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1.
Subst Abuse Treat Prev Policy ; 16(1): 71, 2021 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-34544462

RESUMO

BACKGROUND: Voodoo is a heterogeneous mixture of psychoactive substances that has recently grown in popularity among youth in Egypt. Patients can present with a variety of manifestations that may lead to death in some cases. This study assessed the acute toxic effects of voodoo among patients presented to the Poison Control Center of Ain Shams University Hospitals (PCC-ASUH) during a one year period. METHODS: This is a retrospective study of all patients presented with voodoo intoxication at the PCC-ASUH from 1 January 2017 to 31 December 2017. Clinical data, routine laboratory findings, and ECG results as well as duration of hospitalization and outcome were compiled from hospital records. RESULTS: Seventy-one voodoo intoxication cases meeting the inclusion criteria were analyzed (mean age: 25.19 ± 9.54 years, range: 15-50 years, 97.2 % male). Pulse, blood pressure, and respiratory rate were normal in more than half of all patients. Neurological abnormalities including agitation, hallucinations, disturbance of consciousness were the most frequent manifestations. Respiratory acidosis was the most common laboratory finding (54.9 %), followed by increased serum urea (43.6 %), hypokalemia (33.8 %), hyperglycemia (28.1 %), and leukocytosis (26.7 %). The most common ECG finding was sinus tachycardia (31 %), followed by QT prolongation (15.4 %). More than half of the studied patients (53.5 %) co-administered other illicit substances, most frequently cannabis and tramadol. Most patients recovered fully and were discharged, but death occurred in two cases. CONCLUSIONS: Voodoo toxicity can manifest with many presentations, hampering timely diagnosis. Clinicians should consider possible voodoo poisoning in patients presenting with a history of drug use with neurological symptoms, and they should conduct follow-up arterial blood gases, electrolytes and ECG as voodoo may contain potentially fatal psychoactive substances.


Assuntos
Centros de Controle de Intoxicações , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Adulto , Egito/epidemiologia , Feminino , Hospitais Universitários , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
2.
J Am Geriatr Soc ; 69(8): 2176-2184, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34143890

RESUMO

BACKGROUND: In recent years, use of the herbal supplement kratom has increased in the United States. The reasons for use include pain relief, particularly as a substitute for opioids. OBJECTIVES: To describe epidemiologic trends in kratom-related exposures among older adults reported to U.S. poison centers. DESIGN: Retrospective analysis of American Association of Poison Control Center's National Poison Data System (NPDS). SETTING: Data from all U.S. poison centers from 2014 to 2019 were examined. PARTICIPANTS: Kratom exposure cases involving adults aged 18 and older. Kratom cases were identified by product and NPDS generic codes. Non-human and information-only calls were excluded. Data were examined for all calls for exposures among adults, with a focus on older adults aged 60-69 years and above 70 years. MEASUREMENTS: Descriptive analyses were used to characterize individual demographic, exposure information, clinical effects, and medical outcomes associated with kratom exposures among older adults. Comparisons across age groups (18-59, 60-69, and 70+ years) were made using Fisher's exact tests. RESULTS: Among 3484 kratom-related exposures reported between 2014 and 2019, 4.6% (n = 162) were among adults over 60 years. The number of kratom-related exposures increased over time. Most cases originated with calls from healthcare facilities (81.1%) and involved kratom as a single ingestant (63.0%). The reason for most ingestions was intentional (74.5%). One in five exposures among adults aged 70 and older involved an adverse reaction (e.g., drug interaction; 21.9%), compared with 12.3% among ages 60-69 and 9.6% among ages 18-59 years. Neurological and cardiovascular clinical effects were observed. Twenty-three deaths were observed among older adults. CONCLUSION: Healthcare providers and older adult patients should be aware of the potential risks of kratom use, including medication interactions and falls. When reviewing medication lists, providers should query this population for all medications and substances being used, especially in people being treated for pain.


Assuntos
Mitragyna/envenenamento , Centros de Controle de Intoxicações/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mitragyna/efeitos adversos , Envenenamento/epidemiologia , Estudos Retrospectivos , Estados Unidos/epidemiologia
3.
Ital J Pediatr ; 47(1): 125, 2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078407

