Self-poisoning in older adults: patterns of drug ingestion and clinical outcomes

Doak, Martin W; Nixon, Andrew; Lupton, D J; Waring, W. Stephen

doi:10.1093/ageing/afp046

Cited by 45 publications

(46 citation statements)

References 28 publications

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“…Gastric decontamination measures were reported to the TPIC by hospital staff at the time of the call in 5.3% of cases (130). Single-dose activated charcoal was administered in 4.5% of cases (111); treatment was again non-compliant with international guidelines in 9.9% of these cases (11). MDAC was administered in 1 case.…”

Section: Resultsmentioning

confidence: 99%

Toxicovigilance II: A survey of the spectrum of acute poisoning and current practices in the initial management of poisoning cases admitted to South African hospitals

2012

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Background. Initial management of acute poisoning in South African (SA) hospitals such as gastric decontamination and use of antidotes has not been evaluated relevant to current international guidelines. Objectives. The objective of this study was to conduct a toxicovigilance survey of SA hospital admissions to assess the spectrum of acute poisonings, current practices in gastric decontamination, and use of antidotes in the management of acute poisoning. Methods. A survey was undertaken based on acute poisoning admissions to Tygerberg Academic Hospital (TAH) as well as hospital-based poisoning consultations with the Tygerberg Poison Information Centre (TPIC) over 1 year to investigate trends in admissions and the initial management of hospital admissions for acute poisoning. TAH admission details and TPIC consultation forms for hospital-based cases were analysed for patient demographics, causes of poisoning, gastric decontamination measures and use of antidotes. Results. There were 662 admissions to TAH and 2 459 hospital-based TPIC consultations. Paracetamol and cholinesterase inhibitors were the most common exposures in both studies. Gastric decontamination measures were employed at TAH in 47.7% of cases and in 5.3% of hospital cases reported to the TPIC. Of these, 67.4% in the TAH study and 26.1% in the TPIC study did not comply with international guidelines. N-acetylcysteine was administered inappropriately in 22.1% of the paracetamol poisoning cases at TAH and in 1.6% in the TPIC study. Atropine was administered unnecessarily in 12 of 30 TPIC cases. Conclusion. This study has identified the need for directed training on gastric decontamination measures and use of antidotes and, combined with the previous study, has identified national trends in poisoning.

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Section: Resultsmentioning

confidence: 99%

Toxicovigilance II: A survey of the spectrum of acute poisoning and current practices in the initial management of poisoning cases admitted to South African hospitals

2012

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“…[6] Also, as shown in other European studies, intentional poisoning was more common in adults, and predominantly in females (male/female ratio 1:1.8). [8,9] Poisoning in young children is preventable, and it is well known that age is an important factor in childhood poisoning. Infants and children under the age of 5 are physically closer to the ground than older children, and items such as rat poisons and other pesticides and household chemicals, unsafely stored in easily accessible kitchen and bathroom cupboards, are easily visible and tempting.…”

Section: Discussionmentioning

confidence: 99%

“…[14] As has been shown elsewhere, analgesic poisoning was the most common class of medicine-related exposure and comprised 9.2% of total exposures in the study. [6,8,9] Paracetamol was the single most common exposure across all age groups (5.6% of all exposures). Paracetamol is a non-prescription drug in SA and therefore easily accessible.…”

Section: Discussionmentioning

confidence: 99%

“…However, the high incidence of cholinesterase inhibitor and paracetamol exposures, age and gender demographics in children and female predominance in the adult groups do reflect similar distributions when compared with international and African reports. [6,[8][9][10][11][12] Of greatest concern is the fact that the most common agents responsible for poisoning in this study are readily available on supermarket shelves in SA. Exposures to aldicarb 'rat poison' and amitraz were identified as ongoing toxicovigilance targets for the TPIC.…”

Section: Discussionmentioning

confidence: 99%

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Toxicovigilance I: A survey of acute poisoning in South Africa based on Tygerberg Poison Information Centre data

2012

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Background. The incidence and spectrum of acute poisonings in South Africa are unknown. Poisoning data can be derived from sources such as hospital admission records and poison information centre (PIC) records. Objectives. This study was conducted to examine the extent of the problem and to identify trends and toxicovigilance issues using PIC data. Methods. A survey was conducted based on Tygerberg Poison Information Centre (TPIC) consultations over 1 year. TPIC consultation forms were analysed for patient demographics and causes of poisoning. Results. The TPIC dealt with 4 771 consultations related to human exposures to poisonous substances. The study showed that accidental exposure was more common than intentional poisoning (65.2% v. 34.8%); that 55.8% of cases were adults, of which 57.6% were females; and that 61.4% of adult cases were intentional exposures, and of these 64.3% were females. There was a predominance of accidental exposures (98.8%) and a male predominance (59.7%) in children. Categories of poisoning exposures across all age groups were non-drug chemicals (52.7%), medicines (35.2%) and biological toxins (12.6%). Pesticides (34.8%), irritant/corrosive substances (27.7%) and volatile hydrocarbons (8.3%) were the most common classes of non-drug chemical exposures. Cholinesterase inhibitors (8.8%), anticoagulant rodenticides (7.1%) and pyrethroids (5.0%) were the most commonly ingested non-drug chemicals. Aldicarb and amitraz poisoning were identified as toxicovigilance targets. Analgesics (26.1%) were the most common class of medicine-related exposure, and paracetamol (15.8%), benzodiazepines (9.2%) and antihistamines (5.2%) were the most common medicine-related exposures. Conclusion. The study provided information on evolving trends and identified toxicovigilance targets and the need for continuing toxicology education programmes.

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“…For example, in the case of the geographical dispersion among countries, Japan and some European societies gain relevance: their rates are similar to those of homicides in Brazil. 18,19 In the world as a whole, in absolute fi gures, suicides kill more than homicides and wars taken together. In Brazil, suicide rates are low compared to that of the majority of countries, oscillating between 3.5 to 4.00 per 100,000 inhabitants, and contrasting with homicide rates, which are much higher.…”

Section: Introductionmentioning

confidence: 99%

Suicídio entre pessoas idosas: revisão da literatura

2010

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A literature review was carried out focusing on the main factors associated with suicidal ideation, attempts and completed suicide in elders. The following databases were searched: MEDLINE, PsychINFO, SciELO and Biblioteca Virtual em Violência e Saúde da BIREME (BIREME's Violence and Health Virtual Library), referring to the period from 1980 to 2008. Fifty-two references were selected and analyzed. They showed a strong relationship among suicide ideation, attempt and completion in elderly individuals, which results from the interaction of complex physical, mental, neurobiological and social factors. Suicide associated with depression in the elderly can be prevented, provided the person is properly treated. In Brazil, it is necessary to invest in research, given the persistent increase in suicide rates among aged people, especially among males.

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Self-poisoning in older adults: patterns of drug ingestion and clinical outcomes

Cited by 45 publications

References 28 publications

Toxicovigilance II: A survey of the spectrum of acute poisoning and current practices in the initial management of poisoning cases admitted to South African hospitals

Toxicovigilance II: A survey of the spectrum of acute poisoning and current practices in the initial management of poisoning cases admitted to South African hospitals

Toxicovigilance I: A survey of acute poisoning in South Africa based on Tygerberg Poison Information Centre data

Suicídio entre pessoas idosas: revisão da literatura

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