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PubMed2001

Etiologic and demographic characteristics of poisoning: a prospective hospital-based study in Oman.

BACKGROUND: The health care system in Oman is characterized by its rapid development and free medical services for all its nationals although traditional medicine still plays a major role in daily life. Epidemiological data on poisoning are scanty. OBJECTIVE: To determine the annual rate of poisoning-related Accident & Emergency Department visits at Sultan Qaboos University Hospital in Oman and to evaluate, in both children and adults, the etiologic and demographic characteristics of poisoning cases. The poisoning pattern is contrasted to that of other countries. METHODS: A prospective observational study included all symptomatic and asymptomatic poisoning-related Accident & Emergency Department visits over 4 years (1996-1999). Data were recorded on a specifically designed poison reporting form. RESULTS: Two hundred and four poisoning-related Accident & Emergency Department visits were recorded corresponding to an average annual rate of 1.8/1000 Accident & Emergency Department visits. Therapeutic agents were most commonly involved (50% of all cases). Accidental poisoning in toddlers was most commonly caused by drugs. Intentional poisoning in adults involved mainly therapeutic agents (50%), particularly analgesics, followed by industrial and environmental agents (25%). Animal poisoning (14%) was most commonly encountered in adult males. Traditional remedies constituted 7% of all poisoning cases. A total of 148 patients (73%) were admitted for 1 to 175 days. CONCLUSIONS: Compared to studies performed in urban hospitals in other countries, (1) the annual rate of poisoning-related Accident & Emergency Department visits was substantially lower, (2) psychoactive drugs were less frequently incriminated in intentional ingestions, and (3) we found a significantly higher frequency of poisoning by animals and traditional remedies than reported by urban hospitals in other Middle Eastern countries. The limitations of our study (Accident & Emergency Department-based data collection in an urban hospital) do not permit extrapolation to the rest of the country.

Adolescent↗
PubMed1987

The epidemiology and prevention of paraquat poisoning.

In the UK there was an increase in the annual number of deaths associated with paraquat poisoning between 1966 and 1975. Since that time there has been little change in numbers. High mortality is associated commonly with suicidal intent. Serious accidental poisoning from paraquat has never been frequent in the UK and there have been no deaths reported in children since 1977. The National Poisons Information Service has monitored in detail all reports of paraquat poisoning since 1980. Of the 1074 cases recorded there were 209 deaths. In recent years serious poisoning has been more commonly associated with ingestion of concentrated products by males. Local exposure to paraquat has not resulted in systemic poisoning. International data for paraquat poisoning is incomplete and difficult to compare. There is a scarcity of morbidity data at both international and national levels. Information obtained from Poison Control Centres indicates that paraquat poisoning occurs in many countries but detailed comparisons are hindered by lack of standardised methods of recording. Various measures to prevent paraquat poisoning have been introduced. Their effectiveness has not been studied in detail. Some support is provided by the low incidence of serious accidental paraquat poisoning in the UK, but because of the suicidal nature of paraquat poisoning it is unlikely that current preventative measures will influence the number of deaths occurring each year. Preventative measures against paraquat poisoning should be tailored to national needs, based on and assessed by epidemiological studies.

Adolescent↗
PubMed1999

Our experience in the treatment of acute Amanita phalloides poisoning.