RESUMO

INTRODUCTION: Acute pediatric poisoning is an emerging health and social problem. The aim of this study is to describe the characteristics of a large pediatric cohort exposed to xenobiotics, through the analysis of a Pediatric Poison Control Center (PPCc) registry. METHODS: This study, conducted in the Pediatric Hospital Bambino Gesù of Rome, a reference National Pediatric Hospital, collected data of children whose parents or caregivers contacted the PPCc by phone (group "P"), or who presented to the Emergency Department (group "ED"), during the three-year period 2014-2016. Data were prospectively and systematically collected in a pre-set electronic registry. Comparisons among age groups were performed and multivariable logistic regression models used to investigate associations with outcomes (hospital referral for "P", and hospital admission for "ED"group). RESULTS: We collected data of 1611 children on group P and 1075 on group ED. Both groups were exposed to both pharmaceutical and non-pharmaceutical agents. Pharmaceutical agent exposure increased with age and the most common route of exposure was oral. Only 10% among P group were symptomatic children, with gastrointestinal symptoms. Among the ED patients, 30% were symptomatic children mostly with gastrointestinal (55.4%) and neurologic symptoms (23.8%). Intentional exposure (abuse substance and suicide attempt), which involved 7.7% of patients, was associated with older age and Hospital admission. CONCLUSIONS: Our study describes the characteristics of xenobiotics exposures in different paediatric age groups, highlighting the impact of both pharmacological and intentional exposure. Furthermore, our study shows the utility of a specific PPCc, either through Phone support or by direct access to ED. PPCc phone counselling could avoid unnecessary access to the ED, a relevant achievement, particularly in the time of a pandemic.


Assuntos
Centros de Controle de Intoxicações , Envenenamento/epidemiologia , Adolescente , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Hospitalização/estatística & dados numéricos , Linhas Diretas , Humanos , Lactente , Recém-Nascido , Itália/epidemiologia , Masculino , Estudos Prospectivos , Sistema de Registros , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos
4.
Int J Toxicol ; 40(4): 388-394, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34044595

RESUMO

BACKGROUND: The sudden emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and scarcity of the accurate information especially in the initial phase of the struggle presented a series of challenges to health systems. OBJECTIVE: To evaluate the changes in poisoning cases regarding distribution, types, and characteristics for better framing and planning of the role of our field in responding to pandemics. METHODS: Study of telephone consultation calls and toxicology analysis records of poisoning cases referred to the Dammam Poison Control Center in Saudi Arabia during the first half of 2020. Their distribution according to frequencies, causes, and other characteristics was compared to the first half of 2019. RESULTS: Analysis of telephone consultation calls revealed that the proportion of exposure to disinfectants and hand sanitizers during first half of 2020 increased to 20.4% (n = 496) and 3.4% (n = 83), respectively, compared to 9.8% (n = 215) and 0.4% (n = 10) for surface disinfectants and hand sanitizers, respectively, during the first half of 2019. In 2020, exposure to disinfectants and hand sanitizers dominated in preschool children (0-5 years). The total number of cases suspected for drugs/drugs of abuse overdose during the first 6 months of 2020 (n = 783) showed a significant decrease (P < 0.001) compared to the first 6 months of 2019 (n = 1086). CONCLUSION: The increased availability and use of disinfectants and sanitizers significantly increased the risk of poisoning, especially in preschool-aged children. Public health education for prevention of such home exposures is urgently needed to avoid unnecessary emergency medical system use in such critical time.


Assuntos
COVID-19/epidemiologia , Desinfetantes/toxicidade , Higienizadores de Mão/toxicidade , Centros de Controle de Intoxicações/estatística & dados numéricos , Encaminhamento e Consulta , SARS-CoV-2 , Pré-Escolar , Humanos , Arábia Saudita/epidemiologia , Fatores de Tempo
5.
Subst Use Misuse ; 56(8): 1169-1181, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33939935

RESUMO

OBJECTIVE: Opioid-related deaths are a leading cause of accidental deaths in the United States (U.S.). This study aims to examine the national trends in opioid exposures reported to U.S. poison centers (PCs). METHODS: The National Poison Data System (NPDS) was queried for opioid exposures between 2011 and 2018. We descriptively assessed the demographic and clinical characteristics. Trends in opioid frequencies and rates were analyzed using Poisson regression. Independent predictors of serious adverse events in opioid exposures were studied. RESULTS: There were a total of 604,183 opioid exposure calls made to the PCs during the study period. The frequency of opioid exposures decreased by 28.9% (95% CI: -29.6%, -28.1%; p < 0.001), and the rate of opioid exposures decreased by 21.2% (95% CI: -24.7%, -16.9%; p < 0.001). Multiple substance exposures accounted for 48.9% cases. The most frequent age group was 20-29 years (19.3%). Suspected suicides accounted for 34.9% cases. There were 7,246 deaths in our study sample, with 6.8% of cases demonstrating major effects. Hydrocodone was the most frequently observed opioid causing a toxic exposure and naloxone was used in 20.6% cases. Important predictors of a serious adverse event were age, gender, multi-substance exposures, and reasons for exposure. CONCLUSIONS: Analysis of calls to PCs indicated a decreasing trend of opioid exposures. However, the proportion of SAEs due to such exposures increased. There was a high proportion of intentional exposures and occurred in older age groups. PCs are a vital component of real-time public health surveillance of overdoses in the current opioid crisis.


