Patrón de intoxicaciones pediátricas en Urgencias. Evolución tras 20 años / Pattern of pediatric poisoning in the ER. Evolution after 20 years

Objetivo. Describir y comparar los datos de las intoxicaciones pediátricas, por fármacos y no medicamentosas, enla urgencia pediátrica en 2 cohortes de 2 décadas distintas.Material y métodos. En este estudio descriptivo retrospectivo, de 2 cohortes de pacientes que acudieron a Urgencias en el año 1997 y en el año 2015. Se compararon lascaracterísticas epidemiológicas, clínicas, la adecuación deltratamiento a las guías de los pacientes menores de 14 añosque acudieron a las Urgencias Pediátricas de nuestro hospital.Resultados. En nuestra serie ha habido un aumento delas intoxicaciones por medicamentos, de un 40% en 1997 a un53% en 2015. Por el contrario, se ha encontrado un descensorelativo de las consultas por tóxicos no medicamentosos 60%vs 47%. La distribución por sexo, con predominio femeninoen las intoxicaciones farmacológicas, y masculino en las nofarmacológicas. Las características clínicas no han variado,predominando al clínica digestiva y neurológica. Los tóxicosimplicados han variado con relación a las indicaciones encada período de tiempo, desapareciendo las intoxicacionespor aspirina en la última década. El tratamiento en Urgenciasse ha adecuado a los estándares de calidad que publican lassociedades científicas, abandonando tratamientos que se handemostrado de baja eficacia, como el jarabe de ipecacuanay los lavados gástricos. Los ingresos en nuestra serie handisminuido de un 25% vs 3%, contribuyendo entre otrascausas el desarrollo y especialización de las Unidades deUrgencias Pediátricas.Conclusiones. A pesar de que ciertos datos indican unamejora de la asistencia, sigue habiendo muchos puntos demejora para que la morbimortalidad de las intoxicaciones en pediatría disminuya (AU)

Objective. To describe and compare data on pediatricpoisonings, drug and non-drug, in the pediatric emergencydepartment in 2 cohorts from 2 different decades.Material and methods. This is a retrospective descriptive study of 2 cohorts of patients attending the emergencydepartment in 1997 and 2015. We compared the epidemiological and clinical characteristics and the adequacy of treatmentaccording to the guidelines of patients under 14 years of age,who were attended at the pediatric emergency departmentof our hospital.Results. In our series there has been an increase in drugpoisonings, from 40% in 1997 to 53% in 2015. In contrast,there was a relative decrease in consultations for non-drugintoxications, 60% vs 47%. The distribution by sex, with afemale predominance in pharmacological poisonings, and amale predominance in non-pharmacological poisonings. The clinical characteristics did not vary, with a predominance ofdigestive and neurological symptoms. The toxins involvedhave varied in relation to the indications in each period oftime, the aspirin poisonings disappearing in the last decade.Treatment in the emergency Department has been adaptedto the quality standards published by scientific societies,treatments that have been shown to be of low efficacy hasbeen abandoned, such as syrup of ipecac and gastric lavage.Admissions in our series have decreased by 25% vs 3%,contributed among other causes by the development andspecialisation of paediatric emergency units.Conclusions. Despite certain data indicating an improvement in care, there are still many points of improvementfor the morbidity and mortality of poisoning in pediatrics to decrease. (AU)

Relationship between acute kidney injury and mortality in poisoning - a systematic review and metanalysis.

