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2.
Clin Toxicol (Phila) ; 62(2): 112-119, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38426845

RESUMEN

INTRODUCTION: Hexahydrocannabinol is a hexahydro derivative of cannabinol. Poisoning with hexahydrocannabinol was first observed in Europe in May 2022. METHOD: This is a retrospective observational study of cases of self-reported hexahydrocannabinol exposure reported to French poison centres between 1 January 2022 and 31 May 2023. RESULTS: There were 37 cases, including 19 in May 2023. The median age of the patients was 36 (interquartile range 28-43) years, and most were men. Eight patients had a history of substance use disorder. The route of exposure was ingestion in 24, inhalation (smoking or vaping) in 10, inhalation and ingestion in two and sublingual in one. Clinical features were neurological (85 per cent), cardiovascular (61 per cent), gastrointestinal (33 per cent), psychiatric (27 per cent) and ocular (21 per cent). Fifty-nine per cent of the patients were hospitalized. In four patients, the Poisoning Severity Score was 0 (asymptomatic); in 15 patients, the Score was 1 (minor); in 16, the Score was 2 (moderate); and in two cases, the Score was 3 (severe). In 70 per cent of patients, the outcome was known, and all recovered. Testing of biological samples was only undertaken in six cases. Five patients had positive blood or urine tests for hexahydrocannabinol; in two patients, tetrahydrocannabinol and metabolites were also detected. In addition, there was an additional patient in whom Δ8- and Δ9-tetrahydrocannabinol was detected in the substances used. DISCUSSION: Clinical effects reported in this series included neuropsychiatric and somatic effects. Whilst these cases related to self-reported hexahydrocannabinol use, it is likely that tetrahydrocannabinol use also contributed to the effects in a substantial proportion of cases. This study has some limitations, such as the lack of available information due to the retrospective nature of the study. As a result, it probably overestimates the number of moderate and severe cases due to under-reporting of cases of little or no severity. Analysis of the patient's blood and urine was performed only in six patients, so we cannot be certain that the products consumed by the other patients were hexahydrocannabinol. CONCLUSION: The clinical effects attributed to hexahydrocannabinol were neurological, cardiovascular, gastrointestinal, psychiatric and ocular predominantly and were sometimes serious.


Asunto(s)
Intoxicación , Venenos , Masculino , Humanos , Adulto , Femenino , Dronabinol , Estudios Retrospectivos , Centros de Control de Intoxicaciones , Europa (Continente)
3.
Clin Toxicol (Phila) ; 62(2): 120-125, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38465690

RESUMEN

BACKGROUND: The diagnosis of toxic alcohol poisoning is often based on clinical presentation and nonspecific surrogate laboratory studies due to limited testing availability. Fomepizole is the recommended antidote and often administered empirically. The objective of this study is to identify substances that mimic toxic alcohols and compare key clinical factors between toxic alcohol and non-toxic alcohol exposures when fomepizole was administered. METHODS: This study was a retrospective evaluation using the National Poison Data System from January 1, 2010 through December 31, 2021. Exposures were included if fomepizole was administered. Toxic alcohol exposures had ethylene glycol or methanol as a coded substance. For exposures not coded as a toxic alcohol, the first substance was described. Paracetamol (acetaminophen) exposures from 2020 and 2021 were excluded. RESULTS: Fomepizole was reportedly used 25,110 times over 12 years. Use increased from 1,955 in 2010 to 2,710 in 2021. Most administrations were for reported toxic alcohol poisoning (60 percent) but use in reported non-toxic alcohol poisoning was greater starting in 2020. Toxic alcohol exposures were older (43.3 versus 39.8 years; P < 0.001) and more likely male (65.7 percent versus 58.2 percent). Level of care was mostly a critical care unit (67.7 percent), which was less common in toxic alcohol (63.3 percent) than non-toxic alcohol exposures (74.2 percent). The most common non-toxic alcohol substances were ethanol (24.9 percent) or an unknown drug (17.5 percent). Acidosis, increased creatinine concentration, anion gap, and osmolal gap, and kidney failure were coded in a lower proportion of toxic alcohol exposures than non-toxic alcohol exposures (P < 0.001). DISCUSSION: The inability to provide rapid clinical confirmation of toxic alcohol poisoning results in the empiric administration of fomepizole to many patients who will ultimately have other diagnoses. Although fomepizole is relative well tolerated we estimated that this practice costs between $1.5 to $2.5 million. The major limitations of this work include the biases associated with retrospective record review, and the inability to confirm the exposures which may have resulted in allocation error. CONCLUSION: Most fomepizole use was for a presumed toxic alcohol. This recently shifted to greater use in likely non-toxic alcohol poisoning. Key difference between the groups suggest fomepizole administration was likely due to the difficulty in diagnosis of toxic alcohol poisoning along with the efficacy and safety of fomepizole. Increased toxic alcohol laboratory testing availability could improve timely diagnosis, reserving fomepizole use for toxic alcohol poisoning.