Assuntos
Venenos , Suicídio , Adulto , Idoso , Analgésicos Opioides , Bases de Dados Factuais , Humanos , Centros de Controle de Intoxicações , Estados Unidos , Adulto Jovem
6.
Am J Emerg Med ; 48: 218-223, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33975134

RESUMO

INTRODUCTION: Cannabidiol (CBD) has become a popular supplement in consumer products in recent years, resulting in part from normalization of the cultivation of low THC cannabis in 2018. However, the actual content of CBD-labeled products is frequently uncertain, as oversight of such products is minimal. To date, there is little pragmatic knowledge regarding exposures to products labeled as containing CBD. METHODS: Cases reported to Poison Control Centers from April 1, 2019 and March 31, 2020, the first year in which CBD was identified uniquely as a substance in the National Poison Data System, were analyzed for demographic, temporal, and clinical trends. RESULTS: Poison Control Centers handled 1581 cases exposures to CBD-containing products between April 1, 2019 and March 31, 2020. There was a significant trend of over 5 additional cases related to this substance per month (linear regression coefficient = 5.2, 95% CI: 1.52-8.98). Patients under age 13 years made up 44.0% of reported exposures. Mild CNS depression (10.3%), tachycardia (5.7%), dizziness/vertigo (5.3%), vomiting (4.9%), nausea (4.5%), and agitation (4.4%) were the most frequently reported symptoms. 13% of cases were coded as having "moderate" or "severe" medical outcomes. There were no fatalities. CONCLUSIONS: Cases reported to Poison Control Centers regarding exposures to CBD-labeled products have been increasing, representing an emerging trend of interest to Poison Control Center professionals, clinicians, and public health officials. Further monitoring of this trend is recommended.


Assuntos
Anticonvulsivantes/envenenamento , Canabidiol/envenenamento , Síndromes Neurotóxicas/epidemiologia , Centros de Controle de Intoxicações , Adolescente , Adulto , Idoso , Anticonvulsivantes/efeitos adversos , Canabidiol/efeitos adversos , Criança , Pré-Escolar , Bases de Dados Factuais , Tontura/induzido quimicamente , Tontura/epidemiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Náusea/epidemiologia , Síndromes Neurotóxicas/etiologia , Taquicardia/induzido quimicamente , Taquicardia/epidemiologia , Estados Unidos/epidemiologia , Vertigem/induzido quimicamente , Vertigem/epidemiologia , Vômito/induzido quimicamente , Vômito/epidemiologia , Adulto Jovem
7.
Wilderness Environ Med ; 32(2): 143-148, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34053884

RESUMO

INTRODUCTION: Snake envenomations cause significant morbidity and mortality. The goals of this study were to assess the epidemiology of snakebites in Kentucky and treatment strategies used by physicians reporting to the Kentucky Regional Poison Control Centers. METHODS: This was a descriptive epidemiologic study compiling clinical data on snakebites reported to the Kentucky Regional Poison Control Centers from 2012 to 2016. We built a database of the patient demographics, treatment, and clinical course of each snakebite reported in the study period. Attention was paid to all antivenom interventions and use of contraindicated therapies. RESULTS: We compiled 674 total records. Patient age was 34±18 y (mean±SD), with males (71%) predominating. Most (97%) bites were to a distal upper or lower extremity. The majority (78%) occurred at a private residence. Most reports came between May and September (88%). Of the 674 patients, 24% (n=159) were classified as moderate or severe. Two hundred thirty (34%) patients were admitted to the hospital. Forty-six patients (7%) received surgical consultation, and 12 (2%) underwent surgical intervention. One hundred fifty-three patients received antivenom, with 6±3 vials used per patient. Length of stay was 3±2 d when antivenom was administered and 2±2 d when not administered. Six cases of coagulopathy were noted. Multiple contraindicated therapies were noted. CONCLUSIONS: Snake envenomations are a prevalent public health concern for residents of Kentucky, chiefly during summer months. Significant medical intervention is being performed for many patients, with a high prevalence of contraindicated therapies. More data are needed to fully characterize the epidemiologic impact and appropriateness of the interventions being applied.


