Clinical toxicology (Philadelphia, Pa.)最新文献

{"title":"Bupropion overdose: insights on the role of upper gastrointestinal decontamination endoscopy.","authors":"Lucia Bernasconi, Davide Lonati, Giulia Scaravaggi, Alberto Malovini, Cristina Carolina Benussi, Benedetta Brolli, Eleonora Buscaglia, Monica Carnovale, Valentina Mari Negrini, Martina Pes, Valeria Margherita Petrolini, Elisa Roda, Antonella Rotolo, Azzurra Schicchi, Carlo Alessandro Locatelli","doi":"10.1080/15563650.2026.2663138","DOIUrl":"10.1080/15563650.2026.2663138","url":null,"abstract":"<p><strong>Introduction: </strong>Although bupropion is known to be associated with pharmacobezoar formation, it remains understudied in this context. Upper gastrointestinal endoscopy has emerged as a potential adjunctive decontamination technique for managing acute overdoses associated with pharmacobezoar formation. We aim to evaluate its role in acute bupropion overdoses.</p><p><strong>Methods: </strong>We retrospectively analysed intentional bupropion overdoses referred to the Pavia Poison Control Centre (2015-2024) in which upper endoscopy was performed. Data on patient characteristics, overdose details, co-ingestants, decontamination procedures, endoscopy indications, and findings were collected. Endoscopy outcomes were classified as positive (pharmacobezoars, intact tablets, or paste-like residues) or negative. In parallel, an <i>in vitro</i> model was used to assess the propensity of bupropion to form pharmacobezoars.</p><p><strong>Results: </strong>Forty-seven patients were included (median age 44 years, IQR 27-55; 75% female). The median ingested bupropion dose was 4,500 mg (IQR 4,500-6,750 mg). The median ingested tablets count was 59 (IQR 29-100 mg), and co-ingestants were present in 79% of cases. Upper gastrointestinal decontamination endoscopy was positive in 28 cases (60%). Pharmacobezoars or tablet residues were identified even in patients who had undergone prior decontamination, including orogastric lavage (60%). The only variable significantly associated with positive endoscopic findings was the total number of ingested tablets (<i>P</i> <0.05). In our cohort, nearly three-quarters of patients ingesting ≥30 tablets showed a substantial rate of positive endoscopy 73%, compared to 33% of those ingesting <30 tablets. All positive cases resulted in successful endoscopic removal without complications. The <i>in vitro</i> experiment showed early pharmacobezoar formation within four hours of incubation, persisting for up to 72 hours.</p><p><strong>Discussion: </strong>Acute bupropion overdoses, alone or with co-ingestants, can cause gastric pharmacobezoars and retained tablets/residues despite standard decontamination. Upper gastrointestinal decontamination endoscopy is effective early post-ingestion and may complement or replace conventional methods.</p><p><strong>Conclusions: </strong>Gastric pharmacobezoars and tablet residues are frequently observed in bupropion overdoses, particularly with ingestions of ≥30 tablets, making these patients potential candidates for early endoscopic removal.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"816-826"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978233","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":"Survival from extreme methemoglobinemia due to intentional sodium nitrite poisoning.","authors":"Aynur Yurtseven, Aynur Ecevit Kaya","doi":"10.1080/15563650.2026.2688234","DOIUrl":"10.1080/15563650.2026.2688234","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"841"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148311279","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":"Cardiovascular effects associated with acute recreational drug toxicity presentations to the emergency department: a European drug emergencies network (Euro-DEN plus) study.","authors":"W J van den Busken, Alison M Dines, Florian Eyer, Fridtjof Heyerdahl, Knut Erik Hovda, Matthias E Liechti, Òscar Miró, Odd Martin Vallersnes, David M Wood, Chris Yates, Paul I Dargan, F M J Gresnigt","doi":"10.1080/15563650.2026.2669671","DOIUrl":"10.1080/15563650.2026.2669671","url":null,"abstract":"<p><strong>Introduction: </strong>Recreational drugs affect the cardiovascular system through distinct mechanisms; however, data regarding their cardiovascular impact in the emergency department setting is limited. This study aimed to assess the incidence of cardiovascular effects following recreational drug use in presentations to the emergency department, identify the main drug groups involved, and compare cases with and without cardiovascular effects.