Retrospective Analysis of Anticonvulsant Exposures Admitted to Department of Emergency Medicine in Dokuz Eylül University Hospital

Year 2017, Volume: 1 Issue: 1, 11 - 17, 01.03.2017

Toros Mert Saraçoğlu Nil Hocaoğlu Sedat Yanturalı Rıdvan Atilla Burcu Tanay Demirdöven Başak Bayram

https://doi.org/10.5152/jbachs.2017.77

Cited By: 1

Abstract

Purpose: To evaluate demographic characteristics, clinical signs and symptoms, treatment methods and clinical outcomes of anticonvulsant exposures in cases who were admitted to the Department of Emergency Medicine of in Dokuz Eylül University Hospital DEUH between 2000 and 2010 and reported to the Dokuz Eylül University Drug and Poison Information Center DEUDPIC .Methods: Age, sex, type of the anticonvulsant agents, route and causes of the exposure, clinical signs and symptoms, recommended and applied treatment methods and outcomes were recorded on a standard data forms, then entered into a computerized database program Ruber . The chi-square test was used in the statistical analyses. Results: Seventy seven patients 45 women, 32 men whose data were fully accessible were studied. Exposures were found to mostly occur due to acute 50.6% and intentional 77.9% . Patients presenting with anticonvulsant exposure, were most commonly admitted 32.5% to the DEUH within two hours after the ingestion. The most common causes of poisoning were identified as carbamazepine 32.5% and valproic acid 23.4% . On clinical evaluation, 36.4% of the patients did not develop any clinical signs or symptoms, and 7.8% of the patients developed severe clinical signs and symptoms. Most of the severe cases 66.7% resulted from carbamazepine ingestion. Also, 88.3% of the cases were found to have recovered and were discharged from the hospital without sequelae, no death occurred. The mean length of stay was 19.6±25.6 hours.Conclusion: Carbamazepine intoxication ranked first among the intoxications due to anticonvulsant exposures. In this case, the length of follow up in the emergency department may be prolonged, particularly as a result of the anticholinergic effects of carbamazepine that may delay the onset of clinical manifestations

Keywords

Anticonvulsant, exposure, poisoning, emergency department, Drug and Poisoning Information Centre

References

• McDonagh M, Peterson K, Lee N, Thakurta S. Drug class review: Antiepileptic drugs for indications other than epilepsy: Final report update 2. Drug Class Reviews. Portland (OR): Oregon Health & Sci- ence University; 2008 Oct.
• Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. 2014 Annual report of the American Association of Poison Control Cen- ters’ National Poison Data System (NPDS): 32nd annual report. Clin Toxicol (Phila) 2015; 53:962-1147. [CrossRef]
• Nixon AC, Doak MW, Crozier H, Crooks DP, Waring WS. Patterns of antiepileptic drug overdose differ between men and women: admissions to the Edinburgh Poisons Unit, 2000-2007. QJM 2009; 102:51-56. [CrossRef]
• Person HE, Sjöberg GK, Haines JA, Pronczuk de Garbino J. Poison- ing severity score. Grading of acute poisoning. J Toxicol Clin Toxicol 1998; 36:205-213. [CrossRef]
• Kalkan S, Tuncok Y, Güven H. İlaç ve Zehir Danışma Merkezi’ne bildirilen olgular. Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi 1998; 12:275-283.
• Kıyan S, Özsaraç M, Ersel M, et al. Analysis of patients with acute intoxication in a two year period. Turk J Emerg Med 2009; 9:24-30.
• Kaygusuz K, Gürsoy S, Kılıçcıoğlu F, Özdemirkol İ, Mimaroğlu C. Cum- huriyet Üniversitesi Tıp Fakültesi Hastanesi Yoğun Bakım Ünitesinde 1998-2004 yılları arasında akut ilaç zehirlenmesi tanısı ile takip edilen olguların geriye dönük analizi. C. Ü. Tıp Fakültesi Dergisi 2004; 26:161-165.
• Verstraete AG, Buylaert WA. Survey of patients with acute poison- ing seen in the Emergency Department of the University Hospital of Gent between 1983 and 1990. Eur J Emerg Med 1995; 2:217-223. [CrossRef]
• Çeliker H, Tezcan AE, Günal Aİ, et al. Elazığ bölgesinde intihar amaçlı zehirlenmelerin demografik özellikleri. FÜ Sağlık Bilimleri Dergisi 1996; 10:33-37.
• Bateman DN, Bain M, Gorman D, Murphy D. Changes in parac- etamol, antidepressants and opioid poisoning in Scotland during the 1990s. QJM 2003; 96:125-132. [CrossRef]
• Akkas M, Coskun F, Ulu N, Sivri B. An epidemiological evaluation of 1098 acute poisoning cases from Turkey. Vet Hum Toxicol 2004; 46:213-215.
• Andıran N, Sarikayalar F. Pattern of acute poisonings in childhood in Ankara: what has changed in twenty years? Turk J Pediatr 2004; 46:147-152.
• Ozkose Z, Ayoglu F. Etiological and demographical characteristics of acute adult poisoning in Ankara, Turkey. Hum Exp Toxicol 1999; 18:614-618. [CrossRef]
• Ozyurt G, Tokyay N, Kucer N, et al. Statistical report from Uludag Poison Information Center-34-month experience. Folia Med 1999; 41:101-103.
• Doganay Z, Sunter AT, Guz H, et al. Climatic and diurnal variation in sui- cide attempts in the ED. Am J Emerg Med 2003; 21:271-275. [CrossRef]
• Afshari R, Majdzadeh R, Balali-Mood M. Pattern of acute poison- ings in Mashhad, Iran 1993-2000. J Toxicol Clin Toxicol 2004; 42:965- 975. [CrossRef]
• De Leo D, Bertolote J, Lester D. Self directed violence. In: Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, eds. World report on vio- lence and health. Geneva: World Health Organization 2002: 183-212. http://www.who.int/violence_injury_prevention/violence/world_ report/en/index.html.
• Caravati EM. Unintentional acetaminophen ingestion in children and the potential for hepatotoxicity. J Toxicol Clin Toxicol 2000; 38:291-296. [CrossRef]
• Chyka PA, Seger D, Krenzelok EP, Vale JA, American Academy of Clinical Toxicology, European Association of Poisons Centres and Clinical Toxicologists. Position paper: Single dose activated char- coal. Clin Toxicol 2005; 43:61-87. [CrossRef]
• Vale JA, Kulig K, American Academy of Clinical Toxicology, Europe- an Association of Poisons Centres and Clinical Toxicologists. Posi- tion paper: Gastric lavage. J Toxicol Clin Toxicol 2004; 42:933-943. [CrossRef]
• Tüfekçi IB, Curgunlu A, Sirin F. Characteristics of acute adult poison- ing cases admitted to a university hospital in Istanbul. Hum Exp Tox- icol 2004; 23:347-351. [CrossRef]