Assuntos
Mordeduras de Serpentes , Antivenenos/uso terapêutico , Hospitalização , Humanos , Kentucky/epidemiologia , Masculino , Centros de Controle de Intoxicações , Mordeduras de Serpentes/epidemiologia , Mordeduras de Serpentes/terapia
8.
Am J Emerg Med ; 47: 86-89, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33794474

RESUMO

Bupropion is an antidepressant medication with expanding indications including smoking cessation, weight loss, attention-deficit/hyperactivity disorder, seasonal affective disorder, and amphetamine dependence. Despite its increasing popularity among providers, it has a well-known narrow therapeutic window which can lead to delayed onset of symptoms with extended-release formulations and devastating consequences in overdose. We have noticed some patients misusing bupropion via intravenous use and had difficulty guiding decisions regarding clinical monitoring in these patients. As this route entirely changes the kinetics of bupropion, this has caused concern within our group. We reviewed all the cases of intravenous bupropion use reported to a single poison center without any other coingestants. The majority (66.7%) of patients had moderate effects and one patient had a seizure. No deaths were reported. All patients were symptomatic by the time of initial call to the poison center if they had any reported symptoms due to bupropion. This case series describes the clinical effects reported, and the timing of these effects, after intravenous bupropion use.


Assuntos
Bupropiona/efeitos adversos , Centros de Controle de Intoxicações , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Bupropiona/administração & dosagem , Bupropiona/envenenamento , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
9.
J Med Toxicol ; 17(3): 250-256, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33905077

RESUMO

INTRODUCTION: Between early March 2020 and the end of May 2020, Italy issued strict measures to limit further spread of coronavirus disease 2019 (COVID-19) and became the first European country that imposed a lockdown on the population. The aim of this study was to assess the impact of these restricted conditions on the activity of the Poison Control Center (PCC) of Policlinico Umberto I Hospital-Sapienza University of Rome. METHODS: This was a retrospective analysis of calls received by the PCC during the lockdown period March 9, 2020 through May 31, 2020 compared to the same time period in year 2019 (reference). RESULTS: We observed a reduction in calls from hospitals and emergency departments and an increase in calls from private citizens about exposures to products or intoxications during the lockdown. There were increases in unintentional exposures and exposures to hand and surface sanitizers among household and cleaning products. There was a decrease in calls concerning medications, which were mostly from hospitals and emergency departments. We observed increases in exposures requiring clinical observations among adults and referral to the emergency department among pre-school children. CONCLUSIONS: Public health protection measures against COVID-19 to improve hygiene and maintain clean environments can increase exposures to hazardous products in the domestic environment. We observed an increase in unintentional exposures to household and cleaning products during the lockdown and an increase in ED referrals for pre-school children compared to the previous year. Our data suggest the need for improvements in public campaigns that promote safer handling of household products and prevent unnecessary exposures during a lockdown. The public health promotion activity can benefit the community after the pandemic and prepare the community for lockdowns in the future.


Assuntos
COVID-19/epidemiologia , Centros de Controle de Intoxicações , Envenenamento/terapia , SARS-CoV-2 , Adolescente , Adulto , Idoso , COVID-19/prevenção & controle , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Produtos Domésticos , Humanos , Itália/epidemiologia , Pessoa de Meia-Idade , Envenenamento/prevenção & controle , Saúde Pública , Estudos Retrospectivos , Adulto Jovem
10.
Toxicon ; 196: 25-31, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33798604

RESUMO

An epidemiological study on animal poisoning due to plants and zootoxins has been carried out by the Poison Control Centre of Milan (CAV) in collaboration with the University of Milan (Italy). During the period January 2015-March 2019, the CAV received 932 calls on animal poisonings, 12.66% (n = 118) of which were related to plants and zootoxins. Among these, 95 enquiries (80.51%) concerned exposures to plants and 23 (19.49%) to zootoxins. The dog was the species most frequently involved (67.80% of the calls, n = 80), followed by the cat (26.27%, n = 31). As for the plants, several poisoning episodes were related to glycoside-, alkaloid-, oxalate- and diterpenoid-containing species. Cycas revoluta, Euphorbia pulcherrima and Hydrangea macrophylla were the most often reported plants. The outcome has been reported for half of the episodes (51.58%, n = 49) and it was fatal for 3 animals (6.12%). Regarding the zootoxins, the majority of the enquiries were related to asp viper (Vipera aspis), but exposures to pine processionary moth (Thaumetopoea pityocampa), common toad (Bufo), fire salamander (Salamandra), and jellyfish (phylum Cnidaria) were also reported. The outcome was known in 65.22% of the cases with just one fatal episode. This epidemiological investigation depicts an interesting overview on the issue of plant and zootoxin exposures in domestic animals, highlighting the relevance of these agents as causes of animal poisoning and providing useful information for prevention and diagnosis.


