Assuntos
Encefalopatia Hepática/cirurgia , Transplante de Fígado , Intoxicação Alimentar por Cogumelos/cirurgia , Doença Aguda , Adulto , Idoso , Amanitinas/toxicidade , Feminino , Escala de Coma de Glasgow , Encefalopatia Hepática/etiologia , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Intoxicação Alimentar por Cogumelos/complicaçõesRESUMO
INTRODUCTION: Mushroom poisoning is a cause of major mortality and morbidity all over the world. Although Hong Kong people consume a lot of mushrooms, there are only a few clinical studies and reviews of local mushroom poisoning. This study aimed to review the clinical characteristics, source, and outcome of mushroom poisoning incidences in Hong Kong. METHODS: This descriptive case series review was conducted by the Hong Kong Poison Information Centre and involved all cases of mushroom poisoning reported to the Centre from 1 July 2005 to 30 June 2015. RESULTS: Overall, 67 cases of mushroom poisoning were reported. Of these, 60 (90%) cases presented with gastrointestinal symptoms of vomiting, diarrhoea, and abdominal pain. Gastrointestinal symptoms were early onset (<6 hours post-ingestion) and not severe in 53 patients and all recovered after symptomatic treatment and a short duration of hospital care. Gastrointestinal symptoms, however, were of late onset (≥6 hours post-ingestion) in seven patients; these were life-threatening cases of amatoxin poisoning. In all cases, the poisonous mushroom had been picked from the wild. Three cases were imported from other countries, and four collected and consumed the amatoxin-containing mushrooms in Hong Kong. Of the seven cases of amatoxin poisoning, six were critically ill, of whom one died and two required liver transplantation. There was one confirmed case of hallucinogenic mushroom poisoning caused by Tylopilus nigerrimus after consumption of a commercial mushroom product. A number of poisoning incidences involved the consumption of wild-harvested dried porcini purchased in the market. CONCLUSION: Most cases of mushroom poisoning in Hong Kong presented with gastrointestinal symptoms and followed a benign course. Life-threatening cases of amatoxin poisoning are occasionally seen. Doctors should consider this diagnosis in patients who present with gastrointestinal symptoms that begin 6 hours or more after mushroom consumption.
Assuntos
Amanitinas/intoxicação , Gastroenteropatias/etiologia , Intoxicação Alimentar por Cogumelos/epidemiologia , Dor Abdominal/epidemiologia , Dor Abdominal/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Diarreia/epidemiologia , Diarreia/etiologia , Feminino , Gastroenteropatias/epidemiologia , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vômito/epidemiologia , Vômito/etiologia , Adulto JovemRESUMO
We describe a case of lead exposure after prolonged intake of ashes from burnt Chinese talismans. A 41-year-old woman presented with elevated blood lead level during screening for treatable causes of progressive weakness in her four limbs, clinically compatible with motor neuron disease. The source of lead exposure was confirmed to be Chinese talismans obtained from a religious practitioner in China. The patient was instructed to burn the Chinese talismans to ashes, and ingest the ashes dissolved in water, daily for about 1 month. Analysis of the Chinese talismans revealed a lead concentration of 17 342 µg/g (ppm).
Assuntos
Intoxicação por Chumbo/etiologia , Medicina Tradicional Chinesa/efeitos adversos , Religião e Medicina , Adulto , Feminino , Humanos , Intoxicação por Chumbo/fisiopatologia , Doença dos Neurônios Motores/etiologia , Doença dos Neurônios Motores/fisiopatologiaRESUMO
We report a case of acute poisoning in a 48-year-old man who presented with chest pain, abdominal pain, dizziness, sweatiness, blurred vision, and severe hypotension after ingestion of honey. His electrocardiogram showed sinus bradycardia and transient ST elevation. He made a good recovery after treatment with atropine and close monitoring. Grayanotoxin was detected in his urine and the honey he ingested, which confirmed a diagnosis of mad honey poisoning. This is a condition prevalent in the Black Sea region around Turkey but rarely seen locally. Although mad honey poisoning is life-threatening, early use of atropine is life-saving. Such poisoning may present with ST elevation in the electrocardiogram and symptoms mimicking acute myocardial infarction. It is therefore essential for clinicians to recognise this unusual form of poisoning and avoid the disastrous use of thrombolytic therapy.
