Intoxicaciones agudas por productos químicos: análisis de los primeros 15 años del Sistema Español de Toxicovigilancia (SETV) / Acute poisoning by chemical products: analysis of the first 15 years of the Spanish Toxic Surveillance System (SETv)

OBJETIVO: Existen pocos estudios epidemiológicos, sobre todo de tipo multicéntrico, sobre las intoxicaciones agudas a causa de productos químicos agroindustriales y del hogar en España. El objetivo de este trabajo fue describir el perfil epidemiológico y clínico de estas intoxicaciones en nuestro país, y analizar su evolución temporal. METODOS: El Sistema Español de Toxicovigilancia (SETv) es un registro prospectivo que incluye a 32 Servicios de Urgencias y Unidades de Cuidados intensivos de España. Se realizó un estudio descriptivo observacional de las intoxicaciones agudas por agentes químicos (excluyendo drogas y fármacos) en sus primeros 15 años de funcionamiento (1999-2014). Las comparaciones de proporciones se realizaron mediante las pruebas de Chi-cuadrado o exacta de Fisher, y entre pares de grupos independientes con la prueba de Mann-Whitney. Se consideraron significativos los valores de probabilidad menores de 0,05. RESULTADOS: Los 10.548 casos estudiados presentaban una edad media de 38,41 (+/-22,07) años, siendo significativamente superior en las mujeres (p=0,0001). El 67,7% de las intoxicaciones ocurrieron en el hogar, y las vías de entrada más frecuentes fueron la respiratoria (48,3%), la digestiva (35,3%) y la ocular (13,1%). Los grupos tóxicos más frecuentes fueron los gases tóxicos (31%), los cáusticos (25,6%) y los gases irritantes (12,1%). Un 76,2% de los casos requirieron tratamiento (27,2% con antídotos). Ingresó en un centro hospitalario un 20,6% de las personas, con una estancia media de 32 (+/-151,94) días, con diferencias significativas para los plaguicidas y disolventes (p=0,02). Presentaron secuelas al alta un 2,1%. La mortalidad fue del 1,4% (146 pacientes), con una edad media de 62,08 años (+/-19,58; p=0,0001). CONCLUSIONES: En las intoxicaciones por productos químicos, las medidas preventivas deben centrarse fundamentalmente en el ámbito doméstico, controlando las fuentes de exposición al monóxido de carbono y la manipulación de los productos de limpieza, fundamentalmente los líquidos cáusticos y la generación de gases irritantes al mezclarlos

OBJECTIVE: There are few epidemiological studies on acute poisonings from pesticides, industrials and household products in Spain. The objective of this work is to describe the epidemiological and clinical profile of acute poisonings by chemical products in our country, and analyze their annual evolution. METHODS: The Spanish Toxicovigilance System (SETv) is a prospective registry that includes 32 Emergency Departments and Intensive Care Units in Spain. An observational descriptive study of acute poisoning by chemical agents (excluding pharmacological products and illicit drugs) was carried out, within 1999-2014. Statistical analysis was performed using Chi-square or exact Fisher's tests. Non-parametric continuous variables were compared using the Mann-Whitney U test. P-value less than 0.05 were considered significant. RESULTS: The 10,548 cases studied had a mean age of 38.41 (+/-22.07) years, being significantly higher in women (p=0.0001). 67.7% of the poisonings occurred at home, and the most frequent routes of exposure were respiratory (48.3%), digestive (35.3%) and ocular (13.1%). The most frequent toxic groups were toxic gases (31%), caustics (25.6%) and irritant gases (12.1%). Of the patients that required treatment (76.2%), antidotes were used in 27.2%. 20.6% of the patients were admitted at Hospital, with a median stay of 32 (+/-151.94) days, with significant differences for pesticides and solvents (p=0.02). Sequelae were presented at discharge in 2.1% of patients. Mortality was 1.4% (146 patients) with a mean age of 62.08 years (+/-19.58) (p=0.0001). CONCLUSIONS: The reduction of chemical poisonings should be prevented in the domestic environment, taking into account the sources of exposure to carbon monoxide and the handling of household cleaning products, both caustic liquids and the generation of irritating gases when mixed

Intoxicaciones por drogas de abuso: sustancias emergentes en el siglo XXI / Drug-abuse poisoning: new substances in the 21st century

El uso de productos exógenos para modificar el estado de la cociencia ha sido una constante a lo largo de la historia de la humanidad. Inicialmente se utilizaron sustancias derivadas de plantas, pero la evolución tecnológica permitió la elaboración de sustancias sintetizadas de novo o modificadas de otras ya existentes, que actualmente son consumidas por millones de personas con intención experimental o lúdica. Clásicamente se ha asociado el consumo de determinadas drogas con sectores sociales o culturales determinados (cultura reggae y marihuana, jóvenes yuppies y cocaína, o aficionados a la música electrónica y anfetaminas, por ejemplo). Sin embargo, desde el punto de vista sanitario estas asociaciones carecen de fundamento. No sólo porque el mercado de cualquier tipo de droga transciende estos condicionantes sociales, sino porque es habitual que un mismo consumidor utilice múltiples sustancias persiguiendo distintos efectos, en ocasiones a lo largo de una misma noche. La utilización de este tipo de drogas genera gran cantidad de problemas médicos que motivan asistencia urgente. El presente trabajo repasalas drogas de abuso emergentes más utilizadas en los inicios del siglo XXI y los efectos que tienen sobre la salud de los usuarios (AU)

