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1.
BMC Emerg Med ; 19(1): 55, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615421

RESUMO

BACKGROUND: Recreational use of prescription drugs is widespread. We describe acute poisonings related to the recreational use of prescription drugs. METHODS: Retrospective observational study. We retrospectively registered all patients presenting from October 2013 through March 2015 at a primary care emergency outpatient clinic in Oslo, Norway, with an acute poisoning related to recreational drug use. We registered demographic data, toxic agents taken, clinical course and treatment. From this data set we extracted the 819/2218 (36.9%) cases involving one or more prescription drugs. RESULTS: Among the 819 included cases, 190 (23.2%) were female. Median age was 37 years. The drugs most commonly involved were benzodiazepines in 696 (85.0%) cases, methadone in 60 (7.3%), buprenorphine in 53 (6.5%), other opioids in 56 (6.8%), zopiclone/zolpidem in 26 (3.2%), and methylphenidate in 11 (1.3%). Prescription drugs were combined with other toxic agents in 659 (80.5%) cases; heroin in 351 (42.9%), ethanol in 232 (28.3%), amphetamine in 141 (17.2%), cannabis in 70 (8.5%), gamma-hydroxybutyrate (GHB) in 34 (4.2%), cocaine in 29 (3.5%), and other illegal drugs in 46 (5.6%). The patient was given naloxone in 133 (16.2%) cases, sedation in 15 (1.8%), and flumazenil in 3 (0.4%). In 157 (19.2%) cases, the patient was sent on to hospital. CONCLUSIONS: One in three acute poisonings related to recreational drug use involved prescription drugs. Benzodiazepines were by far the most common class of drugs. Prescription drugs had mostly been taken in combination with illegal drugs or ethanol.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Medicamentos sob Prescrição/envenenamento , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Fatores Etários , Bebidas Alcoólicas/envenenamento , Feminino , Humanos , Drogas Ilícitas/envenenamento , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Estudos Retrospectivos , Fatores Sexuais , Fatores Socioeconômicos , Sinais Vitais , Adulto Jovem
2.
Drug Alcohol Rev ; 38(2): 198-200, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30714231

RESUMO

On 1 March 2018, a 14-year-old girl was found lifeless in a stream behind her high school after having consumed FCKDUP-a beverage containing 11.9% alcohol and sold in 568 mL cans-during her lunch hour. Following her death, the Canadian government took actions at ministerial and parliamentary levels by seeking experts' advice to better regulate highly sweetened alcoholic beverages, otherwise referred to as 'alcopops'. We suggest that the Canadian government uses the work surrounding the alcopop tragedy as an opportunity to make significant amendments and revisions of federal alcohol regulations.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Bebidas Alcoólicas/envenenamento , Adolescente , Comportamento do Adolescente , Canadá , Feminino , Humanos , Assunção de Riscos
3.
J Anal Toxicol ; 41(1): 17-21, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27681344

RESUMO

Ethyl glucuronide (EtG) and ethyl sulfate (EtS) are specific and sensitive biomarkers for the diagnosis of acute or chronic alcohol abuse. Due to postmortem alcohol production in biological tissues, they have recently been evaluated as potential biomarkers of ethanol ingestion. This in vitro study aimed to evaluate all developmental stages of the fly Calliphora vicina L. (Calliphoridae). Different pig substrates were used during the in vitro experiments to rear C. vicina Experiments were performed to: (i) assess the presence of EtG and EtS in larvae, pupae and insects; (ii) study variability due to the substrates characteristics; (iii) evaluate the possibility of false positives due to external alcohol contamination; and (iv) estimate the potential metabolism of ethanol by the insects. EtS was found in all of the samples where the standard was added to the substrate. Muscle provided the most reliable results. EtS was found in larvae, pupae and puparia. EtG and EtS were found in larvae and pupae collected from the body of an alcoholic found dead in his home. This study showed that maggots, pupae and puparia could be a useful matrix for the evaluation of antemortem alcohol ingestion.


