Poisoning by non-edible squash: retrospective series of 353 patients from French Poison Control Centers.

CONTEXT: Among the numerous varieties of squash that exist, some are edible while other bitter-tasting ones are not fit for human consumption. Cases of confusion seem to be multiplying and are characterized by digestive problems (diarrhea, vomiting, and abdominal pain). METHODS: This is a descriptive retrospective study of cases of exposure reported to French Poison Control Centers between 1 January 2012 and 12 December 2016. RESULTS: 353 patients were included, with 71.7% belonging to collective cases of poisoning. The male to female sex ratio was 0.75 for an average age of 38.2 ± 23.6 years. The circumstances of exposure were dietary for 337 patients (95.5%). The majority of the squash consumed was purchased at a store (55.8%) but some also came from the garden (25.5%). 204 patients (57.8%) mostly presented with diarrhea, vomiting, abdominal pain, sometimes with the consequent dehydration, hypotension, tachycardia, headaches, or vertigo. There were no deaths or severe (Poisoning Severity Score (PSS) 3) cases, but there were 14 patients (4.0%) of moderate severity, 190 patients (53.8%) of minor severity (PSS 1), and 149 patients (42.2%) without severity (PSS 0) but among which we include the bitter taste of the squash. The average age of PSS 2 patients was significantly (p = .003) older than that of the PSS <2 patients. CONCLUSION: As the first consequential series in Europe, our study shows that exposure to non-edible squash is frequent. Usually benign, poisoning could be the consequence of the irritating effect of certain cucurbits, the molecules responsible for the taste and toxicity of the fruits. In terms of prevention therefore, we recommend disposing of any squash with a bitter taste.

Lithium poisoning: the value of early digestive tract decontamination.

OBJECTIVE: The objective of this study was to evaluate the effects of early digestive tract decontamination on the severity of acute-on-chronic lithium poisoning (acute poisoning in patients under long-term therapy). MATERIALS AND METHODS: This was an observational and retrospective study of acute-on-chronic lithium overdoses recorded by the Angers Poisons and Toxicovigilance Centre between February 2006 and September 2010. The cases of overdose were divided into two groups: those undergoing early decontamination (by sodium polystyrene sulphonate and/or whole bowel irrigation) and those in whom decontamination was delayed (> 12 h) or not performed. Severity was assessed using the Poisoning Severity Score (PSS). RESULTS: Fifty-nine patients met the inclusion requirements, 15 of whom were decontaminated at an early stage. The mean age of the patients did not differ statistically between the two groups (49 vs. 44 years, p = 0.25). The estimated ingested doses in the early decontaminated and comparison groups were 12.75 and 12.73 g, respectively (p = 0.9), and the PSSs during the first 12 h were 0.8 and 0.69 (p = 0.32). Those patients who were early decontaminated had an overall lower PSS (1.07 vs. 1.79; p = 0.001), maintained a higher GCS (14.93 vs. 13.3; p = 0.038), and their highest measured serum lithium levels were much lower (2.39 vs. 4.08 meq/L; p = 0.001) than those in the comparison group. All patients who received early digestive tract decontamination subsequently recovered. Under multivariate analysis, undergoing early digestive tract decontamination was significantly associated with a lower risk of severe poisoning (OR, 0.21; 95% CI, 0.04-0.99; p = 0.049), regardless of the lithium dose ingested or the serum lithium level. CONCLUSION: Our results thus highlight the usefulness of early digestive tract decontamination. This technique was statistically associated with a reduction in the severity of acute-on-chronic lithium poisoning at a given ingested dose and serum lithium level.