Epidemiología de las intoxicaciones agudas por drogas de abuso en las urgencias de un hospital del Centro de España basada en datos de análisis toxicológico de orina / Epidemiology of acute poisonings for drugs of abuse in the emergency room of a hospital from the Center of Spain based on analysis data toxicological urine

Introducción: las intoxicaciones agudas son motivo de consulta cada vez más frecuente en los Servicios de Urgencia hospitalarios (SUH) debido a la mayor disponibilidad y acceso a productos químicos tóxicos. Se observan diferentes patrones en cada área sanitaria según el tipo de población, geografía y perfil epidemiológico de consumo. Material y métodos: el objetivo de nuestro estudio es realizar un perfil epidemiológico y describir el manejo del paciente que acude por clínica compatible con intoxicación aguda por drogas de abuso (IA) basado en la determinación de tóxicos en orina para seis sustancias (cannabis, opiáceos, cocaína, anfetaminas, benzodiazepinas y éxtasis) solicitados en el período de estudio 2010-2012. Resultados: se solicitaron 2755 peticiones, de las cuales fueron positivas 1429, y se estudiaron al azar 661 historias clínicas. El perfil de paciente intoxicado de nuestra área es el de varón de entre 30 y 40 años, consumidor preferentemente de cannabis y cocaína; las benzodiazepinas son el tóxico más frecuente en las mujeres, con clínica mayoritariamente neurológica, sin diferencias en cuanto a la franja horaria o el mes del año en que recibió el alta desde el propio SUH en casi el 60% de los casos. Discusión: las IA en los SUH representan casi el 1% de las consultas y tienen una escasa mortalidad. En algunos casos, el médico de urgencias comienza el tratamiento antes de conocer el resultado toxicológico, lo que nos hace plantearnos la utilidad real y el coste-efectividad de estas determinaciones en todos los pacientes con alteración del nivel de conciencia. (AU)

Introduction: acute intoxications are a rising and common query demand on the emergency rooms because of the easy access and disponibility to toxic substances, where we can observe different patterns attending to type of population, geography and epidemiologic consume profile. Material and methods: our objective is to analyze the epidemiology and patient handling coming to the Emergency Room (ER) with compatible symptoms of street drugs abuse, based on the determination of cannabis, cocaine, amphetamine, benzodiazepine, opiates and ectasy urine levels in the period 2010-2012. Results: the ER requested 2755 determinations being positive 1429 and randomly examined 661 clinical histories. The profile of intoxicated patient was male, 30 to 40 years old, preferently cannabis and cocaine consumer (benzodiazepine in women), mostly with neurological symptoms when arrive, without differences between months or day time and, almost 60% of them, discharged directly from the ER. Conclusions: acute intoxications barely represent 1% of ER demands and produce poor or scarce mortality. Sometimes, doctors in charge start with therapeutic measures before knowing the results of toxicology, what leads us to ask about actual usefulness and cost-efficiency of the toxicology assay to every patient with low conscious level. (AU)

Intoxicación grave por psicofármacos / Psychotropic drugs poisoning

La intoxicación por psicofármacos es motivo frecuente de consulta a centros de información toxicológica y servicios de urgencia. Habitualmente son por ingestión accidental en niños y por sobredosis intencional en adultos, pero también puede suceder por interacciones con otras sustancias o medicamentos que potencien la toxicidad del psicofármaco. Las maniobras básicas de soporte vital son el pilar de tratamiento del intoxicado grave y las acciones que buscan disminuir la absorción sistémica de la sustancia aminoran la progresión y duración de sus efectos. El uso de antídotos no está recomendado en todos los casos, estos pueden aumentar el riesgo de complicaciones graves. Los objetivos de este artículo son entregar nociones de las manifestaciones clínicas, del manejo inicial y de las complicaciones más frecuentes y graves del intoxicado por ingesta de psicofármacos. Serán agrupados por familia de acuerdo a su clase y uso terapéutico, describiendo los mecanismos de toxicidad. En algunos de ellos hay recomendaciones de consenso respecto del manejo prehospitalario y la derivación a centros de alta complejidad.

The psychotropic drugs poisoning is a frequent cause of calls to Toxicology Centers and consults to emergency departments. Accidental ingestion is frequent in children; otherwise intentional overdose happens in adults. However, interactions with other substances may increase the drug’s toxicity. Basics manoeuvres of vital support are the most important facts in the treatment of the severely poisoned patient. The reduction of drug´s absorption decreases the progression and time effect of the drug. The antidotes are not recommended for all cases because they may increase the risk of severe complications. The objective of this article is to provide information about clinical manifestations, basic management and frequent complications in the severely poisoned patient. We will describe the mechanism of drug’s toxicity by type and therapeutic use. For some of them, there are evidence - based consensus guidelines for out-of-hospital management and emergency department refer.

