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Drug poisoning mortality trends in the Scandinavian countries 1961--1973.

Poisoning mortality rates have increased considerably in Denmark and Sweden, slightly in Norway, and remained essentially the same in Finland, during the period 1961 to 1973. In the present study, fatal poisoning included cases of intoxication by solid or liquid substances classified as suicidal, accidental (alcohol poisonings excepted) or of undetermined intent. From 1961 to 1973 poisoning mortality rates increased in Sweden by about 200%, in Denmark by about 100%, and in Norway by about 50%. In males, the age-standardized mortality rates were: in Denmark and Sweden, about 130; in Finland, about 70, and in Norway, about 30 cases per one million of population in1972. The corresponding figures for females were 125, 75, 40 and 20. Despite this overall rise, rates of suicidal poisoning mortality and mortality from accidental poisoning have decreased in Sweden since 1969. From this year onwards, the classification category "undetermined poisoning" has been used and the decreases in other categories are compensated by an increase in this group. On the basis of the scanty data available, the substances most frequently responsible for fatal poisoning are drugs (in particular barbiturates), other soporifics, and tranquilizers. There is some evidence that poisoning mortality is correlated with the prevalence of drug use and could consequently be reduced by drug control.

Accidents↗

Hospitalized poisonings after renal transplantation in the United States.

BACKGROUND: The national incidence of and risk factors for hospitalized poisonings in renal transplant recipients has not been reported. METHODS: Historical cohort study of 39,628 renal transplant recipients in the United States Renal Data System between 1 July 1994 and 30 June 1998. Associations with time to hospitalizations for a primary diagnosis of poisonings (ICD-9 codes 960.x-989.x) within three years after renal transplant were assessed by Cox Regression. RESULTS: The incidence of hospitalized poisonings was 2.3 patients per 1000 person years. The most frequent causes of poisonings were immunosuppressive agents (25.3%), analgesics/antipyretics (14.1%), psychotropic agents (10.0%), and insulin/antidiabetic agents (7.1%). In Cox Regression analysis, low body mass index (BMI, <21.6 vs. >28.3 kg/m2, adjusted hazard ratio (AHR), 3.02, 95% CI, 1.45-6.28, and allograft rejection, AHR 1.83, 95% CI, 1.15-2.89, were the only factors independently associated with hospitalized poisonings. Hospitalized poisonings were independently associated with increased mortality (AHR, 1.54, 95% CI 1.22-1.92, p = 0.002). CONCLUSIONS: Hospitalized poisonings were associated with increased mortality after renal transplantation. However, almost all reported poisonings in renal transplant recipients were due to the use of prescribed medications. Allograft rejection and low BMI were the only independent risk factors for poisonings identified in this population.

Adult↗

Demographical, aetiological and clinical characteristics of poisonings in Mersin, Turkey.

BACKGROUND: As acute poisoning continues to be an important public health problem, and represents a frequent cause of admission in emergency departments, there is a constant need to have up to date information about it. The aim of this retrospective study was to evaluate the demographical, aetiological and clinical characteristics of acute poisonings who were admitted to a university hospital in the south part of Turkey. METHODS: The data of 195 acute poisoning patients who were admitted to the Emergency Department of Mersin University were retrospectively studied. RESULTS: Most poisonings occurred in the age range 0-6 years (57.5%) for children and 17-25 year (46.7%) for adults. The overall female to male ratio was 1.26. Drugs were the most common cause of poisonings (55.4%). Among the drug poisonings, psychotropics (41.7%) were the most frequent agent, followed by analgesics (20.4%). 67.7% of the cases presented to the emergency department within 3 hours of poisoning and the procedures for elimination of poison were performed in most of them. The clinical status of the patients on arrival was generally good. 69.2% of the patients were hospitalized. The mean duration of hospitalization was 2.4+/-2.8 days. 41.8% of the suicidal cases had a history of psychiatric disorders; 92.8% of the patients were discharged home after toxicological treatment; 2.6% of the cases died. CONCLUSION: Further studies are necessary to collect more data and these data will be helpful not only for determining risk factors of acute poisonings but also for developing education and prevention programmes.

Adolescent↗

White matter hyperintensities and neuropsychological outcome following carbon monoxide poisoning.