Mind-altering substances have been used throughout history. The earliest psychoactive drugs were derived from plants, but technological advances have introduced substances that have been synthesized de novo or that result from modifications of older drugs. Millions now experiment with such substances or use them recreationally. Certain drugs have traditionally been linked to specific social or cultural groups: for example, we associated reggae with marijuana, young urban professionals (yuppies) with cocaine, and electronic music fans with amphetamines. Such ties are unsupported, however, from the health care professional's vantage, not only because the market for any type of drug is more widespread than any of these social settings but also because it is common for users to combine several substances in pursuit of different effects. Several drugs are sometimes used on a single night. Street drugs cause of a large number of medical problems that lead users to seek emergency care. This review discusses the most common new substances on the street at the beginning of the 21st century and their effects on health (AU)

Biowarfare and bioterrorism.

Bioterrorism is not only a reality of the times in which we live but bioweapons have been used for centuries. Critical care physicians play a major role in the recognition of and response to a bioterrorism attack. Critical care clinicians must be familiar with the diagnosis and management of the most likely bioterrorism agents, and also be adequately prepared to manage a mass casualty situation. This article reviews the epidemiology, diagnosis, and treatment of the most likely agents of biowarfare and bioterrorism.

Development and validation of method for analysis of some ototoxic solvents in saliva matrix by headspace gas chromatography/mass spectrometry.

The aim of this study was to develop an analytical method to monitor the saliva matrix for ototoxic solvents absorption: the method is based on headspace gas chromatography/mass spectrometry and represents an alternative biological monitoring for investigating low exposure to hazardous ototoxic solvents. Simultaneous determination of toluene, ethylbenzene, xylenes and styrene has been carried out and the method has been optimized for both instrumental parameters and samples treatment. Chromatographic conditions have been set in order to obtain a good separation of xylene isomers due to the interest in p-xylene as ototoxic one. Method validation has been performed on standards spiked in blank saliva by using two internal standards (2-fluorotoluene and deuterated styrene-d(8)). This method showed the possibility to detect the target compounds with a linear dynamic range of at least a 2 orders of magnitude characterized by a linear determination coefficient (r(2)) greater than 0.999. The limit of detection (LOD) ranged between 0.19 ng/mL (styrene) and 0.54 ng/mL (m-xylene) and the lower limit of quantification (LLOQ) ranged between 0.64 ng/mL (styrene) and 1.8 ng/mL (m-xylene). The method achieved good accuracy (from 99 to 105%) and precision for both intra- and inter-assay (relative standard deviation ranging from 1.7 to 13.8%) for all six compounds concerned. The repeatability was improved by adding sodium sulphate to the matrix. Saliva samples resulted stable for at least 7 days after collection, if stored in headspace vials, at the temperature of 4 degrees C. An evaluation of the main sources of uncertainty of the method is also included: expanded uncertainties ranges between 10 and 16% for all of the target compounds. In summary, the headspace gas chromatography/mass spectrometry method is a highly sensitive, versatile and flexible technique for the biological monitoring of exposure to ototoxic solvents by saliva analysis.

Characterization of a fatal methyl bromide exposure by analysis of the water cooler.

BACKGROUND: A suspected inhalation exposure to methyl bromide (MeBr) in the packaging and shipping area of a chemical manufacturer resulted in a worker fatality and several symptomatic cases. However, air testing was negative for MeBr resulting in uncertainty regarding the potential chemical exposure. Methods of quickly confirming the exposure and magnitude were sought. METHODS: Head space air and water samples were obtained from the breakroom water cooler in the facility and tested for MeBr. RESULTS: Increased levels of MeBr were identified in the air and water samples from the cooler and used to calculate the MeBr concentration of air entering the cooler. The MeBr air concentration within the breakroom was estimated as 1,200-2,100 ppm depending on assumptions regarding the amount of water dispensed from the cooler both before and during the incident. CONCLUSIONS: Estimated MeBr air concentrations in the breakroom were consistent with those known to be associated with reported health effects among the involved workers. The water cooler analysis represented a unique method of retrospectively verifying and quantifying exposure to MeBr.

Methylbromide intoxication: a clinical case study.

The port of Rotterdam, The Netherlands, is the world's largest container port. In 2006, one of these containers caused a chemical incident. Methylbromide is used in some countries as a pesticide for the fumigation of maritime containers. Because of an insufficiently performed detoxification, this insecticide intoxicated several employees and some of the ambulance crew and Mobile Medical Team (MMT). The victims displayed symptoms of sore throat, irritated eyes, and hypersalivation. One of the victims suffered from multiple epileptic seizures. Two victims were admitted to the intensive care unit for respiratory support. Three other employees showed milder symptoms and received supportive care but were not admitted to the hospital. This complicated case shows that the safety of the ambulance crew and MMT must be guaranteed. It also demonstrates that healthcare providers cannot always oversee the accident scene and that there are some pitfalls that are almost impossible to prevent.