Asunto(s)
Intoxicación , Venenos , Humanos , Masculino , Estados Unidos/epidemiología , Fomepizol/uso terapéutico , Venenos/uso terapéutico , Estudios Retrospectivos , Pirazoles/uso terapéutico , Pirazoles/toxicidad , Antídotos/uso terapéutico , Etanol , Metanol , Glicol de Etileno , Diálisis Renal/métodos , Intoxicación/diagnóstico , Intoxicación/epidemiología , Intoxicación/tratamiento farmacológico
4.
Artículo en Alemán | MEDLINE | ID: mdl-38412953

RESUMEN

OBJECTIVE: In this retrospective study, patient records of dogs suffering from poisoning with coumarin derivatives were evaluated to characterize the clinical appearance more precisely. MATERIAL UND METHODS: Retrospective data analysis included 52 dogs with hemostaseologically proven anticoagulant rodenticide poisoning which were treated as inpatients at the Clinic for Small Animals between September 2011 and October 2018. RESULTS: In only 2 dogs (4%) the intake of poison could be observed with certainty. The most common clinical signs observed were reduced general behavior (79%), pallor of the mucosa (79%), anorexia (60%), and dyspnea/tachypnea (60%). In contrast, macroscopically visible internal and external bleedings occurred less frequently. Initially, all cases showed a highly altered prothrombin time and most patients a considerably prolonged activated partial thromboplastin time. Anemia was present in 75% of patients. All dogs included in the study received initially an intravenous treatment with 10 mg/kg vitamin K1. Pretreatment with 1 mg/kg prednisolone was given for prophylaxis of possible incompatibility reactions. No patient showed signs of anaphylactic reaction. Transfusions of whole blood or concentrated red cells were given to only 10 of the 52 animals; only one received 2 transfusions of erythrocytes. 94% of the animals could be discharged home for outpatient therapy after a median length of hospitalization of 3 days (1-9 days) with physiological or almost physiological coagulation test results. CONCLUSION: Anticoagulant rodenticide poisoning is often associated with non-specific symptoms and good prognosis if treated adequately. CLINICAL RELEVANCE: Coagulation diagnostics is always indicated in cases with unclear disorders. In life-threatening emergencies, immediate intravenous infusion of high-dose vitamin K1 is a very effective treatment and results in a rapid increase in coagulation factor activity.


Asunto(s)
Enfermedades de los Perros , Intoxicación , Rodenticidas , Humanos , Perros , Animales , Anticoagulantes , Estudios Retrospectivos , Enfermedades de los Perros/inducido químicamente , Enfermedades de los Perros/diagnóstico , Vitamina K 1 , Intoxicación/veterinaria
5.
Pharmacoepidemiol Drug Saf ; 33(2): e5767, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38357800

