Management of pharmaceutical and recreational drug poisoning

Abstract

Background Poisoning is one of the leading causes of admission to the emergency department and intensive care unit. A large number of epidemiological changes have occurred over the last years such as the exponential growth of new synthetic psychoactive substances. Major progress has also been made in analytical screening and assays, enabling the clinicians to rapidly obtain a definite diagnosis. Methods A committee composed of 30 experts from five scientific societies, the Société de Réanimation de Langue Française (SRLF), the Société Française de Médecine d’Urgence (SFMU), the Société de Toxicologie Clinique (STC), the Société Française de Toxicologie Analytique (SFTA) and the Groupe Francophone de Réanimation et d’Urgences Pédiatriques (GFRUP) evaluated eight fields: (1) severity assessment and initial triage; (2) diagnostic approach and role of toxicological analyses; (3) supportive care; (4) decontamination; (5) elimination enhancement; (6) place of antidotes; (7) specificities related to recreational drug poisoning; and (8) characteristics of cardiotoxicant poisoning. Population, Intervention, Comparison, and Outcome (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Analysis of the literature and formulation of recommendations were then conducted according to the GRADE® methodology. Results The SRLF-SFMU guideline panel provided 41 statements concerning the management of pharmaceutical and recreational drug poisoning. Ethanol and chemical poisoning were excluded from the scope of these recommendations. After two rounds of discussion and various amendments, a strong consensus was reached for all recommendations. Six of these recommendations had a high level of evidence (GRADE 1±) and six had a low level of evidence (GRADE 2±). Twenty-nine recommendations were in the form of expert opinion recommendations due to the low evidences in the literature. Conclusions The experts reached a substantial consensus for several strong recommendations for optimal management of pharmaceutical and recreational drug poisoning, mainly regarding the conditions and effectiveness of naloxone and N-acetylcystein as antidotes to treat opioid and acetaminophen poisoning, respectively.

The Utility of Poisoning Severity Score in Emergency Service

“…In this case, the clinics, emergency services and intensive care units bring significant burden (2). Determining the severity of poisoning allows better determination of the true risks of these patients and development of treatment protocols (3).…”

Importance of early intervention in verapamil overdose – Case Report and antidotes review

“…There are also Dutch practical recommendations and the guideline on the management of drug poisoning, which includes CCBs poisoning. However, in all of them, the level of evidence remains very low and the recommendations are in the form of expert opinion recommendations [21][22][23]. Therefore, treatment continues to be partially physician-dependent.…”

The prevalence of liquid chromatography-tandem mass spectrometry confirmed paediatric poisoning at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa

“…As poisoning is defined by the presence of clinical (somatic and/or mental) manifestations, or laboratory and/or electrocardiographic abnormalities resulting from exposure to a substance that can lead to harmful clinical effects [ 31 ], once all the toxicology investigations and clinical presentations were analysed, the authors classified the cases into one of three groups: substance-intake-unlikely, substance-intake-likely or substance-intake- unclear. The substance-intake-unlikely group were patients whose clinical presentation could be explained by an alternative medical diagnosis and were, therefore, not considered poisoning cases even though they were admitted as cases of suspected poisoning.…”