Acute poisonings treated in hospitals in Oslo: A one-year prospective study (II): Clinical outcome

Heyerdahl, Fridtjof; Bjornas, Maria; Hovda, Knut Erik; Skog, Karina; Opdahl, Anders; Wium, Cecilie; Ekeberg, Øivind; Jacobsen, Dag

doi:10.3109/15563650701210048

Cited by 49 publications

(39 citation statements)

References 28 publications

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“…Hypotension (5.4%, 15/277) and bradycardia (9.0%, 25/277) were not shown to be dependent on the drug type and the patients recovered during their stay in ICU. These results support our previous study (Okumura et al, 2012;Heyerdahl et al, 2008). Conversely, tachycardia was significantly observed in patients suffering from antipsychotics overdose.…”

Section: Discussionsupporting

confidence: 82%

Clinical characteristics of patients who overdose on multiple psychotropic drugs in Tokyo

Hori

Kinoshita

2016

J. Toxicol. Sci.

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-OBJECTIVE: The purpose of this study was to identify the clinical aspects leading to overdose of multiple psychotropic drugs, in order to determine areas which need attention in the proper treatment of overdose patients. METHODS: Patients who were treated for overdose of psychotropic drugs at our emergency and critical center over two years were targeted. The clinical data was gathered from the medical records and database of all patients, including age, gender, vital signs, and laboratory data, drugs, and medical complications during hospital stay. In addition primary patient care at the emergency department was examined. RESULTS: Among the 277 patients treated during this study period, 255 (74.0%) used two or more types of psychotropic drugs. Risk factors associated with endotracheal intubation and aspiration pneumonitis included the use of antipsychotics and/or barbiturates as types of overdose drugs. The mean number of days in the ICU was 3.4 days. Seventy-four patients (26.7%) stayed 4 days or more in the ICU of which 16 patients (5.8%) still had suicidal thoughts. A significantly higher incidence of extended ICU stay or endotracheal intubation and aspiration pneumonitis was observed in the group who overdosed on more than 50 or 60 tablets of psychotropic drugs, respectively. CONCLUSIONS: Patients who ingested an overdose of more than 60 tablets of psychotropic drugs should be considered a high-risk group requiring intensive care with extended ICU stay. In case of including antipsychotics and/or barbiturates, the patient should be observed carefully due to a higher risk of medical complications.

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Section: Discussionsupporting

confidence: 82%

Clinical characteristics of patients who overdose on multiple psychotropic drugs in Tokyo

Hori

Kinoshita

2016

J. Toxicol. Sci.

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“…Forekomst av komplikasjoner ved akutte forgiftninger spriker generelt betydelig mellom ulike studier (9,14), og heller ikke vårt epikrisemateriale kan gi noe sikkert svar på forekomsten. Mangelfulle epikriser har vaert påpekt i andre studier, for eksempel fra Haukeland i 2003 (15).…”

Section: Forløp Og Alvorlighetsgradunclassified

“…For eksempel nevner 23,5% av epikrisene (541 stk) bruk av en eller flere antidoter. I en undersøkelse av alle forgiftningspasienter i Oslo i 2003-04 ble derimot hele 39% behandlet med antidot (14). Kanskje Oslo har en høyere andel alvorlige forgiftinger sammenlignet med resten av landet, men det er ikke sikkert det forklarer hele forskjellen.…”