Trends of poisoning and gross stomach mucosal appearance in fatal poisoning cases: An autopsy study.

The study was of one year duration from 3rd December 2007 to 2nd December 2008 on fatal poisoning cases autopsied at Chigateri Government District hospital mortuary, attached to JJM Medical College, Davangere. The purpose was to know the trends of fatal poisoning cases in the region and also to know the gross stomach mucosal appearances in those cases. Material for the study included fatal poisoning cases autopsied. These poisoning cases included fatal animal bites also. All the data collected in detail was entered in the Proforma and later critically analyzed, tabulated, & compared with other various studies. Significant correlations were seen between- types of poison ingested & survival period, and between treatment intervention & survival period. It was an attempt to try to furnish poison suspected to the FSL based on case files and autopsy findings so as to hasten analysis and reporting.

Evidencia de caso: intoxicación por benzodiazepinas / Case evidence: benzodiazepine poisoning

Las benzodiazepinas, tranquilizantes menores potentes, se recomiendan actualmente para el tratamiento de la ansiedad y en el área quirúrgica como inducción terapéutica del sueño fisiológico en el paciente que va a ser intervenido, a través de un mecanismo de acción facilitan la actividad inhibidora del neurotransmisor ácido gamma-amino butírico o GABA en el sistema nervioso central. A pesar que poseen un margen de seguridad y son drogas poco tóxicas, puede ocurrir que a través de los metabolitos demetilados de las benzodiazepinas, con una vida media mayor (la del diazepan alrededor de 33 horas, con una vida media inicial de 1,0) en dosis sucesivas su acumulación sea capaz de producir reacciones adversas, así como fenómenos de farmacodependencia. Su principal vía de excreción es la orina (70 a 90) y el resto en las heces a través de la bilis. La toxicidad se manifiesta con trastornos nerviosos, gastrointestinales, hematológicos y alérgicos que ceden con la supresión del medicamento. Presentamos a continuación un caso de intoxicación por benzodiazepina de una niña de 5 años de edad que ingresa con manifestaciones neurológicas importantes. Se discutirá el caso clínico, su sintomatología, tratamiento, así como una exhaustiva investigación en la bibliografía mundial.

Benzodiazepines, powerful minor tranquilizers, are currently recommended for anxiety treatment and in surgery as a therapeutic induction to physiological sleep in a patient who is going to OR. Through a mechanism of action facilitates the inhibitory activity of the gammaaminobutyric acid (GABA) neurotransmitter of the central nervous system. Although they have a safety margin and are not very toxic drugs it could happen that through their de-methylated metabolites with a longer half-life (diazepam half-life is about 33 hours, an a starting half-life of 1,0) in consecutive doses their accumulation could cause adverse reactions as well as dependence. Their main excretion way is urine (70 a 90 ) and the rest in feces or through the bile. Their toxicity shows nervous, gastrointestinal, hematologic, and allergic disorders that subside stopping medicine. Now we present a case of benzodiazepine poisoning of a 5 years old girl that was admitted with serious neurological signs. The symptoms and , treatment of the case will be discussed, as well as a thorough research in worldwide bibliography.

Children poisoning in Taiwan.

Poisoning is a well known cause of morbidity and mortality in children. In Taiwan, little information has been published regarding the status of pediatric poisoning exposures. To provide more information on pediatric poisoning exposures for the purpose of poison prevention, a retrospective study was designed and conducted to analyse the data of National Poison Centre (NPC), Taiwan. All telephone inquiries concerning poisoning exposures in those under 19 years of age, received by NPC-Taiwan from July 1985 through December 1993, were included in this study. The age, sex, reason for exposure, route of exposure, substances involved and clinical outcome of those telephone calls were then analyzed. A total of 5,812 inquiries concerning poisoning exposures in children were recorded. Male exposures were more prevalent than females (59%) Vs. 41%) Accidental exposures accounted for 77.7% of the cases and most were exposed by the oral route. Substances most frequently ingested were household products, benzodiazepines and pesticides. The data revealed a mortality rate of 1.4%. Accidental poisoning exposures from household products and drugs remain a significant problem for those younger than 6 years of age. Further education of parents and care takers and the employment of child-resistant containers are needed to prevent cases of pediatric poisoning. Reduction of amphetamine abuse in adolescents is also of major concern and deserves more attention.

Frequency of suicidal attempts by benzodiazepins methods of dertermination during the intoxicatin time

Benzodiazepine groups of drugs are much used, acute intoxication to this family became 21% of patients admitted to ICU in spite of that mortality is nil in addition to 30% of calls for help. The different benzodiazepines are frequent and derived from the same basic molecule. Chromatography and immunological enzymes, morbidity and drug adduction of benzodiazepine group need more attention