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PubMed2004

Characteristics of acute adult poisoning cases admitted to a university hospital in Istanbul.

BACKGROUND: The aim of this retrospective study was to analyse the characteristics of acute adult poisoning cases admitted to a university hospital in Istanbul, Turkey. PATIENTS AND METHODS: All cases admitted to the Emergency Unit of the Istanbul University Cerrahpaşa Medical Faculty Hospital, between January 2001 and December 2001, were included in this study. We analysed the clinical charts for aetiological and demographical characteristics of the acutely poisoned patients. RESULTS: There were 284 poisoning cases (207 females and 77 males) among 11834 patients admitted to the Emergency Unit. This was 2.4% of all emergency admissions. The female-to-male ratio was 3:1. The mean age was 27+/-12 years (age range 15-87) and the majority of the patients (73.94%) were below the age of 30 years. The median age was 24 years. Medicinal drugs were the major cause (69.37%) of the cases, followed by inhalation of gases (14.44%), alcohol (5.99%), alcohol together with illicit drugs (4.23%), food (3.17%), corrosives (1.76%) and pesticides (1.06%). The route of administration was as follows: 84.51% orally, 14.44% by inhalation and 1.06% by intravenous injection. Seventy-one per cent of acute poisonings were self-inflicted and 88% occurred at home. The most frequently involved medicinal drugs were antidepressants and analgesics. In 32.04% of cases, there was more than one medicinal drug responsible for the poisoning. The seasonal distribution in poisoning patients suggested a peak in summer (31.7% of presentations) and winter (30.9%) and lower numbers in spring (22.9%) and autumn (14.5%). The follow-up period of the patients were 1-12 hours for 42 cases (15%), 13-24 hours for 134 cases (47%) and more than 24 hours for 108 cases (38%). Two of the 284 cases with acute poisonings were fatal. This was a university hospital-based study, so these results may not be representative of the general population. Despite this drawback, these data still provide important information about the characteristics of poisoning in the largest city of the country. cn

Acute Disease↗
PubMed2005

Relation of postmortem blood alcohol and drug concentrations in fatal poisonings involving amitriptyline, propoxyphene and promazine.

Drugs and alcohol often occur together in fatal poisonings, complicating the process of determining the cause of death. Especially when found in concentrations generally regarded as toxic but not lethal, the question arises whether the combination of sublethal amounts was the likely cause of death. In this study, we examined poisoning deaths involving amitriptyline, propoxyphene and promazine, which are, after benzodiazepines, the most frequently occurring drugs in Finnish alcohol-related poisonings. From the forensic toxicology database, covering the years 1995-2002, we extracted 332 fatal poisonings, calculated median blood alcohol and drug concentrations, constructed concentration-concentration and concentration-response curves and evaluated the significance of the presence of therapeutic amounts of benzodiazepines. Median amitriptyline and propoxyphene concentrations were lower in alcohol-related cases than in clean drug poisonings. Correspondingly, the median blood alcohol concentrations in all drug-related poisonings were 1.5-2.2 mg/g lower than that found in clean alcohol poisonings. Alcohol concentration proved to be a more sensitive indicator of alcohol-drug interaction than drug concentration. This result suggests that when alcohol is present, relatively small overdoses of the studied drugs may result in fatal poisoning. In this context, fatal drug and alcohol concentrations and the issue of determining the most important agent in fatal drug-alcohol intoxications are discussed.

Amitriptyline↗
PubMed2004

"Getting the lead out" in Hartford, Connecticut: a multifaceted lead-poisoning awareness campaign.