RATIONALE: Three consensus classifications of acute kidney injury have been published. These are RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease published by the Acute Dialysis Quality Initiative workgroup), AKIN (published by the Acute Kidney Injury Network) and KDIGO (published by the Kidney Disease Improving Global Outcome workgroup). Acute kidney injury has been reported consistently as associated with worsened outcomes. However, toxicant-related acute kidney injury has been excluded from the studies used to validate the classifications of acute kidney injury. OBJECTIVE: To study whether poisoned patients who develop acute kidney injury, as defined by consensus definitions/classifications, have higher mortality compared to those who did not. METHODS: Databases were searched from 2004 to 2019 using the following keywords (KDIGO OR "Kidney Disease: Improving Global Outcomes" OR "Kidney Disease Improving Global Outcomes" OR AKIN OR "AKI network" OR "Acute kidney Injury Network" OR ADQI OR RIFLE OR "Acute dialysis quality initiative") AND (intoxication OR poisoning OR overdose OR ingestion) AND (AKI OR kidney OR renal OR ARF). If data were available, we used a random-effects meta-analysis model and Fisher's exact test to compare mortality in patients according to kidney function definitions (acute kidney injury vs not) and stages (stages vs no acute kidney injury), respectively. If data were available, we assessed the correlation between mortality and renal function (no acute kidney injury, risk/stage 1, injury/stage 2 and failure/stage 3) using the Spearman correlation. If available, we collected the results of statistical analyses in studies that have used acute kidney injury to predict mortality. RESULTS: Study selection. Thirty-three relevant studies were found, 22/33 retrospective studies (67%) and 11/33 prospective studies (33%). Paraquat was the most frequent toxicant involved (13/33, 39%). We found a disparity between studies regarding the timeframe during which mortality was assessed, the temporality of the renal function considered to predict mortality (initial/worst) and the criteria used to define/grade acute kidney injury across studies. Univariate association between acute kidney injury definitions/stages and mortality. Consensus definitions/staging of acute kidney injury were associated with higher mortality, using univariate analyses, in twenty-eight (RIFLE = 7; AKIN = 12; KDIGO = 9) studies included but not in five (AKIN = 4, KDIGO = 1). When available data were pooled, RIFLE (5 studies), AKIN (16 studies) and KDIGO definitions (8 studies) of acute kidney injury were associated with a higher mortality (Log unadjusted Odds ratios [95%-confidence interval], 2.60 [2.23; 2.97], 2.02 [1.48; 2,52] and 3.22 [2,65; 3.78], respectively). However, we found high heterogeneity (I2=54,7%) and publication bias among studies using AKIN. In ten studies with available data, the correlation between renal function (no acute kidney injury, risk/stage 1, injury/stage 2, failure/stage 3) and mortality was significant in 5 studies (RIFLE = 2; AKIN = 3), but not in five studies (RIFLE = 1; AKIN = 3; KDIGO = 1).Multivariate association between acute kidney injury definitions/stages and mortality. The definitions of acute kidney injury were associated with higher mortality in two studies (RIFLE = 2), but not in four studies (AKIN = 1 and KDIGO = 3. The stages of acute kidney injury (including one or more stages) were associated with higher mortality in four (RIFLE = 1, AKIN = 1 and KDIGO = 2). CONCLUSIONS: All three consensus definitions/classifications were associated independently with increased mortality in poisoning but with disparity between studies reporting acute kidney injury.

Hospital referrals of patients with acute poisoning by the Belgian Poison Centre: analysis of characteristics, associated factors, compliance and costs.

OBJECTIVE: Aims were (1) to assess the characteristics, associated factors and compliance of patients with acute poisoning advised by the Belgian Poison Centre (BPC) to go (conditionally) to the hospital, (2) to assess the compliance and potential health-economic impact. METHODS: Three types of referrals to the hospital of patients who called the BPC between 1 January and 30 June 2018 were analysed: referrals in case of deterioration in the patient's condition (Hosp-watchful-wait), referrals (Hosp-referral) or urgent referrals (Hosp-urgent-referral). Factors associated with type of recommendation were registered. A survey was conducted on a second dataset of patients who called the BPC between 1 March and 15 May 2019 and referred (conditionally) to the hospital. RESULTS: 5476 referrals were included: 72.4% accidental poisoning, 25.3% intentional self-harm, 1.2% substance abuse and 1.1% unclear intentionality. There were 2368 (43.2%) Hosp-watchful-wait cases, 2677 (48.9%) Hosp-referrals and 431 (7.9%) Hosp-urgent-referrals. In Hosp-watchful-wait cases, soaps and detergents were represented most (20.5%). In Hosp-referrals and Hosp-urgent-referrals, benzodiazepines (12.7% and 15.1%, respectively) predominated. Factors associated with hospitalisation type were number of symptoms, intentionality, type of agent(s) involved and advising antidotes. The survey showed that 7.8% of Hosp-watchful-wait patients went to the hospital versus 57.3% of Hosp-referrals and 59.6% of Hosp-urgent-referrals. The mean cost for Hosp-watchful-wait patients, Hosp-referrals and Hosp-urgent-referrals was estimated at €127, €767 and €796, respectively. CONCLUSION: Only a small proportion of patients followed the advice of the BPC to go (conditionally) to the hospital. A systematic follow-up of cases is warranted to examine the appropriateness of referrals and the compliance of patients.

