[Epidemiology of drug poisoning in the Ramón y Cajal University Hospital during a year]. / Epidemiología de las intoxicaciones medicamentosas durante un año en el Hospital Universitario Ramón y Cajal.

BACKGROUND: In recent years, there has been an increase of drugs poisoning cases seen in the Emergency Department. This study has aimed to evaluate the characteristics of these cases in the Ramón and Cajal Hospital in Madrid. MATERIALS AND METHODS: A descriptive analysis about the drug poisonings diagnosed in 2004 was performed, using a retrospective search in the database of the electronic clinical records. The studied variables were gender, age, intention, drugs, admission into the hospital and relapse. RESULTS: There were 566 drug poisoning (47%) with a cumulative incidence of 0.1%, in which women (62.3%) were found to predominate, and the average patient age was 42.46+/-19.97 years (range 14-100 years). In 64.31% of the cases (566), only one kind of drug was used, benzodiazepine being the most common. This appeared at least once in 62% of the cases. Furthermore, 83% were cases of voluntary poisoning. Of the involuntary poisonings, digoxin was the most common drug with a frequency of 58.4%. A total of 28.6% of the cases were admitted into hospital, while the total number of patients who suffered a relapse in this period was 10%. DISCUSSION: Voluntary drug intoxications are caused mostly by psychoactive drugs, likely due to a high prevalence of underlying psychiatric disease in these patients. However, unintentional intoxications are mainly found in patients under chronic treatment with drugs such as digoxin and antiepileptics. More studies should be carried out to analyze which kind of preventive actions could reduce or avoid the high number of relapses.

Epidemiología de las intoxicaciones medicamentosas durante un año en el Hospital Universitario Ramón y Cajal / Epidemiology of drug poisoning in the Ramón y Cajal University Hospital during a year

un aumento de las intoxicaciones medicamentosasatendidas en los servicios de Urgencias. El objetivode este trabajo fue evaluar las características deéstas en el Hospital Ramón y Cajal de Madrid.Material y métodos. Se realizó un análisisdescriptivo de las intoxicaciones medicamentosasdiagnosticadas en el año 2004, a través de unabúsqueda retrospectiva, en la base de datos de lahistoria clínica electrónica. Las variables estudiadasfueron sexo, edad, intencionalidad, tipo de fármaco,ingreso hospitalario y reincidencia.Resultados. Se recogieron 566 intoxicacionesmedicamentosas con una incidencia acumulada del0,1%, en las cuales existía un predominio de mujeres(62,3%), y la media de edad de los pacientes fue de42,46±19,97 años (rango 14-100 años). En un64,31% de los casos se utilizó un solo tipo defármaco. Las benzodiacepinas, presentes en el 62%de los casos, fueron las de mayor frecuencia. Además,un 83% fueron voluntarias. En las intoxicaciones novoluntarias la digoxina fue el fármaco que apareciócon más frecuencia (58,4%). Un 28,6% del totalrequirieron ingreso hospitalario, mientras que lareincidencia en este periodo fue del 10%.Discusión. Los intentos autolíticos medicamentososson producidos en su mayoría por fármacospsicoactivos, debido probablemente a una altaprevalencia de patología psiquiátrica subyacente enestos pacientes. Las intoxicaciones no voluntarias,sin embargo, se presentan fundamentalmente enpacientes con tratamiento crónico, mediantefármacos como la digoxina o los antiepilépticos. Sedeberán realizar estudios para analizar qué tipo demedidas de prevención pueden disminuir o evitar elgran número de reincidencias

Background. In recent years, there has been anincrease of drugs poisoning cases seen in theEmergency Department. This study has aimed toevaluate the characteristics of these cases in theRamón and Cajal Hospital in Madrid.Materials and methods. A descriptive analysisabout the drug poisonings diagnosed in 2004 wasperformed, using a retrospective search in thedatabase of the electronic clinical records. Thestudied variables were gender, age, intention, drugs,admission into the hospital and relapse.Results. There were 566 drug poisoning (47%) witha cumulative incidence of 0.1%, in which women(62.3%) were found to predominate, and theaverage patient age was 42.46±19.97 years (range14-100 years). In 64.31% of the cases (566), onlyone kind of drug was used, benzodiazepine being themost common. This appeared at least once in 62%of the cases. Furthermore, 83% were cases ofvoluntary poisoning. Of the involuntary poisonings,digoxin was the most common drug with a frequencyof 58.4%. A total of 28.6% of the cases wereadmitted into hospital, while the total number ofpatients who suffered a relapse in this period was10%.Discussion. Voluntary drug intoxications are causedmostly by psychoactive drugs, likely due to a highprevalence of underlying psychiatric disease in thesepatients. However, unintentional intoxications aremainly found in patients under chronic treatmentwith drugs such as digoxin and antiepileptics. Morestudies should be carried out to analyze which kindof preventive actions could reduce or avoid the highnumber of relapses

Monitorización analítica de drogas de abuso en el medio hospitalario / Analytical monitoring of drugs of abuse in the hospital environment

