Clinical toxicology (Philadelphia, Pa.)最新文献

{"title":"Occult bromazolam exposure in patients presenting with opioid or stimulant overdose.","authors":"Adenine Cembellin-Kao, Kim Aldy, Jeffrey Brent, Rachel Culbreth, Crystal LaBozzetta, Miguel Alexander Turcios, Paul Wax, Chase Yonamine, Andrew Stolbach","doi":"10.1080/15563650.2025.2490831","DOIUrl":"https://doi.org/10.1080/15563650.2025.2490831","url":null,"abstract":"<p><strong>Introduction: </strong>Bromazolam is a benzodiazepine, not approved for use in any North American or European jurisdiction that has emerged as an adulterant in the United States illicit drug supply.</p><p><strong>Methods: </strong>This is a case series of seven patients treated for an acute overdose and found to have bromazolam in their blood despite no self-reported exposure. Patients were enrolled from June 2023 to January 2024 as part of the Drug Overdose Toxico-Surveillance Reporting Program, a multi-center, prospective project including patients aged 13 years and older with a suspected life-threatening opioid and/or stimulant overdose. This case series is drawn from a single emergency department from that project. Patients were interviewed on their drug use, and clinical data were collected from electronic medical records. Whole blood was obtained and tested qualitatively for over 1,200 psychoactive substances using liquid chromatography quadrupole time-of-flight mass spectrometry and quantitative measurements using liquid chromatography-tandem quadrupole mass spectrometry.</p><p><strong>Results: </strong>Patients presented with acute signs of excessive sedation (six of seven) or agitation (one of seven). The median blood bromazolam concentration was 29 µg/L (range <5-84 µg/L). Three patients were admitted to hospital or observed for more than 24 h in the emergency department. The reasons for admission/observation were advanced pregnancy, prolonged sedation, and the need for social services. No patients were placed in a critical care unit and all patients survived. During the structured interview, none of the patients reported bromazolam use.</p><p><strong>Discussion: </strong>This case series demonstrated no poor clinical outcomes in patients with acute overdose who had detectable bromazolam concentrations despite no reported bromazolam use. In all cases of sedation, patients responded to naloxone (in all cases the patients admitted to taking opioids, which was confirmed analytically), and there was no ongoing sedation attributed to the detected bromazolam.</p><p><strong>Conclusions: </strong>Substances unknown to patients are present in the drug supply. Toxico-surveillance programs are essential to obtaining information about community patterns of drug use that cannot be obtained from patient history or from medical charts.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":"63 5","pages":"330-336"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors' reply to comment on Fox et al. \"Out-of-hospital assessment and triage of paracetamol (acetaminophen) exposure in the United States and Canada: a consensus guideline\".","authors":"Evelyn Fox, Alicia Dalton, Richard Dart","doi":"10.1080/15563650.2025.2505128","DOIUrl":"https://doi.org/10.1080/15563650.2025.2505128","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":"63 5","pages":"373"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should chlordiazepoxide and diazepam be avoided when treating alcohol withdrawal syndrome in patients with hepatic insufficiency?","authors":"Steven J Weintraub","doi":"10.1080/15563650.2025.2493216","DOIUrl":"https://doi.org/10.1080/15563650.2025.2493216","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Chlordiazepoxide and diazepam are first-line treatments for patients with alcohol withdrawal. However, their use is discouraged in hepatic insufficiency due to concerns that impaired metabolism may prolong their half-lives and those of their active metabolites, increasing the risk of prolonged sedation to an unacceptable level.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;The activity of chlordiazepoxide and its metabolites: &lt;/strong&gt;Findings presented here suggest that chlordiazepoxide has minimal sedative activity-its effect is primarily dependent on its metabolites. Chlordiazepoxide metabolism occurs through hepatic oxidation, so its biotransformation to its metabolites can be markedly delayed in patients with hepatic insufficiency. Because unmetabolized chlordiazepoxide has little activity, this delay may lead to the administration of a considerable cumulative dose before a therapeutic response occurs. This could result in the accumulation of a substantial reservoir of unmetabolized chlordiazepoxide (\"dose-stacking\"). This reservoir would undergo slow biotransformation to chlordiazepoxide metabolites, even after dosing is discontinued. The chlordiazepoxide metabolite demoxepam has a markedly longer half-life (14-95 h) than chlordiazepoxide (6.6-28 h), which may be further prolonged by hepatic insufficiency. Therefore, if chlordiazepoxide dose-stacking occurs in patients with hepatic insufficiency, demoxepam may also accumulate. This can result in a delayed, profound, and prolonged sedative effect.