Assuntos
Bebidas Alcoólicas/envenenamento , Biomarcadores/química , Diagnóstico , Dípteros/química , Glucuronatos/química , Ésteres do Ácido Sulfúrico/química , Consumo de Bebidas Alcoólicas/mortalidade , Animais , Cromatografia Líquida , Dípteros/crescimento & desenvolvimento , Toxicologia Forense/métodos , Coração/efeitos dos fármacos , Humanos , Rim/efeitos dos fármacos , Larva/química , Larva/crescimento & desenvolvimento , Fígado/efeitos dos fármacos , Reprodutibilidade dos Testes , Suínos , Espectrometria de Massas em Tandem , Língua/efeitos dos fármacos
7.
Inj Prev ; 20(1): 21-8, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23710064

RESUMO

OBJECTIVE: To examine unintentional alcohol and drug poisoning in association with substance use disorders (SUDs) and mood and anxiety disorders. METHOD: International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) external-cause-of-injury codes on discharge records of patients ages 12+ years from the 2010 Nationwide Inpatient Sample were examined to identify cases with unintentional alcohol poisoning (E860) and/or drug poisoning (E850-E858). ICD-9-CM diagnosis codes were examined to identify comorbid alcohol dependence, drug dependence, tobacco use disorder, and mood/anxiety disorders. Poisson regression was used to derive risk ratios to assess the associations between these comorbid conditions and alcohol/drug poisoning. RESULTS: Estimated numbers of hospitalisations related to unintentional alcohol and drug poisoning were, respectively, 5623 and 60 423 in men, and 3147 and 68 568 in women. For both sexes, the proportion with SUDs or mood/anxiety disorders was significantly higher among inpatients with alcohol and drug poisoning than among all inpatients. Estimated risk ratios indicated strong relationships of SUDs and mood/ anxiety disorders with unintentional poisoning from alcohol and drugs. The strongest association was between alcohol dependence and alcohol poisoning for both sexes. Significant associations also existed between drug dependence and drug poisoning, and mood/anxiety disorders and poisoning from alcohol and drugs. CONCLUSIONS: SUDs and mood/anxiety disorders are key risk factors for unintentional poisoning by alcohol and drugs among inpatients in the USA. Effective treatments of these disorders should be targeted as poisoning prevention efforts. Future studies are needed to clarify a potential bias in the data due to differential inpatient mental condition screening practices.


Assuntos
Bebidas Alcoólicas/envenenamento , Transtornos de Ansiedade/epidemiologia , Etanol/envenenamento , Drogas Ilícitas/envenenamento , Transtornos do Humor/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Criança , Comorbidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Análise de Regressão , Estados Unidos/epidemiologia , Adulto Jovem
8.
Pediatr Int ; 55(6): 792-4, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24330291

RESUMO

We describe a 15-day-old newborn girl who was fed with formula milk that was accidentally diluted with sake (Japanese wine prepared from fermented rice). The clinical features were flushed skin, tachycardia and low blood pressure indicating circulatory failure, somnolence and metabolic acidosis without hypoglycemia. The serum ethanol concentration was 43.0 mg/dL at 3 h after intake. The patient recovered under intravenous fluid replacement without complications. Follow-up examinations at 1, 2, 3, 6 and 12 months confirmed normal psychomotor development.


Assuntos
Bebidas Alcoólicas/envenenamento , Intoxicação Alcoólica/etiologia , Intoxicação Alcoólica/diagnóstico , Intoxicação Alcoólica/terapia , Feminino , Humanos , Recém-Nascido
9.
Clin Toxicol (Phila) ; 51(7): 566-74, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23879181

