Análise crítica da indicação da lavagem gástrica em intoxicações atendidas em um hospital de ensino / Critical analysis of gastric lavage indication for poisoning cases attended in a university hospital

Objetivo: Avaliar a indicação da lavagem gástrica no tratamento de intoxicações causadas por ingestão. Métodos: Todos os casos de intoxicação causada por ingestão que foram atendidos em dois hospitais do interior de São Paulo e submetidos à lavagem gástrica no período de 1° de janeiro de 2011 a 31 de dezembro de 2015 foram avaliados retrospectivamente quanto à indicação do procedimento, considerando o tempo entre ingestão e atendimento, a toxicidade da substância e as contraindicações para o procedimento. Resultados: Dos 587 casos atendidos, 338 (57,6%) foram submetidos à lavagem gástrica. Dentre esses casos, constatou-se a realização equivocada do procedimento em 95,8% casos. Conclusão: O número de pacientes submetidos à lavagem gástrica neste trabalho foi considerado elevado, mesmo quando orientado pelo centro de atendimento. Apesar da falta de evidências de que a lavagem gástrica traga benefícios nos casos de intoxicação, ela é largamente utilizada em virtude do desconhecimento das indicações e contraindicações desse procedimento por parte dos profissionais de saúde

Objective: To evaluate the indication of gastric lavage in the treatment of poisoning caused by ingestion. Methods: All cases of poisoning caused by ingestion that were treated in two hospitals in inland cities of São Paulo and subjected to gastric lavage from January 1, 2011 to December 31, 2015 were retrospectively assessed as for the indication of the procedure, considering the time between ingestion and care, substance toxicity, and procedure contraindications. Results: Of the 587 cases treated, 338 (57.6%) underwent gastric lavage. The procedure was considered incorrect in 95.8% of cases. Conclusion: The number of patients undergoing gastric lavage in this study was considered high, even when instructed by the center of attendance. Despite the lack of evidence that gastric lavage brings benefits in cases of poisoning, it is widely used due to the lack of knowledge by health professionals of the indications and contraindications of this procedure.

Intoxicación con rodenticidas anticoagulantes: serie de casos y revisión de literatura / Intoxication with anticoagulant rodenticides: Case series and review of the literature

Introducción. Los superwarfarinicos (SWF) son una de las herramientas utilizadas por el ser humano para el control de roedores y a la vez son tóxicos para el hombre y pueden conducir a la muerte sin los debidos cuidados en su uso.Casos clinicos. Tres pacientes masculinos, que consultaron por sangrados (gingivorragia, epistaxis, hematuria, hemartrosis y hematomas cutaneos) asociados a alteraciones del coagulograma (Tiempo de protrombina (TP) y tiempo de tromboplastina parcial (KPTT) prolongados). Todos tuvieron exposición a superwarfarinicos. Nuestro servicio no dispone del análisis de SWF en suero. Se administró vitamina K1 en los tres pacientes y plasma fresco congelado (PFC) en uno solo (sangrado mayor: hematuria). El seguimiento se realizó mediante controles seriados de coagulograma y su evolución fue favorable. Discusión. En todos los casos, el diagnóstico de intoxicación por SWF fue clínico, basado en caracteristicas clínicas de pacientes y alteraciones en sus parámetros de coagulación, y debido a imposibilidad de derivación de análisis a otro laboratorio. Se realizo tratamiento especifico (vitamina K1 y PFC) segun recomendación de expertos, ya que no hay hasta la fecha, estudios clinicos que evaluen las diferentes opciones terapéuticas. Conclusión. La intoxicación por SWF aunque no es frecuente, debe sospecharse en casos de paciente con coagulopatia sin otras causas que puedan justificarlo. El manejo del cuadro tóxico es la reposición de vitamina k y de plasma fresco congelado, en casos donde se necesite una rápida corrección de la alteración hemostática, como los sangrados mayores. Es imprescindible la oportuna consulta con médicos hematólogos y/o la consulta con un centro regional de control de intoxicaciones para todas las exposiciones sospechosas por SWF.