Assuntos
Diterpenos/urina , Mel/intoxicação , Infarto do Miocárdio/diagnóstico , Dor Abdominal/etiologia , Atropina/uso terapêutico , Dor no Peito/etiologia , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To study the epidemiology, causes, and clinical course of Chinese herbal medicine-induced anticholinergic poisoning in Hong Kong. DESIGN: Case series. SETTING: Hong Kong. PATIENTS: All case histories of Chinese herbal medicine-induced anticholinergic poisoning (with laboratory confirmation) recorded by the Hong Kong Poison Information Centre over a 93-month period were accessed for analysis. RESULTS: During the relevant period, 22 clusters of Chinese herbal medicine-induced anticholinergic poisoning involving 32 patients were retrieved. The commonest clinical features were mydriasis (n=32, 100%) and confusion (n=24, 75%). No gastro-intestinal decontamination was performed. None of these patients underwent intubation, defibrillation, cardioversion, pacing, fluid resuscitation, inotropic support or dialysis. Of the 32 patients, 17 (53%) were treated with physostigmine because of confusion, three of whom had previously received intravenous benzodiazepines. No patient could be effectively treated with benzodiazepines alone. There was no mortality, and all the patients were discharged within 3 days. None of them re-attended the emergency department within 1 week of discharge. The commonest cause was the substitution of flos campsis (Campsis grandiflora) by the flower of the Datura species (7 clusters [32%] in 10 patients). CONCLUSION: Mydriasis and confusion were the commonest clinical features of Chinese herbal medicine-induced anticholinergic poisoning in Hong Kong. Physostigmine was frequently used in the treatment; benzodiazepines appeared ineffective. The commonest cause was the substitution of flos campsis (Campsis grandiflora) by the flower of the Datura species.
Assuntos
Benzodiazepinas/uso terapêutico , Antagonistas Colinérgicos/intoxicação , Medicamentos de Ervas Chinesas/intoxicação , Fisostigmina/uso terapêutico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Inibidores da Colinesterase/uso terapêutico , Análise por Conglomerados , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Centros de Controle de Intoxicações , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVES. To (1) characterise the clinical features of Dettol poisoning on a territory-wide basis, (2) assess the need for airway intervention after such poisoning and its time frame after ingestion, and (3) identify predictors for such an intervention. DESIGN. Case series. SETTING. Sixteen accident and emergency departments in Hong Kong. PATIENTS. Patients with Dettol ingestion who presented within 48 hours of ingestion from July 2005 to June 2009, derived from the database of the Hong Kong Poison Information Centre. RESULTS. In all, 213 patient records were identified, of which 36 were excluded based on pre-defined criteria and 177 were analysed. Among the latter, the median age was 32 (range, 2-95) years and the male-to-female ratio was 1:2.7 (48:129). Intentional ingestion constituted the majority (95%) of cases. The most common symptoms were related to the local irritative/corrosive effects on the aero-digestive tract, such as gastro-intestinal upset and localised throat pain. Airway intervention was required in 14 (8%) patients. All interventions were performed within 12 hours of Dettol ingestion and three cases involved re-intubation after extubation. Univariate analysis showed that a Glasgow Coma Scale score of <8, older age, a larger amount ingested, lip swelling, lung crackles, and wheezing were all associated with airway intervention. In the multivariate analysis using forward stepwise logistic regression, only coma (Glasgow Coma Scale score of <8) remained statistically significant. CONCLUSIONS. Delayed airway obstruction (>12 hours after Dettol ingestion) is unlikely. For those who are intubated, careful assessment of airway adequacy before extubation is strongly recommended to avoid extubation failure and subsequent re-intubation. Patients in coma (Glasgow Coma Scale score of <8) should prompt airway intervention.
