Kind and Estimated Stocking Amount of Antidotes for Initial Treatment for Acute Poisoning at Emergency Medical Centers in Korea

Abstract

Antidotes for toxicological emergencies can be life-saving. However, there is no nationwide estimation of the antidotes stocking amount in Korea. This study tried to estimate the quantities of stocking antidotes at emergency department (ED). An expert panel of clinical toxicologists made a list of 18 emergency antidotes. The quantity was estimated by comparing the antidote utilization frequency in a multicenter epidemiological study and the nation-wide EDs' data of National Emergency Department Information System (NEDIS). In an epidemiological study of 11 nationwide EDs from January 2009 to December 2010, only 92 (1.9%) patients had been administered emergency antidotes except activated charcoal among 4,870 cases of acute adult poisoning patients. Comparing with NEDIS data, about 1,400,000 patients visited the 124 EDs nationwide due to acute poisoning and about 103,348 adult doses of the 18 emergency antidotes may be required considering poisoning severity score. Of these, 13,224 (1.9%) adult doses of emergency antidotes (575 of atropine, 144 of calcium gluconate or other calcium salts, 2,587 of flumazenil, 3,450 of N-acetylcysteine, 5,893 of pralidoxime, 287 of hydroxocobalamin, 144 of sodium nitrite, and 144 of sodium thiosulfate) would be needed for maintaining the present level of initial treatment with emergency antidotes at EDs in Korea.Graphical Abstract

An Appraisal of Antidotes’ Effectiveness: Evidence of the Use of Phyto-Antidotes and Biotechnological Advancements

“…Although adequate measures are available in most developed countries to combat poisoning when reported early, more efficient methods of dissemination and administration of these antidotes are also under appraised. Studies, however, revealed inadequate stocking [5,6,[20][21][22] and in some cases, absence of some essential antidotes [4] as major hindrances. This is in sharp contrast to the experience in most rural areas and developing countries where antidotes are hardly available, leaving them with the only option of herbal antidotes.…”

“…There are no general classifications of antidotes as different authors have used different classifications. For instance, antidotes have been classified based on their documented efficacy [5], mechanisms of action [29,30], the group of poisons they are used against [31] and based on clinical urgency of use [12].…”

“…In the United States of America alone, one poisoning case is reported every 14.9 seconds, of which 9% are said to be critical [4]. Similarly, over 3000 poisoning deaths are reported yearly in Korea [5]. Further, the recent amazon fires sent thousands of citizens of the surrounding countries to hospital due to carbon monoxide poisoning and it was reported that German hospitals treated 205,000 acute poisoning patients in 2011 [6].…”

“…However, relevant antisera not being stocked and in insufficient amounts remains a daunting problem. This problem has been repeatedly documented for a range of antidotes in many developed nations, including the United Kingdom (UK), Canada, the US [20,21], Qatar [22] and Korea [5].…”

Expert Consensus Guidelines for Stocking of Antidotes in Hospitals That Provide Emergency Care

“…Second, recent evidence indicates persistent deficiencies in antidote stocking worldwide. 3,4,14,15 The causes of this serious problem are unknown, but are likely related in part to limited education, inadequate awareness, infrequent use, interruptions in supply, and limited hospital pharmacy resources. Previous studies have found that larger hospitals are more likely to have adequate stocks of antidotes than smaller or rural hospitals.…”