INTRODUCTION: The present study aimed at investigating phalloid mushroom poisoning and the toxicological aid services in Plovdiv region as this pathology shows in this country high mortality rate (40-100%) and increasing incidence; it is difficult to diagnose and is far from featuring adequately in the literature in our country. MATERIAL AND METHODS: A caseload of 270 patients with mushroom poisoning from Plovdiv region, Bulgaria, admitted for treatment to the Clinic of Toxicology, Higher Medical Institute, Plovdiv, for the period 1991-1998 was studied. Of these 270 patients 25 (9.26%) had an acute phalloid poisoning. The following indicators were registered: gender, age, reported type of consumed mushrooms, time of appearance of the first complaints after the mushroom consumption, time of medical aid, disease outcome. The diagnosis and the applied treatment was based on our own diagnostic-therapeutic protocol for phalloid intoxication. RESULTS: All phalloid poisoning cases were accidental by character. The most frequently reported type of ingested mushroom was unidentified wild edible mushrooms. Of all the patients males were 56%, females--44% with mean age of 47.71 years (SD = 17.53). From 25 phalloid poisoning cases 15 survived (60%), 10 died (40%). The summer-fall seasonal pattern of phalloid poisoning occurrence was apparent. The mean duration of the latency period was 12 hours (SD--6.66). In 4 (16%) patients the disease exhibited an unusually early onset--up to 2 hours after the mushroom ingestion. The mean time period from the mushroom ingestion to the presentation in a medical institution for first medical aid was 32 hours (SD--21.69), for men--27.59 hours, for women--43.75 hours. Almost one third (32%) of the diseased presented for medical help more than 36 hours after the poisoning. CONCLUSIONS: The acute mushroom poisoning cases in adults comprise 7.01% of the total acute poisoning caseload. The phalloid poisoning accounts for 9.26% of the total number of patients with mushroom poisoning admitted for treatment. The application of contemporary diagnostic-therapeutic protocol lowers the hospital lethality rate from phalloid poisoning to 40%. There were no statistically significant differences in the compared parameters between the subgroups of patients with favorable and lethal outcome and between the subgroups of men and women--most probably due to the small sample. In order to lower the incidence and mortality rate from phalloid mushroom poisoning the authors recommend preventive health education on the problem, targeting the population at risk and the introduction of contemporary diagnostic and treatment methods--determining the amatoxins, intravenous application of Silibinin and liver transplantation.

Acute Disease↗
PubMed1992

A study of major causes and types of poisoning in Khonkaen, Thailand.

To investigate the problem of poisoning in Khonkaen Province, Thailand, a prospective data collection method was used. From 257 acute poisoning cases, the total poisoning rate was found to be 0.76/1000 hospital visits and the case fatality rate was 2.7%. Major types of poisoning found were poisonous animals (28.8%), agricultural chemicals (27.2%), misused therapeutic drugs (19.0%) and household chemicals (10.1%). Major causes of poisoning were suicide attempts (35.4%), accidents (28.4%), ignorance (26.8%) and occupational (8.6%). The most frequent age group affected was 11-30 y (58.8%). Females were found involved more than males (1.2:1). In males, the most frequent cause was unintentional poisoning; in females, it was from suicide attempts. The most frequent types among males were poisonous animals and agricultural chemicals; in females they were agricultural chemicals, misused therapeutic drugs and poisonous animals. The poisoning rate in children 0-5 was 12.1% of the total cases, and poisoning from every type of toxic substance was found. The cause in children was unintentional poisoning. The peak total poisoning time was from August to October.

Adolescent↗
PubMed1993

Ineffectiveness of a mass mailing campaign to improve poison center awareness in a rural population.

The distribution of poison prevention and education literature represents a significant part of poison center outreach programs. Yet the effectiveness, in terms of cost and impact, of mailing this material in an unsolicited fashion has not been investigated. We questioned the effectiveness of poison education literature through mass mailing to increase poison center awareness and improve one's ability to comprehend and retain appropriate first aid response in the event of a poisoning emergency. Two poison education brochures, in English and Spanish translation, and 2 telephone stickers were mailed third class to all 8,948 households in 1 rural county at a total cost of $3,420. A total of 397 (4.4%) households were randomly selected and successfully completed a 23-question telephone survey 6 mo after the mailing. The primary language spoken by the respondents were English, 311 (78%) and Spanish, 86 (22%). Children under the age of 6 y were present in 101 (25%) households. Only 50 (13%) respondents remembered having received any poison education brochures. Although 147 (37%) responded that they had heard of the regional poison center, only 63 (16%) said they would call the poison center first in the event of a poisoning. Forty-four percent indicated they would call 911 first. Only a small increase in penetrance rate was found when comparing 6 mo periods before and after the mailing. We conclude that mass mailing of poison education brochures made little impact in improving poison center awareness and first aid response and was not a cost effective method of poison education.