As part of a citywide effort to increase lead poisoning awareness within the city of Hartford, Connecticut, the Hartford Health Department implemented a multifaceted public health campaign involving several novel elements and partnerships, including the use of municipal sanitation trucks to disseminate lead-poisoning prevention messages throughout the city. To evaluate campaign reach and effectiveness, Health Department personnel collected measures of lead-poisoning knowledge, recall of campaign components, and reports of steps taken to prevent lead poisoning from 180 largely ethnic minority parents of preschool-age children. Key results were as follows: a) Recall of campaign components ranged from 21.5 to 62.6%, with newspaper advertisements and signs on buses and billboards recalled most often and a video broadcast on public-access television recalled least often. b) More than 45% of respondents reported that they took steps to prevent lead poisoning because of at least one of the campaign components, with the newspaper advertisements being the most effective component in terms of prompting lead-poisoning prevention behavior. c) Respondents' awareness was particularly low in terms of how medical personnel and procedures can and cannot detect and prevent lead poisoning in children. This campaign prompted caregivers to take steps to prevent lead poisoning and may help public health professionals in other communities to develop novel ideas through which to embark on similar initiatives.

Adult↗
PubMed2000

Reporting of adverse drug reactions by poison control centres in the US.

BACKGROUND: Although US poison control centres manage approximately 30,000 adverse drug reactions each year, the extent of voluntary reporting of these events to the US Food and Drug Administration (FDA) MedWatch spontaneous surveillance programme is unknown. METHODS: A survey was mailed to directors of all 72 US poison control centres during April 1999 to determine their practices and opinions on reporting adverse drug reactions. The survey requested information on the poison control centre staff's practices in reporting adverse drug reactions to the FDA MedWatch programme during 1998. RESULTS: A total of 56 fully completed surveys were returned. Of the respondents, 30 had not directly submitted adverse drug reaction reports to the FDA, 22 had submitted 10 or less, and 4 had submitted a total of 47 during 1998. Reasons given for not routinely reporting adverse drug reactions included adverse drug reactions reporting is not part of the regular routine (20%), lack of time to complete forms (15%), inability to determine causality (13%), most reactions are already reported and not unique (10%), reporting to the FDA is too much work (9%), and responsibility rests with the attending physician (7%). Direct reporting to MedWatch of any cases of adverse drug reactions was more likely when the poison control centre was certified by the American Association of Poison Control Centers (p < 0.05; odds ratio = 5.1; 95% confidence interval 1.1 to 23.5); however, this practice was not associated with documenting deaths associated with adverse drug reactions, having more than 75% of the staff of the Poison Information Specialists composed of pharmacists or nurses, or managing greater than 20,000 or 34,000 human exposure cases during 1998. Approximately half of the poison control centres directly or indirectly reported some adverse drug reactions to the FDA by virtue of contacting the manufacturer or cooperating with postmarketing surveillance. CONCLUSION: Poison control centres represent an underutilised source of reporting to MedWatch, but several internal and external obstacles limit the direct reporting of adverse drug reactions routinely.

Adverse Drug Reaction Reporting Systems↗
PubMed1981

Epidemiological aspects of poisoning in children observed over a 10-year period.

During 10 years of activity at our Service, we collected 1867 cases of poisoning in children. Our observations concern only subjects hospitalized at our Institute and do not include phone call consultations. Our experience confirmed a higher number of poisonings among males. As far as age was concerned, the highest percentage of cases involved children under five, with a peak between 2 and 3 years of age. A fairly high incidence (8%) of "passive" poisonings was found in infants in their first year of life as a consequence of mistakes by the mother or other people taking care of the child. Voluntary poisonings, occurring in children aged 9 or more, often involved females and accounted for 2.1% of the total. Drugs are the main cause of poisoning in children, followed by household products and by a group of different substances (spoiled foods, nonedible mushrooms, alcoholic beverages). The lowest number of poisonings occurred on Sundays. The time of the day when most accidental poisonings occurred ranged from 10:00 AM to 12:00 noon and from 6:00 to 8:00 PM. Most poisonings took place in the kitchen. The colors preferred by children are white and pink.

Adolescent↗
PubMedDate not supplied

Trends in childhood poisoning: a collaborative study 1970, 1975, 1980.

