ABSTRACT
CONTEXT: Methylphenidate intoxications mostly have a relatively mild course, although serious complications can occur. OBJECTIVE: We aimed to characterize methylphenidate exposures and reassess our current dose threshold for hospital referral (2 mg/kg). METHODS: In a prospective follow-up study, we analysed 364 consecutive methylphenidate exposures that were reported to the Dutch Poisons Information Center. Patients and/or physicians were surveyed by telephone using standardized questionnaires. Three physicians independently scored the observed severity of the intoxication of each patient as 'no/mild' (observation at home) or 'moderate/severe' (hospital referral necessary). RESULTS: Unintentional exposures (40%) mostly occurred at home involving the patients' own medication or those from a family member. Compared to unintentionally exposed patients, intentionally exposed patients were exposed to relatively high methylphenidate doses (3.1 vs 1.6 mg/kg), more often used immediate release methylphenidate formulations (62 vs 34%) and more frequently had concomitant exposures (71 vs 17%). Severe symptoms like convulsions or coma were reported only in patients with concomitant exposures. Following exposure to methylphenidate only (i.e. no concomitant exposures), the most commonly reported symptoms were dry mucosa, headache, agitation, sleepiness and tachycardia. Our results show that the reported methylphenidate dose is predictive of the observed severity of the intoxication and can therefore aid in pre-hospital triage. CONCLUSION: We increased our current dose threshold for hospital referral from 2 to 3 mg/kg. In addition, we will refer patients at lower doses when clinical symptoms indicate the need for hospital referral. Application of this new dose threshold optimizes triage, thereby reducing unnecessary hospital referral and thus costs, without jeopardising patient safety.
Subject(s)
Central Nervous System Stimulants/poisoning , Emergency Medical Services , Evidence-Based Medicine , Methylphenidate/poisoning , Poisoning/therapy , Triage , Adolescent , Adult , Child , Child, Preschool , Dose-Response Relationship, Drug , Female , Humans , Infant , Infant, Newborn , Male , Netherlands , Poison Control Centers , Poisoning/diagnosis , Poisoning/etiology , Prospective Studies , Referral and Consultation , Risk Assessment , Risk Factors , Severity of Illness Index , Surveys and Questionnaires , Young AdultABSTRACT
PURPOSE: To monitor the prevalence of, and the circumstances leading to, adolescent alcohol intoxication admissions in Dutch hospital departments of pediatrics. METHODS: Data were collected in 2007 and 2008, using the Dutch Pediatric Surveillance System, in which pediatricians received questionnaires on varying issues, including adolescent alcohol intoxication admissions. RESULTS: The adolescents treated in 2008, as in 2007, were average youth across proportion of gender, educational level, school performances, family structure, siblings, familiarity with medical or aid agencies, alcohol use, and other (illicit) drug use. In 2008, 13% more adolescents were treated. These adolescents showed a trend of having a younger average age, higher blood alcohol concentrations, and longer durations of mental impairment. About 45% of the adolescents who were treated for alcohol intoxication had purchased alcohol from a commercial place, despite that 51 times the specific adolescent had not reached the legal age of 16 years old. About one-third of the youngsters consumed alcohol at home or at a friend's home. CONCLUSIONS: The number of adolescents suffering from alcohol intoxication increased in 2008 compared with 2007. Parental (lack of) involvement and responsibilities of commercial sales personnel are discussed.
Subject(s)
Alcoholic Intoxication/epidemiology , Adolescent , Child , Hospital Departments , Humans , Netherlands/epidemiology , Patient Admission , Pediatrics , Population Surveillance , PrevalenceABSTRACT
BACKGROUND: Falciparum malaria or malaria tropica is one of the leading causes of childhood mortality worldwide. Malaria-related deaths occur mainly in sub-Saharan Africa, where an estimated 365 million clinical cases of Plasmodium falciparum malaria occur each year. In Europe, imported malaria cases occur due to returning travellers or immigration mostly from African countries. Children are more at risk than adults. The objective of this study was to identify high risk groups for imported childhood malaria in Europe in order to guide development of strategies for prevention, early recognition and management. METHODS: In the period May 2003-January 2005 we reviewed all cases of paediatric malaria in the Netherlands notified by the Dutch Paediatric Surveillance System (Nederland Signalerings Centrum Kindergeneeskunde, NSCK) and the literature on imported malaria in children in Europe published between 1996 and 2006. RESULTS: Malaria occurred mainly in children of long-term (n = 15, 47%) and new (n = 8, 25%) immigrants and was mostly acquired in sub-Saharan Africa. The dominant species was P. falciparum. Only one quarter of children had used adequate malaria chemoprophylaxis. Complicated disease occurred in 10 (31%) of cases. We also reviewed the literature and found 6082 reported cases of imported malaria among children in Europe; among these, four died and only one was reported to develop neurological sequelae. CONCLUSION: Imported malaria in children remains an important problem and is unlikely to decrease unless the reasons for inadequate prophylaxis are addressed.