Advertising↗
PubMed2006

[The changes and clinical significance of serum tumor necrosis factor-alpha and endothelin level in bee sting poisoning].

OBJECTIVE: To investigate the change of serum tumor necrosis factor-alpha (TNFalpha) and endothelin (ET) levels and their clinical significance in patients with bee sting poisoning. METHODS: TNFalpha and ET were measured in 97 patients with bee sting poisoning and the results were compared with those in 35 healthy controls. The 97 patients were divided into three groups i.e. mild poisoning group, moderate poisoning group and severe poisoning group and they were also divided according to prognosis into death group and survival group. RESULTS: The levels of serum TNFalpha (1.36 +/- 0.37) microg/L and ET (55.20 +/- 12.60) ng/L in the slight poisoning group increased a little, but they were not significantly different from those in the controls (1.09 +/- 0.25) microg/L and (50.90 +/- 8.80) ng/L (P > 0.05). In the moderate and severe poisoning groups the levels of serum TNFalpha (2.82 +/- 0.79) microg/L, (4.02 +/- 0.93) microg/L and plasma ET (139.30 +/- 58.80) ng/L, (210.50 +/- 86.30) ng/L were significantly higher than those in the controls (P < 0.01). The levels in the severe poisoning group were much higher than those in the moderate poisoning group and the latter much higher than those in the controls. The levels of serum TNFalpha (4.53 +/- 0.89) microg/L and plasma ET (267.50 +/- 98.70) ng/L in the death group were much higher than those in the survival group (2.40 +/- 0.82) microg/L, (107.60 +/- 57.90) ng/L (P < 0.01). The levels of serum TNFalpha were positively correlated with those of plasma ET (P < 0.01). CONCLUSIONS: TNFalpha and ET may be involved in the pathogenesis of bee sting poisoning. It is shown that the higher the levels of serum TNFalpha and plasma ET, the severer degree of the poisoning and the higher fatality rate. Serum TNFalpha and plasma ET levels may be important clinical index in judging the patients, condition and their prognosis in bee sting poisoning. It was an important clinical significance, that may be useful for medicating with antagonist and inhibitor against TNFalpha and ET to prevention and depress death rate in the patients with bee sting poisoning.

Adolescent↗
PubMedDate not supplied

Role and functions of Poisons Information Centre.

The Poisons Information Centre (PIC) is a specialized unit providing information on prevention, early diagnosis and treatment of poisoning and hazard management. Most of the developed and many developing countries have well established poison control centres with poisons information service, patient management facility and analytical laboratory. In India, the National Poisons Information Centre (NPIC) was established in February, 1995 in the Department of Pharmacology at the All India Institute of Medical Sciences, New Delhi. The centre provides toxicological information and advice on the management of poisoned patients adopted to the level of the enquirer. The basis of this service are the databases on poisoning, drug reactions and also the continuous and systematic collection of data from the library. This information service is available round the clock. The PIC has the training responsibility extending to medical and other health professionals and community. The NPIC organized two successive training courses for medical professionals and para professionals at all health levels. Further, NPIC is a participant of INTOX project of IPCS/WHO, receiving regular yearly training on the use of INTOX database. Laboratory service is an essential component of a poisons control programme, providing analytical services on emergency basis to help in diagnosis and management. The NPIC is developing facilities for quick diagnosis of poisoning cases. Toxicovigilance and prevention of poisoning is another major function of PIC. The Centre has prepared manuals and leaflets on prevention and management cards on treatment of various poisonings. Thus the Centre provides a service with considerable health benefits, reducing morbidity and mortality from poisoning and gives significant financial savings to the community.

Child↗
PubMed2000

Sources of information for acute poisoning in accident and emergency departments in Dublin, Ireland.