A collaborative study of 273 treated poisonings at three regional poison control centers showed a significant decrease in salicylism from 19% of all cases in 1970 to 9% in 1975 and 11% in 1980. A temporal correlation with safety packaging was also seen in the decrease in poisonings by household products from 36% and 42% of all treated poisonings in 1970 and 1975 to 21% in 1980. Poisonings by non-salicylate medications increased from 45% to 68% of treated ingestions. Therapeutic mishaps were relatively constant at 27%, 20% and 20% of all poisonings by medications. In children under one year of age 59% of medicinal poisonings were therapeutic mishaps, significantly higher than the 27% incidence for ages 1 to 5 years. Therapeutic mishaps and ingestions of household products resulted in significantly longer hospitalizations than accidental ingestion of medications. Additional data from two other regional centers permitted analysis of a total of 47 cases of treated salicylism. Therapeutic mishaps showed a possible upward trend from 27% of salicylate poisonings in 1970 to 36% in 1980. Almost all of the therapeutic mishaps with salicylates involved repeated overdose; 18 of the 19 mishaps due to other medications were allergic reactions.

Accidents↗
PubMed1993

Acute poisoning in Izmir, Turkey--a pilot epidemiologic study.

Epidemiologic data on poisonings in Turkey are extremely limited. This is a retrospective chart review to describe the prevalence of poisoning in both adults and children, the presenting clinical features, morbidity and mortality to identify how poisoning in Izmir follows the pattern of other countries and how it is unique. Three hundred sixty-five poisoned patients presented to the Dokuz Eylül University Hospital, Ismir in 1989 to 1990. The distribution frequency of substances ingested reflects that of substances available in the home. Poisoning episodes in small children were most likely to involve hydrocarbons, analgesic, caustics or pesticides (55%). Ethanol, anticonvulsants, tricyclic antidepressants, and pesticides (55%). Ethanol, anticonvulsants, tricyclic antidepressants, and pesticides were the most common toxins seen in adults. A significant number of patients presented late in the course of their poisoning. Of those ingesting pharmaceuticals, mushrooms or plants, emesis, but no other modes of decontamination, was reported for 21%. Toxin "antidotes", gastrointestinal decontamination and enhanced drug removal techniques used in other parts of the world were rarely utilized. Nonetheless, only three patients (0.8%) died. This pilot study supports the need for a Regional Poison Information Center offering poison management advice to the general public as well as to members of the health care professions, the initiation of a public education campaign, and regional treatment by physicians trained in medical toxicology.

Adolescent↗
PubMed1995

The production model as a basis for conducting economic evaluations of regional poison control centers.

To identify the significant inputs, activities, and outputs of a regional poison control center, a production model is described and its potential application to the conduct of economic evaluations delineated. The model can help the researcher identify the significant inputs (costs) incurred through the provision of poison control center services. These inputs directly influence the activities that the poison center is capable of undertaking. Activities undertaken by a poison center are intermediate steps between the inputs and outputs, and serve to convert the various inputs into associated outputs. They form the basis for determining the outputs produced by the poison center services. The outputs derived from poison center services provide the conceptual framework for assessing the effectiveness of a poison center in an economic analysis. Also described are potential applications of the production model in conducting poison center cost-effectiveness and cost-benefit analyses.

Cost-Benefit Analysis↗
PubMed1996

The National Poison Information Center in Poland.

OBJECTIVE: To describe the national poison information program in Poland. RESULTS: There are nine regional poison information centers in Poland associated with acute poisoning wards or diagnostic laboratories. The National Poison Information Center in Lodz prepares information materials (ITOX database, books, periodicals, leaflets, posters) on treatment and prevention to regional and other health care units treating acute poisoning cases and to the general public. The staff of the National Poison Information Center together with the physicians of the Clinic of Acute Poisonings provide a 24 h poison information service accessible to health care units, work safety services, and the general public.

Computer Communication Networks↗
PubMed1999

Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: a randomised controlled clinical trial.

