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Objective:To describe the current situation of gastric lavage operation and put forward measures for improvement by analyzing the clinical characteristics of 294 patients with gastric lavage in Poisoning Treatment Center of The First Affiliated Hospital of Nanjing Medical University.Methods:The clinical data of 294 patients with acute poisoning and gastric lavage from 2019 to 2021 were collected and analyzed retrospectively, and the related parameters (poison type, gastric lavage volume, poisoning to gastric lavage time, etc.) of each year were compared.Results:A total of 653 poisoning patients underwent gastric lavage from 2019 to 2021, with an average age of (44.2 ±20.1) years, and 134 (45.6%) were male. The main causes of gastric lavage were pesticide poisoning (52.72%) and drug poisoning (42.86%). The volume of gastric lavage was less than 10 L for 43.8% of patients and 10-20 L for 32.7% of patients. Patients with gastric lavage within 60 min after ingestion of poison accounted for 45.3%, followed by 25.8% within 61-120 min. The in-hospital mortality rate was 17.7%. The common complications of gastric lavage were: the incidence of gastrointestinal bleeding (55/121, 45.5%), the incidence of aspiration pneumonia (54/140, 38.6%), and the incidences of electrolyte disorder (21% of low potassium, 29% low calcium, and 10.0% low sodium). Compared with the groups in different years, the proportion of gastric lavage in poisoning was 58.85% vs. 46.60% vs. 32.41%, which decreased year by year, with statistical difference ( P <0.05). And there was no difference in the period from ingestion to gastric lavage and gastric lavage fluid volume. There was an increasing trend in poison types between diquat and other insecticides, but there was no statistical difference. Conclusions:From 2019 to 2021, the most common causes of acute gastric lavage were pesticide poisoning and drug poisoning, and the proportion of diquat and other pesticides showed an overall upward trend. A majority of the patients (71.1%) had gastric lavage within 2 h, and 76.5% of the patients had less than 20 L gastric lavage fluid. In the future, we will further control the amount of gastric lavage fluid and pay attention to the gastric lavage operation of new insecticide poisoning.
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Objective: To establish a method for the rapid determination of acetaminophen (APAP) in human plasma by LC-MS/MS. Methods: The plasma samples were extracted by methanol and acetonitrile (1: 1) and purified directly. C(18) column was used for sample separation. The mobile phase were methanol (5 mmol/L ammonium acetate) and water (5 mmol/L ammonium acetate). Samples were analyzed by LC MS/MS with the electrospray ionization multi reaction monitoring (MRM) mode. Results: The calibration curves of APAP was linear in the concentration range of 0~10 mg/L, the correlation coefficient (r) was greater than 0.999 0. The relative standard deviation within and between batches was less than 10%. The recovery rate were 96.81%~101.7%. The detection limit of the method was 0.1 μg/L and the lower limit of quantification was 0.3 μg/L. Conclusion: This method has strong specificity, high sensitivity and reliable determination results. It is suitable for the rapid analysis of clinical plasma samples.