BACKGROUND: Access by accident and emergency staff to up-to-date information on poisoning is essential for optimal management of acute poisoning. Apart from the National Poisons Information Centre, other information sources can be used. The objectives of the study were to identify sources of information on acute poisoning in accidents and emergencies and satisfaction with their use. METHODS: In a cross-sectional survey of medical staff of accidents and emergencies in Dublin in 1997, data were collected by interviewer-administered questionnaire. RESULTS: All 11 accidents and emergencies participated, with a staff response rate of 95%. One hundred and twenty-eight respondents were included. Ninety-seven percent had managed cases of poisoning (median 3 per week). The National Poisons Information Centre had been used by 93% of respondents, textbooks by 80%, paper database by 63%, and disc database (CD-ROM) by 10%. Of those managing cases, the National Poisons Information Centre would always be contacted by 23% and by 53% in most cases. The National Poisons Information Centre and CD-ROMs were rated the most useful sources of information. Information provided by the National Poisons Information Centre was considered sufficient by 98% of respondents. Thirty-three percent considered that advice should always be confirmed by fax. Limitations with the National Poisons Information Centre were described by 55% (e.g., manual transcription), with textbooks (e.g., limited content) by 83%, with paper databases (e.g., incompleteness) by 85%, and with CD-ROMs (e.g., time-consuming) by 54%. CONCLUSION: For the optimal management of acute poisoning, direct access to computerized information databases in accidents and emergencies combined with telephone access to the National Poisons Information Centre is required, with information available in hard copy.

CD-ROM↗
PubMed2002

Comparison of poison exposure data: NHIS and TESS data.

OBJECTIVE: To identify age-adjusted poisoning episode rates, and poison control center contacts due to poisonings in children under 6 years old based on 1997-1999 National Health Interview Survey data; and compare findings with 1997-1999 Toxic Exposure Surveillance System data. METHODS: Secondary analysis of National Health Interview Survey poisoning episode data for children 5 years and younger. Respondents were asked about poison exposures during the previous 3 months. RESULTS: Based on National Health Interview Survey population weighted data there were 196/10,000 poisonings to young children < 6 years. These exposures resulted primarily from harmful solid or liquid substances. A poison control center was called in 86% of exposures to children < 4 years, but only in 70% of the 4-5 year old exposures. The odds of a poison control center not being called were 3.2 times greater for 4-5 year olds (compared to < or = 3 years) and 4.5 times greater for African-American (compared with White-Americans). Comparison of National Health Interview Survey data with data in the 1997-1999 Annual Reports of the Toxic Exposure Surveillance System revealed the number of estimated exposures in the National Health Interview Survey data were approximately half those reported in the Toxic Exposure Surveillance System data. In both datasets, children 1-2 years of age had the highest percent of poisoning exposures. CONCLUSIONS: Using multiple datasets to explore poisoning rates in young children provides a broader perspective. Differences in findings reflect divergent data collection methods and biases inherent in each database. Although the majority of National Health Interview Survey respondents reporting contacting a poison control center for a poisoning exposure, rates are lower in specific subgroups indicating a need for targeted educational efforts.

Age Factors↗
PubMed2001

Poison information centers save lives ... and money!

Poison information centers provide telephone advice on the treatment of poisonings to the lay public and medical professionals. In general, the services of a poison center are provided freely to the caller. However, poison center services are labor intensive and expensive since most poison centers utilize medical professionals to provide service and are available for consultation 24 hours/day. The failure of poison centers to produce revenue has made them vulnerable to closure. Poison centers provide a vital service to society by reducing morbidity and mortality. Often overlooked are the financial benefits of poison centers. By preventing unnecessary hospital admissions and by providing expert advice that may reduce the use of expensive antidotes and lengthy hospital admissions, poison centers save an estimated $6.50 for every dollar invested in their operation. The cost-effectiveness of poison centers is supported by a multitude of research. All entities that benefit from poison center services should assist in the financial support of poison centers.

Cost-Benefit Analysis↗
PubMed2004

[Paracetamol poisonings in Norway 1990-2001].