RESUMO

CONTEXT: Small studies have associated energy drinks-beverages that typically contain high concentrations of caffeine and other stimulants-with serious adverse health events. OBJECTIVE: To assess the incidence and outcomes of toxic exposures to caffeine-containing energy drinks, including caffeinated alcoholic energy drinks, and to evaluate the effect of regulatory actions and educational initiatives on the rates of energy drink exposures. METHODS: We analyzed all unique cases of energy drink exposures reported to the US National Poison Data System (NPDS) between October 1, 2010 and September 30, 2011. We analyzed only exposures to caffeine-containing energy drinks consumed as a single product ingestion and categorized them as caffeine-containing non-alcoholic, alcoholic, or "unknown" for those with unknown formulations. Non-alcoholic energy drinks were further classified as those containing caffeine from a single source and those containing multiple stimulant additives, such as guarana or yerba mate. The data were analyzed for the demographics and outcomes of exposures (unknown data were not included in the denominator for percentages). The rates of change of energy drink-related calls to poison centers were analyzed before and after major regulatory events. RESULTS: Of 2.3 million calls to the NPDS, 4854 (0.2%) were energy drink-related. The 3192 (65.8%) cases involving energy drinks with unknown additives were excluded. Of 1480 non-alcoholic energy drink cases, 50.7% were children < 6 years old; 76.7% were unintentional; and 60.8% were males. The incidence of moderate to major adverse effects of energy drink-related toxicity was 15.2% and 39.3% for non-alcoholic and alcoholic energy drinks, respectively. Major adverse effects consisted of three cases of seizure, two of non-ventricular dysrhythmia, one ventricular dysrhythmia, and one tachypnea. Of the 182 caffeinated alcoholic energy drink cases, 68.2% were < 20 years old; 76.7% were referred to a health care facility. Educational and legislative initiatives to enhance understanding of the health consequences of energy drink consumption were significantly associated with a decreased rate of energy drink-related cases (p = 0.036). CONCLUSIONS: About half the cases of energy drink-related toxicity involved unintentional exposures by children < 6 years old. Educational campaigns and legal restrictions on the sale of energy drinks were associated with decreasing calls to poison centers for energy drink toxicity and are encouraged.


Assuntos
Bebidas Alcoólicas/envenenamento , Arritmias Cardíacas/induzido quimicamente , Cafeína/envenenamento , Estimulantes do Sistema Nervoso Central/envenenamento , Bebidas Energéticas/envenenamento , Convulsões/induzido quimicamente , Adolescente , Adulto , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/prevenção & controle , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Qualidade de Produtos para o Consumidor , Bases de Dados Factuais , Comportamento Alimentar , Feminino , Promoção da Saúde , Humanos , Incidência , Modelos Lineares , Masculino , Envenenamento/epidemiologia , Envenenamento/prevenção & controle , Medição de Risco , Fatores de Risco , Convulsões/epidemiologia , Convulsões/prevenção & controle , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
11.
Travel Med Infect Dis ; 11(3): 190-3, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23566856

RESUMO

BACKGROUND: Common Travel Medicine sources generally do not provide information on the risk of methanol poisoning among travellers who visit Indonesia. The aim of this analysis was to increase knowledge on this topic through reports from bibliographic databases and Internet sources. METHODS: Case reports and studies on methanol poisoning in Indonesia were retrieved through PubMed, Embase and Google Scholar database searching. The Google search was used to retrieve the Web Media articles reporting fatal and non-fatal methanol poisoning in Indonesia, in a timeframe from 01.01.2009 to 03.03.2013. RESULTS: Three case reports of methanol poisoning involving four travellers to Indonesia were found in bibliographic databases. The media sources searching identified 14 articles published online, reporting 22 cases of methanol poisoning among travellers after consumption of local alcohol beverages. The total number of death cases was 18. Some sources report also a large number of cases among the local population. CONCLUSIONS: Methanol poisoning is likely to be an emerging public health problem in Indonesia, with an associated morbidity and mortality among travellers and local people. Some strategies can be implemented to prevent or reduce harm among travellers.