Introduction. Superwarfarinics (SWF) are one of the tools used by humans for rodent control. They are toxic to humans and can lead to death without due care in its use. Clinical cases. Three male patients, who consulted due to bleeding (gingivorragia, epistaxis, hematuria, hamartrosis and skin hematomas) associated with coagulogram alterations (prolonged protombine time (PT) and partial thromboplastin time (KPTT)). All them exposure to superwarfarinics. SWF serum analysis was not available in our hospital. Vitamin K1 was administered in all three patients and fresh frozen plasma (PFC) in only one (major bleeding: hematuria). The followup was performed by serial coagulogram controls and the evolution was. Discussion. In all cases, the diagnosis of SWF intoxication was clinical, based on clinical characteristics of patients and alterations in their coagulation parameters, due to the impossibility of deriving the analysis of SWF in serum to another laboratory. Specific treatment was carried out (vitamin k and PFC) according to experts' recommendation, since there are no clinical studies to evaluate the different therapeutic options to date. Conclusion. SWF poisoning, although not frequent, should be suspected in patients with coagulopathy without other causes that may justify it. The management of toxic symptoms is the administration of vitamin K1 and fresh frozen plasma, in cases where a rapid correction of the haemostatic alteration is required, such as major bleedings. It is essential to consult with hematologists and / or consult a regional poison control center for all suspicious exposures by superwarfarins.

Intoxicaciones con rodenticidas superwarfarínicos / Superwarfarin rodenticide poisoning

Introducción: en la actualidad existe utilización masiva de rodenticidas y su venta no está restringida al público. Las etiologías de intoxicación por estos agentes son variadas pudiendo ser de tipo intencional o accidental. Objetivo: analizar estudios realizados en torno a intoxicaciones con rodenticidas superwarfarínicos en humanos con el propósito de reunir información que oriente a un adecuado tratamiento. Metodología: se realizó una revisión integradora en las bases de datos electrónicas PubMed, TripDataBase, Cochrane, además de Google Scholar y SciELO, libros de divulgación científica, documentos de convenciones, páginas web de instituciones públicas, privadas y artículos vinculados a efectos, cuadro clínico y tratamiento de exposiciones a rodenticidas en seres humanos. Se analizaron los documentos y la información se organizó en tres temáticas: toxicidad de los rodenticidas superwarfarínicos, cuadro clínico y tratamiento médico, y rodenticidas no anticoagulantes disponibles en Chile. Resultados: la dosis tóxica mínima reportada en adultos es de 1 mg de principio activo; en pacientes pediátricos ingestas accidentales rara vez producen síntomas. Los síntomas se observan de forma tardía y su toxicidad es variable. El examen de elección es el International Normalized Ratio (INR) y se realiza en todo paciente con factores de riesgo presentes. El antídoto no se administra de forma profiláctica y la dosis se ajusta individualmente. Conclusión: en niños las ingestas accidentales no son riesgosas por lo que pueden ser observados en el hogar. Pacientes con ingestas masivas requieren controles de INR por meses por lo que es importante que posterior al alta médica exista una óptima coordinación con nivel primario de atención.

Introduction: Currently there is a widespread use of rodenticides, unrestricted to the public. The exposure to these agents may varied being intentional or accidental. Objective: To analyze studies about superwarfarin poisoning in humans, with the purpose of gathering information to guide proper treatment. Methodology: It was conducted an integrative review in the electronic databases PubMed, TripDataBase, Cochrane, Google Scholar and SciELO, science books (reference textbooks), convention documents, websites from public and private institutions and articles about the effects, clinical manifestations and treatment of human exposures to rodenticides. Documents were analyzed and the information organized into three themes: superwarfarin toxicity, clinical features and medical treatment, and non-anticoagulant rodenticides available in Chile. Results: In adults, the minimum dose reported to cause toxicity is 1 mg of active ingredient. In pediatric patients, accidental intakes rarely produce symptoms. The symptoms of poisoning are usually delayed and its toxicity is variable. The test of choice is International Normalized Ratio (INR) and it is performed in all patients with risk factors. The antidote must not be administered prophylactically and the dose is adjusted individually. Conclusions: Accidental intakes in children are not risky and they can be observed at home. Patients with massive intakes require INR monitoring for months so, it is important that an optimal coordination with primary care facilities still exists after medical discharge.