Assuntos
Animais Domésticos , Envenenamento/veterinária , Animais , Gatos , Cnidários , Cycas , Cães , Itália/epidemiologia , Centros de Controle de Intoxicações
11.
Clin Toxicol (Phila) ; 59(11): 969-974, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33849370

RESUMO

OBJECTIVE: Adulteration, substitution or contamination of illicit substances can have clinically significant implications when other illicit substances are included. Such circumstances can present as clusters of poisonings, including severe toxicity and death following exposure to unexpected illicit substances. We report a cluster of laboratory-confirmed lysergic acid diethylamide (LSD) in a powder that was sold as cocaine and used recreationally. METHODS: The Prescription, Recreational and Illicit Substance Evaluation (PRISE) program established by the New South Wales Ministry of Health includes State-based hospital toxicology services, Poisons Information Centre, Forensic & Analytical Science Service and emergency services to identify clusters of severe and unusual toxicity associated with substance use. PRISE criteria include a known cluster (geographically or situationally related) of people with acute severe toxicity, especially when accompanied by a toxidrome that is inconsistent with the history of exposure. A timely comprehensive drug screen and quantification is performed in eligible cases and the results are related to the clinical features. The need for a public health response is then considered. Four individuals inhaled a white powder that was sold as cocaine and developed severe toxicity that was not consistent with cocaine which prompted transfer to hospital for further management. RESULTS: LSD was confirmed in four subjects, and the concentrations in 3 of the individuals were 0.04-0.06 mg/L which are among the highest reported in the literature. Common clinical features were hallucinations, agitation, vomiting, sedation, hypertension, and mydriasis. One subject required intubation and admission to the intensive care unit, two required overnight admission, and the fourth was discharged following oral diazepam after observation. No subject suffered persistent injury. CONCLUSIONS: A close working relationship between pre-hospital emergency services, hospital-based clinical services, public health authorities, and analytical laboratories appears to be advantageous. Favourable clinical outcomes are observed from LSD poisoning despite high exposures with good supportive care.


Assuntos
Estimulantes do Sistema Nervoso Central , Transtornos Relacionados ao Uso de Cocaína , Cocaína , Contaminação de Medicamentos , Overdose de Drogas/diagnóstico , Alucinógenos/envenenamento , Dietilamida do Ácido Lisérgico/envenenamento , Uso Recreativo de Drogas , Administração Intranasal , Adulto , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Overdose de Drogas/epidemiologia , Overdose de Drogas/terapia , Alucinógenos/administração & dosagem , Humanos , Insuflação , Dietilamida do Ácido Lisérgico/administração & dosagem , Masculino , New South Wales/epidemiologia , Centros de Controle de Intoxicações , Pós , Detecção do Abuso de Substâncias , Adulto Jovem
12.
Pan Afr Med J ; 38: 42, 2021.
Artigo em Francês | MEDLINE | ID: mdl-33854671

RESUMO

Introduction: intentional poisoning is a major public health problem in both developed and developing countries. The purpose of this study is to describe the epidemiological features of criminal intoxication in Morocco. Method: we conducted a retrospective study of all cases of criminal intoxication identified by the Morocco Poison Control and Pharmacovigilance Centre (MPCPC) between 1980 and 2014. Results: during the study period, 611 cases of criminal poisoning were recorded, reflecting a rate of 2.1% of all intentional poisoning reported during the same period. The average age of intoxicated patients was 26.4±14.3 years. More than a quarter of the subjects were children under the age of 15 (28.6%). According to the study results, 55.9% were male, with a sex-ratio (M/F) of 1.3. The majority of cases (89.4%) occurred in urban areas. Collective intoxications were reported in 24.4% of cases. The most frequently used products were pesticides (19.1%) and plants (19%). Patients developed different symptoms based on the toxic substances used, the amount ingested and the time elapsed before treatment. A range of digestive, neurological, respiratory and cardiovascular disorders were reported. Out of 440 patients with outcome data available, 27 died. The remainder of patients survived with or without sequelae. Conclusion: criminal poisoning is a major issue. The number of cases is probably underestimated due to a large number of undiagnosed or unreported cases.


Assuntos
Crime , Farmacovigilância , Envenenamento/epidemiologia , Venenos/administração & dosagem , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos/epidemiologia , Praguicidas/envenenamento , Intoxicação por Plantas/epidemiologia , Centros de Controle de Intoxicações/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
13.
Artigo em Alemão | MEDLINE | ID: mdl-33688973

