Severe and fatal pharmaceutical poisoning in young children in the UK

Anderson, Mark; Hawkins, Leonard; Eddleston, Michael; Thompson, John Paul; Vale, J. A.; Thomas, Simon H.L.

doi:10.1136/archdischild-2015-309921

Cited by 30 publications

(14 citation statements)

References 13 publications

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“…In the present study, benzodiazepine anxiolytics represented the main group of medicines involved in poisonings. In a study by Anderson et al, 23 carried out in the United Kingdom, benzodiazepines represented 19% of poisoning cases, reinforcing that these substances often cause accidents. In an investigation by Azkunaga et al (Spain), 20 paracetamol held the first place (12.9%), followed by benzodiazepines (10.3%).…”

Section: Discussionmentioning

confidence: 97%

Accidental Poisoning in Children and Adolescents Admitted to a Referral Toxicology Department of a Brazilian Emergency Hospital

Vilaça

Volpe

Ladeira

2020

Rev. paul. pediatr.

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Objective: To describe the profile of children and adolescents admitted for exogenous unintentional poisoning in the emergency room and analyze factors associated with subsequent in-hospital admissions. Methods: This is a cross-sectional study based on hospital records of all subjects up to 19 years-old admitted in 2013 at a specialized toxicology service on a major public emergency hospital due to unintentional intoxication (as reported). Accidents with poisonous animals and insects were excluded. Percentages and frequencies were calculated for the qualitative variables, and measures of central tendency and dispersion for the continuous quantitative variables. Multivariate analysis was performed using binary logistic regression to identify variables associated with subsequent in-hospital admissions. Results: In 2013, 353 cases were reported. Poisonings were more frequent in children 0-4 years-old (72.5%) and in boys (55%). The vast majority was of dwellers of the Metropolitan Region of Belo Horizonte (83%), and 90% of the accidental poisonings occurred at home. 82.7% of the poisonings occurred by oral ingestion, especially of medicinal (36.5%) and cleaning products (29.4% of all poisonings). Only 12.2% of the cases resulted in hospitalization, and only one resulted in death. Residing outside Belo Horizonte (OR=5.20 [95%CI 2.37-11.44]) and poisoning by two or more products (OR=4.29 [95%CI 1.33-13.82]) were considered risk factors for hospitalization. Conclusions: Accidental poisonings occurred most frequently by ingestion of household medications and cleaning products, especially among children under 4 years-old. Preventive strategies should be primarily directed for this prevalent profile.

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Section: Discussionmentioning

confidence: 97%

Accidental Poisoning in Children and Adolescents Admitted to a Referral Toxicology Department of a Brazilian Emergency Hospital

Vilaça

Volpe

Ladeira

2020

Rev. paul. pediatr.

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“…This observation is infrequently documented in recent studies of other South Asian countries although there are reports of salbutamol-induced severe toxicity [ 27 ]. In the United Kingdom (UK), methadone which is a long opioid analgesic given for the treatment of opioid dependence and chronic pain had been implicated as the most common cause of drug-related accidental poisoning deaths among toddlers [ 28 ]. In another report from the UK, accidental ingestions of benzodiazepines and methadone accounted for the highest number of admissions needing intensive care treatment in the same age group [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Accidental and Deliberate Self-Poisoning with Medications and Medication Errors among Children in Rural Sri Lanka

