Clinical toxicology (Philadelphia, Pa.)最新文献

{"title":"Link between paediatric suicidal poisonings and school calendar: a national French Poison Centres study.","authors":"Mathieu Glaizal, Matthieu Petit, Corinne Schmitt, Nicolas Simon","doi":"10.1080/15563650.2026.2654541","DOIUrl":"10.1080/15563650.2026.2654541","url":null,"abstract":"<p><strong>Introduction: </strong>Calls to French Poison Centres reflected the observed increase in attempted suicides during the COVID-19 pandemic, especially among adolescent girls and young women. We aim to investigate, through French Poison Centres data, another poorly documented (particularly in France) characteristic of paediatric suicidal behaviours: the influence of school holiday periods on their frequency.</p><p><strong>Methods: </strong>We performed a retrospective descriptive study of the weekly number of suicidal self-poisonings managed by French Poison Centres in patients under the age of 18 in mainland France from 1 January 2017 to 31 December 2024. For comparison, weekly adult cases over the same period were also counted.</p><p><strong>Results: </strong>Prior to (2017-2019), during (2020-2021) and following (2022-2024) the pandemic, a substantial fluctuation was observed in the weekly number of paediatric self-poisonings throughout each year. However, there was a notable synchronization in the low points between years, despite an overall increase of 79% in the annual numbers between the pre- and post-COVID-19 periods. These lower parts corresponded to weeks of school closure, planned holidays and not lockdowns. The sustained increase in annual cases affected girls (+90%) much more than boys (+27%), and the link with the school calendar was only valid for girls.Over the same eight-year period, neither an annual increase in cases nor a link with school holidays was observed among adults.</p><p><strong>Discussion: </strong>Without overlooking the numerous factors outside the school environment that influence young people's mental health, including the growing importance of their digital social life, our findings also suggest the existence of school-specific stressors to which girls may be particularly vulnerable. Although we cannot here identify and quantify the endogenous (self-esteem, pressure related to academic performance, etc.) and exogenous (bullying, relationships with teachers, etc.) components of these stressors, the link to French pupils' low scores on numerous indicators from international studies on student well-being, with a pronounced gender disparity, seems worth considering.</p><p><strong>Conclusion: </strong>At the French national level, our findings illustrate both the persistence of the \"COVID-19 effect\" of increased paediatric suicidal poisonings, particularly in girls, after the pandemic; and the strong association between these attempts and school time, specifically among girls and regardless of the pandemic.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"917-922"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731193","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":"Comment on serum cannabinoid profiles of emergency department patients presenting with cannabinoid hyperemesis syndrome and acute cannabis intoxication.","authors":"Daniel-Jiajun Yu, Eric Villeneuve, Sophie Gosselin, Josh J Wang","doi":"10.1080/15563650.2026.2729698","DOIUrl":"10.1080/15563650.2026.2729698","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"970-971"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922548","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 effects of hyperbaric oxygen dosing on the delayed neuropsychiatric sequalae of carbon monoxide poisoning.","authors":"Ivan Gur, Alon Safrai, Yuval Nov","doi":"10.1080/15563650.2026.2666318","DOIUrl":"10.1080/15563650.2026.2666318","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;A paucity of evidence exists as to the comparative effectiveness of various hyperbaric oxygen regimens in preventing delayed neuropsychiatric sequelae. We aimed to compare the effect of four such treatment regimens: (1) &lt;i&gt;P&lt;/i&gt;O&lt;sub&gt;2&lt;/sub&gt; = 2.0&lt;sub&gt;ATA&lt;/sub&gt; for 90 min once; (2) &lt;i&gt;P&lt;/i&gt;O&lt;sub&gt;2&lt;/sub&gt; = 2.0&lt;sub&gt;ATA&lt;/sub&gt; for 90 min thrice; (3) &lt;i&gt;P&lt;/i&gt;O&lt;sub&gt;2&lt;/sub&gt; = 2.8&lt;sub&gt;ATA&lt;/sub&gt; for 90 min once; and (4) &lt;i&gt;P&lt;/i&gt;O&lt;sub&gt;2&lt;/sub&gt; = 2.8&lt;sub&gt;ATA&lt;/sub&gt; for 90 min once followed by two sessions of 2.0&lt;sub&gt;ATA&lt;/sub&gt;.