Multi-level analysis of symptoms of poison exposure reported to the Japanese Poison Information Center.

Two types of analytical multi-level approach to analyse symptoms after exposure to poisons were performed using numerical data extracted from reports received by the JAPAN POISON INFORMATION CENTER on the number "Poisoning 110" during 1998-2017. In the first approach, data collected in 2017, 2012, 2007 and 2002 were used, while in the second approach, all data collected during 1999-2017 were used. In the first approach, according to the odds ratio, the order of causative agents was industrial drugs>home drugs>general drugs and in the second approach, it was industrial drugs>foods/natural poisoning>agricultural drugs. However, in the first approach, the order based on the 95% confidence interval (CI) and profile likelihood was general drugs>home drugs>industrial drugs and in the second approach, the order based on 95% CI, profile likelihood and Wald value was agricultural drugs>foods/natural poisoning>industrial drugs. These multi-prospects were developed using a multilevel approach and the most optimized model was selected from the number of numerical data and the adaptability of fit of the multi-level logistic regression models in this report.

[Advances in the application of clinical toxicology in the treatment of acute poisoning].

Acute poisoning is a component of emergency medicine and a key public health problem in clinical toxicology. In recent years, the research and development of industrial chemicals and drugs have developed rapidly, and the incidence of acute drug poisoning has been increasing. It is very important to strengthen the application research of clinical toxicology in acute poisoning, to identify rare and new toxic drugs, and to create conditions for rapid detection of toxic substances. Therefore, this article reviews the types of acute poisoning, the epidemiological characteristics, the detection technology and significance of clinical toxicology, the role of clinical toxicology in the treatment of acute poisoning and its application.

Evaluation of types of poisoning exposure calls managed by the Malaysia National Poison Centre (2006-2015): A retrospective review.

OBJECTIVE: Accidental or intentional poisoning is a public health concern requiring intervention. The current study designs to evaluate the types of poisoning exposure calls received by the Malaysia National Poison Centre (NPC) over a 10-year period. SETTINGS AND DATA SOURCES: The poisoning enquiries database (2006-2015) from the Malaysia NPC was used for the analysis. PARTICIPANTS: The NPC records all telephone calls that it manages using a validated and standardised form. Demographics and types of the poisoning exposure calls were extracted and descriptive analysis was applied. PRIMARY AND SECONDARY OUTCOMES: The primary outcome of this study is to evaluate NPC data for trends in the poisoning exposure calls based on the types and modes of poisoning over a 10-year period. The secondary outcome is to evaluate the characteristics of human exposure cases based on the calls received by the NPC. RESULTS: There was a notable increase in the number of poisoning exposure calls noticed during the 10-year period but dropped significantly in 2012. The highest number of poisoning exposure calls came from Selangor (21.0%), Perak (18.0%) and Negeri Sembilan (9.8%). More than half of the exposure was intentional (53.8%) involving more women (50.3%) as compared with men (41.9%), and in the 20-29 years age group category (33.5%). Exposure mostly occurred at home (96%) through the ingestion route (94.1%). Pharmaceutical products (40.5%), pesticides (31.7%) and household products (20.1%) were the common agents implicated for intentional exposure. CONCLUSIONS: There is an increasing trend in enquiries on poisoning exposure calls made to the NPC. Most of the intentional poisoning exposures occurred among younger women and involved pharmaceuticals, pesticides or household products. Poisoning safety education and other interventions are needed to curb poisoning incidents.

Intox, detox, antidotes - Evidence based diagnosis and treatment of acute intoxications.