OBJECTIVE: To assess neurological sequelae in patients with all grades of carbon monoxide (CO) poisoning after treatment with hyperbaric oxygen (HBO) and normobaric oxygen (NBO). DESIGN: Randomised controlled double-blind trial, including an extended series of neuropsychological tests and sham treatments in a multiplace hyperbaric chamber for patients treated with NBO. SETTING: The multiplace hyperbaric chamber at the Alfred Hospital, a university-attached quarternary referral centre in Melbourne providing the only hyperbaric service in the State of Victoria. PATIENTS: All patients referred with CO poisoning between 1 September 1993 and 30 December 1995, irrespective of severity of poisoning. Pregnant women, children, burns victims and those refusing consent were excluded. INTERVENTION: Daily 100-minute treatments with 100% oxygen in a hyperbaric chamber--60 minutes at 2.8 atmospheres absolute for the HBO group and at 1.0 atmosphere absolute for the NBO group--for three days (or for six days for patients who were clinically abnormal or had poor neuropsychological outcome after three treatments). Both groups received continuous high flow oxygen between treatments. MAIN OUTCOME MEASURES: Neuropsychological performance at completion of treatment, and at one month where possible. RESULTS: More patients in the HBO group required additional treatments (28% v. 15%, P = 0.01 for all patients; 35% v. 13%, P = 0.001 for severely poisoned patients). HBO patients had a worse outcome in the learning test at completion of treatment (P = 0.01 for all patients; P = 0.005 for severely poisoned patients) and a greater number of abnormal test results at completion of treatment (P = 0.02 for all patients; P = 0.008 for severely poisoned patients). A greater percentage of severely poisoned patients in the HBO group had a poor outcome at completion of treatment (P = 0.03). Delayed neurological sequelae were restricted to HBO patients (P = 0.03). No outcome measure was worse in the NBO group. CONCLUSION: In this trial, in which both groups received high doses of oxygen, HBO therapy did not benefit, and may have worsened, the outcome. We cannot recommend its use in CO poisoning.

Adult↗
PubMed1994

Lead poisoning and other causes of mortality in trumpeter (Cygnus buccinator) and tundra (C. columbianus) swans in western Washington.

Lead poisoning and other causes of mortality of 115 trumpeter (Cygnus buccinator) and 21 tundra (C. columbianus) swans from northwestern Washington (USA) from 1986 to 1992 are reported. Necropsies were performed on all 136 swans, liver lead analysis conducted on 110, and differentiation between lead and steel shot pellets recovered from gizzards in 97 swans. Shot pellets were detected in 44 (32%) of 136 gizzards. Lead shot was recovered from 32 (33%) of 97 gizzards and steel shot from 16 (16%). Mean intensity of lead shot in gizzards was nearly five times greater than steel shot. Thirty-nine (35%) of 110 livers had lead concentrations diagnostic of lead poisoning (> 6 ppm, wet weight). Mean (+/- SE) weight for 61 non-lead poisoned trumpeter swans was 9.8 (+/- 0.30) kg, significantly heavier (P < 0.05) than 30 lead poisoned trumpeters (mean = 6.8 +/- 0.23 kg). There was no significant difference (P > 0.05) in weights between lead poisoned (n = 9) and non-lead poisoned (n = 12) tundra swans. Lead poisoning was the primary cause of death, accounting for 29% of the mortalities. Other causes of mortality identified were aspergillosis (17%), illegally shot (11%), and other traumatic factors (12%). The cause of death for 43 swans was not determined. Lead poisoning from the ingestion of lead shot continues to be a principal cause of mortality in swans overwintering in northwestern Washington.

Animals↗
PubMed1999

History of USDA poisonous plant research.

Research on poisonous plants was instituted by the United States Department of Agriculture (USDA) as a result of serious livestock poisoning by plants as the pioneers moved west in the mid-to-late 1800s and early 1900s. Historical records indicate the USDA began poisonous plant research in 1894 under the direction of Mr. V. K. Chestnut, a botanist (Table 1 briefly summarizes those who have directed poisonous plant research from the inception to the present). Mr. Chestnut's responsibility (1894-1904) was primarily administrative, although he did extensive field work in Washington and Montana. Temporary field stations were set up to study specific poisonous plant problems. These included field stations at Hugo and Woodland Park, Colorado, and Imperial, Nebraska (1905-1909), to study locoweed; Gunnison, Colorado (1910-1912), to primarily study larkspur; and Greycliff, Montana (1912-1915), to study the poisonous plants of the Yellowstone Valley. Dr. Rodney True replaced Mr. Chestnut in 1904 and in 1905 hired Dr. C. D. Marsh (1905-1930) to establish the temporary field stations listed above. In 1915 a permanent facility was established at Salina, Utah, under the direction of C. D. Marsh who remained in charge until 1930 when he retired; he was followed by A. B. Clawson until 1937 when Dr. Ward Huffman was placed in charge. Research on poisonous plants was located at the Salina Experiment Station until 1955 when the station was closed and the laboratory moved to the campus of Utah State Agricultural College at Logan, Utah, where it is currently located. Dr. Wayne Binns was hired as the director of the laboratory in 1954 and retired in 1972. In 1972 Dr. Lynn F. James, who joined the PRPL staff in July 1957, was appointed as Research Leader and presently directs the research at the Poisonous Plant Research Laboratory.

