identify trends in methamphetamine-related harms and characterise the clinical features of ED presentations involving methamphetamine with gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL).MethodsWe retrospectively interrogated a database of all toxicology-related presentations to two central London EDs, extracting data on drugs involved for presentations relating to methamphetamine between 2005 and 2018 to enable analysis of trends. Further clinical data were extracted for presentations between 2014 and 2018 to give a 4-year case series.ResultsA total of 1244 presentations involving the use of methamphetamine were identified. The number of presentations rose from 4 in 2005 (1.9% of all recreational drug presentations) to 294 (16.2%) in 2018. A total of 850 cases were identified for the 2014–2018 case series, 94.9% were male with a median (range) age of 35.1 (16–67) years. The most common clinical features in the methamphetamine presentations were neuropsychiatric: agitation (41.5%), anxiety (35.2%), hallucinations (16.5%) and psychosis (14.8%). GHB/GBL was co-used in 54.2% of presentations and appeared to attenuate the neuropsychiatric features seen. Use of GHB/GBL was associated with a higher Poisoning Severity Score and requirement for level 2/3 (high dependency unit/intensive care unit (ICU)) care.ConclusionED attendances in central London relating to methamphetamine use have risen over the last decade. Combining methamphetamine with GHB/GBL is common and is associated with a higher Poisoning Severity Score and need for ICU level care. Further work is required to establish whether further resources need to be directed at this clinical and public health problem.

Clinical use of the poisoning severity score in acute pediatric poisoning

To make an accurate diagnosis of poisoning and determine the severity of poisoning quickly without losing time are critical for managing the patient's medical treatment and predicting the prognosis. This study aimed to investigate PSS and Glasgow Coma Scale Score (GCS) effectiveness in predicting outcomes in acute pediatric poisoning. We retrospectively reviewed the data of intoxicated patients aged under 18 years who were admitted to the pediatric emergency service of Ondokuz Mayıs University Faculty of Medicine Clinical Research and Practice Hospital between January 1, 2018, and December 31, 2018. Two hundred twenty-two patients were admitted to our pediatric emergency department (ED) after drug ingestions. Of the patients enrolled in the study, 148 (66.7 %) were female, and 74 (33.3%) were male. The mean age was 105.8±75.3 months, and the median age was 65 (12-213) months. 96 (43.3%) poisoning cases were in the age range of 12-18 years. According to Poisoning Severity Score, it was found that 84 cases (37.4%) were asymptomatic (PSS score=0), 86 cases (38.7%) were minor (PSS score=1), 48 cases (21.6%) were moderate (score=2) and four cases (1.8%) were severe (PSS score=3). Combined using the Poisoning Severity Score with the patient's biochemical and physiological values may help improve an accurate diagnosis of poisoning and determine the severity of poisoning more accurately.

Exposures and suspected intoxications during SARS-CoV-2 pandemic: preliminary results from an Italian poison control centre

Data on cleaner and disinfectant exposure and misuse-related acute intoxications in Italy during SARS-CoV-2 pandemic are still lacking. The aim of the present study was to analyse and describe cleaner and disinfectant-related intoxications during SARS-CoV-2 pandemic in an Italian poison control centre. Data were obtained from the toxicological consultations requested to the Toxicology Unit and Poison Centre, Careggi University Hospital, Florence (Italy). We compared data from January 1st to April 30th of 2019 and 2020. Data concerning probable or acute intoxication from any causative agent in the general population (all age groups), from private individuals or from Regional and National health structures, were included in the analysis. A toxicological evaluation was also performed to calculate the Poisoning Severity Score.In 2019, 451 phone counselling sessions were performed and compared to a total of 410 calls received during the same period of 2020. In both periods, the majority of events occurred in paediatric (0–17 years) and adult (18–65 years) patients, who were mainly exposed to one toxic agent, and intoxications took place principally at home due to domestic accidents. The oral route of intoxication was the most frequently observed one, followed by inhalation of toxic agents, which increased by 4.7% in 2020. In 2020, sanitizers and cleaners were reported in 21.6% of cases compared to 12.5% in 2019. This is the first study describing cleaner and disinfectant-related intoxications in Italy. Our results suggested a possible misuse of these products during the SARS-CoV-2 pandemic, underling the effects of home isolation on mental health and unintentional toxic exposures.

