Poisoning in older adults: the experience of the national poisons information centre.

Data regarding the incidence, morbidity, and mortality of poisoning in older adults are limited. A retrospective review of enquiries to the National Poisons Information Centre, involving adults aged over-65 years, was conducted from 2001-2003 inclusive. Information on poisoning circumstances, patient demographics, type and number of agent(s), symptoms, enquiry source, location, and route of exposure was collated. 575 adults over-65 years of age were poisoned during the study period. 37.2% (n=214) of poisonings were intentional, 54.4% (n=313) were unintentional, in 5.6% (n=32) of cases the circumstances were unknown, and 2.8% (n=16) were requests for information only. 70.3% (n=404) of poisonings involved pharmaceuticals, 29.0% (n=167) chemicals, and 0.7% (n=4) foreign bodies. The principal pharmaceuticals included cardiovascular drugs, hypnotics/sedatives, and antidepressants. 145 (25%) patients were poisoned with multiple pharmaceutical agents. Overall, 301 (52.3%/) older adults were symptomatic and there were 5 fatalities. Substantial morbidity and mortality occurred following poisoning in older adults. Poison prevention strategies are needed to reduce toxic exposures.

Renal and liver transplantation for toxin-induced organ failure.

OBJECTIVE: Determine the number and outcome of renal (January 1987-June 2001, inclusive) and liver transplants (January 1993-June 2001) performed in Ireland for drug or toxin-induced organ failure and identify the toxins involved. METHODS: Retrospective review of national transplant coordinators' records and patient charts. RESULTS: Fourteen patients received renal transplants for nephropathy secondary to drugs or toxins. In 12 of these cases, renal failure was attributed to chronic toxicity, principally cyclosporin A therapy (seven cases). One-year patient and graft survival were 100%. Twenty-nine liver transplants were for toxin-induced organ failure, and 20 of these were for chronic ethanol induced liver disease. One-year patient and graft survival rates were 77% and 73%, respectively. CONCLUSIONS: Kidney and liver transplants were needed more often because of chronic toxicity than acute poisoning. Both groups had good outcomes at one year post-transplantation.

Pack-size legislation reduces severity of paracetamol overdoses in Ireland.

BACKGROUND: Legislation was introduced in Ireland in October 2001 to control the sale of paracetamol in non-pharmacy outlets. Preparations are now limited to 12 tablets per pack and only one pack can be sold per transaction. AIM: To assess the impact of this legislation on acute deliberate paracetamol overdoses. METHODS: We reviewed acute deliberate paracetamol overdoses reported during two 24-months periods before and after October 2001. We grouped cases according to the number of tablets taken and compared the periods using chi-square and Mann-Whitney tests. RESULTS: The number of tablets taken in acute deliberate paracetamol overdose fell significantly after October 2001 (chi2 = 11.663, P = 0.0029). Fewer cases involved 12-24 tablets (U = 74, P < 0.001) and fewer cases involved more than 24 tablets (U = 131.5, P = 0.0006). CONCLUSION: Legislation controlling sale and packaging of paracetamol preparations appears to be associated with a significant fall in the number of tablets taken in acute deliberate paracetamol overdoses.

Morbidity and mortality following inadvertent poisoning with decanted chemicals.

Decanting of chemicals from their original containers is a hazardous practice that can result in inadvertent poisoning. We conducted a four-year prospective observational study to analyse the epidemiology of accidental poisoning with decanted chemicals. 157 patients were poisoned following accidental exposure to chemicals transferred to innocuous containers. 106 patients attended hospital emergency departments, 17 attended a general practitioner and 34 were instructed to seek medical advice if symptomatic. 112 patients developed clinical features, 9 patients required admission to intensive care and 4 of these needed intubation and ventilation. There was 1 fatality following inadvertent ingestion of paraquat. The predominant symptoms were gastrointestinal upset and a burning sensation in the mouth, throat, and stomach. Decanted chemicals included household, industrial, automobile, and agricultural products. Caustic agents accounted for approximately 33% of decanted chemicals. Decanting of chemicals into innocuous containers results in significant morbidity, mortality, and cost to the health service.

Bupropion (Zyban) toxicity.

Bupropion is a monocyclic antidepressant structurally related to amphetamine. Zyban, a sustained-release formulation of bupropion hydrochloride, was recently released in Ireland, as a smoking cessation aid. In the initial 6 months since it's introduction, 12 overdose cases have been reported to The National Poisons Information Centre. 8 patients developed symptoms of toxicity. Common features included tachycardia, drowsiness, hallucinations and convulsions. Two patients developed severe cardiac arrhythmias, including one patient who was resuscitated following a cardiac arrest. All patients recovered without sequelae. We report a case of a 31 year old female who required admission to the Intensive Care Unit for ventilation and full supportive therapy, following ingestion of 13.5g bupropion. Recurrent seizures were treated with diazepam and broad complex tachycardia was successfully treated with adenosine. Zyban caused significant neurological and cardiovascular toxicity in overdose. The potential toxic effects should be considered when prescribing it as a smoking cessation aid.