Can we more efficiently save patients with vitamin K-dependent coagulopathy caused by superwarfarin intoxication?

No abstract available.

Evaluation of risk factors in patients with vitamin K-dependent coagulopathy presumed to be caused by exposure to brodifacoum

BACKGROUND/AIMS: Recently, many cases of vitamin K-dependent coagulopathy of unknown origin have been reported. Such patients lack any relevant family history and have no systemic disease, raising suspicion of superwarfarin intoxication. We evaluated individual risk factors causing coagulopathy and hemorrhagic symptoms in patients with suspected superwarfarin intoxication. In addition, we determined how to effectively treat vitamin K-dependent coagulopathy caused by suspected superwarfarin intoxication. METHODS: Seven patients with suspected superwarfarin intoxication who lacked any definitive history of rodenticide ingestion were included. Thirty-one patients initially diagnosed with rodenticide poisoning were also included. We performed a retrospective chart review of all subjects and examined clinical data including patient demographics and medical histories. RESULTS: Patients initially diagnosed with rodenticide poisoning were divided into two groups, one of which had a laboratory abnormality (prothrombin time [PT] > 13 seconds) and another group with PTs in the normal range. There was no significant difference between the two groups in any of age, gender, the extent of chronic alcohol consumption, the causative rodenticide, psychiatric problems, ingestion of drugs interacting with warfarin, the extent of intoxication, or the type of ingestion attempt. The albumin level of the former group was significantly lower than that of the latter group (p = 0.014). Furthermore, a significant difference between the two groups was evident in terms of simultaneous ingestion of rodenticide and alcohol (p = 0.023). CONCLUSIONS: Most patients with superwarfarin poisoning did not exhibit any complication. When such complications were evident, they were associated with serum albumin level and coingestion of rodenticide and alcohol.

Ingestão acidental de brodifacoum por um cão / Brodifacoum accidental ingestion by a dog

Produtos utilizados para controle de roedores ocupam a terceira posição entre as causas mais comuns de exposições a agentes tóxicos em cães. Cerca de 20% dessas exposições resultam em intoxicação (OSWEILER, 1998). A terapêutica adequada e o tempo decorrido entre a ingestão e os primeiros procedimentos são os principais fatores determinantes do sucesso do tratamento, o qual pode ocasionar distúrbios de coagulação e morte do paciente, se não for bem conduzido. Este trabalho relata um caso de ingestão acidental de brodifacoum por um cão e a subsequente abordagem terapêutica emergencial.

Choque hipovolêmico em um cão com suspeita de intoxicação por cumarínico: relato de caso / Hypovolemic shock in a dog with suspected coumarin poisoning: case report

Um cão adulto, fêmea, SRD e 5,0 kg foi atendido no Hospital de Clínicas Veterinárias da Universidade Federal do Rio Grande do Sul com sinais de choque. A anamnese não revelou nenhuma informação consistente. No exame clínico, o paciente apresentava estado de estupor, midríase, hipotermia (36,5oC), bradicardia (50 b.p.m), cianose e presença de hemorragia contínua em região digital. O animal foi imediatamente colocado em oxigênio e submetido à fluidoterapia intensiva com fluido cristalóide (90ml/kg/hora).

Comparative analysis of 607 autopsy cases of poisoning death / 法医学杂志

OBJECTIVE@#To provide references for forensic expertise by investigating the kinds of toxicant, routes of exposure and manners of poisoning deaths, etc.@*METHODS@#Six hundred and seven autopsy cases of poisoning deaths from 1957 to 2008 in Department of Forensic Medicine, Tongji Medical College (Tongji Forensic Science Identification Center of Hubei), were comparatively reviewed.@*RESULTS@#In 218 cases from 1999 to 2008, more than 50% of decedents were male in the ages of 30-49. The toxicants are usually taken orally and the most common manner of death was accidental. The common substances involved in poisoning death were rodenticide, poisoning gas and insecticide. Compared to the data of 1983-1998 and 1957-1982, the common toxic agents had changed significantly. The number of cases involving insecticide and cyanide poisoning decreased in recent years, and the number of cases of rodenticide, poisoning gas, alcohols poisoning displayed an increase tendency, especially for drugs abuse.@*CONCLUSION@#Poisoning deaths of pesticides remain a major public health problem for a long time and the awareness of prevention need to be raised, especially for the prevention of deaths from multiple poisons.