BACKGROUND AND AIM: Aim of this review is to describe the role of clinical toxicology in the context of acute medicine. A special focus is put on antidotes and important aspects of diagnosis and therapy of acute intoxications. The data of the annual report of GIZ-Nord Poisons Centre is analyzed concerning the following aspects: what intoxications are relevant in acute medicine, are there special aspects in therapy, e.g. antidotes, and what antidotes are relevant? More over intoxication-related fatalities are analyzed. RESULTS AND CONCLUSION: In 2015 the poisons centre was consulted in 33,000 cases of acute intoxications. The most important groups are drugs (e.g. antidepressants, beta blockers and calcium channel blockers), chemical products (e.g. products containing surfactant, corrosive substances and toxic alcohols like methanol), plants and recreational drugs. Intoxications are relevant in acute medicine. Some substances can cause fatal intoxications. Important antidotes are naloxone for opiods, acetylcystein for paracetamol, fomepizole and ethanol for toxic alcohols and diazepam for intoxications caused by chloroquine.

Comparison of the Poisoning Severity Score and National Poison Data System schemes for the severity assessment of animal poisonings: a pilot study.

CONTEXT: To date, there are no publicly available schemes designed and evaluated specifically for severity assessment of animal poisonings. This poses challenges for the evaluation and comparison of animal poisoning exposure data. OBJECTIVE: Our objective for this pilot study was to evaluate agreement between raters using the Poisoning Severity Score (PSS) and National Poison Data System (NPDS) medical outcome scheme for severity assessment of canine exposures reported to a multistate poison center (PC) and to identify issues regarding their use for severity assessment of animal poisonings. Agreement between both schemes was also assessed. METHODS: The first 196 canine exposures reported to a multistate PC between 1 January and 31 August 2016 were selected and initial inquiry data from exposures was scored by four independent raters. Interrater agreement and agreement between the severity systems was calculated using weighted kappa (Κ) (Light's kappa). Reported clinical effects were also described. RESULTS: Interrater agreement for both the PSS (Κ 0.31; 95% CI 0.19, 0.43) and NPDS schemes (Κ 0.34; 95% CI 0.22, 0.44) was low. Agreement between the schemes was slight (Κ 0.05; 95% CI -0.08, 0.16) for pooled results from all four raters. For the PSS, 71.7% (n = 281) of ratings were minor, 23.0% (n = 90) moderate, and 5.4% (n = 21) severe. For the NPDS, 69.6% (n = 273) of ratings were minor, 27.0% (n = 106) moderate, and 3.3% (n = 13) severe. The top three reported clinical effects included vomiting (n = 86, 29.9%) drowsiness/lethargy (n = 38, 13.2%), and diarrhea (n = 24, 8.3%). DISCUSSION AND CONCLUSIONS: This study shows considerable variability between raters using either the PSS or NPDS schemes for canine exposures severity assessment. The subjective nature of the schemes, the influence of intra- and interrater variation, and predominance of minor cases on the study findings should be taken into account when interpreting this data. Further evaluation of these schemes is warranted and could help inform their future use for animal poisoning severity assessment.

Tratamiento de la mordedura por víbora en España / Viper bite treatment in Spain

La mordedura de víbora es, con mucho, el accidente ofídico más frecuente en nuestro país. Causa entre 100 y 150 ingresos anuales en España, siendo difícil saber el número real de urgencias atendidas por este motivo. Una correcta clasificación del grado de envenenamiento y la utilización de antivenenos son la clave para un adecuado manejo de la situación. Actualmente las controversias sobre el uso o no de antivenenos están siendo superadas debido a su alta purificación, el descenso de las reacciones alérgicas que producen y a su eficacia terapéutica. Este artículo pretende ser una puesta al día sobre la atención en Urgencias de esta afección, exponiendo de forma clara las posibilidades de tratamiento (AU)

Viper snake bite is, by far, the most common ophidian accident in Spain. It is responsible for between 100 and 150 hospitalizations per year in this country, although it is difficult to determine the frequency of emergency admissions due to this cause. The cornerstone to their approach rests on the correct evaluation of the possible effects derived from envenomation and the use of anti-venoms. In spite of all the controversies surrounding the use of anti-venoms, they have become a powerful therapeutic weapon ever since the serum has been highly purified and the great decrease of related anaphylactic reactions. The aim of this article is to update the emergency room procedures when viper bites are suspected, and to clarify the main therapeutic recommendations (AU)

Intoxicación aguda por anestésicos locales / Acute toxicity due to local anesthetics