Objetivos. Conocer qué clase de drogas de abuso son más consumidas por la población que acude a nuestro hospital situado en el área 4 de Madrid, qué tipo de policonsumo existe y cuál es el perfil de este tipo de pacientes. Metodología. Se realiza un estudio retrospectivo de todos los pacientes a los que durante el año 2002 se les solicitó un screening de drogas de abuso en orina. Los análisis se realizaron en el autoanalizador AxSym® de Abbott® por inmunoensayo de polarización de fluorescencia (FPIA). Resultados. El 55,1% de los pacientes remitidos a estudio (n = 357) fue positivo en alguna droga de abuso. De ellos, un 23,3% fue por cannabis, 16,2% por cocaína, 9% por anfetaminas y 6,7% por opiáceos. Un 12% de los pacientes era policonsumidor. La combinación más frecuente fue cocaína con opiáceos, seguido de cocaína con cannabis y cocaína con anfetaminas. El consumo de drogas fue más elevado en varones que en mujeres con la excepción de los opiáceos. En los menores de 30 años el consumo mayoritario fue de cannabis y cocaína, mientras que los opiáceos fueron más consumidos por mayores de 30 años. Las muestras analizadas procedían mayoritariamente de los servicios de Psiquiatría (35,6%), Urgencias (34%) e Infecciosas (11%). Aquellos pacientes en los que se confirmó su drogodependencia fueron derivados en su mayoría a centros de atención psiquiátrica especializada para su posterior seguimiento. Conclusión. En nuestro medio el policonsumo es habitual, debiendo tener en cuenta los datos poblacionales para ajustar las solicitudes

Objectives. A study was conducted in order to assess what kind of drugs of abuse are most commonly consumed by the population that comes to our hospital, located in Area 4 in Madrid, as well as policonsumption patterns and patient profiles. Material and methods. A retrospective study was conducted in all patients for whom, during the year 2002, a toxicological urine drug screen was requested. Analysis were made by fluorescence polarization immunoassay (FPIA) using Abbott's( AxSym( autoanalyzer. Results. 55.1% of the studied sample (n = 357) were positive for any of the drugs of abuse. Of these, 23.3% was due to cannabis, 16.2% to cocaine, 9% to amphetamines and 6.7% to opiates. Regarding policonsumption, 12% of the patients conformed this category. The most frequent combination was opiate and cocaine, followed by cocaine plus cannabis and cocaine plus amphetamines. Drug consumption was higher in males than in females except for opiate abuse which was equal for both. In patients uder 30 years old, main consumption was that of cannabis and cocaine, while opiates were consumed in higher proportions by patients over 30 years old. The origins of samples analyzed were primarly Psychiatry (35.6%), Emergency (34%) and Infectious Disease (11%) Departments. Patients for whom a drug dependence diagnosis was confirmed were referred, in most cases, to specialized psychiatry centres for follow up. Conclusion. Policonsumption is usual

Clomipramine test: serum level determination in three groups of psychiatric patients.

Concentrations of clomipramine, a specific and potent serotonin uptake inhibitor, are measured in 67 psychiatric patients and 12 normal volunteers. The psychiatric patients are grouped according to the DSM III R criteria namely; pathological gamblers, obsessive compulsives and sufferers of panic disorders. Before and 30, 60, 90 and 120 min after an intravenous infusion of the drug (12.5 mg in 10 min), serum samples are collected to evaluate the concentrations of cortisol, prolactine and growth hormone. Simultaneously the clomipramine concentration of these samples is determined and these results only are reported in this communication. Very different drug concentrations are observed in individual patients receiving the same amount of drug, indicating a substantial inter-individual variability of drug metabolism. No statistical differences (Newman-Keules test) between the clomipramine concentrations from the patients of the three psychiatric groups and the normal group are observed. Neither are statistical correlations observed when clomipramine concentrations from all individuals (n = 79) are related with the age, sex or consumer behaviour (cigarette smoking, alcohol and coffee intakes) of the patients.

[Clinical use of pharmacologic monitoring at a hospital community]. / Utilización clínica de la monitorización farmacológica en una comunidad hospitalaria.

This study reveals the efficiency of phenobarbital, diphenilhidantoine, carbamazepine, valproic acid and teophyline serum levels for their correct adjustment within the concentration gap considered optimal to produce the desired pharmacological effect. A total population of 882 patients treated with the drugs previously named is studied and an important improvement in dose adjustment is observed during these years as a consequence of drug's serum level knowledge.

Rapid gas-chromatographic microdetermination of soluphylline in serum.

A nitrogen-specific gas-chromatographic method is described for the quantitative analysis of soluphylline without the need for derivatization or evaporation of solvent, and using only 50 microliters of serum. The analysis is performed isothermally on a silicone stationary phase, 2% SP 2250 DA (Supelco). After a single neutral extraction with ethyl acetate containing the internal standard (beta-hydroxypropyl theophylline), an aliquot of the organic solvent is injected directly into the gas chromatograph. The detector sensitivity (least measurable amount) for soluphylline was 1 ng.

Can a single measurement of carbamazepine suffice for therapeutic monitoring?

Using fluorescence polarization immunoassay, we measured the peak and trough concentrations of total and free carbamazepine in serum and saliva from 33 epileptic children. We found that, except for patients who show side effects, measurement of trough values in a single sample, collected after an overnight fast and before the morning dose, sufficiently estimates clinical response. Moreover, total carbamazepine is as informative as free carbamazepine.

Determination of clobazam and its N-demethyl metabolite in serum of epileptic patients.

We describe a gas-liquid chromatographic method, using a nitrogen-specific detector, which is suitable for the simultaneous quantitation of clobazam and its main metabolite N-demethyl clobazam in the serum of epileptic patients treated with other anticonvulsant co-medication. Flunitrazepam (internal standard) is added to the sample and after extraction with a toluene/ethyl acetate mixture (3 + 1 by vol), the organic extract is evaporated and the residue is reconstituted in a small volume of solvent and chromatographed on a 3% SP2250 column. The sensitivity limits are about 2 to 5 micrograms per liter of original sample.