Academies and Institutes↗
PubMed1998

[Analysis of 25 episodes of acute occupational poisoning accidents and studies on its preventive strategy].

OBJECTIVE: To study the causes of the occurrence of severe acute occupational poisoning and its first-aid, and to improve its prevention and management. METHODS: Data of labor health conditions in 25 episodes of poisoning during the past 13 years were collected and analyzed statistically according to industries, enterprises and toxicals. RESULTS: Twenty-five episodes of poisoning accidents involved 131 persons, with 22 deaths. The incidence rate of occupational poisoning accidents in township and town enterprises exceeded that in state-owned ones. Ten kinds of toxicants were involved in the poisoning, with the hydrogen sulfide, benzene, carbon monoxide, phosgene and organophosphorus pesticide at the top five places in the number of cases with poisoning they caused. There were another 131 persons intoxicated during their emergency action and eight deaths, with a higher incidence and mortality rates due to poisoning than those in the operation workers. CONCLUSION: The major causes of the poisoning accidents were lack of knowledge of prevention and protection from them. It laid a good foundation for the establishment of emergency rescuing system in the grassroots.

Accidents, Occupational↗
PubMed2000

The changing pattern of poisoning with psychoactive drugs in Croatia.

The aim of this study was to analyse the frequency of poisoning with psychoactive drugs (benzodiazepines, antidepressants and neuroleptics) over the last 15 years in Croatia. The analysis was based on poisoning incidents reported over the phone (hot line) to the Zagreb Poison Control Center and included two periods: 1985-1991 (period I) and 1992-1999 (period II). The data were analysed separately for children and adults. Each phone call was counted as one poisoning incident. Child poisoning with neuroleptics was significantly higher in period II than in period I and so was the adult poisoning with antidepressants, amytriptyline, and combined psychoactive drugs. The frequency of total psychoactive drug poisoning was significantly higher in adults than in children in both periods. From 1992, the frequency of adult poisoning with antidepressants considerably increased as one of the many consequences of war-related stress. The results indicate a need for careful psychiatric evaluation and more critical use of antidepressants in affected individuals.

Adult↗
PubMed2003

[Gas poisoning].

Poisoning by gases in our area is an important problem due to its high incidence. In the specific case of carbon monoxide poisoning, this is the main cause of death by poisoning in our environment, on many occasions coexisting with cyanide poisoning. Both poisonings can be severe, their diagnosis being based on the mere suspicions of the doctor. Besides, their importance lies in the fact that both poisonings have a very specific treatment. Normo or hyperbaric oxygenotherapy is the treatment for carbon monoxide poisoning. In the case of cyanide poisoning, hydroxocobalamin is nowadays the treatment of choice, since it has proved itself to be an efficient antidote.

Acute Disease↗
PubMed2000

[Poisons and antidotes according to Gunyetü'l Muhassilin and an 18th century Ottoman pamphlet].

This study deals with the chapter on poisons (Sümum) of Gunyetü'l-Muhassilin, a translation, and a pamphlet on antidotes called Panzehir, by Ahmed Sani, one of the most prominent figures of the Ottoman physicians. As a foreword, the terminology related with the subject; and an introduction to the Islamic medical theory, the basis of the subject, is discussed. The main topics on poisons are; protection against and treatment of poisons; being poisoned by the sting of insects, snakes etc. and diseases such as rabies, as a result of bites of animals and their treatment; treatment of poisoned suppuration; insecticide drugs and measures; and common drugs against all kinds of poisons. Immunization and nutrition with respect to being poisoned; and preventive measures against insects; and mineral and organic antidotes are also discussed. The classification of diseases and treatment ase evaluated on the humoral theory basis. The treatment of insect poisoning is viewed from the perspective of its symptoms. The pamphlet named Panzehir is about a special antidote, the bezoar stone. This antidote is divided into two, of the mineral and the animal origin and the uses of the bezoar are discussed. A vocabulary is added to help readers to understand the terminology.