BACKGROUND: After the introduction of new regulations in 1981 and 1990 in Norway, over-the-counter sales of paracetamol and acetylsalicylic acid have been limited to 10 grams. From 1990 the sale of paracetamol has increased dramatically; that of acetylsalicylic acid has accordingly been reduced. We have investigated the morbidity and mortality from overdoses of analgesics, especially paracetamol, in the period 1990-2001. MATERIAL AND METHOD: We collected data from the inquiries received by the National Poisons Information Centre in Norway. Data on hospital admissions and deaths have been recorded from the Norwegian Patient Register. These data have also been used to collect anonymous case records from all patients who died following intake of paracetamol. We also sent questionnaires to 57 hospital departments in a survey of deaths from paracetamol poisoning. RESULTS: Calls concerning paracetamol poisonings to the National Poisons Information Centre doubled to about 400 calls per year over the period. In 30% of cases serious poisoning was suspected. Hospital admissions diagnosed primarily as analgesic poisoning increased from 848 to 1162. On average, 52% of poisonings were caused by paracetamol, 13% by opioids, 5% by acetylsalicylic acid; in 27% the analgesic involved was not specified. 59 deaths were diagnosed as poisoning from analgesics as primary cause, 13 of them due to paracetamol, 26 to opioids, 2 to acetylsalicylic acid; in 18 cases the analgesic involved was not specified. The questionnaires gave insignificant additional information. INTERPRETATION: The number of paracetamol poisonings has increased since 1990 in accordance with the dramatic increase in sales of paracetamol in Norway. Although the mortality of paracetamol poisoning is low (1-2 deaths annually), it represents the most critical poisoning problem among non-opioid analgesics. It is important to monitor the morbidity and mortality of paracetamol poisoning, as new regulations introduced from 2003 will increase the availability of paracetamol and other selected non-opioid analgesics.

Acetaminophen↗
PubMed1996

Estimating underreported pesticide poisonings in Nicaragua.

We undertook to estimate the degree of underreporting to a regional pesticide poisoning registry, and to estimate the true incidence of poisoning in an agricultural region of Nicaragua. We surveyed 633 workers at 25 of 33 agricultural cooperatives and any nearby private forms in a area geographically convenient to the regional health headquarters with a short structured interview about pesticide poisonings. Eighty-three percent of workers described current use of pesticides. Twenty-five percent described a pesticide poisoning in the preceding 12 months, and almost one-half (48%) described having been made ill by pesticides at some point in time. Sixty-nine (11%) described a poisoning in the preceding month, 23 of whom had received medical attention. The names of the medically treated were sought in the Regional Pesticide Poisoning Registry for the survey year of 1988. Only 8 of the 23 subjects were found reported to the registry when a total of 1,143 human pesticide poisonings were reported in the entire region. Using 65% as an estimate of underreporting to the registry, we calculate that 3,300 (95% CI 2100-7500) poisonings had received treatment in the region in 1988, of whom more than 2,100 remained unreported. Based on the ratio of total poisonings (treated and untreated) to registry-reported poisonings among our survey respondents, we estimate that 6,700 (95% CI 4100-18000) systemic poisonings, occurred in 1988 in the region. Underreporting of pesticide poisonings disguises the enormity of the problem in developing countries. Even in a region with a strong emphasis on illness reporting for targeted conditions, underreporting is substantial. This method for estimating underreporting is easily applied and provides a rough estimate of registry underreporting and actual incidence for conditions identifiable by a community-applied questionnaire.

Adolescent↗
PubMed2006

Antidotes for acute cardenolide (cardiac glycoside) poisoning.