BACKGROUND: Carbon monoxide (CO) poisoning may result in white matter hyperintensities (WMH) and neurocognitive impairments. OBJECTIVE: To assess in a prospective study WMH in CO-poisoned patients and their relationship to cognitive functioning. METHODS: Seventy-three consecutive CO-poisoned patients were studied. MR scans and neurocognitive tests were administered on day 1 (within 36 hours after CO poisoning), 2 weeks, and 6 months. Age- and sex-matched control subjects for white matter analyses only were obtained from the authors' normative imaging database. MR scans were rated for WMH in the periventricular and centrum semiovale regions, using a 4-point rating scale. Two independent raters rated the scans, and a consensus was reached. RESULTS: Thirty percent of CO-poisoned patients had cognitive sequelae. Twelve percent of the CO-poisoned patients had WMH, with significantly more periventricular, but not centrum semiovale, WMH than control subjects. The WMH in CO-poisoned patients did not change from day 1 to 6 months. Centrum semiovale hyperintensities were related to worse cognitive performance. Duration of loss of consciousness correlated with cognitive impairment at all three times. Initial carboxyhemoglobin levels correlated with loss of consciousness but not with WMH or cognitive sequelae. CONCLUSIONS: CO poisoning can result in brain injury manifested by WMH and cognitive sequelae. The WMH were not related to CO poisoning severity. The WMH occurred in both the periventricular and the centrum semiovale regions; however, only those in the centrum semiovale were significantly associated with cognitive impairments.

Adolescent↗

Diazepam in the treatment of organophosphorus ester pesticide poisoning.

Although the main site of action of diazepam, as with other benzodiazepines, is at the gamma-aminobutyric acid A (GABAA) receptor, the degree to which the beneficial actions of diazepam in organophosphorus (OP) ester pesticide poisoning are mediated through the GABAA receptor has been a matter of controversy. Although in most series of OP intoxications, convulsions have been relatively uncommon, it is probable that convulsions produce long-term sequelae in the central nervous system by causing structural damage. Animal studies have demonstrated that diazepam prevents and treats convulsions produced by OPs and may prevent the late effects caused by damage to the central nervous system induced by such convulsions. Consequently, the use of diazepam is an important part of the treatment regimen of severe OP poisoning as it prevents, or at least reduces the duration of, convulsions. In addition, case reports suggest that diazepam will also ameliorate muscle fasciculation, a subjectively unpleasant feature of OP pesticide poisoning. There are no data, either experimental or clinical, demonstrating any clear effect of diazepam alone on lethality in OP poisoning. In fact, in one study of large animals, diazepam, given alone, increased lethality. In animals experimentally poisoned with OPs, combined treatment with atropine and diazepam significantly lowered lethality compared with atropine treatment alone, indicating a clear beneficial effect. There are numerous case reports of the use of diazepam, generally as an adjunct to other more specific OP antidotes such as atropine and/or pyridinium oximes. Based on this evidence and pharmacodynamic studies in experimental animals, diazepam should be given to patients poisoned with OPs whenever convulsions or pronounced muscle fasciculation are present. In severe poisoning, diazepam administration should be considered even before these complications develop. Although diazepam has a large therapeutic index, there appears to be no place for its routine use in OP poisoning. Diazepam should be given intravenously to patients treated in hospital for OP poisoning, although the intramuscular route is used to administer diazepam outside hospital, such as on the battlefield, when an auto-injector is employed. It should be recognised, however, that absorption by the intramuscular route is poor.

Animals↗

Epidemiology of adult poisoning at China Medical University.

OBJECTIVE: The objective of this study was to evaluate characteristics of the adult poisoned patient population at a university hospital in the People's Republic of China. METHODS: A prospective observational study was conducted at the Department of Emergency Medicine, China Medical University and included all poisoning cases presenting to the Emergency Department during a one year period. Data collection forms were designed and placed in the Emergency Department. Data were recorded by Emergency Department staff for all poisoned patients presenting during the study period (March 1, 1994 to February 28, 1995). RESULTS: Six hundred ninety-eight poisoned patients were collected in this study. Sedative/hypnotic agents (27.9%) were involved most commonly. The second most frequent toxicologic emergency was carbon monoxide (19%). Food poisoning was the third most common cause of poisoning (5.5%) and was equal to pesticide poisoning. The most common route of exposure was ingestion (71%). Twelve percent of the patients were admitted and 2.4% died. CONCLUSION: This first epidemiological report of adult poisoning from the People's Republic of China offers emergency physicians and toxicologists a preliminary understanding of the most common toxicologic problems seen in adults in a university hospital in China, and will aid in improving the delivery of emergency care to poisoned patients in the People's Republic of China.