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Humans , Chromatography, Liquid/methods , Acetaminophen , Tandem Mass Spectrometry/methods , Methanol , Chromatography, High Pressure Liquid/methodsABSTRACT
Background Acute drug poisonings are increasing year by year and have become the leading cause of acute poisoning in Shanghai in recent years, and the related prevention and control work is faced with a tough situation. Objective To understand the composition of drugs leading to acute poisonings and describe the epidemiological tendency of reported acute drug poisonings in Shanghai. Methods We collected registered acute drug poisoning case information from the Shanghai Health Information System under Shanghai Health Statistics Center, including demographic characteristics and clinical diagnosis. There were totally 86476 cases reported from 2019 to 2021. The distributions of drugs and victims were described by year. Incidence tendency of acute drug poisonings was analyzed by chi-square test and the analysis focused on analgesic, hypnotics, and antidepressant drug-associated poisonings. Spatial autocorrelation analysis was performed by GeoDa1.20 through calculating global and local Moran's I. Results There was an ascendant tendency in both case count (22132 cases in 2019, 29071 cases in 2020, and 35273 cases in 2021) and crude morbidity (0.89‰ in 2019, 1.21‰ in 2020, and 1.46‰ in 2021) of patients who received outpatient service or emergency treatment for acute drug poisonings from 2019 to 2021 in Shanghai. The top 3 kinds of acute poisoning drugs were analgesics, hypnotics, and antidepressants. The morbidity rates of acute drug poisonings associated with antidepressants (χ2=2700.15, P<0.05) and analgesics (χ2=2294.01, P<0.05) increased year by year. The leading 3 kinds of drugs associated with acute drug poisonings in the same age group were similar. Analgesics showed high frequency staying in the top 3 acute poisoning drugs in most age groups for the 3 years (the highest morbidity was 0.84‰ in male or 1.07‰ in female). Antidepressants were in the top 3 acute poisoning drugs in the under 59 years age groups for the 3 years (male morbidity rate was 0.12‰-0.44‰, and female morbidity rate was 0.06‰-0.45‰). Hypnotics were in the top 3 acute poisoning drugs in the ≥ 18 years age groups for the 3 years (morbidity rate in male was 0.28‰-0.98‰, and morbidity rate in female was 0.21‰-0.92‰). Cardiovascular drugs were in the top 3 acute poisoning drugs in the > 60 years age group for the 3 years (male morbidity rate was 0.40‰-1.03‰, and female morbidity rate was 0.66‰-0.81‰). Regarding the causes of poisonings, accidental poisoning and exposure was the main cause in the ≤ 17 years groups (male constituent ratio was 57.64%-67.12%, and female constituent ratio was 55.27%-68.27%); suicide (male constituent ratio was 20.28%-43.51%, and female constituent ratio was 25.18%-52.02%) had a higher percentage than accidental poisoning and exposure (male constituent ratio was 16.97%-23.62%, and female constituent ratio was 12.76%-17.63%) in the 18-59 years age groups; accidental poisoning and exposure (male constituent ratio was 24.38%-45.18%, and female constituent ratio was 32.69%-38.11%) had a higher percentage than suicide (male constituent ratio was 12.35%-14.02%, and female constituent ratio was 11.92%-12.31%) in the > 60 years age group. The spatial autocorrelation analysis showed that the distribution of acute poisoning cases caused by analgesics, hypnotics, or antidepressants was not random. It was mostly positive spatial clustering. The high-morbidity area was always in the outer-ring circle, especially in Xuhui, Changning, and Jing'an districts, which suggested a high-high cluster pattern. Conclusion In view of the increasing morbidity rate of acute drug poisoning cases in Shanghai in this study, it is urgent to take prevention and control actions. We should plan further studies and different strategies toward different victims with distinct drug poisoning characteristics and areas with high morbidity rates.
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@#Due to their good safety, wide application scope and quick onset time, lipid emulsions are full of promise to reverse drug poisoning. In this review, a number of clinical case reports were summarized to analyze the detoxification effect of lipid emulsions on local anesthetic, antiarrhythmic, psychotropic and organophosphate poisoning, as well as the possible adverse reactions of lipid emulsions therapy.Meanwhile, the mechanisms underlying lipid emulsions therapy, such as lipid sink theory, enhanced body basal metabolism and positively affected cardiovascular function, were fully interpreted.Besides, a few potential solutions to the problems still existing in lipid emulsions therapy were proposed, in order to consolidate the understanding of lipid emulsions therapy and promote its rational application in reversing drug poisoning.
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Introducción. La consulta por intoxicación medicamentosa en los niños se da con frecuencia en los servicios de emergencias médicas; en la adolescencia, es cuando ocurren de forma intencional. Objetivo. Caracterizar los patrones epidemiológicos de la intoxicación medicamentosa en adolescentes ingresados al Hospital Municipal de Bahía Blanca. Material y método. Estudio descriptivo, basado en la revisión de historias clínicas de pacientes de 10 a 19 años que consultaron por intoxicación medicamentosa, entre los años 2012 y 2016. Las variables analizadas fueron edad, sexo, fármaco consumido, causa, manifestaciones clínicas y días de internación. Resultados. Se recopilaron 72 pacientes. La edad media fue de 16 años, razón mujer-hombre de 2,5:1. Predominaron las intoxicaciones por ansiolíticos (30%), seguidas de las polimedicamentosas (25%). El 95% manifestaron intención suicida, de los cuales el 55% ya tenían antecedentes. Conclusión. La intoxicación medicamentosa ocurrió, predominantemente, en mujeres, y se destacó el gran porcentaje de adolescentes que presentaba episodios previos.