</p><p><strong>Methods: </strong>Data were extracted from the European Drug Emergency Network (Euro-DEN Plus) dataset from October 2013 to December 2021. Recreational drugs were categorised into ten main drug groups: opioids, cocaine, crack cocaine, cannabis, 3,4-methylenedioxymethamfetamine, amfetamine-type stimulants, gamma-hydroxybutyrate and gamma-butyrolactone, hallucinogens, benzodiazepines, and ketamine.</p><p><strong>Results: </strong>Among 59,571 presentations, 13,905 (23.3%) involved cardiovascular effects. Cocaine (OR 3.19, 95% CI 2.99-3.39) and 3,4 methylenedioxymethamphetamine (OR 1.18, 95% CI 1.13-1.23) showed the strongest associations with cardiovascular features, including chest pain, palpitations, hypertension, and arrhythmias. Opioids (OR 0.35, 95% CI 0.31-0.38) and benzodiazepines (OR 0.38, 95% CI 0.32-0.44) were associated with less frequent cardiovascular features. Patients with cardiovascular features exhibited higher median values for temperature, heart rate, blood pressure, and respiratory rate (p <0.001). Cardiovascular features were associated with an increased risk of intubation (OR 1.91, 95% CI 1.70-2.15), critical care admission (OR 2.18, 95% CI 2.00-2.38), and mortality (OR 15.8, 95% CI 7.36-33.9).</p><p><strong>Discussion: </strong>Cardiovascular effects were common in acute recreational drug toxicity. Cocaine and amfetamine-type stimulants increased the risk of chest pain and arrhythmias, with chest pain being a key indicator of acute coronary syndrome. Cardiovascular effects were more frequently observed with cocaine than with crack cocaine. Cannabis was positively associated with palpitations but not arrhythmias. Gamma-hydroxybutyrate and gamma-butyrolactone, opioids, and benzodiazepines were linked to hypotension. The presence of cardiovascular effects was associated with worse outcomes, underscoring the need for thorough cardiac assessment.</p><p><strong>Conclusions: </strong>Cardiovascular effects were present in almost a quarter of emergency department presentations with acute recreational drug toxicity, particularly involving cocaine and 3,4 methylenedioxymethamphetamine.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"746-754"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304572","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":"Portal venous gas after ingestion of concentrated hydrogen peroxide.","authors":"Ting-An Chen, Yen-Wen Chen, Yang Ho, Chen-Chang Yang","doi":"10.1080/15563650.2026.2688231","DOIUrl":"10.1080/15563650.2026.2688231","url":null,"abstract":"<p><strong>Introduction: </strong>Ingestion of concentrated hydrogen peroxide can cause corrosive injury and rapid gas formation, leading to intramural gas and portal venous gas. While portal venous gas reflects intravascular gas formation, its relationship with systemic gas embolism remains uncertain.</p><p><strong>Case summary: </strong>A 37-year-old man ingested 50% hydrogen peroxide and presented with vomiting and abdominal distension. Computed tomography demonstrated intramural gas and portal venous gas, and endoscopy showed corrosive injury. Hyperbaric oxygen therapy was initiated but was not completed initially. Repeat imaging demonstrated persistent intramural gas, and a second hyperbaric oxygen therapy session was performed. Follow-up imaging demonstrated complete resolution.</p><p><strong>Images: </strong>Serial computed tomography imaging demonstrated intramural gas and portal venous gas at presentation, persistence at six hours, and complete resolution on follow-up imaging.</p><p><strong>Conclusion: </strong>Hydrogen peroxide ingestion may result in corrosive injury and extensive portal venous gas. Early imaging and endoscopic assessment are important, and hyperbaric oxygen therapy may be considered in selected patients.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"836-838"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341898","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":"Methotrexate toxicity in the setting of oral therapeutic errors: a multicenter retrospective study.","authors":"Michael Moss, David B Liss, Andrew J Chambers, Kirk L Cumpston, Carrie Oakland, Jon Cole, Nathan P Charlton, Frank Dicker, Maryann Mazer-Amirshahi, Brandon K Wills","doi":"10.1080/15563650.2026.2649907","DOIUrl":"10.1080/15563650.2026.2649907","url":null,"abstract":"<p><strong>Introduction: </strong>Methotrexate, a dihydrofolate reductase inhibitor with immunosuppressive and disease-modifying effects, is typically dosed orally once weekly. Misunderstanding instructions can lead to daily instead of weekly dosing. This study characterizes thresholds for toxicity from unintentional daily ingestion in adults.