Assuntos
Metanol/envenenamento , Viagem , Adolescente , Adulto , Bebidas Alcoólicas/envenenamento , Intoxicação Alcoólica , Cegueira/induzido quimicamente , Feminino , Humanos , Indonésia , Masculino , Pessoa de Meia-Idade
12.
BMC Cancer ; 12: 475, 2012 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-23066954

RESUMO

BACKGROUND: Gastric cancer is the second most common cause of death from cancer in the world. Epidemiological findings on alcohol use in relation to gastric cancer remain controversial. The aim of this study was to examine the effect of alcohol consumption on the risk of gastric cancer. METHODS: The association between alcohol intake and the risk of gastric cancer was examined in a population-based cohort of 7,150 men in Kaunas, Lithuania, who were enrolled during 1972-1974 or 1976-1980. After up to 30 years of follow-up, 185 gastric cancer cases were identified. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HR) and corresponding 95% confidence intervals (95% CI). The attained age was used as a time-scale. RESULTS: After adjustment for smoking, education level and body mass index, the HR of gastric cancer was 2.00 (95% CI: 1.04-3.82) for the highest alcohol consumption frequency (2-7 times per week) compared with occasional drinking (a few times per year) and 1.90 (95% CI: 1.13-3.18) for ≥ 100.0 g ethanol/week versus 0.1-9.9 g ethanol/week. A stronger effect of alcohol consumption on gastric cancer risk was observed during the second half of the study (1993-2008). In the analysis of gastric cancer risk by alcoholic beverage type, all beverages were included simultaneously in the model. The multivariate HR for men who consumed ≥ 0.5 litre of wine per occasion (compared with those who consumed <0.5 litre) was 2.95 (95% CI: 1.30-6.68). Higher consumption of beer or vodka was not statistically significantly associated with gastric cancer risk. After adjustment for smoking, education level, body mass index and ethanol, we found no excess risk of gastric cancer in association with total acetaldehyde intake. CONCLUSIONS: This study supports a link between alcohol consumption (primarily from ethanol) and the development of gastric cancer in the Lithuanian population. Although an association with heavy wine consumption was observed, the effect of exposure to acetaldehyde on the development of gastric cancer in this cohort was not confirmed. Further research is needed to provide a more detailed evaluation of alcohol drinking and gastric cancer risk.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Bebidas Alcoólicas/estatística & dados numéricos , Neoplasias Gástricas/epidemiologia , Acetaldeído/envenenamento , Idoso , Consumo de Bebidas Alcoólicas/efeitos adversos , Bebidas Alcoólicas/envenenamento , Índice de Massa Corporal , Estudos de Coortes , Intervalos de Confiança , Escolaridade , Seguimentos , Humanos , Lituânia/epidemiologia , Masculino , Modelos de Riscos Proporcionais , Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Neoplasias Gástricas/etiologia
13.
MMWR Morb Mortal Wkly Rep ; 61(39): 782-4, 2012 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-23034585

RESUMO

Foodborne botulism is a rare, potentially fatal paralytic illness caused by eating food contaminated by Clostridium botulinum toxin. It occurs most often as a single case not linked to others by a common food source. As a result of improvements in food canning, when outbreaks do occur, they typically involve fewer than five persons. During October 2-4 2011, eight maximum security inmates at the Utah State Prison in Salt Lake County were diagnosed with foodborne botulism. An investigation by Salt Lake Valley Heath Department, Utah Department of Health, and CDC identified pruno, an illicit alcoholic brew, as the vehicle. The principal ingredients in pruno are fruit, sugar, and water. Many additional ingredients, including root vegetables, are sometimes added, depending on the availability of foods in prison. A baked potato saved from a meal served weeks earlier and added to the pruno was the suspected source of C. botulinum spores. Many of the affected inmates suffered severe morbidity, and some required prolonged hospitalizations. Knowing the link between pruno and botulism might help public health and correctional authorities prevent future outbreaks, respond quickly with appropriate health-care to inmates with acute descending paralysis and/or other symptoms, and reduce associated treatment costs to states.