BACKGROUND: Cardenolides are naturally occurring plant toxins which act primarily on the heart. While poisoning with the digitalis cardenolides (digoxin and digitoxin) are reported worldwide, cardiotoxicity from other cardenolides such as the yellow oleander are also a major problem, with tens of thousands of cases of poisoning each year in South Asia. Because cardenolides from these plants are structurally similar, acute poisonings are managed using similar treatments. The benefit of these treatments is of interest, particularly in the context of cost since most poisonings occur in developing countries where resources are very limited. OBJECTIVES: To determine the efficacy of antidotes for the treatment of acute cardenolide poisoning, in particular atropine, isoprenaline (isoproterenol), multiple-dose activated charcoal (MDAC), fructose-1,6-diphosphate, sodium bicarbonate, magnesium, phenytoin and anti-digoxin Fab antitoxin. SEARCH STRATEGY: We searched MEDLINE, EMBASE, the Controlled Trials Register of the Cochrane Collaboration, Current Awareness in Clinical Toxicology, Info Trac, www.google.com.au, and Science Citation Index of studies identified by the previous searches. We manually searched the bibliographies of identified articles and personally contacted experts in the field. SELECTION CRITERIA: Randomised controlled trials where antidotes were administered to patients with acute symptomatic cardenolide poisoning were identified. DATA COLLECTION AND ANALYSIS: We independently extracted data on study design, including the method of randomisation, participant characteristics, type of intervention and outcomes from each study. We independently assessed methodological quality of the included studies. A pooled analysis was not appropriate. MAIN RESULTS: Two randomised controlled trials were identified, both were conducted in patients with yellow oleander poisoning. One trial investigated the effect of MDAC on mortality, the relative risk (RR) was 0.31 (95% confidence interval (CI) 0.12 to 0.83) indicating a beneficial effect. The second study found a beneficial effect of anti-digoxin Fab antitoxin on the presence of cardiac dysrhythmias at two hours post-administration; the RR was 0.60 (95% CI 0.44 to 0.81). Other benefits were also noted in both studies and serious adverse effects were minimal. Studies assessing the effect of antidotes on other cardenolides were not identified. One ongoing study investigating the activated charcoal for acute yellow oleander self-poisoning was also identified. AUTHORS' CONCLUSIONS: There is some evidence to suggest that MDAC and anti-digoxin Fab antitoxin may be effective treatments for yellow oleander poisoning. However, the efficacy and indications of these interventions for the treatment of acute digitalis poisoning is uncertain due to the lack of good quality controlled clinical trials. Given pharmacokinetic differences between individual cardenolides, the effect of antidotes administered to patients with yellow oleander poisoning cannot be readily translated to those of other cardenolides. Unfortunately cost limits the use of antidotes such as anti-digoxin Fab antitoxin in developing countries where cardenolide poisonings are frequent. More research is required using relatively cheap antidotes which may also be effective.

Acute Disease↗
PubMed2006

Analysis of 8000 hospital admissions for acute poisoning in a rural area of Sri Lanka.

BACKGROUND: Acute poisoning, especially deliberate self-poisoning with agricultural pesticides, is an emerging global public health problem, but reliable incidence estimates are lacking. Only a few previous studies have assessed the impact of regulatory or other preventive measures. OBJECTIVE: To estimate trends in incidence and causes of acute poisoning over time in rural Sri Lanka, and to assess the possible impact of policies that aimed to restrict availability of highly toxic pesticides. METHODS: Time series of incidence of acute poisoning based on retrospective in-patient records of six government hospitals in southern Sri Lanka from 1990 to 2002. RESULTS: Data of 8,110 admissions for acute poisoning were available for analysis. Most cases were young adults, who deliberately self-poisoned themselves with pesticides, males outnumbering females. Average incidence rate of acute poisoning over the study period was 318 per 100,000 (95% confidence interval [CI], 311 to 325). Incidence of all poisoning showed an increase over the period of study. However, this increase was lower for pesticide poisoning, and the mortality rate and case fatality ratio of pesticides went down towards the end of the 1990s. The decline in mortality was attributed to regulatory controls for the group of highly hazardous organophosphorus compounds implemented in 1995 and for the organochlorine endosulfan in 1998. CONCLUSIONS: Regulatory control of highly toxic pesticides provides important health benefits, especially in terms of lower number of deaths from self-poisoning. However, despite the positive effect of these bans, many deaths from pesticide self-poisoning still occur after ingestion of agricultural pesticides classified as only moderately poisonous.