</p><p><strong>Methods: </strong>This was a multi-center retrospective cohort study using records from six regional poison centers between January 1, 2000 and January 24, 2023. Inclusion criteria were adults ≥18 years of age with a therapeutic error of oral methotrexate administration more frequently than weekly. We defined organ system dysfunction as any cytopenia, severe mucositis/stomatitis, severe dermatologic manifestations, renal dysfunction, or elevated aminotransferase activity. The primary outcome was the threshold cumulative dose and duration associated with any organ system dysfunction.</p><p><strong>Results: </strong>We screened 139 cases and after exclusion, 54 cases remained. Median age was 64 years (IQR 57-70) and 70% of cases were female. There were 51 cases (95%) prescribed methotrexate weekly, and 50 (93%) instead took methotrexate daily. Median duration and dose of methotrexate was six days (IQR 4-9 days) and 66 mg (IQR 45-108 mg), respectively. End organ dysfunction occurred in 31 (57%) cases, 29 (94%) of which had mucositis and 16 (52%) had any cytopenia. There were two deaths. No patient developed organ system dysfunction if methotrexate was taken for less than three consecutive days, or a total dose of <37.5 mg.</p><p><strong>Discussion: </strong>Despite relatively low doses and duration of methotrexate exposure, patients commonly developed significant end organ toxicity. These thresholds provide additional data to develop triage and management guidelines. Healthcare providers should counsel patients on appropriate dosing. Limitations include use of voluntarily reported poison center data.</p><p><strong>Conclusions: </strong>Daily methotrexate administration may result in severe organ dysfunction after relatively low dose and duration therapeutic errors.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"801-807"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731179","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":"Packed red blood cell transfusion affecting phosphatidylethanol concentration.","authors":"Brian G Lewis, Jessica J Krueger, Angela Padilla-Jones, Jerry Snow, Kamisha L Johnson-Davis, Steven C Curry","doi":"10.1080/15563650.2026.2675039","DOIUrl":"10.1080/15563650.2026.2675039","url":null,"abstract":"<p><strong>Introduction: </strong>Toxicologists are often called upon to interpret results of drug testing. Phosphatidylethanol is a biomarker sensitive for ethanol consumption within the previous one to four weeks and is commonly used in monitoring for alcohol abstinence in organ transplant candidates. Phosphatidylethanol is stable in stored units of packed red blood cells and has been shown to create \"false positive\" or iatrogenically elevated phosphatidylethanol concentrations after blood transfusion.</p><p><strong>Methods: </strong>In this prospective observational study, 50 subjects receiving one unit of packed red blood cells transfusion had their pre- and post-transfusion whole blood phosphatidylethanol concentrations measured using whole blood samples in EDTA vacutainers obtained within 24 hours of transfusion. Phosphatidylethanol was measured using liquid chromatography-tandem mass spectrometry with a 15% coefficient of variance. Pre- and post-transfusion hemoglobin and hematocrit were also measured.</p><p><strong>Results: </strong>Four (8%) subjects had an increase in phosphatidylethanol from \"negative\" (<20 ng/mL) to \"positive\" (>20 ng/mL) after transfusion. Six (12%) total subjects had any increase in phosphatidylethanol concentration beyond the coefficient of variance with a maximum increase of 51 ng/mL. No subjects had a decrease in phosphatidylethanol beyond the coefficient of variance.</p><p><strong>Discussion: </strong>This study adds to the evidence that patients receiving blood transfusions may have iatrogenically elevated phosphatidylethanol concentrations, even with a single unit of packed red blood cells.</p><p><strong>Conclusion: </strong>Phosphatidylethanol concentrations should be interpreted with caution if a patient has recently received a blood transfusion.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"827-831"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148146055","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":"Ambulance services' use of poison information in Great Britain - a retrospective records analysis of calls and TOXBASE^® accesses.","authors":"Lisa Schölin, Gill Jackson, Caroline McGrory, David Lupton, Adam Lloyd, Peter Holmes, Nathaniel Keymer, Hayley Williams, Michael Eddleston","doi":"10.1080/15563650.2026.2661378","DOIUrl":"10.1080/15563650.2026.2661378","url":null,"abstract":"<p><strong>Introduction: </strong>Poison information centres advise health professionals on toxic exposures and recommend appropriate responses, preventing transfer where hospital treatment is not required. No study to date has detailed ambulance enquiries for poison information in Great Britain. The aim of this study is to describe ambulance services' use of the National Poison Information Service through helpline calls and TOXBASE^® accesses.