Retrospective evaluation of patients at follow-up with acute poisoning in Intensive Care Unit.

OBJECTIVE: Poisonings are among the major causes of emergency visits and intensive care hospitalizations. The aim of our study is to evaluate intoxicated patients at follow-up and treated in the Intensive Care Unit (ICU) in terms of demographic characteristics, type of poisonings and results of treatment. MATERIALS AND METHODS: Patients at follow-up aged 17 or older admitted with intoxication to the ICU between January 1, 2009 and December 31, 2011 were included in the study. Age, gender, presenting symptoms, duration of hospitalization, type of poisoning, the way of poisoning, medical history, seasons, hospitalization costs, treatment and prognosis of the patients were analyzed. RESULTS: Totally, 153 (8.9%) out of 1375 follow-up patients in the ICU had acute intoxication. The mean age of intoxicated patients was 29.4 ± 11, 68% of them were female, 78.4% of them were under 35 years old, and intoxication was most common in the 17-25 age group. 114 of them (94.1%) were suicidal. The most common cause of poisoning was drug-poisoning by 88.2%, and most common presenting symptoms were nausea and vomiting by 71.2%. Mean length of stay was 2.4 ± 1.6 days, and the average cost of hospitalization was 761 ± 884 Turkish Liras or 271 ± 315 USD. 5 patients (3.3%) were intubated because of respiratory failure. There was no mortal case. CONCLUSION: Suicide attempts are prominent in acute poisoning, and the young female population is at higher risk. It was found that drugs, particularly antidepressants and antipsychotic agents were the most common cause of poisoning. The high cost of treatment of acute intoxication cases is a major cause of economic burden. Clinicians should be more careful when prescribing such drugs.

Is there a difference in mad honey poisoning between geriatric and non-geriatric patient groups?

OBJECTIVE: This study aims to investigate the demographic, toxicological characteristics of the mad honey intoxication at ages 65 and above, to analyze the electrocardiographic parameters, and to compare with the mad honey intoxication at ages below 65 years. PATIENTS AND METHODS: Eighty-two patients, who had been treated and followed-up between June 2013 and November 2014 in the Emergency Service of the Findikli State Hospital, Turkey, due to diagnosis of mad honey intoxication, were included in our observational study. Age, gender, toxicological characteristics, laboratory parameters, heart rates, systolic and diastolic blood pressures, laboratory analyses and electrocardiographic data of the patients were recorded and analyzed. Patients with known coronary artery disease, chronic renal failure, arrhythmias, valvular heart disease, history of thyroid disease and electrolyte imbalance were not included in the study. RESULTS: Eighty-two (80.5% was male and the mean age was 53 ± 15 years) patients followed-up due to mad honey intoxication were included in our study. There were 64 (78%) patients aged below 65 years, and 18 (22%) patients aged 65 and above. The mean heart rate was 45 ± 7 beats/min, systolic blood pressure was 83 ± 12 mmHg and diastolic blood pressure was 52 ± 9 mmHg on admission. The onset of symptoms of the patients was found as 0.84 hours on average after mad honey consumption, the average amount of honey consumed was 3.7 ± 1.1 tablespoons, and the mean recovery time of the symptoms was found to be 1.04 hours. The most common presenting symptoms were nausea-vomiting in 82 (100%) patients and dizziness in 73 (89%) patients. Patients were found to consume mad honey mostly for achieving a remission in gastrointestinal complaints (n=18, 22%), and for utilizing its blood pressure lowering properties (n=11, 13.4%), in addition to the dietary consumption. Looking at the heart rates of the patients on admission to the emergency service, 65 (79.3%) patients had normal sinus rhythm/sinus bradycardia, 12 (14.6%) patients had a 1st degree atrioventricular block, 3 (3.7%) patients had nodal rhythm, 1 (1.2%) patient had atrial fibrillation and 1 (1.2%) patient had preexcitation. There were no significant pathological findings in the routine laboratory examinations of patients. It was found that all patients achieved normal sinus rhythm and normal blood pressure values after medical treatment, and were discharged approximately 5.65 hours after observation and follow-up. In our study, prolonged intensive-care need, pacemaker need and mortality caused by mad honey intoxication were not found. In the comparison of data of all patients above and below 65 years of age, there was a statistically significant finding that the geriatric patients consume mad honey mostly for hypotensive purposes and gastrointestinal complaints; in addition, the symptoms were starting early and the recovery period was longer in geriatric patients. CONCLUSIONS: The mad honey poisoning should be considered in previously healthy patients with unexplained symptoms of bradycardia, hypotension, and atrioventricular block. Therefore, diet history should carefully be obtained from the patients admitted with bradycardia and hypotension. And, in addition to the primary cardiac, neurological and metabolic disorders, mad honey intoxication should also be considered in the differential diagnosis. In geriatric patients admitted due to mad honey intoxication, the mad honey is usually consumed to reduce blood pressure and resolve gastrointestinal problems; and, their symptoms begin early, and last longer after mad honey consumption. In terms of other parameters, the geriatric age group has similar characteristics to non-geriatric age group.

Nutritional status and laboratory parameters among internal medicine inpatients.

BACKGROUND: Malnutrition is a clinical state resulting in prolonged hospital stay, increase in severity of infections and poor wound healing. AIMS: Our aim was to investigate the prevalence and etiologic factors of malnutrition in medical inpatients. STUDY DESIGN: A total of 290 consecutively admitted internal medicine patients from February to May 2012 were included. On admission, demographic data, anthropometric measurements, laboratory parameters and nutritional screening test results were recorded. METHODS: Nutritional risk score-2002 for patients under 65 years old, mini nutritional assessment for older patients and subjective global assessment (SGA) tests performed. Relation of demographic characteristics, laboratory parameters, weight and body mass index (BMI) with nutritional status were evaluated. RESULTS: Mean age was 61±17 years; 145 patients were male. Among 160 patients<65 years old, 34 were in malnutrition (21%), 41 (26%) were under risk of malnutrition and 85 (53%) were normal. When they were divided into three groups according to SGA, we found significant difference in hemoglobin, low density lipoprotein (LDL), high density lipoprotein, cholesterol, triglyceride, albumin and protein, weight and BMI. Among 130 patients over 65 years old, 47 patients (37%) were in malnutrition, 41 (31%) were under risk of malnutrition and 42 (32%) were normal. There was significant difference in LDL, cholesterol, albumin, protein, weight and BMI between three groups; each 1 g/dl decrease in serum albumin and age older than 65 years old increased malnutrition risk 5.21 and 1.97 times, respectively. CONCLUSION: Malnutrition risk is high among internal medicine inpatients and risk seems to be higher among older patients. Nutritional screening of geriatric patients, close follow-up and providing earlier health care would contribute rehabilitation of chronic diseases and decrease re-admissions.