Section: Forløp Og Alvorlighetsgradunclassified

Forgiftninger ved norske somatiske sykehus i 2008

Skjerdal¹,

Haga²,

Muan³

et al. 2011

Nor J Epidemiol

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INNLEDNINGHvert år innlegges ca. 12 000 personer med akutte forgiftninger på somatiske sykehus i Norge (1). Statistikk fra Norsk pasientregister (NPR) gir imidlertid ikke detaljer om forhold rundt forgiftningene, hvilke stoffer (forgiftningsagens) pasientene var eksponert for, eller alvorlighetsgrad. Giftinformasjonen, Helsedirektoratet, samlet i 2008 inn anonymiserte epikriser fra somatiske sykehus angående pasienter med akutte forgiftninger. Nasjonal innsamling av forgiftningsepikriser i denne størrelsesordenen har ikke tidligere vaert gjennomført i Norge. Vi ønsket gjennom dette arbeidet å skaffe detaljert informasjon om epidemiologiske forhold ved akutte forgiftninger, som naermere karakterisering av forgiftningspasientene, vanligste agens involvert, bakgrunn for eksponeringene og forekomst av alvorlige forgiftninger. MATERIALE OG METODEStudien er basert på frivillig innsendelse av anonymiserte epikriser fra somatiske sykehus. Alle de største og de fleste mindre sykehus i landet ble via brev fra Giftinformasjonen oppfordret til å sende inn anonymiserte epikriser fra pasienter innlagt med akutte forgiftninger i 2008. Akutte forgiftninger ble definert som tilfeller kodet med ICD-10-koder T4n-T65 eller F10-19 med 0 som fjerdetegn som hoved-eller bidiagnose. De av sykehusene som i følge tall fra NPR behandlet flest forgiftningspasienter foregående år fikk i tillegg en påminnelse per telefon.Opplysninger fra de mottatte epikrisene ble standardisert og lagt inn i et excelbasert registreringsskjema og deretter bearbeidet videre. Følgende forhold ble registrert: ICD10-koder, kjønn, aldersgruppe, forekomst av rusmisbruk, tidligere forgiftninger eller kjent psykisk sykdom, hovedagens, tilleggsagens, symptomer, eliminasjonstiltak (kull, brekkmiddel, ventrikkeltøm-ming), behandling, antall liggedøgn og anbefalt oppføl-ging etter utskriving. Spiseforstyrrelser og selvskading ble registrert som psykisk sykdom. Leilighetsvis bruk av narkotika, tablettmisbruk og bruk av dopingmidler ble oppført som rusmisbruk. Hvis flere agens var involvert registrerte vi det vi vurderte som viktigst for toksisiteten som hovedagens. Hvis det ikke var mulig å utpeke ett hovedagens ble alle agens oppført som tilleggsagens. Alvorlighetsgraden av forgiftningene ble vurdert ved hjelp av Poisoning Severity Score (PSS) (2). PSS er et verktøy der man benytter en tabell med graderte symptomer og kliniske tegn til å vurdere alvorligheten av konkrete tilfeller. Forventet alvorlighet basert på anamnese er ikke med i vurderingene, og det tas heller ikke hensyn til behandling som er gitt.

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“…The outcome in hospital care is good even with the cases treated in the intensive care unit (ICU) with the mortality rate less than 3%, [1][2][3][4] and in a Norwegian study by Lund et al the hospital mortality was even less, 0.8%. 5 The hospital length of stay (LOS) is usually less than one day.…”

Section: Introductionmentioning

confidence: 99%

A retrospective analysis of the impact of toxicological diagnostics on clinical decision making in cases of acute drug poisoning

2017

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The outcome of acute drug poisoning is good. In only a few occasions specific treatments are needed. Toxicological screenings are recommended when acute drug poisoning is suspected. In this retrospective observational study the impact of routine screening on treatment decisions was analyzed. All patients with acute drug poisoning admitted to the emergency department of our university hospital during one year (2013) were retrospectively analyzed. The patients were categorized into two groups: those who received specific therapies due to the poisoning and those who received only symptomatic treatment. Results: there were a total of 318 cases with acute drug poisoning of which 120 led to intensive care treatment. Toxicological screening was performed in 225 cases (70.8%). The screening tests were more often taken from patients who were unconscious (89%) or had altered consciousness (79%) than from patients with normal consciousness (63%, P<0.001). The rate of specific treatment was higher among screened patients compared with patients without screening (18.7 vs 1.1%, P<0.001). However, unexpected screening results were found in 37 of the 225 screened patients out of whom only 6 cases received specific treatment. Most patients with acute drug poisoning were toxicologically screened, but every sixth had an unexpected finding. The rate of patients with unexpected screening result receiving specific treatment was low.

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Acute poisonings treated in hospitals in Oslo: A one-year prospective study (II): Clinical outcome

Abstract: In-hospital mortality in poisoned patients remained low, few patients entailed complications, and most patients survived without permanent sequelae. Drug- and alcohol-abuse related poisonings were most severe.

Cited by 49 publications

References 28 publications

Clinical characteristics of patients who overdose on multiple psychotropic drugs in Tokyo

Clinical characteristics of patients who overdose on multiple psychotropic drugs in Tokyo

Forgiftninger ved norske somatiske sykehus i 2008

A retrospective analysis of the impact of toxicological diagnostics on clinical decision making in cases of acute drug poisoning

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