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;The activity of diazepam and its major metabolite: &lt;/strong&gt;The major metabolite of diazepam, desmethyldiazepam, is no more sedating than diazepam itself. As a result, the rapid onset sedative effect of diazepam-reaching its peak within 5 min when administered intravenously and within 120 min when administered orally-is unaffected by hepatic insufficiency. This allows accurate titration of diazepam to avoid prolonged sedation, even with compromised liver function.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The widely accepted assertion that the increased risk of prolonged sedation when using chlordiazepoxide to treat alcohol withdrawal in patients with hepatic insufficiency is primarily due to the prolonged half-lives of chlordiazepoxide and its metabolites appears incorrect. It primarily results from a delayed onset of action and peak effect, driven by slowed chlordiazepoxide metabolism and the greater activity of its metabolites compared to the parent drug. These factors combine to increase the risk of dose-stacking. Dose-stacking is readily avoided with diazepam use in patients with hepatic insufficiency because its rapid time-to-peak effect is unaffected.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Although it has long been recommended that diazepam be avoided for the treatment of alcohol withdrawal in patients with hepatic insufficiency, the findings presented here suggest that it can be used as long as the dosing interval exceeds the time-to-","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":"63 5","pages":"303-309"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous extracorporeal clearance in metformin-associated lactic acidosis and metformin-induced lactic acidosis: a systematic review.","authors":"Matthew S Correia,&nbsp;B Z Horowitz","doi":"10.1080/15563650.2022.2127363","DOIUrl":"https://doi.org/10.1080/15563650.2022.2127363","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Metformin poisoning with lactic acidosis is an uncommon yet clinically serious condition related to the inhibition of normal aerobic metabolism. Toxicity may occur after an acute overdose although it is much more common after a systemic insult, such as acute kidney injury, in the setting of chronic use. Hemodialysis is currently the preferred extracorporeal treatment modality (Grade 1D evidence) although some patients may be too hemodynamically unstable to tolerate it. Continuous renal replacement therapy is considered an alternative if hemodialysis is unavailable but an evaluation of survival amongst this specific treatment class is lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess overall survival and provide an updated review of the toxicokinetic elimination parameters of patients receiving continuous renal replacement therapy for metformin poisoning.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A comprehensive search was performed using the EMBASE and MEDLINE libraries from inception until November 30, 2021. Data was extracted and findings were summarized. Toxicokinetic parameters were analyzed and confirmed for accuracy when data permitted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eighty-three reports met inclusion criteria. These consisted of only low-quality evidence including 75 case reports, four case series, and four descriptive retrospective reviews. Overall survival among patients suffering from metformin toxicity who received continuous extracorporeal treatment was 85.8%. When stratified between metformin-induced lactic acidosis and metformin-associated lactic acidosis, survival was 75.0% and 87.4%, respectively. Available continuous renal replacement therapy toxicokinetic parameters were quite heterogeneous. Errors in previously published toxicokinetic calculations were noted in only two instances. The overall average and median peak metformin concentrations were 70.5 mg/L and 41.9 mg/L, respectively. The average and median extracorporeal clearance rates were 39.0 mL/min and 42.1 mL/min (range 9.0-58.7 