Introduction. Drug poisoning among children is a frequent reason for visits to the emergency department; among adolescents, it is intentional. Objective. To describe the characteristics of drug poisoning among adolescents admitted to the municipal hospital of Bahía Blanca. Material and method. Descriptive study based on the review of medical records of patients aged 10-19 years seen for drug poisoning between 2012 and 2016. The following outcome measures were analyzed: age, sex, drug used, cause, clinical manifestations, and length of stay in days. Results. Data from 72 patients were collected. Their mean age was 16 years, and the female:male ratio was 2.5:1. Anxiolytic poisoning (30%) predominated, followed by polydrug use (25%). Ninety-five percent of patients showed a suicidal intention; of these, 55% had a history of suicide attempt. Conclusion. Drug poisoning was observed predominantly among girls; it is worth noting the high percentage of youth who had a history of suicide attempt.
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Humans , Adolescent , Adolescent , Nonprescription Drugs/toxicity , Emergency Medical ServicesABSTRACT
Objective Explore the sodium citrate anticoagulation in the continuity of plasma adsorption closed-circuit circulation of anticoagulation therapy method and effect. Methods Line into the continuity of plasma adsorption treatment of 156 cases of acute drug poisoning patients were randomly(random number) divided into two groups, 78 cases in each group, respectively adopt low molecular heparin (group A), sodium citrate anticoagulation (group B). Contrast analysis of two groups after the therapy began 30 min, 3 h, 6 h before the filter in patients with pressure, transmembrane pressure, pressure drop, at the same time to compare two groups of 10 min before the start of treatment, after treatment began to 3 h, 6 h platelet, coagulation time live enzymes, vein in the body of free Ca2+, Na+and HCO3- 24 h and internal bleeding. Results Two groups in gender, age, clinical diagnosis, blood purification time comparative differences had no statistical significance (P>0.05);Two groups of 30 min after the start of treatment, 3 h, 6 h patients before pressure, transmembrane pressure, filter pressure drop compared differences were no statistical significance (P>0.05); Part of coagulation treatment after low molecular heparin group live enzymes the sodium citrate group significantly prolonged (P<0.01);Platelets, HCO3- the two groups after treatment, intravenous free Ca2+ and Na+ differences had no statistical significance (P>0.05). Conclusions In the continuous plasma adsorption treatment process using sodium citrate anticoagulation with clinical feasibility, safety.
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The drug poisoning is the most common cause of children′s accident.The percentage is increasing every year. Analgesics,non-steroidal anti-inflammatory drugs and antihistamines are the most commonly ingested drugs in children.The principles of management of drug poisoning are:(1)resuscitation and initial stabilization; (2)diagnosis of type of poision.According to recent studies,gastric lavage should not routinely be used in all poisoning cases,instead the use of activated carbon is recommended.For severe or special cases advanced life support technologies such as mechanical ventilation,blood purification,extracorpo-real membrane oxygenation should be considered.
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To investigate the role of clinical pharmacists in the treatment team for acute drug poisoning,the pharmaceutical prac-tice of clinical pharmacists involved in the treatment of acute metronidazole poisoning was reported in the present paper. Clinical phar-macists assisted physicians in developing blood perfusion regimen on the basis of drug characteristics. Referring to the related guide-lines and evidence-based medicine, clinical pharmacists optimized the drug treatment programs to avoid drug-induced liver injury and stress ulcer. Meanwhile,clinical pharmacists provided an individualized heparin regimen and pharmaceutical care for the patient. With the close collaboration with physicians,the patient obtained perfect medicine therapy and pharmaceutical care. It is suggested clinical pharmacists play an active role in the rescue of acute drug poisoning patient by providing poisoning drug information for physicians time-ly and participating in the design of drug treatment programs using professional knowledge.