No disponible

Retrospective study on the incidence of envenomation and accessibility to antivenom in Burkina Faso

Snakebite is a common neglected public health issue, especially in poor rural areas of sub-Saharan Africa, Asia and Latin America. Passive immunotherapy with safe and effective antivenom is the only approved treatment for it. This study aimed to determine the incidence of snakebites, and to assess the availability and accessibility of antivenoms, from 2010 to 2014, in Burkina Faso. Methods The assessment of snakebite cases managed in all health facilities from 2010 to 2014 was performed from the Statistical Yearbook of the Ministry of Health. Antivenom consumption data were collected from the drug wholesalers established in Burkina Faso. Results Snakebites are among the five leading causes of consultations in health districts. From 2010 to 2014, 114,126 envenomation cases occurred in Burkina Faso, out of which 62,293 (54.6 %) victims have been hospitalized resulting in 1,362 (2 %) deaths. The annual incidence and mortality were respectively 130 bites and 1.75 deaths per 100,000 inhabitants. The amount of antivenom sold by wholesalers were 5,738 vials with a total cost of US$ 539,055 (annual average = US$ 107,811). The high cost of these antivenoms (between US$ 42 and 170 per dose according to brand) limited their use by rural people, the main victims of snakebites, whose income is insufficient. Thus, only 4 % of patients received antivenom treatment over the past five years. The price of antivenom was reduced in 2015 to US$ 3.4 by a public drug wholesaler. Conclusion The study confirmed the high burden of snakebites in Burkina Faso. To better manage envenomation, Burkina Faso implemented a strategy consisting in seeking affordable sources of antivenom supply of good quality and innovative mechanisms of subsidy.

Hospital outcomes and economic costs from poisoning cases in Illinois.

CONTEXT: Since 2009, poisonings have been the leading cause of fatal injuries in the United States (US) and remain a continuing public health issue. Because of the varying definitions for what constitutes a poisoning case, there are inconsistencies in the annual number of cases reported among national health surveys. OBJECTIVES: The main objective of this study was to describe poisonings treated in Illinois hospitals by type of exposure, as well as to detail demographic characteristics, acute outcomes, and general cost estimates for those exposed to poisoning. We also compared a broad definition for poisoning used in our analysis with the definitions used by four national health surveys in order to assess the adequacy of various definitions in capturing poisonings for surveillance. MATERIAL AND METHODS: We conducted a comprehensive analysis of outpatients and inpatients treated in Illinois hospitals in 2010 using the Illinois hospital database. Age-adjusted incidence rates were calculated. RESULTS: In Illinois, 425,491 patients were treated in hospitals for poisoning in 2010, of whom 222,339 were inpatients. The age-adjusted incidence rate was 3,189 per 100,000 persons, with an average length of stay among inpatients of 5.5 days. The cumulative hospital charges were $7.9 billion. DISCUSSION AND CONCLUSION: The definitions used in national surveys miss 60-90% of poisoning cases. Poisoning is the leading cause of fatal injuries in the U.S., but as this study shows broadening the definition for poisoning may provide a more accurate representation of the direct and indirect effects of poisoning in the US.

[Mass poisoning events]. / Massenvergiftungen.

BACKGROUND: Mass poisoning events are rare and different in some respects from other mass casualties, especially with regard to diagnosis and triage. OBJECTIVES: Based on the description of important historical events and experiences of poison control centers, an overview is provided for different types of mass poisoning events as well as guidelines for specific medical management. MATERIALS AND METHODS: The review is based on a literature search and case reports notified to the Giftinformationszentrum-Nord Poisons Center. RESULTS: Toxicological risk assessment is based on identification of all relevant agents, evaluation of their toxic hazards (toxicity), and evaluation of the exposure (dose and pathway) for all persons exposed. This risk assessment constitutes the basis of medical diagnosis and management. In cases of suspicion of poisoning or poisonings caused by illegal drugs, risk assessment may be difficult due to the lack of important data needed for risk assessment. Mass poisonings caused by ethanol or contaminated food are well understood, with therapy being mainly symptomatic. However, in rare poisonings by other agents, a specific antidote treatment may be important. Thus, adequate antidote supplies must be available for these events. CONCLUSION: As hardly any medical professional has personal practical knowledge of mass poisoning casualties, such events are unique experiences. Thorough preparation and intensive cooperation with poison control centers and-if applicable-public health authorities may be important for best practice event management.