Assuntos
Desinfetantes/intoxicação , Intubação Intratraqueal , Xilenos/intoxicação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
OBJECTIVES: To review the characteristics of the consultation about the management of mercury exposure and identify the controversial issues on the clinical management of individuals with a history of mercury exposure. DESIGN: Descriptive case series. SETTING: Hong Kong Poison Information Centre, Hong Kong. PARTICIPANTS: Persons consulting the Hong Kong Poison Information Centre about individuals with possible or definitive mercury exposure. MAIN OUTCOME MEASURES: Characteristics of the consultations, including: the demographics of affected individuals, source and reason for the consultation, tissue mercury levels, the source of mercury exposure, specific intervention if any, and clinical outcomes. RESULTS: Forty-one consultations were analysed. Most consultations were from the public sector. Reasons of the consultation were very variable. Individuals with abnormal tissue mercury levels were uncommon. There was only one case of acute mercury poisoning. The majority of identified individuals were not subjected to specific interventions. Chelation therapy was given to three patients, but in one of them it was considered to be contra-indicated. CONCLUSION: The management of mercury exposure is highly variable. Recommendations were made on the approach to an individual with potential mercury exposure or poisoning.
Assuntos
Intoxicação por Mercúrio/terapia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Hong Kong , Humanos , Masculino , Intoxicação por Mercúrio/diagnóstico , Pessoa de Meia-Idade , Centros de Controle de Intoxicações , Encaminhamento e ConsultaAssuntos
Serviço Hospitalar de Emergência , Medição de Risco/métodos , Inquéritos e Questionários , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Feminino , Hong Kong , Hospitalização , Humanos , Institucionalização , Modelos Logísticos , Masculino , Razão de Chances , Prognóstico , Curva ROCRESUMO
OBJECTIVE: To investigate the prevalence and characteristics of abusive drug exposure among non-fatal motor vehicle driver casualties presenting to a designated trauma centre in Hong Kong. DESIGN: Cross-sectional study. SETTING: Designated trauma centre/regional accident and emergency department in Hong Kong. SUBJECTS: Non-fatal motor vehicle driver casualties who presented to the trauma centre from 1 January 2007 to 31 December 2007. MAIN OUTCOME MEASURES: Screening of abusive drug exposure using commercial bedside urine immunoassay kits. RESULTS: Drug screening was performed in 395 injured drivers, 10% of whom tested positive for the drugs of interest. Ketamine was the most commonly detected abusive substance (found in 45% of the subjects). A significantly higher proportion of young drivers (aged <25 years) screened positive (odds ratio=2.3; 95% confidence interval, 1.0-5.2; P=0.04), with the rate being 21%. The presence of these drugs in urine was related to the time of occurrence of the crash; those occurring between midnight and dawn revealed a trend towards a higher proportion of casualties testing drug-positive (odds ratio=2.2; 95% confidence interval, 0.9-5.3; P=0.07). There were no significant differences in the frequency of persons testing positive for the screened drugs with respect to gender, class of motor vehicle driven, or the day of the week on which the crash occurred. CONCLUSIONS: The prevalence of drugged driving among non-fatal casualties in our series of Hong Kong drivers was 10%. The frequency of such drivers testing positive for drugs was significantly higher in persons aged less than 25 years. These findings indicate a need to amend existing laws and implement on-site drug screening for suspected drugged drivers.
Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Detecção do Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Fatores Etários , Estudos Transversais , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Prevalência , Fatores de Tempo , Centros de Traumatologia , Adulto JovemRESUMO
OBJECTIVE: To investigate the efficacy and safety of lidocaine nasal spray before nasogastric tube insertion in an emergency department. DESIGN: Double-blind, randomised controlled study. SETTING: Emergency department of a major regional hospital in Hong Kong. PATIENTS: A total of 206 adult patients, for whom nasogastric tube insertion was indicated. MAIN OUTCOME MEASURES: Primary outcome was discomfort gauged on a visual analogue scale, and Likert scale addressing difficulty of nasogastric tube insertion. RESULTS: Compared with placebo spray use, lidocaine spray use was associated with less patient discomfort, and less difficulty in nasogastric tube insertion, both difference being statistically significant. CONCLUSION: Intranasal lidocaine spray before nasogastric tube insertion was safe and effective in reducing patient discomfort related to the procedure.
