Retrospective Investigation of Treatment Protocols for Drug Poisonings Admitted to Emergency Department

Abstract

Objective: The purpose of this study was to investigate the demographic and etiologic features of acute poisoning cases, the toxic substances which cause the poisonings and their properties, laboratory findings and clinical features retrospectively and to show what could be the precautions to be taken.

Patients and Methods: Total of 483 patients, who were admitted to emergency department with drug poisoning within 3 years and whose information was available were taken into this retrospective study. The patients’ age, sex, date of admission to hospital, duration of hospitalization in emergency department and intensive care unit, clinical outcomes, agents and amounts of drugs taken, applied antidote and extracorporeal treatments, laboratory values of cases were examined.

Results: 179 (37,1%) of the cases were followed up for an average of 3,21 ± 4,5 days in the intensive care unit and 304 (62,9%) patients were followed up for an average of 2,1 ± 2 days in the observation unit of the emergency department. When the lipophilicity of poisoning drugs were examined, in 191 (39.5%) patients only lipophilic, in 100 (20.7%) patients lipophilic and additional substance, in 83 (17.2%) patients only hydrophilic and in 109 (22.6%) patients hydrophilic drug and additional substance was found. Extracorporeal treatment was applied to 14 patients. Our mortality rate was found 0.62%.

Conclusion: Early intervention in poisonings is life-saving. Supportive therapies, antidotes and extracorporal techniques may reduce mortality, but toxicological guidelines may be needed to guide clinicians in more extensive studies. 

Keywords

• intoxication,extracorporeal,mortality,duration of hospitalization,lipid

Kaynakça

1. 1. Demirel İ. A Retrospective Analysis of Intoxication Cases in Intensive Care Unit of Elazığ Education and Research Hospital. Fırat Med J. 2010;15:184-7.
2. 2. Osterhoudt KC, Trevor M. Penning. "Drug toxicity and poisoning." Goodman & Gilman’s The Pharmacological Basis of Therapeutics 2011:73-87.
3. 3. Demir G, Eren GA, Hergünsel O, Çukurova Z, Kızanlık Y. The retrograde analysis of the intoxication cases managed in our intensive care unit between 2003-2007. Med J Bakırköy 2008;4:139-43.
4. 4. Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. 2014 Annual Report of the AmericanAssociation of Poison Control Centers' National Poison Data System (NPDS): 32nd Annual Report. ClinToxicol (Phila). 2015;53:962-1147.
5. 5. Göksu S, Yıldırım C, Koçoğlu H, Tutak A, Öner Ü. Characteristics of acuteadult poisoning in Gaziantep, Turkey. J Toxicol & Clin Toxicol. 2002;40:833-37.
6. 6. Akköse Ş, Bulut M, Armağan E, Cebicci H. Acute poisoning in adults in the years 1996-2001 treated in the Uludağ University Hospital, Marmara region, Turkey. Clin Toxicol 2005;43:105-09.
7. 7. Özayar E, Değerli S, Güleç H, Şahin Ş, Dereli N. Retrospective Analysis of Intoxication Cases in the ICU. Yoğun Bakım Derg. 2011;3:59-62.
8. 8. Koylu R, Dundar ZD, Koylu O, et al. The Experiences in a Toxicology Unit: A Review of 623 Cases. J Clin Med Res. 2014;6:59-65.