Adolescent↗

Unintentional childhood poisoning in athens: a mirror of consumerism?

OBJECTIVE: To estimate the incidence of unintentional childhood injuries resulting from accidental poisonings in the Greater Athens area and to ascertain what fraction of this incidence could be linked to specified conditions, amenable to preventive interventions. METHODS: Prospective study over 12 months of 670 children hospitalized 224 hours for accidental poisoning. Site: Two pediatric hospitals and three smaller units in Greater Athens admitting children < or = 15 years old. Information was recorded in a semistructured questionnaire and the data were analyzed through simple stratification by one or more variables. Results Accidental poisoning requiring hospitalization > or = 24 hours was 50% higher among boys than among girls, peaked towards the end of the second year, and declined sharply after the fourth year of life with an estimated incidence of 500 cases per 100,000 among children > or = 5 years old. Cigarettes were the most common agent among infants, whereas medicinal products dominated all other childhood periods. Detergents, petroleum products, and pesticides each contributed about 10% of all poisonings with detergents peaking during the second year of life, petroleum products during the third year, and pesticides remaining constant, in proportional terms, throughout childhood. During the working hours of the day the incidence of poisonings was 80% higher than during the late afternoon and evening hours or the weekends, the times when both parents are usually at home; the excess was statistically significant. The presence of both parents at home in the afternoon hours was associated with an almost 50% reduction of hospitalized poisoning. The accessibility of products with poisoning potential was of major importance. Some specific conditions that led to the incident included storage of potentially poisoning products in the refrigerator, storage of such products in containers of innocuous products, without proper labeling, and parental errors in medication. CONCLUSIONS: Unintentional childhood poisoning further reflects an interaction between inappropriate storage of consumer products and suboptimal supervision during the housekeeping hours of the day.

Adolescent↗

A retrospective study of poisoning in Tehran.

OBJECTIVE: To examine the causes and mortality of poisoning in Tehran. METHODS: The 7000 poisoning cases referred to Loghman-Hakim Hospital in Tehran over six months in 1994 were evaluated retrospectively. RESULTS: The overall female to male ratio was 1.8:1. Most poisonings occurred in the age range 2-6 y for children and 21-40 y for adults. Oral ingestion was the most common route of intoxication. In children, boys had a higher frequency of poisonings than girls. Most cases of children were referred to the hospital between 8 am and 8 pm. In adults referred to the hospital, there was little diurnal variation in poisoning presentations. In adults, drugs were the most common cause of intoxication (60.2%). Of these, benzodiazepines (24.5%) were the most frequent, followed by antidepressants (20.5%) and analgesics (18%). Pesticide and opiate intoxications were also commonly observed. In children, after drugs (32.1%), hydrocarbons were the most frequent cause of poisoning (19.2%). Pesticide poisonings were most often fatal (19.2%), followed by barbiturates (18.6%) and opiates (16.2%). Organophosphate insecticides were responsible for 57% of total pesticide poisoning cases. Of the deaths, 87.5% were attributed to suicide. CONCLUSION: The majority of poisoning cases in adults occur intentionally and in children accidentally.

Adolescent↗

Carbon monoxide poisoning: potentially preventable cases.

UNLABELLED: The objective of the study was to describe epidemiological and clinical data regarding acute carbon monoxide (CO) poisoning in an urban area of North Italy. 95 consecutive adult patients admitted to Milan and Turin Poisons Control Centres (PCC) for CO poisoning between October 1993 and March 1995 were enrolled into the study. Epidemiological and medical parameters were recorded in a standardised collection data sheet, which included age, sex, circumstances of poisoning, severity grading (0-3), blood HbCO level upon admission. RESULTS: 86 cases of CO poisoning (90.5%) were due to accidental exposures, 9 to intentional suicide attempts. A majority of cases occurred in late autumn through winter months, from October to February. The highest proportion of accidental CO poisoning cases (92%) occurred in the household setting. In 57 cases the acute severity grading was higher than 1 (median 2); blood HbCO level upon admission was 40% in 16% of the cases (mean 31.6%--median 32.7%). CONCLUSIONS: Carbon monoxide exposure represents a significant cause of severe but potentially preventable accidental poisoning. The study indicates the need for public education campaigns aimed to warn people against the silent killer at home, and to promote preventive measures. The clinical course of CO poisoning is often severe. A standardised collection data system, to record all the cases of acute CO intoxication in Emergency Departments, can help evaluate the real incidence and clinical significance of this poisoning.