</p><p><strong>Methods: </strong>Retrospective records analysis of ambulance calls and TOXBASE^® accesses between 1 April 2022 and 31 March 2023 in England, Scotland, and Wales. The data were analysed descriptively with frequency statistics calculated for patient demographics, characteristics of the poisoning, and advice for transfer to onward care.</p><p><strong>Results: </strong>There were 4,053 ambulance enquiries, representing 11.0% of calls. The rate of calls per 100,000 population was 6.9 for English, 3.2 for Welsh, and 0.4 for Scottish ambulance services. Conversely, the rate of TOXBASE^® accesses was 369.2 per 100,000 for English, 233.9 for Scottish, and 111.9 for Welsh ambulance services. Phone enquiries were mostly for intentional poisoning (2342/4053 [57.8%]) involving pharmaceuticals (3502/4053 [86.4%]). Most enquiries were benign exposures at the time of the call; Poisoning Severity Score None or asymptomatic (2256/4053[55.7%]) or Minor (1536/4053[37.9%]). Most calls resulted in advice for patient transfer to definitive care (3114/4053, 76.8%). For calls and TOXBASE^® accesses, the most common agent was paracetamol.</p><p><strong>Discussion: </strong>Ambulance services in Great Britain commonly seek poison information to inform patient management by phone and TOXBASE^®. Calls primarily relate to intentional poisoning with advice to transfer to further care. Yet, for a quarter of cases no further care is advised which likely has a cost-saving effect. Further research is needed to explore how and when paramedics seek poison information.</p><p><strong>Conclusions: </strong>These data emphasise the importance of ensuring poisons management advice is tuned to ambulance services' needs to ensure appropriate management and patient transfer.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"808-815"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944559","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 thallium poisoning: clinical features, toxicokinetics and one-year neurological outcomes.","authors":"Chen Chen, Yuhao Yuan, Wenshuai Tan, Xiangting Gao, Zhonghao Yu, Jiaqi Liu, Yiwu Zhou, Xiaohong Zhao","doi":"10.1080/15563650.2026.2697048","DOIUrl":"10.1080/15563650.2026.2697048","url":null,"abstract":"<p><strong>Introduction: </strong>Thallium poisoning is a rare but highly toxic heavy metal intoxication associated with peripheral neuropathy. However, longitudinal data integrating toxicokinetic profiles with electrophysiological outcomes remain limited.</p><p><strong>Methods: </strong>Five patients with confirmed acute thallium poisoning were evaluated. Clinical symptoms, laboratory results, dynamic serum and urinary thallium concentrations, and electrophysiological results were recorded. All patients underwent electrophysiological follow-up one year later. Thallium elimination kinetics were analyzed using nonlinear regression.</p><p><strong>Results: </strong>All patients developed peripheral neuropathy. Sensory symptoms generally preceded the onset of alopecia. During treatment, dynamic monitoring showed a progressive decrease in thallium concentrations. Toxicokinetic analysis suggested an approximate first-order elimination pattern, with an estimated serum half-life ranging from 3.8 to 5.7 days. Electrophysiological studies revealed distal axonal neuropathy characterized by reduced compound muscle action potential amplitudes. At one-year follow-up, residual axonal involvement persisted in some patients.</p><p><strong>Discussion: </strong>Peripheral neuropathic symptoms may serve as an early clinical indicator of thallium poisoning. Persistent electrophysiological abnormalities despite declining thallium levels suggest incomplete neurological recovery.</p><p><strong>Conclusions: </strong>Dynamic monitoring of thallium levels can help evaluate elimination kinetics during detoxification therapy. Persistent axonal injury suggests that thallium-induced neuropathy may result in long-term neurological sequelae, highlighting the importance of early diagnosis and long-term electrophysiological monitoring.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"832-835"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703132","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":"Paracetamol adducts following overdose treated with a shorter acetylcysteine infusion: findings from the NACSTOP 2 trial.","authors":"Anselm Wong, Laura P James, Richard McNulty, Naren Gunja, Andis Graudins","doi":"10.1080/15563650.2026.2655388","DOIUrl":"10.1080/15563650.2026.2655388","url":null,"abstract":"<p><strong>Introduction: </strong>Paracetamol protein adducts in the circulation are a specific biomarker of paracetamol oxidation, and a highly sensitive measure of potential hepatic injury following overdose. We performed an analytical sub-study of adducts during a clinical trial (NACSTOP2) of abbreviated (12 hour) versus control (20 hour) acetylcysteine to identify any signal of decreased antidotal effectiveness with shortened therapy.