A study to assess the utility of poison severity score, pseudocholinesterase levels and Glasgow coma scale in predicting severity and clinical outcome of organophosphorus poisoning

Background: Suicides due to organophosphate self-poisoning is a major cause of concern world over. Organophosphate compounds (OP) possess a major cause of suicide in India. There is a greater need for tools to predict severity of OP poisoning. We in this study try to assess the utility of the Glasgow coma scale (GCS), pseudocholinesterase levels and the poisoning severity score (PSS) in estimating severity and clinical prognosis of OP poisoning in patients of south India.Methods: A prospective study was conducted over 2 years in department of medicine, KIMS hospital and research centre, patients who were >18 years of age were included. OP poisoning was determined by either history of consumption or clinical features. Pseudocholinesterase levels at admission, PPS and GCS scores were assessed at admission and at 24 hours. Clinical, demographical, and certain laboratory investigation were recorded. Patients were followed till the patient stayed in intensive care unit.Results: In present study 100 patients were enrolled. Significant association was observed between GCS (p<0.001), PSS (p<0.001) and outcome of OP poisoning. Unexpectedly no significant association was observed with pseudocholinesterase level (p=0.118). A total of 83% patients were improved after treatment and mortality rate observed was 17%. Out of these 83% severe complications were observed in 14% of the patients.Conclusions: The findings of this study highlight the usefulness of GCS and PSS systems for predicting severity of OP poisoning. Identification of severity at an early stage followed by prompt treatment can prevent deaths. Our study did not find any association between pseudocholinesterase levels at admission and severity of OP poisoning.

Probabilistic model to predict the outcome in acute suicidal chemical poisoning cases from age and gender of patient and type of chemical poison consumed

Background: Acute chemical poisoning is a significant global health problem. Chemical poisons include agrochemical, household and industrial poison subtypes. The present study used a probabilistic model based on age, gender and type of poison consumed by the patient to predict the outcome in acute suicidal poisoning cases. Material and methods: A prospective observational study was conducted at emergency department of SMS Hospital, Jaipur, India, from January 2019 to February 2020. Patients over 15 years of age with poisoning severity score 2 or above were included in the study. Probabilistic model was used to predict the outcome measured in terms of cure, death and left against medical advice (LAMA) using Minitab 14. Results: Poisoning cases were 0.32 % of all emergency presentations. Out of them, 857 (59.6 %) had consumed chemical poison. Their mean age was 32 years and men to women ratio was 1.22. Agrochemical subtype was most common followed by household and industrial poisoning. Analysis by Probabilistic model showed that person between 30-60 years is more likely to be cured and chances of death and LAMA are highest in age group 60-75. Gender-wise, men have higher possibility for recovery. Besides, a person has highest chances of recovery in case of household poisons; death is most common in industrial poisons and LAMA in agrochemical poisons. Conclusion: The study concluded that in poisoning, patients' basic information like age, gender, type of poison consumed can be used to identify high death probability and LAMA risk patients. It will assist in designing and monitoring the most effective strategies for them.

Gross Hematuria in Patients with Wasp Sting: A Retrospective Study

Background: Wasp sting is common in the world, and gross hematuria after wasp sting has been reported in Asia to occur before AKI. Gross hematuria is often used by clinicians as a sign indicated for intensive care and blood purification treatment. However, there is no study on the clinical characteristics and prognosis of wasp sting patients complicated with gross hematuria. Methods: The demographic characteristics and clinical data of 363 patients with wasp sting admitted to Suining Central Hospital from January 2016 to December 2018 were retrospectively analyzed. At admission, the poisoning severity score was used as the criterion for severity classification. According to the presence of gross hematuria, the patients were divided into gross hematuria group and non-gross hematuria group. Multivariate logistic regression analysis was performed to explore the risk factors for gross hematuria.Results: Of the 363 wasp sting patients, 219 were male and 144 were female, mean age was 55.9±16.3 years. 51 (14%) had gross hematuria, 39(10.7%) had Acute Kidney Injury(AKI), 105 (28.9%) had rhabdomyolysis, 61(16.8%) had hemolysis, 56 (15.4%) had Multiple Organ Dysfunction Syndrome (MODS), 13 (3.6%) had Acute Respiratory Distress Syndrome (ARDS), 45(12.4%) went on to receive renal replacement therapy, and 14 (3.9%) died. Patients with gross hematuria group had significantly higher poisoning severity scores when admitted to the hospital than those without gross hematuria group (2.2±0.5 vs. 1.1±0.3, P<0.001).Conclusion: Gross hematuria is one of the early clinical symptoms of severe wasp sting patients. AKI incidence and mortality of patients with gross hematuria are significantly increased. Prompt treatment should be taken for wasp sting patients complicated with gross hematuria. The poisoning severity score can be used for early assessment of the severity of wasp sting patients.