RESUMEN

PURPOSE: Medication poisoning is the most common method of self-harm. Longitudinal studies incorporating pre- and post-COVID-19 pandemic data are required to describe the phenomenon and to evaluate the long-term impact on mental health. METHODS: Calls to the Poison Control Center of Policlinico Umberto I Hospital - Sapienza University of Rome, Italy, were analyzed retrospectively for characteristics and clinical presentation of cases of interest from January 2018 to December 2022. RESULTS: A total of 756 cases of self-harm by medication poisonings were recorded in the study period. A reduction in rate of cases in 2020 was followed by a return to pre-pandemic levels by 2021. When separately analyzing single- and multi-agent cases, occurrence of cases involving just one medication increased since early 2021, with a peak in 2022 (7.8% of total calls, 95% CI 6.2-9.5, from 4.9%, 95% CI 4.1-5.8 in 2018). This increase in the rate of cases, mostly of none or mild severity, was driven by youth aged 12-21, in which the relative proportion of single- versus multi-agent cases showed an increasing trend since 2020 (from 42.6% in 2018 to 78.6% in 2022). Acetaminophen was the medication most frequently involved and benzodiazepines the largest class. A psychiatric background was increasingly seen in 2022, especially in age group 12-21. CONCLUSION: Single-agent medication self-harm may be an increasingly prevailing phenomenon. Young adolescents with a psychiatric background might be most vulnerable to this behavior in the COVID-19 pandemic aftermath. Healthcare professionals should expect favorable clinical outcome and improve both counseling and psychotherapy supervision in individuals at risk.


Asunto(s)
COVID-19 , Intoxicación , Conducta Autodestructiva , Adolescente , Humanos , Estudios Retrospectivos , Centros de Control de Intoxicaciones , Pandemias , Conducta Autodestructiva/epidemiología , COVID-19/epidemiología , Intoxicación/epidemiología , Intoxicación/terapia
6.
Sud Med Ekspert ; 67(1): 47-55, 2024.
Artículo en Ruso | MEDLINE | ID: mdl-38353015

RESUMEN

Over several months, 14 people were admitted in 6 hospitals with severe symptoms of intoxication with psychoactive substances as a result of mass poisoning. All symptoms occurred after taking a drink that contained crushed phenazepam tablets. Samples of blood (n=10) and urine (n=6) taken from 14 sufferers for forensic, chemical and toxicological examination were analyzed using the HPLC-MS/MS method. Phenazepam was detected in the biomaterial of all 14 patients. Other psychoactive substances (baclofen, pregabalin, chlorprothixene, chlorpromazine, phenibut, tramadol, diazepam), narcotic substances and ethanol were also found in the sufferers. The phenazepam concentration in the blood was in the range of 109.75-786.50 ng/ml, in the urine - 8.97-101.28 ng/ml. The pharmacokinetic and toxicokinetic characteristics of toxicants as well as additional factors characterizing the phenotype of the sufferer in addition to drug's content in the biological material must be taken into account to determine the toxicity level of phenazepam against the background of combined action with other psychoactive substances.


Asunto(s)
Intoxicación , Espectrometría de Masas en Tándem , Humanos , Benzodiazepinas/orina , Etanol , Cromatografía Líquida de Alta Presión , Intoxicación/diagnóstico
7.
BMC Pediatr ; 24(1): 135, 2024 Feb 22.
Artículo en Inglés | MEDLINE | ID: mdl-38383350

RESUMEN

BACKGROUND: Poisoning among children and adolescents is a public health problem worldwide. To take preventive measures, the pattern of this problem should be determined. This study aimed to describe the demographic characteristics of poisoning in children and to investigate the relationship between the types of poisoning and demographic factors in children in Kermanshah province. METHODS: This cross-sectional, descriptive-analytical study was conducted on 250 children and adolescents under 18 years of age who were referred to Mohammad Kermanshahi Pediatric Hospital in Kermanshah province due to poisoning during 2019-2022. The demographic and epidemiological data of patients were extracted from their medical files and analyzed. RESULTS: Out of 250 cases of poisoning, 173 (69.2%) cases were unintentional, 96 (55.5%) of whom were boys. Further, 77 (30.8%) cases of poisoning were intentional, of whom 49 (63.6%) were girls. There was a significant difference between gender and intentional and unintentional poisonings (p-value = 0.005). The median age of unintentional poisoning was 3 (IQR = 2.5) and that of intentional poisoning was 14 (IQR = 2). Most cases of poisoning were in cities, 145 (83.8%) of them were unintentional and 66 (85.7%) were intentional. Most cases of intentional and unintentional poisonings occurred in spring 2017 (35.1%) and autumn 2016 (34.6%), respectively. The most common causes of poisoning were narcotics (n = 36, 34.3%) and drugs (n = 35, 33.3%) in the age group 0-3 years and drugs (n = 46, 66.9) in the age group 11-18 years. CONCLUSIONS: The most common causes of poisoning were narcotics and drugs in children and drugs in adolescents. To prevent poisoning in children, parents are required to increase their knowledge of the safe storage of narcotics and drugs, such as not storing methadone in a water bottle. Targeted evaluation and preventive measures are also needed in adolescent poisoning.