Aluminium phosphide poisoning: management and prevention.

Death by Aluminium phosphide (AIP) and organo-phosphide poisoning are the commonest forms of poisoning in India. Aluminium phosphide is used as rodenticide and pesticide in grain storage facilities. It produces phosphine gas, which results in mitochondrial poisoning. There is no known antidote for AIP poisoning. The effects of AIP poisoning, mediated by phosphine and mechanism of action have not been established.The information related to this poisoning is available in the literature and substantiated by practical experience. Liberated phosphine cannot be detoxified but Magnesium sulphate has been reported to be effective. Another remedy can be rapid absorption by coconut oil which might be helpful. Treatment consists of gastric lavage with potassium permanganate solution, oral administration of charcoal and sorbitol suspension, intravenous administration of sodium bicarbonate, magnesium sulphate and calcium gluconate, and oral administration of sodium bicarbonate and coconut oil. Use of coconut oil for treatment in this poisoning is suggested, although clinical trials and scientific approval is still awaited. Every suggestion, news regarding new modality of treatment for this poisoning needs to be shared in the interest of saving precious human lives. It is with this aim the present paper is written.

Aplicación de las normas terapéuticas en pacientes intoxicados por plaguicidas, servicio de emergencias Hospital Doctor Roberto Calderón Gutierrez, Managua 2008-2009 / Application of treatment guidelines in patients poisoned by pesticides, Hospital emergency room Doctor Roberto Calderon Gutierrez, Managua 2008-2009

El objetivo del presente estudio fue obtener información sobre la aplicacion de las Normas Terapéuticas en el manejo brindado a pacientes que acudieron por intoxicación por plaguicidas, principalmente por Fosfina, Organofosforados, Paraquat y Rodenticidas, así como información sobre las condiciones sociodemográficas de los pacientes en estudio, para responder cuál fue la distribución de frecuencia de pacientes por edad y género, la procedencia de los pacientes, grado de instrucción, así como la relación de las intoxicaciones con su evolución clínica según el manejo brindado en sala de emergencias de este centro asistencial, utilizando como base cientifica las Normas Terapeuticas del Ministerio de Salud de Nicaragua. Diseño Metodologico Tipo de Estudio: Corresponde a una investigación analítica, del cumplimiento de normas de manejo de pacientes intoxicados por plaguicidas, principalmente por Fosfina, Organofosforados, Paraquat y Rodenticidas. El Universo esta constituido por 46 pacientes correspondientes al total de ingresos con diagnóstico de intoxicación por estos plaguicidas, por el servicio de Emergencias del Hospital “Roberto Calderón Gutiérrez.” de 2008 a 2009. Resultados: Se recopilaron 46 casos de intoxicaciones por plaguicidas Fosfina, Paraquat, Organofosforados y Rodenticidas con predominio del sexo masculino, de escolaridad primaria, con una edad media entre 15 y 25 años. Geográficamente, la mayor proporción de casos corresponde a la zona urbana, sin ocupacion y solteros. El plaguicida mayor utilizado es la Fosfina, con una severidad global del 60% y una mortalidad general del 72%. La mayoria con finalidad autolítica, utilizando la vía digestiva como via de ingreso del tóxico...

Aplicación de las normas terapéuticas en pacientes intoxicados por plaguicidas, servicio de emergencias Hospital Doctor Roberto Calderón Gutierrez, Managua 2008-2009 / Application of treatment guidelines in patients poisoned by pesticides, Hospital emergency room Doctor Roberto Calderon Gutierrez, Managua 2008-2009

