Self‐poisoning treated in an ICU: drug pattern, acute mortality and short‐term survival

Strøm, J.; Thisted, B; Krantz, T.; Sørensen, M.K.

doi:10.1111/j.1399-6576.1986.tb02386.x

Cited by 45 publications

(26 citation statements)

References 12 publications

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“…We know that once people are admitted to hospital they have a good chance to survive an overdose of antidepressants. Strom et al (15) reported a case fatality rate of 3 % of people admitted to hospital following an overdose with tricyclic antidepressants compared to 6% for all overdoses.…”

Section: Discussionmentioning

confidence: 99%

A comparison of the drugs taken in fatal and nonfatal self‐poisoning

Michel

Waeber

Valach

et al. 1994

Acta Psychiatr Scand

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The objective of this study was a) to compare patterns of drug use in fatal and nonfatal overdoses and b) to find out if toxic drugs are overrepresented in overdoses with fatal outcome. A total of 179 cases of fatal overdoses in Switzerland (population 6.6 million) were compared with 269 medically treated self-poisoners from the agglomeration of Berne (population 301,630). Because of frequent multiple drug use, all the different compounds taken singly or in combination with other drugs were recorded and grouped according to drug types. The patterns of the frequencies of drugs used were remarkably similar in both groups. The majority of the drugs were psychotropics (81% in fatal and 68% in nonfatal overdose). Twenty-nine completed suicides were the result of drug combinations specifically recommended by EXIT. In the remaining cases benzodiazepines were used most frequently in both attempted and completed suicide, often in combination with other drugs or alcohol. Barbiturates were the only drugs recorded significantly more often in fatal overdoses (9% vs 3%). No significant difference was found for tricyclic antidepressants (13% vs 10%), or other types of drugs. The results are consistent with our assumption that drugs with higher toxicity would be overrepresented in overdoses with fatal outcome. Barbiturates, which are well known to be dangerous in overdose, were clearly associated with fatal overdoses, but not tricyclic antidepressants. This, in our view, suggests that the risk of prescribing tricyclic antidepressants should not be overestimated. The frequent use of benzodiazepines in completed suicide, however, indicates that there are no truly safe drugs in overdose.

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Section: Discussionmentioning

confidence: 99%

A comparison of the drugs taken in fatal and nonfatal self‐poisoning

Michel

Waeber

Valach

et al. 1994

Acta Psychiatr Scand

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“…[1–3] The clinical course and ultimate outcome, in turn, is related to the agent, the dose, pre-existing comorbidities, the time from exposure to presentation to a healthcare facility and the experience of care provider. [167] However, there is scarcity of data from the Indian subcontinent regarding the epidemiology and outcome of patients presenting with acute poisoning, especially from those patients admitted to ICU. Hence, we aimed to determine the profile and outcome of acute toxicology in patients admitted to ICU of a tertiary care hospital in the cosmopolitan city of New Delhi, India.…”

Section: Introductionmentioning

confidence: 99%

Profile and outcome of patients with acute toxicity admitted in intensive care unit: Experiences from a major corporate hospital in urban India

et al. 2011

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Background and Aim:There is scarcity of data from the Indian subcontinent regarding the profile and outcome of patients presenting with acute poisoning admitted to intensive care units (ICU). We undertook this retrospective analysis to assess the course and outcome of such patients admitted in an ICU of a tertiary care private hospital.Methods:We analyzed data from 138 patients admitted to ICU with acute poisoning between July 2006 and March 2009. Data regarding type of poisoning, time of presentation, reason for ICU admission, ICU course and outcome were obtained.Results:Seventy (50.7%) patients were males and majority (47.8%) of admissions were from age group 21 to 30 years. The most common agents were benzodiazepines, 41/138 (29.7%), followed by alcohol, 34/138 (24.63%) and opioids, 10/138 (7.2%). Thirty-two (23%) consumed two or more agents. Commonest mode of toxicity was suicidal (78.3%) and the route of exposure was mainly oral (97.8%). The highest incidence of toxicity was due to drugs (46.3%) followed by household agents (13%). Organ failure was present in 67 patients (48.5%). During their ICU course, dialysis was required in four, inotropic support in 14 and ventilator support in 13 patients. ICU mortality was 3/138 (2.8%). All deaths were due to aluminium phosphide poisoning.Conclusions:The present data give an insight into epidemiology of poisoning and represents a trend in urban India. The spectrum differs as we cater to urban middle and upper class. There is an increasing variety and complexity of toxins, with substance abuse attributing to significant number of cases.

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“…Impaired conscious level on admission was associated with mortality (Heyman et al, 1996). One study reported that multiple drug ingestion was associated with an increased risk of death (Heyman et al, 1996), another that death was more likely when a single substance was ingested (Henderson et al, 1993), while a third study reported the highest mortality rates for salicylates and co‐proxamol ingestion (Strom et al, 1986).…”

Section: Resultsmentioning

confidence: 99%

The Hospital Management of Fatal Self‐Poisoning in Industrialized Countries: An Opportunity for Suicide Prevention?

Kapur¹,

Turnbull

Hawton³

et al. 2006

Suicide & Life Threat Behav

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Suicide by self-poisoning is a prevalent cause of death worldwide. A substantial proportion of individuals who poison themselves come into contact with medical services before they die. Our focus in the current study was the medical management of drug self-poisoning in industrialized countries and its possible contribution to suicide prevention. We reviewed the literature to determine the proportion of self-poisoning suicides who reach hospital alive, the sociodemographic and clinical characteristics of in-hospital overdose deaths, the in-hospital management this group of patients receives, and whether there are specific aspects of pre-hospital care and in-hospital management that have the potential to improve survival. Between 11% and 28% of individuals who died following deliberate ingestion of drugs reached hospital alive. The substances which were most frequently implicated in death were paracetamol (acetaminophen) and paracetamol compounds, tricyclic antidepressants, and benzodiazepines. Most patients received fairly intensive treatment, yet death may have been preventable in a small proportion of cases. Only one intervention (the administration of acetylcysteine) was shown to reduce mortality and this was in a highly selected group of patients (those who had ingested paracetamol and developed fulminant hepatic failure). It is possible that other interventions such as better airway management, the prompt administration of activated charcoal, and improved pre-hospital care may improve outcomes but their potential contribution to suicide prevention needs to be investigated in future studies.

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Self‐poisoning treated in an ICU: drug pattern, acute mortality and short‐term survival

Cited by 45 publications

References 12 publications

A comparison of the drugs taken in fatal and nonfatal self‐poisoning

A comparison of the drugs taken in fatal and nonfatal self‐poisoning

Profile and outcome of patients with acute toxicity admitted in intensive care unit: Experiences from a major corporate hospital in urban India

The Hospital Management of Fatal Self‐Poisoning in Industrialized Countries: An Opportunity for Suicide Prevention?

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