Acute Disease↗
PubMed2000

Patterns and problems of deliberate self-poisoning in the developing world.

Deliberate self-harm is a major problem in the developing world, responsible for around 600 000 deaths in 1990. The toxicity of available poisons and paucity of medical services ensure that mortality from self-poisoning is far greater in the tropics than in the industrialized world. Few data are available on the poisons most commonly used for self-harm in different parts of the world. This paper reviews the literature on poisoning, to identify the important poisons used for self-harm in these regions. Pesticides are the most important poison throughout the tropics, being both common and associated with a high mortality rate. In some regions, particular pesticides have become the most popular method of self-harm, gaining a notoriety amongst both health-care workers and public. Self-poisoning with medicines such as benzodiazepines and antidepressants is common in urban areas, but associated with few deaths. The antimalarial chloroquine appears the most significant medicine, self-poisoning being common in both Africa and the Pacific region, and often fatal. Paracetamol (acetaminophen) is used in many countries but in few has it reached the popularity typical of the UK. Domestic and industrial chemicals are responsible for significant numbers of deaths and long-term disabilities world-wide. Self-poisoning with plant parts, although uncommon globally, is locally popular in some regions. Few of these poisons have specific antidotes. This emphasizes the importance of determining whether interventions aimed at reducing poison absorption actually produce a clinical benefit, reducing death and complication rates. Future research to improve medical management and find effective ways of reducing the incidence of self-harm, together with more widespread provision of interventions proven to be effective, could rapidly reduce the number of deaths from self-poisoning in the developing world.

Adolescent↗
PubMed1998

An epidemiological study of acute carbon monoxide poisoning in the West Midlands.

OBJECTIVES: To describe the epidemiology of carbon monoxide (CO) poisoning in a defined population, identifying those at greatest risk from acute poisoning resulting in admission to hospital or death. METHODS: A retrospective study with routinely collected information, set in the former West Midlands Regional Health Authority; population of 5.2 million. The data comprised 939 deaths and 701 hospital admissions due to CO poisoning between January 1988 to December 1994. The main outcome measures were age and sex standardised incidence rates (SIRs) for non-intentional, suicidal, and undetermined poisonings for health authorities and the linear relation with socioeconomic deprivation. RESULTS: Overall rate of non-intentional poisonings over the 7 year period was 7.6/100,000, an annual rate of 1.1/100,000. The 7 year rates were highest in people > or = 85; men 24.0/100,000 and women 19.7/100,000. For suicides the 7 year rate was 19.6/100,000, an annual rate of 2.8/100,000. The 7 year rates were highest for men of 35-39, 64.1/100,000, and for women aged 45-49, 15.3/100,000. None of the causes of poisoning were related to deprivation. Non-intentional poisonings showed a strong seasonal variation with the highest rates being recorded in the months October to March. Increased rates of poisoning were found in the rural districts of the West Midlands. There seems to have been a decline in suicides coinciding with the introduction of three way catalytic converters on cars. CONCLUSIONS: Elderly people and the very young are at the greatest risk from non-intentional CO poisoning and rates are highest in the winter months. Although deaths from non-intentional CO poisoning are declining nationally, in the West Midlands they have remained stable and hospital admissions are increasing. It is not solely an urban phenomenon with rates for non-intentional CO poisoning and suicides higher in the rural districts. Health authorities need to consider all populations in any prevention programme. Further work is needed to establish the extent of the burden of chronic CO poisoning and the impact of catalytic converters on suicides.

Adolescent↗
PubMed2005

Hyperbaric oxygen for carbon monoxide poisoning : a systematic review and critical analysis of the evidence.