mL/min). The average and median elimination half-life parameters were 27.5 h and median 23.0 h. Elimination half-life ranged from seven to 74 h. There was no meaningful relationship between peak metformin concentration and continuous extracorporeal treatment half-life at lower concentrations, though at very high concentrations (over 200 mg/L), there was a trend towards a half-life below 20 h. There is insufficient data to robustly evaluate overall survival in relation to the extracorporeal clearance rate. Finally, there was no relevant relationship between maximal lactate concentration and survival, nor nadir pH and survival, for patients with either type of metformin toxicity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This retrospective systematic analysis of published cases treating metformin related lactic acidosis with continuous renal replacement therapy notes an overall slightly greater survival percentage compared to ","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1266-1276"},"PeriodicalIF":3.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33512181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of pesticide ban on suicide trend - a 20-year study from a tertiary care center in Central Kerala from 2001 to 2020.","authors":"M Indira,&nbsp;Manu Johns Chowallur,&nbsp;Aryamol M K,&nbsp;Chien-Yu Lin,&nbsp;Shu-Sen Chang,&nbsp;Mannil Sooraj,&nbsp;Jithin Thomas","doi":"10.1080/15563650.2022.2129671","DOIUrl":"https://doi.org/10.1080/15563650.2022.2129671","url":null,"abstract":"<p><p><b>Introduction:</b> We assessed the effect of the pesticide regulations implemented in 2011 on suicide trend in Kerala state of India.<b>Materials and methods:</b> Data were collected from case records of suicide autopsies done in a single tertiary care hospital in Thrissur district of Kerala in 2001-2020. Linear trends in overall suicide rates were identified using joinpoint regression analysis. We used Poisson regression models to estimate the annual expected number of suicides in 2011-2020 and calculated the rate ratios between the observed number of suicide and that expected according to the linear pre-ban suicide trend (2005-2010).<b>Results:</b> There were a total of 14,593 suicide autopsies (2501 pesticide autopsies) in 2001-2020. Carbofuran was the commonest pesticide identified, followed by quinalphos, zinc phosphide, and chlorpyrifos. In 2011-2020, overall suicide rates were 22%-48% and pesticide suicide rates were 20%-55% lower than those expected according to pre-ban suicide trends (2005-2010), with the only exception of a 16% higher-than-expected pesticide suicide rate in 2011. There was no change in trend in hanging suicides.<b>Conclusion:</b> Lower-than-expected overall and pesticide suicide rates were found in Thrissur district after the 2011 bans of pesticides in Kerala, with no evidence of means replacement to hanging.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1214-1219"},"PeriodicalIF":3.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40647411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe glycerol intoxication mimicking toxic alcohol ingestion following large volume consumption of vanilla essence.","authors":"Lori Coulson,&nbsp;Anna Surla,&nbsp;Viet Tran,&nbsp;Kerry Hoggett","doi":"10.1080/15563650.2022.2114911","DOIUrl":"https://doi.org/10.1080/15563650.2022.2114911","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with ethanol dependence may consume vanilla extract for the high alcohol content.</p><p><strong>Case presentation: </strong>A 42-year-old male with ethanol dependence who developed status epilepticus, severe anion gap metabolic acidosis and a hyperosmolar non-ketotic coma after ingestion of 600 mL vanilla essence. He was found to have an osmolar gap of 151 with a marked pseudohypertriglyceridaemia of 96.4 mmol/L (8350 mg/dL), found to be secondary to significantly elevated glycerol levels. The patient required intubation for status epilepticus and dialysis to correct the severe acid-base disturbance and remove excess glycerol. The patient made a full recovery.</p><p><strong>Discussion: </strong>Glycerol is traditionally thought to be a nontoxic alcohol, but this represents a severe case of glycerol toxicity requiring treatment with dialysis. It may represent an emerging or underdiagnosed clinical presentation given availability of high-glycerol products. In the right clinical context, pseudohypertriglyceridaemia and altered mental state may be recognised as glycerol intoxication, avoiding the need for unnecessary investigations.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1248-1250"},"PeriodicalIF":3.