El objetivo del presente estudio fue obtener información sobre la aplicación de las Normas Terapéuticas en el manejo brindado a pacientes que acudieron por intoxicación por plaguicidas, principalmente por Fosfina, Organofosforados, Paraquat y Rodenticidas, así como información sobre las condiciones sociodemográficas de los pacientes en estudio, para responder cuál fue la distribución de frecuencia de pacientes por edad y género, la procedencia de los pacientes, grado de instrucción, así como la relación de las intoxicaciones con su evolución clínica según el manejo brindado en sala de emergencias de este centro asistencial, utilizando como base científica las Normas Terapeuticas del Ministerio de Salud de Nicaragua. Diseño Metodologico Tipo de Estudio: Corresponde a una investigación analítica, del cumplimiento de normas de manejo de pacientes intoxicados por plaguicidas, principalmente por Fosfina, Organofosforados, Paraquat y Rodenticidas. El Universo esta constituido por 46 pacientes correspondientes al total de ingresos con diagnóstico de intoxicación por estos plaguicidas, por el servicio de Emergencias del Hospital “Roberto Calderón Gutiérrez.” de 2008 a 2009. Resultados: Se recopilaron 46 casos de intoxicaciones por plaguicidas Fosfina, Paraquat, Organofosforados y Rodenticidas con predominio del sexo masculino, de escolaridad primaria, con una edad media entre 15 y 25 años. Geográficamente, la mayor proporción de casos corresponde a la zona urbana, sin ocupación y solteros. El plaguicida mayor utilizado es la Fosfina, con una severidad global del 60% y una mortalidad general del 72%. La mayoría con finalidad autolítica, utilizando la vía digestiva como via de ingreso del tóxico...

Epidemiology of acute poisoning in children due to household substances. Mortality and morbidity in Hazara division

Acute Poisoning in children due to house hold substances is a global problem, however mortality and morbidity is nowadays very less in developed countries due to precautionary measures and better treatment facilities while situation in developing countries like Pakistan is alarming one. The present study was conducted to know about the death and injuries due to household poisoning in children in Hazara Division. The purpose of study was also too seek measures to reduce the risk factor. This prospective study was carried out in the Paedriatic unit of Ayub Hospital Complex and Department of Forensic Medicine and Toxicology, Ayub Medical College, Abbottabad from July to 2008 to September 2009. A total number of 6 leases of acute poisoning of children were brought to emergency department of Ayub Hospital Complex. 45 cases were admitted in Paedriatic unit while 16 were treated in emergency department were sent back to home. There were 37 male children [60.65%] and 24 [39.34%] female. The maximum number of cases were between age group 1-5 years 43 [70.49%]. 99% percent cases in our this study were of accidental nature only one case was homicidal nature while suicidal was none. Insecticide / rodenticide were the commonist agent ingested, followed by pharmacutical products. Kerosene oil was the third commonist agent ingested in our studies. Mortality rate was 3.27%. Organo-phosphorus compound [insecticide], rodentcide and kerosene oil [petroleum products] and pharmaceutical products are common source of household accidental poison globally. In developed countries there frequencies is decreasing rapidly due to health education and precautionary measures adopted mandatorily by manufacturers but in developing countries like Pakistan the situation is same as 50 years back. The risk factor can be reduced by adopting preventive measures at national level through health education of masses and parents and making products safety measures mandatory for manufacturers, moreover parents must be educated about the harms of some Herbal agents containing Opiates and on safe storage of medicines and house hold poisonous agents

The antidotal effects of high-dosage gamma-aminobutyric acid on acute tetramine poisoning as compared with sodium dimercaptopropane sulfonate / 华中科技大学学报（医学）（英德文版）

To investigate the therapeutic effect of high-dosage gamma-aminobutyric acid (GABA) on acute tetramine (TET) poisoning, 50 Kunming mice were divided into 5 groups at random and the antidotal effects of GABA or sodium dimercaptopropane sulfonate (Na-DMPS) on poisoned mice in different groups were observed in order to compare the therapeutic effects of high-dosage GABA with those of Na-DMPS. Slices of brain tissue of the poisoned mice were made to examine pathological changes of cells. The survival analysis was employed. Our results showed that both high-dosage GABA and Na-DMPS could obviously prolong the survival time, delay onset of convulsion and muscular twitch, and ameliorate the symptoms after acute tetramine poisoning in the mice. Better effects could be achieved with earlier use of high dosage GABA or Na-DMPS. There was no significant difference in prolonging the survival time between high-dose GABA and Na-DMPS used immediately after poisioning. It is concluded that high-dosage GABA can effectively antagonize acute toxicity of teramine in mice. And it is suggested that high-dosage GABA may be used as an excellent antidote for acute TET poisoning in clinical practice. The indications and correct dosage for clinical use awaits to be further studied.