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We retrospectively reviewed the records of all patients treated in a large regional hyperbaric referral facility over the past 30 years, and identified patients displaying any new cognitive, motor or psychiatric symptoms within 2-40 days from exposure to carbon monoxide - any of which was defined as delayed neuropsychiatric sequelae. Excluded were patients not complying with the full prescribed treatment course or those lacking a full medical record for at least a year following exposure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 312 patients included in the final analysis, the incidence of delayed neuropsychiatric sequelae was 31/87 (36%), 20/54 (37%), 20/102 (20%) and 13/69 (19%) in the 2.0&lt;sub&gt;ATA&lt;/sub&gt; once, 2.0&lt;sub&gt;ATA&lt;/sub&gt; thrice, 2.8&lt;sub&gt;ATA&lt;/sub&gt; once and 2.8&lt;sub&gt;ATA&lt;/sub&gt; thrice treatment groups, respectively (&lt;i&gt;P&lt;/i&gt; = 0.011). Patients treated with the lower-pressure regimen (2.0&lt;sub&gt;ATA&lt;/sub&gt; once and thrice) had a significantly higher delayed neuropsychiatric sequelae rate compared to those treated with higher &lt;i&gt;P&lt;/i&gt;O&lt;sub&gt;2&lt;/sub&gt; (2.8&lt;sub&gt;ATA&lt;/sub&gt; once and thrice) - 36.2% versus 19.3% respectively (&lt;i&gt;P&lt;/i&gt; = 0.0013). In a multivariate logistic regression model adjusting for age, carboxyhemoglobin levels, and presenting symptoms, the higher-pressure protocol was independently associated with a 55% reduction in the odds of developing delayed neuropsychiatric sequelae (adjusted odds ratio = 0.45; 95% confidence interval: 0.26-0.77; &lt;i&gt;P&lt;/i&gt; = 0.004). Increasing the frequency of sessions from one to three was not associated with a statistically significant benefit (&lt;i&gt;P&lt;/i&gt; = 0.9). The presence of seizures on admission was the strongest predictor of poor outcome (adjusted odds ratio = 4.27; &lt;i&gt;P&lt;/i&gt; = 0.023).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The observed 55% reduction in the odds of developing delayed neuropsychiatric sequelae with the 2.8&lt;sub&gt;ATA&lt;/sub&gt; protocol suggests that achieving a higher initial partial pressure of oxygen is critical to effectively interrupting the inflammatory cascades associated with carbon monoxide toxicity. Because additional sessions did not confer a statistically significant benefit, meeting this initial therapeutic threshold appears more impactful than treatment frequency. Notably, the neuroprotective benefits of the higher-pressure regimen were sustained even among high-risk patients presenting with seizures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusi","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"888-896"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147966926","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":"Analysis of patients with hydrogen sulfide poisoning reported to the Taiwan Poison Control Center between 1986 and 2021.","authors":"Yuan-Chih Wen, Feng-Yuan Chu, Te-Hao Wang, Jou-Fang Deng, Chen-Chang Yang","doi":"10.1080/15563650.2026.2675040","DOIUrl":"10.1080/15563650.2026.2675040","url":null,"abstract":"<p><strong>Introduction: </strong>Hydrogen sulfide exposure is a major cause of occupational poisoning and is frequently associated with life-threatening effects. This study aimed to investigate the patterns, poisoning severity, and predictors of severity in patients with hydrogen sulfide poisoning in Taiwan.</p><p><strong>Methods: </strong>This study identified all hydrogen sulfide poisoning cases reported to the Taiwan Poison Control Center between 1986 and 2021. Their medical records were independently reviewed by two trained clinical toxicologists. Categorical variables were assessed using Fisher's exact test, while continuous variables were analyzed using the Mann-Whitney <i>U</i>-test. Multiple variable logistic regression was performed to calculate adjusted odds ratios and 95% confidence intervals for various factors associated with severe-to-fatal outcomes, adjusted for age and sex.</p><p><strong>Results: </strong>A total of 168 patients were included in the study. Over 70% were exposed occupationally, including those working in the manufacturing industry (41.6%), underground settings (17.9%), and hot spring reservoirs (14.3%). Severe-to-fatal poisoning occurred in 93 patients (46 with severe poisoning and 47 fatalities). Several factors were found to be associated with severe-to-fatal poisoning, including working in confined spaces (adjusted odds ratio = 2.59, <i>P</i> = 0.03), underground workplaces (adjusted odds ratio = 6.60, <i>P</i> = 0.002) and presence of lung infiltrations (adjusted odds ratio = 167.6, <i>P</i> = 0.001). Higher initial pH (adjusted odds ratio = 0.48, <i>P</i> = 0.039) and bicarbonate levels (adjusted odds ratio = 0.79, <i>P</i> = 0.02) were associated with lower odds of severe-to-fatal poisoning. Prompt administration of sodium nitrite before out-of-hospital cardiac arrest was related to a lower odds of death (adjusted odds ratio = 0.43, <i>P</i> = 0.49), though the result did not reach statistical significance.</p><p><strong>Discussion: </strong>Hydrogen sulfide poisoning in Taiwan was predominantly occupational and frequently occurred in confined environments, with a high proportion of severe and fatal outcomes. These findings underscore the critical role of environmental conditions and early clinical presentation in determining poisoning severity. While sodium nitrite may have potential therapeutic value, its effectiveness remains uncertain. Further studies are needed to clarify the role of sodium nitrite and optimize management strategies.