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Objective To investigate the clinical liver function protective effect of Shuganning injection for treatment of patients with drug poisoning.Methods One hundred and forty patients with drug poisoning consistent with thecriteria of enrollment into the study were admitted into the Department of Emergency Medicine in the First Hospital of Jilin University-the Eastern Division from January 2015 to August 2016, and they were randomly divided into observation group and control group by the computer generated random numbers, 70 cases in each group. After admission, all the cases were treated with routine treatment including detoxification, removal of toxin, organ protection, symptomatic and supporting treatment, etc. Based on the routine treatment, additionally, Shuganning injection 20 mL+ 10% glucose injection 250 mL, intravenous drip slowly, once a day was given in the observation group; the therapeutic course was 14 days in both groups. The changes of serum glutamic transaminase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBiL) levels were determined before and 7 and 14 days after treatment respectively to evaluate the situation of liver function in the two groups.Results Before treatment, there were no statistical significant differences in the levels of serum ALT, AST and TBil in the two groups (allP > 0.05); with the prolongation of treatment, the above-mentioned indexes of the two groups were gradually reduced, on the 14th day after treatment, they reached the lowest levels, and the degree of decrease in level on the 14th day in the observation group was more significant than that in the control group [ALT (U/L): 32.6±10.8 vs. 98.3±34.5, AST (U/L): 39.4±14.3 vs. 138.5±25.6, TBil (μmol/L): 4.8±1.7 vs. 13.2±2.3, allP < 0.05].Conclusion Shuganning injection has a protective effect on liver function in patients with drug poisoning.
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Objective To study the effect of comprehensive nursing care on patients with drug poisoning. Methods 102 cases of drugs in our hospital from September 2014 to September 2016 the poisoning patients were analyzed, using randomly divided into study group and control group, 51 cases in each group, the control group of nursing mode of patients on the basis of comprehensive nursing intervention group were treated by using SAS model, and SDS measurement of adverse psychological state of patients in the two groups, the success probability, death rate, SAS score, SDS score and total satisfaction were compared between the two groups. Results The rescue failure rate of the study group (7.8%) was significantly lower than that of the reference group (23.6%), and there was a difference between the two groups. The SAS score and SDS score in the study group than the control group (78.4%) , with statistical significance (P<0.05), the satisfaction of study group (98%) was significantly higher than that of control group, with statistical significance (P<0.05). Conclusion Drug poisoning patients using evidence-based nursing can improve the emergency into Power, ease the patient's bad mood, patient satisfaction is relatively high
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Objective To study the effect of comprehensive nursing care on patients with drug poisoning. Methods 102 cases of drugs in our hospital from September 2014 to September 2016 the poisoning patients were analyzed, using randomly divided into study group and control group, 51 cases in each group, the control group of nursing mode of patients on the basis of comprehensive nursing intervention group were treated by using SAS model, and SDS measurement of adverse psychological state of patients in the two groups, the success probability, death rate, SAS score, SDS score and total satisfaction were compared between the two groups. Results The rescue failure rate of the study group (7.8%) was significantly lower than that of the reference group (23.6%), and there was a difference between the two groups. The SAS score and SDS score in the study group than the control group (78.4%) , with statistical significance (P<0.05), the satisfaction of study group (98%) was significantly higher than that of control group, with statistical significance (P<0.05). Conclusion Drug poisoning patients using evidence-based nursing can improve the emergency into Power, ease the patient's bad mood, patient satisfaction is relatively high
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Cardiovascular drugs are commonly used in clinical medicine,which can cause refractory shock and cardiac arrest when poisoning.Lipid emulsion was mainly used for detoxification of lipophilic anesthetics poisoning in the past.Recently more and more studies and clinical cases suggest that lipid emulsion can be adopted as one of therapies for cardiovascular drugs poisoning.Now we review and focus on the research status of the lipid emulsion in the treatment of cardiovascular drugs poisoning,the related mechanisms of detoxification,therapeutic regimen and adverse effect.