Asunto(s)
Metadona , Intoxicación , Niño , Masculino , Femenino , Humanos , Adolescente , Recién Nacido , Lactante , Preescolar , Ciudades , Irán/epidemiología , Estudios Transversales , Narcóticos , Intoxicación/epidemiología , Intoxicación/etiología
8.
Am Fam Physician ; 109(2): 143-153, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38393798

RESUMEN

Poisoning is the leading cause of injury-related morbidity and mortality in the United States. The highest rates of exposure to poisons occur in children five years and younger, but opioid overdoses in young adults account for most deaths from poisonings in recent years. Intentional or accidental medication poisoning should be considered when evaluating patients with mental status changes, vital sign abnormalities, seizures, and gastrointestinal or cardiovascular problems. For all poisoned patients, a comprehensive history and physical examination are needed. Knowledge of toxidromes may help identify the cause in unknown ingestions; however, their usefulness may be limited when multiple toxins are ingested. Electrocardiography is indicated in patients reporting chest pain and dyspnea and in overdoses of beta blockers, tricyclic antidepressants, and antidysrhythmics. Measurement of electrolyte, serum creatinine, and serum bicarbonate levels and calculation of the anion gap may be helpful based on the clinical presentation. Treatment of a patient with acute poisoning is based on resuscitation and stabilization with a focus on airway, breathing, and circulation. When poisoning is suspected, the Poison Control provides health care workers and the public with access to a specialist 24 hours a day.


Asunto(s)
Sobredosis de Droga , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Intoxicación , Niño , Adulto Joven , Humanos , Estados Unidos/epidemiología , Sobredosis de Droga/diagnóstico , Sobredosis de Droga/terapia , Intoxicación/diagnóstico , Intoxicación/terapia
10.
Medicine (Baltimore) ; 103(7): e36971, 2024 Feb 16.
Artículo en Inglés | MEDLINE | ID: mdl-38363928

RESUMEN

RATIONALE: Anticoagulant rodenticides (ARs) are a substantial fraction of murine types. AR poisoning causes bleeding from the skin, mucous membranes, and multiple organs. However, reports of AR-induced cerebral hemorrhage are scarce. PATIENT CONCERNS: A 40-year-old male presented with dizziness, headache, and limb weakness for 5 days and with coagulopathy. Two days prior to the onset of these symptoms, the patient was exposed to dead mice. DIAGNOSES: Rodenticide intoxication-induced cerebral hemorrhage. INTERVENTIONS: Vitamin K1 infusion, administration of dehydrating agents to reduce intracranial pressure, and correction of acid-base and electrolyte imbalances. OUTCOMES: After 9 days of treatment, the patient's symptoms were relieved, and reexamination revealed that coagulation parameters returned to normal levels. The patient was eventually discharged for observation with oral vitamin K1. CONCLUSIONS: Rodenticide poisoning can lead to intracerebral hemorrhage, and treatment with vitamin K1 infusion is effective. LESSON: Rodenticide poisoning-induced cerebral hemorrhage is rarely reported. Because its symptoms are nonspecific, it is easy to miss the diagnosis or misdiagnose. When patients present with direct and indirect symptoms such as dizziness, headache, and limb weakness, rodenticide poisoning should be considered. Coagulation function and head computed tomography or magnetic resonance imaging examination should be performed at the earliest to confirm the diagnosis and provide timely treatment.