</p><p><strong>Methods: </strong>We measured adducts from a convenience sample of subjects enrolled in the randomised-controlled NACSTOP2 trial evaluating a 12-hour (\"abbreviated\"; 200 mg/kg over four hours, 50 mg/kg over 8 hours) vs 20-hour acetylcysteine regimen (\"control\"; 200 mg/kg over four hours, 100 mg/kg over 16 hours). Adducts were assayed using high-performance liquid chromatography with electrochemical detection.</p><p><strong>Results: </strong>The median alanine transaminase 20 hours after the initiation of acetylcysteine were 13 U/L (IQR 10-25 U/L) in the abbreviated 12-hour regimen group (<i>n</i> = 29), compared to the control group 14 U/L (IQR 10-19 U/L; <i>n</i> = 28) (<i>P</i> = 0.46). Adduct concentrations after 20 hours post initiation of acetylcysteine were similarly low in both groups: median 0.18 µmol/L, (IQR 0.09-0.24 µmol/L) to the control 0.17 µmol/L (IQR 0.11-0.27), P = 0.43.</p><p><strong>Discussion: </strong>In both the NACSTOP and NACSTOP 2 trials, adduct concentrations remained low in this selected cohort of low risk patients, supporting abbreviation of the acetylcysteine regimen.</p><p><strong>Conclusions: </strong>In selected low-risk patients, paracetamol adduct formation remained similarly low whether acetylcysteine was stopped after 12 hours or continued for the standard 20 hours.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"775-779"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731181","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":"Medication errors in home care settings: a 13-year retrospective cohort study in the Ramathibodi Poison Center.","authors":"Phantakan Tansuwannarat, Monsicha Wangpipatwong, Achara Tongpoo, Panee Rittilert, Satariya Trakulsrichai","doi":"10.1080/15563650.2026.2712465","DOIUrl":"https://doi.org/10.1080/15563650.2026.2712465","url":null,"abstract":"<p><strong>Introduction: </strong>Medication errors are a leading cause of preventable harm worldwide, yet evidence has predominantly focused on healthcare settings, with limited data from home care, particularly in Southeast Asia.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using 2011-2023 data from the Ramathibodi Poison Center, including patients with medication errors occurring outside healthcare facilities. Clinical effects, management of medication errors, and outcomes were considered as primary outcomes, while the secondary outcome was factors associated with harm, defined as National Coordinating Council for Medication Error Reporting and Prevention Category ≥ E.</p><p><strong>Results: </strong>A total of 925 patients were included. Children (<15 years) accounted for 68.1% of cases, with almost all aged under 10 years. Wrong-drug errors predominated (72.4%), followed by wrong-dose errors (27.4%). Commonly implicated substances included topical dermatologic/antiseptic agents, analgesics, and herbal/traditional products. Medication errors resulting in patient harm were frequent (Category E, 58.6%; Category F, 25.8%), although most cases were managed with supportive care, and no fatalities occurred. In multivariable analysis, underlying disease (adjusted odds ratio 3.10; 95% CI 1.70-5.66) and wrong-drug errors (adjusted odds ratio 2.51; 95% CI 1.67-3.76) were independently associated with harm.</p><p><strong>Discussion: </strong>Home-based medication errors predominantly affected children and were largely driven by caregiver-dependent administration of incorrect medications. The predominance of wrong-drug errors suggests that failures in medication identification and storage, rather than dosing complexity alone, are central mechanisms in this setting. The high proportion of Categories E and F events indicates that these medication errors frequently result in clinically meaningful harm, despite the generally mild clinical presentation. The absence of fatalities might reflect the involvement of commonly available medications and timely access to healthcare services. Factors contributing to harm due to medication errors include the presence of underlying disease and wrong-drug errors.</p><p><strong>Conclusion: </strong>Medication errors in home care settings commonly result in temporary harm requiring intervention or hospitalization. Interventions targeting medication identification, caregiver education, and safe storage practices are essential to reduce preventable harm.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-9"},"PeriodicalIF":3.3,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842776","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}