Effect of supplementary feeding of vitamin K1 on difethialone treated Indian gerbil, Tatera indica Hardwicke in laboratory.

Two dosages (1 and 2 mg/kg) of vitamin K1 supplementation for 5 and 15 days were given to Indian gerbil T. indica fed on difethialone bait (0.0025%) for one day. The results indicated that the lower dosage could not reverse the anticoagulation process, however the period of mortality was considerably increased from 3-9 days (in control) to 5-14 days (5 days supplementation regime). Subsequently when the vitamin K1 dosage was doubled and given for 15 days, there was 100% reversal of anticoagulation process and all the test gerbils became normal within a month of poisoning with difethialone bait.

The study of status and advances on tetramine poisoning / 法医学杂志

Tetramethylenedisulphotetramine(TETS) is virulent rodenticides which was strictly forbidden to use in China. Poison dose of TETS is very little, LD50 in rats in 0.1 mg/kg. Manifestations and signs of TETS poisoning are showed in 5 min. The long dated effect of poisoning is extremely strict. Mamy studys on TETS are restricted on the treatment of TETS poisoning, while that of poisoning mechanism is very few. This paper reviewed TETS poisoning mechanism, pathological changes and research advances.

Intoxicación por rodendicida - superwarfarina: descripción de un caso clínico / Poisoning by rodenticide - superwarfarin: description of a clinical case

Los rodendicidas de uso doméstico están fácilmente disponibles en el comercio y, corresponden en general a superwarfarinas, cuyo mecanismo de acción es semejantea los anticoagulantes de uso clínico, pero difiere en una vida media más prolongada (meses) y una potencia cien veces mayor.Presentamos el caso clínico de una intoxicación con fines suicidas de Rodilon® (difethialone) 10 cajas de 50 g. La paciente ingresa con un tiempo de protrombina(TP) de 6 por ciento con un INR de 12.4, requiriendo administración de vitamina K1 durante varios meses. Las manifestaciones clínicas fueron leves (gingivorragia y petequias) al ingreso.En caso de no contar con el antecedente de ingesta, la intoxicación debe sospecharse en toda hipoprotrombinemia adquirida, sin antecedentes familiares de diátesis hemorrágica y, con función hepática normal.

Rodenticide-induced hepatotoxicity.

Hepatotoxicity following acute poisoning with rodenticides has been infrequently reported in literature. To emphasize the fact that this form of clinical presentation is not unusual we are reporting two cases of rodenticide poisoning masquerading as severe hepatic dysfunction.

The profile of acute poisonings in Harayana-Rohtak Study.

A prospective study of 559 cases of acute poisoning who came to this hospital over a period of 14 months. 91.4% cases were of self poisoning (suicidal), 8.1% accidental and only 0.5% homicidal. Majority of patients were young (mean age 27 years), males twice the number of females. Almost 3/4th of the total patients belonged to lower socio-economic group (rural more than urban). The common causative factors which led to self poisoning were marital disharmony, economic hardships and scolding/disagreement with other family members. Aluminium phosphide (ALP) was the most commonly abused substance followed by organophosphates and zinc phosphide in 67.8, 13.9 and 4.3% cases respectively. The overall mortality rate in the series was 33.82%, but true mortality rate in patients who consumed ALP was as high as 67.6%. Most of these cases (94.9%) were not given any preliminary treatment in the village primary health centre (PHC) nearest to the site of mishap and they were brought/referred to this hospital straight and thus most valuable time crucial for effective treatment was lost. Easy availability of a highly toxic substance like ALP at peak moments of frustration has added fuel to the fire and pushed up the incidence of self-poisoning. Suggested preventive measures include caging of tablets in plastic packs, stringent restrictions on free supply of ALP and education of medical/paramedical personnel involved in health care delivery at grass root level.