Found Down: Approach to the Patient with an Unknown Poisoning

Parris, Mehruba Anwar; Calello, Diane P.

doi:10.1016/j.emc.2022.01.011

Cited by 6 publications

(3 citation statements)

References 26 publications

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“…Altered mental status, gastrointestinal complaints, cardiovascular compromise, seizures, and temperature-related disorders can all be toxin-related. 9 In our case, the diagnosis was unclear and the data obtained did not correlate with the results of the initial toxicological analyses.…”

Section: Discussioncontrasting

confidence: 53%

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From unknown poisoning to carbamazepine poisoning

et al. 2023

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In the 2020 annual report of the American Association of Poison Control Centers, 2562 toxic exposures to carbamazepine have been reported, 908 resulted in hospitalization, and among these about 5-6% were life-threatening or resulted in significant disability. A 15-year-old female patient was brought under suspicion of alcohol poisoning. The result of alcoholemia was 11.0mg/dL and the toxicological screening for THC, opiates, methadone, tramadol, amphetamine, MDMA, cocaine, benzodiazepines, buprenorphine was negative. At admission she was comatose (GCS=6), with metabolic acidosis, hypotension, rare short-term partial seizures, isochoric and later dilated pupils, body temperature was 36.4°C, with oxygen saturation from 89 up to 93%. Toxicological analysis were immediately extended. After three hours of admission, a result was obtained where the plasma concentration for carbamazepine was 167mmol/L. The patient was quickly prepared for hemodialysis which was performed for four hours. After 8 hours of admission the patient woke up with stable vital parameters.

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Section: Discussioncontrasting

confidence: 53%

“…Airway, breathing, circulation (ABCs) is central to the management of unknown poisoned patient. 9,10 In patients who have unknown overdoses, a toxidrome can assist in making a diagnosis and is also useful for anticipating other symptoms that may occur. 10 A comatose state in a patient could be caused by either nontoxicological trigger (e.g.…”

Section: Discussionmentioning

confidence: 99%

From unknown poisoning to carbamazepine poisoning

et al. 2023

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“…[5][6][7] Nonetheless, clinicians may encounter challenges in obtaining precise exposure histories from certain patients. [6][7][8] There are no epidemiological data on these patients in China; however, a study in South Korea found that 21.7% (97/446) of patients visited the ED for unknown poisoning. [6] Toxicological analysis plays a crucial role in diagnosis and treatment, particularly in patients with suspected poisoning and uncertain exposure history.…”

Section: Introductionmentioning

confidence: 99%

The value of toxicological analysis in acute poisoning patients with uncertain exposure histories: a retrospective and descriptive study from an institute of poisoning

Shi,

Ba,

Xia

et al. 2024

World Journal of Emergency Medicine

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BACKGROUND:In clinical practice, some patients might not be able or unwilling to provide a thorough history of medication and poison exposure. The aim of this study was to use toxicological analysis to examine the clinical characteristics of patients with acute poisoning whose exposure history was uncertain from a toxicological analysis perspective.METHODS: This was a retrospective and descriptive study from an institute of poisoning. Patient registration information and test reports spanning the period from April 1, 2020 to March 31, 2022, were obtained. Patients with uncertain exposure histories and who underwent toxicological analysis were included. Clinical manifestations and categories of toxics were analyzed.RESULTS: Among the 195 patients with positive toxicological analysis results, the main causes of uncertain exposure history was disturbance of consciousness (62.6%), unawareness (23.6%) and unwillingness or lack of cooperation (13.8%). The predominant clinical manifestations were disturbed consciousness (62.6%), followed by vomiting and nausea (14.4%) and liver function abnormalities (8.7%). A comparison of clinical manifestations between patients with positive and negative (n=99) toxicological analyses results revealed significantly different proportions of disturbances in consciousness (63% vs. 21%), dizziness (1.5% vs. 5.1%), multi-organ failure (1.5% vs. 7.1%), and local pain (0 vs 4%). The main categories of substances involved were psychiatric medications (23.1%), sedatives (20.5%), insecticides (13.8%), and herbicides (12.8%). CONCLUSION:The clinical manifestations of acute poisoning in patients with an uncertain exposure history are diverse and nonspecific, and toxicological analysis plays a pivotal role in the diagnosis and differential diagnosis of such patients.

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Case Files of the Emory University Medical Toxicology Fellowship: A Patient Presents to the Outpatient Toxicology Clinic with Delusions of Being Poisoned

Dernbach,

Carpenter

2024

J. Med. Toxicol.

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Found Down: Approach to the Patient with an Unknown Poisoning

Cited by 6 publications

References 26 publications

From unknown poisoning to carbamazepine poisoning

From unknown poisoning to carbamazepine poisoning

The value of toxicological analysis in acute poisoning patients with uncertain exposure histories: a retrospective and descriptive study from an institute of poisoning

Case Files of the Emory University Medical Toxicology Fellowship: A Patient Presents to the Outpatient Toxicology Clinic with Delusions of Being Poisoned

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