Accidents, Home↗

[Comparison between the poisoning severity score and specific grading scales used at the Department of Clinical Toxicology in Krakow].

The aim of the present study has been to assess the concordance in severity grading when using the Poisoning Severity Score (PSS), proposed by IPCS/EC/EAPCCT vs. some specific grading scales. Cases of acute poisoning admitted to the Department of Clinical Toxicology in Kraków during months January, March, May, July, August and October 1998 (n = 820) were evaluated. Severity grading was performed in all cases using both the PSS and special grading scales developed by the poisons centre in Kraków. The PSS is assessing severity on the basis of observed clinical signs and symptoms (at their maximum), but does not take into account potential risks or plasma/serum concentrations. The Kraków scales include both clinical symptoms on admission and results of toxicological analyses. Ethanol (39.4%), drugs (36.2%) and carbon monoxide (7.9%) were the most commonly involved toxic agents. Overall concordance between the PSS and the Kraków scales was at hand in 596 cases (72.7%). The lack of concordance was most evident for ethanol and carbon monoxide cases--the PSS generally giving a lower grade. The discordance was less pronounced for grade 3 (life-threatening) poisonings. Significant number of ethanol poisoning in Kraków centre require medicolegal certification thus ethanol concentration (blood or expired air) is considered while evaluating the poisoning severity. Moreover majority (more than 70%) of acutely ethanol poisoned patients treated at the Department are chronic alcoholics so clinical evidence of intoxication may be minimal at blood ethanol levels higher than 3.0 g/L. For ethanol intoxication the blood ethanol concentration was considered in the Kraków scale but not in the PSS, and when the blood concentrations were disregarded and clinical symptoms only were evaluated the concordance improved between the different systems from 72.7% to 92.3%. Thereby also the overall concordance in the study increased to 82.9%. The less satisfying concordance for carbon monoxide cases was mainly caused by discrepancies in the evaluation of neurological symptoms. Also the blood lactate concentration, COHb level, duration of exposure and patient's age are considered in the Kraków scale but not in PSS. The PSS is intended as a general scheme for grading severity of acute poisoning. In this study an acceptable concordance between the PSS and some locally developed grading scales was at hand in the majority of cases, but it seems that for specific poisons, like carbon monoxide, some modifications and additional criteria may be justified. Further studies to test the reliability of the PSS are encouraged.

Adult↗

Carbon monoxide poisoning in the Republic of Ireland.

Carbon monoxide (CO) poisoning remains a common preventable cause of morbidity and mortality from poisoning worldwide. Common environmental sources include motor vehicle exhaust, faulty kerosene or gas heaters used in unventilated rooms, and fireplaces with blocked flues. This paper describes the epidemiology of CO poisoning in Ireland, using Hospital Inpatient Enquiry (HIPE) data, Mortality data and data from the National Poisons Information Centre (NPIC). CO poisoning is responsible for over 40 deaths per year in Ireland. Many occur at home as a result of house-fires. Incomplete combustion of domestic fuels is responsible for many cases of non-fatal unintentional CO poisoning. In comparison, most intentional poisonings are caused by motor vehicle exhaust, representing approximately 6.4% of successful suicides. The advent of catalytic converters in cars may lead to a decline in the effectiveness of this method of suicide. This study illustrates the hidden impact of CO poisoning. Most deaths occur at home and thus do not come to the attention of the health services. Those admitted to hospital represent the milder end of the spectrum and generally recover after a short stay. It is important that the public be aware of the risks of CO poisoning and that Public Health action be taken.

Adolescent↗

Poisoning: an unnatural cause of morbidity and mortality in rural India.

BACKGROUND: Ninety-nine percent of fatal poisonings occur in developing countries, particularly among agricultural workers. In a particular area, it is important to known the magnitude and pattern of acute poisonings, as it is important for early diagnosis and treatment and also for preventive measures. METHODS: Hospital records of all unnatural causes of deaths were reviewed at Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra during the five years period, 1997-2001. Autopsy records in fatal poisonings were studied for age, sex, residence, marital status, type of poison and manner of poisoning (accidental, suicidal or homicidal). Admission and death rates of acute poisonings were compared with those from other unnatural causes. RESULTS: Acute poisoning is the leading most cause of unnatural deaths and third common cause of emergency hospitalizations in this rural part of India. Of all fatal cases, 67% were males, 63% married, 83% with rural residence and 63.4% suicides. Responsible poison could not be ascertained in 16% of clinical and 9.9% of fatal cases. Insecticides were responsible for 35% of clinical and 55.4% of fatal cases. CONCLUSIONS: Young married males of rural background with agricultural occupation and failure of monsoon are the risk factors associated with poisoning cases.