</p><p><strong>Conclusions: </strong>Working in confined workplaces or underground environments, initial metabolic acidosis, and pulmonary infiltrates were each associated with a higher odd of a severe-to-fatal hydrogen sulfide poisoning. Early sodium nitrite use before out-of-hospital cardiac arrest might be associated with lower, albeit statistically insignificant, case fatality.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"933-942"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148255538","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 lacosamide intoxication in end-stage renal disease: effective removal with sequential high-flux dialysis and hemodiafiltration.","authors":"Juan Rey Valeriano, Gloria Queipo de Llano Orellana, Isabel Gomila Muñiz, Jordi Puiguriguer Ferrando, Bernardino Barceló Martín","doi":"10.1080/15563650.2026.2693679","DOIUrl":"10.1080/15563650.2026.2693679","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"964-966"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148595422","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":"Acute iron toxicity following therapeutic intravenous ferric carboxymaltose in chronic liver dysfunction.","authors":"Robert Short-Burchell, Dino Druda, Sarah Hodgson","doi":"10.1080/15563650.2026.2695234","DOIUrl":"10.1080/15563650.2026.2695234","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"967-969"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148815269","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":"Clinical analysis of 21 cases of chlorfenapyr poisoning.","authors":"Zhigao Xu, Ding Yuan, Yanwu Yu, Guiying Zhu, Gaiqin Yan, Jihong Chen, Jianjun Guo, Lu Che, Yan Li, Yuqi Du, Heying Yue, Fang Yang, Yi Li, Yan Zhang, Yanxia Gao","doi":"10.1080/15563650.2026.2669184","DOIUrl":"10.1080/15563650.2026.2669184","url":null,"abstract":"<p><strong>Introduction: </strong>Chlorfenapyr is a pyrrole insecticide metabolized to the active toxin tralopyril. Reports of poisoning have increased recently. This retrospective study analyzed clinical data to examine clinical features and describe characteristics observed in fatal outcomes.</p><p><strong>Methods: </strong>Clinical data were collected from patients with chlorfenapyr poisoning at the First Affiliated Hospital of Zhengzhou University (2020-2024). Patients were categorized into survivors and non-survivors to describe demographic, clinical, laboratory, and imaging findings.</p><p><strong>Results: </strong>Twenty-one patients were included (case fatality: 28.6%). Among oral exposures, non-survivors ingested a higher estimated dose than survivors, with median 122.5 mL (IQR 105-125 mL) versus 20.0 mL (IQR 20.0-30.0 mL). Non-survivors exhibited longer symptom latency, median 24.0 versus 1.0 h and a delay in neurological symptoms, with median of 2.5 days. Plasma concentrations of chlorfenapyr and tralopyril were numerically higher in non-survivors, median 293 versus 147 ng/mL and 946 versus 531 ng/mL, respectively, compared to survivors. Clinically, non-survivors universally (100%) exhibited fever, diaphoresis, and impaired consciousness; they also showed higher frequencies of paresthesia (50%), bowel/bladder dysfunction (50%), and muscle weakness (50%). Laboratory analysis in non-survivors revealed higher creatine kinase, median 1266.0 versus 72.0 U/L, aspartate aminotransferase, lactate dehydrogenase, myoglobin, prothrombin time, and lipase. Abnormal magnetic resonance imaging signals were observed in all non-survivors (3/3) compared to only 12.5% (1/8) of survivors.</p><p><strong>Discussion: </strong>In this cohort, the observed latent period followed by a hypermetabolic state aligns with the delayed conversion of chlorfenapyr to tralopyril and its uncoupling of mitochondrial respiration. The specific pattern of elevated muscle enzymes and central nervous system lesions reflects injury primarily to tissues with high metabolic demand. Furthermore, the sustained plasma toxin concentrations despite extracorporeal clearance indicate a large total body burden and prolonged toxicity.</p><p><strong>Conclusion: </strong>Fatal chlorfenapyr poisoning was characterized by a latency period followed by a hypermetabolic state (fever, diaphoresis) and severe neurological/muscular injury. Fever, impaired consciousness, elevated muscle enzymes (notably CK), and specific brainstem/spinal cord MRI abnormalities were observed in fatal cases, whereas these features were largely absent in survivors.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"897-907"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148146050","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":"Mass Datura poisoning in Martinique - a descriptive case series.","authors":"Jonathan Florentin, Hatem Kallel, Noura Boudeau-Zohair, Remi Neviere, Bruno Mégarbane, Dabor Resiere","doi":"10.1080/15563650.2026.2649349","DOIUrl":"10.1080/15563650.2026.2649349","url":null,"abstract":"<p><strong>Introduction: </strong>The severity and clinical consequences of exposure to Datura have been infrequently investigated. No data exist in the French Indies of America. We aimed to describe presentations and outcomes in a mass poisoning attributed to a Datura-contaminated batch of organic buckwheat flour, managed in Martinique.