Assuntos
Bebidas Alcoólicas/microbiologia , Bebidas Alcoólicas/envenenamento , Botulismo/etiologia , Prisioneiros , Adulto , Botulismo/complicações , Botulismo/diagnóstico , Clostridium botulinum/isolamento & purificação , Manipulação de Alimentos , Hospitalização , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Prisões , Solanum tuberosum , Utah , Adulto Jovem
14.
Emerg Med Australas ; 24(4): 451-3, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22862764

RESUMO

Methanol poisoning has become very uncommon in Australasia with regulations that have reduced its retail availability. This report describes a young tourist who developed sudden onset visual failure and rapid breathing 2 days after ingestion of a complimentary local drink called Arrack when travelling in Indonesia. She presented to a hospital in New Zealand with severe metabolic acidosis and a highly toxic methanol level at 17 mmol/L. The cocktail was consumed at a popular tourist bar but is likely to have been mixed from home-brewed or 'moonshine' alcohol tainted with methanol. The aetiology of methanol poisoning, its optic toxicology and therapeutic measures are discussed, as is the concerning number of methanol poisoning cases among tourists to Indonesia over recent years.


Assuntos
Bebidas Alcoólicas/envenenamento , Metanol/envenenamento , Doenças do Nervo Óptico/induzido quimicamente , Transtornos da Visão/induzido quimicamente , Feminino , Humanos , Indonésia , Viagem , Adulto Jovem
15.
Child Abuse Negl ; 36(4): 362-9, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22571909

RESUMO

OBJECTIVE: Although the majority of poisonings in young children are due to exploratory ingestions and might be prevented through improved caregiver supervision, the circumstances that warrant evaluation for suspected maltreatment and referral to Child Protective Services (CPS) are unclear. Therefore the objective of this study was to determine the percentage and characteristics of young poisoning victims who were evaluated for child maltreatment by the hospital team (social work and/or child protection team) and/or referred to CPS. METHODS: Retrospective study of poisoning victims<6 years old seen at an urban children's hospital from 2006 to 2008. Logistic regression was performed to evaluate the associations between the outcomes (evaluation for maltreatment by hospital team and/or referral to CPS) and predictor variables (demographics and circumstances, type and severity of poisoning). RESULTS: Among 928 poisonings, 41% were from household products, 20% from over-the-counter drugs, 7% from prescription narcotics/sedatives, 29% from other prescription drugs, and ≤ 1% each from ethanol, illicit drugs, or other substances. Most children were asymptomatic (69%) or stable (28%); 3% were critically ill. Only 13% were evaluated by the hospital team and 4% were referred to CPS. Demographic characteristics were not associated with referral to CPS. Higher clinical severity was associated with increased referral (p<0.001). Compared to poisonings with over-the-counter drugs, referrals were more likely for poisonings with ethanol and prescription narcotics/sedatives, but not other prescription drugs or household products (p<0.001). All illicit drug poisonings and 44% of ethanol poisonings were referred. The majority of referrals to CPS were for concerns for illicit drugs, poor supervision or multiple forms of maltreatment; 6% were secondary to concerns for intentional poisoning. CONCLUSIONS: Evaluations and referrals to CPS for maltreatment are uncommon in young poisoning victims. Referrals occurred consistently for illicit drugs but not ethanol. Although referrals were more likely for higher severity poisonings, it is unclear if the severity of poisoning is associated with the level of supervisory neglect or a marker of ongoing risk to the child. These findings suggest the need to identify risk factors for ongoing harm and the development of clinical guidelines used to determine which poisoning victims should be referred to Child Protective Services.


Assuntos
Maus-Tratos Infantis/diagnóstico , Bem-Estar da Criança , Envenenamento/etiologia , Bebidas Alcoólicas/envenenamento , Cuidadores/estatística & dados numéricos , Pré-Escolar , Métodos Epidemiológicos , Feminino , Produtos Domésticos/envenenamento , Humanos , Drogas Ilícitas/envenenamento , Lactente , Recém-Nascido , Masculino , Medicamentos sem Prescrição/envenenamento , Philadelphia , Medicamentos sob Prescrição/envenenamento , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos
16.
Saudi J Kidney Dis Transpl ; 23(1): 37-43, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22237216

