Aim To examine the efficacy and safety of antiepileptic drugs (AED) for the inpatient treatment of patients with moderate to severe alcohol withdrawal syndrome (AWS). Methods We searched in databases and gray literature to include randomized controlled clinical trials in adults that compare the use of AED versus placebo or any other medication. Studies that did not specify severity or were performed on an outpatient basis were excluded. The outcomes were improvement of symptoms, delirium tremens, seizures and adverse events. Two researchers independently selected the references, extracted the data and assessed the risk of bias. A qualitative synthesis was made and, when the heterogeneity was mild or moderate, a meta-analysis was performed. The quality of the evidence obtained was evaluated with the Grading of Recommendations Assessment, Development and Evaluation tool. Results In total, 26 studies with 1709 patients were included. No benefit is described in withdrawal syndrome severity measured by scales or in the development of delirium tremens. The only possible meta-analysis showed that there are no differences in the incidence of seizures (risk ratio [RR] = 1.0; confidence interval (CI) 95% 0.76–1.33), even when compared with placebo (RR = 0.95; CI95% 0.57–1.57). There were also no differences in adverse events, although a higher proportion of some mild cases were described with the use of carbamazepine and valproic acid. Conclusions The routine use of AED is not suggested in the treatment of patients with moderate or severe AWS unless indicated for comorbidity (weak recommendation against using moderate quality of evidence).

In Colombia, paraquat poisoning (PQ) is one of the main causes of self-inflicted pesticide poisoning. There is not antidotal treatment against its toxicity, influencing an uncertain prognosis and changeful survival. Objective: To describe the prognosis of patients with PQ poisoning treated in a high-level hospital and to evaluate the association of mortality with clinical and laboratory test variables, considering its variation over time. Methods: Retrospective study between 2011 and 2018 at the Hospital San Vicente Fundación (Medellín, Colombia). Included cases diagnosed with PQ poisoning, of any age and sex. Diagnoses of concomitant intake of other toxins, underlying lung disease, and trauma were excluded. Sociodemographic and clinical characteristics were described, the effect on mortality and variation over time were analyzed, to search for prognostic research candidates. Results: Cohort of 67 patients, mostly single men, under 30 years of age, located in rural area was recruited. A mortality of 37.3% (95% CI 36.9 to 37.7%) was found, median time to death of 117 h (IQR 62h-238h). The instantaneous risk of dying for the male sex was 1.93; 95% CI 1.44 to 10.26; p = 0.007. Laboratory changes over time: AST (HR = 1.009; 95% CI; 1.007-1.012; p≤0.001), ALT (HR = 1.008; 95% CI 1.006-1.01; p≤0.001), total bilirubin (HR = 1.23; 95% CI 1,173-1.29; p≤0.001), creatinine (HR = 1.53; 95% CI 1,398-1,667; p≤0.001). Conclusion: Factors associated with mortality in PQ poisoning: ingested dose, intentional intake, male sex, and age. The change over time of AST, ALT, creatinine, and total bilirubin is related to death. Design dynamic models with clinical and laboratory test variables that include their evolution during the hospital stay can optimize the prognosis prediction.

Introducción: El consumo de cocaína se ha incrementado y con ello el número de consultas a urgencias y hospitalizaciones por intoxicación aguda. El objetivo fue describir las características y complicaciones de los pacientes intoxicados por cocaína que acudieron al servicio de urgencias de un hospital de alta complejidad de Colombia. Método: estudio de corte transversal. Se incluyeron pacientes atendidos durante 2016 y 2019 con intoxicación por cocaína, según historia clínica y test de cocaína positivo y sin enfermedad de base que afectara directamente la supervivencia. Se describieron las características sociodemográficas y clínicas y se estimó la mortalidad y prevalencia de complicaciones. Resultados: se incluyeron 159 pacientes, en su mayoría hombres, con bajo nivel educativo y mediana de edad de 31 años. La mortalidad fue de 3,8%. La prevalencia de lesión renal aguda (LRA) fue de 29,6% (IC95% 22,6 a 37,3%), 8,8% (IC95% 4,3 – 14,3%) para insuficiencia hepática aguda (IHA), 4,4% (IC95% 1,8 a 8,9%) para infarto agudo de miocardio (IAM) y 4,4% (IC 95% 1,8-8,9%) para ataque cerebrovascular (ACV).  Los niveles elevados de fosfocreatin quinasa (CPK) fueron encontrados con valores mayor a mil en 80% de pacientes con LRA, 100% de IHA, y en 50% de ACV. Conclusión: la intoxicación aguda por cocaína produce alteraciones multiorgánicas principalmente renales y hepáticas, que pueden ser por daño directo y también posiblemente por daño muscular reflejado en la elevación de CPK. Esto puede indicar la necesidad de vigilancia estricta de esta enzima y su investigación como variable pronóstica.