Context . Acute intoxications are frequently seen in Dutch hospitals. Based on single-centre studies and the fact that there are no clear guidelines, we hypothesised that hospital admission of acute intoxications may vary. Furthermore, decontamination treatment of poisonings may differ between hospitals, as earlier studies showed that adherence to international guidelines concerning decontamination may be poor. Objective . We aim to identify possible variations in Dutch hospital admission and decontamination treatment of patients with acute intoxications. Materials and methods . Data on acute intoxications was retrospectively collected from patient records from the emergency departments of six Dutch hospitals. All patients older than 14 years who presented between 1 January 2008 and 31 December 2008 were included in the study. Results . The percentage of suicide attempts differed signifi cantly between the hospitals (25 -73%, p Ͻ 0.0001) as equally the percentage of intoxications with drugs of abuse (18 -61%, p Ͻ 0.0001). Marked differences in admission rates were found (27 -78%, p Ͻ 0.0001) and these differences remained even when intoxications because of suicide attempts and drugs of abuse were analysed separately (admission rate of 52 -87%, p Ͻ 0.0001 and 8 -71%, p Ͻ 0.0001 respectively). Reported consultation with the National Poisons Information Centre differed between hospitals (range 0% to 80 -100%). No statistical differences were found between hospitals for the use of activated charcoal (16.1 -42.5%, p = 0.037). Gastric lavage was used infrequently in all hospitals. (6.6 -16.7%, p = 0.614). Discussion and conclusion . The admission rate of patients with an acute intoxication varies considerably, especially in the case of intoxications with drugs of abuse. Consultations with the National Poisons Information Centre differed between the six hospitals. Rates of decontamination did not vary, which may indicate adherence to guidelines by the American Academy of Clinical Toxicology, European Association of Poisons Centres and Clinical Toxicologists. National guidelines or admission algorithms may reduce variations in poisoning management and make the care for these patients more effi cient.

The algorithms had good sensitivity and better specificity than current clinical practice in most hospitals. It is too early to advocate their implementation, but results indicate that it is possible to use clinical parameters objectively to reduce unnecessary admissions to the ward.

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Abstract:The authors describe the clinical presentation of a 59-year old woman in the emergency room, with agitation, confusion and hypothermia. She was previously diagnosed with hypothalamic-pituitary insufficiency with complete dysfunction of the pituitary gland, poikilothermia and central diabetes insipidus, treated with hormone supplements. In the emergency room, she showed a dysregulation in temperature, altered mental status and hyponatremia. The differential diagnosis was hypothermia based on infection with the history of poikilothermia, with dysregulation of her diabetes insipidus. Poikilothermia is an extremely rare condition in humans in which the body temperature variates with the surrounding temperature. Dysregulation may develop due to different causes.