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Suicide attempts in children are an important worldwide cause of morbidity and mortality and an emerging reason for admission in Pediatric Critical Care. Objective: Identify the epidemiologic and clinical characteristics of patients with drug poisoning with a suicide purpose as an admission cause in a Chilean Pediatric Intensive Care Unit (PICU). Design: Retrospective observational study. Setting: 14 beds PICU of a tertiary care public teaching hospital in Santiago de Chile. Material and Method: All patients admitted to the PICU between January 2005 and December 2008 for self-inflicted drug poisoning with an expressed intention of suicide were included. Analysis of the PICU clinical chart was performed with sampling on an excel data base. For seasonal distribution we used statistical analysis Xil. Results: 178 of 3045 PICU admissions were diagnosed as drug poisoning (5,8 percent), 108 of them for suicide attempts (60,6 percent).The number of annual patients increased, with highest incidence in spring and autumn and lowest in winter. Mean and median age was 13 years, 8,4 percent less than 12 years. 88,9 percent were females. They used polipharmacy in 57 percent. Drugs were taken from home. Antidepressants and sedatives were the most often used. An underlying psychiatric condition was present in 100 cases (92,6 percent). Associated factors were family disfunction, school problems, abuse and violation and bullying. Mean PICU stay was 1,46 days with 16,7 percent requiring transient mechanical ventilation No death was reported in this serie. Conclusions: The number of cases of suicide attempt via drug ingestion as a motive for admission in PICU is increasing, causing a raising number of short and transient admissions, more in spring less in winter. Risk factors were mostly an underlying psychiatric disorder and family disfunction.
Introducción: El intento de suicidio en pediatría, via ingestión de fármacos, es una importante causa de mor-bimortalidad en el mundo y un creciente motivo de ingreso a cuidados intensivos. Objetivo: Identificar las características clínicas y epidemiológicas de los pacientes con intoxicación por fármacos con un intento de suicidio, como causa de ingreso a una Unidad de Cuidados Intensivos Pediátricos en Chile (UC1P). Diseño: Estudio retrospectivo observacional. Pacientes y Método: UClP de 14 camas críticas en un hospital pediátrico de Santiago. Se incluyeron todos los pacientes ingresados a la UClP debido a intento de suicidio por ingestión de fármacos, entre enero 2005 a diciembre 2008. Resultados: 178 de 3 045 egresos se debieron a intoxicación por fármacos (5,8 por ciento) ,108 de ellos por intento de suicidio (60,6 por ciento). La tendencia observada es a un incremento anual, con mayor incidencia en primavera y otoño, y menor en invierno. La media y mediana de edad fue de 13 años, 8,4 por ciento menor de 12 años. 88,9 por ciento fueron mujeres, Se utilizó polifarmacia en un 57 por ciento con fármacos disponibles en el hogar. Antidepresivos y sedantes fueron los más usados. Patología psiquiátrica de base se diagnosticó en un 92,6 por ciento de los casos. Factores asociados fueron disfunción familiar, problemas en el colegio, abuso y violación, bullying. La estadía promedio en UClP fue de 1,5 días, requiriendo un 16,7 por ciento ventilación mecánica transitoria. No hubo fallecidos en esta serie. Conclusiones: El intento de suicidio por ingestión de fármacos como motivo de ingreso a UClP ha aumentado, requiriendo estadías cortas y transitorias, mayormente en primavera y menos en invierno. Factores asociados fueron patología psiquiátrica de base y disfunción familiar.