Dayasiri¹,

Jayamanne

Jayasinghe

2020

Emergency Medicine International

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Context. Pharmaceutical products are the leading cause accidental poisoning in middle- and high-income countries. Patterns of poisoning with medicinal drugs change across different geographic regions and over decades owing to variability in prescription practice, sociocultural factors, safe storage of medicines, and free availability of over the counter medications. Methods. This multicentre descriptive study was conducted over a seven-year period (February 2007 to January 2014) to assess patterns and trends of medicinal drug-related poisoning among children less than 12 years of age in thirty-six hospitals across rural Sri Lanka. Children with both accidental and deliberate medication poisonings and medication errors were recruited to the study. Data on poisoning events and medication errors were gathered via patient/parent interviews using multistructured questionnaires that assessed demographic factors, first aid measures, location and circumstances of poisoning, clinical management, and complications. In addition, focus group discussions were performed on all children and their families who had deliberate poisoning events and medication errors. Results and Conclusions. Among 1621 children presented with acute poisoning over seven years of age, 410 children had acute poisoning with medications. Male children (225, 54.9%) outnumbered female children. Paracetomol (137, 35.6%), salbutamol (55, 14.3%), and chlorpheniramine (35, 9.1%) were the most commonly poisoned medications. Prospective data at Anuradhapura teaching hospital (n = 112) revealed that unsafe first aid measures were practiced on 22 (19.6%) children. Although the majority of children remained asymptomatic (61, 54.5%), neurological symptoms (34, 67%) were predominantly seen in symptomatic children. The majority of poisonings took place within home premises (76, 67.9%). There were 16 reports of medication errors (14.2% of acute poisoning events) either due to erroneous administration by caregivers or erroneous issue of medicines by health workers. The current study did not observe mortality following medication poisonings. This study brings to light the burden of medicinal drug-related poisoning morbidity among children in rural Sri Lanka. Potentially, interventions such as community educational initiatives, written safety warnings, increased use of child resistant containers, and enforcement of laws to bring down accidental medication poisonings need to be implemented, and their effectiveness should be evaluated.

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“…A 17‐hr (75% interquartile range) gap between naloxone discontinuation and respiratory arrest or distress (table ) mandating endotracheal intubation revealed that the routine practice of 6‐ to 8‐hr naloxone‐free time may not be enough for all patients and a longer observation period after naloxone discontinuation is needed. This has already been declared in methadone toxicity in children who are the most common victims of fatal accidental pharmaceutical poisonings . Position statements do not routinely recommend gastric lavage in poisoned patients and limit it to special situations, although this is not studied in methadone toxicity .…”

Section: Discussionmentioning

confidence: 99%

Suspected Methadone Toxicity: from Hospital to Autopsy Bed

Gharehdaghi

Takalloo-Bakhtiari

Hassanian‐Moghaddam

et al. 2017

Basic Clin Pharma Tox

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High mortality rates have been reported for methadone in both adults and children. We aimed to determine the pattern of toxicity, possible underlying diseases and treatment challenges in patients referred to our centre with early diagnosis of methadone toxicity and who later died. Medical files of all methadone-poisoned patients who had been admitted to a referral centre of toxicology between March 2011 and March 2016, died during the hospital stay and sent for autopsy to Legal Medicine Organization were retrospectively evaluated. In a total of 94 patients, autopsy findings and laboratory evaluations showed that cause of death was pure methadone toxicity in 57 (60.6%). Other causes of death were ischaemic heart disease in ten, co-ingestions (toxicities including methadone) in eight, brain haemorrhage, multi-organ failure and pneumosepsis (each in four), meningitis/encephalitis in three and head trauma and other toxicities (other than methadone but including an opioid, each in two) patients. Time of cardiopulmonary arrest was significantly different between those with pure methadone toxicity and those who died due to other causes (p = 0.01). Patients who had died due to co-ingestions and other toxicities were younger (p = 0.029) and took more bolus doses of naloxone (p = 0.042). In methadone users, especially in older ages and those with trivial response to naloxone administration, loss of consciousness should not be strictly attributed to methadone toxicity. In such patients, thorough evaluation for other possible causes of loss of consciousness is mandatory.

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Severe and fatal pharmaceutical poisoning in young children in the UK

Abstract: Methadone is the most common pharmaceutical causing fatal poisoning and a common cause of intensive care unit admissions in young children in the UK.

Cited by 30 publications

References 13 publications

Accidental Poisoning in Children and Adolescents Admitted to a Referral Toxicology Department of a Brazilian Emergency Hospital

Accidental Poisoning in Children and Adolescents Admitted to a Referral Toxicology Department of a Brazilian Emergency Hospital

Accidental and Deliberate Self-Poisoning with Medications and Medication Errors among Children in Rural Sri Lanka

Suspected Methadone Toxicity: from Hospital to Autopsy Bed

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