Adolescent↗

Acute poisoning in children. Cases hospitalized during a three-year period in Trinidad.

The aim of this study is to describe the epidemiological features of acute poisoning in children less than 16 years old who were admitted to a paediatric hospital in north Trinidad. The specific objectives included the determination of the age range most susceptible to poisoning, which agents are mainly responsible, an examination of the need for preventive strategies and educational programmes as well as to evaluate the need for a poison control centre in the country. Data were extracted from the medical records of 169 patients (83 males (49%) and 86 females (51%) with acute poisoning during the period of January 1998 to December 2000. The results revealed that the majority of cases of poisoning were accidental (84.6%), suicide (11.2%) and forced poisoning (4.1%). The largest category of poisoning was a miscellaneous group (24.8%) followed by the drug category (21.8%), kerosene (19.5%), pesticides (15.9%) and bleach (9.4%). Paraquat ingestion constituted 5.3% of cases. The highest prevalence of acute poisoning occurred within the age group of 0-4 years (69.2%), followed by the age group of 10-13 years (13.6%), 5-9 years (9.4%) and the age group with the lowest incidence was 14-16 years (7.6%). The only fatality was a female (10-13 year-group) and this was due to suicidal ingestion of paraquat. All other cases were treated and subsequently discharged. The frequency of accidental poisoning in Trinidad merits more widespread public education aimed at preventing exposure to toxic substances while increasing the use of deterrents such as child-resistant containers.

Acute Disease↗

[The study of poisoning-suicide-attempted patients in emergency departments of 25 hospitals in China].

OBJECTIVE: This study aimed to develop an estimate of the actuality and characteristics of poisoning suicide attempted patients in emergency department (ED) in China. METHODS: We selected 25 hospital EDs in whole country as the investigation spots, and designed one special questionnaire to collect information from the poisoning suicide attempted patients from 1st July, 2001 to 30th June, 2002. RESULTS: Results were based on 4060 cases hospitalized during the investigating period. In general frequency analysis, the ratio of male to female was 1:2.95. In all patients, 98.40% cases took poisons orally, and 93.57% cases occurred at home. The average age was 31.5 years old (min 8, max 93). The leading occupations of cases were farmers, unemployed house-wives, jobless, service people and students. The main types of poisons were druggery (54.29%) and pesticide (35.84%). 2044 cases (59.23%) were cured timely (in 1 hour). When comparing cases from rural hospitals (RHs) and urban hospitals (UHs): ratio of poisoning attempted suicides in RHs to all poisoning cases was higher than UHs with significant gender difference (P < 0.05). UHs number one cause of poisoning was druggery, but in RHs it was pesticide. CONCLUSION: Poisoning attempted suicide was very serious in China. Farmers and women were among the high-risk groups. Druggery and pesticide were the primary poisons, suggesting that management enforcement was in urgent need.

Adolescent↗

[Mercury concentration in cerebrospinal fluid in patients with chronic mercury poisoning].

OBJECTIVE: To investigate the changes of mercury (Hg) levels in cerebrospinal fluid (CSF) in patients with chronic mercury poisoning and elucidate the neurotoxic mechanism of mercury. METHODS: Nine patients with chronic mercury poisoning (poisoning group) as well as eight patients without exposure to mercury were included in this study. Mercury concentrations of 24 hour urine (U-Hg) and CSF (CSF-Hg) were measured with cold-vapor atomic absorption spectrometry-alkali stannous chloride method. The concentration of blood (B-Hg) at the same day was measured with cold-vapor atomic absorption spectrometry-acidic stannous chloride method. In five patients of poisoning group, these concentrations before chelation therapy were compared with those after chelation therapy. RESULTS: The levels of B-Hg, U-Hg, and CSF-Hg in poisoning group (250.00 +/- 48.54, 160.07 +/- 91.15, 20.22 +/- 10.21 nmol/L, respectively) were significantly higher than those in control group (81.04 +/- 63.01, 24.73 +/- 9.96 nmol/L, undetectable, respectively; P < 0.01). In nine patients of poisoning group, CSF-Hg concentrations were correlated with B-Hg (r = 0.675, P < 0.05), but not U-Hg. After chelation therapy with dimercaptopropane sulfonate in five patients of poisoning group, the levels of B-Hg, U-Hg, and CSF-Hg were decreased significantly (P < 0.05). The reduction of CSF-Hg was not related with B-Hg and U-Hg. CONCLUSION: CSF-Hg concentration in chronic mercury poisoning patient is increased with the rise of B-Hg, but not U-Hg. When the levels of B-Hg and U-Hg drop to normal, the CSF-Hg level is still high enough to be detected. It indicates that mercury is combined with protein after entering brain and this complex is difficult to cross through blood-cerebral barrier. The complex may cause neuromuscular disorder and fremitus in chronic mercury poisoning.