Antidotes↗
PubMed2004

Influence of pesticide regulation on acute poisoning deaths in Sri Lanka.

OBJECTIVES: To assess in a developing Asian country the impact of pesticide regulation on the number of deaths from poisoning. These regulations, which were implemented in Sri Lanka from the 1970s, aimed to reduce the number of deaths - the majority from self-poisoning - by limiting the availability and use of highly toxic pesticides. METHODS: Information on legislative changes was obtained from the Ministry of Agriculture, national and district hospital admission data were obtained from the Sri Lanka Health Statistics Unit, and individual details of deaths by pesticide poisoning were obtained from a manual review of patients' notes and intensive care unit records in Anuradhapura. FINDINGS: Between 1986 and 2000, the total national number of admissions due to poisoning doubled, and admissions due to pesticide poisoning increased by more than 50%. At the same time, the case fatality proportion (CFP) fell for total poisonings and for poisonings due to pesticides. In 1991_92, 72% of pesticide-induced deaths in Anuradhapura were caused by organophosphorus (OP) and carbamate pesticides - in particular, the WHO class I OPs monocrotophos and methamidophos. From 1991, the import of these pesticides was reduced gradually until they were banned for routine use in January 1995, with a corresponding fall in deaths. Unfortunately, their place in agricultural practice was taken by the WHO class II organochlorine endosulfan, which led to a rise in deaths from status epilepticus - from one in 1994 to 50 in 1998. Endosulfan was banned in 1998, and over the following three years the number of endosulfan deaths fell to three. However, at the end of the decade, the number of deaths from pesticides was at a similar level to that of 1991, with WHO class II OPs causing the most deaths. Although these drugs are less toxic than class I OPs, the management of class II OPs remains difficult because they are, nevertheless, still highly toxic, and their toxicity is exacerbated by the paucity of available facilities. CONCLUSION: The fall in CFP amidst a rising incidence of self-poisoning suggests that Sri Lanka's programmes of pesticide regulation were beneficial. However, a closer inspection of pesticide-induced deaths in one hospital revealed switching to other highly toxic pesticides, as one was banned and replaced in agricultural practice by another. Future regulation must predict this switching and bear in mind the ease of treatment of replacement pesticides. Furthermore, such regulations must be implemented alongside other strategies, such as integrated pest management, to reduce the overall pesticide availability for self-harm.

Acute Disease↗
PubMed2000

[Poisons and antidotes according to Gunyetü'l Muhassilin and an 18th century Ottoman pamphlet].

This study deals with the chapter on poisons (Sümum) of Gunyetü'l-Muhassilin, a translation, and a pamphlet on antidotes called Panzehir, by Ahmed Sani,one of the most prominent figures of the Ottoman physicians. As a foreword, the terminology related with the subject; and an introduction to the Islamic medical theory, the basis of the subject, is discussed. The main topics on poison are; protection against and treatment of poisons; being poisoned by the sting of insects, snakes etc. and diseases such as rabies, as a result of bites of animals and their treatment; treatment of poisoned suppuration; insecticide drugs and measures; and common drugs against all kinds of poisons. Immunization and nutrition with respect to being poisoned; and preventive measures against insects; and mineral and organic antidotes are also discussed. The classification of diseases and treatment are evaluated on the humoral theory basis. The treatment of insect poisoning is viewed from the perspective of its symptoms. The pamphlet named Panzehir is about a special antidote, the bezoar stone. This antidote is divided into two, of the mineral and the animal origin; and the uses of the bezoar are discussed.A vocabulary is added to help readers to understand the terminology.

Antidotes↗