9. 9. Güzel IŞ, Kibar AE, Vidinlisan S. Evaluation of demographic characteristics in intoxication cases who admitted to emergency room in pediatric unit. Genel Tıp Derg. 2011;21: 101-7.
10. 10. Eddleston M. Patterns and problems of deliberate self‐poisoning in the developing world. QJ Med. 2000;93;715-31.
11. 11. Yüce HH. Retrospectıve analysis of intoxication cases who were followed up in the intensıve care unit in Giresun area. Bidder Tıp Bilimleri Dergisi. 2011;3:32-5.
12. 12. Bohnert ASB, Fudalej S, Ilgen MA. Increasing Poisoning Mortality Rates in the United States, 1999–2006. Public Health Rep. 2010;125:542-7.
13. 13. Watson WA, Litovitz TL, Rodgers GC Jr, et al. 2004 Annual report of the American Association of Poison Control Centers toxic exposure surveillance system. Am J Emerg Med. 2005;23:589-666.
14. 14. Hanssens Y, Deleu D, Taqi A. Etiologic and demographic characteristics of poisoning: a prospective hospital-based study in Oman. J Toxicol ClinToxicol. 2001;39:371-80.
15. 15. Brandenburg R, Brinkman S, de Keizer NF, Kesecioglu J, Meulenbelt J, de Lange DW. The need for ICU admission in intoxicated patients: a prediction model. Clin Toxicol. 2017;55:4-11.
16. 16. SJ Kim, SP Chung, HW Gil, et al. The poisoning information database covers a large proportion of real poisoning cases in Korea. J Korean Med Sci. 2016; 31: 1037-41.
17. 17. Pablo A, Marcela G, Eli L, et al. Medication overdoses at a public emergency department in Santiago, Chile. Western J Emerg Med. 2016;17: 75-80.
18. 18. Seydaoğlu G, Satar S, Alparslan N. Frequency and mortality risk factors of acute adult poisoning in Adana, Turkey, 1997-2002. Mt Sinai J Med. 2005; 72: 393-401.
19. 19. Karcıoğlu Ö, Ayrık C, Tomruk Ö, Topaçoğlu H, Keleş A. Retrospective analysis of adult poisoning cases in the emergency department. O.M.Ü. Tıp Dergisi. 2000; 17: 156-62.
20. 20. Toft S, Horwitz H, Dalhoff KP. Long-term mortality after poisoning with antipsychotics, Clinical Toxicol. 2017;55:267-74.
21. 21. Koçak R, Tanrıverdi Z, Seyrek E, Alsparslan N. Acute poisoning: A two years retrospective study. Bulletin of Çukurova Medical Faculty. 1987; 12: 381-7.
22. 22. Tüfekçi BI, Çurgunoğlu A, Şirin F. Characteristics of acute adult poisoning cases admitted to a university hospital in İstanbul. Human & Experimental Toxicol. 2004;23:347-51.
23. 23. Demircan C, Kahveci F, Engindeniz Z, et al. Analysis of acute adult poisoning cases among patients admitted to the emergency department in Bursa, Turkey. Gazi Tıp Derg. 2009;20:157-62.
24. 24. Kavalcı C, Durukan P, Çevik Y, Özer M, İkizceli İ. Analyses of intoxication cases: one-year experience of a new hospital. Turk J Emerg Med. 2006;6:163-6.
25. 25. Akköse Ş, Köksal Ö, Fedakar R, Emircan Ş, Durmuş O. Poisoning Cases in adults in the years 1996-2004. Uludağ Üniversitesi Tıp Fakültesi Dergisi. 2006;32:25-7.
26. 26. Ok G, Erbüyün K, Mirzai T, Vatansever D, Tok D. The retrospective analysis of intoxications admitted to our emergency service. Toksikoloji Dergisi. 2006;4:5-9.
27. 27. Güloğlu C, Kara IH. Acute poisoning cases admitted to university hospital emergency department in Diyarbakir, Turkey. Hum Exp Toxicol. 2005; 24: 49-54.
28. 28. Beaune S, Juvin P, Beauchet A, Casalino E, Megarbane B. Deliberate drug poisonings admitted to an emergency department in Paris area – a descriptive study and assessment of risk factors for intensive care admission. Eur Rev Med Pharmacol Sci. 2016;20:1174-9.
29. 29. Finkelstein Y, Macdonald EM, Hollands S, et al. Repetition of intentional drug overdose: a population-based study. Clinical Toxicol. 2016;54:585-9.
30. 30. Guven FMK, Turkdogan KA, Duman A, et al. Cost analysis of different venues for treating suicide cases presented to the emergency department. Biomed Res- India. 2014;25:431-6.
31. 31. Cengiz M, Baysal Z, Ganidağlı S, Altindag A. Characteristics of poisoning cases in adult intensive care unit in Sanliurfa, Turkey. Saudi Med J. 2006;27:497-502.
32. 32. Kaya S, Kararmaz A, Karaman H, Turhanoğlu S. The Retrospective Analysis of the Poisoning Cases in Intensive Care Unit. Dicle Tıp Derg. 2006;33:242-4.
33. 33. Beskow J. Depression and suicide. Pharmacopsychiatry 1990;23:3-8.
34. 34. Cheng AT. Mental illness and suicide. A case-control study in East Taiwan. Arch Gen Psych. 1995; 52: 594-603.
35. 35. Avşaroğulları L, Senol V, Akdur O, Akin A, Durukan P, Özkan S. Characteristics of acute adult poisoning in a univercity hospital emergency department in central Turkey: a three-year analysisi. J Pak Med Assoc. 2012;62:129-33.
36. 36. Unverir P, Atilla R, Karcioglu O, Topacoglu H, Demiral Y, Tuncok Y. A retrospective analysis of antidepressant poisonings in the emergency department: 11-year experience. Human & Experimental Toxicol. 2006; 25: 605-12.
37. 37. Mowry JB, Spyker DA, Brooks DE, Zimmerman A, Schauben JL. 2015 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 33rd Annual Report, Clinical Toxicology. 2016; 54:924-1109.
38. 38. Ersoy A, Kara D, Cangir CC, Erdoğan E, Ali A, Büyükyıldırım A. Evaluating intoxicated patients in intensive care unit. Okmeydanı Tıp Dergisi. 2013; 29: 72-5.
39. 39. Pedroso JA, Silva CA. The nephrologist as a consultant for acute poisoning: epidemiology of severe poisonings in the State of Rio Grande do Sul and techniques to enhance renal elimination. J Bras Nefrol. 2010; 32: 340-8.