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40333396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The onset and severity of acute opioid toxicity in heroin overdose cases: a retrospective cohort study at a supervised injecting facility in Melbourne, Australia.","authors":"Nathan C Stam,&nbsp;Shelley Cogger,&nbsp;Jennifer L Schumann,&nbsp;Anthony Weeks,&nbsp;Amanda Roxburgh,&nbsp;Paul M Dietze,&nbsp;Nicolas Clark","doi":"10.1080/15563650.2022.2126371","DOIUrl":"https://doi.org/10.1080/15563650.2022.2126371","url":null,"abstract":"<p><strong>Aim: </strong>To differentiate the severity of acute opioid toxicity and describe both the clinical and physiological features associated with heroin overdose in a cohort of witnessed overdose cases.</p><p><strong>Methods: </strong>Witnessed heroin overdose cases over a 12-month period (30 June 2018 - 30 June 2019) at the Medically Supervised Injecting Room (MSIR) in Melbourne, Australia were examined. The severity of acute opioid toxicity was classified according to the level of clinical intervention required to manage the overdose cases where an escalating level of care was provided. Heroin overdose cases were classified into one of three graded severity categories and a fourth complicated heroin overdose category.</p><p><strong>Results: </strong>A total of 1218 heroin overdose cases were identified from 60,693 supervised injecting visits over the study period. On the spectrum of toxicity, 78% (<i>n</i> = 955) of overdose cases were classified as Grade 1 severity, 7% (<i>n</i> = 83) as Grade 2 severity, and 13% (<i>n</i> = 161) as Grade 3 acute opioid toxicity severity cases, as well as 2% (<i>n</i> = 19) classified as complicated heroin overdose cases. The median onset time for heroin overdose cases was 17 min (IQR 11-28 min) from the time the individual was ready to prepare and inject heroin until clinical intervention was initiated.</p><p><strong>Conclusion: </strong>We demonstrated that heroin overdose is a dynamic illness and cases differ in the severity of acute opioid toxicity. The risk of airway occlusion including positional asphyxia was an early and consistent feature across all levels of toxicity, while exaggerated respiratory depression together with exaggerated depression of consciousness was increasingly observed with greater levels of toxicity. We also demonstrated the importance of early intervention in overdose cases, where in a large cohort of heroin overdose cases there were no fatal outcomes, a very low hospitalisation rate and most cases were able to be managed to clinical resolution on-site.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1227-1234"},"PeriodicalIF":3.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33491326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous lipid emulsion for ivermectin toxicity in an eight-year-old male.","authors":"Molly K Stott,&nbsp;Martha S Phillips,&nbsp;Sophia Sheikh","doi":"10.1080/15563650.2022.2134023","DOIUrl":"https://doi.org/10.1080/15563650.2022.2134023","url":null,"abstract":"S. E. Hodgson Victorian Poisons Information Centre, Austin Health, Victoria, Australia Emergency Department, Austin Health, Victoria, Australia sarah.hodgson@austin.org.au A. Graudins Victorian Poisons Information Centre, Austin Health, Victoria, Australia Monash Clinical Toxicology Unit, Emergency Medical Service, Monash Health, Victoria, Australia Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash Emergency Research Collaborative, Monash University, Dandenong, Australia","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1287-1288"},"PeriodicalIF":3.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40645491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vasodilation in patients with calcium channel blocker poisoning treated with high-dose insulin: a comparison of amlodipine versus non-dihydropyridines.","authors":"Jon B Cole,&nbsp;Samantha C Lee,&nbsp;Matthew E Prekker,&nbsp;Nathan M Kunzler,&nbsp;Kelly A Considine,&nbsp;Brian E Driver,&nbsp;Michael A Puskarich,&nbsp;Travis D Olives","doi":"10.1080/15563650.2022.2131565","DOIUrl":"https://doi.org/10.1080/15563650.2022.2131565","url":null,"abstract":"<p><p><b>Background:</b> High dose insulin (HDI), an inotrope and vasodilator, is a standard therapy for calcium channel blocker (CCB) poisoning. HDI causes vasodilation by stimulating endothelial nitric oxide synthase (eNOS). Most literature supporting HDI for CCB poisoning involves verapamil toxicity; however, amlodipine now causes more CCB poisonings. Unlike other CCBs, amlodipine stimulates eNOS and may cause synergistic vasodilation with HDI. The purpose of this study was to determine if amlodipine-poisoned patients treated with HDI had more evidence of vasodilation than similarly treated patients with non-dihydropyridine (non-DHP) poisoning.