Assuntos
Anestésicos Locais/administração & dosagem , Intubação Gastrointestinal/métodos , Lidocaína/administração & dosagem , Dor/prevenção & controle , Anestésicos Locais/efeitos adversos , Método Duplo-Cego , Serviço Hospitalar de Emergência , Feminino , Hong Kong , Humanos , Intubação Gastrointestinal/efeitos adversos , Lidocaína/efeitos adversos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Medição da Dor , Estudos ProspectivosRESUMO
OBJECTIVES: To study the acute clinical presentations of ketamine abusers in Hong Kong. DESIGN: Retrospective chart review. SETTING: Fifteen accident and emergency departments in Hong Kong. PATIENTS: Consultations associated with recent ketamine use either confirmed by history or urine test were searched for from the database of the Hospital Authority Hong Kong Poison Information Centre from 1 July 2005 to 30 June 2008. Their medical records and investigation results were analysed. RESULTS: A total of 233 records of ketamine use were included for review. Patient ages ranged from 13 to 60, with a median of 22 years, and the male-to-female ratio being 2.1:1. The most common symptoms of ketamine misuse were impaired consciousness (45%), abdominal pain (21%), lower urinary tract symptoms (12%), and dizziness (12%). The most common abnormal physical findings were high blood pressure (40%), followed by tachycardia (39%), abdominal tenderness (18%), and white powder in the nostrils (17%). CONCLUSION: Most ketamine abusers presented acutely with transient central nervous system depression, abdominal pain, or lower urinary tract symptoms. Clinicians should be alert to the typical age-group, signs and symptoms of such abusers presenting in an acute medical setting.
Assuntos
Anestésicos Dissociativos/efeitos adversos , Serviço Hospitalar de Emergência , Ketamina/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/complicações , Adolescente , Adulto , Feminino , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Chinese medicine plays an important role in providing medical care for people in countries with large Chinese communities, including Hong Kong. The aconite herb is one of the commonly-prescribed ingredients for various clinical problems. However, due to its narrow therapeutic index, toxicities are not uncommonly encountered, including life-threatening cardiac arrhythmias like ventricular arrhythmias. We report a 57-year-old woman with reversible intraventricular conduction defect attributed to the use of processed Fuzi.
Assuntos
Aconitina/intoxicação , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/diagnóstico , Bloqueio de Ramo , Medicamentos de Ervas Chinesas/intoxicação , Eletrocardiografia/métodos , Feminino , Hong Kong , Humanos , Medicina Tradicional do Leste Asiático , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
INTRODUCTION: Nonradioactive cesium chloride (CsCl) is used by some alternative medicine advocates as a treatment for cancer. The therapy was proven to be neither safe nor effective. Chronic use of CsCl has resulted in cases with severe cardiotoxicity. CASE REPORT: A 65-year-old lady presented to our hospital's accident and emergency department with recurrent syncope attacks. Electrocardiogram monitoring showed QT prolongation and transient Torsades de Pointes (TDP) ventricular tachycardia. She was taking anticancer naturopathic drugs for 6 weeks before admission. One of her naturopathic drugs was subsequently confirmed containing 89% CsCl by weight. Besides conventional treatment of QT prolongation and TDP, the patient was given a 4-week course of oral Prussian blue to enhance gastrointestinal elimination of cesium. The serum half-life of cesium was reduced from 61.7 to 29.4 days after the use of Prussian blue. QT prolongation was normalized in 27 days. DISCUSSION: To our knowledge, this is the first published case of nonradioactive cesium poisoning treated with Prussian blue. A transient rise in serum cesium level was observed during Prussian blue therapy. Possible explanations for this observation include poor drug compliance during outpatient treatment and redistribution of cesium from body stores. CONCLUSION: Nonradioactive CsCl poisoning can result in severe cardiotoxicity with QT prolongation and TDP ventricular tachycardia. The key points in the management of nonradioactive cesium poisoning include cessation of cesium exposure, vigorous electrolytes replacement, and oral Prussian blue therapy.
Assuntos
Antineoplásicos/intoxicação , Césio/intoxicação , Cloretos/intoxicação , Terapias Complementares/efeitos adversos , Torsades de Pointes/induzido quimicamente , Idoso , Antídotos/administração & dosagem , Quimioterapia Combinada , Eletrocardiografia , Eletrólitos/administração & dosagem , Feminino , Ferrocianetos/administração & dosagem , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/patologia , Taquicardia Ventricular/induzido quimicamente , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/terapia , Torsades de Pointes/diagnóstico , Torsades de Pointes/terapia , Resultado do TratamentoRESUMO
Ten young ketamine abusers presented with lower urinary tract symptoms to two regional hospitals in Hong Kong. Investigations demonstrated contracted bladders and other urinary tract abnormalities. These types of findings have never been reported before in ketamine abusers. The possible aetiology is also discussed.