RESUMO

BACKGROUND AND OBJECTIVE: Since 1963, the poison control center in Berlin has been the central helpline for the Berlin and Brandenburg population on the subject of poisoning. Furthermore, the institution performs a vital function in the field of poisoning prevention. The aim of this paper is to describe the development of the volume of consultations and their content from 1999 to 2018. Differences in the urban and rural origin of the callers as well as in the private or professional background of the inquiries are considered. The results will serve to improve prevention work. METHODS: The case data of the poison control center (1999-2018) were evaluated and analyzed using descriptive statistical methods. Correlations between the categories "origin of call" (urban or rural area), "background" (private or professional), and "noxious agent" were analyzed using the Pearson's chi-squared test. RESULTS: The annual volume of consultations tended to increase. In particular, the increases are mainly related to inquiries regarding exposures of adults and seniors. The most frequent topics were poisoning with medications and products used in daily life. Inquiries about illegal drugs increased the most (average annual growth rate 6.3%). Inquiring persons with a private background can be helped directly in most cases (86.8%), so medical treatment is rarely recommended. Private persons call more frequently from urban areas, while calls from medical staff predominate in rural areas. Calls about pesticides, mushrooms, animals, and plants were more common in rural areas. Calls about food, foreign bodies, stimulants (alcoholic, caffeinated, and nicotine-containing foods/consumables), or illegal drugs, on the other hand, were received more frequently from urban areas.


Assuntos
Corpos Estranhos , Drogas Ilícitas , Envenenamento , Adulto , Animais , Berlim , Alemanha/epidemiologia , Humanos , Centros de Controle de Intoxicações , Envenenamento/epidemiologia
14.
Drug Alcohol Depend ; 222: 108657, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33713974

RESUMO

BACKGROUND: Supersized alcopops are single-serving high-alcohol-content beverages frequently consumed by underage drinkers. However, little data exist regarding the public health burden of supersized alcopops during the last decade. The current study examined the characteristics of calls to U.S. poison control centers involving supersized alcopops. This study also compared the proportion of calls for underage consumers between calls involving consumption of supersized alcopops and calls involving other types of alcohol (e.g., liquor, beer, wine). METHODS: Data from the National Poison Data System (NPDS) repository of calls to U.S. poison control centers were analyzed. RESULTS: Between 2010 and 2019, poison control centers received 1719 calls for exposures to supersized alcopops. Nearly one-half of calls involving supersized alcopop consumption (46.3 %) were made for consumers who were below the legal drinking age. In all years, the proportion of calls for supersized alcopops that were for underage exposures greatly exceeded the proportion of calls that were for underage exposures for other types of alcohol. For those 0-11 years of age, 91 % of supersized alcopop exposures were unintentional; however, for each other age group, at least 84 % of exposures were intentional. Supersized alcopop exposures involved a co-ingested product in more than 80 % of cases among patients of legal drinking age and less than 50 % of cases among patient under legal drinking age. CONCLUSIONS: Compared to other alcohol products, calls to U.S poison control centers for supersized alcopops disproportionately involved underage drinkers. To protect youth, improved regulation of supersized alcopop products is urgently needed.


Assuntos
Venenos , Consumo de Álcool por Menores , Adolescente , Idoso de 80 Anos ou mais , Bebidas Alcoólicas , Etanol , Humanos , Centros de Controle de Intoxicações , Estados Unidos/epidemiologia
16.
J Vet Emerg Crit Care (San Antonio) ; 31(3): 396-401, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33751786

RESUMO

OBJECTIVE: To calculate risk differences of traditional laundry detergents as compared to pods, describe clinical signs expected from exposure, and outline commonly employed treatment options. DESIGN: Retrospective review of cases reported to Pet Poison Helpline (PPH) from the dates of March 1, 2012 to March 1, 2015. SETTING: The computer database of the PPH, an international animal poison control center. ANIMALS: Four hundred and forty-three dogs (294 exposed to liquid pods; 149 exposed to liquid or powder laundry detergent) were included in this study. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The database for Pet Poison Helpline (PPH) was searched for all dog exposures to "laundry detergent." Each case was checked for known or suspected exposure to any brand of laundry detergent either as a bulk package of liquid or powder or when packaged as a pod that included the word "pod," "packet," "pac," "pocket," "sachet," or other terms that were indicative of a single-use contained portion of concentrated liquid laundry detergent. Dogs that were exposed to the detergent in a liquid-pod form were 1.8 times more likely to develop clinical signs, 1.3 times more likely to develop emesis, and 1.8 times more likely to develop a cough than those exposed to the traditional form. CONCLUSIONS: Dogs are almost twice as likely to develop emesis and coughing after being exposed to pods of laundry detergent compared to the traditional form. These signs can result in a more severe and acute emergency situation. With symptomatic and supportive care, the prognosis is good for these patients.