Poisoning with carbon monoxide (CO) is an important cause of unintentional and intentional injury worldwide. Hyperbaric oxygen (HBO) enhances CO elimination and has been postulated to reduce the incidence of neurological sequelae. These observations have led some clinicians to use HBO for selected patients with CO poisoning, although there is considerable variability in clinical practice. This article assesses the effectiveness of HBO compared with normobaric oxygen (NBO) for the prevention of neurological sequelae in patients with acute CO poisoning. The following databases were searched: MEDLINE (1966 to present), EMBASE (1980 to present), and the Controlled Trials Register of the Cochrane Collaboration, supplemented by a manual review of bibliographies of identified articles and discussion with recognised content experts. All randomised controlled trials involving people acutely poisoned with CO, regardless of severity, were examined. The primary analysis included all trials from which data could be extracted. Sensitivity analysis examined trials with better validity (defined using the validated instrument of Jadad) and those enrolling more severely poisoned patients. Two reviewers independently extracted from each trial, including information on the number of randomised patients, types of participants, the dose and duration of the intervention, and the prevalence of neurological sequelae at follow-up. A pooled odds ratio (OR) for the presence of neurological symptoms at 1-month follow-up was calculated using a random effects model. Bayesian models were also investigated to illustrate the degree of certainty about clinical effectiveness. Eight randomised controlled trials were identified. Two had no evaluable data and were excluded. The remaining trials were of varying quality and two have been published only as abstracts. The severity of CO poisoning varied among trials. At 1-month follow-up after treatment, sequelae possibly related to CO poisoning were present in 242 of 761 patients (36.1%) treated with NBO, compared with 259 of 718 patients (31.8%) treated with HBO. Restricting the analysis to the trials with the highest quality scores or those that enrolled all patients regardless of severity did not change the lack of statistical significance in the outcome of the pooled analysis. We found empiric evidence of multiple biases that operated to inflate the benefit of HBO in two positive trials. In contrast, the interpretation of negative trials was hampered by low rates of follow-up, unusual interventions for control patients and inclusion of less severely poisoned patients. Collectively, these limitations may have led negative trials to overlook a real and substantial benefit of HBO (type II error). There is conflicting evidence regarding the efficacy of HBO treatment for patients with CO poisoning. Methodological shortcomings are evident in all published trials, with empiric evidence of bias in some, particularly those that suggest a benefit of HBO. Bayesian analysis further illustrates the uncertainty about a meaningful clinical benefit. Consequently, firm guidelines regarding the use of HBO for patients with CO poisoning cannot be established. Further research is needed to better define the role of HBO, if any, in the treatment of CO poisoning. Such research should not exclude patients with severe poisoning, have a primary outcome that is clinically meaningful and have oversight from an independent data monitoring and ethics committee.

Carbon Monoxide Poisoning↗
PubMed2002

[Antipyretic poisoning].

OBJECTIVE: To establish the current incidence of poisoning caused by oral antipyretics in the Spanish pediatric population. METHODS: From January 1998 to December 2000, all cases of poisoning due to antipyretic ingestion in children aged up to 14 years old were recorded and tabulated in the Poison Control Center. RESULTS: A total of 13,044 cases of drug poisoning were recorded. Acetaminophen accounted for 11.0 %, acetylsalicylic acid (ASA) for 3 % and ibuprofen for 1.5 % of the cases (p < 0.001). The risk of acetaminophen poisoning was 5.6 higher than that of ibuprofen poisoning (RR: 5.6; 95 % CI: 4.8-6.5). Seventy three percent of poisonings occurred in children aged 1-3 years old. Poisonings were considered serious in 9.4 % of those produced by acetaminophen, 2 % of those produced by ASA and 1 % of those produced by ibuprofen (p < 0.001). Information from the Poison Control Center were requested mainly by emergency department physicians (78.9 %), followed by pediatricians (15.4 %), other physicians (4.7 %) and nursing staff (1 %). CONCLUSIONS: Because of their frequency and potential toxicity, drug and household product poisonings in childhood are a significant public health problem. Among the antipyretics evaluated, acetaminophen was the most frequently associated with poisoning and with severe intoxications. We recommend several preventive strategies to reduce the incidence of drug poisoning in childhood.

Acetaminophen↗