RESUMO

Methanol is a cheap and potent adulterant of illicit liquors. Hemodialysis (HD) is the best method to rapidly remove both toxic acid metabolites and parent alcohols, and it plays a fundamental role in treating severely poisoned patients. This retrospective study was carried out on 91 patients with detectable serum methanol levels who underwent HD. Because toxic alcohol levels were not immediately available, the initial diagnosis and treatment was based on clinical history with evidence of toxic alcohol intake, presence of high anion metabolic acidosis and/or end organ damage. Patients received bicarbonate, ethanol, according to clinical features and blood gases. Patients underwent HD in the setting of known methanol ingestion with high anion gap metabolic acidosis, or evidence of end-organ damage, regardless of methanol level. HD prescription included large surface area dialyzer (≥ 1.5 m²), blood flow rate of 250-350 mL/min and dialysate flow rate of 500 mL/min for 4-6 h. Between 9 and 11 July 2009, 91 males with mean age 40 ± 8.5 years underwent HD, and 13 patients required a second HD session. Patients consumed 100-500 mL illicit liquors, and symptoms appeared six and 60 h later. Clinical features were gastro-intestinal symptoms (83.5%), visual disturbances (60.4%), central nervous system symptoms (59.3%) and dyspnea (43.9%). Before HD, mean pH was 7.11 ± 0.04 (range 6.70- 7.33) and mean bicarbonate levels were 8.5 ± 4.9 mmol/L (range 2-18). Three patients died due to methanol intoxication. Mortality was associated with severe metabolic acidosis (pH ≤ 6.90), ventilator requirement and coma/seizure on admission (P < 0.001). Timely HD, bicarbonate, ethanol and supportive therapy can be life-saving in methanol intoxication.


Assuntos
Bebidas Alcoólicas/envenenamento , Metanol/envenenamento , Diálise Renal , Acidose/induzido quimicamente , Acidose/terapia , Adulto , Bicarbonatos/administração & dosagem , Distribuição de Qui-Quadrado , Coma/induzido quimicamente , Coma/terapia , Terapia Combinada , Etanol/administração & dosagem , Humanos , Concentração de Íons de Hidrogênio , Índia , Masculino , Metanol/sangue , Pessoa de Meia-Idade , Envenenamento/etiologia , Envenenamento/mortalidade , Envenenamento/terapia , Respiração Artificial , Estudos Retrospectivos , Convulsões/induzido quimicamente , Convulsões/terapia , Fatores de Tempo , Resultado do Tratamento
17.
Ann Emerg Med ; 59(1): 67-9, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21820210

RESUMO

We describe a case series of emergency department (ED) visits for intoxication related to the use of the caffeinated alcoholic beverage Four Loko. Medical records from the 4-month period July to November 2010 were hand searched for key words such as "intoxicated," "caffeinated," "Four Loko," "alcohol," and "EtOH." Patients were included if they were younger than 25 years. Eleven cases were included. Eight (72.7%) patients presented during October 2010. The median age was 16.4 years; 90.9% were under the legal drinking age of 21 years. Seven (63.6 %) were male patients. All arrived by emergency medical services (EMS). Four patients (36.3%) were found in high-risk settings, with altered mental status on subway tracks, in public buildings, or parks after dark. Two patients had blood alcohol concentrations greater than 200 mg/dL. Six patients (54.5%) had emesis. Two patients (18.2%) were admitted to hospital, 1 each because of seizures and persistent tachycardia. Patients intoxicated with Four Loko were younger than the legal drinking age, found in high-risk situations, and often admitted to the hospital. Many of these patients used EMS and resources in the ED for alleviation of adverse effects of Four Loko.


Assuntos
Bebidas Alcoólicas/envenenamento , Intoxicação Alcoólica/epidemiologia , Serviço Hospitalar de Emergência , Adolescente , Intoxicação Alcoólica/diagnóstico , Intoxicação Alcoólica/terapia , Cafeína/envenenamento , Feminino , Humanos , Masculino , Adulto Jovem
18.
Prescrire Int ; 20(120): 236-7, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21970084

RESUMO

Between 2000 and 2008, the American Association of Poison Control Centers recorded 1439 cases in which drugs or alcohol were used to mistreat children under 7 years of age, representing an average of 160 reports per year. Median age was 2 years, and 57% of victims were boys. The substances included psychotropic drugs, analgesics, cold remedies, alcohol, and illicit drugs. 18 children died, while 32 children experienced life-threatening effects or residual disability. It is not clear whether these results can be extrapolated to the French population. In France, a yearly survey of the Centres for Evaluation and Information on Pharmacodependence (CEIP) identified 162 cases of "chemical submission", 3 of which involved children. In practice, it is often difficult to recognise when a child is being maltreated, especially when medications, illicit drugs or alcohol are used. Taking into consideration the known adverse effect profile of a drug may provide a clue, help to limit harms to the child and allow appropriate management.