Adult↗

[Study on repair capacity of DNA damage associated with chronic benzene poisoning].

OBJECTIVE: To explore the repair capacity of DNA damage associated with chronic benzene poisonings. METHODS: 63 workers suffered from chronic benzene poisonings and 45 workers exposed to benzene, who were engaged in the same job title, were investigated. Comet assay and cytokinesis-block micronucleus (CBMN) detection were used to evaluate gamma-radiation-induced DNA and chromosomal damage and repair capacity in peripheral blood lymphocyte. RESULTS: The comet tail length difference of the benzene poisoning group (4.64 +/- 1.57 microm) was significantly higher than that of the control group (3.77 +/- 1.30 microm) (P = 0.0029). There was no significant difference of the 3AB index between the poisoning group and the control group. The relative risk of benzene poisoning in the subject with comet tail length difference > 3.81 was significantly higher than that in the subject with comet tail length difference < or = 3.81 microm (OR = 2.490, 95% CI:1.068 - 5.806, P = 0.0346). The relative risk increased along with the comet tail length difference, and the trend was significant (P = 0.0024). There was no significant difference between the relative risk of benzene poisoning in the subject with 3AB index < 0.20 and that in the subject with 3AB index > or = 0.20. CONCLUSION: DNA repair capacity on DNA-strand level might tightly associate with chronic benzene poisoning. The DNA repair capacity on DNA-strand level would be worse, and the benzene poisoning risk could be higher. There was no clear relation between the DNA repair capacity on chromosome level and the benzene poisoning risk.

Adult↗

Basal ganglia volumes following CO poisoning: A prospective longitudinal study.

Carbon monoxide (CO) poisoning may result in focal and diffuse neuropathological changes, including basal ganglia lesions. The effect of CO poisoning on basal ganglia volumes over time is unclear. We assessed basal ganglia volumes longitudinally following CO poisoning. We prospectively enrolled 73 CO poisoned patients who underwent brain MR imaging on day 1 (baseline), 2 weeks, and 6 months post-CO poisoning. Basal ganglia volumes were obtained. One patient had bilateral globus pallidus lesions at two weeks and 6 months. Of the CO-poisoned patients 28% had volume reduction in at least one basal ganglia structure by 6 months, of which 21% had putamen, 15% had caudate, 15% had globus pallidus, and 16% had total basal ganglia volume reduction. Putamen volumes were significantly smaller from baseline to six months (p = 0.02). Verbal memory and mental processing speed correlated with smaller putamen and globus pallidus volumes. Carbon monoxide poisoning results in basal ganglia volume reduction 6 months post CO poisoning. Slow mental processing speed and impaired memory correlated with smaller putamen and globus pallidus volumes. Clinicians need to be aware of basal ganglia neuropathologic changes in the absence of observable lesions following CO poisoning.

Adolescent↗

[Mycetismus in children--report of an epidemic of poisoning].

In the autumn of 1988 an outbreak of mushroom poisoning occurred in the surroundings of Zagreb. In less than 3 week period about 140 cases of poisoning were recorded, 17 of whom were children treated at the Department of Pediatrics. Nine children developed gastrointestinal and 18 phalloid syndrome. In the differential diagnosis of each gastroenterocolitis, mushroom poisoning should be taken into consideration, especially during warm and wet summer and autumn. The detection and identification of the poison is the main principle in diagnostics and medical treatment of each poisoning, thus of mushroom poisoning. Incriminated mushroom was identified in 21 of 27 patients (77.8%). Timely application of general therapeutic procedures, especially thorough gastric lavage in each patient, and application of plasmapheresis in case of Amanita phalloides poisoning have been found effective in reducing lethality and in rapid clinical recovery. Of the total number of 18 Amanita phalloides poisoned children, 4 died which is a lethality rate of 22%. In health education it should be pointed out that there are no simple methods for distinguishing edible mushrooms from poisonous ones.

Adolescent↗