Assuntos
Detergentes/toxicidade , Doenças do Cão/induzido quimicamente , Embalagem de Produtos , Animais , Bases de Dados Factuais , Cães , Internacionalidade , Centros de Controle de Intoxicações , Estudos Retrospectivos , Fatores de Risco , Vômito/veterinária
17.
Clin Toxicol (Phila) ; 59(11): 992-1001, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33720783

RESUMO

BACKGROUND: Bites by the European adder (Vipera berus) in the UK are uncommon but potentially life threatening, and can be associated with marked limb swelling and disability. Following an interruption in Zagreb Imunoloski zavod antivenom supply around 2012, the UK changed its national choice of antivenom for Vipera berus to ViperaTAb, an ovine Fab monospecific antivenom. In the absence of randomised controlled trials, we established an audit to review its use in clinical practice. METHODS: A prospective audit of ViperaTAb use was conducted from March 2016 until November 2020 by the UK National Poison Information Service (NPIS). Users of the NPIS online toxicology database, TOXBASE, considering the use of antivenom for V. berus envenoming were invited to discuss the case with the on-call clinical toxicology consultant. Information was collected prospectively on indications, administration, adverse reactions and outcome of patients administered ViperaTAb antivenom. RESULTS: One hundred and seventy patients were administered ViperaTAb antivenom over five years. One hundred and thirty-two were adults and 38 children (median age and range: 38, 2-87 years). Bites occurred across the UK, but most commonly in coastal regions of Wales and of South-West and East England. Median time to presentation was 2.1 (IQR 1.5-4.0) h and to antivenom administration from presentation was 2.0 (IQR 0.9-3.6) h. A minority of patients presented to hospital more than 12 h after being bitten (n = 19, 11.2%) or received antivenom more than 12 h after presenting to hospital (n = 17, 10.0%). Features of systemic envenoming were present in 64/170 (37.6%) patients, including 23 (13.5%) with anaphylaxis and 26 (15.3%) with hypotension (nine with both). Clinician assessment considered the initial antivenom to have been effective in 122/169 (72.2%) patients. Repeated dosing was common, occurring in 55/169 (32.5%), predominantly due to persisting or worsening local effects (46/51, 90.2%). There were three cases of probable early adverse reaction. No deaths occurred during the study. Complications of envenoming were rare but included four patients that underwent surgery, three patients each with acute kidney injury, mild coagulopathy, or thrombocytopenia (one severe). The median duration of hospital stay was 43.7 (IQR 22.5-66.5) h, longer for children than adults (52.5 vs 41.3 h). CONCLUSION: ViperaTAb antivenom appears to be effective and safe and should be administered as soon as possible for patients meeting clinical criteria. Patients require close observation following antivenom to detect adverse reactions and progression or recurrence of envenoming. Close collaboration with expert NPIS consultant advice can help optimise antivenom timing, ensure repeated dosing is given appropriately, and avoid unnecessary surgical intervention. All hospitals, particularly those located in areas of relatively high incidence, should stock sufficient antivenom available at short notice, 24 h a day.


Assuntos
Antivenenos/uso terapêutico , Fragmentos Fab das Imunoglobulinas/uso terapêutico , Mordeduras de Serpentes/tratamento farmacológico , Venenos de Víboras/antagonistas & inibidores , Viperidae , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Antivenenos/efeitos adversos , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Fragmentos Fab das Imunoglobulinas/efeitos adversos , Tempo de Internação , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Admissão do Paciente , Centros de Controle de Intoxicações , Estudos Prospectivos , Índice de Gravidade de Doença , Mordeduras de Serpentes/diagnóstico , Mordeduras de Serpentes/metabolismo , Fatores de Tempo , Resultado do Tratamento , Reino Unido , Venenos de Víboras/metabolismo , Viperidae/metabolismo , Adulto Jovem
18.
Clin Toxicol (Phila) ; 59(11): 1009-1014, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33755514

RESUMO

BACKGROUND: The advent of COVID-19 increased attention to hand hygiene in prevention of disease transmission. To meet the increased demand for hand sanitizer during the pandemic, the US FDA issued an Emergency Use Authorization allowing new manufacturers and importers to enter the market. Some of the newly introduced hand sanitizer products contained methanol in lieu of ethanol or isopropanol. We describe five patients with fatal methanol poisoning resulting from hand sanitizers improperly containing methanol. CASE SUMMARY: Comparing a 5-month period from 2019 to the same time frame in 2020, the Arizona Poison and Drug Information Center has seen an increase of 124% in exposures to hand sanitizer. Of these cases, 28% involved methanol-contaminated hand sanitizer. Five of these patients died from methanol poisoning. All five cases had similar clinical features with severe high anion gap metabolic acidosis and, in four patients, elevated osmolal gap. Methanol concentrations were consistently very elevated, but these results were not available before the patients succumbed. Four of the patients received fomepizole and adjunctive care. Two patients received emergency extracorporeal therapy. All five died despite maximal treatment efforts. CONCLUSION: During the pandemic in 2020, there was a proliferation of alcohol-based hand sanitizers which contained methanol. Exposure to these products, which failed to meet regulatory standards, led to increased harm and death. Challenges to treatment of methanol poisoning, especially in rural areas, include lack of access to timely laboratory measurement of methanol concentrations and lack of available emergency hemodialysis without transfer of the patient.