Assuntos
Maus-Tratos Infantis , Envenenamento , Bebidas Alcoólicas/envenenamento , Criança , Maus-Tratos Infantis/diagnóstico , Pré-Escolar , Feminino , França/epidemiologia , Humanos , Drogas Ilícitas/envenenamento , Masculino , Envenenamento/epidemiologia , Envenenamento/mortalidade , Psicotrópicos/envenenamento , Estados Unidos/epidemiologia
20.
Clin Toxicol (Phila) ; 49(6): 471-7, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21761961

RESUMO

INTRODUCTION: Polyhexamethyleneguanidine hydrochloride (PHMG) is an antimicrobial biocide of the guanidine family. In the period from August 2006 to May 2007, more than 12500 patients were admitted to hospital with a history of drinking illegal cheap "vodka" in 44 different regions in Russia, of whom 9.4% died. In reality, the "vodka" was an antiseptic liquid composed of ethanol (≈93%), diethyl phthalate, and 0.1-0.14% PHMG (brand name "Extrasept-1"). MATERIAL AND METHODS: We performed an analysis of the clinical features and outcome in four poisoning treatment centers in the cities of Perm, Ekaterinburg, Irkutsk, and Khabarovsk. A total of 579 patients (215 females and 364 males) with similar symptoms were included. RESULTS: The main symptoms on admission included jaundice (99.7%), skin itch (78.4%), weakness (96%), anorexia (65.8%), dizziness (65.3%), nausea (54.8%), vomiting (22.6%), stomach ache (52.7%), diarrhea (32%), and fever (50%). Mild symptoms were found in 2.5% of cases, moderate in 63%, and severe in 34.5%. Laboratory results were (mean ± SD): total bilirubin 249 ± 158 µmol/L, direct bilirubin 166 ± 97 µmol/L, cholesterol 14 ± 8 mmol/L, alanine aminotransferase 207 ± 174 IU/L, aspartate aminotransferase 174 ± 230 IU/L, alkaline phosphatase 742 ± 751 IU/L, and gamma-glutamyltranspeptidase 1199 ± 1095 IU/L. Patients generally recovered over a period of 1-5 months, although high levels of alkaline phosphatase and gamma-glutamyltranspeptidase were still found in all patients examined after 6 months. Sixty-one patients (10.5%) died between 23 and 150 days after poisoning. Local cholestasis, inflammatory infiltration, and fibrosis developing into cirrhosis were found by liver biopsy. CONCLUSION: Acute liver injury caused by PHMG-hydrochloride or PHMG in combination with either ethanol or diethyl phthalate can be characterized as cholestatic hepatitis with a severe inflammatory component causing high mortality.


Assuntos
Depressores do Sistema Nervoso Central/envenenamento , Doença Hepática Induzida por Substâncias e Drogas/patologia , Colestase/patologia , Desinfetantes/envenenamento , Etanol/envenenamento , Guanidinas/envenenamento , Doença Aguda , Adolescente , Adulto , Fatores Etários , Idoso , Bebidas Alcoólicas/envenenamento , Doença Hepática Induzida por Substâncias e Drogas/diagnóstico por imagem , Colestase/diagnóstico por imagem , Técnicas de Laboratório Clínico , Epidemias , Feminino , Encefalopatia Hepática/induzido quimicamente , Encefalopatia Hepática/psicologia , Humanos , Fígado/patologia , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Envenenamento/diagnóstico , Envenenamento/epidemiologia , Envenenamento/mortalidade , Estudos Retrospectivos , Federação Russa/epidemiologia , Fatores Sexuais , Classe Social , Ultrassonografia , Adulto Jovem
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