Epidemiology of cardiac dysrhythmias in acute intoxication

Abstract

Cardiac dysrhythmias are common in acute intoxications. However, epidemiological data is rare and restricted to specific substances. From 1995 to 2003 (until September) 91 285 inquiries of physicians and paramedics to a poison center regarding acute intoxications were analyzed revealing 9888 patients (10.8%) suffering from disturbances of the cardiac rhythm. In a first step of the explorative data analysis dysrhythmias were graduated into three categories (I: tachycardia/bradycardia; II: arrhythmia/conduction disorder; III: ventricular dysrhythmia/cardiac arrest) and the frequencies of the involved substances were determined. In a second step substances which resulted to be of significant interest were investigated for their specific pattern of dysrhythmias. For category I (n = 8730) predominantly tricyclic antidepressants, neuroleptics, benzodiazepines, betablockers, and nonsteroidal antiinflammatory drugs were registered (II: [n = 949] tricyclic antidepressants, digitalis glycosides, benzodiazepines, neuroleptics, Ca antagonists; III: [n = 209] tricyclic antidepressants, neuroleptics, sotalol, ethanol, central nervous system stimulants). Tricyclic antidepressants resulted in 23.4% of the reported cases in symptoms of category I (II: 2.3%, III: 0.6%; n = 8535). The highest rates of dysrhythmias were observed for sotalol (I: 34.7%, II: 21.6%, III: 8.0%; n = 176) as compared to the lowest rates found for paracetamol (I: 5.2%, II: 0.3%, III: 0.1%; n = 6429). The present investigation provided a comprehensive clinical overview about the frequency of dysrhythmias and involved substances during acute poisonings in emergency medicine. Furthermore, the specific effects of selected substances concerning dysrhythmias could be determined in view of a clinical database.

Poisoning-induced Out-of-Hospital Cardiac Arrest and Outcomes according to Poison Agent

“…In a report on 5,529 cases of individuals intoxicated by recreational drugs and new psychoactive substances in Europe, 69.5% of these individuals went to the hospital by ambulance, 56.9% of whom were medically discharged from the ED; only 35 (0.6%) presented with cardiac arrest ( 23 ). In Germany, a report using poison data from ambulance services found that 10.8% of the 91,285 patients has dysrhythmia, and 111 (0.1%) had cardiac arrest ( 24 ). We could not directly compare our findings with the cardiac arrest survival rate of this study due to the lack of information on survival.…”

Response to Neuvonen et al: Sotalol, unlike the other beta‐blockers, increases the QTc interval and risk of torsades de pointes ventricular tachycardia in severe poisonings

“…To our knowledge, the largest and most recent study, which systematically researched cardiac dysrhythmias in poisonings by von Mach et al was published in 2004. 3 Although dysrhythmias were reported for sotalol, no fatalities occurred. In our study, we did not advocate to take sotalol exposures lightly.…”

Intoxikationen mit Medikamenten im Kindesalter bei einem regionalen Giftinformationszentrum

“…In diesen Fäl-len ist die Indikationen zur Antidottherapie mit Azetylcystein großzügig zu stellen[6,12].-Kardiale Symptomatik: b 2 -Sympathomimetika, ImidazolinDerivate, Digitalis-Glykoside, b-Blocker und Theophyllin. Diese Substanzgruppen führen zu tachykarden (b 2 -Sympathomimetika, Imidazolin-Derivate, Theophyllin) oder bradykarden (Digitalis-Glykoside, b-Blocker) Herzrhythmusstörungen[11].…”