Drug overdose surveillance using hospital discharge data.

OBJECTIVES: We compared three methods for identifying drug overdose cases in inpatient hospital discharge data on their ability to classify drug overdoses by intent and drug type(s) involved. METHODS: We compared three International Classification of Diseases, Ninth Revision, Clinical Modification code-based case definitions using Kentucky hospital discharge data for 2000-2011. The first definition (Definition 1) was based on the external-cause-of-injury (E-code) matrix. The other two definitions were based on the Injury Surveillance Workgroup on Poisoning (ISW7) consensus recommendations for national and state poisoning surveillance using the principal diagnosis or first E-code (Definition 2) or any diagnosis/E-code (Definition 3). RESULTS: Definition 3 identified almost 50% more drug overdose cases than did Definition 1. The increase was largely due to cases with a first-listed E-code describing a drug overdose but a principal diagnosis that was different from drug overdose (e.g., mental disorders, or respiratory or circulatory system failure). Regardless of the definition, more than 53% of the hospitalizations were self-inflicted drug overdoses; benzodiazepines were involved in about 30% of the hospitalizations. The 2011 age-adjusted drug overdose hospitalization rate in Kentucky was 146/100,000 population using Definition 3 and 107/100,000 population using Definition 1. CONCLUSION: The ISW7 drug overdose definition using any drug poisoning diagnosis/E-code (Definition 3) is potentially the highest sensitivity definition for counting drug overdose hospitalizations, including by intent and drug type(s) involved. As the states enact policies and plan for adequate treatment resources, standardized drug overdose definitions are critical for accurate reporting, trend analysis, policy evaluation, and state-to-state comparison.

[Cases of poisoning in Germany. Disease entity, documentation, and aspects of the event]. / Vergiftungen in Deutschland. Krankheitsbegriff, Dokumentation und Einblicke in das Geschehen.

Cases of poisoning account for a distinct share of accidents in Germany, which is particularly high for accidents involving children. Cases of poisoning resulting from suicidal intent or abuse are not counted as accidents. Compared to other cases of disease and accidents, the numerical documentation of cases of poisoning is inadequate. Presently, there is no institution in Germany that could make available representative and meaningful data on the current state of poisoning. Owing to intensive scientific cooperation between the poison information centers (funded by the federal states) and the Poison and Product Documentation Center at the Federal Institute for Risk Assessment (BfR DocCenter) as well as to international cooperation, harmonized and standardized tools have been developed for the appropriate documentation and reporting of procedures to account for poisoning accidents. The first evaluation for 2005-2012 based on published and processed figures for the Federal Republic of Germany yielded the following results: Of approximately 230,000 telephone inquiries received in 2012, about 207,000 involved exposure of humans to different noxae. An annual increase of 3-5 % was recorded. For 2011, analyses of subsets processed by means of standardized methods yielded the following results: Medicines were involved in about 39 % of the cases recorded (of these, medicinal products for humans in 99 %); chemical/physicochemical agents in about 26 % (of these, cleaning and maintenance products in 46 %); products of daily use in about 14 % (of these, cosmetics in 40 %); and plants in about 10 %. More than 90 % of cases were acute poisoning and less than 5 %, chronic poisoning. Regarding the degree of severity of poisoning, an asymptomatic course was reported for 44 % of the cases; minor manifestations were experienced in 30 %, moderate ones in 6 %, and severe manifestations in 2 % of the cases recorded. Fatal cases were rare (< 0.1 %). The majority of cases (67 %) were caused by poisoning accidents, followed by suicidal action (20 %), with abuse and industrial poisoning (4 %) in third position; 1 % of the cases of poisoning were attributed to adverse drug reactions (ADR) and mistaking a medicinal product for another one. Infants aged 1-2 years have the highest risk of poisoning. A panel of the BfR Committee for the Assessment of Poisonings has already developed proposals for a national monitoring scheme of poisoning incidents. The aim is to prepare annual reports similar to the report of the National Poison Data System (NPDS) maintained by the American Association of Poison Control Centers (AAPCC) in the USA.