Asunto(s)
Intoxicación , Rodenticidas , Masculino , Humanos , Ratones , Animales , Adulto , Vitamina K 1 , Mareo , Anticoagulantes , Hemorragia Cerebral/inducido químicamente , Hemorragia Cerebral/diagnóstico por imagen , Cefalea
11.
Clin Toxicol (Phila) ; 62(2): 107-111, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38416057

RESUMEN

INTRODUCTION: Ammonia solution (ammonium hydroxide) is used to convert cocaine hydrochloride to freebase cocaine. Due to its causticity, unintentional exposure to ammonia in a substance use context can result in injury. The objective of this study was to describe the characteristics of unintentional oral and buccal ammonia solution exposure in a substance use context. METHODS: A retrospective study was conducted using the French poison centres database over a 10-year period (2009-2018). RESULTS: A total of 1,546 files were extracted, and 263 substance users were included. There was a significant increase in the number of these exposures between 2009 and 2018. Unintentional ingestion of ammonia solution was linked to product decanting in 89 per cent of cases. Substance use prior to the exposure and a festive context, such as free parties or teknivals, were identified in 25 per cent and 21 per cent of cases, respectively. Patients received a hospital examination in 87 per cent of cases. The severity of intoxication in substance users was graded as moderate (33 per cent) or severe (15 per cent) using the Poisoning Severity Score. DISCUSSION: The increased number of ammonia solution cases reported was consistent with an increase in the number of crack users in Europe in the same period. Ammonia solution exposure can suggest the possibility of substance use disorders. In such cases, patients can be referred to receive appropriate treatment and support. This study had some limitations, such as the lack of available information due to the retrospective nature of the study and the non-standardized questions asked by the poison centre during the medical phone interviews. CONCLUSION: Oral and buccal ammonia solution exposure in known substance users in France increased between 2009 and 2018. These users were mostly young men. A festive context and decanting were frequent. Patients were mainly referred to emergency departments to receive clinical examination and care. The potential severity of oral or buccal ammonia solution exposure in substance users requires increased vigilance among all healthcare professionals involved in the management of these intoxication cases.


Asunto(s)
Cocaína , Intoxicación , Venenos , Trastornos Relacionados con Sustancias , Masculino , Humanos , Estudios Retrospectivos , Amoníaco , Centros de Control de Intoxicaciones , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/epidemiología , Intoxicación/terapia
12.
Sci Rep ; 14(1): 3544, 2024 02 12.
Artículo en Inglés | MEDLINE | ID: mdl-38347059

RESUMEN

Acute poisonings are a global public health problem, which implies costs and disease burden for society. In Colombia, there is a significant underreporting of data on acute poisoning and data gaps on the toxicological profile of the population. This study aims to identify the epidemiology of acute poisoning in a high-complexity hospital in southwestern Colombia. A descriptive study with retrospective data collection was performed. The variables were expressed through the measure of central tendency and dispersion. Categorical variables were described in proportions. A total of 406 patients were included. The median age was 31 years (IQR 23-48), 56.2% were male, and only 19.2% had a history of mental illness. Suicidal intent represented 58.8% of the cases, and the most frequent route of exposure was the oral route (81.6%). The most prevalent groups of substances were pesticides (34.2%) and medicines (32%). The most common etiological agent was organophosphates (16.5%). Cholinergic toxidrome was the most common. The average stay in the ICU was 4.5 days (± 4.8), and the mortality was 4.2%. The principal causes of acute poisoning were drugs and pesticides, with a predominant etiology of organophosphates and depressants of the central nervous system. There was a significant predominance of young male patients with suicidal intent, low mental disorders, elevated unemployment rate, and similar mortality reported in other studies. This study improves the knowledge about acute poisoning in southwestern Colombian to carry out multicenter analytic studies.