The impact of alcohol exposure on clinical feature in patients with acute poisoning

Background : Alcohol is one of the most commonly co-ingested agents in acute poisoning patients visiting the emergency department (ED). The aim of this study was to compare the outcomes and clinical features of acute-poisoning patients with and without co-ingestion of alcohol. Methods: We retrospectively investigated poisoning patients who visited in the ED from January 2010 to December 2016 in a single center, Republic of Korea. Patients were classified into two groups: with or without alcohol co-ingestion. Data on clinical variables, outcomes, and poisoning severity score (PSS) were collected and compared. Primary outcomes analyzed were admission to the general ward or intensive care unit (ICU) from ED and discharge against medical advice (AMA). Results: A total of 730 patients were included in the study, with 285 (39.0%) in the alcohol co-ingestion (ALC+) group. The patients who had also co-ingested alcohol, more were male, the peak age distribution was 45-54 years old, more had arrived at the ED at night. The rate of discharge against medical advice (AMA) was higher in the ALC+ group (136; 47.7%) than the ALC- group (p = 0.001). In multivariate analysis of DSP, the absence of alcohol co-ingestion (odds ratio [OR]1.41; 95% confidence interval [CI] 1.01-1.96), poisoning severity score (OR 1.74; 95% CI 1.34-2.27), previous MDD history (OR 1.57; 95% CI 1.13-2.19) and GCS score < 13 (OR 2.09; 95% CI 1.48-2.95) were shown to be independent predictive factors of admission (p = 0.042, p < 0.001, p = 0.008, p < 0.001). Conclusion: Alcohol co-ingestion in poisoning patients was a factor affecting admission to the general ward or ICU in the ED. Therefore, emergency physicians assessing the disposition of poisoning patients should be aware that poisoning patients who have co-ingested alcohol may be uncooperative and be at high risk for the AMA discharge.

Features reported after exposure to automatic dishwashing rinse aids

Introduction: Automatic dishwashing rinse aids are drying aids which contain non-ionic surfactants, usually ethoxylated alcohols, typically at concentrations of ≤30%. Objective: To assess the reported toxicity of rinse aids. Methods: Telephone enquiries to the UK National Poisons Information Service were analysed from January 2008 to June 2019. Results: Ingestion: Ingestion was involved in 976 cases and produced gastrointestinal features, coughing and central nervous system depression, particularly in young children. In those in whom the amount ingested was known, the majority (56%) of children <18 years and of adults (57%) ingested <50 mL of rinse aid. Although moderate or severe exposures (Poisoning Severity Score (PSS) ≥ 2) were uncommon, they occurred significantly ( p < 0.0008) more often in adults (9.0%) than in children (1.8%); however, three of the four adults with PSS ≥ 2 co-ingested other substances. Eye exposure: Ocular exposure was reported in 35 cases, of whom 29 developed features. Eye irritation ( n = 10, 28.6%) and eye pain ( n = 10, 28.6%) were reported most commonly, and three patients (8.6%) developed corneal abrasions (PSS 2). Dermal exposure: Thirty-four patients were exposed dermally, and six (17.6%) reported features, including rash, numbness, pruritus and burns (PSS 1). Conclusions: Overall, clinical features developed in 47% of patients exposed to rinse aids, but more severe features (PSS ≥ 2) were rare (<3%) following exposure by any route.