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Humans , Male , Adolescent , Female , Child , Poisoning/epidemiology , Suicide, Attempted/statistics & numerical data , Substance-Related Disorders/epidemiology , Antidepressive Agents/poisoning , Chile/epidemiology , Poisoning/psychology , Hypnotics and Sedatives/poisoning , Retrospective Studies , Risk Factors , Seasons , Intensive Care Units, Pediatric/statistics & numerical dataABSTRACT
PURPOSE: The incidence of infectious disease, which has been the cause of death in pediatric period, was decreased. But, the opportunistic exposure to toxic substance shows a tendency to increase. We performed this study in order to find out preventive measures and the latest inclination of acute poisoning in childhood. METHODS: From January 1985 to July 1996, 88 children with acute drug and chemical poisoning, who diagnosed at Presbyterian Medical Center, were analyzed retrospectively. RESULTS: 1) It occurred more frequently in male than female (1.7:1) and high incidence was noted in 0-4 year-old age group (75%). 2) Annual distribution of poisoning shows a tendency to increased. 3) There was no significant seasonal difference in frequency of poisoning. 4) The vast majority (85%) of poison exposure were accidental and therapeutic intent was present in 7.5% of cases and suicidal intent was 7.5% of cases. 5) We noticed an hourly predominance with most accidents occurring from 9 a.m. to 1 p.m. and from 5 p.m. to 9 p.m., 35% respectively. 6) Categories with the largest numbers of total exposure, in descending order by exposure frequently, include the following : drug (30.1%), insecticide (20.4), rodenticide (12.9%), glacial acetic acid (13.9%), herbicide (4.3%), Carbon monoxide (3.2%), others (13%). So, food and household material are leading cause of poisoning, except drug. Of drug, DDS was the most common and then psychotherapeutic drugs were the next. 7) The chief complaints on admission were nausea and vomiting (32%), mental change (26%) irritability (9%), peripheral cyanosis (8%), seizure (5%), and in case of 20%, the patient were found incidentally without symptoms. 8) There were complications which were pneumonia, pulmonary fibrosis, esophageal stricture and pneumothorax. And death occurred in 4 cases, due to insecticide (2 cases), herbicide and rodenticide, 1 case respectively. CONCLUSIONS: In previous report in Korea, causative substance of poisoning were drug, carbone monoxide, insecticide, rodenticide in descending order. In our study, drug was the most common cause of poisoning. But it' s proportion was decreased compared with previous report, and carbone monoxide intoxication was markedly decreased. But, we noticed that the proportion of household material, such as glacial acetic acid and other household chemical, was increased. So, we should be pay more attention to poisoning and try to prevent them.
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Child , Female , Humans , Male , Acetic Acid , Carbon , Carbon Monoxide , Cause of Death , Communicable Diseases , Cyanosis , Esophageal Stenosis , Family Characteristics , Incidence , Korea , Nausea , Pneumonia , Pneumothorax , Poisoning , Protestantism , Pulmonary Fibrosis , Retrospective Studies , Seasons , Seizures , Statistics as Topic , VomitingABSTRACT
PURPOSE: Poisoning represents one of the most common accidents encountered by young children. Recently, mortality due to poisoning has gradually decreased, but the incidence has not decreased. We performed this study to compare the following factors during 1980's and 1990's : sex distribution, urban and rural distribution, causative substances. METHODS: A clinical study was performed on 90 cases of acute poisoning who were admitted in the pediatric department of Cho Sun University Hospital from Jan. 1980 to Aug. 1995. RESULTS: 1) The poisoning occured more frequently in males than in females, and the highest incidence was observed in the 1 to 5 year age group(50.0%). 2) Seasonal incidence was more prevalent in summer(from June to August). 3) The frequency of poisoning in the country was higher than in urban, but no significant difference between urban and the country in 1990s. 4) The causative substances were agricultural chemicals(36.7%), drugs(23.3%), household inseticide(21.1%). 5) In 1990s, poisoning due to houshold insecticide was decreased, whereas poisoning due to drug increased. 6) The cause of poisoning was mainly accidental(82.2%). 7) Accident was the leading cause of poisoning in children up to 10 years old, whereas suicidal attempts happened at the 10 to 15 year age group. 8) Death in the hospital was one case(1.1%). CONCLUSIONS: Urban incidence gradually increased and accidental poisoning due to medicine also increased. So, we conclude that prevention such as education and use of grip-tight cap or similar safety devices is important.