Objective:To update our epidemiological knowledge of acute poisoning in Hong Kong. Methods: A multicentred prospective study was conducted for six months in six major accident and emergency departments in Hong Kong. A specially designed form was used to collect demographic data, type of poison involved, cause of poisoning, management, disposal as well as final outcome of the poisoned patients. Results: A total of 1,467 patients (male: 588, female: 879) were included in the study. Most of them were young adults (32% were between 20 and 40 years old). Suicidal attempt (64%) was the most common cause of poisoning. Notably, 379 (26%) patients took more than one poison. Among the 2,007 counts of poison taken, sleeping pills (24%) and analgesics (18%) were the most commonly used drugs and paracetamol was the commonest single ingredient involved in poisoning. Most patients were treated with supportive measures, and about 40% and 15% of the patients were given gastrointestinal decontamination and specific antidotes respectively in their management, in which activated charcoal and N-acetylcysteine were the most common. Concerning disposal from the emergency department, 91% of the poisoned cases required in-patient management. Most patients had an uneventful recovery but 5 (0.3%) had significant disability and 21 (1.4%) died. Suicidal carbon monoxide poisoning was the leading cause of mortality in our study. Conclusions: Most acute poisonings in Hong Kong were suicidal in nature and paracetamol was the commonest agent. Activated charcoal was the most commonly used decontamination method and most patients had an uneventful recovery. (Hong Kong j.emerg.med. 2005;12:156-161)

To evaluate the impact of the recently established Emergency Department (ED) Toxicology Team of Queen Mary Hospital (QMH) in the management of acute intoxication. Method: A descriptive comparative study with retrospective data collection from all intoxicated and suspected intoxicated patients over two separate half-year periods in 2001 and 2006, before and after the establishment of the ED Toxicology Team in July 2005. Data on reasons of intoxication, drugs and substances involved, ED treatments, patient disposition, length of stay in ED, length of stay in hospital, patient outcome, and 30-day ED re-attendance and hospital re-admission were collected and examined. Results: A total of 333 intoxicated patients were included in the study, 171 in 2001 and 162 in 2006. The basic epidemiological data were similar in both groups. There was a marked reduction in hospital admissions from 89.5% to 40.7% (P<0.01) and significant decline in average length of hospital stay from 46.8 hours to 29.2 hours (P<0.05). There was no statistically significant difference in patient outcome, 30-day ED re-attendance and hospital re-admission. Conclusion: Our findings showed that the establishment of the ED Toxicology Team in QMH achieved significant reductions in hospital admissions and the length of stay in hospital in the management of patients with acute intoxication without jeopardising patient outcome. The results illustrate that the new model has a beneficial role in reducing cost and alleviating stress on hospital bed availability, therefore it can be recognised as a cost-effective means of management of acute intoxication.

Oral communication abstractsCriteria P Sensitivity (%) OC280 Prenatal prediction of homozygous α-thalassaemia using ultrasonographic placental thickness, fetal cardiothoracic ratio and middle cerebral artery Doppler Objectives: To compare the predictive values of three ultrasonographic parameters (placental thickness (PT), fetal cardiothoracic ratio (CTR) and middle cerebral artery peak systolic velocity (MCAPSV)), alone or in combination, in pregnancies affected by homozygous α-thalassaemia. Methods: At-risk women were prospectively studied using serial ultrasound examinations to exclude affected pregnancies. The final diagnosis was confirmed at birth or by a prenatal invasive test followed by DNA or hemoglobin analyses. Outcome measures Ultrasound in Obstetrics & Gynecology 2007; 30: 367-455

Puffer fish poisoning caused by tetrodotoxin, a potent neurotoxin, is uncommon in Hong Kong. We report a total of seven cases of puffer fish poisoning with different levels of severity. Two of them developed respiratory distress and subsequently required endotracheal intubation and respiratory support while the others presented with numbness and mild weakness. Most of them experienced perioral numbness as the first symptom. The mean time of symptoms onset was approximately 94 minutes. All of our patients survived the intoxication.

An 86-year-old gentleman was brought to the emergency department after a massive overdose of slowrelease potassium chloride and indapamide. The initial serum potassium was 6.8 mmol/L. His abdominal X-ray did not reveal any radio-opaque drugs. Whole bowel irrigation was commenced shortly after presentation. There was no rebound of hyperkalaemia and his stay in the acute hospital was short. Slowrelease potassium overdose is uncommonly reported in the medical literature; such poisoning in the elderly has not been reported. Previous case reports are summarised and the management of this uncommon poisoning is discussed. (Hong Kong j.emerg.med. 2007;14:169-173) Case presentationA n 8 6 -ye a r -o l d g e n t l e m a n , w i t h h i s t o r y o f hypertension and regular follow-up in a government outpatient clinic (GOPD), was suspected to have early dementia and was referred to the memory clinic. Currently, he was on indapamide (Natrilix) 2.5 mg daily and slow-release potassium chloride (Slow-K, 600 mg or 8 mmol per tablet) 2 tablets per day. In March 2007, he was followed up three days before attending our department and was given a total of 41 tablets of Natrilix and 82 tablets of Slow-K. One day before attending our department, his daughterin-law found that only a few tablets of the drugs were left. He was brought to the GOPD and was immediately referred to our department. He was estimated to have ingested at least 30 tablets of