Asunto(s)
Plaguicidas , Intoxicación , Adulto , Femenino , Humanos , Masculino , Colombia/epidemiología , Servicio de Urgencia en Hospital , Hospitales Universitarios , Organofosfatos , Estudios Retrospectivos
15.
Clin Toxicol (Phila) ; 62(1): 61-63, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38231203

RESUMEN

INTRODUCTION: Methanol poisoning is a life-threatening emergency, in which the presence of a lentiform fork sign on magnetic resonance imaging, although not exclusive to methanol poisoning, can be of diagnostic assistance. This report highlights the additional value of diffusion-weighted imaging in methanol poisoning. CASE SUMMARY: A 38-year-old man was admitted to the hospital with severe metabolic acidosis, coma and visual disturbances due to methanol poisoning. IMAGES: Initial computed tomography of the brain was unremarkable. However, magnetic resonance imaging revealed the lentiform fork sign, with diffusion-weighted imaging changes in the lentiform nuclei. CONCLUSION: Diffusion-weighted imaging sequences provide additional information compared to traditional magnetic resonance imaging in assessing methanol poisoning. Systematic evaluation is needed to fully understand and utilize the potential predictive value of diffusion-weighted imaging in this context.


Asunto(s)
Alcoholismo , Intoxicación , Masculino , Humanos , Adulto , Metanol , Imagen de Difusión por Resonancia Magnética , Imagen por Resonancia Magnética/métodos , Encéfalo/patología , Intoxicación/diagnóstico
18.
Inj Prev ; 30(1): 81-83, 2024 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-37923357

RESUMEN

The America's Poison Centres National Poison Data System (NPDS) is set up for the active surveillance of voluntarily reported poisoning cases in near real-time. The Centres for Disease Control and Prevention (CDC)'s Wide-ranging Online Data for Epidemiologic Research (WONDER) database is final national mortality data from state registries. We compared suicide poisoning deaths in both datasets from 2000 to 2020 and tested their relationship using a simple linear regression model. Mean annual suicide poisoning deaths during the review period were 699 (SD 145) in NPDS, and 6150 (SD 577) in WONDER. NPDS annual cases averaged 11% of cases recorded in WONDER (SD 2%; Range 8%-16%). The regression coefficient for the linear relationship between annual deaths recorded in both datasets was 0.18 (p-value<0.001, R2=0.51). The rapidly available NPDS data on fatal self-poisoning may provide sentinel surveillance regarding self-poisonings, but do not reliably predict final national data on suicide poisoning.


Asunto(s)
Intoxicación , Venenos , Suicidio , Humanos , Estados Unidos/epidemiología , Centros de Control de Intoxicaciones , Bases de Datos Factuales , Centers for Disease Control and Prevention, U.S. , Intoxicación/epidemiología
19.
Blood Purif ; 53(1): 49-60, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-37918359

RESUMEN

Rescue of acute poisoning is a race against time, and it is particularly important to remove toxic substances in time. Traditional methods include gastric lavage, promoting elimination, chelating agents, and other treatments. Hemoperfusion is a common blood purification technique. In the clinical practice of acute poisoning, hemoperfusion can directly remove toxic substances through its unique adsorption effect, showing its excellent efficacy. This paper reviews the experience of hemoperfusion in the treatment of various drug overdoses, pesticides, biological toxins, and industrial poisons, even drug addiction. It is hoped to provide a reference for clinicians in acute poisoning rescue.


Asunto(s)
Hemoperfusión , Intoxicación , Venenos , Humanos , Hemoperfusión/métodos , Intoxicación/terapia
20.
Trop Doct ; 54(1): 66-68, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37674474

RESUMEN

Pneumomediastinum is not an uncommon manifestation of lung toxicity in acute paraquat ingestion. The condition is almost invariably seen with other lung parenchymal abnormalities such as consolidations, ground-glass opacities and interlobular septal thickening. The diagnosis may be challenging in cases with no history of toxin exposure, presentation with a subacute illness and/or absence of typical local or systemic features of paraquat toxicity.


Asunto(s)
Enfisema Mediastínico , Neumonía Organizada , Neumonía , Intoxicación , Humanos , Paraquat , Enfisema Mediastínico/diagnóstico , Enfisema Mediastínico/diagnóstico por imagen , Pulmón
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