</p><p><strong>Methods: </strong>All patients who contacted the emergency call center or were treated at Martinique's University Hospital for presumed Datura poisoning in February-March 2019 were included. Data were collected retrospectively from the records. Quantitative parameters are expressed as median, [IQR].</p><p><strong>Results: </strong>Fifty-one poisoned patients were identified including 31 females (62%) and 20 males (38%), with a median age of 40 years [IQR 30-53 years]. Time to symptom onset was one hour [IQR 1-2 hours]. The most frequent symptoms included dry mouth (67%), vertigo (43%), inebriation (43%) and gastrointestinal disturbances (31%). One patient required intensive care. All patients recovered completely.</p><p><strong>Discussion: </strong>The rapid intervention of the Regional Health Agency, retrieving the incriminated batch and informing the public together with hospital team's engagement, limited the extent of poisonings.</p><p><strong>Conclusion: </strong>Martinique's Datura contamination of buckwheat flour resulted in fifty-one poisonings with mild-to-moderate toxicities. A multidisciplinary toxicosurveillance and a rapid public health response are required to limit the extent of population exposure and poisoning severity.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"955-958"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805197","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":"Suspected serotonin toxicity following combined nefopam and tramadol use in an older adult.","authors":"Phillip Bibawy, Iqra Ghauri","doi":"10.1080/15563650.2026.2692607","DOIUrl":"10.1080/15563650.2026.2692607","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"962-963"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148393150","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":"Flumazenil use in acute poisoning: improved composite clinical outcomes in a propensity-matched retrospective cohort study.","authors":"Sze Yi Choi, Shan Liu","doi":"10.1080/15563650.2026.2665214","DOIUrl":"10.1080/15563650.2026.2665214","url":null,"abstract":"<p><strong>Introduction: </strong>Despite being an effective benzodiazepine antagonist, flumazenil is not routinely used in patients with overdose due to the potential risk of major adverse events. Although recent studies have reported a low rate of major adverse events, the benefit of its utility on clinical outcomes remains unclear. This study aims to determine the effect of flumazenil treatment on the clinical outcomes of comatose patients with acute benzodiazepine or nonbenzodiazepine hypnotics poisoning.</p><p><strong>Methods: </strong>This was a retrospective observational study on consecutive adult patients reported to the Hong Kong Poison Control Centre from 1 July 2008 to 31 December 2024 for benzodiazepine or nonbenzodiazepine hypnotics overdose with Glasgow Coma Scale eight or less. Patients treated with flumazenil, the intervention, were matched with patients in the control group by propensity score matching. The Finkelstein-Schoenfeld method with matched pairs approach was used to compare the primary outcome, a hierarchical composite endpoint consisting of in-hospital death, intensive care unit admission, and length of hospital stay. Secondary outcomes included mechanical ventilation and pneumonia within two days.</p><p><strong>Results: </strong>A total of 599 patients were included for propensity score matching, and 98 patients in the intervention group and 501 patients in the control group were matched in a 1:1 ratio. Two patients in the intervention group and one patient in the control group died during the in-patient episode of care; the deaths in the intervention group were not attributed to flumazenil. The hierarchical composite endpoint (in-hospital death, then ICU admission, then length of hospital stay) in the interventional group was significantly improved, with a win ratio of 1.68 (95% CI 1.17-2.41). The ICU admission rate (42.9% vs 69.4%, <i>P <</i>0.001) and the proportion of patients who received mechanical ventilation (35.7% versus 65.3%, <i>P <</i>0.001) was significantly lower in the intervention group. No difference was found in the death, length of stay and occurrence of rapid-onset pneumonia.</p><p><strong>Discussion: </strong>These results indicate the improvement of primary outcome in the intervention group was predominantly attributed to the reduction in ICU admission and mechanical ventilation. The effect size of flumazenil treatment could be partially offset by the adoption of non-invasive airway management strategy.</p><p><strong>Conclusion: </strong>Among comatose patients with acute benzodiazepine or nonbenzodiazepine hypnotics poisoning, flumazenil treatment was associated with reduction in ICU admission and mechanical ventilation; as well as a better outcome for the composite endpoint of in-hospital death, ICU admission rate, and length of hospital stay.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"872-880"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978228","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}