<b>Methods:</b> This was a retrospective study from a single poison center. Cases were identified via the generic code \"Calcium Antagonists\" in which the therapy \"High Dose Insulin/Glucose\" was \"performed, whether or not recommended\" from 2019-2021. Evidence of vasodilation was assessed via maximum number of vasopressor infusions per case, vasopressor doses, and use of rescue methylene blue to treat refractory vasoplegia.<b>Results:</b> Thirty-three patients were enrolled: 18 poisoned with amlodipine, 15 with non-DHPs (verapamil <i>n</i> = 10, diltiazem <i>n</i> = 5). The median number of maximum concomitant vasopressors in the amlodipine group was 3 (IQR: 2-5; range 0-6) and 2 in the non-DHP group (IQR: 1-3; range 0-5; <i>p</i> = 0.04); median difference in maximum concomitant vasopressors between groups was 1 (95% confidence interval: 0-2). Median maximum epinephrine dosing was higher in the amlodipine group (0.31 mcg/kg/min) compared to non-DHPs (0.09 mcg/kg/min; <i>p</i> = 0.03). Use of rescue methylene blue was more common in the amlodipine group (7/18 [39%]) than in the non-DHP group (0; <i>p</i> = 0.009).<b>Conclusions:</b> Amlodipine poisoned patients treated with HDI required more vasopressors, higher doses of epinephrine, and more often received rescue methylene blue than similarly treated patients with verapamil or diltiazem poisoning. These differences suggest amlodipine-poisoned patients had more evidence of vasodilation. Further study is warranted to determine if synergistic vasodilation occurs when HDI is used to treat amlodipine poisoning.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1205-1213"},"PeriodicalIF":3.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40669351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Poisoning in older adults: characterization of exposures reported to the Dutch Poisons Information Center.","authors":"Saskia J Rietjens,&nbsp;Joyce E M van der Heijden,&nbsp;Dylan W de Lange","doi":"10.1080/15563650.2022.2116339","DOIUrl":"https://doi.org/10.1080/15563650.2022.2116339","url":null,"abstract":"<p><p><b>Introduction:</b> The annual number of patients > 65 years old about whom the Dutch Poisons Information Center (DPIC) was consulted has more than doubled in the last decade. We aimed to gain insight in the type and circumstances of exposures reported to the DPIC involving older patients, in order to help prevent future poisonings. <b>Methods:</b> Enquiries to the DPIC involving patients > 65 years old were prospectively included from January 2019 to June 2019. Data were collected on patient characteristics (e.g., age, gender, and living situation) and exposure characteristics (e.g., type and exposure scenario). <b>Results:</b> In the first half of 2019, the DPIC was consulted about 1051 patients > 65 years old. The median age of the patients was 77 years old (range: 66-104 years) and women were over-represented (61%). A total of 1650 different substances were reported, 1213 pharmaceutical exposures (74%) and 437 non-pharmaceutical exposures (26%), mostly household products (<i>n</i> = 162). Most pharmaceutical exposures involved cardiovascular agents (<i>n</i> = 367, 30%), central and peripheral nervous system agents (<i>n</i> = 354, 29%), and analgesics (<i>n</i> = 152, 13%). In 71% of the patients exposed to pharmaceuticals, the drugs were taken unintentionally (<i>n</i> = 471), frequently caused by medication errors made by the patients themselves (<i>n</i> = 357, 76%). Most common scenarios included inadvertently taken/given a double (<i>n</i> = 140, 30%) or more than double (<i>n</i> = 94, 20%) dose or the wrong medication (<i>n</i> = 124, 26%). The most common scenario for unintentional exposure to non-pharmaceuticals was \"mistook product for food/drink\" (<i>n</i> = 122, 37%). <b>Conclusions:</b> The majority of intoxications in older adults are accidental and often involve medication errors. Unintentional poisoning is often preventable. If patients are cognitively impaired, potentially harmful substances should be kept out of their reach and medication should only be administered under direct supervision. Clear labelling, simplified drug regimens and the use of automatic medication dispensers could reduce the risk of medication errors in older patients.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1240-1247"},"PeriodicalIF":3.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33479349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}