No abstract

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 find out the characteristics and presentations of imperforate hymen in the local population in Hong Kong and to assess if diagnosis of imperforate hymen made in the emergency department can reduce time to operation and length of hospital stay. Design: Retrospective study. Setting: A regional public hospital in Hong Kong. Patients: We retrospectively collected data of all patients with the diagnosis of imperforate hymen (ICD 9 coding 752.42) from the period of January 1999 to June 2009. Demographics of the patients, their presenting symptoms and signs, the diagnostic process, investigation findings and time of operation were recorded and analysed. Results: Fifteen cases of imperforate hymen were reported during that period. All were adolescent girls aged from 10 to 15 years. A total of 13 patients presented to the accident and emergency department (AED). Seven patients had the diagnosis made in the AED and 2 patients received bedside pelvic ultrasound. More than half of them (8 patients) presented with acute retention of urine. Other presentations included lower abdominal pain, constipation, lower abdominal mass, and protruding introital mass. Most cases diagnosed in the AED (5 out of 7) were admitted to the gynaecology ward while the others were admitted to the surgical or urology wards. Five out of the 7 cases diagnosed in the AED received operation within 24 hours; whereas only 1 out of the 6 cases with the diagnosis made after admission had operation within 24 hours. The difference was statistically significant (p=0.035, Fisher's exact test). The mean length of stay of the group diagnosed in the AED was 1.9 days while the mean length of stay for the group diagnosed after admission was 4.2 days. Conclusion: Early diagnosis of imperforate hymen and haematometrocolpos in the AED for adolescent girls with primary amenorrhoea could have positive impact on proper admission to the gynaecology ward, prompt operation and shorter length of stay in hospital.

We report an 89-year-old retired farmer with prolonged bradycardia and hypotension after pyrethroid insecticides ingestion in a suicidal attempt. This patient also had a clinical manifestation mimicking organophosphate poisoning, included confusion, lacrimation and salivation. He required intensive care support, atropine and inotrope infusions treatments. Only metabolites of synthetic pyrethroid insecticides (3-phenoxybenzoic acid and 3-phenoxybenzaldehyde) were detected in the urine sample. In the serum toxicology screening, specific analysis for organophosphate pesticides was negative. He eventually recovered without major sequela. (Hong Kong j.emerg.med. 2016;23:47-51)

Paraquat is highly toxic to human and is widely used in agriculture as a contact herbicide. However, it is easily accessible in agricultural product shops. Seven cases of paraquat poisoning were treated in Tuen Mun Hospital from 1998-2005. The mortality (4 out of 7) was very high. One patient died after oral exposure to paraquat despite immunosuppressive and antioxidant therapies. The mechanism of toxicity and potential new therapies of paraquat poisoning are discussed in the article.