Assuntos
COVID-19 , Higienizadores de Mão/envenenamento , Metanol/envenenamento , Envenenamento/etiologia , Adulto , Arizona/epidemiologia , Feminino , Higienizadores de Mão/química , Humanos , Masculino , Pessoa de Meia-Idade , Centros de Controle de Intoxicações/estatística & dados numéricos , Envenenamento/terapia , Sindemia
19.
Clin Toxicol (Phila) ; 59(11): 963-968, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33755500

RESUMO

OBJECTIVE: Severe toxicity from ingestions of oral sustained-release potassium is rare. While acute hyperkalaemia requires urgent intervention given the risk of cardiac toxicity, there is a lack of clinical consensus on optimal management. The aim of this study was to characterise the clinical manifestations of acute potassium overdose and its management approach. METHODS: This is a retrospective case series of patients presenting following oral potassium overdose of ≥6000mg between January 2009 and December 2020 in Queensland, Australia as recorded in the state's Poisons Information Centre database and a tertiary Clinical Toxicology Unit database. Patients were identified from prospective databases maintained by both units and data were extracted from these in addition to medical records. RESULTS: Thirteen presentations in eleven patients occurred in the twelve-year period. The median age was 35 years (range 14-55 years). The median dose ingested was 6.4 mmol/kg (range 0.9-30.8 mmol/kg). Severe hyperkalaemia >7mmol/L occurred in five patients, four with ingestions ≥60,000mg. All patients with hyperkalaemia received multiple modes of intracellular potassium shifting therapy. Four patients had endoscopic removal of pharmacobezoars. One also underwent whole bowel irrigation. Three presentations were managed with haemodialysis. All patients were discharged home with a median length of stay of 20 h. CONCLUSION: Aggressive medical therapy to shift potassium into cells appears to be the mainstay of treatment in patients with normal renal function. Early decontamination may limit peak potassium concentrations. It is unclear if haemodialysis provides significant additional benefit in patients with normal renal function.


Assuntos
Antídotos/uso terapêutico , Endoscopia do Sistema Digestório , Hiperpotassemia/terapia , Potássio/envenenamento , Diálise Renal , Irrigação Terapêutica , Administração Oral , Adolescente , Adulto , Bases de Dados Factuais , Preparações de Ação Retardada , Overdose de Drogas , Feminino , Humanos , Hiperpotassemia/sangue , Hiperpotassemia/induzido quimicamente , Hiperpotassemia/diagnóstico , Masculino , Pessoa de Meia-Idade , Centros de Controle de Intoxicações , Potássio/administração & dosagem , Potássio/sangue , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
20.
Clin Toxicol (Phila) ; 59(11): 1015-1022, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33787424

RESUMO

PURPOSE: Critical access hospitals (CAH) are an important source of exposures for poison control centers (PCC), yet there is a paucity of literature on how these calls differ from larger, more urban hospitals (UH). This study aimed to compare call characteristics from CAH and UH received by a regional PCC. METHODS: This retrospective chart review used the Toxicall® database of the Kansas PCC. All cases involving calls from a health care facility from 1 January 2012 to 31 December 2017 were identified. Cases were then identified as either from a CAH or from one of the four largest UH in Kansas for comparison. CAH were defined using the criteria from the Centers for Medicare & Medicaid Services. All information was de-identified in REDCAPS and analyzed in Microsoft Excel. FINDINGS: A total of 12,469 unique patient cases were identified, including 6392 CAH and 6077 UH cases. Patients at UH were more likely to have longer duration of medical effects and experience more severe medical effects. Significant differences in the unique exposures, rates of intentional overdose, routes, and number of exposures were found. Patients at CAH were more likely to receive activated charcoal, flumazenil, and be transferred to another healthcare facility, but were less likely to have been referred by the PCC, need an ICU admission, or require consultation with a toxicologist. CONCLUSIONS: PCC calls from CAHs were common and resulted in significant differences when compared to UH calls. Future research is warranted to optimize PCC services for rural hospitals.


Assuntos
Hospitais Rurais , Hospitais Urbanos , Centros de Controle de Intoxicações , Envenenamento/terapia , Serviços de Saúde Rural , Serviços Urbanos de Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Recém-Nascido , Kansas/epidemiologia , Masculino , Pessoa de Meia-Idade , Envenenamento/diagnóstico , Envenenamento/epidemiologia , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
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