Sources of information for acute poisoning in accident and emergency departments in Dublin, Ireland.

BACKGROUND: Access by accident and emergency staff to up-to-date information on poisoning is essential for optimal management of acute poisoning. Apart from the National Poisons Information Centre, other information sources can be used. The objectives of the study were to identify sources of information on acute poisoning in accidents and emergencies and satisfaction with their use. METHODS: In a cross-sectional survey of medical staff of accidents and emergencies in Dublin in 1997, data were collected by interviewer-administered questionnaire. RESULTS: All 11 accidents and emergencies participated, with a staff response rate of 95%. One hundred and twenty-eight respondents were included. Ninety-seven percent had managed cases of poisoning (median 3 per week). The National Poisons Information Centre had been used by 93% of respondents, textbooks by 80%, paper database by 63%, and disc database (CD-ROM) by 10%. Of those managing cases, the National Poisons Information Centre would always be contacted by 23% and by 53% in most cases. The National Poisons Information Centre and CD-ROMs were rated the most useful sources of information. Information provided by the National Poisons Information Centre was considered sufficient by 98% of respondents. Thirty-three percent considered that advice should always be confirmed by fax. Limitations with the National Poisons Information Centre were described by 55% (e.g., manual transcription), with textbooks (e.g., limited content) by 83%, with paper databases (e.g., incompleteness) by 85%, and with CD-ROMs (e.g., time-consuming) by 54%. CONCLUSION: For the optimal management of acute poisoning, direct access to computerized information databases in accidents and emergencies combined with telephone access to the National Poisons Information Centre is required, with information available in hard copy.

Parenteral exposure to detomidine and butorphanol.

We report a case of intramuscular injection of detomidine and butorphanol in a 36 year-old-man who recovered without sequelae. Detomidine is an alpha 2 adrenergic agonist, similar to clonidine. Detomidine (Domosedan) and butorphanol (Stadol) are commonly used as preanesthetics and to produce chemical restraint, sedation and analgesia in animals, especially horses, but there are no published reports of human toxicity.

Ecstasy abuse in Ireland.

Since the late 1970s, ecstasy (MDMA) has enjoyed increasing popularity as a recreational drug. We report a dramatic increase in reports of ecstasy ingestion to the National Poisons Information Centre from zero in January 1991 to thirty seven in June 1992. We have analysed these thirty seven cases retrospectively for age and sex distribution, clinical details and outcome. The patients involved were predominantly male (80%) and aged 10-30 years, the highest incidence being in the 16-25 year old age group. Thirty two (86%) patients were symptomatic. Symptoms in most cases were relatively mild. One death was reported due to congestive heart failure. The symptoms most frequently reported include dilated pupils, agitation, excitement, hallucinations, tachycardia, palpitations, CNS depression, incontinence and psychiatric symptoms.

A case of methylene chloride (nitromors) poisoning, effects on carboxyhaemoglobin levels.

The literature contains only one report of methylene chloride poisoning after ingestion. Unfortunately carboxyhaemoglobin (COHb) levels were not obtained in this case. We now describe a fatal case where a similar amount of the solvent was ingested and after which toxicology screening was done.

Self poisoning: admission to intensive care over a one year period.

The charts of all cases of self-poisoning admitted to an intensive care unit over one year are reviewed Two distinct groups are seen, according to the substances ingested The group who took prescription medications tended to be younger, and had a better outcome Those poisoned with household or industrial products were older, had a longer stay in intensive care, needed more intensive therapy and organ support and had a higher mortality.

Childhood poisoning in Dublin.

A prospective survey was carried out over a three month period to assess the incidence of accidental poisoning in children. The survey also examined the role of child resistant closures (CRC) and other form of packaging in the prevention of poisoning. Two hundred and six children with suspected poisoning attended the casualty departments of the three Dublin children's hospitals surveyed. Ninety three percent of the children were less than five years old. Medications were thought to have been ingested by 65%, household or gardening products by 34% and plants by 1%. Most children had no symptoms and received no treatment except emesis or oral fluid and demulcents. Twenty five percent required admission to hospital. There were no fatalities during the study period. Only 8.5% of the medications involved had been in containers with CRC's. Twenty percent were in blister packs or strips. A substantial number of poisonings occurred at a time when medicines were not in their normal place although in most cases they were still in the original container. We propose a two-phase approach to poisoning prevention--more widespread use of CRC's and public education on safe storage of medicines.

Use of glycopyrrolate and atropine in acute organophosphorus poisoning.

Two cases of organophosphorus poisoning are reported. Both were treated with a combination of atropine and glycopyrrolate as well as benzodiazepine and pralidoxime. The advantages of glycopyrrolate over atropine are discussed.